bluuebunny/crossref_metadata_2025 huggingface dataset:
Salvage of the Lower Limb after a Full Thickness Burn with Loss of the Knee Extensor Mechanism: A Case Report
Authors: Sarraf Khaled M , Atherton Duncan D , Jayaweera Asantha R , Gibbons Charles E , Jones Isabel
Published: October 2016

We report on a 79-year-old woman who underwent salvage of the knee and lower leg using a Whichita Fusion Nail for knee arthrodesis, combined with a medial gastrocnemius muscle flap for a 3% contact burn that resulted in loss of the extensor mechanism. This provided an alternative to above-knee amputation when extensor mechanism reconstruction was not feasible.
Antibiotic-Coated Pins for Prevention of Pintract Infection: A Rabbit Study
Authors: Rahimnia AR , Abbaspour A , Rezaei Yadollah , Khodadadi A , Alizadeh AM , Mohagheghi MA , Semeyari H , Fooladi AA Imani , Izadi M , Keshavarz P , Yasui N
Published: October 2016

Purpose.

To evaluate the efficacy of antibiotic-coated pins for prevention of pin tract infection in a rabbit model.

Methods.

10 rabbits were divided into 2 groups. A unilateral external fixator was applied to the tibia with 4 self-taping 1.8-mm pins. In the test group, pins were coated with hydroxyapatite and antibiotic. In the control group, pins were not coated. All pins were then placed in Staphylococcus aureus–containing media. At postoperative day 5, all 40 pin sites were subcutaneously inoculated with S aureus. The sites were clinically examined for signs of pin tract infection. Nine days later, a piece of soft tissue around the pin site was harvested for microbiologic examination.

Results.

In the test group, all except one pin sites appeared clean and without clinical infection, and the culture media remained clear. In the control group, all pin sites showed evidence of clinical infection and yielded positive cultures, and the culture media became dark indicating growth of S aureus.

Conclusion.

Antibiotic-coated pins were effective in preventing pin tract infection.
Review Article: Joint Aspiration for Diagnosis of Periprosthetic Infection
Authors: Yee Dennis KH , Chiu KY , Yan CH , Ng FY
Published: October 2016

Joint aspiration is a reliable tool for diagnosis of periprosthetic infection. There are different indications, techniques, and approaches for joint aspiration. We recommend that it be performed selectively when infection is suspected clinically. The specimens should be interpreted based on the results of the culture as well as the white cell count and differential. Specimen collection, transport, and analysis should be prompt to ensure yield accuracy.
Two-Stage Knee Arthrodesis Using a Cemented Modular Tumour Replacement System for Recalcitrant Septic Proximal Tibial Non-Union: A Case Report
Authors: Corona Pablo S , Soldado Francisco , Amat Carles , Flores Xavier
Published: October 2016

Knee arthrodesis is an alternative to amputation for treating recalcitrant septic non-union of the proximal tibia with bone loss, soft-tissue compromise, and knee-joint involvement. Nonetheless, arthrodesis is difficult to achieve if bone loss is massive, and the septic environment can result in failed bone fusion. We report on a 77-year-old man with massive bone loss secondary to recalcitrant septic non-union who underwent radical bone resection, followed by knee arthrodesis using a cemented modular intercalary megaprosthesis in conjunction with a microvascularised flap in 2 stages.
Rhinosporidiosis of the Left Wrist Joint: A Case Report
Authors: Mondal Surojit , Chowdhury Aniket
Published: October 2016

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It usually occurs in the mucous membranes of nose, nasopharynx, and eyes, and less commonly in extra nasal sites such as skin, bones, genitalia, and even the internal organs. Rhinosporidiosis occurs in the wrist joint with isolated bony involvement is rare. We report one such case in a 50-year-old man who presented with a non-tender, fixed swelling over his anterolateral aspect of left forearm. Radiography and computed tomography showed a lytic destructive lesion involving the distal radius, ulna, carpals, and base of metacarpals. Biopsy revealed features of rhinosporidiosis. The patient underwent below-elbow amputation.
Cephalomedullary Nail versus Sliding Hip Screw for Unstable Intertrochanteric Fractures in Elderly Patients
Authors: Chua Ivan Tjun Huat , Rajamoney Ganesan Naidu , Kwek Ernest Beng Kee
Published: October 2016

Purpose.

To compare the short-term ambulatory function of elderly patients after fixation of unstable intertrochanteric fractures with either the AO-ASIF proximal femoral nail anti-rotation (PFNA) device or the dynamic hip screw (DHS).

Methods.

63 patients aged ≥60 years underwent fixation for unstable intertrochanteric fractures (AO types A2 and A3) using the PFNA (n=25) or DHS (n=38). The decision for the type of implant used was based on the lead surgeon's preference, according to perceived fracture stability and clinical experience. In patients having PFNA fixation, weight bearing ambulation and rehabilitation was commenced on day 2. The extent of weight bearing was decided by the lead surgeon based on the stability of the fracture. In patients having DHS fixation, non-weight bearing and ambulation with a walking aid was commenced on day 2. Ambulatory function before injury and after surgery was measured using the Parker Mobility Score (PMS). The 2 groups were compared in terms of the PMS, ambulatory independence, and environmental mobility.

Results.

Respectively in PFNA and DHS patients, 32% and 13% (p=0.035) were ambulant with a walking frame at discharge; the remainder were wheelchair bound. Patients treated with PFNA had significantly higher median PMS at 6 months (4 vs. 2, p=0.002), median ambulatory independence score at 6 months (4 vs. 3, p=0.004) and at 12 months (5 vs. 4, p=0.001), and median environmental mobility score at 6 months (2 vs. 1, p=0.007). They also had significantly higher percentage of patients able to ambulate outdoor and in community at 6 months (64% vs. 29%, p=0.02) and able to walk independently or with a walking aid at 12 months (96% vs. 69%, p=0.01). There were 3 complications. Two patients treated with PFNA had blade cut-out, owing to poor fracture reduction. One patient treated with DHS had screw cut-out and subsequently developed avascular necrosis of the femoral head.

