bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE PLIGHT OF THE TRAUMATIC AMPUTEE
Authors: Pierce Raymond O , Kernek Clyde B , Ambrose Thomas A 
Published: April 2021

ABSTRACT
This retrospective review of the long-term problems of patients with lower extremity amputation from trauma fails to support the opinion that most traumatic amputees do well. Overall, anatomic problems involved 51% of the amputees, and social problems involved 56%. Attempting limb salvage with subsequent secondary amputation did not seem to compromise the long-term outcome for these problems. The surgeon performing the amputation should try to obtain the best possible stump and insure that the patient gets the careful follow up and multidisciplinary team support needed to manage the anticipated problems.
GAIT ANALYSIS OF DYSVASCULAR BELOW-KNEE AND CONTRALATERAL THROUGH-KNEE BILATERAL AMPUTEES: A PRELIMINARY REPORT
Authors: Pinzur Michael S , Smith Douglas , Tornow Devin , Meade Kevin , Patwardhan Avinash 
Published: April 2021

ABSTRACT
Four elderly peripheral vascular insufficiency below-knee amputees, average age 58, underwent contralateral through-knee amputation for gangrene. All four became household ambulators with end-weight bearing designed prosthetic sockets and four-bar linkage knees. Gait analysis was performed with two AMTI (Newton, Mass) Biomechanics Force Platforms and a Watsmart Motion Monitoring System (Waterloo, Ontario). All four were observed to apparently "lock" the four-bar linkage prosthetic knee into extension during midstance and double limb support phases of gait All subjectively felt that their through-knee limb was then* more stable limb. Weight-bearing occurred during 63% of the gait cycle on the below-knee limb, 54% on the through-knee limb, and 17% in double limb support Walking propulsion, as measured by forefoot impulse, was similar in the two limbs. The first peak of vertical force, corresponding to the elevation of the center of body weight as it passes over the weight-bearing limb, averaged 98% of body weight on the through-knee limb and only 93% on the below-knee limb. The second peak, corresponding to the kinetic energy of the falling trunk and muscle function providing linear acceleration of the center of body weight during propulsion, averaged 96% of body weight on the through-knee limb, and only 73% on the below-knee limb. Progression of the center of pressure, a qualitative measure of limb stability, was more orderly hi the through-knee limbs. In a preliminary laboratory gait analysis, elderly peripheral vascular insufficiency below-knee amputees who became household walkers following contralateral through-knee amputation derived greater stability from their through-knee limbs without the expected loss of walking propulsion. The authors conclude that, 1) unilateral belowknee amputees who are projected to be marginal walkers following contralateral limb amputation may benefit from the stability afforded by through-knee amputation of the second limb; and 2) elderly patients who possess the ability the heal an amputation at the below-knee level, but project to be marginal walkers, may also benefit from the stability in walking with an end-weight bearing prosthesis afforded by through-knee amputation, without the expected loss of walking propulsion.
ONE-STAGE RECONSTRUCTION OF THE NAILFOLD
Authors: Kasdan Morton L , Stulls John T 
Published: April 2021

ABSTRACT
Management of nailfold deformity is a difficult problem, with only seven documented techniques of reconstruction to date. We report 17 who underwent nailfold reconstruction with use of a one-stage, dorsal rotational flap with full thickness skin graft. Results show increases in range of motion and improved nail appearance.
ENDOSCOPIC ACL RECONSTRUCTION
Authors: Jackson Douglas W , Kenna Robert , Simon Timothy M , Kurzweil Peter R 
Published: April 2021

ABSTRACT
The endoscopic technique offers the advantage of one incision and a femoral osseous tunnel trajectory that is more in line with the collagen fibers of the graft. Technically, it is more demanding to reproducibly obtain the interference fixation than using the two-incision technique. There is a tendency for screw and graft divergence in the femoral tunnel. The exact clinical significance of this screw and bone plug divergence has yet to be clarified. Surgeons must assess their ability to obtain the best results for the patient There is a definite learning curve for the endoscopic technique. We believe that, with further advances in instrumentation, fixation, and alternative grafts, it will eventually be the approach of preference for ACL reconstructions.
ARTHROSCOPIC CATEGORIZATION OF INTERCARPAL LIGAMENTOUS INJURIES OF THE WRIST
Authors: Ruch David S , Siegel David , Chabon Stephen J , Koman L Andrew , Poehling Gary G 
Published: April 2021

