bluuebunny/crossref_metadata_2025_split huggingface dataset:
BIOMECHANICAL EFFECTS OF GAMMA IRRADIATION ON FRESH FROZEN ALLOGRAFTS IN VIVO
Authors: Godette George A , Kopta Joseph A , Egle Davis M 
Published: April 2021

ABSTRACT
The effect of gamma irradiation on the mechanical properties of allograft in a rabbit model was examined. Tibial allografts were tested in torsion to failure to detennine maximum torque and maximum stress. Statistically significant degradation in the torsional strength of irradiated tibias vs controls was demonstrated. Femoral allografts were orthotopically implanted into experimental rabbits and secured with an intramedullary pin. Rates of incorporation and failure patterns were significantly altered by irradiation. These data suggest that sterilization of fresh-frozen allografts with 2.5 Mrad or greater severely degrades the ability of the graft to resist torsion. The rate of incorporation of freshfrozen allografts also may be dramatically decreased as a result of irradiation.
RESULTS OF THE TOTAL BI-METRIC CEMENTLESS HIP ARTHROPLASTY
Authors: Robertsen Kell , Gaarden Morten , Teichert Gerhardt , Langhoff Otto 
Published: April 2021

ABSTRACT
A 2.9-year follow up of 50 primary Bi-Metric System cementless, porous-coated hip arthroplasties (Biomet) is presented. Four patients were operated bilaterally. In two patients, revision arthroplasty was carried out, in one because of infection, in the other because of loosening of the stem. The average Harris hip score was 96 points. The pain level according to d'Aubigné was 5.87. All patients belonged to Jensen's social function group 1. According to Engh's x-ray score, the femoral component achieved an average total of 19 points. Twenty-three patients with heterotopic ossification were graded according to Brooker et al; 18 patients belonged to group ?-?, and 5 patients to group ?1. Discrepancy of leg length was measured in 20 patients, and averaged 0.52 cm (range: 0 cm to 2.5 cm). Four patients complained of thigh pain, but they had no radiographic evidence of loosening of components. The mean age was 63.4 years for women and 58.1 for men. Acceptably high Harris Hip Scores were obtained for the Bi-Metric hip prosthesis at 2-year follow up.
FIBROUS DYSPLASIA
Authors: Stanton Robert P , Montgomery Ben E 
Published: April 2021

ABSTRACT
Fibrous dysplasia provides the orthopedic surgeon with tremendous reconstructive challenges. The manifestations of the condition are very diverse and often involve organ systems not routinely cared for by the orthopedic surgeon. We present a concise review of the radiography, histology, clinical manifestations, and complications of this condition, with the main focus on the non-orthopedic management challenges.
Percutaneous vs Modified Phemister Epiphysiodesis of the Lower Extremity
Authors: Scott Allison C , Urquhart Bradford A , Cain Thomas E 
Published: April 2021

ABSTRACT
Epiphysiodesis of the lower extremity for limb-length discrepancy has been performed on 24 patients by both the modified Phemister and a percutaneous method. The primary complication of epiphysiodesis by both methods was continued growth of the physeal plate (12% and 15%, respectively). Failure of epiphysiodesis was attributed to young skeletal age at surgery in three of five cases. Closer attention to physeal ablation and close follow up should prevent this complication. No angular deformities resulted in any patient. During 16 proximal fibular procedures, there were no neurologic complications. The percutaneous method is preferred due to ease of surgical procedure, minimaf incisions, limited disability to the normal extremity, and equal results.
Comparison of the Hospital Cost of Primary and Revision Total Knee Arthroplasty After Cost Containment
Authors: Iorio Richard , Healy William L , Richards Julie A 
Published: April 2021

