bluuebunny/crossref_metadata_2025 huggingface dataset:
Rehabilitation after two-part fractures of the neck of the humerus
Authors: Hodgson S. A. , Mawson S. J. , Stanley D.
Published: July 2003

We undertook a prospective, controlled trial which compared two rehabilitation programmes for 86 patients who sustained two-part fractures of the proximal humerus. Patients were randomised either to receive immediate physiotherapy within one week (group A) or delayed physiotherapy after three weeks of immobilisation in a collar and cuff sling (group B).

At 16 weeks after the fracture, patients in group A had less pain (p < 0.01) and had greater shoulder function (p < 0.001) than those in group B. At 52 weeks, the differences between the groups had reduced. Although group A still had greater shoulder function and less pain, there was no statistical difference when compared with group B. By analysis of the area under the curve, an overall measure up to the 52-week period, group A experienced less pain as measured by the SF36 general health questionnaire and had improved shoulder function.

Our results show that patients with two-part fractures of the proximal humerus who begin immediate physiotherapy, experience less pain. The gains in shoulder function persist at 52 weeks which suggests that patients do not benefit from immobilisation before beginning physiotherapy.
Total elbow replacement using the Kudo prosthesis
Authors: Potter D. , Claydon P. , Stanley D.
Published: July 2003

Between 1993 and 1996, we undertook 35 Kudo 5 total elbow replacements in a consecutive series of 31 rheumatoid patients. A total of 25 patients (29 procedures) was evaluated at a mean follow-up of six years (5 to 7.5) using the Mayo Clinic performance index. In addition, all patients were assessed for loosening using standard anteroposterior and lateral radiographs.

At review, 19 elbows (65%) had either no pain or mild pain, ten (35%) had moderate pain and none had severe pain. The mean arc of flexion/extension was 94° (35 to 130) and supination/pronation was 128° (30 to 165).

A fracture of the medial epicondyle occurred during surgery in one patient. This was successfully treated with a single AO screw and a standard Kudo 5 implant was inserted. Postoperatively, there were no infections. One patient had a dislocation which was treated by closed reduction and five had neurapraxia of the ulnar nerve.

Radiologically, there was no evidence of loosening of the humeral component, but two ulnar components had progressive radiolucent lines suggestive of loosening. Two other ulnar components had incomplete and non-progressive radiolucent lines. With definite radiological loosening as the endpoint, the probability of survival of the Kudo 5 prosthesis at five years using the Kaplan-Meier method was 89%.
Impingement syndrome associated with whiplash injury
Authors: Chauhan S. K. , Peckham T. , Turner R.
Published: July 2003

We examined 524 patients with whiplash injuries for delayed onset of shoulder pain in order to establish whether this was due to impingement syndrome. A total of 476 patients (91%) responded to a questionnaire of which 102 (22%) were entered into the study; 43 had both a positive impingement sign and Neer test. The incidence of impingement-type pain was 9%. After treatment 23 patients (5%) had a significant improvement in their symptoms, ten (2%) had a moderate improvement and nine had no improvement. Impingement-type pain can occur after whiplash injuries and can be successfully treated.
Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly
Authors: Tidermark J. , Ponzer S. , Svensson O. , Söderqvist A. , Törnkvist H.
Published: July 2003

The treatment algorithms for displaced fractures of the femoral neck need to be improved if we are to reduce the need for secondary surgery. We have studied 102 patients of mean age 80 years, with an acute displaced fracture of the femoral neck. They were randomly placed into two groups, treated either by internal fixation (IF) with two cannulated screws or total hip replacement (THR). None showed severe cognitive dysfunction, all were able to walk independently, and all lived in their own home. They were reviewed at four, 12 and 24 months after surgery. Outcome measurements included hip complications, revision surgery, hip function according to Charnley and the health-related quality of life (HRQoL) according to EuroQol (EQ-5D).

The failure rate after 24 months was higher in the IF group than in the THR group with regard to hip complications (36% and 4%, respectively; p < 0.001), and the number of revision procedures (42% and 4%, p < 0.001). Hip function was significantly better in the THR group at all follow-up reviews regarding pain (p < 0.005), movement (p < 0.05 except at 4 months) and walking (p < 0.05). The reduction in HRQoL (EQ-5D index score) was also significantly lower in the THR group than in the IF group, comparing the pre-fracture situation with that at all follow-up reviews (p < 0.05).

The results of our study strongly suggest that THR provides a better outcome than IF for elderly, relatively healthy, lucid patients with a displaced fracture of the femoral neck.
The treatment of recurrent posterolateral instability of the elbow
Authors: Olsen B. S. , Søjbjerg J. O.
Published: July 2003

This study describes the surgical technique used for reconstruction and reinforcement of the lateral collateral ligament complex in patients with posterolateral instability of the elbow and the results. A triceps tendon graft from the ipsilateral elbow which was inserted through bone tunnels and fixed with bone anchors augmented the reconstruction.

