bluuebunny/crossref_metadata_2025_split huggingface dataset:
STRESS FRACTURE OF THE PUBIC RAMUS IN FEMALE RECRUITS
Authors: Hill P. F. , Chatterji S. , Chambers D. , Keeling J. D. 
Published: February 2018

During a four-month period we observed 12 stress fractures of the inferior pubic ramus in 11 military recruits undergoing basic training. Eleven of these were in women. This high number was considered to be caused by the introduction of mixed training of male and female recruits; this forces women to increase their stride length when marching. The presenting symptom was chronic groin pain which failed to settle with rest, and the clinical diagnoses were confirmed by radiographs in all but one patient who was diagnosed by 99mTc bone scanning. Since the required stride length has been reduced there have been no new cases of stress fracture of the pelvis.
LONG-TERM RESULTS OF CONSERVATIVE TREATMENT FOR ACROMIOCLAVICULAR DISLOCATION
Authors: Rawes M. L. , Dias J. J. 
Published: February 2018

We have reviewed 30 patients who had been treated conservatively for acromioclavicular dislocation between 1979 and 1982 at an average of 12.5 years after the injury. All except one had a good outcome as did five others contacted by telephone. In all patients reviewed the acromioclavicular joint remained subluxed or dislocated. With conservative treatment a good long-term outcome can be expected without restoration of the anatomical configuration of the joint.
ACQUIRED THUMB FLEXION CONTRACTURE IN CHILDREN
Authors: Slakey J. B. , Hennrikus W. L. 
Published: February 2018

We examined prospectively 4719 newborn infants to determine the congenital incidence of trigger thumb. No cases were found. Fifteen other children aged from 15 to 51 months had surgery for this condition. The anomaly had not been seen at birth and all thumbs presented with a flexion contracture without triggering. The condition is usually seen after birth as a flexion contracture of the interphalangeal joint. The term ‘congenital’ is a misnomer because patients acquire the deformity after birth. The term ‘trigger’ is inaccurate as most thumbs show a fixed-flexion contracture without triggering. We suggest that rather than ‘congenital trigger thumb’ a more appropriate description of this disorder is ‘acquired thumb flexion contracture in children’. If the contracture persists after one year of age, treatment by dividing the A-1 pulley is simple and effective.
HERBERT SCREW FIXATION OF SCAPHOID FRACTURES
Authors: Filan S. L. , Herbert T. J. 
Published: February 2018

We reviewed the records of 431 patients who had open reduction and internal fixation of the scaphoid performed by one surgeon (TJH) over a 13-year period. The Herbert bone screw provided adequate internal fixation without the use of plaster immobilisation, promoting a rapid functional recovery. On average, patients returned to work 4.7 weeks after surgery and wrist function was significantly improved, even when the fracture failed to unite. Healing rates for acute fractures were better than those reported for plaster immobilisation and were independent of fracture location. In the case of established nonunions, healing depended on the stage and location of the fracture, but the progress of arthritis was halted and carpal collapse significantly improved. Internal fixation of the scaphoid using the Herbert bone screw, although technically demanding, has few complications and appears to offer significant advantages over other methods of treatment.
SHOULDER PAIN IN LONG-TERM HAEMODIALYSIS PATIENTS
Authors: Konishiike T. , Hashizume H. , Nishida K. , Inoue H. , Nagoshi M. 
Published: February 2018

We reviewed 166 adult patients on long-term haemodialysis, dividing them into three groups according to the presence and type of shoulder pain. The 24 patients in group A, with spontaneous pain related to a supine posture, had been under haemodialysis for significantly longer than the others, and had a much higher incidence of carpal tunnel syndrome. Open or arthroscopic resection of the coracoacromial ligament in 21 shoulders relieved pain during haemodialysis and night pain, and histological examination showed amyloid deposits and inflammatory-cell infiltration in the subacromial bursa in almost all cases, and in the tenosynovium of the bicipital groove in some. We conclude that one type of shoulder pain experienced by patients on long-term haemodialysis is caused by the subacromial impingement of amyloid deposits. This should be distinguished from other types of shoulder pain, because it can be relieved by resection of the coracoacromial ligament.
THE AFFERENT PATHWAYS OF DISCOGENIC LOW-BACK PAIN
Authors: Nakamura S. , Takahashi K. , Takahashi Y. , Yamagata M. , Moriya H. 
Published: February 2018