ABSTRACT
Revision total knee arthroplasty (TKA) consumes more time, more work, and more supplies than primary TKA. This study compared the hospital cost of primary and revision TKA after the introduction of cost-containment programs (implant standardization, clinical pathway, and competitive bid implant purchasing) at our hospital.
Hospital financial records of 207 primary unilateral TKA operations and 32 revision TKA operations performed from October 1993 through September 1995 were analyzed. A cost-accounting system provided actual hospital cost data for each procedure. Accurate calculation of hospital income or loss was determined for all 239 procedures. The average hospital length of stay was 4.7 days for primary unilateral TKA and 5.1 days for revision TKA. There were 26 three-component revision operations and 6 one- or two-component revision operations. The average hospital cost was $10,421 for primary TKA and $1 1 ,906 for revision TKA. The average net hospital income (hospital revenue - hospital expense) was $3211 for primary TKA and $1853 for revision TKA. The payer mix included indemnity insurance, Medicare, Medicaid, managed care, and workmen's compensation. All payers were profitable except for Medicaid and selected managed care contracts for both primary and revision TKA. As a result of cost-containment programs, revision TKA can be profitable at our institution.
Influence of Tibial Bone Quality on Loosening of the Tibial Component in Total Knee Arthroplasty for Rheumatoid Arthritis: Long-Term Results
Authors: Sugita Takehiko , Umehara Jutaro , Sato Katsumi , Inoue Hisayoshi 
Published: April 2021

ABSTRACT
This study examined the relationship between the bone quality of the proximal tibia, which was quantitatively investigated by histomorphometric method at the time of total knee arthroplasty, and the occurrence of loosening of an all-polyethylene tibial component in nine rheumatoid arthritis patients. Despite severe osteoporosis, there was no loosening after 12.8 years. These results suggest that even severe osteoporosis does not influence the occurrence of loosening of a cemented, all-polyethylene tibial component in rheumatoid patients with low activity levels. We recommend the use of all-polyethylene tibial component for low-activity patients.
Intermediate-Term Clinical and Radiographic Results of Synatomic and AGC Knee Prostheses
Authors: Rinta-Kiikka I , Savilahti S , Pajamäki J , Lindholm T S 
Published: April 2021

ABSTRACT
This study compared two total knee prostheses to determine whether the clinical and radiographic outcomes were different, focusing primarily on the patellofemoral articulation. The study group was comprised of 75 Synatomic (short-stemmed, anatomic VF type) and 79 AGC 2000 (universal, nonanatomic) prostheses. Patients underwent follow-up for an average of 63 and 50 months, respectively. At latest foilow-up, the mean knee joint score was 84.4 in the Synatomic and 86.5 in the AGC group. Mean knee function scores were 63.5 and 63.4, respectively. No statistically significant difference was noted between the two prostheses.
The Treatment of Symptomatic Os Acromiale
Authors: Ryu Richard K N , Fan Robert S P , Dunbar William H 
Published: April 2021

ABSTRACT
Os acromiale is an uncommon condition of the shoulder. When symptomatic, os acromiale may cause impingement pain, rotator cuff tears, or pain through abnormal motion at the unfused apophysis. Treatment of symptomatic os acromiale is controversial. This article reports on four patients with symptomatic mesoacromions who were treated with open reduction and internal fixation. All four patients recovered full function postoperatively with UCLA shoulder rating scores improving from 19 preoperatively to 35 postoperatively. Open reduction and internal fixation of a symptomatic meso-acromion is a reliable and reproducible technique in which the deltoid attachment and lever arm are minimally affected.
Comparison of Bone-Patellar Tendon-Bone Interference Screw Fixation and Hamstring Transfemoral Screw Fixation in Anterior Cruciate Ligament Reconstruction
Authors: Randall R Lor , Wolf Eugene M , Heilmann Moira R , Lotz Jeff 
Published: April 2021

ABSTRACT
While bone-patellar tendon-bone (BPTB) interference screw anterior cruciate ligament (ACL) reconstruction is a biomechanically sound construct, alternative techniques have been developed secondary to potential donor site morbidity. This study evaluates a system designed to address this problem that involves a transfemoral screw fixation device and stapling of hamstring tendons. Seven pairs of cadaveric knees underwent ACL reconstruction using either BPTB interference screw technique or semitendinosus gracilis (STG) transfemoral screw fixation and stapling. Tensile testing was performed. There was no significant difference between the two fixation types with regard to stiffness, maximum load to failure, elongation, energy to failure and yield load, displacement, and energy.
Expression of nm23 Protein in Human Osteosarcoma in Relationship With Early Metastasis
Authors: Liao Wei Ming , Chiu Kwong Yuen , Li Fo Bao , Qiu Ju Shi , Han Shi Yin , Chow Shew Ping 
Published: April 2021

