bluuebunny/crossref_metadata_2025 huggingface dataset:
Mycobacterium Chelonae Infection after Total Knee Arthroplasty: A Case Report
Authors: Lee Raymond Peter , Cheung Kin Wing , Chiu Kwok Hing , Tsang Man Leung
Published: October 2016

We present a case of Mycobacterium chelonae infection after total knee arthroplasty in a 70-year-old woman. The patient underwent implant removal, drainage, debridement, and insertion of a gentamycin-load cement spacer. After 4 months, the second-stage surgery was performed. Intravenous amikacin (6 weeks) and oral clarithromycin (12 weeks) were given. At the 12-month follow-up, the patient achieved 90° of flexion and could walk with a stick for up to 15 minutes. She was not taking any analgesics.
Percutaneous Tension Band Wiring for Patellar Fractures
Authors: Rathi Akhilesh , Swamy MKS , Prasantha I , Consul Ashu , Bansal Abhishek , Bahl Vibhu
Published: October 2016

Purpose.

To evaluate outcome of percutaneous tension band wiring for transverse fractures of the patella.

Methods.

16 men and 7 women aged 27 to 65 (mean, 40) years underwent percutaneous tension band wiring for transverse fractures of the patella with a displacement of >3 mm. Pain, operating time, mobility, functional score, and complications were evaluated.

Results.

20 patients underwent successful percutaneous tension band wiring. The remaining 3 patients in whom closed reduction failed underwent open reduction and tension band wiring. The mean operating time was 46 (range, 28–62) minutes. The mean follow-up period was 20 (range, 15–30) months. At the latest follow-up, all patients had regained full extension. The objective score was excellent in 20 patients and good in 3, whereas the subjective score was excellent in 17, good in 5, and fair in one. All patients had radiological union at week 8. One patient had patellofemoral arthritis (secondary to a postoperative articular step). Two patients developed superficial infections, which resolved after antibiotic therapy. Mean thigh muscle wasting was 0.7 (range, 0.4–1) cm. Three patients encountered hardware problems (impingement/irritation of the skin over the knee) necessitating implant removal.

Conclusion.

Percutaneous tension band wiring is a viable option for transverse fractures of the patella.
Aneurysmal Bone Cysts of the Vertebrae
Authors: Lim Jason Beng Teck , Sharma Himanshu , Reid Robin , Reece Anthony Tony
Published: October 2016

Purpose.

To review records of 14 patients with aneurysmal bone cysts (ABCs) of the spine.

Methods.

Using the Scottish Bone Tumour Registry for the period of October 1952 to November 2005, records of 9 females and 5 males aged 8 to 63 (mean, 25.3) years who had ABCs of the spine and were followed up for a mean of 7.1 years were reviewed.

Results.

The most commonly involved site was the lumbar vertebrae (n=6), followed by the thoracic (n=4), cervical (n=3), and sacral (n=1) vertebrae. The mean duration of symptoms at presentation was 8.8 (range, 0.3–24) months. The symptoms included gradually increasing pain in the back (n=14), a palpable spinal mass (n=4), spinal deformity (n=2), and neurological defcits (n=5). All the patients underwent surgery: intra-lesional excision (curettage) without bone grafting (n=3), excision (n=7, 2 of whom had adjuvant radiotherapy), and open excisional biopsy (n=4, 2 of whom had iliac crest bone grafting). One patient with a cervical ABC underwent preoperative angiographic embolisation. Another patient with a sacral ABC underwent percutaneous sclerotherapy. Two patients had recurrence. One had recurrence within 4 months and underwent adjuvant radiotherapy; another had recurrence 16.8 years later and underwent repeat curettage. No major complications were encountered.

Conclusion.

Most ABCs of the spine occurred in young females. Intra-lesional excision was an effective treatment.
Antegrade Interlocking Nailing versus Dynamic Compression Plating for Humeral Shaft Fractures
Authors: Kulkarni Sunil G , Varshneya Ankit , Jain Mohit , Kulkarni Vidhisha S , Kulkarni Govind S , Kulkarni Milind G , Kulkarni Ruta M
Published: October 2016

Purpose.

To compare antegrade interlocking nailing with dynamic compression plating for humeral shaft fractures in terms of functional outcomes, union and complication rates.

Methods.

34 men and 22 women aged >18 years with fresh humeral shaft fractures (up to grade IIIa) with or without neurological deficits underwent either antegrade interlocking nailing (n=31) or dynamic compression plating (n=25). Functional outcome of the upper limbs (according to the American Shoulder and Elbow Surgeons [ASES] score), pain, rates of union, and complications in the 2 groups were compared.

Results.

Respectively in the nailing and plating groups, mean operating times were 65 and 112 minutes (p<0.001), mean blood loss volumes were 20 and 232 ml (p<0.001), mean ASES scores were 31.4 and 29.0 (p=0.448), complication rates were 20% (6/31) and 24% (6/25) [p=0.900], non-union rates were 13% (4/31) and 8% (2/25) [p=0.625], and delayed union rates were 7% (2/31) and 4% (1/25) [p=0.787].

Conclusion.

Both techniques were appropriate for treating humeral shaft fractures.
Tension Band Wiring versus Knowles Pinning for Non-Union of Type-2 Distal Clavicle Fractures
Authors: Wu Chi-Chuan
Published: October 2016

Purpose.

To compare tension band wiring (TBW) with Knowles pinning for non-union of type-2 distal clavicle fractures.

Methods.

22 men and 6 women aged 23 to 62 (mean, 39) years underwent TBW (n=17) or Knowles pinning (n=11) for non-union of type-2 distal clavicle fractures. Both techniques were supplemented with autogenic cancellous bone grafting. Functional outcome of the shoulder was evaluated using the Constant scoring system (maximum score, 100). Excellent (≥90) and good (≥80) scores were defined as satisfactory.

Results.