Conclusion.

Unstable intertrochanteric fractures in elderly patients with good pre-fracture ambulatory function stabilised with the PFNA resulted in better short-term ambulatory function.
Proximal Femoral Locking Plate versus Dynamic Hip Screw for Unstable Intertrochanteric Femoral Fractures
Authors: Dhamangaonkar Anoop C , Joshi Deepak , Goregaonkar Arvind B , Tawari Akhil A
Published: October 2016

Purpose.

To compare the outcome in patients who underwent surgery for unstable intertrochanteric femoral fractures using the proximal femoral locking plate versus the dynamic hip screw (DHS).

Methods.

15 men and 5 women aged 32 to 78 (mean, 55) years were randomised to the proximal femoral locking plate group, whereas 14 men and 6 women aged 38 to 75 (mean, 59) years were randomised to the conventional 135° DHS group. The time to union, medialisation of the shaft, neck-shaft angle, limb shortening, varus collapse, and functional outcome (using the Hospital for Special Surgery Hip Rating System) were assessed.

Results.

Respectively in the locking plate and DHS groups, the mean times to union were 14.6 and 16.5 weeks (p=0.067) and the mean limb shortenings were 0.3 and 1.4 cm (p<0.001). Medialisation of the shaft occurred in 0 and 15 patients (p<0.0001); varus collapse occurred in 2 and 5 patients (p=0.408); the functional hip score was good-to-excellent in 18 and 11 patients (p=0.031); deep wound infection occurred in 3 and 2 patients; and implant cut-out occurred in one patient each group.

Conclusion.

A non-collapsing locking plate achieved bone union in unstable intertrochanteric fractures with lower risks of limb shortening and medialisation of the shaft.
Plating, Nailing, External Fixation, and Fibular Strut Grafting for Non-Union of Humeral Shaft Fractures
Authors: Padhye Kedar P , Kulkarni Vidhisha S , Kulkarni GS , Kulkarni Milind G , Kulkarni Sunil , Kulkarni Ruta , Patii Mayur D , Ravi Priyanka Y
Published: October 2016

Purpose.

To compare various treatment modalities (plating, Ilizarov external fixation, and non-vascular fibular cortical strut grafting) for non-union of humeral shaft fractures.

Methods.

Records of 9 women and 26 men aged 24 to 71 (mean, 42) years who presented with non-union of humeral shaft fractures were reviewed. The humeral shaft fractures were secondary to low-energy trauma (n=22) or vehicular accidents (n=13) and involved the proximal (n=9), middle (n=15), and distal (n=11) regions. 13 of the fractures were open. Infection was evident in 8 of the non-unions. For non-unions with infection (n=8), a 2-stage procedure entailing temporary Ilizarov fixation followed by plating was used. For non-unions without infection (n=23), one-stage plating and cancellous bone grafting was used. For non-unions of osteoporotic bone (n=4), one-stage non-vascularised fibular strut grafting was used. Outcome was measured using the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system.

Results.

The 35 patients were followed up for a mean of 16 (range, 6–60) months. All achieved bone union except for one (who had persistent infection). Respectively for non-unions with infection, nonunions without infection, and non-unions of osteoporotic bone, the mean times to bone union were 6.5 (range, 4–10), 5 (range, 4–8), and 10 (range, 6–14) months, the mean improvement in DASH score was 30, 43, and 18, and malalignment was noted in 5, 2, and one patient. Three patients had a preoperative radial nerve palsy for which standard tendon transfer was performed 6 weeks after treatment for non-union.

Conclusion.

Compression plating achieved the best results. An external fixator may be used temporarily for infected non-unions. Fibular strut grafting may be used when non-unions warrant additional stability.
Verification of the Australian Orthopaedic Association National Joint Replacement Registry Using a Surgeon's Database
Authors: Jang Bob , Walsh Nichola A , Bruce Warwick JM
Published: October 2016

Purpose.

To assess the completeness of registration and any discrepancies between the senior author's database and the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR).

Methods.

From 2002 to 2005, the senior author performed 231 primary total hip arthroplasty (THA) on 217 patients using the Corail femoral stem and one of the 3 types of the acetabular component: Pinnacle, ASR, or Duraloc/Option. The name of each patient was forwarded to the AOA NJRR for matching and verification.

Results.

The AOA NJRR recorded 230 of the 231 primary THAs; all but one was matched with the senior author's database. Nine (3.9%) of them were revised by the same (n=7) or another (n=2) surgeon. Three (43%) of the 7 revision surgeries were not recorded on the AOA NJRR. One patient revised for a ceramic liner fracture was incorrectly recorded as ‘wear acetabulum’ in the AOA NJRR.

Conclusion.