ABSTRACT
Nm23 protein expression was analyzed by immunohistochemical staining using formalin-fixed, paraffinembedded sections from 39 cases with osteosarcomas and compared with the histologic findings and early metastasis for the purpose of detecting nm23 expression in osteosarcoma and elucidating the clinical significance of its expression. Immunoreactivity of nm23 protein was detected in 48.7% of the total cases. There was no statistical difference between nm23 expression and early metastasis, but there was a trend for cases with nm23 expression to progress to early metastasis within 1 year after operation. The role of nm23 as a tumor metastasis suppressor in osteosarcomas appeared less prominent.
Comparison of MRI and Radiographs in the Evaluation of Acromial Morphology
Authors: Wang Jeffrey C , Hatch Joshua D , Shapiro Matthew S 
Published: April 2021

ABSTRACT
This study compared the accuracy of magnetic resonance imaging (MRI) grading of acromions using supraspinatus outlet view radiographs. Thirty-two consecutive patients (1 7 men and 1 5 women) treated for shoulder disorders were included in the study. Average patient age was 58.5 years. All patients had both a supraspinatus outlet radiograph and an MRI of the shoulder. Each acromion was graded by three independent observers at separate intervals by radiographs and MRI and the results were compared.
The incidence of the three acromial types determined by radiographs was: type 1=6%, type 11=66%, and type 111=28%. The incidence of the three acromial types determined by MRI was: type 1=6%, type 11=69%, and type 111=25%. There was essentially no difference in the incidence of acromial morphology between the two groups. Magnetic resonance imaging demonstrated the same shape as shown on the plain radiographs in 97% of the patients (95% confidence interval, 0.84-0.99).
Magnetic resonance imaging is similar to supraspinatus outlet radiographs in determining acromial type. Acromial grading by MRI is a valid method of determining acromial morphology.
Tension-Band Technique for Ankle Fusion
Authors: Wu Chi-Chuan , Shih Chun-Hsiung , Chen Wen-Jer , Tai Ching-Lung 
Published: April 2021

ABSTRACT
A prospective study was conducted to develop a better technique for ankle fusion. Eleven consecutive patients were treated using the tension-band technique for ankle fusion and underwent follow-up for a minimum of 2 years (range: 2-5 years). All 1 1 patients achieved solid fusion for a fusion rate of 1 00%. Average time to fusion was 3 months (range: 2-6 months). The indication for ankle fusion was intractable aching pain that could not be controlled by conservative methods. Two of 11 patients underwent surgery due to infected arthritis. After ankle fusion, there was no recurrence of infection during a 3-year follow-up period.
The technique included osteotomy of the bimalleoli from the inside out, removal of articular cartilage and preserving wedge space for cancellous bone grafting, with or without staple stabilization, and external immobilization supplementation. The functional outcome in all 1 1 patients improved from unsatisfactory preoperatively to satisfactory at latest follow-up (P<.001). No significant complications were noted. This simple technique proved excellent for ankle fusion with a satisfactory outcome and is recommended for treating severe ankle arthropathies.
Percutaneous Sclerotherapy for Congenital Venous Malformations in the Extremities
Authors: Yao Yuki , Lomis Nick N T , Scott Steven M , Yoon Hyo-Chun , Miller Franklin J 
Published: April 2021

ABSTRACT
Between January 1991 and January 1998, a total of 15 patients underwent direct injection sclerotherapy for painful peripheral venous malformations. Duplex ultrasonography or venography was used in all cases for the detection and localization of tortuous venous structures. Direct injection with absolute ethyl alcohol was performed in 12 patients, and Sotradecol or sodium morrhuate was used in 5 patients. Provocative lidocaine testing was used in 2 patients in whom major nerves were in proximity to the malformations. All patients underwent follow-up in the clinic with duplex examination after each sclerotherapy.
Clinical symptoms of all patients improved during average follow-up of 2.5 years (range: 3 months to 6 years.) Duplex examination was useful in detecting the venous component including the size and course of veins, which were often less well seen on magnetic resonance imaging. Duplex study was helpful in follow-up after sclerotherapy in all patients.
Direct injection sclerotherapy is an acceptable treatment modality for venous malformations. Complications are manageable, and regular follow-up with Duplex is helpful.
Assessment of the Endoscopic Semitendinosus/Gracilis Autograft Procedure With Interference Screw Fixation for Reconstruction of the Anterior Cruciate Ligament
Authors: Allen Aaron D , Sitter Michael R , Marchetto Paul , Kelly John D , Mattacola Carl G 
Published: April 2021