ABSTRACT
Recent advances in our knowledge of wrist ligamentous anatomy, as well as improvements in arthroscopic techniques, permit the diagnosis and treatment of a wide variety of wrist injuries. The authors review current concepts in wrist ligamentous anatomy, patterns of instability, and the role of the arthroscope in the evaluation and treatment of such instability. Specifically, wrist portal anatomy and techniques of arthroscopic treatment of patients with partial and complete intercarpal ligament injuries are described. Chronic complete injuries are a contraindication of arthroscopic treatment. The authors conclude that wrist arthroscopy provides a valuable method of diagnosing and treating partial and complete intercarpal ligamentous injuries.
PRACTICE PATTERNS IN PROPHYLAXIS OF DEEP VEIN THROMBOSIS AMONG US ORTHOPEDIC SURGEONS
Authors: Paiement Guy D 
Published: April 2021

ABSTRACT
Thromboembolic disease meets all the criteria of a major public health problem. Some studies have estimated that up to 200000 Americans die each year as a result of pulmonary embolism.1 Furthermore, at least 50% of these people had an otherwise very good prognosis and should not have died. Thus, about 100 000 deaths from pulmonary embolism are preventable. This study indicates that, while primary prophylaxis is almost universal among orthopedic surgeons, very few practice secondary prevention, which could be the reason for the large number of deaths attributed to thromboembolic disease.
OLECRANIZATION OF THE PATELLA
Authors: Rungee James L , Fay Michael J , Deberardino Thomas M 
Published: April 2021

ABSTRACT
Olecranization of the patella is a technique employed by some to maintain the normal anatomic relationship of the femorotibial articulation following posterior cruciate ligament (PCL) repairs and reconstructions. It involves temporarily placing a large diameter pin longitudinally through the patella and into the tibia. The patella thus becomes a bony shelf and, in theory, holds the tibia forward, protecting the knee from a posterior drawer force. This technique appears desirable in that it allows postoperative knee motion while theoretically affording protection to the PCL. Unfortunately, it is based on an erroneous concept that the spatial relationship of the patella and tibia remains constant throughout knee flexion. Negative experience at our institution with this technique prompted our investigation. Using lateral radiographs of 20 normal knees taken at four different positions of flexion, we studied the relative motion that occurs between the patella and tibia in the sagittal plane during knee flexion from 0° to 90% and defined two separate arcs of patellar motion. The patellar tendon arc is a 30° arc through which the patella traverses relative to the tibia during knee flexion. The patellar arc is a 22° arc on which the patella flexes relative to itself during knee flexion. We also studied the effect that olecranization of the patella has on the PCL in six cadaver knees. Using a combination of direct tension measurement, radiographic measurement, and fluoroscopy, we found that olecranization of the patella not only fails to protect the PCL, but actually induces a detrimental posterior drawer force during knee flexion. Based on clinical experience and laboratory findings, we strongly recommend that olecranization of the patella be abandoned as a means of postoperative ligamentous protection following PCL repair or reconstruction.
THE POROUS-COATED ANATOMIC (PCA) TOTAL HIP ARTHROPLASTY: A REVIEW OF 73 UNCEMENTED CASES WITH 2-YEAR FOLLOW UP
Authors: Billotti Joseph , Zimmerman Mark C , Pizzurro Joseph , Mango Thomas , Billings Joseph , Parsons J Russell 
Published: April 2021

ABSTRACT
A total of 73 hips in 62 patients who underwent non-cemented total hip arthroplasties (THA) with porous-coated anatomic (PCA, Howmedica) prostheses have been reviewed. A complete evaluation including preoperative and postoperative Harris hip scores (HHSs), a complete radiographic study, and complication determination has been completed with greater than 2-year follow up. Diagnoses included osteoarthritis (74.0%), rheumatoid arthritis (4.1%), avascular necrosis (15.1%), and posttraumatic arthritis following fracture (6.8%). The complication rate was 10.9% (8 complications/73 arthroplasties); 20 patients (35.6%) received bilateral implants. The mean preoperative HHS for the entire group was 38.7, and the mean postoperative score, irrespective of postoperative time, was 93.6. Key findings regarding the consecutive radiographic review of each arthroplasty included: 9.6% lucencies, 43.8% stress shielding, stable fibrous ingrowth in 74.0%, tip sclerosis in 19.2%, and cortical widening in 4.1 %. The finding of loose beads from the pore ingrowth area of the prosthesis was minimal (7 beads in 6 patients). These results demonstrate the efficacy of the PCA prosthesis.
CERVICAL CHEMONUCLEOLYSIS
Authors: Gomez-Castresana F B , Herrero C Vazquez , Horche J L Baltes 
Published: April 2021