The operation was performed on 18 consecutive patients with instability after an acute traumatic dislocation. The mean follow-up was 44 months (14 to 88). There were no recurrent dislocations. The elbow was stable in 14 patients; three had some minor limitation of movement. Thirteen had no or only occasional slight pain, 15 returned to their normal level of activity and 17 were satisfied with the outcome. There was only one failure.
Radiographic observation of the scaphoid shift test
Authors: Park M. J.
Published: July 2003

The movements of the carpal bones during the scaphoid shift test were evaluated radiographically in 60 wrists. The clinical results were graded according to the degree of subluxation of the scaphoid and pain on the dorsum of the wrist. Lateral radiographs at rest and under stress were taken and the relative movements of the scaphoid with respect to the radius and lunate, and the rotation of the scaphoid and lunate were calculated.

Dorsal displacement of the scaphoid with respect to the radius was significantly associated with the clinical grade of subluxation. There was correlation between the amount of pain and the displacement of the scaphoid from the lunate, but not from the radius. The wrists with a painful shift test had greater relative displacement of the scaphoid from the lunate than those with painless subluxation.

These observations support the view that pain associated with subluxation of the scaphoid during the shift test is a significant finding, and that radiographic analysis of the test may confirm a positive result when dynamic scaphoid instability is suspected.
Fixation of fractures of the femoral neck
Authors: Lykke N. , Lerud P. J. , Strømsøe K. , Thorngren K.-G.
Published: July 2003

In a prospective, randomised trial, we compared the use of three Ullevaal hip screws with that of two Hansson hook-pins in 278 patients with fractures of the femoral neck. Background factors were similar in both groups. Follow-up was for two years.

There were no significant differences between the groups in length of time of surgery, hospital stay, general complications, mortality, pain or walking ability. Likewise, the rates of early failure of fixation, nonunion, and the need for reoperation did not differ significantly between the groups. The use of hook-pins was associated with less drill penetrations of the femoral head during surgery (odds ratio 2.6, p= 0.05) and a lower incidence of necrosis of the femoral head (odds ratio 3.5, p = 0.04). There was a strong relationship between poor reduction and fixation of the fracture and subsequent reoperation (p = 0.0005 and p = 0.0001, respectively). Likewise, peroperative drill penetration of the femoral head was associated with a greater risk of reoperation (p = 0.038). Both methods gave favourable results. In total, 22% of the patients needed a major reoperation (usually hemiarthroplasty), while in 7% of the cases the fixation device needed to be removed. Osteosynthesis as the sole method for operation of all fractures of the femoral neck was thus successful in 78% of patients. With selective treatment most of the remaining patients would have benefited if treated by a primary arthroplasty. Accurate selection requires the development of better prognostic methods.
Wear of enhanced ultra-high molecular-weight polyethylene (Hylamer) in combination with a 22.225 mm diameter zirconia femoral head
Authors: Wroblewski B. M. , Siney P. D. , Fleming P. A.
Published: July 2003

We have prospectively studied the wear of enhanced ultra-high molecular-weight polyethylene (Hylamer) in combination with a zirconia femoral head of 22.225 mm diameter on a cemented, triple-tapered, collarless, polished stem, the C Stem.

The 71 patients who underwent total hip arthroplasty had a mean follow-up of six years (3 to 8). No patient died or was lost to follow-up. The clinical results were excellent with 96% of patients satisfied. There were no revisions. Two cups were considered to be loose radiologically. One was avulsed from the cement in a skiing accident, with a periprosthetic fracture of the femur, but has remained stable for more than seven years. One femur shows radiological appearances which are compatible with a healing infection. One femoral component is at risk of loosening. The mean rate of penetration of the cup was 0.22 mm/year (0.06 to 0.55).

Our results appear to be within the guidelines set by the National Institute of Clinical Excellence. We have discontinued the use of Hylamer despite excellent clinical results and no revisions to date because the high initial rates of penetration did not settle to the expected low levels within the anticipated time.
Total ankle replacement
Authors: Wood P. L. R. , Deakin S.
Published: July 2003

Between 1993 and 2000 we implanted 200 cementless, mobile-bearing STAR total ankle replacements. None was lost to follow-up for reasons other than the death of a patient. The mean follow-up was for 46 months (24 to 101).

A complication requiring further surgery developed in eight ankles and 14 were revised or fused. The cumulative survival rate at five years was 92.7% (95% CI 86.6 to 98.8) with time to decision to revision or fusion as an endpoint.

The most frequent complications were delayed wound healing and fracture of a malleolus. These became less common with experience of the operation. The radiological appearance of the interface of the tibial implant was significantly related to its operative fit and to the type of bioactive coating.
EXTRA-ARTICULAR EXTRUSION OF AN OSTEOCHONDRAL FRAGMENT OF THE TALAR DOME
Authors: Herscovici D. , Infante A. F. , Scaduto J. M.
Published: July 2003

Osteochondral fractures of the talus are uncommon. They are classified according to Berndt and Harty, as progressing in severity through four stages. This classification, however, does not address extra-articular extrusion of the osteochondral fragment. We report an osteochondral lesion of the talar dome which presented as an extruded extra-articular fragment in a closed injury of the ankle. This type of lesion may offer a continuation to the four original stages. Clinicians should be aware that this pattern of fracture can occur, and thus allow a more accurate diagnosis and the provision of some aid in the treatment of these injuries.
Mechanical factors in the initiation and propagation of tears of the rotator cuff
Authors: Reilly P. , Amis A. A. , Wallace A. L. , Emery R. J. H.
Published: July 2003

Differential strain has been proposed to be a causative factor in failure of the supraspinatus tendon. We quantified the strains on the joint and bursal sides of the supraspinatus tendon with increasing load (20 to 200 N) and during 120° of glenohumeral abduction with a constant tensile load (20 to 100 N).