ABSTRACT
The semitendinosus/gracilis autograft procedure with interference screw fixation was evaluated for clinical effectiveness of anterior cruciate ligament (ACL) reconstruction. Thirty patients underwent the procedure and were evaluated an average of 15 months postoperatively. Results revealed 22 (73%) patients had a standard knee evaluation form score of normal or nearly normal, and 24 (80%) patients returned to strenuous or moderate activity levels. Average Lyshoim outcome score was 89, and bilateral KT-2000 differences were <3 mm at follow-up. Functional knee test symmetry index percentage outcome for the one-legged hop test was 92.6% for distance and 98% for time. Length of time (ie, ≤90 days or ≥91 days) between injury and surgery was independent of outcome. These findings indicate the semitendinosus/gracilis autograft is a viable procedure for reconstruction of the ACL-deficient knee.
Closed-Wedge Tibial Osteotomy: Conventional Technique Versus a New System of Compression-Dynamic Fixation
Authors: Tigani D , Del Baldo A , Trentani P , Trentani F , Marinelli A , Bianchi G 
Published: April 2021

Abstract
Two groups of patients treated with different techniques of closed wedge tibial osteotomy were analyzed. Twenty-eight patients underwent the conventional technique and 31 patients underwent a closed-wedge osteotomy using a new osteotomy cutting jig and compression-dynamic fixation. The groups were comparable with respect to age, gender, and deformity. Using the conventional technique, only 68% of knees had an optimal postoperative femorotibial angle between 167° and 175°, compared to 88% using the new device (P=.02). High tibial osteotomy with an osteotomy jig provides a more accurate correction of deformity than the conventional technique.
Complications Related to Postoperative Casting After Surgical Treatment of Subluxed/Dislocated Hips in Patients With Cerebral Palsy
Authors: Lubicky John P , Bernotas Sarunas , Herman Jean E 
Published: April 2021

Abstract
Three hundred sixteen subluxed/dislocated hips (222 patients) underwent upper femoral osteotomy. Of these, 286 (90.5%) hips were casted (average patient age: 8.9 years) and 30 (9.5%) were not (average patient age: 13.6 years). Average follow-up was 4.7 years. Complications in the casted/noncasted groups (per hip) were: 43/0 (15%/0%) skin sores; 11/1 (3.8%/3.3%) wound infections; 6/0 (2.1%/0%) instrumentation failures; 22/1 (7.7%/3.3%) reoperations; and 13/1 (4.596/3.3%) rehospitalizations. Differences between the groups were not statistically significant. Casted patients were younger and more neurologically involved.
Casting is useful to ensure healing of osteotomies, prevent instrumentation failure and injury to the operated legs, and allow for ease of handling. Complications that occurred were managed and had no long-term sequelae.
Intraoperative Hemostasis During Spinal Reconstructive Procedures
Authors: Thibodeaux Kerry T , Lorio Morgan P , Block Jon E 
Published: April 2021

Abstract
In a consecutive sample of patients undergoing similar spinal reconstructive procedures in the thoracolumbar region, hemostatic effectiveness of a collagen-based composite (CoStasis; Cohesion Technologies, Palo Alto, Calif) (n=10) was compared with standard hemostatic methods (manual compression) (n=9). All patients treated with CoStasis at the operative site(s) demonstrated immediate hemostasis, whereas all cases treated with gauze and sponges showed protracted bleeding (P<.01). The average perioperative blood loss was approximately twice as great among control patients compared to CoStasis patients (1322 mL versus 685 mL; P=.02). Total transfusion requirements and operative duration also were less among CoStasis patients. These findings suggest CoStasis may provide effective hemostasis in spinal reconstructive procedures such as instrumented fusion where blood loss is excessive.
The Incidence of Pathology Detected by Magnetic Resonance Imaging of the Knee: Differences Based on the Specialty of the Requesting Physician
Authors: Bernstein Joseph , Cain Eric L , Kneeland J Bruce , Dalinka Murray K 
Published: April 2021