Of the 28 patients, 25 were followed up for a mean of 2.6 (range, 1.1–4.2) years, whereas 3 were lost to follow-up. The median times to union were not significantly different between the TBW (n=15) and Knowles pinning (n=10) groups (4.0 vs. 4.3 months, p=0.94). Five non-unions treated with TBW had migration of the Kirschner wires, which was resolved by further restriction of shoulder motion. There were no other complications such as deep infection, non-unions, or malunions. All 25 patients achieved satisfactory full range of shoulder motion with minimal pain.

Conclusion.

Both techniques achieved high rates of satisfactory outcome. TBW may result in Kirschner wire migration but is preferred for cases with a small distal fragment.
Does a Mixed Training Course on the Oxford Unicompartmental Knee Arthroplasty Improve Non-Technical Skills of Orthopaedic Surgeons?
Authors: Alvand Abtin , Gill Harinderjit S , Price Andrew J , Dodd Christopher AF , Murray David W , Rees Jonathan L
Published: October 2016

Purpose.

To determine whether a mixed course on the Oxford unicompartmental knee arthroplasty (UKA) could improve the non-technical (cognitive) skills of performing UKA.

Methods.

120 delegates consisting of consultant orthopaedic surgeons and advanced surgical trainees attended a 2-day course. 104 (87%) of the delegates had performed total knee arthroplasties, whereas 79 (66%) had performed UKAs. The course consisted of didactic lectures, interactive surgical demonstrations, and practical dry-bone skills workshops. Cognitive skills were assessed at the start (day 1) and end (day 2) of the course using 10 multiple-choice questions. The maximum test score was 10. Multilevel modelling was used to compare the pre- and post-course test scores. The pairings of pre- and post-course scores were not known because of a confidentiality clause.

Results.

Of the 120 delegates, 71 (59%) took the pre-course test and 120 (100%) took the post-course test. The median score improved significantly from 2 (interquartile range [IQR], 0.5–3.5) to 6 (IQR, 4.5– 7.5) [bootstrap p<0.0001] for every single one of the randomly allocated pairings. Most delegates had poor cognitive skills for the UKA before the course and improved significantly after the course. Subanalysis of each question topic showed significant improvement in scores for all topics after the course (bootstrap p<0.0001). Nonetheless, the extent to which individual topic scores improved varied widely. The odds ratio for the preversus post-course total test score was 4.36.

Conclusion.

A mixed continuing medical education course could enhance the non-technical (cognitive) skills for UKA.
A Fractured and Immovable Ceramic Liner in a Screw-Fixed Acetabular Shell during Total Hip Arthroplasty: A Case Report
Authors: Butt Usman , Knowles David
Published: October 2016

We report a complication during total hip arthroplasty using an uncemented press-fit acetabular shell and ceramic liner for a woman with osteoarthritis. Fracture of the ceramic liner occurred during its insertion owing to non-concentric reduction. The main body of the ceramic liner became wedged in the acetabular shell and was resistant to removal. The shell itself was immovable owing to the prior insertion of 2 polyaxial screws, to which access was covered. Successful removal involved drilling a hole in the ceramic liner as a stress riser, and then cracking the liner with a Steinman pin.
Obturator Hernia Presenting as Hip Pain: A Case Report
Authors: Chan Ping Keung , Ng Tze Pui , Lam Ying Lee
Published: October 2016

We report an 86-year-old women with an obturator hernia presenting with recurrent right hip pain. Obturator hernia is a diagnostic challenge because the hernial mass is usually concealed beneath the pectineus. It should be suspected in emaciated, multiparous, elderly women presenting with unexplained pain in the groin, hip, thigh, or knee. High levels of clinical suspicion of the high-risk patients and recourse to investigation by computed tomography are important, as delay in diagnosis and treatment is associated with increased morbidity and mortality.
Chondromyxoid Fibroma of the Clavicle Extending to the Adjacent Joint: A Case Report
Authors: Aggarwal Aditya , Bachhal Vikas , Soni Ashwani , Rangdal Sushil
Published: October 2016

Chondromyxoid fibroma is a rare benign bone tumour usually involving bones of the lower extremity in young adults. We present a case of chondromyxoid fibroma of the left clavicle extending to the adjacent joint in a 84-year-old man. The tumour had breached the hyaline cartilage of acromioclavicular joint. The tumour was excised en bloc, and the humeral head was curetted and grafted with autogenous cancellous bone. Postoperatively, the patient had an uneventful recovery and regained excellent function of the left shoulder without any pain or stiffness. At the 18-month follow-up, there was no sign of recurrence.
Extra-Osseous Tenosynovial Chondromatosis of the Middle Finger: A Case Report
Authors: Khadilakar Madhav S , Patil Atul A , Shah Nakul S , Deshmukh Sanjay D , Anand Mani
Published: October 2016

Extra-osseous tenosynovial chondromatosis is rare and has a high rate of local recurrence. We report a 23-year-old man who presented with a 6-month history of pain and swelling of the right middle finger and painful limitation of the ring finger flexion secondary to this condition. Surgical exploration revealed multiple loose bodies of varying size arising from the flexor tendon sheath. Histopathological examination revealed mature chondroid tissue and focal calcification. After 2 years of follow-up, the patient had achieved an excellent functional recovery and showed no evidence of recurrence.
Magnetic Resonance Imaging Evaluation of Patellar Tendon Graft Remodelling after Anterior Cruciate Ligament Reconstruction with or without Platelet-Rich Plasma
Authors: Seijas Roberto , Ares Oscar , Catala Jordi , Alvarez-Diaz Pedro , Cusco Xavier , Cugat Ramon
Published: October 2016

Purpose.

To evaluate the stages of patellar tendon graft remodelling using magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) reconstruction with or without platelet-rich plasma (PRP) injection.

Methods.

