bluuebunny/crossref_metadata_2025_split huggingface dataset:
OSTEOSARCOMA IN CHILDREN
Authors: Price C. H. G. , Zhuber K. , Salzer-Kuntschik M. , Salzer M. , Willert H. G. , Immenkamp M. , Groh P. , Matêjovský Z. , Keyl W. 
Published: February 2018

A study is presented of the aetiology and results of treatment in a group of 125 proven osteosarcomas present in children under fifteen years of age. These cases have been collected from the records of one English and six European treatment centres. There is a slight male preponderance, but the striking aetiological feature is the very high proportion of tumours of the long bones of the limbs (96 per cent). The two and a half and five year disease-free survival rates were respectively 15 and 12 per cent, with a further 9 per cent still living, but under observation for less than two and a half years. Evidence of metastasis after two and a half years is very unusual, but no child with a tumour of an axial or girdle bone lived this length of time. Although the differences in the results of the different methods of treatment employed are not statistically valid, the largest number of long survivors had been treated by early amputation, which method also provided the lowest rate of local tumour recurrences. Reasons are discussed which indicate that prompt ablation is the treatment of choice, perhaps with certain advantages in the light of recent advances in adjuvant treatment. The past situation in connection with childhood osteosarcoma certainly provides strong support for immediate carefully designed clinical trials of the new adjuvant methods cited.
THE EFFECT OF METHOTREXATE-LOADED BONE CEMENT ON LOCAL DESTRUCTION BY THE VX2 TUMOUR
Authors: Wang H. M. , Crank S. , Oliver G. , Galasko C. S. B. 
Published: February 2018

Previous studies have shown that the activity of the cytostatic drug methotrexate (MTX) embedded in acrylic cement is not affected by thermal changes in the cement. MTX is slowly released from the cement for several months and remains biologically active throughout this period. Our aim was to determine whether MTX embedded in cement would control the local growth of a tumour. In 15 rabbits we injected 0.1 ml of VX2 tumour suspension into the proximal tibia. At 3, 5, 7, 10 and 14 days three animals were killed and the tibiae removed and examined histologically. With increasing growth of the VX2 carcinoma there was increased bone destruction and a rise in the numbers of osteoclasts, but after 14 days the numbers of osteoclasts had decreased. We then injected VX2 into the tibiae of another 45 rabbits. After 5 days most of the tumour was curetted out and the defect filled with cement containing either 0 g, 0.1 g, 0.5 g, 1.0 g or 2.0 g MTX/40 g cement. The rabbits were divided into three groups and killed at 3, 7 or 10 days after implantation of cement. The number of osteoclasts and the amount of bone destruction were measured in each tibia. In all three groups bone destruction and osteoclast proliferation were markedly decreased with higher doses of MTX, but bone destruction was not eliminated. Our findings show that in the higher doses used, which were not toxic to the animal, MTX-embedded cement may be of value in minimising the amount of tumour-induced osteolysis and may be a useful adjunct in the surgical management of pathological fractures.
HIV INFECTION OF HUMAN CARTILAGE
Authors: Campbell D. G. , Li P. , Oakeshott R. D. 
Published: February 2018

Infection of human cartilage with HIV in vivo has not previously been reported. Specimens of articular cartilage taken at postmortem from ten patients who were HIV-positive were examined. Two had AIDS and eight were believed to have stage-2 disease. The standard polymerase chain reaction (PCR) protocol was modified to allow semiquantitative analysis of the samples. Oligonucleotide primers labelled with 32P gamma-ATP were used to detect a segment of HIV DNA and a control DNA gene segment (HLA genome) to estimate the ratio of infected cells. The 32P-labelled PCR products were separated on acrylamide gels and visualised directly by autoradiography and computer densitometry. Infection of human cartilage in vivo was demonstrated in nine of the ten samples in which the PCR analysis was positive. The other did not react sufficiently to produce detectable radiolabelled PCR product despite repeated DNA digestion and extraction. Cartilage infected with HIV could be a potential source of HIV when used in operations.
QUALITY-OF-LIFE IMPROVEMENT COMPARED AFTER HIP AND KNEE REPLACEMENT
Authors: Norman-Taylor F. H. , Palmer C. R. , Villar R. N. 
Published: February 2018