Although the AOA NJRR achieved high registration completeness for primary THA, accuracy for revision THA was much lower.
Epidural and Intradural Cement Leakage following Percutaneous Vertebroplasty: A Case Report
Authors: Kulkarni Arvind G , Shah Sambhav P , Deopujari CE
Published: October 2016

A 48-year-old woman presented with severe bilateral leg pain, urinary incontinence, and paraparesis following vertebroplasty in another hospital 15 days earlier. Computed tomography and magnetic resonance imaging showed blocks of epidural and intradural cement from T12 to L1 with neurological compression. She underwent corpectomy of L1 and removal of extradural cement, followed by anterior reconstruction with an expandable cage and dual rod-screw construct (Kaneda system). Postoperatively, the patient had minimal improvement in leg pain and neurological deficit. Computed tomographic myelography was therefore performed and revealed complete blockage, which is suspected to be due to intradural cement leakage. The patient underwent posterior durotomy and removal of the cement. Postoperatively, the patient reported immediate pain relief. Her neurological status gradually improved over months. At the 2-year follow-up, the patient was able to walk with support and to perform activities of daily living and had regained her urinary function.
High-Energy Bilateral Knee Dislocations in a Young Man: A Case Report
Authors: Colen Sascha , van den Bekerom Michel PJ , Truijen Jan
Published: October 2016

Bilateral knee dislocations are rare. We report one such case in a 22-year-old man. His clinical presentation, radiographical findings, and the operative and non-operative treatments are discussed, with emphasis on the timing of treatment and rehabilitation.
Outcome of Locking Compression Plating for Proximal Humeral Fractures: A Prospective Study
Authors: Chowdary Umapathi , Prasad Hari , Subramanyam P Krishna
Published: October 2016

Purpose.

To evaluate the outcome of open reduction and internal fixation using locking compression plates for proximal humeral fractures.

Methods.

54 men and 16 women aged 28 to 79 (mean, 54) years underwent open reduction and internal fixation using a locking compression plate for closed 2-part (n=22), 3-part (n=38), and 4-part (n=10) proximal humeral fractures. 10 of the patients also had dislocation of the humeral head; 4 had fractures extending to the shaft. Wound condition, functional outcome, bone union, amount of collapse, and malalignment were assessed. Functional outcome was assessed using the Constant-Murley score.

Results.

The mean follow-up period was 15 (range, 6–24) months. All fractures achieved union after a mean of 9 (range, 6–12) weeks. The mean Constant-Murley scores for the injured and normal shoulders were 72 and 82, respectively (88% of normal). The final outcome was excellent in 14 patients, good in 28, moderate in 22, and poor in 6. In the latter 6 patients, 2 had screw penetration, 2 had plate impingement, one had a mal-reduced greater tuberosity, and one had adhesive capsulitis. All were preventable. In all, 18 patients had 20 complications: subacromial impingement of the plate (n=6), mal-reduction of the greater tuberosity (n=6), screw penetration (n=2), adhesive capsulitis (n=2), superficial infection (n=2), and haematoma (n=2); 12 of these complications were technique-related.

Conclusion.

Locking proximal humeral plates enabled stable fixation in all Neer-type proximal humeral fractures. Most complications were technique-related.
Polyaxial versus Uniaxial Volar Locking Plate for Distal Radial Fractures
Authors: Al-Mouazzen Louay , Chou Daud Tai Shan , Kyriakopoulos Georgios , Hambidge John
Published: October 2016

Purpose.

To compare the penetration of the distal screws in relation to the thickness of the distal metaphysis in the polyaxial versus uniaxial volar locking plates.

Methods.

Records of 78 patients aged 16 to 79 years who underwent open reduction and internal fixation for distal radial fractures (n=81) were reviewed. All fracture subtypes were included. 20 men and 22 women aged 18 to 79 (mean, 50) years were treated with the uniaxial locking plate, whereas 15 men and 21 women aged 16 to 79 (mean, 51) years were treated with the polyaxial locking plate. The choice of plate was determined by the operating surgeon based on familiarity and perceived advantages of the 2 plates. Penetration of the distal locking screws in relation to the volar-dorsal thickness of the distal radial metaphysis was measured, and the percentage of subchondral bone unsupported by the screws calculated.

Results.

The mean percentage of unsupported subchondral bone was significantly lower in the polyaxial than uniaxial volar locking plate group (12% vs. 23%, p<0.001). No patient had screw overpenetration.

Conclusion.

The polyaxial volar locking plate system enabled deeper insertion of distal screws into the subchondral bone, and thus providing better buttress for the fracture fragments.
Total Knee Arthroplasty with an Oxidised Zirconium Femoral Component: A 5-Year Follow-up Study
Authors: Park Derek H , Leong Julian , Palmer Stephen J
Published: October 2016

Purpose.

To report the early results of the Oxinium Genesis II prosthesis with an oxidised zirconium femoral component in 55 patients.

Methods.

71 knees in 21 men and 34 women aged 32 to 75 (mean, 55) years were evaluated; 16 of the patients had bilateral staged total knee replacements with a mean interval of 9 (range, 6–16) months between surgeries. The indications for surgery included osteoarthritis (n=57), rheumatoid arthritis (n=13) and revision from a unicompartmental knee replacement for osteoarthritis (n=1). Postoperatively, patients were evaluated using the Knee Society score (KSS), the modified Oxford Knee Score, and the SF-12 health survey, as were component position, leg and knee alignment, and prosthesis-bone interface or fixation on radiographs.

Results.

The mean follow-up was 62 (range, 51–88) months. The mean KSS, Oxford Knee Score, and SF-12 physical component score improved significantly. Radiolucent lines (<2 mm) were noted in the tibial cement-bone interface in 17 knees (most commonly in zones 4 and 1) and in the femoral cement-bone interface in one knee. The alignment of the knees and positioning of the components were acceptable. There were no revisions for septic or aseptic loosening.

Conclusion.

Early results of the Oxinium Genesis II prosthesis are comparable to the standard total knee prostheses.
Total Hip Arthroplasty through the Mini-Incision (Micro-Hip) Approach versus the Standard Transgluteal (Bauer) Approach: A Prospective, Randomised Study
Authors: Dienstknecht T , Lüring C , Tingart M , Grifka J , Sendtner E
Published: October 2016

Purpose.

To compare outcome after total hip arthroplasty (THA) through the mini-incision approach versus the standard transgluteal approach.