98 patients aged 18 to 65 years with complete rupture of the ACL were randomised to undergo reconstruction with the autologous patellar tendon grafts with or without PRP injection. For the PRP group, 8 ml of PRP was obtained in the surgery room and was percutaneously injected into the suprapatellar joint after portal suture. MRI was obtained at months 4, 6, and 12. Remodelling stages of the grafts were classified as hypointense, mildly hyperintense, moderately hyperintense, severely hyperintense, and diffusely hyperintense by a radiologist blinded to treatment allocation.

Results.

More patients in the PRP group than controls attained higher stages of remodelling at month 4 (p=0.003), month 6 (p=0.0001), and month 12 (p=0.354).

Conclusion.

PRP enabled faster remodelling of patellar tendon grafts.
Position of the Patella in Adults in Central India: Evaluation of the Insall-Salvati Ratio
Authors: Upadhyay Sachin , Raza HKT , Srivastava Pranay
Published: October 2016

Purpose.

To assess the Insall-Salvati ratio in normal Indian adults to determine its applicability and the incidence of patella alta and baja in Indian populations.

Method.

800 knees in 200 men and 200 women aged 18 to 50 (mean, 30) years were evaluated using lateral radiographs. The knee was set in semi-flexion (30°) to enable good visualisation of the patellar tendon and its insertion into the tibia on radiographs. The length of the patellar tendon (LT) over the length of the patella (LP)—the Insall-Salvati ratio—was measured, using a vernier caliper.

Results.

The mean LT/LP ratio was 1.14 (standard deviation, 0.18). Based on the 95% confidence interval, the ratio was considered normal if within ±40%. The LT/LP ratio was significantly higher in females than males (1.17 vs. 1.12, p<0.01). The cut-off point of patella alta was significantly greater in our Indian subjects than in western subjects (>1.5 vs. >1.2, p<0.0001). In the present cohort, the frequencies of patella alta (ratio, >1.5) and patella baja (ratio, <0.7) were 2.8% and 1%, respectively.

Conclusion.

The use of the Insall-Salvati ratio to determine the patellar position is less applicable to Indian populations in which squatting, sitting cross-legged, and kneeling are customs. We propose that the normal range of the ratio for squatters among Indian populations be 0.7 to 1.5.
Safe Zone for Retractor Placement to the Lumbar Spine via the Transpsoas Approach
Authors: Spivak Jeffery M , Paulino Carl B , Patel Ashish , Shanti Nael , Pathare Neil
Published: October 2016

Purpose.

To measure anatomic variations of the lumbar plexus within the psoas in relation to the L2/3, L3/4, and L4/5 disc spaces and to delineate a safe zone to avoid nerve injury during retractor placement via the transpsoas approach.

Methods.

Six male and 6 female cadavers (24 psoas/lumbar plexuses) aged 35 to 74 years were dissected. The lumbar plexus was isolated bilaterally. The L2, L3, and L4 nerve roots were identified and isolated without disturbing their natural anatomic course. The anteroposterior (AP) diameter of each intervertebral disc at L2/3, L3/4, and L4/5 was used as a reference. Four measurements were made using a caliper: the AP and mediolateral (ML) diameters of the psoas and AP and ML excursions of each nerve root. Percentages were calculated for the 4 measurements using the reference of the AP diameter of the intervertebral disc at each level. Comparison between left and right sides, between males and females, and between excursions of nerve roots were made.

Results.

The AP diameter of the psoas increased from L2 to L4, with a mean vertebral body coverage of 80%, 86%, and 85% at L2/3, L3/4, and L4/5, respectively. Both the L2 and L3 nerve roots demonstrated substantial anterior trajectories as they coursed distally in the lumbar spine. No nerve root encroached anteriorly beyond 33% of the intervertebral disc space at L2 to L5.

Conclusion.

The lumbar plexus area corresponding to the anterior half of the intervertebral disc was the safe zone. Procedures to the lumbar spine via the transpsoas approach should be performed within the safe zone to avoid nerve injury.
Telangiectatic Osteosarcoma
Authors: Colomina Jordi , Peiro Ana , Trullols Laura , Gracia Isidre
Published: October 2016

Purpose.

To review records of 8 patients with telangiectatic osteosarcoma (TOS) and determine whether pathologic fractures correlate with recurrence and survival.

Methods.

Records of 4 men and 4 women aged 17 to 44 (mean, 28) years treated for TOS were reviewed.

Results.

Of the 8 patients, 4 developed a pathologic fracture and 4 did not. In each group, 2 patients underwent limb salvage surgery and 2 underwent amputation. All patients received neoadjuvant and adjuvant chemotherapy with a combination of at least 2 of the following drugs: doxorubicin, methotrexate, cisplatin, and vincristin. After a mean follow-up of 5.6 (range, 2–16) years, all 4 patients with a pathologic fracture and 2 of the 4 patients without a pathologic fracture were still alive and disease-free. For the remaining patients, one died after 31 months from progression of a lung metastasis, and the other was alive with the disease and had had 2 recurrences, a lung metastasis, and an infection with Klebsiella oxytoca that eventually led to an amputation.

Conclusion.

The presence of a pathologic fracture in patients with TOS was not associated with worse outcome in terms of recurrence and survival.
Posterior Intrafocal Pinning for Reduction of Oblique, Extension Supracondylar Humeral Fractures in Children: A Technical Note
Authors: Vioreanu Mihai H , Baker Joseph F , Gul Rehan
Published: October 2016

A closed reduction technique using a posteriorly inserted intrafocal Kirschner wire for unstable Gartland type-III supracondylar humeral fractures in children is described. This surgical technique has been used in 7 patients. None had neurovascular complications, and all achieved bone union and had good or excellent functional and cosmetic results.
Effect of Calcium Triphosphate Cement on Proximal Humeral Fracture Osteosynthesis: A Finite Element Analysis
Authors: Kennedy Jim , Feerick Emer , McGarry Patrick , FitzPatrick David , Mullett Hannan
Published: October 2016

Purpose.