Total hip and total knee arthroplasty both provide a considerable improvement in quality of life, but there is no evidence to suggest that one is more successful than the other. We studied 72 patients in a prospective trial before and after total hip or total knee replacement. We recorded scores for disability and distress derived from the Harris hip score and the British Orthopaedic Association knee assessment score, and used them to generate quality of life (QoL) scores using the Rosser Index Matrix immediately before and at one year after surgery. The patients awaiting knee replacement had significantly lower QoL scores than those awaiting hip replacement (p = 0.011). The QoL scores at one year were high and almost identical for both groups (p = 0.46). Further analysis showed that gender and weight were not significant predictors of improvement of QoL scores, but age (p = 0.03) and whether the hip or knee was replaced (p = 0.006) were significant factors.
PREDICTION OF THE OUTCOME AFTER HIP FRACTURE IN ELDERLY PATIENTS
Authors: Svensson O. , Strömberg L. , Öhlén G. , Lindgren U. 
Published: February 2018

We report a prospective study of 232 consecutive patients with hip fractures. All were over 64 years of age and living independently before admission to a geriatric orthopaedic ward. We assessed the value, at admission, of predicting factors for independent living at one year after injury. The most important factors were: (1) preinjury function in activities of daily living (grade A or B on the Katz et al (1963) scale); (2) absence of other medical conditions which would impair rehabilitation; and (3) cognitive function better than 7 on the Pfeiffer (1975) mental questionnaire. The odds ratios (95% CI) for these three predictors were 3.5 (1.3 to 9.1), 2.9 (1.3 to 6.1) and 2.4 (1.9 to 4.9), respectively. When all predictors were positive at admission, 92% were living independently at one year; with one, two or three negative predictors, the percentages living independently were 76, 61 and 27, respectively. The median values of the total number of days in hospital, irrespective of diagnosis, during the first year were 12, 24, 29 and 149 days for the four groups. The mortality at one year was predictable on admission only by the number of medical conditions: with no other diagnosis than the fracture the mortality was 0%; with one or two additional conditions the mortality was 14%; and with three or more additional diagnoses it was 24%. These simple and robust predictors can be used to optimise resources for rehabilitation.
BIPOLAR SALVAGE SHOULDER ARTHROPLASTY
Authors: Watson M. 
Published: February 2018

A bipolar spacer was inserted for severe arthritic destruction of the shoulder in 14 patients, and followed up for a mean of 5.9 years. In one patient the operation failed because of infection. Two others required revision for loss of low-friction properties which caused loosening of the humeral component. At the end of the follow-up all the patients showed improvement. The Hospital for Special Surgery pain score had increased from 5.3 to 18.9 and the movement score from 7.5 to 20.1.
METACARPAL LENGTHENING AFTER TRAUMATIC AMPUTATION OF THE THUMB
Authors: Finsen V. , Russwurm H. 
Published: February 2018

In nine patients of median age 34 years who had sustained an amputation of the thumb at a median 24 (5 to 131) months previously, we lengthened the first metacarpal by 30 (17 to 36) mm. Seven amputations had been through the proximal phalanx and two through the metacarpal. The first two patients had autogenous grafting at a second stage, but the other seven had callotasis alone. In these patients the external fixators were removed at a median 189 (115 to 271) days after osteotomy. In six cases the adductor pollicis tendon was transferred proximally and the first web deepened. There was late fracture or palmar flexion of the callus in five patients, but this required further surgery in only one. Treatment was complete at 326 (140 to 489) days after osteotomy. The extended thumb retained its sensitivity; both grasp and key-pinch strength were satisfactory and only one patient felt that the result did not warrant the long course of treatment. Metacarpal lengthening by this method is a prolonged procedure, but provides a valuable alternative to more complex reconstructions.
TREATMENT OF SEVERE FLEXION DEFORMITY OF THE KNEE IN CHILDREN AND ADOLESCENTS USING THE ILIZAROV TECHNIQUE
Authors: Damsin J.-P. , Ghanem I. 
Published: February 2018

We have used the Ilizarov technique for severe flexion deformity of the knee in 11 patients (13 knees) between 1986 and 1994 and have followed them up for an average of 4.1 years. The age of the patients at operation ranged from 1.7 to 18.8 years. The femoral and tibial components were connected by two anterior hinges, medial and lateral, and two posterior distraction rods. The deformity was corrected to a femorotibial lateral shaft angle of less than 20°. A permanent orthosis was applied after removal of the fixator. Fractures occurred in four patients and paralysis of the common peroneal nerve in another. There was a recurrence of the deformity in four patients. At the last review all patients were able to walk on their operated leg with or without an orthosis. We have found the Ilizarov method to be helpful in correcting severe fixed flexion deformity of the knee, with relatively few complications, but the basic principles of the method must be carefully followed.
STRUCTURAL ALLOGRAFT IN TWO-STAGE REVISIONS FOR FAILED SEPTIC HIP ARTHROPLASTY
Authors: Alexeeff M. , Mahomed N. , Morsi E. , Garbuz D. , Gross A. , Latner A. J. 
Published: February 2018