Abstract
The usage patterns of magnetic resonance imaging (MRI) by orthopedic and nonorthopedic surgeons were studied. A sample consisting of the radiologist reports from all knee MRIs in a single year at our institution were reviewed. Studies to evaluate tumors or infections were excluded. Reports were classified as normal or demonstrating degenerative joint disease, meniscal tears, cruciate ligament pathology, collateral ligament pathology, focal chondral defects, chondromalacia patella, cysts, extensor mechanism dysfunction, intraosseous edema, or fractures. Six hundred eighteen reports were reviewed. The combined incidence of a normal study or one that found only degenerative joint disease was 45% for nonorthopedic surgeons and 27.6% for orthopedic surgeons (P<.00001). Given the higher incidence of normal findings in studies ordered by nonorthopedic surgeons, these physicians probably use MRI more for screening whereas orthopedic surgeons are more apt to use it for confirmation. Therefore, if clinical guidelines for using MRI are to be established, differences in use as a function of specialty must be acknowledged.
Shoulder Arthroplasty Without a Rotator Cuff
Authors: Walch Gilles 
Published: April 2021

Patients with a glenohumeral arthritis and a deficient rotator cuff represent a therapeutic challenge. In 1987, Paul M. C ram mot, MD introduced a new reverse design to treat this patient population.
This reverse design shoulder prosthesis has a cup placed within the proximal humerus and a hemisphere fixated to the glenoid. This prosthetic design relies on the deltoid to provide active elevation.
In this issue, Dr Gilles Walch, a leading international expert in shoulder surgery, shares his views on the reverse design prosthesis. Dr Walch has had vast experience and reports a high success rate with the implant, which is currently under IDE study in the United States.
Evaluation and Treatment of Open Calcaneal Fractures: A Retrospective Analysis
Authors: Lawrence Steven J , Grau Gregory F 
Published: April 2021

Abstract
The primary evaluation and management of 47 consecutive patients with 48 open calcaneal fractures was retrospectively analyzed. The fractures were treated over a 7year period. Forty-two fractures resulted from blunt trauma, and 6 followed penetrating trauma. The predominant mechanism of injury was a motor vehicle accident.
Initial treatment consisted of emergent irrigation and debridement of the open wound with intravenous antibiotic prophylaxis. Most patients underwent a second debridement. More than two thirds of the wounds were >5 cm in length, degioving-type injuries, associated with a significant neurovascular deficit and/or required a freetissue transfer. Internal fixation of the os calcis was undertaken in 40% of patients. In addition, >40% of patients sustained concomitant foot and ankle fractures. Two patients underwent below-the-knee amputations as primary treatment. Five patients required a free-tissue transfer. Complications included two infections and one below-the-knee amputation. Two deaths occurred due to unrelated causes.
Treatment standards for the optimal management of open calcaneal fractures remain controversial. A better understanding of this complex injury will help determine suitable treatment strategies.
Intercalary Tibial Allografts Following Tumor Resection: The Role of Fibular Centralization
Authors: Mohler David G , Yaszay Burt , Hong Richard , Wera Glenn 
Published: April 2021

Abstract
Options to reconstruct intercalary tibial defects include allografts, vascularized bone transfers, autogenous cortical grafts, endoprostheses, and llizarov bone transport. Five patients underwent intercalary bulk allograft reconstruction following en bloc resection of tibial sarcomas. Two patients underwent immediate fibular centralization and iliac crest bone grafting in addition to the allograft. Two patients who underwent fibular centralization during primary reconstruction united uneventfully. The remaining three patients developed nonunion, of which one was successfully salvaged by fibular centralization. A combined allograft transplant and fibular centralization with iliac crest bone grafting is an effective procedure to reconstruct the tibial diaphysis, as well as a salvage procedure for allograft nonunion.
Hematogenous Septic Arthritis of the Adult Hip
Authors: Yeargan S Austin , Perry John J , Kane Thomas J , Richardson Allen B 
Published: April 2021

Abstract
A retrospective review of 10 patients admitted to 4 regional hospitals between 1987 and 1997 in whom acute septic hip arthritis was diagnosed was performed to compare presentation, laboratory and radiographic findings, treatment, and outcome. Patients presented with fever, hip or groin pain, and an inability to bear weight. Most patients manifested a leukocytosis, and all patients had an elevated erythrocyte sedimentation rate. Hematogenous septic hip arthritis is rare. The consequences of a missed diagnosis are serious and include death. Clinical examination combined with appropriate laboratory and radiographic studies leads to prompt diagnosis and treatment.