The afferent pathways of discogenic low-back pain have not been fully investigated. We hypothesised that this pain was transmitted mainly by sympathetic afferent fibres in the L2 nerve root, and in 33 patients we used selective local anaesthesia of this nerve. Low-back pain disappeared or significantly decreased in all patients after the injection. Needle insertion provoked pain which radiated to the low back in 23 patients and the area of skin hypoalgesia produced included the area of pre-existing pain in all but one. None of the nine patients with related sciatica had relief of that component of their symptoms. Our findings show that the main afferent pathways of pain from the lower intervertebral discs are through the L2 spinal nerve root, presumably via sympathetic afferents from the sinuvertebral nerves. Discogenic low-back pain should be regarded as a visceral pain in respect of its neural pathways. Infiltration of the L2 nerve is a useful diagnostic test and also has some therapeutic value.
THE CERVICAL SPINE IN ATHETOID CEREBRAL PALSY
Authors: Harada T. , Ebara S. , Anwar M. M. , Okawa A. , Kajiura I. , Hiroshima K. , Ono K. 
Published: February 2018

We have reviewed the cervical spine radiographs of 180 patients with athetoid cerebral palsy and compared them with those of 417 control subjects. Disc degeneration occurred earlier and progressed more rapidly in the patients, with advanced disc degeneration in 51%, eight times the frequency in normal subjects. At the C3/4 and C4/5 levels, there was listhetic instability in 17% and 27% of the patients, respectively, again six and eight times more frequently than in the control subjects. Angular instability was seen, particularly at the C3/4, C4/5 and C5/6 levels. We found a significantly higher incidence of narrowing of the cervical canal in the patients, notably at the C4 and C5 levels, where the average was 14.4 mm in the patients and 16.4 mm in normal subjects. The combination of disc degeneration and listhetic instability with a narrow canal predisposes these patients to relatively rapid progression to a devastating neurological deficit.
MANAGEMENT OF PERTHES DISEASE OF LATE ONSET IN SOUTHERN INDIA
Authors: Joseph B. , Srinivas G. , Thomas R. 
Published: February 2018

We analysed the short-term outcome after varus osteotomy for Perthes’ disease in 48 older children from south-west India, comparing them with 30 historical controls. The children were between 7 and 12 years of age at the onset of the disease. All had stage-I or stage-II disease, with half or more of the epiphysis involved. The operated children had an open-wedge subtrochanteric varus osteotomy with derotation or extension and a trochanteric epiphyseodesis. Weight-bearing was avoided until late stage III. The non-operated children had been treated symptomatically by conservative methods. At the time of healing, 62.5% of the operated group had spherical femoral heads compared with 20% of those treated non-operatively (p < 0.001). Of the operated children with Catterall group-IV involvement, 48% had good results as against 24% of the non-operated group (p < 0.05). The percentage increase in the radius of the affected femoral head compared with the normal side was significantly lower in children who had operations (14.68 v 25.65; p < 0.001). We have shown that the short-term results of early surgical containment in children over seven years of age are satisfactory.
PERIPROSTHETIC BONE RESORPTION
Authors: Aspenberg P. , Herbertsson P. 
Published: February 2018

Using a rat model, we created a bone-to-titanium interface and applied phagocytosable high-density polyethylene pArticles between the bone and implant, either initially or when the interface had matured. No fibrous membrane developed and no bone resorption was found. If sliding movements were initiated at the interface after two weeks, there was formation of a fibrous membrane. The additional application of pArticles did not change the thickness of the membrane, and there were only minor qualitative changes. Creation of a membrane by movement followed by cessation of movement and the application of pArticles caused the membrane to persist, whereas in a pArticle-free control group bone-to-metal contact was re-established. Our findings suggest that mechanical stimuli are of primary importance for prosthetic loosening, and that pArticles may modulate the later stages of the loosening process.
INFLUENCE OF MATERIALS FOR FIXATION IMPLANTS ON LOCAL INFECTION
Authors: Arens S. , Schlegel U. , Printzen G. , Ziegler W. J. , Perren S. M. , Hansis M. 
Published: February 2018