To measure the effect of void-filling calcium triphosphate cement on the loads at the implant-bone interface of a proximal humeral fracture osteosynthesis using a finite element analysis.

Methods.

Finite element models of a 3-part proximal humeral fracture fixed with a plate with and without calcium triphosphate cement augmentation were generated from a quantitative computed tomography dataset of an intact proximal humerus. Material properties were assigned to bone fragments using published expressions relating Young's modulus to local Hounsfield number. Boundary conditions were then applied to the model to replicate the physiological loads. The effect of void-filling calcium triphosphate cement was analysed.

Results.

When the void was filled with calcium triphosphate cement, the pressure gradient of the bone surrounding the screws in the medial fracture fragment decreased 97% from up to 21.41 to 0.66 MPa. Peak pressure of the fracture planes decreased 95% from 6.10 to 0.30 MPa and occurred along the medial aspect. The mean stress in the screw locking mechanisms decreased 78% from 71.23 to 15.92 MPa. The angled proximal metaphyseal screw had the highest stress.

Conclusion.

Augmentation with calcium triphosphate cement improves initial stability and reduces stress on the implant-bone interface.
Joint Hypermobility and Anterior Cruciate Ligament Injury
Authors: Vaishya Raju , Hasija Rohit
Published: October 2016

Purpose.

To compare the rates of joint hypermobility in patients with and without anterior cruciate ligament (ACL) injury.

Methods.

Records of 135 men and 75 women (mean age, 24.6 years) who underwent ACL reconstructions were reviewed and compared with 55 male and 35 female controls with no knee injury. Joint hypermobility was evaluated by 2 examiners using the Beighton score. The maximum score was 9, and a score of ≥4 was defined as hypermobility.

Results.

The mean time from injury to presentation was 18 days. A non-contact mechanism of injury was more common. The inter-observer reliability was 0.7. 127 (60.5%) of the patients with ACL injury and 23 (25.5%) of the controls had hypermobility (p<0.01). Among them, 58% and 24% were men and 65% and 29% were women, respectively. Female gender was associated with hypermobility. Patients with ACL injury were more likely to have joint hypermobility with an odds ratio of 4.46.

Conclusion.

Joint hypermobility was more common in patients with ACL injury.
Using the Transverse Acetabular Ligament as a Landmark for Acetabular Anteversion: An Intraoperative Measurement
Authors: Inoue Masahiro , Majima Tokifumi , Abe Satomi , Nakamura Takayuki , Kanno Taiki , Masuda Takeshi , Minami Akio
Published: October 2016

Purpose.

To measure the transverse acetabular ligament (TAL) anteversion in hips with severe deformity, using fluoroscopy–computed tomographic navigation.

Methods.

31 hips in 10 men and 19 women aged 40 to 78 (mean, 58.7) years who underwent total hip arthroplasty for primary osteoarthritis (n=6) or osteoarthritis secondary to developmental hip dysplasia (n=19) or congenital hip dislocation (n=6) were included. The severity of hip dislocation was classified according to the Crowe classification; 15 hips were grade 1, 7 were grade 2, 3 were grade 3, and 6 were grade 4. The TAL anteversion was measured using fluoroscopy–computed tomographic navigation. The difference in TAL anteversion between non-dislocated hips (Crowe grade 1, n=15) and dislocated hips (Crowe grades 2–4, n=16) was compared.

Results.

In all 31 hips, the TAL could be visualised intra-operatively. No patient reported severe pain, early wear, loosening, or dislocation after 2 years. The mean TAL anteversion and inclination angles measured by the navigation system were 26.5° (SD, 8.9°; range, 8°–42°) and 41.5° (SD, 4.6°; range, 32°–49°), respectively. 22 of the 31 hips were in the safe zone. TAL anteversion in non-dislocated and dislocated hips was not significantly different. Inter- and intra-observer mean absolute differences in TAL anteversion were 0.3° and 0.4°, respectively.

Conclusion.

The TAL is a useful anatomic landmark for total hip arthroplasty in dislocated hips.
Computed Tomography-Guided Core Needle Biopsy versus Incisional Biopsy in Diagnosing Musculoskeletal Lesions
Authors: Kiatisevi Piya , Thanakit Voranuch , Sukunthanak Bhasanan , Boonthatip Mayura , Bumrungchart Saraporn , Witoonchart Kiat
Published: October 2016

Purpose.

To compare computed tomography (CT)– guided core needle biopsy (CNB) with incisional biopsy in diagnosing musculoskeletal lesions.

Methods.

62 men and 50 women aged 12 to 83 (mean, 45) years who underwent a CT-guided CNB were compared with 31 men and 33 women aged 9 to 81 (mean, 53) years who underwent an incisional biopsy. All specimens had final pathology report to compare with. Comparisons were made in terms of (1) diagnostic rate, (2) accuracy in distinguishing benign from malignant lesions, (3) accuracy in distinguishing low- from high-grade sarcomas, (4) accuracy for histological diagnosis, and (5) complication and repeated biopsy rates.

Results.

The diagnostic rate of CT-guided CNB and incisional biopsy was not significantly different (92.9% vs. 96.9%, p=0.33), nor were the accuracy in distinguishing benign from malignant lesions (100% vs. 98.4%, p=0.37), the accuracy in distinguishing low- from high-grade sarcomas (100% vs. 100%, p=1.00), the accuracy for specific diagnosis (75.9% vs. 85.2%, p=0.17), the repeated biopsy rate (6.3% vs. 4.7%, p=0.75), and the complication rate (0.9% vs. 4.7%, p=0.14). The accuracy for specific diagnosis was higher for bone than soft-tissue lesions for both CT-guided CNB (87.0% vs. 59.5%, p=0.002) and incisional biopsy (87.0% vs. 77.3%, p=0.43). The accuracy of CT-guided CNB for specific diagnosis of benign soft-tissue tumours as well as infection and inflammation was relatively low.

