bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medial Arch Orthosis for Paediatric Flatfoot
Authors: Sinha Shivam , Song Hae Ryong , Kim Hak Jun , Park Man Sik , Yoon Yeoung Chool , Song Sang Heon 
Published: October 2016

Purpose. To evaluate any correlation between various foot angles and their respective American Orthopaedic Foot and Ankle Society (AOFAS) scores for pain, and the effectiveness of a medial arch orthosis. Methods. 81 children with bilateral symptomatic flatfoot were randomised into orthosis (n=55) and control (n=26) groups. The orthosis group consisted of 33 male and 22 female patients aged 36 to 204 (mean, 99) months and they were given a medial arch support. The control group consisted of 15 male and 11 female patients aged 36 to 192 (mean, 100) months and they were managed with analgesics. Foot angles including anteroposterior (AP) and lateral talocalcaneal (TC) angles, AP and lateral talo–first metatarsal (TFM) angles, calcaneal pitch angle (in lateral plane), and talonavicular (TN) angle were measured, as were AOFAS scores for pain for the forefoot, midfoot, and hindfoot. Results. After orthosis treatment, all AOFAS scores and all foot angles (except for the AP-TN angle) improved significantly. In the controls, all AOFAS scores (except for the midfoot score) and only the AP-TFM angle improved significantly. In the orthosis group, the AOFAS hindfoot score correlated positively with the lateral TC angle of the left foot ( r=0.345, p=0.010) and negatively with the calcaneal pitch angle of the right foot ( r=–0.33, p=0.015). In the control group, the lateral TFM angle of the left foot correlated negatively with the AOFAS forefoot ( r=–0.566, p=0.003) and midfoot scores ( r=–0.497, p=0.001), whereas the calcaneal pitch angle of the left foot correlated positively with the AOFAS forefoot score ( r=0.497, p=0.010). Conclusion. Medial arch support orthosis significantly improved AOFAS scores and foot angles. Calcaneal pitch angle and lateral TC angle correlated well with AOFAS hindfoot scores.
Calamine Lotion to Reduce Skin Irritation in Children with Cast Immobilisation
Authors: Mak May Fong , Li Wenyun , Mahadev Arjandas 
Published: October 2016

Purpose. To evaluate the effect of calamine lotion in reducing skin irritation in children with cast immobilisation and to identify factors correlating with skin irritation. Methods. 250 children aged 6 to 15 years who underwent cast immobilisation for limb fractures were assigned into calamine (n=122) and noncalamine (n=128) groups. Data were collected at the time the cast was applied and removed. Potential confounders (gender, age, race, medical history, drug allergy, cast type, duration of casting, and extent of itch prior to casting) were identified. Each patient graded his levels of itch, sweat, and heat using a 5-point scale (with 5 indicating most severe). The on-duty plaster technician recorded the presence and type of skin lesions (blisters, wounds, or others) during cast removal. Results. Children in the calamine group were less likely to develop skin lesions (1 vs. 9, odds ratio [OR]=0.115, p=0.009), had less itch during casting (mean difference=0.74, p<0.0001), had a greater decrease in the itch level (mean difference=0.84, p<0.0001), and had lower sweat levels (p=0.048). After adjusting for confounders, the chance of developing skin lesions remained lower in the calamine group (OR=0.063, p=0.003). Being an older child and having shorter duration of casting were associated with presence of skin lesions. The odds for having skin lesions increased by 39.2% per year increase in age (OR=1.392, p=0.04) and decreased by 9.4% per day increase in casting duration (OR=0.906, p=0.03). The decrease in itch level remained significantly greater in the calamine group after adjusting for confounders (p<0.0001). Conclusion. Calamine lotion may reduce skin irritation in children with full casts.
A 45-Degree Radiographic Method for Measuring the Neck Shaft Angle and Anteversion of the Femur: A Pilot Study
Authors: Teo Pock Chin , Mohd Kassim Abdul Yazid , Thevarajan K 
Published: October 2016

Purpose. To propose a novel method to measure the neck shaft angle and anteversion of the femur using anteroposterior and 45° oblique radiographs. Methods. Three human subjects were used to verify the 45° oblique method. The true neck shaft angle and anteversion of the femur were determined using computed tomography. The true values were compared with the values derived by the 45° oblique method after correcting the distortion using a formula. Results. With the true values based on computed tomography as references, the neck shaft angle and anteversion of the 3 subjects deviated +0.82° to +4.66° and −2.14° to +2.55° in lateral 45° oblique radiographs, respectively, whereas the corresponding values in medial 45° oblique radiographs were +0.98° to +5.93° and −10.09° to +1.58°. The lateral 45° oblique method resulted in smaller range of deviation and were more accurate. Conclusion. This 45° oblique method is useful in surgical planning, especially for femoral derotational osteotomy in children. This new method enables easy calculation of the true neck shaft angle and anteversion, with low radiation exposure.
Time Required for Effective Action of Phenol against Giant Cell Tumour Cells
Authors: Nithyananth Manasseh , Priscilla Anne Jennifer , Boopalan PVJRC , Titus VTK , Lee Vernon N 
Published: October 2016