Resistance to infection may be influenced by foreign bodies such as devices for fracture fixation. It is known that stainless steel and commercially-pure titanium have different biocompatibilities. We have investigated susceptibility to infection after a local bacterial challenge using standard 2.0 dynamic compression plates of either stainless steel or titanium in rabbit tibiae. After the wounds had been closed, various concentrations of a strain of Staphylococcus aureus were inoculated percutaneously. Under otherwise identical experimental conditions the rate of infection for steel plates (75%) was significantly higher than that for titanium plates (35%) (p < 0.05).
ARTHROSCOPIC RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT USING BONE-PATELLAR TENDON-BONE GRAFTS WITH AND WITHOUT AUGMENTATION
Authors: Grøntvedt T. , Engebretsen L. , Bredland T. 
Published: February 2018

In 100 consecutive patients with chronic deficiency of the anterior cruciate ligament we reconstructed the ligament using a bone-patellar tendon-bone autograft either with or without a Kennedy ligament augmentation device. The patients had an aggressive rehabilitation programme supervised by two physiotherapists. They were followed prospectively for at least two years by one surgeon, and assessed after six months and at one and two years. No significant functional or clinical difference was found between the two groups and the stability of the knees did not deteriorate with time in either group. The addition of a Kennedy ligament augmentation device gave no better results than the bone-patellar tendon-bone technique alone.
THROMBOPROPHYLAXIS AND DEATH AFTER TOTAL HIP REPLACEMENT
Authors: Murray D. W. , Britton A. R. , Bulstrode C. J. K. 
Published: February 2018

The recommendation that patients having a total hip replacement should receive pharmacological thromboprophylaxis is based on the belief that fatal pulmonary embolism is common, and that prophylaxis will decrease the death rate. To investigate these assumptions we performed a meta-analysis of all studies on hip replacement which included information about death or fatal pulmonary embolism. A total of 130 000 patients was included. The studies were so varied in content and quality that the results of our analysis must be interpreted with some caution. The fatal pulmonary embolism rate was 0.1% to 0.2% even in patients who received no prophylaxis. This is an order of magnitude lower than that which is generally quoted, and therefore the potential benefit of prophylaxis is small and may not justify the risks. To balance the risks and benefits we must consider the overall death rate. This was 0.3% to 0.4%, and neither heparin nor any other prophylactic agent caused a significant decrease. Our study demonstrates that there is not enough evidence in the literature to conclude that any form of pharmacological thromboprophylaxis decreases the death rate after total hip replacement. For this reason guidelines which recommend their routine use to prevent death after hip replacement are not justified.
LONG-TERM CLINICAL AND RADIOLOGICAL RESULTS OF THE LORD TOTAL HIP PROSTHESIS
Authors: Malchau H. , Herberts P. , Wang Y. X. , Kärrholm J. , Romanus B. 
Published: February 2018

We enrolled 98 patients (107 hips) with a mean age of 47 years (SD 8.6) into a prospective study of the Madreporic Lord THR; 34 hips had primary and 73 secondary osteoarthritis. After ten years, the survival rate using revision as the endpoint for failure was 70% (±9) for the cup and 98% (±0.3) for the stem. The combined clinical and radiological survival rates were 46% (±11) and 81% (±10), respectively. Osteoporosis due to stress-shielding was observed in the proximal femur. Hips with radiologically dense bone postoperatively showed the most pronounced bone loss. We recommend continued radiological follow-up of patients with this type of implant to allow revision to be performed before there is severe bony destruction of the pelvis.
DAMAGE TO THE SUPERIOR GLUTEAL NERVE AFTER THE HARDINGE APPROACH TO THE HIP
Authors: Ramesh M. , O’Byrne J. M. , McCarthy N. , Jarvis A. , Mahalingham K. , Cashman W. F. 
Published: February 2018

We studied prospectively 81 consecutive patients undergoing hip surgery using the Hardinge (1982) approach. The abductor muscles of the hip in these patients were assessed electrophysiologically and clinically by the modified Trendelenburg test. Power was measured using a force plate. We performed assessment at two weeks, and at three and nine months after operation. At two weeks we found that 19 patients (23%) showed evidence of damage to the superior gluteal nerve. By three months, five of these had recovered. The nine patients with complete denervation at three months showed no signs of recovery when reassessed at nine months. Persistent damage to the nerve was associated with a positive Trendelenburg test.
THE ORTHOPAEDIC IMPLICATIONS OF PERIPHERAL LIMB ISCHAEMIA IN INFANTS AND CHILDREN
Authors: Farrar M. J. , Bennet G. C. , Wilson N. I. L. , Azmy A. 
Published: February 2018

