bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Measurement Methods of Movement and Grip Strength in Children with a Previous Upper Extremity Fracture: A Comparative, Prospective Research
Authors: Korhonen L. , Pokka T. , Holappa A. , Serlo W. , Sinikumpu J.-J. 
Published: June 2019

Background and Aims: Decreased range of motion of the elbow and forearm and decreased grip strength are potential findings following a childhood upper extremity fracture. Clinical follow-up is essential because spontaneous improvement is seen several months after the injury. Freehand measuring with a goniometer and hydraulic dynamometer is used to evaluate clinical result. The new methods are justified in avoiding human typewriting errors, thus improving patient safety. Nevertheless, their feasibility in child patients is unknown. This study aimed to evaluate congruence between the computer-assisted and the free-hand measuring methods. Materials and Methods: A total of 59 children with a previous supracondylar humerus fracture were clinically examined by means of free-hand (transparent goniometer and hydraulic dynamometer; Jamar, Lafayette Ltd.) and computer-assisted (E-Link System Packages, Biometrics Ltd.) methods. The range of motion and grip strength were measured separately using both methods. Agreement between the measurements was evaluated using the Bland–Altman method. Results: The results between the two methods were incongruent and the differences between measurements increased along with the mean of measurements in all categories except elbow extension. Rotational range of motions were smaller and grip strength was weaker while measuring with the computer-assisted method. The mean discrepancy was 0.97° (95% confidence interval = −2.46 to 0.53) for elbow extension and 7.97° (95% confidence interval = 6.60–9.33) for elbow flexion. Conclusions: Grip strength is used to evaluate impairment of hand function. The study method showed slightly lower results in grip strength. Range of motion is essential when evaluating the outcome of supracondylar humerus fracture, while >10° of change in elbow range of motion associate with impaired function. As compared with the gold-standard goniometer, the methods were not congruent. However, all differences were under 10° and probably beyond clinical importance. Because of its advantages in recording the outcomes to electronical charts, the computer-assisted method is recommended option in performing the follow-up of complicated pediatric supracondylar humerus fractures.
The ratio of fasting plasma glucose to hemoglobin A1c as a predictor of all-cause mortality in individuals with normal glucose levels: The Jichi Medical School cohort study
Authors: Kakehi Eiichi , Kotani Kazuhiko , Gotoh Tadao , Kayaba Kazunori , Ishikawa Shizukiyo 
Published: June 2019

Objectives: The fasting plasma glucose/hemoglobin A1c ratio is considered a marker associated with glucose metabolism disorders, including fasting hyperglycemia. However, it remains unclear whether this ratio can be used for the prevention of deaths in individuals with normal fasting plasma glucose levels. This study aimed to see the predictive value of the fasting plasma glucose/hemoglobin A1c ratio for all-cause mortality in a general population with normal fasting plasma glucose levels. Methods: The study investigated prospectively a cohort of 1087 multi-regional, community-dwelling Japanese participants (women, 69.2%) for a follow-up period of 11.3 years. We included individuals with fasting plasma glucose levels <6.11 mmol/L and excluded those meeting the diabetes criteria. All-cause mortality was the primary outcome and hazard ratios were calculated using the Cox proportional hazard model after dividing the fasting plasma glucose/hemoglobin A1c ratios into tertiles. Results: There were 54 deaths (25 women) during the follow-up period. The high tertile group had a significantly higher hazard ratio for all-cause mortality than the low tertile group in women (multivariate-adjusted hazard ratio = 4.45; 95% confidence interval = 1.26–15.72), but not clearly in men. Conclusion: The data of the population-based cohort study suggest that a high fasting plasma glucose/hemoglobin A1c ratio can predict all-cause mortality in women with normal fasting plasma glucose levels.
Slope reduction osteotomy decreases ACL graft forces and reduces anterior tibial translation under axial load - a biomechanical study
Authors: Imhoff Florian B. , Mehl Julian , Obopilwe Elifho , Imhoff Andreas , Beitzel Knut 
Published: June 2019

