bluuebunny/crossref_metadata_2025 huggingface dataset:
A Review of the Ecological Functions of Reed Bamboo, Genus Ochlandra in the Western Ghats of India: Implications for Sustainable Conservation
Authors: SijiMol K. , Dev Suma Arun , Sreekumar V. B.
Published: October 2016

Reeds are a tall, thin, shrubby, highly productive grass of the Poaceae family, and have a worldwide distribution except for in Antarctica. Temperate reed species include Phragmites australis (Cav.) Trin. ex Steud. , Arundo donax L., Phalaris arundinacea L. Tropical reeds include bamboo genus Ochlandra and are endemic to the Western Ghats of India as well as to Sri Lanka. Reeds are an important component of the forest ecosystem, providing numerous ecosystem services which help to maintain forest stability. They are a keystone species and serve as an important food source for many animals. Reed biomass is widely used for solid biofuel production and for mitigating greenhouse gas emissions. They are an excellent sink for carbon sequestration and the absorption of point-source pollution from the waterbeds. Reed bamboos have been considered as the most important non-timber forest product (NTFPs) for the subsistence and support of the economically weaker strata of the society. Owing to ever increasing demand, coupled with unscientific management practices, there has been a gradual depletion of reed resources over the years. The reed bamboo biomass of the Western Ghats, in particular, has been severely depleted, and there is an urgent need for effective conservation and proper scientific management to ensure its viability and long-term survival. This review summarizes the versatility and importance of reeds in terms of ecological benefits, carbon sequestration ability, soil and water management potential and ecosystem services, with particular reference to the endemic reed bamboo resources of the Western Ghats of India.
Patterns of Presentation of Congenital Scoliosis
Authors: Mohanty S , Kumar N
Published: October 2016

In analysing and investigating 66 consecutive cases of congenital scoliosis, we aimed to evaluate the clinical pattern of presentation, identify the underlying vertebral anomaly causing the deformity, and determine the frequency of associated intraspinal anomalies, cardiovascular anomalies and genitourinary anomalies.

Associated general anomalies were seen in 44% of the cases. The commonest pattern of deformity was a right-sided thoracolumbar curve. Hemivertebra was the most common vertebral anomaly (45%). Occult intraspinal anomalies were seen in 15% of cases, diastematomyelia being the commonest anomaly. Genitourinary anomalies and cardiovascular abnormalities were encountered in 6% and 15% of patients respectively.

As decision making in the treatment of congenital scoliosis depends on the natural history of progression of the deformity and associated intra and extra spinal anomalies, identification of all associated anomalies is essential.
The Timing of Spinal Fusion in Adolescent Idiopathic Scoliosis
Authors: Mohanty SP , Kumar M Narendra , Kishore BG Nand , Babu S Suresh
Published: October 2016

102 cases of idiopathic adolescent scoliosis seen over a period of 5 years were studied. 59 patients who were treated surgically and followed up for a minimum of 48 months, fell into one of two groups: Group I — those operated on within 3 years following the adolescent growth spurt, and Group II — those who were operated on at or after skeletal maturity. 35 patients were treated by Harrington instrumentation and posterior fusion and 24 by Harrington instrumentation, segmental sublaminar wiring and posterior fusion. In 7 patients anterior release was performed initially. In Group I, the extent of deformity correction and elimination of the rib hump were better, and complications such as neurological deficit, hook dislodgement and implant breakage were encountered less frequently. Harrington instrumentation, segmental sublaminar wiring and posterior fusion gave better results than instrumentation and fusion. Our results suggest that surgical correction should be done within 3 years following growth spurt, i.e. 14 to 16 years of age.
Peroneal Compartment Syndrome of Non-Traumatic Origin: A Case Report
Authors: Ashton L Andrew , Jarman PG , Marel E
Published: October 2016

A patient with acute peroneal compartment syndrome is presented. This case is unusual because the pathology was localised to the peroneal compartment only and because trauma was not an aetiological factor. Acute and chronic compartment syndromes are discussed and differentiated, and the importance of a high index of suspicion in all cases is emphasised.
Qualitative Analysis of Polyethylene Wear in a Bipolar Femoral Prosthesis: A Case Report
Authors: Kaku Nobuhiro , Tsumura Hiroshi , Torisu Takehiko
Published: October 2016

We researched the qualitative changes in the polyethylene of a bipolar head retrieved at revision occurring in vivo using optical microscopy and Fourier transform infrared spectroscopy. The bearing surface of the outer head was smooth with no definable scratches delamination. However, the evidence of delamination of the beveled throat region and cracking at the base of the leaf was noticed. The degree of oxidation was different in each area of the polyethylene in the bearing component and that of the rim was shown to be higher than that of the bearing surface. Comparing the rate of ketone and ester, ketone binding was frequently found around the prosthetic rim rather that at the bearing surface. However, the ratio of ester at the surface was higher than that at the deep area of the same rim. We considered these results showed local environmental effects in vivo play a significant role in dictating the response.
Total Hip Arthroplasty for Arthrodesed Hips
Authors: Howard M.B. , Bruce W.J.M. , Walsh W. , Goldberg J.A.
Published: October 2016

The benefits of converting an ankylosed or arthrodesed hip to total hip arthroplasty have been reported in the literature as have the technical difficulties associated with this procedure.1,2,4 This review, however, outlines the experience of a single surgeon (WJMB) at a single institution using uncemented prostheses.