We tested ten fresh frozen cadaver shoulders on a purpose-built rig. Differential variable reluctance extensometers allowed calculation of the strain.

Static loading to 100 N or more increased strains on the joint side significantly more than on the bursal side. During glenohumeral abduction an increasing and significant difference in strain was measured between the joint and bursal sides of the supraspinatus tendon, which reached a maximum of 10.6% at abduction of 120°. The joint side strain of 7.5% reached values which were previously reported to cause failure.

Differential strain causes shearing between the layers of the supraspinatus tendon, which may contribute to the propagation of intratendinous defects that are initiated by high joint side strains.
Electromagnetic augmentation of antibiotic efficacy in infection of orthopaedic implants
Authors: Pickering S. A. W. , Bayston R. , Scammell B. E.
Published: July 2003

Infection of orthopaedic implants is a significant problem, with increased antibiotic resistance of adherent ‘biofilm’ bacteria causing difficulties in treatment. We have investigated the in vitro effect of a pulsed electromagnetic field (PEMF) on the efficacy of antibiotics in the treatment of infection of implants.

Five-day biofilms of Staphylococcus epidermidis were grown on the tips of stainless-steel pegs. They were exposed for 12 hours to varying concentrations of gentamicin or vancomycin in microtitre trays at 37°C and 5% CO2. The test group were exposed to a PEMF. The control tray was not exposed to a PEMF. After exposure to antibiotic the pegs were incubated overnight, before standard plating onto blood agar for colony counting.

Exposure to a PEMF increased the effectiveness of gentamicin against the five-day biofilms of Staphylococcus epidermidis. In three of five experiments there was reduction of at least 50% in the minimum biofilm inhibitory concentration. In a fourth experiment there was a two-log difference in colony count at 160 mg/l of gentamicin. Analysis of variance (ANOVA) confirmed an effect by a PEMF on the efficacy of gentamicin which was significant at p < 0.05. There was no significant effect with vancomycin.
The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus
Authors: Tingart M. J. , Apreleva M. , von Stechow D. , Zurakowski D. , Warner J. J. P.
Published: July 2003

The operative treatment of fractures of the proximal humerus can be complicated by poor bone quality. Our aim was to evaluate a new method which allows prediction of the bone quality of the proximal humerus from radiographs.

Anteroposterior radiographs were taken of 19 human cadaver humeri. The cortical thickness was measured at two levels of the proximal humeral diaphysis. The bone mineral density (BMD) was determined for the humeral head (HH), the surgical neck (SN), the greater tuberosity (GT) and lesser tuberosity (LT) using dual-energy x-ray absorptiometry.

The mean cortical thickness was 4.4 ± 1.0 mm. Specimens aged 70 years or less had a significantly higher cortical thickness than those aged over 70 years. A significant positive correlation was found between cortical thickness and the BMD for each region of interest.

The cortical thickness of the proximal diaphysis is a reliable predictor of the bone quality of the proximal humerus.
Vascularity in a new model of atrophic nonunion
Authors: Reed A. A. C. , Joyner C. J. , Isefuku S. , Brownlow H. C. , Simpson A. H. R. W.
Published: July 2003

Our aim was to develop a clinically relevant model of atrophic nonunion in the rat to test the hypothesis that the vessel density of atrophic nonunion reaches that of normal healing bone, but at a later time-point. Atrophic nonunion is usually attributed to impaired blood supply and is poorly understood.

We determined the number of blood vessels at the site of an osteotomy using immunolocalisation techniques in both normally healing bones and in atrophic nonunion. At one week after operation there were significantly fewer blood vessels in the nonunion group than in the healing group. By eight weeks, the number in the atrophic nonunion group had reached the same level as that in the healing group.

Our findings suggest that the number of blood vessels in atrophic nonunion reaches the same level as that in healing bone, but at a later time-point. Diminished vascularity within the first three weeks, but not at a later time-point, may prevent fractures from uniting.
Case report
Authors: Faundez A. A. , Ceroni D. , Kaelin A.
Published: July 2003

A six-year-old girl sustained a Monteggia type-I equivalent fracture of the right forearm. We describe the method of treatment of this rare fracture and its outcome.
Trochanteric slide osteotomy in revision total hip arthroplasty for loosening
Authors: Langlais F. , Lambotte J. C. , Collin Ph. , Langlois F. , Fontaine J. W. , Thomazeau H.
Published: July 2003

We used a trochanteric slide osteotomy (TSO) in 94 consecutive revision total hip arthroplasties (90 with replacement of both the cup and stem). This technique proved to be adequate for removing the components, with few complications (two minor fractures), and for implanting acetabular allografts (18%) and reinforcement devices (23%). Trochanteric union was obtained in most patients (96%), even in those with septic loosening (18/19), major femoral osteolysis (32/32), or previous trochanteric osteotomy (17/18). TSO is versatile, since it can be extended by a femoral flap (four cases) or a distal femoral window (eight cases). Despite significant bone loss, in 24% of the femora and 57% of the acetabula, favourable midterm results were achieved and only six reoperations were required, including two for trochanteric nonunion and two for loosening. It leaves the lateral femoral cortex intact so that a stem longer than 200 mm was needed in only 25% of patients. This is a considerable advantage compared with the extended trochanteric osteotomy in which the long lateral flap (12 to 14 cm) requires an average length of stem of 220 mm beyond the calcar.