Methods.

80 women and 63 men aged 33 to 89 (mean, 62) years with primary osteoarthritis of the hip were randomised to undergo unilateral THA through a mini-incision approach (Micro-hip, n=55) or standard, lateral, transgluteal approach (Bauer, n=88). Levels of haemoglobin, haematocrit, serum creatine kinase, and C-reactive protein, length of hospital stay, mobilisation, and any complication were recorded. Visual analogue scale (VAS) for pain was assessed. Hip function was assessed using the Harris Hip Score and the Oxford Hip Score, whereas general health was assessed using the EQ-5D general health questionnaire. The cup inclination and varus/ valgus of the stem position were measured using a goniometer.

Results.

The Micro-hip group achieved a significantly lower mean incision length (9.3 vs. 13.4 cm, p<0.001), mean surgical time (60 vs. 68 minutes, p=0.021), mean reduction in haemoglobin level (2.1 vs. 2.8 g/dl, p<0.001), and mean VAS for pain from hour 6 to day 6 (all p<0.05). One patient in the Micro-hip group developed early aseptic loosening of the cup and underwent revision surgery at month 4. Three patients in the Bauer group and one patient in the Micro-hip group sustained intra-operative non-displaced fractures of the proximal femur, which were fixed with cerclages. Two patients in the Micro-hip group developed deep vein thrombosis during week 1.

Conclusion.

THA through the Micro-hip approach achieved faster pain relief.
Anthropometric Estimation of Body Height after Surgical Correction of Scoliosis
Authors: Babu S Suresh , Kiran Kopuri Ravi , Babu TV Suresh , Mohanty SP
Published: October 2016

Purpose.

To estimate the height loss in 28 patients who had undergone surgery for scoliosis before skeletal maturity.

Methods.

28 women patients aged 11 to 18 (mean, 15) years underwent Harrington instrumentation, segmental sublaminar wiring, and posterior spinal fusion for idiopathic scoliosis. The patients' mean age at menarche was 13 (range, 10–16) years. Pre- and post-operative radiographs of the spine were taken to determine curve types, the Cobb angle, and the degree of correction. The standing and sitting heights were measured using a flexible steel tape, and the expected standing and sitting heights were derived using formulae.

Results.

At the final follow up, the mean patient age was 20 (16–32) years. The mean standing height was 155.2 cm and the mean sitting height was 77.4 cm. Using the formulae, the mean expected standing height was 158.4 cm, indicating height loss of 3.2 cm ( t=4.6, p=0.0001), and the mean expected sitting height was 79.9 cm, indicating height loss of 2.6 cm ( t=3.84, p=0.001). The curve types of the 28 patients were sub-divided as thoracic (n=7), thoracolumbar (n=18), and double major (n=3). Patients with thoracolumbar curves achieved better correction and less loss of standing and sitting heights. Percentage loss of standing and sitting heights were not correlated with the apex of the curve or the degree of correction.

Conclusion.

Height loss after surgery was acceptable in comparison with height loss associated with progression of scoliosis without surgery.
Review Article: Perioperative Care in Enhanced Recovery for Total Hip and Knee Arthroplasty
Authors: Stowers Marinus DJ , Lemanu Daniel P , Coleman Brendan , Hill Andrew G , Munro Jacob T
Published: October 2016

Enhanced recovery pathways for total hip and knee arthroplasty can reduce length of hospital stay and perioperative morbidity. 22 studies were reviewed for identification of perioperative care interventions, including preoperative (n=4), intra-operative (n=8), and postoperative (n=4) care interventions. Factors that improve outcomes included use of pre-emptive and multimodal analgesia regimens to reduce opioid consumption, identification of patients with poor nutritional status and provision of supplements preoperatively to improve wound healing and reduce length of hospital stay, use of warming systems and tranexamic acid, avoidance of drains to reduce operative blood loss and subsequent transfusion, and early ambulation with pharmacological and mechanical prophylaxis to reduce venous thromboembolism and to speed recovery.
Gentamycin-Impregnated Calcium Phosphate Cement for Calcaneal Osteomyelitis: A Case Report
Authors: Iwakura Takashi , Lee Sang Yang , Niikura Takahiro , Miwa Masahiko , Sakai Yoshitada , Nishida Kotaro , Kuroda Ryosuke , Kurosaka Masahiro
Published: October 2016

We report a case of chronic calcaneal osteomyelitis in a diabetic patient who was successfully treated with radical debridement and gentamycin-impregnated calcium phosphate cement. At 1.5-year follow-up, the patient could walk without any assistance. Calcium phosphate cement is an effective local antibiotic delivery system and a biocompatible material for filling the debrided space to facilitate bone formation.
Review Article: Patient-Specific versus Standard Instrumentation for Total Knee Arthroplasty
Authors: Sharareh Behnam , Schwarzkopf Ran
Published: October 2016

This meta-analysis reviewed 12 studies comparing patient-specific instrumentation (PSI) with standard instrumentation (SI) for total knee arthroplasty in terms of postoperative coronal alignment and operation time. There is no significant difference between PSI and SI in terms of hip-knee-ankle angle (overall coronal alignment or mechanical axis), tibial coronal alignment, and operation time.
Single-Door Cervical Laminoplasty Using Titanium Miniplates Alone
Authors: Tung Kam Lung , Cheung Philip , Kwok Tik Koon , Wong Kam Kwong , Mak Kan Hing , Wong Wing Cheung
Published: October 2016

Purpose.

To review outcome of 29 patients who underwent single-door cervical laminoplasty for myelopathy using titanium miniplates alone.

Methods.