We report 11 patients having revision of total hip arthroplasty using massive structural allografts for failure due to sepsis and associated bone loss. All patients had a two-stage reconstruction and the mean follow-up was 47.8 months (24 to 72). Positive cultures were obtained at the first stage in nine of the 11 patients, with Staphylococcus epidermidis being the most common organism. The other two patients had draining sinuses with negative cultures. There was no recurrence of infection in any patient. The mean increase in the modified Harris hip score was 45 and all the grafts appeared to have united to host bone. Two patients required additional procedures, but only one was related to the allograft. Complications included an incomplete sciatic nerve palsy and one case of graft resorption. Our results support the use of massive allografts in failed septic hip arthroplasty in which there is associated bone loss.
AN EVALUATION OF THE CONSTANT-MURLEY SHOULDER ASSESSMENT
Authors: Conboy V. B. , Morris R. W. , Kiss J. , Carr A. J. 
Published: February 2018

We have analysed the Constant-Murley (1987) assessment for 25 patients with shoulder pathology. We found the score easy to use, with low inter- and intraobserver errors, but sufficiently imprecise in repeated measurements to give concern in its use for clinical follow-up of patients. We have calculated 95% confidence limits for a single assessment to be within 16 to 20 points in most cases. In addition, we found that all our subjects with instability as their main problem scored within five points of the maximum; this suggests that the scoring method may need to be revised for use on these patients.
ANTERIOR INTEROSSEOUS NERVE LESIONS
Authors: Seror P. 
Published: February 2018

Lesions of the anterior interosseous nerve in the forearm are rare and often misdiagnosed as tendon injuries. A consecutive series of 13 patients with this condition referred for electrodiagnosis is reviewed. Only three had originally a correct clinical diagnosis and three were initially considered to have tendon ruptures. Five cases were of mechanical origin and seven due to ‘neuritis’. All showed electrophysiological abnormalities, most commonly involving the pronator quadratus. Late spontaneous recovery was common, and only one case had surgical exploration.
OCCIPITO-ATLANTO-AXIAL FUSION IN MORQUIO-BRAILSFORD SYNDROME
Authors: Ransford A. O. , Crockard H. A. , Stevens J. M. , Modaghegh S. 
Published: February 2018

In 17 patients (eleven males, six females) with Morquio-Brailsford syndrome (mucopolysaccharidosis IV) we have used onlay femoral and tibial autografts placed posteriorly and secured to the laminae of C1 and C2 to obtain satisfactory occipito-C1/C2 posterior fusion. They were immobilised postoperatively in a halo-plaster body jacket for four months. The age at operation varied between three and 28 years. Those with myelopathic symptoms of recent onset made some recovery, but severely myelopathic patients showed little or no recovery. We advise prophylactic occipitocervical fusion in these patients since the cartilaginous dens is not strong enough to ensure atlanto-axial mechanical stability.
TRANSFORMING GROWTH FACTOR-β1 STIMULATES BONE ONGROWTH TO WEIGHT-LOADED TRICALCIUM PHOSPHATE COATED IMPLANTS
Authors: Lind M. , Overgaard S. , Ongpipattanakul B. , Nguyen T. , Bünger C. , Søballe K. 
Published: February 2018