TSO provides an approach similar in size to the standard trochanteric osteotomy but with a rate of nonunion of 4% versus 15%. It reduces the risk of difficulties with removal of the stem, and removes the need for routine distal anchoring of long revision stems. The limited distal femoral compromise is very important in patients with a long life expectancy.
Dorsal root ganglion neurones with dichotomising afferent fibres to both the lumbar disc and the groin skin
Authors: Sameda H. , Takahashi Y. , Takahashi K. , Chiba T. , Ohtori S. , Moriya H.
Published: July 2003

Dorsal root ganglion neurones with dichotomising axons are present in several species and are considered to play a role in referred pain. Clinically, patients with lesions in the lower lumbar discs occasionally complain of pain in the groin. We investigated the existence of dichotomising afferent neurones projecting axons both to the lumbar disc and to the groin skin, using the double fluorescent-labelling technique in rats.

We observed neurones labelled with a tracer applied at the ventral portion of the L5-L6 disc and another tracer placed on the groin skin in L1 and L2 dorsal root ganglia. Our results showed that the double-labelled neurones had peripheral axons which dichotomised into both the L5-L6 disc and the groin skin, indicating the convergence of afferent sensory information from the disc and groin skin. Our findings provide a possible neuroanatomical mechanism for referred groin pain in patients with disc lesions.
Body-exhaust suit versus occlusive clothing
Authors: Der Tavitian J. , Ong S. M. , Taub N. A. , Taylor G. J. S.
Published: July 2003

We randomly allocated 50 total knee replacements to scrub teams wearing body-exhaust suits (BES) or Rotecno occlusive clothing. The effectiveness of the clothing was assessed using air and wound bacterial counts.

Bacteria were recovered from 62% of wounds (64% BES, 60% Rotecno). The mean air count was 0.5 CFU/ m3 with BES and 1.0 CFU/m3 with Rotecno (p = 0.014). The mean wound counts were 14 bacteria/wound with BES and eight bacteria/wound with Rotecno (p = 0.171). There was no correlation between the air and wound counts (r = −0.011, Spearman’s).

The higher air counts suggest that Rotecno occlusive clothing is less effective than BES, but wounds were equally contaminated with both types of clothing suggesting that at very low levels of air contamination the contribution of bacteria to the wound from the air is irrelevant. Even doubling the air counts from 0.5 to 1.0 CFU/m3 had no detectable effect on the wound.

This allows a reassessment to be made of other sources of contamination the effect of which would previously have been overwhelmed by contamination from air.
Zirconia and alumina ceramics in comparison with stainless-steel heads
Authors: Hernigou P. , Bahrami T.
Published: July 2003

Although alumina has been used in orthopaedic surgery since the 1970s, the long-term clinical results of zirconia have not been well documented in vivo. We studied hips with these two different ceramics during the same period and with a minimum follow-up of ten years. Because the size of the alumina and zirconia heads was different, hips with 32 mm alumina heads and those with 28 mm zirconia heads were compared with control hips with stainless-steel heads of the same size. Our aim was to compare the two ceramics.

There was an increased linear rate of penetration of the femoral heads into the liner between years five and 12 for the zirconia and the stainless-steel groups. This was severe in the zirconia group (0.4 mm/year compared with 0.13 mm/year for the stainless-steel group). During the same 12-year period there was, however, no significant change in the rate of wear in the alumina group (0.07 mm/year). The mean wear at the most recent follow-up was 1360 mm3 for the 28 mm zirconia group, 683 mm3 for the 28 mm stainless-steel group, 755 mm3 for the 32 mm alumina group and 1314 mm3 for the 32 mm stainless-steel group. The monoclinic content rose on the surface of three zirconia heads which were retrieved at revision. This change was associated with an increase in the surface roughness. A change in the roundness with an increase in the sphericity deviation was also observed both in the articular and non-articular parts of the femoral heads. The increase in rate of wear in the zirconia group was only evident after eight years and may be linked to a long-term biodegradation of zirconia in vivo, associated with the altered roughness and roundness which was observed on the retrieved heads.
Linear sebaceous naevus syndrome and resistant rickets
Authors: Hosalkar H. S. , Jones D. H. , Offiah A. , Hall C.
Published: July 2003

The association between vitamin-D-resistant rickets and linear sebaceous naevus syndrome is extremely rare. Only eight cases have been described in the English literature and in none were the skeletal aspects addressed. We present three new cases and describe the musculoskeletal features. The details and outcome of surgery for correction of the deformities are discussed. The disturbances of metabolism of vitamin D and the effects of pharmacological treatment are also described.
Relapsed infantile Blount’s disease treated by hemiplateau elevation using the Ilizarov frame
Authors: Jones S. , Hosalkar H. S. , Hill R. A. , Hartley J.
Published: July 2003

We have treated seven children with relapsed infantile Blount’s disease by elevation of the hemiplateau using the Ilizarov frame.