Aims and Objectives: To perform an anterior closing wedge osteotomy by 10° for slope reduction and investigate the effect of axial load and anterior drawer on forces on ACL graft, strain and femoro-tibial kinematics in a native, ACL-deficient and reconstructed knee. Materials and Methods: Ten cadaveric knees with an increased native slope were selected for this study based on CT meas-urements. An anterior closing-wedge osteotomy was performed by 10° and fixed with an external fixator. Tibial axial load (200 N, 400 N) was applied, while the tibial side was mounted on a free mov-ing X-Y-table with open rotation in 30° of knee flexion. Additionally, an anterior drawer (134 N) was performed with and without axial load (200 N). Specimens underwent native testing, cut ACL, and reconstructed ACL with a standardized quadruple semi-t/gracilis-allograft. Each condition was ran-domly tested with native slope and reduced slope. Change of forces on ACL-graft (attached load-cell) and strain on native ACL (via DVRT) were recorded. Throughout testing, 3D motion tracking captured anterior tibial translation (ATT) and rotation versus the fixed femur. Results: Preoperative, specimens showed an averaged lateral and medial slope of (average ±SD) 10° ± 1.4°, and age 48.2 ± 5.8years. Slope reduction significantly decreased forces on ACL graft by 17% (p=0.001) at 200 N and by 33% (p=0.0001) at 400 N of axial load. Furthermore, ATT was significantly decreased after slope reduc-tion in native (p=0.01), cut (p=0.005), and ACL-graft (p=0.01) status. Strain in native ACL de-creased by 9.7 ± 0.13% (p<0.0001) after slope reduction without any load. However, anterior drawer without axial load maintained significantly higher anterior tibial translation (native-pre 4.12 ± 0.65 mm vs. native-post 5.82 ± 1.51 mm, cut-ACL-pre 9.35 ± 1.57 mm vs cut-ACL-post 12.0 ± 3.53 mm, ACL-recon-pre 4.60 ± 0.97 mm vs. ACL-recon-post 5.73 ± 1.45 mm) and significantly higher forces on ACL graft (p=0.0006) after osteotomy. When axial load was combined with anterior drawer no significant change on ATT after osteotomy was observed. Rotational analysis did show a significant effect in the ACL cut condition due to slope correction. Overall, native and reconstruct-ed ACL showed the same tibial kinematics throughout testing. Conclusion: In general, osteotomy lowered ACL graft force and ACL strain when the joint was axially loaded. Anterior tibial translation was reduced even in an ACL deficient knee. When anterior drawer was performed without axial load, ATT was higher after slope reduction in every condition.
Typical Pain Patters in Patients after total knee arthroplasty
Authors: Mathis Dominik T. , Hauser Antonia , Amsler Felix , Hirschmann Michael 
Published: June 2019

Aims and Objectives: About 20% of patients after total knee arthroplasty (TKA) are not satisfied nor pain free. After a challenging diagnostic workup it is not unusual that revision surgery becomes necessary. There is a general consensus that knee revision surgery should only be performed when the causes of the complaints are identified. In the clinical diagnostic process the detection of pain patterns that are typical for specific pathologies is paramount. Revision surgeons in clinical practice are well aware of some pain patterns but to date there is no study dealing with detection and identification of typical pain patterns in patients with painful TKA. The purpose of this study is the detection and definition of typical pain patterns in patients with painful TKA and the assignment to typical pathologies such as instability, stiffness, loosening, patellofemoral overstuffing and mechanical dysfunctions. Materials and Methods: A consecutive number of 129 patients, which were seen in the consultation at a specialized knee centre between 2012 and 2017 due to painful primary knee arthroplasty and whose diagnostic workup resulted in revision surgery were included. Defined criteria were retrospectively assessed from pre-existing patient documentation, statistic analysis (chi-squared test) and the assignment to the underlying pathology was performed. The criteria include localisation, intensity and character of pain, position and type of the prosthetic components, postoperative course, indication for revision surgery and demographic data such as age of the patient at primary surgery, sex, time between primary and revision surgery, socioeconomic status. Results: Typical pain patterns were defined and assigned to specific pathologies. Significant correlation was shown between localisation, intensity and character of pain and demographic data, type and position of the prosthetic components, surgical technique as well as the underlying cause for revision surgery such as instability, stiffness, loosening, patellofemoral overstuffing and mechanical dysfunction. Conclusion: The detection and definition of typical pain patterns in patients with pain after TKA and the assignment of identified pathologies will be applied in the improvement of the diagnostic process. Only when the exact cause of pain is determined, the therapy can be successful. The results of this study allow improving the clinical diagnostic process of patients with pain after TKA and help to enhance the indications for possible revision surgery.
Good correlation of the maximal relative bone tracer uptake in SPECT/CT and intraoperative findings of chondral lesions graded with the ICRS
Authors: Schiapparelli Filippo-Franco , Ammann Nora , Rasch Helmut , Amsler Felix , Hirschmann Michael 
Published: June 2019