Between November 1991 and June 1996, 5 arthrodesed hips underwent uncemented total hip arthroplasty in 4 males and 1 female. Clinical and radiological follow-up review was for at least three years in all patients.

In general, patients were satisfied with the outcome of their surgery with Harris Hip scores improving from an average of 62 preoperatively to an average of 72 postoperatively. The surgical outcome in these difficult cases was not as satisfactory as for routine total hip arthroplasty.

Meticulous preoperative planning is required to aim toward leg length restoration and restoration of the abductor moment arm5. A modular prosthesis allows versatility at surgery.
Correlation between the Acetabular Diameter and Thickness in Thais
Authors: Varodompun Namchai , Thinley Tshewang , Visutipol Boonyarak , Ketmalasiri Bunyat , Pattarabunjerd Narongchai
Published: October 2016

We conducted a study on dried cadaveric pelvic bones to determine the relation between acetabular diameter and thickness of the acetabular wall.

The acetabulum was divided into four quadrants: antero-superior, postero-superior, postero-inferior, and anteroinferior. The diameters of the acetabulum were measured for 152 pelvic bones. The thickness of the center of the acetabulum was measured with the use of a caliper at four quadrants of the acetabulum. The average acetabular diameter was found to be 51.8224 mm for all the acetabuli. The average thickness in the posterior quadrant has been calculated to be about 50% of the acetabular diameter, which is about 26 mm. The acetabular diameter and the thickness of the acetabulum correlated very well though there was very little significance statistically (0.099) due to the lack of full data for all the individual bones.

Linear correlation between the thickness and the diameter is definitely collinear but the correlation is not statistically significant. Some additional factors such as bone density, body mass, etc, are required to correlate the thickness and the diameter. Further study is required in this field.
Power Spectrum Analysis of Compound Muscle Action Potential in Carpal Tunnel Syndrome Patients
Authors: Ogura Taku , Kubo Toshikazu , Okuda Yoshiki , Lee Kookho , Kira Yasuhiko , Aramaki Shunzo , Nakanishi Fumihiko
Published: October 2016

The objective of using wave-form analysis to assess compound muscle action potential (CMAP) in entrapment neuropathy had not been fully developed. We applied the power spectrum analysis to patients with carpal tunnel syndrome (CTS) for this purpose. 24 patients with CTS were divided into three stages according to Mackinnon's classification, and 50 normal volunteers were examined. CMAP was obtained from the abductor pollicis brevis with supramaximal stimulation to median nerve. Mean and peak frequencies were measured by power spectrum analysis.

The distal latencies of CMAP and the sensory nerve conduction velocities showed some prolongation in CTS patients. Integral values of CMAP were also decreased in CTS patients. Mean and peak frequencies of power spectrum of CMAP in volunteers were 134Hz and 98 Hz, respectively. These values shifted into lower frequencies in CTS patients, namely 102Hz and 61Hz.

Regardless of clinical stage, distal latency of CTS patients correlated with mean frequency.
Osteophyte at the Sacroiliac Joint as a Cause of Sciatica: A Report of Four Cases
Authors: Kumar Bhaskaranand , Sriram K.G. , George Chacko
Published: October 2016

Four cases of sciatica due to osteophytes impinging on the sciatic nerve at the sacroiliac joint are reported. Of these 4 cases, 2 were treated conservatively and the other 2 required surgical excision of the osteophyte. The report highlights the importance of keeping this uncommon etiology in the differential diagnosis of sciatica.
Laser Doppler Flow Imaging of Open Lower Leg Fractures in an Animal Experimental Model
Authors: Herzog L , Huber FX , Meeder PJ , Muhr G , Buchholz J
Published: October 2016

Purpose.

Open lower leg fractures are frequently associated with severe soft tissue damage, followed by osteomyelitis. Using an animal experimental model, we investigated the effect of timing of coverage of a tibial fracture with a local muscle flap.

Methods.

80 rabbits had a tibial fracture induced in a standardised fashion, which was stabilised by screw osteosynthesis. After 3 (group A; n=40) and 7 days (group B; n=40), respectively, the tissue defect was covered by a local gastrocnemius flap. In increasing intervals from 1 to 2, 4, 8, and 16 weeks, the rabbits from each group were killed and the bone fracture was analysed histomorphologically Cortical microcirculation was measured by 2-channel laser doppler flowmetry.

Results.

Muscle flaps after 3 days improved perfusion significantly as compared with 7 days (24 Flux [standard error, 5 Flux] versus 10 Flux [3 Flux]; baseline, 1.4 Flux). Group A animals also displayed a lower rate of necrosis (0 versus 38). The incidence of osteomyelitis was higher in group B than in group A (24% versus 0%).

Conclusion.

Laser doppler flowmetry was proven to be a reliable, minimally invasive means for identifying avital tissue, leading to reduction in the loss of vital bone tissue in experimental settings.
Giant Cell Tumour of Bone with Late Presentation: Review of Treatment and Outcome
Authors: Ng ES , Saw A , Sengupta S , Nazarina AR , Path M
Published: October 2016

Purpose.

To review cases of giant cell tumour of bone or osteoclastoma managed at the University Malaya Medical Center, University of Malaya, Kuala Lumpur, from January 1990 to December 1999.

Methods.

Medical records of all patients with musculoskeletal tumours were reviewed. Demographic data, clinical presentation, surgical management, and clinical outcomes were reviewed retrospectively.

Results.