Records of 20 men and 9 women aged 35 to 79 (mean, 64.3) years who underwent single-door cervical laminoplasty for myelopathy using titanium miniplates alone were reviewed. A total of 125 laminae were opened; 97 of them were fixed with a titanium miniplate. In 19 patients, a 20-hole titanium miniplate bent to the contour of a lamina was used and fixed into 3 laminae at alternate levels. In the remaining 10 patients, the pre-contoured ARCH Laminoplasty System was used and fixed into all laminae. In most patients, screw fixation was unicortical, and no spacer or bone graft was used.

Results.

The mean follow-up duration was 4 (range, 2–9) years. At one-year follow-up, the mean Japanese Orthopaedic Association (JOA) score improved from 9.2 to 13.2 (p<0.001). The mean JOA recovery rate was 64%. No patient had neurological deterioration. The mean anteroposterior diameter increased from 14.3 mm to 19.7 mm; the mean increase was 6.1 mm in the plated laminae and 5.3 mm in the unplated laminae (p=0.11). Out of the 125 laminae, there were 2 hinge non-unions in the unplated laminae, and 2 screw pullouts (not associated with plate loosening). No patient had penetration into the vertebral foramen or neuroforamen. Spring-back closure occurred in 5 (18%) of the 28 unplated laminae, with a mean of <3 mm loss of the initial expansion. Two patients developed transient C5 palsy presenting as shoulder abduction weakness. One patient had a delayed dural tear due to a sharp spike at the edge of the opened C6 lamina.

Conclusion.

Single-door cervical laminoplasty using miniplates alone is a safe technique and achieves a high hinge union rate, good canal expansion, and neurological recovery.
Type 3 Internal Hemipelvectomy: A Report of Two Cases
Authors: Imanishi Jungo , Yazawa Yasuo , Oda Hiromi , Okubo Taketo
Published: October 2016

Type 3 internal hemipelvectomy involves resection of the pubis. We report on 2 patients who underwent type 3 internal hemipelvectomy. One patient developed a bladder hernia, tumour recurrence, and a pathological fracture of the proximal femur. These were resolved with external hemipelvectomy 7 months later. Another patient underwent additional fascia lata transplantation to prevent development of hernia. Both patients had a stress fracture in the contralateral posterior ilium mimicking bone metastasis.
Arthroscopic Revision Arthrodesis for Non-Union of the Naviculocuneiform Joint: A Case Report
Authors: Lui Tun Hing
Published: October 2016

Naviculocuneiform arthrodesis is a viable treatment for symptomatic flatfoot with sag of the naviculocuneiform joint. Nonetheless, non-union is a common complication, and revision arthrodesis is indicated. This study reports arthroscopic revision arthrodesis for non-union of the naviculocuneiform. Accurate debridement and bone grafting of the nonunion site was performed arthroscopically.
Double Arthroscopic Transtendon Repair of Partial-Thickness Articular Surface Tears of the Rotator Cuff: A Surgical Technique
Authors: Fukuta Shoji , Amari Rui , Tsutsui Takahiko
Published: October 2016

This study describes a technique of simultaneous arthroscopy and bursoscopy for transtendon repair of a partial-thickness articular surface rotator cuff tear. All procedures are under simultaneous visualisation from both the glenohumeral joint and the subacromial space to reduce the risk of intraoperative complications.
Congenital Absence of the Posterior Arch of the Atlas with Concomitant Fusion to the Axis: A Case Report
Authors: Png Wenxian , Hey Hwee Weng Dennis , Mohan Kapil , Yue Wai-Mun
Published: October 2016

We present a 52-year-old man with congenital absence of the posterior arch of the atlas and concomitant fusion of the posterior tubercle of the atlas to the spinal process of the axis. He had normal reflexes and no motor deficit. He underwent C3-C7 laminoplasty and achieved good outcome.
Weekly Injection of Teriparatide for Bone Ingrowth after Cementless Total Knee Arthroplasty
Authors: Kaneko Takao , Otani Takahiro , Kono Norihiko , Mochizuki Yuta , Mori Takeo , Nango Nobuhito , Ikegami Hiroyasu , Musha Yoshiro
Published: October 2016

Purpose.

To compare bone mineral density (BMD) in patients with or without weekly injection of teriparatide to promote bone ingrowth after cementless total knee arthroplasty (TKA).

Methods.

Records of 8 men and 32 women (mean age, 75.6 years) who underwent cementless TKA for medial knee osteoarthritis with (n=20) or without (n=20) once-weekly subcutaneous/hypodermic injection of teriparatide for 48 weeks were reviewed. BMD and bone volume/total volume (BV/TV) of the bone-prosthesis interface of the proximal tibia in 6 regions of interest (ROI) were assessed at 3, 6, 9, and 12 months using multi-detector computed tomography.

Results.

Patients with or without weekly injection of teriparatide after cementless TKA were comparable in terms of baseline characteristics and pre- and postoperative knee range of motion and Knee Society knee and function scores. In ROI 1 (medial), ROI 3 (anteromedial), and ROI 4 (posteromedial), the BV/TV increased throughout the postoperative period in patients with weekly injection of teriparatide and declined after 6 months in patients without weekly injection of teriparatide. These 3 ROIs of the 2 groups differed significantly only in BMD at 6, 9, and 12 months. In ROI 2 (lateral), ROI 5 (anterolateral), and ROI 6 (posterolateral), both BV/TV and BMD showed a decreasing trend, and these 3 ROIs of the 2 groups did not differ significantly.

Conclusion.

Weekly injection of teriparatide after cementless TKA promoted bone ingrowth mostly in the medial aspect of the bone-prosthesis interface.
Segmental Excision versus Intralesional Curettage with Adjuvant Therapy for Giant Cell Tumour of Bone
Authors: Yacob Omar , Umer Masood , Gul Marrium , Qadir Irfan
Published: October 2016

Purpose.