ABSTRACT
Forty patients with 44 cervical disc herniations were injected with 1500 to 1800 U of chymopapain from September 1988 to March 1992. After prophylactic H1-H2 receptor antagonist administration and under neuroleptanalgesia, a needle was inserted into the disk through an anterolateral approach, guided by x-ray monitoring. The discography performed before the enzyme injection confirmed the herniation in every case. The diagnosis was established by radiculography, computerized tomography (CT) scan, radiculoCT scan, magnetic resonance imaging (MRI), or discography. Average follow up was 21.4 months (range: 3 to 43). Overall, there were 34 (85%) satisfactory results, 3 fair (7.5%), and 3 poor (7.5%) results. There were no complications, and the average hospital stay was 26 hours. Post-injection MRI performed in 18 cases confirmed the complete disappearance of the herniation in 13 cases. These data support the efficacy and innocuity of chymopapain chemonucleolysis in managing soft cervical disk herniations.
ARTHRODESIS FOLLOWING FAILED TOTAL KNEE ARTHROPLASTY: COMPREHENSIVE REVIEW AND META-ANALYSIS OF RECENT LITERATURE
Authors: Damron Timothy A , McBeath Andrew A 
Published: April 2021

ABSTRACT
With the increasing duration of follow up on total knee arthroplasties, more revision arthroplasties are being performed. When revision is not advisable, a salvage procedure such as arthrodesis or resection arthroplasty is indicated. This article provides a comprehensive review of the literature regarding arthrodesis following failed total knee arthroplasty. In addition, a statistical meta-analysis of five studies using modern arthrodesis techniques is presented. A statistically significant greater fusion rate with intramedullary nail arthrodesis compared to external fixation is documented. Gram negative and mixed infections are found to be significant risk factors for failure of arthrodesis.
TIBIAL PILON FRACTURES: A COMPARATIVE CLINICAL STUDY OF MANAGEMENT TECHNIQUES AND RESULTS
Authors: Crutchfield Edward H , Seligson David , Henry Stephen L , Warnholtz Ascan 
Published: April 2021

ABSTRACT
Thirty-eight consecutive pilon fractures were reviewed retrospectively to compare the radiographic and clinical results with the original injuries based on three different treatment options: external fixation only, external fixation with limited internal fixation, and internal fixation only. Dates of injury were from February 1985 to February 1989. Treatment method was the surgeon's preference. The mean follow-up time was 28 months. Results were tabulated by clinical and radiographic scores. In general, simple fracture types had good results; complex ones did less well. In this study, fracture severity appeared to be the key variable in outcome.
LOWER LIMB SALVAGE: MICROVASCULAR RECONSTRUCTION OF POST-TRAUMATIC SOFT TISSUE AND SKELETAL DEFECTS
Authors: Tomaino Matthew M 
Published: April 2021

ABSTRACT
This study reviews the principles of reconstructive microsurgery for lower limb salvage after severe open tibial fractures. Initial decision-making principles are reviewed with reference to useful scoring systems directed at appropriate patient selection for limb salvage. Soft tissue reconstruction is discussed with emphasis on timing and selection. Skeletal reconstruction focuses on available options and indications.
Use of MRI in Evaluating Postoperative Changes in Patients With Bone and Soft Tissue Tumors
Authors: Griffiths Harry J , Thompson Roby C , Nitke Steven J , Olson Paul N , Thielen Kent R , Amundson Paul 
Published: April 2021

ABSTRACT
We reviewed the clinical, surgical and magnetic resonance imaging (MRI) findings in 80 patients who underwent resection of primary benign or malignant bone or soft tissue tumors. There were 18 benign and 62 malignant tumors. Although 31 patients were originally thought to have recurrence, on review only 20 patients were considered to have recurred. Of these, three were found only to have postoperative changes at surgery. Seventeen patients actually had recurrence of tumor. We believe that the presence of an actual mass lesion on MRI is the cornerstone for the correct diagnosis of recurrent tumor.
Complications When Using the Cannulated 3.5 mm Screw System
Authors: Schwend Richard K , Hennrikus William L , O'Brien Thomas J , Millis Michael B , Lynch Michael R 
Published: April 2021