Most of the 31 patients who were treated for giant cell tumour of bone presented late on the basis of the duration of their symptoms and radiological features. Five of the patients had been referred for local recurrences. 26 patients were treated for primary tumours: 18 needed wide excision, 7 curettage, and one amputation. The joint could not be preserved and arthrodesis was performed for 11 patients. Three (12%) of the 26 patients had local recurrence during a mean follow-up of 60 months, including one (6%) who had recurrence after wide excision and 2 (29%) after curettage. Pulmonary metastasis was noted in 4 cases, 2 of which were confirmed histologically.

Conclusion.

Even in an advanced stage of disease, good clinical outcomes can be achieved with adequate excision and appropriate reconstruction. For lesions around the knee, autologous rotational grafting is a good alternative method of reconstruction.
Chondrocyte Damage following Osteochondral Grafting Using Metal and Plastic Punches: Comparative Study in an Animal Model
Authors: Nabavi-Tabrizi A , Turnbull A , Dao Q , Appleyard R
Published: October 2016

Purpose.

Osteochondral impaction grafting to manage isolated chondral defects in femoral condyles usually uses a metal punch to impact the grafts into predrilled cavities. Damage to the chondrocytes during impaction is a concern, however, and new methods are being sought to minimise the damage. We studied if impaction with a plastic punch instead of a metal punch reduces the extent of chondrocyte damage in an animal model.

Methods.

32 osteochondral plugs were prepared from knees of 10 freshly slaughtered sheep knees; the contralateral condyles were then prepared to receive the osteochondral grafts. 20 plugs were impacted into predrilled holes: 10 using a metal punch and 10 using a plastic punch. The 12 remaining plugs were used as controls. The plugs were recovered, incubated for 24 hours in calf serum, and stained with 3-[4,5-dimethylthiazol]-2,5-diphenyltetrazolium to measure the content of viable cells. Digital photographs of the stained cartilage were then analysed on a 0-to-255 grey-scale.

Results.

We found no significant difference in the extent of chondrocyte damage caused by impaction using metal and plastic punches. The content of viable cells in plugs impacted by metal and plastic punches, however, was significantly lower than that in the control plugs, as reflected by higher means of light intensity of 52.9 (p<0.001) and 32.4 (p=0.005), respectively.

Conclusion.

Impaction grafting clearly damages chondrocytes of the osteochondral plug. The use of a plastic punch does not reduce the extent of chondrocyte damage during the impaction grafting procedure.
Autologous Chondrocyte Implantation Using a Bilayer Collagen Membrane: A Preliminary Report
Authors: Cherubino P , Grassi FA , Bulgheroni P , Ronga M
Published: October 2016

Purpose.

To present preliminary clinical experience with Matrix-induced autologous chondrocyte implantation, a new tissue-engineering technique for treatment of deep cartilage defects, in which autologous chondrocytes are seeded on a tridimensional scaffold provided by a bilayer type I–III collagen membrane.

Methods.

From December 1999 to January 2001, 13 patients underwent implantation procedure for deep cartilage defects. Age of patients ranged from 18 to 49 years (mean age, 35 years). The mean defect size was 3.5 cm2 (range, 2.0–4.5 cm2). Clinical and functional evaluation were performed using various score systems for the ankle and the knee, and magnetic resonance imaging was performed at 6 and 12 months postoperatively. Membrane structure and cellular population were investigated by light microscopy, scanning electron microscopy, and electrophoresis before implantation.

Results.

The mean follow-up was 6.5 months (range, 2–15 months). No complications were observed in the postoperative period. The 6 patients with a minimum follow-up of 6 months showed an improvement in clinical and functional status after surgery. Magnetic resonance images showed the presence of hyaline-like cartilage at the site of implantation; there was evidence of chondroblasts and type II collagen inside the seeded membrane.

Conclusion.

Matrix-induced autologous chondrocyte implantation offers several advantages with respect to the traditional cultured cell procedure. These include technical simplicity, short operating time, minimal invasiveness, and easier access to difficult sites. It appears to be a reliable method for the repair of deep cartilage defects.
The Shape and Size of Femoral Components in Revision Total Hip Arthroplasty among Chinese Patients
Authors: Chiu KY , Ng TP , Tang WM , Cheng HC , Hung TSL , Tse PYT , Ko PS
Published: October 2016

Purpose.

39 sets of preoperative hip X-rays were studied to find out whether Chinese patients need revision femoral components with a different shape and size from western patients.

Methods.

From July 1998 to June 2001, the pre-revision X-rays of 39 revision total hip replacements among 38 Chinese patients (21 men and 17 women) were studied. The component size that produced the best distal canal-filling in the anteroposterior X-ray was determined by using templates of 200-mm femoral components used commonly for Caucasian patients.

Results.

The diameter of the component needed was 13.5 mm or less in 54% of cases, compared with only 17% for Caucasian patients as reported in the literature (p<0.01). When lateral templates of the corresponding size were put over the lateral X-rays, the anterior cortex of the 200-mm straight stem was shown to have thinned by 2.0 mm or more in 36% of hips; for 200-mm bowed stem, there was thinning of the anterior cortex by 2.0 mm or more in only 5% of hips (p<0.01).

Conclusion.

Chinese patients are likely to need smaller femoral components than Caucasian patients, and may benefit from bowed-stem components in femoral revision.
Sympathetic Skin Response in Patients with Spinal Cord Injury
Authors: Ogura T , Kubo T , Lee K , Katayama Y , Kira Y , Aramaki S
Published: October 2016

Purpose.

To assess the effectiveness of sympathetic skin response in evaluating peripheral sympathetic nerve activity of patients with spinal cord injury, and to report on the basic properties of sympathetic skin response.