Bone growth into cementless prosthetic components is compromised by osteoporosis, by any gap between the implant and the bone, by micromotion, and after the revision of failed prostheses. Recombinant human transforming growth factor-β1 (rhTGF-β1) has recently been shown to be a potent stimulator of bone healing and bone formation in various models in vivo. We have investigated the potential of rhTGF-β1, adsorbed on to weight-loaded tricalcium phosphate (TCP) coated implants, to enhance bone ongrowth and mechanical fixation. We inserted cylindrical grit-blasted titanium alloy implants bilaterally into the weight-bearing part of the medial femoral condyles of ten skeletally mature dogs. The implants were mounted on special devices which ensured stable weight-loading during each gait cycle. All implants were initially surrounded by a 0.75 mm gap and were coated with TCP ceramic. Each animal received two implants, one with 0.3 μg rhTGF-β1 adsorbed on the ceramic surface and the other without growth factor. Histological analysis showed that bone ongrowth was significantly increased from 22 ± 5.6% bone-implant contact in the control group to 36 ± 2.9% in the rhTGF-β stimulated group, an increase of 59%. The volume of bone in the gap was increased by 16% in rhTGF-β1-stimulated TCP-coated implants, but this difference was not significant. Mechanical push-out tests showed no difference in fixation of the implant between the two groups. Our study suggests that rhTGF-β1 adsorbed on TCP-ceramic-coated implants can enhance bone ongrowth.
UNIPOLAR OR BIPOLAR PROSTHESIS FOR DISPLACED INTRACAPSULAR HIP FRACTURE IN OCTOGENARIANS
Authors: Calder S. J. , Anderson G. H. , Jagger C. , Harper W. M. , Gregg P. J. 
Published: February 2018

We performed a randomised prospective trial to compare a cemented unipolar prosthesis (Thompson) with a cemented bipolar prosthesis (Monk) in the treatment of displaced intracapsular fractures of the hip in patients over 80 years of age. Patients with a mental test score of less than 5/13 were excluded but the mortality was still about 30% at one year in both groups. We therefore feel that subjective criteria such as the level of pain and the return to the preinjury state are of paramount importance. Two years after operation there was no statistical difference between the rate of complications in the two groups. After adjusting for confounding factors such as differences in the level of function before injury between the groups, the degree of return to the preinjury state was significantly greater (p = 0.04) when using the unipolar prosthesis, which is one-quarter of the price of the bipolar. We cannot therefore justify the use of an expensive bipolar prosthesis in patients over 80 years of age.
SURVIVORSHIP ANALYSIS OF THE KINEMATIC STABILIZER TOTAL KNEE REPLACEMENT
Authors: Emmerson K. R. , Moran C. G. , Pinder I. M. 
Published: February 2018

The Kinematic Stabilizer is a posterior-cruciate-substituting design of total knee replacement. We have reviewed 109 primary total knee replacements in 95 patients at a mean follow-up time of 12.7 years (10 to 14). We used survival analysis with failure defined as revision of the implant. This gave a cumulative survival rate of 95% (95% CI± 5%) at ten years and 87% (± 10%) at 13 years. These results from an independent centre confirm the value of an established design of cemented total knee replacement and question the wisdom of the introduction of modifications and new designs without properly controlled trials.
CARPAL BOX RADIOGRAPHY IN SUSPECTED SCAPHOID FRACTURE
Authors: Roolker W. , Tiel-van Buul M. M. C. , Bossuyt P. M. M. , Bakker A. J. , Bos K. E. , Marti R. K. , Broekhuizen A. H. 
Published: February 2018

We have assessed the value of using a simple apparatus, the Carpal Box, in patients with suspected scaphoid fracture, to produce elongated and magnified radiographs of the carpus. The interobserver agreement between 60 observers of standard scaphoid radiographs and longitudinal and transverse Carpal Box radiographs (X-CB) was compared in 11 patients. Three-phase bone scanning was used as a comparative standard. If at least 75% of the observers agreed and the result was confirmed by three-phase bone scanning, the outcome was termed reliable. Scaphoid radiographs and the longitudinal X-CB films were reliable in four patients and the transverse X-CB films in six patients. The bone scan suggested a scaphoid fracture in five of the 11 patients. Agreement in the interpretation of the standard scaphoid radiographs was acceptable in only 36% of patients: in interpretation of transverse Carpal Box radiographs this figure increased to 55%.
FRACTURES OF THE DISTAL END OF THE RADIUS TREATED BY INTERNAL FIXATION AND EARLY FUNCTION
Authors: Rikli D. A. , Regazzoni P. 
Published: February 2018

Fractures of the distal end of the radius should be treated on the same principles as other fractures involving joints. Displaced articular fractures require open reduction to allow anatomical reconstruction of both the radiocarpal and the radio-ulnar joints. For extra-articular fractures with severe comminution and shortening this enables the radial length to be re-established achieving radio-ulnar congruency. Stable internal fixation can be achieved with two 2.0 AO titanium plates placed on each of the ‘lateral’ and the ‘intermediate’ columns of the wrist at an angle of 50° to 70°. This gives good stability despite the tiny dimensions of the plates, and allows early function. We report a series of 20 fractures treated by this method of internal fixation with satisfactory results in all.
TREATMENT OF HIGH-ENERGY TIBIAL PLATEAU FRACTURES BY THE ILIZAROV CIRCULAR FIXATOR
Authors: Dendrinos G. K. , Kontos S. , Katsenis D. , Dalas A. 
Published: February 2018