Three boys and four girls with a mean age of 10.5 years were reviewed at a mean of 29 months after surgery. All had improved considerably and were pleased with the results. The improvements in radiological measurements were statistically significant (p < 0.001). Three-dimensional CT reconstruction was useful for planning surgery. There were no major complications. The advantages of this technique are that in addition to elevation of the hemiplateau, rotational deformities and limb-length discrepancies may be addressed.
Degradation of hydroxyapatite coating on a well-functioning femoral component
Authors: Aebli N. , Krebs J. , Schwenke D. , Stich H. , Schawalder P. , Theis J.-C.
Published: July 2003

We carried out a histological study of a proximally hydroxyapatite (HA)-coated femoral component, retrieved after 9.5 years of good function. The HA coating had completely degraded. Bone was in direct contact with the titanium surface in all the areas which had been coated, with no interposing fibrous tissue. There were no signs of particles, third-body wear, adverse tissue reactions or osteolysis. Bone remodelling was evident by the presence of resorption lacunae; tetracycline labelling showed bone laid down six years after implantation.

The loss of the HA-coating had no negative effect on the osseo-integration of the stem. We conclude that the HA coating contributes to the fixation of the implant and that its degradation does not adversely affect the long-term fixation.
A strategy for reducing blood-transfusion requirements in elective orthopaedic surgery
Authors: Helm A. T. , Karski M. T. , Parsons S. J. , Sampath J. S. , Bale R. S.
Published: July 2003

We prospectively audited 79 patients undergoing primary knee or hip arthroplasty (38 knees, 41 hips) and found that 66% (58% of knees, 73% of hips) had at least one unit of blood transfused postoperatively, with a mean transfusion requirement of 1.3 units per patient (1.1 for knees, 0 to 6; 1.5 for hips, 0 to 4).

We then established a new protocol for postoperative blood transfusion. This requires the calculation of the maximum allowable blood loss (MABL) that each individual patient can safely lose based upon their weight and preoperative haematocrit. The total blood loss up to this volume is replaced with colloid. When a patient’s total blood loss reaches their MABL their haematocrit is measured at the bedside using the Microspin system (Bayer plc, Newbury, UK). If their haematocrit is low (< 0.30 for men, < 0.27 for women), blood is transfused. As a safety net all patients have their haemoglobin formally checked on days 1, 2, and 3 after surgery and have a transfusion if the haemoglobin levels are less than 8.5 g/dl.

We conducted a further audit of 82 patients (35 knees, 47 hips) after the introduction of this protocol. Under the new protocol only 24% of patients required blood (11% of knees, 34% of hips) with a mean transfusion requirement of 0.56 units per patient (0.26 for knees, 0 to 4; 0.79 for hips, 0 to 4).

The use of clinical audit and the introduction of strict guidelines for transfusion can change transfusion practice and result in improved patient care. Our transfusion protocol is a simple and effective method of keeping transfusion to a minimum and is particularly useful in departments which do not have the facility to use autologous blood or reinfusion drains for elective orthopaedic surgery.
Os acromiale associated with tear of the rotator cuff treated operatively
Authors: Boehm T. D. , Matzer M. , Brazda D. , Gohlke F. E.
Published: July 2003

Os acromiale is a rare anatomical abnormality and treatment is controversial. Our retrospective study analyses the outcome of excision, acromioplasty and bony fusion of the os acromiale when it is associated with a tear of the rotator cuff.

After a mean follow-up of 41 months, 33 patients were radiologically and clinically assessed using the Constant score. The surgical procedure was to repair the rotator cuff together with excision of the os acromiale in six patients, acromioplasty in five, and fusion in 22.

Of the 22 attempted fusions seven failed radiologically. The Constant scores were 82%, 81%, 81% and 84% for patients who had excision, acromioplasty, successful fusion and unsuccessful fusion respectively. There were no statistically significant differences.

We conclude that a small mobile os acromiale can be resected, a large stable os acromiale treated by acromioplasty and a large unstable os acromiale by fusion to the acromion. Even without radiological fusion the clinical outcome can be good.
Dynamic foot movement in children treated for congenital talipes equinovarus
Authors: Theologis T. N. , Harrington M. E. , Thompson N. , Benson M. K. D.
Published: July 2003

The aim of this study was to define objectively gait function in children with treated congenital talipes equinovarus (CTEV) and a good clinical result. The study also attempted an analysis of movement within the foot during gait. We compared 20 children with treated CTEV with 15 control subjects. Clinical assessment demonstrated good results from treatment. Three-dimensional gait analysis provided kinematic and kinetic data describing movement and moments at the joints of the lower limb during gait. A new method was used to study movement within the foot during gait. The data on gait showed significantly increased internal rotation of the foot during walking which was partially compensated for by external rotation at the hip. A mild foot drop and reduced plantar flexor power were also observed. Dorsiflexion at the midfoot was significantly increased, which probably compensated for reduced mobility at the hindfoot. Patients treated for CTEV with a good clinical result should be expected to have nearly normal gait and dynamic foot movement, but there may be residual intoeing, mild foot drop, loss of plantar flexor power with compensatory increased midfoot dorsiflexion and external hip rotation.
Outcome after reconstruction of the anterior cruciate ligament in athletic patients
Authors: Meighan A. A. S. , Keating J. F. , Will E.
Published: July 2003

We randomised 31 patients with acute tears of the anterior cruciate ligament (ACL) to receive either early (within 2 weeks) or delayed (8 to 12 weeks) reconstruction using a quadruple hamstring graft in order to determine if there was any functional advantage to early reconstruction. Outcome measures included return of knee movement, muscle dynamometry, International Knee Documentation Committee (IKDC) scores and Tegner activity levels.