Conclusion.

CT-guided CNB is safe, easy to perform, efficient, and less invasive, and should be considered as a first-line biopsy for musculoskeletal lesions.
Collagen Expression in Various Degenerative Meniscal Changes: An Immunohistological Study
Authors: Mine Takatomo , Ihara Koichiro , Kawamura Hiroyuki , Date Ryo , Umehara Keitaro
Published: October 2016

Purpose.

To examine changes in acid mucopolysaccharides and collagen expression during meniscal degeneration, tearing, and repair, using menisci excised from knee joint surgeries.

Methods.

Menisci excised from 23 patients aged 15 to 80 years who underwent meniscal surgery for flap and bucket handle tears (n=11) and total knee arthroplasty (TKA) for osteoarthritis (n=12) were examined histologically. Staining images were converted to greyscale images to measure the mean grey levels, which indicated densitometry. Comparisons were made between acutely injured menisci and menisci with and without degeneration (from patients with osteoarthritis) in terms of acid mucopolysaccharides, collagen types I, II, and III expression.

Results.

In menisci with no degeneration, acid mucopolysaccharides, collagen types I and II were expressed throughout the entire meniscus except for the circulating area. Collagen type III was intensely expressed at the exterior peripheral border and on the surface. During progression of meniscal degeneration, the expression of acid mucopolysaccharides increased, and the expression of collagen types I, II, and III decreased. In acutely injured menisci, collagen types II and III disappeared first, followed by collagen type I, resulting in the abrogation of fibre construction.

Conclusion.

In normal menisci, acid mucopolysaccharides and collagen types I, II, and III were well-balanced, and meniscal function was maintained. When the limits of repair were exceeded, the meniscus tissue deteriorated owing to the disappearance of collagen types II and III and a decrease in collagen type I, resulting in the abrogation of meniscus fabric construction.
Total Knee Replacement System with a Ceramic Femoral Component versus Two Traditional Metallic Designs: A Prospective Short-Term Study
Authors: Bergschmidt Philipp , Bader Rainer , Kluess Daniel , Zietz Carmen , Schwemmer Benjamin , Kundt Guenther , Mittelmeier Wolfram
Published: October 2016

Purpose.

To compare the short-term outcome of the Multigen Plus system using a symmetric ceramic femoral component with that of 2 metallic total knee replacement (TKR) systems.

Methods.

60 patients (62 knees) with osteoarthritis or rheumatoid arthritis underwent primary TKR using the Genia system (n=20), the Multigen Plus system (n=17), and the Multigen Plus system with a ceramic femoral component (n=25). Outcome was evaluated pre- and post-operatively (at 3, 12, and 24 months) using the Hospital for Special Surgery (HSS) score, the Western Ontario and McMaster Universities (WOMAC) score, and the Short-Form 36 (SF-36) score.

Results.

The 3 groups did not differ significantly at all 4 time points in terms of the HSS score, WOMAC score, and SF-36 score. The range of motion was significantly less in patients treated with the Genia system. Postoperatively, the HSS and WOMAC scores improved significantly in all 3 groups, whereas the SF-36 score improved significantly (at 12 and 24 months) only in patients treated with the Multigen Plus system with a ceramic femoral component. The implant position in most patients was optimal. All radiolucent lines were within 1 mm and did not progress.

Conclusion.

The short-term outcome of the 3 TKR systems was comparable. Ceramic femoral components performed comparably to traditional metallic designs.
Ropivacaine versus Bupivacaine for 3-in-l Block during Total Knee Arthroplasty
Authors: Theodosiadis Panagiotis , Sachinis Nick , Goroszeniuk Teo , Grosomanidis Vasilios , Chalidis Byron
Published: October 2016

Purpose.

To compare the use of ropivacaine versus bupivacaine for 3-in-1 block during total knee arthroplasty (TKA) in terms of efficacy and safety (lack of toxicity).

Methods.

14 men and 26 women aged 58 to 77 (median, 70) years who had the American Society of Anesthesiologists (ASA) grades I to III physical status were randomised to receive ropivacaine (n=20) or bupivacaine (n=20) of a concentration of 0.5% for 3-in-1 block during TKA. The dosage was 0.5 ml/kg. In addition, a sciatic nerve block (20 ml of prilocaine 1%) was used. The onset of the block, duration of postoperative analgesia, level of motor block, and any side-effects were compared.

Results.

The median time to onset of block was significantly shorter in those receiving ropivacaine than bupivacaine (13 vs. 17.5 minutes, p<0.001), but the levels of motor blockade were not significantly different (p=0.355). Complete analgesia was achieved throughout the procedure. There was no significant difference between the ropivacaine and bupivacaine groups in terms of the mean duration of analgesia (398 vs. 367 minutes, p=0.62), the mean VAS scores at all time points, and the mean total morphine consumption. One patient in the ropivacaine group developed a joint haematoma and 2 patients in the bupivacaine group had excessive wound drainage. Both conditions resolved after antibiotic use.

Conclusion.

Ropivacaine and bupivacaine showed similar anesthetic and analgesic effects, but the former had a significantly faster onset time.
Mechanical Failure of the Distal Radius Volar Locking Plate
Authors: Foo Tun-Lin , Gan Aaron WT , Soh Tamara , Chew Winston YC
Published: October 2016

Purpose.

To review 9 cases of mechanical failure of the volar locking plate for distal radial fractures.

Methods.

Records of 374 consecutive patients who underwent volar locking plating for distal radial fractures were reviewed. Mechanical failures of the volar locking plate were defined as plate breakage or bending, screw breakage or loosening, or collapse of articular fragments resulting in intra-articular screw extrusion.

Results.