We treated 24 patients with high-energy fractures of the tibial plateau by the Ilizarov fixator and transfixion wires. Eleven fractures were open, and 20 patients had complex injuries. Twelve were treated by ligamentotaxis and percutaneous fixation, seven by limited open reduction and five by extensive open reduction. All were followed for at least 24 months. All the fractures united, with an average time to healing of 14.4 weeks. Thirteen patients achieved full extension and 13 more than 110° of flexion. Twenty-two knees were stable. Fifteen patients walked normally and the rest with only a slight limp. All but two knees had an articular step-off of less than 4 mm and all had normal axial alignment except two. There were no cases of postoperative skin infection, osteomyelitis or septic arthritis. Ilizarov circular fixation is an ideal method of treatment for these fractures when extensive dissection and internal fixation are contraindicated due to trauma to the soft tissue, deficiency of bone stock, and bony comminution.
LONG-TERM RESULTS AFTER REALIGNMENT OPERATIONS FOR SLIPPED UPPER FEMORAL EPIPHYSIS
Authors: Jerre R. , Hansson G. , Wallin J. , Karlsson J. 
Published: February 2018

We reviewed the long-term results of the treatment of slipped upper femoral epiphysis (SUFE) using realignment procedures in 36 patients (37 hips) at an average follow-up of 33.8 years (26 to 42). There were serious short-term complications in seven of the 22 hips treated by subcapital osteotomy, three of the 11 hips treated by intertrochanteric osteotomy and three of the four hips treated by manipulative reduction. At re-examination, the clinical and radiological results were excellent or good in 41% of the hips treated by subcapital osteotomy, in 36% treated by intertrochanteric osteotomy and in none treated by manipulative reduction. In all, seven hips (19%) had had arthrodesis or total hip replacement. The natural history of SUFE was probably not improved by any of the treatments used in our study. We therefore discourage the use of subcapital and intertrochanteric osteotomy as well as manipulative reduction in the primary treatment of chronic SUFE.
NON-CEMENTED REPLACEMENT OF THE TRAPEZIOMETACARPAL JOINT
Authors: Wachtl S. W. , Sennwald G. R. 
Published: February 2018

We treated 43 patients (38 women and 5 men) with osteoarthritis of the basal joint of the thumb by non-cemented arthroplasty of the first carpometacarpal joint as described by Ledoux. The probability of a patient avoiding revision for 12 months was 62% and for 16 months 59%. The indications for revision were aseptic loosening in 83% and luxation in 17%. The surviving prostheses were reviewed clinically and radiologically at a mean follow-up of 25.3 months. Pain on loading, movement or at rest was seen in 75% of the patients. There was significant reduction in the range of movement of the trapeziometacarpal joint and of wrist strength. Radiological assessment showed significant subsidence of the stem in the first metacarpal and migration of the cup, with the stem loose in 15% and the cup in 46%. We no longer recommend this method of joint replacement.
SURGICAL RELEASE OF KNEE FLEXION CONTRACTURES IN MYELOMENINGOCELE
Authors: Marshall P. D. , Broughton N. S. , Menelaus M. B. , Graham H. K. 
Published: February 2018

We report the results of a prospective study of the surgical release of 45 knee flexion contractures in 28 patients with myelomeningocele. The neurosegmental level was thoracic in ten patients, L1/2 in one, L3/4 in 11, and L5/S1 in six. In walkers the indication for surgery was a fixed flexion contracture impeding walking, and in non-walking patients it was a flexion contracture impeding transfers or sitting balance, or likely to do so with increasing deformity. The mean age at surgery was 6.4 years (3 to 21) and the mean period of follow-up 13 years (4 to 20). The mean knee flexion contracture before surgery was 39° (25 to 70) which improved to 5° at maximum correction and to 13° at latest follow-up. We conclude that surgical release of knee flexion contractures in myelomeningocele improves gait in all children who walk, particularly those with low lumbar lesions. Recurrence of knee flexion contractures after surgical release is most common in those with thoracic lesions who do not achieve independent walking.