Aims and Objectives: It is a pertinent question if SPECT/CT is able to reflect the cartilage status of the knee. Hence, it was the purpose of this study to evaluate the correlation between maximal relative bone tracer uptake (mrBTU) of preoperative SPECT/CT and intraoperative findings of chondral lesions assessed with the International Cartilage Repair Society (ICRS) scoring. Materials and Methods: Thirty-three consecutive patients (male: female=11: 22; mean age ± standard deviation 61±15) with bi- or tri-compartmental osteoarthritis of the knee who underwent SPECT/CT before total knee arthroplasty (TKA) were included. The knee was divided into 11 anatomical regions. In each region, mrBTU values were calculated twice by two observers within a six weeks interval. The intraclass correlation coefficient (ICC) was calculated and mean values were used. Intraoperatively, for every region the cartilage status with regards to ICRS score was assessed. A non-parametrical Spearman’s correlation was performed. A factor analysis was performed on mrBTU and ICRS scores (p<0.05). Results: The ICC presented excellent correlations. The Spearman’s correlation performed separately on mrBTU and ICRS scores showed diffuse significant correlations which were especially strong between regions of the same knee compartment (p < 0.01). The Spearmann correlation calculated between rmBTU and IRCS scores evidenced very strong correlations on the medial femoral condyle, on the ventral two third of the medial tibia plateau (p < 0.01) and good correlations on the proximal femoral trochlea and on the medial patellar facet (p < 0.05). Conclusion: A highly significant correlation between SPECT/CT and intraoperative findings was demonstrated. The use of an objective measure as the rmBTU for osteoarthritis could overcome the limit of the subjectivity of MRI findings.
No growth disturbance after trochleoplasty for recurrent patellar dislocation in adolescents with open growth plates
Authors: Williams Sean Robert , Nelitz Manfred 
Published: June 2019

Aims and Objectives: Trochlear dysplasia is the most important risk factor to patellofemoral instability in adolescents, therefore trochleoplasty to reshape the trochlear groove is the treatment of choice in patients with severe trochlear dysplasia. However, in the presence of open growth plates there is a potential risk of injury of the distal femoral growth plate and subsequent growth disturbance. Therefore, most authors do not recommend trochleoplasty in skeletally immature patients. The effect of trochleoplasty on femoral growth when performed before closure of the distal femoral physis remains unclear. The hypothesis of the study was, that In patients with open growth plates and an expected growth of less than two years trochleoplasty does not cause growth disturbance of the distal femur. Materials and Methods: 18 consecutive adolescents (18 knees) with open physes and severe trochlear dysplasia underwent trochleoplasty. Pre- and postoperative radiographic examination included AP and lateral views to assess leg axis and patella alta. Preoperatively a radiograph of the left hand was performed to measure skeletal age. MRI was performed to evaluate trochlear dysplasia and tibial tubercle-trochlear groove (TT-TG) distance. Evaluation included pre- and postoperative physical examination with evaluation of leg length and leg axis, Kujala score, Activity Rating Scale (ARS) and Tegner activity score. Results: The average age at the time of operation was 12.6 y (range, 12.2 - 13.3) in girls and 14.5 y (14.0 - 15.4) in boys. The average follow-up after operation was 2.3 years after surgery (range, 2.0 - 3.0 years). At follow-up in all patients the growth plates of the knee were closed. Impairment of growth of the distal femur was neither found clinically nor radiographically. No recurrent dislocation occurred. The median Kujala score and median VAS showed significant improvement (p < 0.01). The activity level according to the Tegner activity score did not change statistically significant. Conclusion: In this study, trochleoplasty as a treatment for patellofemoral instability in patients with open physes and an expected growth of not more than two years showed good clinical results without redislocation and no growth disturbance. Therefore, in selected adolescent patients with severe trochlear dysplasia trochleoplasty can be safely performed up to two years before the projected end of growth.
Geometry of Torsional Malalignment Syndrom: Trochlear Dysplasia but not Torsion Predicts Lateral Patellar Instability
Authors: Balcarek Peter , Vogel Dennis 
Published: June 2019

Aims and Objectives: To analyze parameters of limb malalignment and patellar tracking in patients with torsional malalignment syndrome presenting with clinical symptoms of either patellofemoral pain or patellar instability. Materials and Methods: Between April 2015 and July 2017, 428 patients were treated for lateral patellar instability (LPD), and 333 patients were treated for patellofemoral pain syndrome (PFPS). Sixty-two patients (14.5%) with patellar instability (LPD group) and 29 patients (8.7%) with patellofemoral pain (PFPS group) had additional torsional malalignment and were included in this study. All patients underwent magnetic resonance imaging assessment of torsional alignment and patellar tracking, including femoral antetorsion, tibial torsion, knee rotation, tibial tuberosity-trochlear groove distance, tibial tuberosity-posterior cruciate ligament distance, Dejour’s classification of trochlear dysplasia, lateral trochlear inclination angle, and patellar height Results: Groups differed significantly in terms of trochlear dysplasia (p<0.001), lateral trochlear inclination angle (p<0.001) and tibial tuberosity-trochlear groove distance (p=0.0167) but did not differ in terms of femoral torsion (LPD group 20.02° +/- 8.8°; PFPS group 20.03° +/- 7.91°; p=0.8545), tibial torsion (LPD group 39.53° +/- 9.23°; PFPS group 41.24° +/- 7.28°; p=0.3616), and knee rotation (LPD group 10.42° +/- 5.16°; PFPS group 8.48° +/- 7.81°; p=0.0163). Only measures of coronal alignment were positively correlated. This was also true for the tibial tuberosity-trochlear groove distance and knee rotation but not for any other parameters of torsional limb alignment. Trochlear dysplasia (type B-D) was identified as the only significant predictor of patellar instability. Conclusion: Torsional malalignment syndrome, represented in this study by two clinical entities - PFPS and LPD - is not characterized by a typical constellation of different malalignment parameters. Between groups, parameters differed significantly only in terms of trochlear dysplasia and the tibial tuberosity-trochlear groove distance, with trochlear dysplasia (type B-D), but not torsion, identified as predictor of lateral patellar instability.
Persistent traumatic peroneal nerve palsy - surgical treatment by neuromusculotendinous gastrocnemius muscle transfer
Authors: Hoppert Matthias , Dornseifer Ulf 
Published: June 2019