Methods.

Sympathetic skin response evoked by electrical stimulation was recorded from the palms and soles of healthy volunteers and patients with spinal cord injury.

Results.

Sympathetic skin response was recorded in 17 healthy volunteers and 14 patients with spinal cord injury. Of the 4 waveforms, the shortest latency was obtained from the palm; the sympathetic skin response was 1.2 to 1.4 ms at all stimulated sites, 1.9 to 2.0 ms at the sole, with a difference of about 0.6 ms between the palm and the sole. None of the patients with spinal cord injury responded at either the upper or lower limbs. In patients with a thoracic cord injury, some responded at the upper limbs but none at the lower limbs; some responded at neither upper nor the lower limbs; and some responded at both upper and lower limbs. The conducting pathway of sympathetic skin response in the spinal cord for the upper limbs descends to the upper thoracic cord (T4–6), and the conducting pathway for the lower limbs departs from the spinal cord at the lower thoracic cord (T9–10).

Conclusion.

It appears that sympathetic skin response should be used for the evaluation and morbid investigation of the functional abnormalities of the sympathetic nervous system in patients with spinal cord lesions such as spinal cord injuries, cervical spondylosis, and spinal canal stenosis.
Comparison of Two Methods of Percutaneous Pin Fixation in Displaced Supracondylar Fractures of the Humerus in Children
Authors: Foead A , Penafort R , Saw A , Sengupta S
Published: October 2016

Purpose.

To conduct a prospective randomised controlled study to compare the stability and risk of nerve injury between fractures treated by medial-lateral pin fixation and those treated by 2-lateral pin fixation.

Methods.

Patients with displaced supracondylar fractures admitted between May 2000 and December 2001 were recruited into the study. They were randomised to treatment either with medial-lateral pin fixation (n=34) or with 2-lateral pin fixation (n=32).

Results.

66 children with the mean age of 5.78 years were admitted during the study period. 11 of them were lost to follow-up. The mean follow-up period of the remaining 55 patients was 8.93 months. The difference in the carrying angle between injured and normal elbows was 3.57° and 3.70° in medial-lateral pin fixation and 2-lateral pin fixation, respectively. The extension and flexion loss was 7.14° and 8.68° respectively in medial-lateral pin fixation, and 7.11° and 11.26° respectively in 2-lateral pin fixation. The Baumann angle difference was 5.96° in medial-lateral pin fixation, and 5.30° in 2-lateral pin fixation. The difference in the medial epicondylar epiphyseal angle was 6.07° in medial-lateral pin fixation and 6.92° in 2-lateral pin fixation. Statistical analyses show that these differences are not significant. Five iatrogenic ulnar nerve injuries developed in the group treated by medial-lateral pin fixation, while 2 ulnar nerve and one radial nerve injuries were seen after 2-lateral pin fixation. Again the differences were not statistically significant.

Conclusion.

Both methods of fixation were comparable in terms of stability, duration of bone healing, and risks of injury to the nerve.
Therapeutic Results of Acromioclavicular Joint Dislocation Complicated by Rotator Cuff Tear
Authors: Takase K , Yamamoto K , Imakiire A
Published: October 2016

Purpose.

To evaluate the operative findings and postoperative results of one-stage repair on patients with acromioclavicular joint dislocation complicated by rotator cuff tear.

Methods.

Between 1992 and 1999, one-stage repair was performed on 5 patients with acromioclavicular joint dislocation complicated by rotator cuff tears. Modified Cadenat procedure for acromioclavicular joint dislocation, and McLaughlin procedure for rotator cuff tear, were performed on these patients. Postoperative results at the final examination were assessed according to the criteria for therapeutic effects on shoulder joint disorders of the Japanese Orthopaedic Association.

Results.

There was partial-thickness cuff tear in one patient, and full-thickness cuff tear in the remaining 4 patients. In all patients, tears were located only in the supraspinatus tendon, and were medium or small ones with maximal diameter of 3 cm or less. After a mean follow-up period of 56 months (range, 36–79 months), all patients were assessed to have excellent results. No patient showed a good reduction of the acromioclavicular joint.

Conclusion.

For patients successfully treated by one-stage repair, satisfactory results were obtained without pain or disturbance in activities of daily living.
Musculoskeletal Tissue Banking in Singapore: 15 Years of Experience (1988–2003)
Authors: Nather A
Published: October 2016

Purpose.

To report 15 years' experience of musculoskeletal tissue banking by the National University Hospital Tissue Bank.

Methods.

This study describes the development of Singapore's national bone bank since its establishment in 1988. The bone bank's protocol follows guidelines recommended by the American Association of Tissue Banks and the European Association of Tissue Banks using strict donor selection criteria. Informed consent is obtained from all potential donors for tissue procurement and laboratory tests. Detailed medical history, thorough clinical examination, and chart review is performed for consenting donors. Suitable donors are subjected to tests for hepatitis B, hepatitis C, syphilis, and culture/sensitivity test of tissue for aerobic and anaerobic organisms. For living donors, repeat testing for AIDS and hepatitis C is performed at least 180 days after procurement. Tissue procurement is performed under sterile conditions. Small tissues are procured using the ‘sterile double jar technique’ and long bones using the ‘sterile triple wrap technique’, both developed by the author. Deep-frozen bones are gamma irradiated at 25 kilograys. Morsellised bones are lyophilised and gamma irradiated. Meticulous preparation for grafts is performed during transplantation. Antibiotic prophylaxis is used for 2 weeks.