Two cases of symptomatic deep-venous thrombosis occurred in the early group. The mean range of movement was significantly greater at two weeks in the delayed group. Quadriceps muscle power was significantly better in the delayed group at 12 weeks (p < 0.05). These trends were evident at later time points, but were not statistically significant. One patient in each group had clinically significant knee stiffness at 52 weeks. IKDC scores and Tegner activity levels were not significantly different at 52 weeks. We conclude that there is no functional advantage to be gained by early reconstruction of the ACL.
The results of revision knee arthroplasty with and without retention of secure cemented femoral components
Authors: Mackay D. C. , Siddique M. S.
Published: July 2003

We have compared the survival of 67 revision arthroplasties of the knee undertaken for aseptic loosening with and without the retention of a secure, cemented femoral component. All the patients had undergone a single primary procedure at a mean of nine years previously. In group I (25 knees) the original femoral component was secure and was retained. There were no abrasions or osteolysis. The knees were stable, normally aligned, with minimal bone loss. In group II 42 knees did not fulfil these criteria and underwent revision of both components. The mean follow-up was four years.

Re-revision for loosening was required in seven knees (28%) in group I and three (7%) in group II (p < 0.01). The remaining knees function well with Knee Society scores averaging 84/69 and no radiological evidence of osteolysis. When revising cemented implants, retention of a secure femoral component cannot be recommended even when conditions appear to be suitable.
The influence of early ambulation and other factors on headache after lumbar myelography
Authors: Murata Y. , Yamagata M. , Ogata S. , Shimizu K. , Ikeda Y. , Hirayama J. , Yamada H.
Published: July 2003

In order to determine the influence of early ambulation and other factors on headaches occurring after lumbar myelography we randomised 207 patients (127 men and 80 women) into two groups. Following the investigation, we allowed the 101 patients (65 men and 36 women) in group A to sit or stand freely, while we confined the 106 patients (62 men and 44 women) in group B to bed for 20 hours. The nine patients in group B who could not maintain bed rest were excluded.

There was no significant difference between the two groups as regards the prevalence of spinal headache (8.9% in group A v 14.4% in group B). Patients who reported headaches, however, were significantly more likely to be women (18.7%) than men (7.3%), be younger (mean age 45 years v 56 years), have a higher cerebrospinal pressure before removal of fluid (mean values 172 v 137 mm H2O) and a lower systolic (mean values 120 v 134 mmHg) and diastolic blood pressure.

We conclude that, although other factors may be associated with headaches, late ambulation is not effective in preventing spinal headaches after lumbar myelography.
Survival analysis is a better estimate of recurrent disc herniation
Authors: Gaston P. , Marshall R. W.
Published: July 2003

Studies on recurrent disc herniation quote rates of recurrence without regard to the times of recurrence and the influence of longer follow-up. Our objective was to assess the use of survival analysis to measure the rate of revision after lumbar microdiscectomy. We undertook a retrospective analysis of the hospital records of 993 patients who underwent lumbar microdiscectomy over a period of ten years. After calculating the overall rate of revision for the mean length of follow-up, we carried out a survival analysis using the life-table method. During the study period 49 patients had a revision microdiscectomy. This gave an overall rate of revision of 4.9% at a mean follow-up of 5.25 years. Using survival analysis, the rate of revision was 7.9% at a follow-up of ten years when the number at risk was 84. Survival analysis gives a more accurate estimation of the true rate of recurrence for patients undergoing lumbar microdiscectomy. The method allows better comparison between different interventions for disc herniation.
Primary subacute epiphyseal and metaepiphyseal osteomyelitis in children
Authors: Hempfing A. , Placzek R. , Göttsche T. , Meiss A. L.
Published: July 2003

We present three children with primary subacute epiphyseal and metaepiphyseal osteomyelitis. The diagnosis was delayed because of subtle radiological findings and mild general symptoms. Primary epiphyseal osteomyelitis is extremely rare. We believe that this is the first time that the MRI findings have been presented. In the first case they revealed a perforation into the knee and therefore an intra-articular epiphyseal approach was used for debridement. In the second and third cases the metaepiphyseal lesions showed considerable physical involvement and a metaphyseal approach was chosen. We believe that in this condition MRI is essential both for diagnosis and in the planning of surgical treatment.
Orthotopic and heterotopic lower leg reimplantation
Authors: Daigeler A. , Fansa H. , Schneider W.
Published: July 2003

Reimplantation is a well-established procedure in reconstructive surgery. This is especially so after amputation of the upper limb since prostheses provide limited function. In unilateral amputation of the lower leg orthotopic reimplantation is the treatment of choice. With bilateral amputation, in which orthotopic reimplantation is not possible because of the complexity of the trauma, heterotopic reimplantation is an option.

We report five patients who received orthotopic and two who received heterotopic reimplantations of the lower leg. We assessed the functional outcome with reference to cutaneous sensation, mobility, pain, and the cosmetic result.