Aims and Objectives: Common peroneal nerve palsy is a relatively frequent complication in trauma of the knee and lower extremity. Persistent traumatic peroneal nerve palsy is usually treated by tendon transfer. A surgical concept for the treatment by neurotized lateral gastrocnemius muscle transfer is demonstrated with the aim of restoring active voluntary dorsiflexion. The indication, the surgical technique and the results obtained in two own cases with review of the literature are presented. Materials and Methods: Surgical technique: The lateral head of the gastrocnemius muscle is transferred to the tendons of the anterior tibial muscle group. The intact proximal end of the deep peroneal nerve is transpositioned to the tibial nerve of the gastrocnemius muscle by microsurgical technique. The transferred muscle is reinnervated by nerve coaptation between the undamaged proximal part of the deep peroneal nerve and the motor branch of the tibial nerve supplying the gastrocnemius muscle. The key steps of the surgical technique are described. Results: Short term results of the own cases appeared excellent. In both patients the transferred gastrocnemius muscle showed signs of reinnervation within 6 months after the operation. The patients achieved stable functional gait, voluntary movement of the transferred muscle and active range of motion of about 40 degrees. The early clinical results are compared with the clinical series in the literature since 1994. Conclusion: Early clinical results after the neuromusculotendinous gastrocnemius muscle transfer appear highly successful. They still need to be compared with conventional tendon transfer procedures. The described operative approach offers some advantages compared with other methods in the reconstruction of a drop foot secondary to traumatic common peroneal nerve palsy in a well-selected group of patients. In contrast to the commonly used treatment of tibialis posterior muscle transfer no reeducation of the transferred muscle is needed. We review the indications and limitations of this technique.
Functional Outcome of Revision Osteosynthesis after failed surgical treatment of patellar fractures
Authors: Müller Elena , Frosch Karl-Heinz 
Published: June 2019

Aims and Objectives: Patellar fractures account for approximately 1% of all skeletal fractures. They are rare, but due to the crucial function of the patella in the extensor mechanism of the knee they can lead to a serious impairment. New data are revealing functional impairment remains common even with improved surgical techniques. The aim of this study is to asses the functional outcome of patients after revision surgery in case of secondary fracture dislocation or remaining articular incongruity. Materials and Methods: The study was designed as a retrospective observatory study. We included all patients who underwent a revision surgery because of a remaining articular incongruity or a secondary fracture dislocation or re-fracture from January 2010 until december 2016. Results: Sixteen patients of mean age 51,8 years were included in the study with a mean follow-up period of 28,8 months. Fifteen patients had AO type C fractures, within ten a C3 fracture. Thirteen were initially treated with tension band wiring via k-wires or cannulated screws. The reason for a revision surgery were 5 times a remaining articular incongruity, 11 times a secondary fracture dislocation or re-fracture. We analysed pain, satisfaction, range of motion, Böstman-Score, Tegner-Score and KOOS and could extract follow-up data from 15 of the patients. All fractures healed, no articular incongruity remained. Mean pain measured with the visual analogue scale (0-10) was at rest 0,57 (range 0-3,5), on exertion 2,79 (range 0-8). The measurement of the range of motion compared with the opposite knee showed a complete extension. Mean Flexion was 120°, in the opposite knee 136° (p = 0,05). Mean postoperative Böstman-Score and Tegner-Score were 25,11 (good, max. 30) and 78,67 (moderate, max. 100). KOOS: symptoms 66,8 points, pain 77,55 points, ADL 75,67 points and qualitiy of life 56,25 points. Conclusion: Early revision surgery in case of secondary fracture dislocation, re-fracture or remaining articular incongruity leads to statisfactory functional outcomes. Furthermore in case of complexe fractures the tension band wiring technique shouldn’t be the first choice, alternatives like the plate osteosynthesis should be considered.