Results.

The bank maintains a good quality control. In January 2003, it was accredited ISO 9001 status. Up to June 2003, it has procured 440 bones from 440 living donors and 1055 allografts from 63 deceased donors. 854 musculoskeletal transplantations have been performed using tissues processed by the bank. Complication rate encountered was only 2.2%.

Conclusion.

The tissue bank provides high-quality allografts for safe tissue transplantations.
New Modified Technique of Osteotomy for Hallux Valgus
Authors: Oh IS , Kim MK , Lee SH
Published: October 2016

Purpose.

To improve the technique of osteotomy for hallux valgus (bunion).

Methods.

38 cases of a new modified osteotomy procedure for hallux valgus were performed for 22 patients (21 women and one man). During a 3-year (range, 2–5 years) follow-up, the patients underwent physical examination; and their American Orthopedic Foot and Ankle Society hallux-metatarso-phalangeal-interphalangeal scale scores and standard foot radiographic measurements were recorded.

Results.

20 of the 22 patients (38 cases) had no pain, achieved good cosmesis, and were completely satisfied with the results of the operation. The remaining 2 patients had occasional mild discomfort. The mean hallux-metatarso-phalangeal-interphalangeal scale score was 93 points (range, 78–100 points). The mean preoperative and postoperative metatarsophalangeal angles were 34 degrees and 11 degrees, respectively. The mean postoperative reduction of the inter-metatarsal angle and metatarsophalangeal angle were 6 degrees and 23 degrees, respectively.

Conclusion.

The new technique of osteotomy achieved even greater stability and accurate correction of the deformity in our 38 cases. Furthermore, it was more effective than conventional ‘chevron’ osteotomy in terms of correction of the deformity. Therefore, it should be used more widely.
Paget's Sarcoma: Limb Salvage by Custom Mega Prosthesis: Four Case Reports
Authors: Mayilvahanan N , Bose JC , Paraskumar M , Rajkumar G , Sivaseelam A , Jaheer H , Natarajan S
Published: October 2016

Of 4 Paget's sarcoma patients (age range, 55–68 years) underwent limb salvage surgery by custom mega prosthesis, 3 had lesions in the upper extremity and one in the proximal femur. Three of the patients were at stage IIB of the disease, according to Enneking's system of staging musculoskeletal tumours. All 4 patients underwent wide resection with a mean length of 152.5 mm. The defects were reconstructed with custom-made prostheses: proximal humeral prostheses in 2 of the patients, total elbow prosthesis in one, and total hip prosthesis in one. During a mean postoperative follow-up period of 40 months, one died of disseminated disease 14 months after surgery; one remained disease-free; 2 had local recurrence and required amputation, of whom one died of disseminated disease one year after amputation, the other had no further evidence of the disease. We report the functional outcomes of the 2 patients who were alive at the latest follow-up. The 2-year patient survival rate was 50%.
Blood Salvage in Total Hip and Knee Arthroplasty in a Community Hospital: A Retrospective Study
Authors: Jain R , Jain S
Published: October 2016

Purposes:

To assess the results of postoperative and intra-operative blood salvage in patients undergoing total knee and hip arthroplasty, respectively, and to determine if both methods of blood salvage reduce allogeneic transfusion.

Methods:

Of 229 patients who attempted blood salvage, 114 of 152 patients who underwent total knee arthroplasty received the salvaged blood postoperatively, 35 of 77 patients who underwent total hip arthroplasty received the salvaged blood intra-operatively. Various data were collected to assess whether certain factors resulted in autologous and/or allogeneic blood transfusions.

Results:

Patients that received postoperative salvaged blood after total knee arthroplasty generally had higher postoperative levels of haemoglobin and haematocrit compared to those who did not. Patients with autologous blood transfusion following cemented knee surgery were less likely to require allogeneic blood transfusion. For hip arthroplasty patients, postoperative levels of haemoglobin and haematocrit were similar in both groups who received and did not receive salvaged blood. Lower preoperative haemoglobin and haematocrit levels correlated with a greater likelihood of autologous and/or allogeneic blood transfusion for both knee and hip arthroplasty patients.

Conclusions:

Although total knee arthroplasty patients who received salvaged blood had higher haemoglobin levels on the first postoperative day, the receipt of salvaged blood did not significantly reduce the incidence of allogeneic blood transfusion, because salvaged blood was a kind of blood loss. However, reinfusion of salvaged blood may reduce the number of units of allogeneic blood used. Given the short supply of allogeneic blood and its risks of transmitting disease, intra-operative and postoperative blood salvage carries clear advantages.
Does the Self-Centering Mechanism of Bipolar Hip Endoprosthesis Really Work in vivo?
Authors: Tsumura H , Kaku N , Torisu T
Published: October 2016

Purposes.

To examine radiographically the component motion in a bipolar prosthesis and to determine whether the self-centering mechanism really works in vivo.

Methods.

38 patients with 41 bipolar hip endoprostheses (30 for coxarthrosis and 11 for osteonecrosis of femoral head) were included in this study. Two radiographs of each case were taken to evaluate the self-centering mechanism. The first anteroposterior radiograph of both hip joints was taken at the maximum abduction while the patient standing on the endoprosthetic leg. The second radiograph was taken after the patient returned to neutral position while standing on 2 legs. In the present study, the order in which the radiographs were taken differed from previously reported studies. The radiographs were analysed using the method similar to that of Drinker and Murray. The adductive motion from abduction to a neutral position is within the range of inner bearing oscillation.