To review the functional outcome and local recurrence rate of 29 patients who underwent segmental excision or intralesional curettage with adjuvant therapy for giant cell tumour (GCT) of bone.

Methods.

Records of 17 men and 12 women (mean age, 30.17 years) who underwent segmental excision (n=18) or intralesional curettage followed by adjuvant therapy (n=11) for GCT of the femur (n=13), tibia (n=8), radius (n=6), or ulna (n=2) were reviewed. Nine of the patients had recurrent GCT of bone and had undergone segmental excision (n=6) or intralesional curettage (n=3) elsewhere. Functional outcome was evaluated using the Musculoskeletal Tumour Society (MSTS) scoring system.

Results.

The mean follow-up period was 6.4 (range, 3–13.5) years. 14 patients were followed up for 3 to 5 years, 12 for 5 to 10 years, and 3 for >10 years. Of 20 patients with primary GCT of bone, 12 underwent segmental excision and had no recurrence, and 8 underwent intralesional curettage, 2 of whom developed local recurrence. Of the remaining 9 patients with recurrent GCT of bone, there was one re-recurrence in each surgical option. Local recurrence was not associated with Campanacci grading or type of surgery. One of 18 patients with segmental excision and 3 of 11 patients with intralesional curettage had local recurrence (5.6% vs. 27.3%, p=0.139). The MSTS score was excellent in 7, good in 6, moderate in 2, fair in 2, and poor in one patient after segmental excision, whereas the score was excellent in 9 and good in 2 patients after intralesional curettage (p=0.206). The proportion of yielding an excellent outcome was higher after intralesional curettage (38.9% vs. 81.8%, p=0.0289). Nonetheless, the mean MSTS score of the 2 groups was comparable (74.17% vs. 86.36%, p=0.054).

Conclusion.

Local recurrence of GCT was not associated with the surgical option. Nonetheless, intralesional curettage resulted in better functional outcome.
Land acquisition and rural transformation
Authors: Roy Animesh
Published: October 2016

This paper is an outcome of a household survey conducted in Rajarhat, a place in West Bengal that witnessed the largest dispossession of farmers from their land in the last three decades for the establishment of business hubs, industrial technology (IT) parks, and dwelling units. The study substantiates that large-scale acquisition of agricultural land has transformed the rural livelihood structure of the workforce of dispossessed households in three ways. First, the share of non-farm workers has increased dramatically; second, the majority of these workers have established a foothold in various self-employment and nonfarm economic activities; and third, a small proportion remains unemployed in the post-acquisition stage. The temporary work opportunities created by the government for dispossessed households are not inclusive, and dispossessed households that are well-linked with the local governance have gained more in securing these opportunities.
Ankle Block versus Popliteal Fossa Block as Primary Anesthesia for Forefoot Surgical Procedures
Authors: Hunter Joshua , Anderson Robert B. , Jones Carroll P. , Cohen Bruce
Published: October 2016

Category:

Midfoot/Forefoot

Introduction/Purpose:

Postoperative pain is often difficult to control with oral medications, often times requiring large doses of opioid analgesia. The purpose of this study is to compare the analgesic effects of an ankle block (AB) to a single shot popliteal fossa block (PFB) for patients undergoing orthopaedic forefoot procedures. Our hypothesis is that a PFB would have fewer conversions to general anesthesia, less pain medication requirements and better pain control in the immediate postoperative period.

Methods:

Patients having elective outpatient orthopaedic foot and ankle procedures were invited to participate. Patients with Diabetes, peripheral neuropathy, bilateral procedures, allergy to local anesthetics and procedures proximal to chopart’s joint were excluded. Patients were randomized to either an ultrasound guided AB or PFB by an anesthesiologist pre-operatively. Intraoperative conversion to general anesthesia and PACU opioid requirements were converted to mg of Morphine and then recorded. Postoperative pain was assessed using the visual analog scale (VAS) at regular time intervals until postoperative day (POD) 2. Patients rated their block experience on a 1-5 scale, with 5 being very effective.

Results:

A total of 167 patients participated in the study with 88 patients (53%) receiving an AB and 79 (47%) receiving a single shot PFB. No difference in the conversion to general anesthesia was seen between the two groups (12 patients in AB v. 10 in PFB, p>0.05), with the most common reason being movement without pain in both groups. PACU morphine requirements were significantly reduced in the PFB group (p=0.004). The VAS was significantly lower for the PFB patients for all time points 24 hrs after surgery (p < 0.01). Individual and combined complication rates were similar between both groups (AB 11.4% v PFB 10.1%, p>0.05). The PFB lasted longer (14.5 hrs v 20.9 hrs, p < 0.001). Both groups felt their block was effective (AB 4.79/5 v PFB 4.82/5, p=0.68)

Conclusion:

Regional anesthesia can be a safe and reliable adjunct to perioperative pain management with high patient satisfaction in patients undergoing elective forefoot procedures. However, better pain management and decreased opioid requirements in the immediate perioperative period was seen in patients having a popliteal fossa block when compared to an ankle block.
A Longitudinal Analysis of 25 Years of Foot & Ankle Fellowship Training
Authors: Hamid Kamran S. , Nunley James A.
Published: October 2016

Category:

Other

Introduction/Purpose:

There is a growing demand for orthopaedic surgeons trained in management of foot and ankle conditions, yet there remains wide variation in the process of fellowship training and a dearth of outcomes assessment. The 2016- 2017 American Orthopaedic Foot & Ankle Society (AOFAS) Fellowship Match consisted of 75 available positions—a 44% increase over that a decade prior. Of the 48 programs offering positions, 6 offer standardization and oversight by the Accreditation Council for Graduate Medical Education (ACGME). We aimed to assess the educational curriculum, research production and career paths of 25 years of graduates from the longest running ACGME accredited foot and ankle fellowship program in the United States.