Peripheral limb ischaemia is rare in children. We have treated only 12 infants and children with this condition in the past 15 years at the Royal Hospital for Sick Children in Glasgow. There were nine neonates and three older children. Most were suffering from life-threatening illnesses or severe infection. Two were born with ischaemic arms with no apparent cause. We have analysed the factors leading to ischaemia, the outcome of the initial treatment and the later orthopaedic problems. Two required amputation of both legs, one of an arm, two of feet and one of toes. Two had skin grafts. All surgery was performed after demarcation was well established and delayed closure was used after amputation. Five children developed limb-length discrepancy or an angular deformity. To date two have required additional corrective surgery.
PHYSICAL EXAMINATION IS SUFFICIENT FOR THE DIAGNOSIS OF SPRAINED ANKLES
Authors: van Dijk C. N. , Lim L. S. L. , Bossuyt P. M. M. , Marti R. K. 
Published: February 2018

We studied the merits of physical examination after inversion injury of the ankle in 160 consecutive patients. They had an explanatory operation if they had a positive arthrogram and/or positive signs on a delayed physical examination. To determine the interobserver variation in delayed physical examination, five different examiners were asked to give independent assessment of the injury. Those with limited clinical experience produced more accurate results when physical examination was performed at five days after the injury, rather than within 48 hours. The specificity and sensitivity of delayed physical examination for the presence or absence of a lesion of an ankle ligament were found to be 84% and 96%, respectively. The interobserver agreement for the delayed physical examination of the ankle was good (kappa values 0.5, 0.6, 0.6 and 1.0). Delayed physical examination gives information of diagnostic quality which is equal to that of arthrography, and causes little discomfort to the patient.
ACCURACY OF INTRAMEDULLARY TEMPLATES IN FEMORAL AND TIBIAL RADIOGRAPHS
Authors: Krettek C. , Blauth M. , Miclau T. , Rudolf J. , Könemann B. , Schandelmaier P. 
Published: February 2018

The accuracy of templates used for the preoperative planning of the fixation of intramedullary fractures depends on radiological magnification. To study the accuracy of these templates, we randomly selected 100 femoral and 100 tibial radiographs taken after stabilisation by an intramedullary nail using a standard technique. We then compared the known nail length with the corresponding measurements on the radiographs. The mean magnification factor for the femur was 9% and for the tibia 7%; these differ considerably from the range of magnification of the manufacturers’ templates (femur, 15% to 17%; tibia 10% to 15%). We conclude that templates are unreliable for the selection of implant length and that this should be done by intraoperative measurements.
FREE VASCULARISED FIBULAR GRAFTING FOR RECONSTRUCTION AFTER TUMOUR RESECTION
Authors: Hsu R. W.-W. , Wood M. B. , Sim F. H. , Chao E. Y. S. 
Published: February 2018

We have reviewed 30 patients at a mean of 36 months after free vascularised fibular transfer to reconstruct massive skeletal defects after resection of primary bone tumours. There were 23 malignant and 7 benign neoplasms, half in the lower limb and half in the upper. Arthrodesis was performed in 15 and intercalary bone replacement in 15. The mean fibular graft length was 189 mm. Union was achieved in 27 (90%) at an average of 7.6 months, and the 3-year survival was 89%. There was a high complication rate (50%), but most resolved without greatly influencing the final outcome. There was local recurrence in two (6.7%), but 16 of the 24 assessed patients (67%) had satisfactory functional results. This is a reasonably effective means of reconstruction for limb salvage after resection of tumours.
FREE VASCULARISED FIBULAR STRUT GRAFT FOR ANTERIOR SPINAL FUSION
Authors: Minami A. , Kaneda K. , Satoh S. , Abumi K. , Kutsumi K. 
Published: February 2018

A vascularised fibular strut graft was used for anterior spinal fusion in 16 patients with spinal kyphosis. The procedure was abandoned in three because of difficulty in establishing a vascular anastomosis and in one because the grafted fibula dislodged two days after operation. One patient died after five days. Of the 11 remaining patients, there were seven males and four females. Their ages at the time of operation averaged 30.9 years (12 to 71). The number of vertebrae fused averaged 6.7 (5 to 9) and the length of fibula grafted averaged 10.9 cm (6.5 to 18). Average follow-up was 54 months (27 to 84). Bone union occurred at both ends of the grafted fibula in all 11 patients, with an average time to union of 5.5 months (3 to 8). We did not see a fracture of the grafted fibula. Two patients had postoperative complications; the graft dislodged in one and laryngeal oedema occurred two days after operation in the other. A vascularised fibular strut graft provides a biomechanically stable and long-standing support in spinal fusion because the weak phase of creeping substitution does not take place in the graft.
ISOKINETIC STRENGTH AFTER TEARS OF THE SUPRASPINATUS TENDON
Authors: Itoi E. , Minagawa H. , Sato T. , Sato K. , Tabata S. 
Published: February 2018