Results.

The outer head alignment changed from 23 degrees to 12 degrees in the patients with osteonecrosis. However, the valgus position of the outer head (36 degrees) remained unchanged in the patients with coxarthrosis standing on 2 legs in the neutral position.

Conclusion.

The self-centering mechanism of the bipolar endoprosthesis functioned in the patients with osteonecrosis, but did not work in the coxarthrosis group.
Debridement and Continuous Irrigation for the Treatment of Pyogenic Arthritis Caused by the Use of Intra-Articular Injection in the Osteoarthritic Knee: Indications and Outcomes
Authors: Tsumura H , Ikeda S , Torisu T
Published: October 2016

Purpose.

To discuss the indications and therapeutic outcomes of synovectomy, debridement, and continuous irrigation for the treatment of pyogenic arthritis caused by intra-articular injection used in the treatment of osteoarthritis of the knee.

Methods.

Records of 41 patients with infectious arthritis of the knee who presented to our hospital from 1981 were reviewed. 11 of them had a history of intra-articular injection. They underwent synovectomy, debridement, and continuous irrigation using a Salem double-lumen tube after confirmation that one side of the femorotibial joint cartilage was basically healthy.

Results.

The infection was successfully treated in 9 of the 11 patients. Of these 9 patients, one died after 3 years and 2 underwent total knee arthroplasty after 3 and 8 years. The remaining 6 patients were followed up for 5 to 15 years. Five of them had deteriorating arthropathy, and the condition was unchanged in the others. Two of these 6 patients had pain while walking, and their Japanese Orthopaedic Association scores were 70. The remaining 4 had good knee function and reduction of pain, with a mean Japanese Orthopaedic Association score of 91 and a mean range of motion of 131 degrees.

Conclusion.

Arthrodesis is frequently considered the treatment for osteoarthritis if the joint destruction has affected the weight-bearing surface. However, in our experience, even when inflammatory granulation develops in the cartilage surface of one side of the femorotibial joint, good results can still be obtained by synovectomy, debridement, and continuous irrigation. After the pyogenic arthritis has subsided, if osteoarthritis has advanced and bowleg has exacerbated, further treatment options are available, such as tibial resection and even joint replacement. Continuous irrigation should be considered a feasible treatment option for pyogenic arthritis.
Reconstructive Treatment following Resection of High-Grade Soft-Tissue Sarcomas of the Lower Limb
Authors: Leow AM , Halim AS , Wan Z
Published: October 2016

Purpose.

To review the role of free tissue transfer in reconstructive surgery following resection of high-grade soft-tissue sarcomas of the lower limb.

Methods.

Medical records of all consecutive patients with high-grade soft-tissue sarcomas of the lower limbs between August 1997 and September 2003 were reviewed.

Results.

Of 8 patients (6 women and 2 men) aged between 19 and 65 years, 4 had malignant fibrous histiocytoma, one had malignant peripheral nerve sheath tumour, one had synovial sarcoma, one had recurrent liposarcoma, and one had epitheloid sarcoma. The tumour sizes ranged from 132 cm2 to 483 cm2. The soft-tissue defects following tumour extirpation ranged from 153 cm2 to 896 cm2. The flaps used were 3 free latissimus dorsi flaps, 2 free osteoseptocutaneous fibula flaps (one vascularised fibula flap and one ‘double barrel’ fibula flap), one free rectus abdominis flap, 2 free mini-transverse rectus abdominis flaps, and one pedicled rectus abdominis flap. Five patients did not have local recurrence and systemic metastases.

Conclusion.

Tissue transfer allows early adjuvant therapy facilitating the multimodal approach for the high-grade soft-tissue sarcomas of the lower extremity.
Capsulolabral Augmentation by Blood Injection Increases the Intrinsic Stability Provided by the Glenoid
Authors: Tan AHC , Kiesau CS , Gibbs KB , Matsen FA
Published: October 2016

Purpose.

To test the hypothesis that the intrinsic stability of the cadaveric glenoid can be augmented by the injection of blood into the labrum.

Methods.

The intrinsic stability of 10 fresh frozen cadaveric glenoids was assessed by measuring the balance stability angle. Pretreatment values of 8 directions in each glenoid were obtained. The labrum was then injected with blood freshly drawn from a volunteer. After the injected blood clotted, measurements of the balance stability angle of the 8 directions were again obtained.

Results.

The mean pre-injection balance stability angle for 7 of the 8 directions were significantly increased by the injection of blood: anterosuperior, from 25 to 35 degrees (p<0.005); anterior, from 27 to 34 degrees (p<0.01); anteroinferior, from 36 to 39 degrees (p<0.005); inferior, from 38 to 41 degrees (p<0.02); posteroinferior, from 35 to 42 degrees (p<0.01); posterior, from 27 to 35 degrees (p<0.0005); and posterosuperior, from 26 to 29 degrees (p<0.005). Cross-sections of injected labra demonstrated a firm clot within the labrum with substantial increases in thickness.

Conclusion.

The intrinsic stability of cadaveric glenoids can be significantly augmented by the injection of blood into the labrum. It is possible that blood injection may be a useful primary or adjunct procedure in the open or arthroscopic management of glenohumeral instability.
Clinical Results of Modified Mitchell's Osteotomy for Hallux Valgus Augmented with Oblique Lesser Metatarsal Osteotomy
Authors: Yamamoto K , Imakiire A , Katori Y , Masaoka T , Koizumi R
Published: October 2016

Purpose.