Methods:

A database of graduates from a single foot and ankle fellowship program was utilized to identify practice types and locations as well as tabulate PubMed indexed articles authored by fellows while in the program. The educational curriculum corresponding to their training is described. Additionally, historical data from the AOFAS Match Program was evaluated for trends.

Results:

Between 2005-2015, there were 515 graduates of AOFAS sponsored foot & ankle fellowship programs in the U.S. (Figure 1). Successful match rates for fellowship applicants ranged from 80-96% and program fill rates varied between 61-93%. Our fellowship program has graduated 50 fellows in the past 25 years of whom 37 (74%) practice in the U.S. and 13 (26%) practice abroad. When accounting for international, military and academic practitioners, 54% of our graduates entered practice types with a teaching component. Research articles for each fellow were examined and on average 1.9 PubMed indexed articles (range 0-12) were published by fellows during their tenure in the program. Graduates going into military, international and U.S. academic practices published 2.5, 2.8 and 3.7 articles during training, respectively.

Conclusion:

As technical and cognitive demands of foot and ankle surgeons increase, the need for optimized fellowship training has become paramount. Assessment of educational curriculum, research production and graduate practice type may help fellowships identify areas for improvement in order to meet program and trainee goals.
Is Syndesmotic Screw Removal Needed Before Weight-Bearing Ambulation?
Authors: Kim Jong-Kil , Jeong Seong-Yup , Lee Kwang-Bok
Published: October 2016

Category:

Trauma

Introduction/Purpose:

In syndesmosis injury, numerous clinical and biomechanical investigations showed some concensus as follows; 1)There are no difference in stainless steel versus titanium screws. 2)A 4.5-mm screw apparently provides greater resistance to shear stress than a 3.5-mm screw. 3)The level of placement probably does not affect outcome. 4)Three-cortical versus four-cortical screw placement does not affect biomechanical stability. But, whether the syndesmosis screw should be removed prior to weight-bearing or not is still debated. The aim of this study is to compare the functional outcome between screw removal and retain group, and between diastasis and no diastasis group.

Methods:

One hundred twelve patients had undertaken open reduction and internal fixation due to syndesmosis injury, who divided into 4 groups; (A) syndesmotic screw removal before weight-bearing (postoperative 3 months, n=56) and (B) retained group (n=56), (C) recurrence of diastasis (n=16) and (D) no diastasis (n=40) after screw removal. Radiological diastasis, VAS, AOFAS ankle-hindfoot score, SF-12, complications (screw loosening and breakage) were evaluated between groups.

Results:

AOFAS ankle-hindfoot score shows 75.10±10.40 in group A, 77.07±10.60 in group B, and SF12 shows 45.78±5.68 in group A, 47.33±5.83 in group B, there is no significant difference between group A and B in AOFAS ankle-hindfoot score and SF- 12 (p=0.487, p=0.319). Radiological diastasis significantly develops (p=0.025) in group A (16/56) compare to B (2/56), but screw loosening or breakage significantly develops (p=0.001) in group B (8/56) compare to group A (0/56). AOFAS ankle-hindfoot score shows 70.33±6.22 in group C, 76.50±10.26 in group D, and SF12 shows 49.85±3.83 in group C, 47.40±8.01 in group D, there is no significant difference between group C and D in AOFAS ankle-hindfoot score and SF-12 (p=0.808, p=0.065). There is no significant difference between group C and D B in VAS, AOFAS ankle-hindfoot score and SF-12.

Conclusion:

Diastasis recurrence is significantly higher in removal group. But, screw retain group shows higher breakage, loosening rate than removal group. Clinical outcome such as VAS, AOFAS ankle-hindfoot score and SF-12 is no significant different in two groups.Also, if diastasis recurred, it did not affect clinical outcome. Therefore, we couldn’t conclude that syndesmotic screw removal is needed before weight-bearing (postoperaive 3 months).
Short versus ‘Standard’ Scarf Osteotomy for Hallux Valgus Correction
Authors: Qasim Sultan N. , Mangwani Jitendra
Published: October 2016

Category:

Bunion

Introduction/Purpose:

Scarf osteotomy is an established procedure for correction of hallux valgus deformity. The technique has evolved and is effectively used for all grades of deformities. Short osteotomy (short scarf/modified chevron) and single screw fixation is an effective option for correction of mild to moderate hallux valgus deformity leading to lesser soft tissue disruption, smaller scar and being cost effective. Aim of this study was to compare radiological parameters of hallux valgus correction by a ‘standard’ scarf osteotomy and 2-screw fixation with a short osteotomy and single screw fixation

Methods:

We performed a retrospective review of prospectively collected data. The cases were identified from theatre log. 37 consecutive patients, operated between January 2013 and December 2014, were included. All had mild deformity as defined by maximum pre-operative intermetartarsal angle of 13 degrees. 16(43%) had short osteotomy with single screw fixation (Group 1) and the remaining 21 (57%) had ‘standard’ scarf osteotomy with 2 screw fixation (Group 2). Preoperative and final postoperative weight bearing radiographs were independently reviewed by both authors. Radiological parameters assessed were Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA) and Medial Sesamoid position.Sesamoid position was determined by dividing metatarsal head into three equal sections and recorded as more than 50% of medial sesamoid in a section. The three grades were 3(lateral), 2(central) and 1(medial).Both groups were comparable for distribution of age and pre-operative radiological measures. Mean duration of X-Ray follow up was 3 months (range 2-12). SPSS version 20 was used to perform statistical analysis.