We measured the isokinetic strength of abduction, adduction, internal rotation, and external rotation in ten patients with full-thickness tears of the supraspinatus and ten with partial-thickness tears. The measurements were repeated after intra-articular or intrabursal injection of local anaesthetic. Pain blocks produced significant increases in strength in both full and partial-thickness tears. After the block, the strength in full-thickness tears compared with the opposite side was 67% to 81% in abduction and 67% to 78% in external rotation, both significantly smaller than those on the uninvolved side (p = 0.0064, p = 0.0170). In partial-thickness tears the strength after the block ranged from 82% to 111%, with no significant differences between the involved and uninvolved sides. The decreases in strength of 19% to 33% in abduction and 22% to 33% in external rotation after full-thickness tears appear to represent the contribution of supraspinatus to the strength of the shoulder.
PRIMARY CHARNLEY TOTAL HIP ARTHROPLASTY FOR CONGENITAL DYSPLASIA
Authors: Okamoto T. , Inao S. , Gotoh E. , Ando M. 
Published: February 2018

We performed Charnley total hip arthroplasties on 64 patients (71 hips) between 1976 and 1984 for moderate congenital acetabular dysplasia in which a superolateral cement thickness of less than 20 mm was expected when the cup was placed in the true acetabulum at an angle of 45°. Of these, 59 hips were examined 10 to 17 years after operation; 37 (group A) had been operated on between 1976 and 1982 using Charnley’s original technique of cementing the acetabulum and 22 (group B) between 1983 and 1984 using more modern techniques. In group A, aseptic loosening of the socket was observed in ten hips (27.0%) and the 17-year survival rate was 81.5%. In group B, loosening was noted in only one socket (4.5%) and the 13-year survival rate was 100%. The improved techniques produced significantly better long-term results in fixation of the cup in dysplastic hips without bone grafting.
HYDROXYAPATITE IN REVISION OF TOTAL HIP REPLACEMENTS WITH MASSIVE ACETABULAR DEFECTS
Authors: Oonishi H. , Iwaki Y. , Kin N. , Kushitani S. , Murata N. , Wakitani S. , Imoto K. 
Published: February 2018

Hydroxyapatite (HA) granules of 100 to 300 μm, 0.9 to 1.2 mm and 3.0 to 5.0 mm were mixed in a ratio of 10:45:45 and packed into massive bone deficiencies in revision operations for total hip arthroplasty. We did not use additional graft or cup support for deficiencies of the lateral and medial wall. The procedure was carried out in 40 hips between 1986 and 1992. The radiographic spaces seen at the interface between HA and bone immediately after surgery disappeared within three months. Some spaces appeared between HA granules near the bone in the lateral part of two joints, and three sockets migrated in patients with severe segmental and cavitary deficiencies. Direct bonding of HA to bone was observed radiologically without morphological changes, except in the three joints with migration. All patients could walk without pain but the three with definite loosening needed crutches.
CERAMIC-CERAMIC AND METAL-POLYETHYLENE TOTAL HIP REPLACEMENTS
Authors: Lerouge S. , Huk O. , Yahia L’H. , Witvoet J. , Sedel L. 
Published: February 2018

We made a semiquantitative study of the comparative histology of pseudomembranes from 12 loose cemented ceramic-ceramic and 18 metal-polyethylene total hip replacements. We found no significant difference in cellular reaction between the two groups, but there was a major difference in the origin of the particulate debris. In the metal-polyethylene group, polyethylene of articular origin was predominant, while in the ceramic-ceramic group the cellular reaction appeared to be a response to zirconia ceramic particles used to opacify cement used for fixation. Isolation and characterisation of the debris showed that the zirconia particles formed the greatest proportion (76%) in ceramic-ceramic hips, while alumina debris of articular origin formed only 12%. Our study has indicated that aseptic loosening of ceramic cups is not due to a response to debris generated at the articular interface, but to mechanical factors which lead to fragmentation of the cement.