To evaluate postoperative results of modified Mitchell's osteotomy and its combination with oblique metatarsal osteotomy for the treatment of hallux valgus.

Methods.

A total of 93 feet of 53 patients (2 men and 51 women) with hallux valgus underwent modified Mitchell's osteotomy and were followed up for at least 5 years. Patients' age ranged from 17 to 83 years, and the duration of follow-up ranged from 5 years one month to 18 years 4 months. Modified Mitchell's osteotomy was performed on 53 feet in 31 patients (group A), whereas modified Mitchell's osteotomy augmented with oblique lesser metatarsal osteotomy was performed to the remaining 40 feet in 22 patients (group B). Postoperative results were assessed using a clinical assessment system developed by the Tokyo Medical University based on 5 categories: pain in the first metatarsophalangeal, deformity of the metatarsophalangeal, plantar callosity and/or metatarsalgia of lesser metatarsals, the use of commercially available shoes, and local inflammatory symptoms.

Results.

Mean total score improved from 3.8 to 7.9 on a 10-point scale. Scores for 2 categories—plantar callosity and/or metatarsalgia and the use of commercially available shoes—were significantly higher in group B at postoperative 5 years. Before surgery, at postoperative 3 weeks, and at postoperative 5 years, respectively, the mean hallux valgus angles were 34.2°, 12.0°, and 17.1°; mean M1–M2 angles were 16.7°, 7.4°, and 8.7°; mean M1–M5 angles were 34.9°, 25.8°, and 26.6°; and mean sesamoid bone shifts were 8.7 mm, 4.3 mm, and 5.9 mm.

Conclusion.

Modified Mitchell's osteotomy shortens the length of the first metatarsal bone and thus relieves tension in soft tissues such as the adductor hallucis. Nonetheless, the procedure can induce metatarsophalangeal joint malalignment and metatarsalgia, and plantar callosity may develop or persist after surgery. Combining oblique metatarsal osteotomy of the lesser metatarsal bones is useful in patients with uneven metatarsal bone lengths and metatarsophalangeal joint malalignment.
Alkalinisation of Local Anaesthetics Prescribed for Pain Relief after Surgical Decompression of Carpal Tunnel Syndrome
Authors: Ozer H , Solak S , Oguz T , Ocguder A , Colakoglu T , Babacan A
Published: October 2016

Purpose.

To compare the duration of analgesia achieved following administration of buffered prilocaine versus plain prilocaine to patients undergoing surgical decompression of the median nerve.

Methods.

40 (32 female and 8 male; mean age, 50.5 years) patients who underwent surgical decompression of carpal tunnel syndrome were recruited. Patients were randomly allocated to 2 groups: the alkalinised group was given 10 ml of prilocaine hydrochloride 2% buffered with 1 ml of sodium bicarbonate 8.4%, whereas the non-alkalinised group received 10 ml of plain prilocaine hydrochloride 2% solution. Patients were asked to rate their comfort level at the operation site in the first 6 hours following surgery and after discharge from hospital using a visual analogue scale (VAS). The duration of analgesic effect was evaluated every 3 hours. Additional oral analgesia in the form of paracetamol 500 mg tablets was available to patients if required for breakthrough pain.

Results.

Significantly lower VAS scores were reported by the alkalinised group during the first postoperative 12 hours. The change of VAS scores over time was significantly higher in the non-alkalinised group. The mean analgesic requirement for paracetamol tablets in the alkalinised and non-alkalinised groups was 4 and 34, respectively.

Conclusion.

Buffered prilocaine provided a longer postoperative pain-free period for patients undergoing surgical decompression of the median nerve. It is easy, safe, and cost-effective.
Diabetic Muscle Infarction of the Peroneus Brevis: A Case Report
Authors: Lim YW , Thamboo TP
Published: October 2016

Diabetic muscle infarction of the peroneus brevis is a rare complication of diabetes mellitus. It often presents with an acute leg pain without any obvious signs. Due to poor awareness of this condition, it is often misdiagnosed and results in anxiety of the patient and unnecessary investigations. It is ominous as it usually indicates vascular disease of the end organs. We report a case where the patient presented to several physicians for leg pain without any other clinical signs. The diagnosis was suspected on ultrasound and confirmed with biopsy. The symptoms improved dramatically after excision. Although most literature suggests conservative treatment by non–weight bearing and analgesia, the recovery period can last for more than 6 weeks, with a recurrence rate of 50%. We feel that there is a role for excision biopsy of the lesion for both diagnosis and treatment. In this case, symptoms improved remarkably and the patient was able to ambulate without pain 2 days after the operation without needing any analgesia.
Prevalence and Surgical Significance of a High-Origin Anterior Tibial Artery
Authors: Tindall AJ , Shetty AA , James KD , Middleton A , Fernando KWK
Published: October 2016

Purpose.

To assess the prevalence of proximal high-origin anterior tibial artery and its surgical significance.

Methods.

100 knees were prospectively studied using colour Doppler ultrasonography. No patient had a history of lower-limb arterial pathology or previous knee surgery. All ultrasound images were assessed by a single experienced vascular technician to eliminate inter-observer variability.

Results.

The mean age of the patients was 56 years (range, 21–96 years). Prevalence of the high-origin anterior tibial arterial pattern was 6%, greater than that reported by previous angiographic or cadaveric studies. In all patients with high-origin anterior tibial artery, the artery was in direct contact with the posterior cortex of the tibia.

Conclusion.