Nine mechanical failures occurred between 2 weeks and 3 months in 8 (2.4%) of the patients aged 25 to 82 (median, 74) years with AO fracture types of A3 (n=4), C1 (n=1), C2 (n=1), and C3 (n=3). Mechanical failures included screw pullout (n=5), locking plate bending (n=2), locking screws breakage (n=1), and loosening of locked variable angle screws (n=1). One patient underwent revision of fixation and 2 underwent implant removal. The remainder were treated conservatively. All patients were followed up for a minimum of 12 months; their mean flexion arc was 87° (standard deviation [SD], 17°) and the mean rotation arc was 136° (SD, 29°). According to the Green and O'Brien score, their outcomes were good (n=1), fair (n=4), and poor (n=3).

Conclusion.

Although mechanical failure of volar locking plate is uncommon, some are potentially preventable.
Cervical Epidural Haematoma Causing Brown-Sequard Syndrome: A Case Report
Authors: Kulkarni Arvind G , Nag Kushal , Shah Sambhav
Published: October 2016

Brown-Sequard syndrome secondary to compression of the spinal cord by an epidural haematoma following minor trauma is rare. A 65-year-old woman presented with neck pain and sudden onset hemiplegia with contralateral anaesthesia. Magnetic resonance imaging showed a haematoma in the epidural space in the C3 to C5 levels. She underwent open-door laminoplasty for evacuation of the haematoma. At the 2-year follow-up, she had regained normal sensations and a neurological grade of 5/5.
Ganglia Arising from the Transverse Acetabular Ligament: A Report of Two Cases
Authors: Botchu Rajesh , Esler Colin N , Lloyd David M , Rennie Winston J
Published: October 2016

Ganglia arising from the hip are rare. Its diagnosis is difficult owing to the anatomic location. A high index of suspicion and high-resolution imaging is essential to make the diagnosis. Treatment depends on the size, location, and symptoms. This report is of 2 patients with ganglia arising from the transverse acetabular ligament.
Isolated Posterior High Ankle Sprain: A Report of Three Cases
Authors: Botchu Rajesh , Allen Patricia , Rennie Winston J
Published: October 2016

High ankle sprains are difficult to diagnose and account for 10% of all ankle sprains. A high index of suspicion is essential for diagnosis. High ankle sprains are managed symptomatically, with prolonged rehabilitation. The posterior inferior tibiofibular ligament is the strongest syndesmotic ligament; isolated injury of it is rare. We present 3 cases of isolated posterior high ankle sprain and discuss the relevant anatomy, mechanism of injury, and management.
Early Active Motion Protocol following Triple Kessler Repair for Flexor Tendon Injury
Authors: Rajappa S , Menon PG , Kumar M Mohan , Raj D Gokul
Published: October 2016

Purpose.

To evaluate outcome of 6-strand triple Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation.

Methods.

25 men and one woman (36 fingers) underwent 6-strand triple Kessler repair for flexor tendon injuries in zones 2 to 5, followed by early active motion rehabilitation. Rehabilitation was started at days 3 to 5. Patients were instructed to passively flex all the fingers with the uninjured hand and to actively retain this position for 10 seconds. Active extension within the confines of the splint was allowed. At the end of week 8, strength training was commenced until a satisfactory range of motion was regained. Outcome measures included total active motion, grip strength, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Complications such as infection and wound dehiscence were recorded.

Results.

The mean follow-up was 1.2 (range, 1–2) years. Outcome was excellent in 24 digits, good in 4, and poor in 8. The mean grip strength was 80% (range, 60–100%) of normal in dominant hands and 60% (range, 50–65%) of normal in non-dominant hands. The mean DASH score was 15 (range, 0–52). One patient had wound dehiscence and superficial infection.

Conclusion.

Six-strand triple Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation yields satisfactory results.
Hibernoma of the Thigh: A Report of Four Cases
Authors: Salim Bouabid , Belkacem Chagar
Published: October 2016

Hibernoma is a rare benign adypocyte tumour of brown fat. We report on 4 patients with hibernoma of the thigh. Clinical features and magnetic resonance imaging suggested the tumours were liposarcomas, but biopsy yielded the diagnosis of hibernoma. All 4 patients underwent complete excision of the tumour and had no recurrence.
Enhanced Recovery Programme for Total Knee Replacement to Reduce the Length of Hospital Stay
Authors: Dwyer Amitabh J , Thomas William , Humphry Simon , Porter Paul
Published: October 2016

Purpose.

To compare the length of hospital stay in patients undergoing primary total knee replacement (TKR) with or without enhanced recovery (ER) programme.

Methods.

Medical records of 57 and 55 consecutive patients who underwent primary TKR with or without ER programme, respectively, were reviewed. 17 men and 40 women aged 43 to 87 (mean, 70) years with ER programme were compared with 22 men and 33 women aged 53 to 90 (mean, 73) years without ER programme in terms of the preoperative haemoglobin level, American Association of Anesthesiologists (ASA) physical status grading, body mass index (BMI), and length of hospital stay.

Results.

The length of hospital stay was significantly shorter in the ER than non-ER groups in overall patients (6 vs. 7.8 days, p=0.0003), in patients with preoperative haemoglobin level of ⩾14 g/dl (5.4 vs. 7.7 days, p=0.02), in patients with preoperative haemoglobin level of ±14 g/dl (6.2 vs. 7.7 days, p=0.02), in patients with ASA grades 1 and 2 (5.6 vs. 7.6 days, p=0.01), in patients with ASA grade 3 (6.4 vs. 8.2 days, p=0.01), in patients with BMI of ±30 kg/m2 (6 vs. 8.1 days, p=0.0061), and in patients with BMI of ⩾30 kg/m2 (5.9 vs. 7.5 days, p=0.0006). Complications were noted in 4 ER patients and 5 non-ER patients.

Conclusion.

ER programmes are readily transferable to patients undergoing TKR and significantly reduced the length of hospital stay.
Cemented versus Cementless Hemiarthroplasty for Femoral Neck Fractures in the Elderly
Authors: Ng Zhaowen Dennis , Krishna Lingaraj
Published: October 2016

Purpose.