The functional outcome was good, as was the patients’ satisfaction. Their mobility, stability, and psychological state were satisfactory. Patients with heterotopic reimplantations preferred the reimplanted leg to a prosthesis. Although reimplantation of the lower leg requires prolonged hospitalisation, delayed mobilisation and secondary operations, we conclude that there is an indication for this operation in order to improve the patient’s quality of life.
Open treatment of anterior impingement of the ankle
Authors: Coull R. , Raffiq T. , James L. E. , Stephens M. M.
Published: July 2003

We assessed the long-term outcome of open debridement for the treatment of anterior impingement of the ankle in 27 patients. By using preoperative radiographs to group patients according to both the McDermott and the van Dijk scoring system, we assessed the accuracy of these classifications in predicting outcome. The Ogilvie-Harris scoring system, a visual analogue scale of patient satisfaction, the time to return to full activities, and the ability to return to sports determined the clinical outcome. Follow-up radiographs were used to assess the recurrence of osteophytes. We also assessed the incidence of talar osteochondral lesions at surgery.

At a mean follow-up of 7.3 years, 23 of 25 patients (92%) without joint-space narrowing had a good or excellent result. Improvement in the Ogilvie-Harris score was seen in all patients. In athletes, 19 of 24 (79%) were able to return to sports at the same level. Two patients with preoperative joint-space narrowing had a poor result.

Osteophytes usually recurred and most patients did not feel that the range of dorsiflexion returned to normal, but symptomatic relief allowed most to return to high-level sport.

Our results for non-arthritic joints suggest that this is a safe and successful procedure.
Variation in the position and orientation of the elbow flexion axis
Authors: Ericson A. , Arndt A. , Stark A. , Wretenberg P. , Lundberg A.
Published: July 2003

We analysed the axis of movement in the normal elbow during flexion in vivo using radiostereometric analysis (RSA). The results show an intraindividual variation in the inclination of the axis ranging from 2.1° to 14.3° in the frontal and from 1.6° to 9.8° in the horizontal plane analysed at 30° increments. The inclination of the mean axis of rotation varied within a range of 12.7° in the frontal and 4.6° in the horizontal plane. In both planes, the mean axes were located close to a line joining the centres of the trochlea and capitellum. The intra- and interindividual variations of the axes of flexion of the elbow were greater than previously reported. These factors should be considered in the development of elbow prostheses.
Operative and functional treatment of rupture of the lateral ligament of the ankle
Authors: Pijnenburg A. C. M. , Bogaard K. , Krips R. , Marti R. K. , Bossuyt P. M. M. , van Dijk C. N.
Published: July 2003

Consecutive patients with a confirmed rupture of at least one of the lateral ligaments of the ankle were randomly assigned to receive either operative or functional treatment. They were evaluated at a median of 8 years (6 to 11).

In total, 370 patients were included. Follow-up was available for 317 (86%). Fewer patients allocated to operative treatment reported residual pain compared with those who had been allocated to functional treatment (16% versus 25%, RR 0.64, CI 041 to 1.0). Fewer surgically-treated patients reported symptoms of giving way (20% versus 32%, RR 0.62, CI 0.42 to 0.92) and recurrent sprains (22% versus 34%, RR 0.66, CI 0.45 to 0.94). The anterior drawer test was less frequently positive in surgically-treated patients (30% versus 54%, RR 0.54, CI 0.41 to 0.72). The median Povacz score was significantly higher in the operative group (26 versus 22, p < 0.001).

Compared with functional treatment, operative treatment gives a better long-term outcome in terms of residual pain, recurrent sprains and stability.
Pharmacist Intervention Program for Control of Hypertension
Authors: Chabot Isabelle , Moisan Jocelyne , Grégoire Jean-Pierre , Milot Alain
Published: July 2003

BACKGROUND:

Pharmaceutical care programs have been shown to improve outcomes in hypertension. However, most programs required direct access to patient medical chart and patient consultation sessions by appointment.

OBJECTIVE:

To follow the current practice of community pharmacy, exploring the effect of an intervention program on blood pressure (BP) and factors affecting BP.

METHODS:

Treated hypertensive patients were enrolled in a 9-month controlled study involving 9 community pharmacies. The PRECEDE–PROCEED model was used as conceptual framework to identify factors affecting BP, to incorporate those factors in an intervention program, and to evaluate the impact of the program. A computerized decision-aid tool was used by pharmacists from 4 pharmacies to provide pharmaceutical care to subjects (n = 41); pharmacists from the 5 other pharmacies performed usual care (n = 59). As there was a statistically significant interaction due to family income in describing the impact of pharmacists' intervention on BP, population was stratified by family income in the analyses.

RESULTS:

Compared with the control group, the pharmacy program resulted in significant systolic BP reduction (-7.8 vs. 0.5 mm Hg; p = 0.01) and an increase in the proportion of controlled patients only for those with high incomes. In the high-income group, the program also had a positive impact on physical activity, self-reported adherence, health concerns, and information transmitted. The low-income group did not appear to benefit from the program.