ABSTRACT
Five patients with breakage of instrumentation when using the cannulated 3.5 mm screw system for fracture fixation are reported. Four 1.25 mm guide wires were sheared off by the cannulated drill and one 3.5 mm cannulated tap sleeve fractured. This article presents potential dangers when using the cannulated 3.5 mm screw system for general fracture care.
Modified Mitchell's Bunionectomy (Wu's Bunionectomy)
Authors: Wu Kent K 
Published: April 2021

ABSTRACT
A standard Wu's bunionectomy consists of an oblique first metatarsal neck osteotomy with a lateral, proximal, and plantar displacement of the first metatarsal head and firm fixation of the osteotomy site with two Herbert screws. The outstanding features of this surgical technique include its surgical simplicity, secure fixation of the osteotomy site, no need for subsequent screw removal, ease of screw insertion, complete absence of screw breakage, little postoperative pain, and a relatively greater degree of correcting the various deformities associated with a hallus valgus foot than those normally achieved by either a Mitchell's bunionectomy or a Chevron bunionectomy.
Evaluation of Herbert Screw Fixation for the Treatment of Displaced Scaphoid Nonunions
Authors: Feldman Michael D , Manske Paul R , Welch Robert L , Szerzinski Jean M 
Published: April 2021

ABSTRACT
Ten cases of unstable scaphoid nonunions treated with Herbert screw fixation were compared to nine cases treated with Herbert screw fixation supplemented with a single Kirschner wire (K-wire) across the fracture site. Corticocancellous bone graft from the distal radius was used in all cases to reconstruct the scaphoid. The age of the patients and duration of the nonunions were similar in both groups. Postoperative radiographs demonstrated that only 5 of 10 patients with Herbert screw fixation alone healed, while 8 of 9 patients with Herbert screw and K-wire fixation healed. The time to union averaged 4.9 months in the patients supplemented with a K-wire and 7.8 months in those patients without the K-wire.
Compression Arthrodesis of the Ankle by Triangular External Fixation: Biomechanical and Clinical Evaluation
Authors: Berman Arnold T , Bosacco Stephen J , Parks Brent G , Israelite Craig L , Austin David K , Farrell Eric D , Quartararo Louis G 
Published: April 2021

ABSTRACT
This article describes a technique of ankle arthrodesis using a triangular external fixation frame and presents the results of biomechanical analysis and clinical experience with the frame. Clinical evaluation of 23 ankle arthrodeses performed using a triangular external fixation frame yielded a 91 .3% fusion rate at an average of 11 weeks postfusion. The triangular frame was 79% suffer than a compression-only external frame in torsion and 39% stiffer in anteroposterior bending. This high rate of fusion is attributed to the elimination of micromotion at the fusion site because of the increased rigidity of the triangular external compression frame.
Inhibition of Particulate Debris-Induced Osteolysis by Alendronate in a Rat Model
Authors: Thadani Peter J , Waxman Bryan , Sladek Eduard , Barmada Riad , Gonzalez Mark H 
Published: April 2021

J Abstract
A rat model was used to study the efficacy of alendronate therapy in inhibition of particle-induced periprosthetic osteolysis. A prosthesis was simulated by inserting a cylindrical polymethylmethacrylate plug into the distal femur of 24 rats allowing the plug to communicate with the joint space. Intra-articular injections of irregularly-shaped ultra-high molecular weight polyethylene particles of 20-200 µm in diameter were administered at 2-week intervals. The rats were randomized into two groups (n=12 each). Group A rats received twice weekly subcutaneous injections of alendronate sodium while group B rats received injections of saline vehicle only. At 10 weeks all rats were sacrificed. The distal femurs were harvested and axial sections were prepared for histologic analysis. Each section was graded on a scale of 1-4, quantifying the degree of osteolysis surrounding the polymethylmethacrylate plug. Microscopic examination showed a significant (P<.0001) difference in the amount of periprosthetic bone. Femurs from group A treated with alendronate demonstrated mostly normal or near-normal periprosthetic trabeculations, whereas femurs from group B treated with saline showed extensive bone resorption. There was no qualitative difference in the inflammatory cellular response between the groups. This study established the ability of alendronate to inhibit the osteoclastic-mediated osteolysis around joint implants.
One-Stage Bilateral Total Hip Arthroplasty in Patients ≥75 Years
Authors: Weinstein Marc A , Keggi John M , Zatorski Laurine E , Keggi Kristaps J 
Published: April 2021