To compare cemented versus cementless bipolar hemiarthroplasty in terms of operating time, blood loss, pain, functional outcome, morbidity, and mortality.

Methods.

Medical records of 207 patients aged ⩾60 years who underwent bipolar hemiarthroplasty for displaced femoral neck fracture using a cemented (n=96) or cementless (n=111) prosthesis were reviewed. Postoperative thigh pain, ambulatory status, and complications were assessed.

Results.

The cemented group had significantly longer operating time (p=0.017) and greater intraoperative blood loss (p=0.024). Postoperative thigh pain was significantly higher in the cementless group (p=0.023).

Conclusion.

Cementless hemiarthroplasty is preferred over cemented hemiarthroplasty because of reduced operating time and intra-operative blood loss. It was associated with increased postoperative thigh pain, but functional outcomes, complications, and mortality were similar between the 2 groups.
Audit of Operation Notes in an Orthopaedic Unit
Authors: Sweed Tamer Ahmed , Bonajmah Abdallah Aly , Mussa Mohammed Altayeb
Published: October 2016

Purpose.

To audit operation notes of 50 patients according to the guidelines of the Royal College of Surgeons.

Methods.

Proforma operation notes of 50 consecutive patients treated in an orthopaedic department were audited by a single reviewer, according to the guidelines of the Royal College of Surgeons in terms of date and time of surgery, name of surgeon, procedure, operative diagnosis, incision details, signature, closure details, tourniquet time, postoperative instructions, complications, prosthesis used, and serial numbers.

Results.

There were 45 trauma cases and 5 elective cases. The operating surgeons were consultants (32%), senior registrars (36%), and registrars (32%). 28% and 72% of the operation notes were written by operating surgeons and assistants, respectively. Of the 14 operating surgeons who wrote their own notes, one was a consultant, 6 were senior registrars, and 7 were registrars representing 6%, 33%, and 44% of the respective grades of surgeons. All the notes were handwritten; 20% had illegible parts (all in the description of the operative technique). Documentation was good for date and time of surgery (100%), name of surgeon (100%), procedure (100%), duration of surgery (94%), operative diagnosis (92%), incision details (84%), and signature (84%). Documentation was poor for tourniquet time (32%; pneumatic tourniquet was used in 25 patients, only 8 of whom were documented), closure details (16%), and postoperative instructions (24%).

Conclusion.

Documentation of operative details in our department was generally good, except for closure details, tourniquet time, and postoperative instructions.
Prevalence and Risk Factors of Lateral Epicondylitis in a Mountain Village in Japan
Authors: Tajika Tsuyoshi , Kobayashi Tsutomu , Yamamoto Atsushi , Kaneko Tetsuya , Takagishi Kenji
Published: October 2016

Purpose.

To determine the prevalence and risk factors of lateral epicondylitis in a mountain village in Japan.

Methods.

176 men and 246 women aged 24 to 86 (mean, 61) years from a mountain village in Japan underwent regular medical examination and completed a self-administered questionnaire with items related to gender, weight, height, dominant hand, heaviness of labour (no job, light, intermediate, and heavy), presence of elbow pain 2 weeks before examination, and smoking and drinking experience. The diagnosis of lateral epicondylitis was based on self-reported symptoms and clinical signs.

Results.

The prevalence of lateral epicondylitis in a mountain village in Japan was 3.8% (95% confidence interval [CI], 2.2%-6.1%). Of the 422 subjects, 47 had elbow pain and 16 of them were diagnosed to have definite lateral epicondylitis. 15 of them were right-handed and had involvement of the left (n=8) and right (n=7) sides; the remaining one was left-handed and had involvement of the left side. The dominant hand was not associated with the affected side (p=1.00). Heaviness of labour was not associated with the elbow pain scores. The prevalence was highest in subjects aged 50 to 59 years (9% [95% CI, 3.8%-17.1%]) and those with no job (14% [95% CI, 1.1%-44.1%]).

Conclusion.

Lateral epicondylitis was not associated with gender, age, body mass index, dominant hand, heaviness of labour, smoking, or drinking.
Sports-Related Fractures in South East Scotland: An Analysis of 990 Fractures
Authors: Aitken Stuart A , Watson Bruce S , Wood Alexander M , Court-Brown Charles M
Published: October 2016

Purpose.

To describe the characteristics of all sports-related fractures in patients aged ≥15 years in South East Scotland in one year.

Methods.

Medical records of 990 consecutive patients aged ≥15 years who presented to the Orthopaedic Trauma Unit of the Royal Infirmary of Edinburgh with sports-related fractures between 1 July 2007 and 30 June 2008 were reviewed. Acute fractures of the upper limbs, lower limbs, pelvis, and cervical spine were included, but those of the skull, facial bones, and thorax were excluded, as were stress and chronic fractures.

Results.

The incidence of sports-related fractures was 1.8/1000/year (82% involving men). The median age of patients was 25 (interquartile range, 19–35) years. Sports-related fractures accounted for 24.6% and 5.1% of all fractures in men and women, respectively. Men aged 15 to 19 years were 9 times more likely to have sports-related fractures than women of the same age. The sports-related fractures involved the upper limbs (52.4%), lower limbs (45.4%), and axial skeleton (2.2%). 12 of 49 sports (football, rugby, skiing, snowboarding, 3 cycling disciplines, horse riding, motocross, basketball, martial arts, and ice skating) accounted for 82.8% of all sports-related fractures. Upper limb fractures outnumbered lower limb fractures in all sports, except for horse riding and motocross that the proportions were similar.

Conclusion.

In South East Scotland, most sports-related fractures involved the upper limbs
Reconstruction for Chronic Grade-II Posterior Cruciate Ligament Deficiency in Malaysian Military Personnel
Authors: Ahmad Shahrulazua , Mahidon Rafedon , Shukur Mohammad Hassan , Hamdan Amiruddin , Kasmin Musa
Published: October 2016

Purpose.