CONCLUSIONS:

Pharmacist intervention can modify factors affecting adherence, improve adherence, and reduce BP levels in patients treated with antihypertensive agents. Impact of pharmacist intervention on BP differed according to patient income status.
Argatroban for Heparin-Induced Thrombocytopenia in Hepato-Renal Failure and CVVHD
Authors: Dager William E , White Richard H
Published: July 2003

OBJECTIVE:

To report a case of significant hepatic and renal failure with the use of argatroban in a patient with heparin-induced thrombocytopenia (HIT) requiring continuous veno-veno hemodialysis (CVVHD).

CASE SUMMARY:

A 37-year-old Hispanic man with diabetes mellitus, ethanol abuse, and recent crank use developed a venous thrombosis and possible pulmonary embolism, followed by acute liver and renal failure requiring continuous veno-venous hemofiltration. After several days of heparin therapy, the dialyzer circuit thrombosed and the platelet count decreased to 82 times 103/mm3. Antibodies for HIT by enzyme-linked immunosorbent assay were positive. Heparin was discontinued, and an argatroban infusion was initiated. After 39 hours on argatroban, the infusion was stopped when minor bleeding was observed with a concurrent activated partial thromboplastin time (aPTT) of 100 seconds. The dialyzer circuit did not clot during the argatroban infusion and did not apparently influence dose-related aPTT measurements. Several days were required for the aPTT to decrease after stopping the argatroban infusion. Fresh frozen plasma had no apparent effect on aPTT values.

DISCUSSION:

Several different agents are currently available to provide effective anticoagulation in patients who have immune-mediated HIT. Argatroban is hepatically cleared and may be the preferred direct thrombin inhibitor in the presence of significant renal impairment, but conversely has prolonged effects in hepatic failure. Limited data are available regarding use of direct thrombin inhibitors in patients who have severe hepatic impairment with concurrent renal failure requiring CVVHD. Scant data are available regarding the effect of hemodialysis on the elimination of argatroban.

CONCLUSIONS:

The optimal anticoagulant for use in a patient with HIT and concurrent hepatic and renal failure is unclear. No direct thrombin inhibitor has a proven advantage; therefore, selection may depend on clinical factors. Dosing in these patients requires very careful management.
Attitudes toward group‐based inequality: Social dominance or social identity?
Authors: Schmitt Michael T. , Branscombe Nyla R. , Kappen Diane M.
Published: July 2003

In five studies we explored how the context in which people think about the social structure and the implications of the social structure for one's in‐group affect attitudes toward inequality. In Studies 1 and 2 we found that social dominance orientation (SDO) scores reflect attitudes toward specific types of inequality that are salient in context. Consistent with social identity theory, in Studies 3 to 5 we found that SDO scores reflected the interests of specific group identities. Indeed, when we compared existing privileged and disadvantaged groups, and when we manipulated in‐group status, we found that participants held more positive attitudes toward inequality when the in‐group was privileged, compared to when the in‐group was disadvantaged. Across all of our studies, results were consistent with the contention that attitudes toward inequality are group‐specific and depend on the social‐structural position of salient in‐groups. We discuss the implications of our findings for social dominance theory.
Social dominance orientation and gender: The moderating role of gender identity
Authors: Wilson Marc Stewart , Liu James H.
Published: July 2003

The aim of this research was to investigate the claim that gender differences in levels of social dominance orientation (SDO; Pratto, Sidanius, Stallworth, & Malle, 1994), a personality variable measuring a general predisposition towards anti‐egalitarianism, are essentially invariant (Sidanius & Pratto, 1999). Previous findings have indicated that (regardless of covariate) males display higher levels of SDO than females. Two studies were conducted to test the expectation (derived from social identity theory) that the gender‐SDO relationship would be moderated by strength of gender group identification. Both samples (150 non‐students and 163 students) completed the full SDO6 measure, and measures of gender group identification. Consistent with predictions, strength of gender identification was found to moderate the gender‐SDO relationship, such that increasing group identification was associated with increasing SDO scores for males, and decreasing SDO for females. This result raises questions concerning the theoretical basis of social dominance theory, and whether gender group membership should be accorded a different status from other ‘arbitrary‐set’ group memberships.
Why social dominance theory has been falsified
Authors: Turner John C. , Reynolds Katherine J.
Published: July 2003

Schmitt, Branscombe and Kappen (2003) and Wilson and Lui (2003) present a persuasive series of studies which raise major problems for the conceptualization of social dominance orientation in social dominance theory. Building on these and other data in the literature, this commentary summarizes six fundamental criticisms which can be made of the theory. We conclude that social dominance theory is flawed by conceptual inconsistencies and has been disconfirmed empirically in relation to its key hypothesis of behavioural asymmetry. The reaction of subordinate groups to the social hierarchy is better explained by social identity theory.
Will the real social dominance theory please stand up?
Authors: Schmitt Michael T. , Branscombe Nyla R.
Published: July 2003

In our research, we (Schmitt, Branscombe, & Kappen) questioned the assumption that social dominance orientation (SDO) scores reflect a general orientation toward group‐based inequality. After considering the objections raised by Sidanius and Pratto, we conclude that our data pose problems for SDO's explanatory potential and social dominance theory's invariance hypothesis. We concur with Turner and Reynolds' contentions that social dominance theory is hindered by internal theoretical inconsistencies, and that attitudes toward intergroup inequality are better understood in terms of social identity processes.