Results:

Mean age of patients was 49 years +/- 13 years. Mean improvement in radiological measures in degrees was - HVA from 24.4 to 10.9 (Group 1) and 35.3 to 12.6 (Group 2), IMA 10.0 to 3.3 (Group 1) and 10.5 to 5.4 (Group 2), DMAA 8.5 to 5.4 (Group 1) and 10.9 to 5.8 (Group 2), Medial Sesamoid position changed from 3 to 1 for both groups. Wilcoxon Signed Rank test showed all these improvements to be significant. T-test showed that both groups were comparable, with no statistically significant difference, for improvements in all radiological parameters.

Conclusion:

Short osteotomy with single screw fixation is equally effective in correction of symptomatic mild hallux valgus deformity as compared to ‘standard’ scarf osteotomy with the advantage of a smaller scar, lesser soft tissue disruption. We believe it is also cost effective because of potential reduction in duration of surgery and the cost of the implant.
The Syndesmotic Insufficiency in Mobile Bearing TAR – A Challenging and Underestimated Problem
Authors: Wagener Joe , Schweizer Christine , Zwicky Lukas , Hintermann Beat
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

The consequence of a missed syndesmotic insufficiency during mobile bearing total ankle replacement (TAR) surgery is subsequent valgus deformity leading to dissociation of the distal tibiofibular joint and failure of the TAR. The purpose of this study was to retrospectively review the patients who developed a syndesmotic insufficiency, which lead to a revision surgery, after primary TAR in our centre. The primary goal was to identify red-flags for possible syndesmotic insufficiency in preoperative planning of TAR, in order to reduce this type of complication.

Methods:

We identified twenty patients (12 females and 8 males) with a missed instability of the distal tibio-fibular joint appearing 3.5 years (range 0.8-9.5 years) after primary TAR. Patient’s records, preoperative and postoperative radiographs and intraoperative fluoroscope images were reviewed especially with regard to previous ankle or lower leg fractures. Functional outcome was assessed with the use of the American Orthopaedic Foot&Ankle (AOFAS) hindfoot score.

Results:

The mean follow-up after last revision surgery was 3.5 years. The median AOFAS Score at last follow-up was 72.5. We could identify 3 risk factors for possible failure: (a) The nature of trauma: Weber-C-Type fractures or Maisonneuve-Type fractures were found in 13 of 20 cases. (b) A defect in the lateral tibial plafond after for example, a pilon fracture or arising due to cyst formation, was found in 3 cases. Here we concluded that the defect lead to a subsequent valgus tilt of the tibial component, acting as a stress riser in the distal tibio-fibular joint. (c) The remaining 4 cases showed a high tibial resection probably leading to an iatrogenic lesion of the anterior and posterior distal tibio-fibular ligaments.

Conclusion:

Knowing the etiology of posttraumatic osteoarthritis of the ankle joint is mandatory to identify a syndesmotic insufficiency in the preoperative work-up for mobile bearing three-component TAR. Due to these findings, our surgical protocol for TAR was adapted accordingly. If one or more of the risk factors are present during surgery we suggest performing distal tibio- fibular fusion.
Phase 1 trial of rituximab, lenalidomide, and ibrutinib in previously untreated follicular lymphoma: Alliance A051103
Authors: Ujjani Chaitra S. , Jung Sin-Ho , Pitcher Brandelyn , Martin Peter , Park Steven I. , Blum Kristie A. , Smith Sonali M. , Czuczman Myron , Davids Matthew S. , Levine Ellis , Lewis Lionel D. , Smith Scott E. , Bartlett Nancy L. , Leonard John P. , Cheson Bruce D.
Published: October 2016

Key Points

The combination of rituximab, lenalidomide, and ibrutinib is associated with a high incidence of rash in follicular lymphoma (all grades 82%). Efficacy of the triplet appears similar to rituximab-lenalidomide in the same patient population.
Using Lean Six Sigma Methodology to Improve Quality of the Anesthesia Supply Chain in a Pediatric Hospital
Authors: Roberts Renée J. , Wilson Ashley E. , Quezado Zenaide
Published: October 2016

Six Sigma and Lean methodologies are effective quality improvement tools in many health care settings. We applied the DMAIC methodology (define, measure, analyze, improve, control) to address deficiencies in our pediatric anesthesia supply chain. We defined supply chain problems by mapping existing processes and soliciting comments from those involved. We used daily distance walked by anesthesia technicians and number of callouts for missing supplies as measurements that we analyzed before and after implementing improvements (anesthesia cart redesign). We showed improvement in the metrics after those interventions were implemented, and those improvements were sustained and thus controlled 1 year after implementation.
Recent progress and future challenges in algal biofuel production
Authors: Shurin Jonathan B. , Burkart Michael D. , Mayfield Stephen P. , Smith Val H.
Published: October 2016

Modern society is fueled by fossil energy produced millions of years ago by photosynthetic organisms. Cultivating contemporary photosynthetic producers to generate energy and capture carbon from the atmosphere is one potential approach to sustaining society without disrupting the climate. Algae, photosynthetic aquatic microorganisms, are the fastest growing primary producers in the world and can therefore produce more energy with less land, water, and nutrients than terrestrial plant crops. We review recent progress and challenges in developing bioenergy technology based on algae. A variety of high-value products in addition to biofuels can be harvested from algal biomass, and these may be key to developing algal biotechnology and realizing the commercial potential of these organisms. Aspects of algal biology that differentiate them from plants demand an integrative approach based on genetics, cell biology, ecology, and evolution. We call for a systems approach to research on algal biotechnology rooted in understanding their biology, from the level of genes to ecosystems, and integrating perspectives from physical, chemical, and social sciences to solve one of the most critical outstanding technological problems.