This highlights the danger of using sharp instruments in knee procedures that involve extension of osteotomy to the posterior tibial cortex, particularly high-tibial osteotomy and total knee replacement. Knowledge of the anatomical variations in the branching of the popliteal artery is important because damage to its branches can be limb- or life-threatening.
Open Medial Placement of Kirschner Wires for Supracondylar Humeral Fractures in Children
Authors: Barlas K , George B , Hashmi F , Bagga T
Published: October 2016

Purpose.

To assess the efficacy of our protocol for treatment of displaced Gartland type-3 supracondylar fractures of the humerus in children.

Methods.

Records of 43 children with displaced Gartland type-3 supracondylar fractures of the humerus admitted from October 1997 to October 2003 were reviewed. Patients were treated within 12 hours of admission by closed reduction (n=33) or open reduction (n=10). Crossed medial and lateral Kirschner wires through a medial approach were used in all patients. A 3-cm incision was made medially to identify the correct entry point of the medial wire, and thus prevent ulnar nerve injury. The incision was extendable for open reduction if closed reduction was unsuccessful.

Results.

The mean age of the 43 patients was 7.2 years (range, 2–14 years). The mean follow-up period was 48 months (range, 12–84 months). 83% of the fractures occurred in boys. All fractures were closed, extension type, with 28 (65.1%) involved the right elbow. No patient had iatrogenic ulnar nerve injury. All patients showed satisfactory results according to Flynn criteria.

Conclusion.

If closed reduction is unsuccessful, open reduction and open medial placement of crossed Kirschner wires can provide reliable results. The small medial incision provides a viewing point for entry of the wire and prevents iatrogenic injury of the ulnar nerve. It is cosmetically more acceptable and can be extended to facilitate open reduction.
Repair of Acute Achilles Tendon Rupture Using a Double-Ended Needle
Authors: Ng ES , Ng YO , Gupta R , Lim F , Mah E
Published: October 2016

Purpose.

To compare the results of Achilles tendon repair using a standard open procedure or a minimally invasive technique using a double-ended needle, and to determine whether the latter technique reduces the incidence of sural nerve injury and soft-tissue complications.

Methods.

Between the period February 1995 and September 2000 inclusive, 68 consecutive patients with acute Achilles tendon rupture underwent surgical repair in our hospitals. A standard open repair was performed on 43 patients (mean age 36 years and range 17–74 years, 30 males), while 25 patients (mean age 34 years and range 19–68 years, 17 males) elected to undergo the minimally invasive procedure involving a double-ended needle. Postoperative protocols were identical for the 2 groups. Patients were assessed for re-rupture, calf muscle strength, calf atrophy, wound healing, and ability to return to pre-injury activity. The mean follow-up period was 65.5 (range, 34–90) months.

Results.

One late re-rupture and one sural nerve injury occurred in the standard open repair group. No re-rupture or sural nerve injury occurred in those having minimally invasive surgery, they also reported fewer complications related to wound healing and a shorter hospital stay. Calf atrophy was also significantly less in this group (p<0.05).

Conclusion.

This double-ended needle repair technique is simple and reproducible. The needle is easy to make using a standard mini Steinmann pin with minimal cost. Combined with appropriate rehabilitation, the technique achieves good results and is associated with a low morbidity and complications.
Hand Grip Strength in the Adult Malaysian Population
Authors: Kamarul T , Ahmad TS , Loh WYC
Published: October 2016

Purpose.

To measure the hand grip strength of Malaysians aged 18 to 65 years.

Methods.

Between January and April 2003, 412 subjects (200 women and 212 men) were recruited from staff, students, and visitors of the University of Malaya Medical Centre. Socioeconomic, general health, and lifestyle data were collected from each subject using a standard questionnaire. Weight and height were measured prior to testing. Standardised positioning and instructions based on several hand grip protocols were used. Data were collected using the LIDO kinetic work set.

Results.

93% of the subjects were right-hand dominant and 7% were left-hand dominant. Hand grip strength was significantly correlated with hand dominance, gender, occupation, height, and weight, but not body mass index. No significant differences in grip strength were noted with regard to race or level of income. Men were stronger than women in all age-groups, with a ratio of 1.75:1. In both right- and left-hand dominant groups, the dominant hand was consistently stronger than the non-dominant side, with a ratio of 1.12:1 in the right-hand dominant group and 1.05:1 in the left-hand dominant group. The strongest hand grip strength in the right-hand dominant group occurred in the age-group of 25 to 34 years; in the left-hand dominant group it was in the age-group of 18 to 24 years. In western populations, the mean grip strength can be as much as 1.5 times greater than in the Malaysian population.

Conclusion.

Data derived from western populations cannot be applied to a comparable Malaysian population. Gender, hand dominance, age, occupation, weight, and height must be considered when establishing normal values for grip strength.
Locked Overlapping Dislocation of the Pubic Symphysis into the Obturator Foramen: A Case Report
Authors: Sreesobh KV , Sageer AM , Raffic M
Published: October 2016

A 20-year-old man sustained an overlapping dislocation of the pubic symphysis following a low-velocity side-to-side compression injury. Such injuries are rare in the literature. This case, where the pubis was locked into the obturator foramen, may be the first of its kind to be reported. The pubic symphysis was successfully reduced by levering, with difficulty, the locked pubic body out of the left obturator foramen. As the reduction was unstable, the pubic symphysis was fixed with 2 reconstruction plates. The patient was able to mobilise fully after 3 months and returned to work. At 18 months' follow-up he was able to void urine normally after urethral repair.