To evaluate the outcome of reconstruction for chronic grade-II posterior cruciate ligament (PCL) deficiency in Malaysian military personnel.

Methods.

Medical records of 16 male military personnel aged 25 to 41 years who underwent reconstruction for chronic grade-II PCL deficiency using the quadruple hamstrings tendon by a single surgeon were reviewed. The mean time from injury to surgery was 43.6 (range, 3–104) months. 10 patients had grade-I (n=4), grade-III (n=2), and grade-IV (n=4) lesions of the medial femoral condyles. Seven patients had medial (n=6) and lateral (n=1) meniscus tears. At the 2-year follow-up, patients were asked to complete a questionnaire consisting of the Lysholm score, Tegner activity level, and International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form. Posterior drawer test, KT-2000 arthrometer test for posterior translation of the tibia, and military health grade (MHG) were assessed by an independent assessor.

Results.

At the 2-year follow-up, the mean Lysholm score was 83; the score was excellent in 2 patients, good in 9, fair in 4, and poor in one. The mean IKDC subjective score was 74. The median Tegner activity level increased from 5.5 to 6. The posterior drawer test of 11 patients improved to grade I and the remaining 5 remained at grade II. The mean posterior translation of the tibia was 2.4 mm postoperatively; the posterior translation was normal in 8 patients, nearly normal in 7, and abnormal (≥6 mm) in one. The MHG improved in 14 patients and remained unchanged in 2. The latter 2 patients had no chondral lesion or meniscus injury. The first one was 40 years old with a postoperative IKDC score of 55 and a Tegner activity level of 2. The second one was 34 years old with a postoperative IKDC score of 65 and posterior translation of the tibia of 6 mm.

Conclusion.

Surgical reconstruction for chronic grade-II PCL injury achieved satisfactory outcome and may be appropriate for military personnel.
Ceramic-on-Ceramic Total Hip Arthroplasty in Patients Younger Than 55 Years
Authors: Shah Roshan P , Scolaro John A , Componovo Roger , Garino Jonathan P , Lee Gwo-Chin
Published: October 2016

Purpose.

To review the outcomes of 65 patients younger than 55 years who underwent uncemented total hip arthroplasty (THA) using third-generation ceramic-on-ceramic prostheses.

Methods.

Medical records of 30 men and 35 women (80 hips) aged 18 to 55 (mean, 39) years who underwent uncemented THA using third-generation ceramic-on-ceramic prostheses by a single surgeon were reviewed. 61 THAs used the Reflection cup with the Synergy stem (n=49), Spectron stem (n=7), or Anthology stem (n=5), and 19 THAs used the Trident cup with the Secur-Fit stem. Outcomes were assessed based on the UCLA Activity Score and Harris Hip Score, as well as radiolucency around the implants, malposition, and subsidence on radiographs. Patients were asked about their satisfaction with current activity level (yes/no), activity limitation (no limitation, musculoskeletal limitation, psychological impediments and lack of motivation, and pain or disability of the operative hip), and change in occupational activity level (same or similar, more active, and less active or disability).

Results.

The mean follow-up period was 54 (range, 24–110) months. Six patients were excluded from the analysis owing to prosthetic failure secondary to ceramic liner fracture after falling (n=2), acetabular component loosening (n=1), intolerable squeak (n=1), periprosthetic fracture (n=1), and instability (n=1). The mean UCLA Activity Score improved from 4.0 (range, 1–10) to 7.7 (range, 2–10) [p<0.001], and the mean Harris Hip Score improved from 52.8 (range, 25–69) to 91.0 (range, 38–100) [p<0.001]. No hip had evidence of subsidence, loosening, or osteolysis. 52 (80%) patients were satisfied with their activity level; 28 (43%) patients reported no activity limitation; and 57 (88%) patients kept the same or similar occupation.

Conclusion.

Ceramic-on-ceramic THA achieved acceptable clinical and radiographic outcomes.
Total Hip Replacement Using a Highly Cross-Linked Polyethylene Liner in Asians with Small Acetabulum
Authors: Chua Weiliang , Roy Shuvendu , Sng Jonathan , Liang Shen , De Shamal Das
Published: October 2016

Purpose.

To evaluate the medium-term outcomes of total hip replacement (THR) using a thin highly cross-linked polyethylene (HXLPE) liner in an Asian population.

Methods.

Medical records of 20 men and 44 women aged 26 to 80 (mean, 59) years who underwent 80 THRs using a thin HXLPE liner by a single surgeon were reviewed. Indications for THR included dysplasia (n=26), avascular necrosis (n=26), osteoarthritis (n=22), rheumatoid arthritis (n=4), and ankylosing spondylitis (n=2). The surgical technique, implant used, and rehabilitation protocol were standardised. Radiographs were evaluated for cup migration and peri-implant radiolucency. Femoral head penetration was assessed at day 1 and last follow-up using the Kang modification of the Dorr and Wan method and the PowerPoint method.

Results.

After a mean follow-up of 7.5 (range, 5.0–11.9) years, no patient had undergone acetabular revision. Two hips were revised for the femoral stem. Femoral head penetration did not correlate with sex, age at surgery, hip pathology, acetabular inclination angle, cup size, or liner thickness. The maximum femoral head penetration was 0.09 mm/year, which was below the osteolysis threshold of 0.1 mm/year. The mean±standard deviation femoral head penetration was 0.29±0.12 mm (or 0.04±0.02 mm/year) by the PowerPoint method and 0.17±0.22 mm (or 0.02±0.03 mm/year) by the Kang modification of the Dorr and Wan method. Femoral head penetration correlated with the number of years of follow-up (p=0.012).

Conclusion.

The use of a thin HXLPE liner in primary THR for patients with small acetabulum achieved good outcomes after a mean of 7.5 years.