Abstract
Since 1991, 43 one-stage sequential bilateral total hip arthroplasties (THAs) in patients 3*75 years have been performed by the authors. The results were assessed to determine whether this procedure can be performed safely and with good outcome in this subset of patients. These results were compared to those of 1 36 patients <75 years who underwent the same procedure. The one-stage bilateral procedure was performed in ail patients who had significant arthritic disease of both hips. There was no difference in length of surgery or length of hospital stay. Patients 3*75 years were more likely to experience minor postoperative morbidity such as ileus and urinary tract infections. The incidence of myocardial ischemia was 2.3% in the elderly group. With a mean follow-up of 2.5 years, 90% of the elderly patients lived independently, 80% walked without assistive devices, and 90% were pain free. Therefore, onestage sequential bilatéral THA is a safe and effective option for patients >75 years when pain and functional limitations affect quality of life.
Vertebral Body Fracture of the Lumbar Spine in Elderly Women: More Severe in Osteoarthritis of the Knee Than in Femoral Neck Fracture
Authors: Kanai Hiroyuki , Igarashi Mitsuo , Yamamoto Seizo 
Published: April 2021

Abstract
This study investigated bone fragility by comparing fractures of the vertebral body of the spine in elderly women receiving total knee replacement (TKR) (group 1) due to severe osteoarthritis of the knee and those with femoral neck fractures (group 2) attributable to osteoporosis. Forty-two women each were selected retrospectively for group 1 and prospectively for group 2. Patient age ranged from 64-83 years. Vertebral body fractures of the lumbar spine were significantly more severe in group 1 than in group 2 (P<.001). Patients undergoing TKR due to osteoarthritis of the knee had systemic bone fragility, which included the spine.
Alternate Surgical Approaches in Mobile-Bearing Total Knee Arthroplasty
Authors: Keblish Peter A 
Published: April 2021

Abstract
Surgical approaches in nonconstrained mobile-bearing total knee arthroplasty (TKA) should provide the best access for specific deformity correction. Alternatives to the standard medial approach include the medial midvastus and subvastus approaches, and the direct lateral approach, with or without tibial tubercle osteotomy or proximal "rectus snip." The direct lateral approach is a recommended alternative for fixed valgus knees, especially if there is lateral patellar subluxation and significant rotational deformity. The subvastus and midvastus medial approaches preserve quadriceps integrity and patella stability, and are recommended for severely unstable knees in nonobese, non-fixed valgus, and medial unicompartmental knee replacements.
Revision Total Knee Arthroplasty Using Large Distal Femoral Augments for Severe Metaphyseal Bone Deficiency: A Preliminary Study
Authors: Werle Jason R , Goodman Stuart B , Imrie Susanna N 
Published: April 2021

Abstract
Managing severe structural femoral metaphyseal bone loss in revision total knee arthroplasty is a challenging problem facing the revision knee surgeon. This study assesses the use of large (30 mm) metal distal femoral augments to compensate for severe bone deficiencies. Hospital for Special Surgery scores, Knee Society scores, and range of motion improved after implantation of femoral components with 30-mm distal femoral augments. There was no radiographic evidence of loosening, and no implants had been revised at mean 37-month follow-up. This appears to be an acceptable technique based on the intermediate-term results.
The Impact of Mixed Components on Polyethylene Wear
Authors: Bowen Richard E , Dorey Frederick J , Thomas Bert J 
Published: April 2021

Abstract
Wear rates were measured in 50 mixed and 71 matched total hip arthroplasties with s* 3-year follow-up to determine whether implanting mixed hip components increased polyethylene wear. Average patient age was 61 years for the mixed group and 57 years for the matched group. Average radiographic follow-up was 5.8 years and 6.8 years, respectively. The average linear wear rate for the mixed and matched groups was 0.11 mm/y. Therefore, implanting same-size, total hip components from different manufacturers did not lead to large increases in polyethylene wear.
Photoelastic and Thermoelastic Measurement of Stress on the Proximal Femur Before and After Implantation of a Hip Prosthesis With Retention of the Femoral Neck
Authors: Refior Hans J¨rgen , Schidlo Christoph , Plitz Wolfgang , Heining Sandro 
Published: April 2021

Abstract
This study demonstrated the improved medial support and the transfer of load onto the retained neck of the femur using seven fresh frozen femurs. Results confirm the reliability of the thermoelastic stress analysis method, which is comparable to the photoelastic surface coating method, but with greater sensitivity. The loading pattern after stem implantation shows a homogeneous transfer of force onto the preserved femoral neck. After femoral neck removal, an inhomogeneous increase of the intertrochanteric compression loading was observed. Therefore, improved biomechanical conditions are created for a permanently stable implantation of stem prostheses with retention of the femoral neck.