Purpose. To evaluate the time required for effective action of phenol against the giant cell tumour (GCT) cells. Methods. Fresh GCT cells were harvested from 9 patients with primary GCT of the distal femur (n=4), proximal tibia (n=4), and proximal humerus (n=1), with the Campanacci tumour grades 3 (n=6), 2 (n=2), and 1 (n=1). Specimens were immersed in 80 % phenol for one, 3, 6, and 10 minutes, and were assessed by a single pathologist for irreversible cell death and the depth of phenol penetration. Results. Phenol caused consistent GCT cell death in 6 of the 9 specimens after 3 minutes and in all 9 specimens after 6 minutes, compared to none in controls (p<0.0001). The mean depths of phenol penetration were 15 (range, 11–20) and 19 (range, 15–25) cell thickness after 6 and 10 minutes, respectively (p<0.0001). Conclusion. GCT cells immersed in 80% phenol for 6 minutes resulted in consistent cell death.
Risk Factors for Recurrence of Giant Cell Tumours of Bone
Authors: Siddiqui Mashfiqul A , Seng Chusheng , Tan Mann Hong 
Published: October 2016

Purpose. To determine the risk factors for recurrence of giant cell tumours (GCTs) of bone. Methods. Medical records of 29 men and 29 women (mean age, 34 years) treated for primary (n=53) or recurrent (n=5) GCTs of bone and followed up for a mean of 40.2 months were reviewed. The tumours were located in the distal femur (n=18), proximal tibia (n=10), proximal femur (n=8), distal radius (n=7), proximal fibula (n=4), distal ulna (n=3), calcaneum (n=3), sacrum (n=2), vertebra (n=1), metatarsal (n=1), and distal humerus (n=1). 26 patients had pathological fractures, 12 had cortical break, and 20 had neither. The Campanacci grades of the tumours were I (n=1), II (n=18), and III (n=33); the grades of the remaining 6 tumours were unknown because radiographs were unavailable. The Enneking stages of the tumours were 1 (n=51), 2 (n=6), and 3 (n=1). Treatment included curettage and cementation (n=29), curettage, cementation, and adjuvant treatment with distilled water or liquid nitrogen for bones without fracture (n=18), wide resection for extensive soft tissue involvement (n=9), and amputation (n=2) for a recurrent GCT of the distal femur and a primary GCT of the calcaneus. Reconstruction included cementation (n=27), bone grafting (n=7), cementation/bone grafting with internal fixation (n=14), reconstruction with endoprosthesis (n=3), and none (n=7). Results. 19 patients had recurrence after a mean of 23.1 months. The overall recurrence-free survival at years 1, 2, and 3 were 86%, 79%, and 72%, respectively. Recurrence did not correlate with patient age (p=0.20), primary or recurrent tumour at presentation (p=0.12), Campanacci grade (p=0.10), Enneking stage (p=0.54), or presence of pathological fracture (p=0.28). Compared to GCTs at other locations, GCTs in the proximal tibia were more likely to recur (27% vs. 60%, p=0.04). Conclusion. GCTs of the proximal tibia are more likely to recur than those at other locations.
Histological Changes and Neural Elements in the Posterior Cruciate Ligament in Osteoarthritic Knees
Authors: Rajgopal Ashok , Vasdev Nandini , Pathak Abhishek , Gautam Dheeraj , Vasdev Attique 
Published: October 2016

Purpose. To evaluate histological changes and neural elements in 100 posterior cruciate ligaments (PCLs) in patients with osteoarthritis. Methods. 100 PCLs were obtained from a consecutive series of 46 women and 16 men aged 49 to 91 (mean, 67) years who underwent primary PCL-retaining total knee replacement for osteoarthritis. Histology was examined using conventional light microscopy. The PCLs were graded histologically in terms of parallel orientation of collagen fibres, mucoid degeneration, inflammation, and haemosiderin deposition. Histological changes were graded as normal, mild degeneration, moderate degeneration, and severe degeneration. The neural elements were assessed using immunohistochemical staining for S100 protein and neurofilaments. The histopathologist was blinded to the age, gender, and clinical and radiological grades of osteoarthritis. Results. One specimen was excluded from analysis owing to inadequate tissue. In the remaining 99 specimens, histology was normal in 72, mildly degenerative in 4, moderately degenerative in 4, and severely degenerative in 15. 76 specimens were positive for S100 protein or neurofilament or both by immunohistochemical staining, indicating the presence of neural elements. Conclusion. Most knees with osteoarthritis present with viable PCLs. Retaining the PCL in total knee replacement is a good option for better kinematics, stability, and proprioception.
Comparison of Two Pressurisers for Cementation of the Proximal Femur
Authors: Morishima Takkan , Choy Godwin GH , Crawford Ross W , Wilson Lance J 
Published: October 2016

Purpose. To compare pressures generated by 2 different cement pressurisers at various locations in the proximal femur. Methods. Two groups of 5 synthetic femurs were used, and 6 pressure sensors were placed in the femur at 20-mm intervals proximally to distally. Cement was filled into the femoral canal retrogradely using a cement gun with either the half-moon pressuriser or the femoral canal pressuriser. Maximum pressures and pressure time integrals (cumulative pressure over time) of the 2 pressurisers were compared. Results. At all sensors, the half-moon pressuriser produced higher maximum pressures and pressure time integrals than the femoral canal pressuriser, but the difference was significant only at sensor 1 (proximal femur). This may result in reduced cement interdigitation in the proximal femur. Conclusion. The half-moon pressuriser produced higher maximum cementation pressures and pressure time integrals than the femoral canal pressuriser in the proximal femur region, which is critical for rotational stability of the implant and prevention of implant fracture.
Polarus Nail Fixation for Proximal Humeral Fractures
Authors: Fazal MA , Baloch Irshad , Ashwood N 
Published: October 2016

Purpose. To report the outcomes of Polarus nail fixation for displaced proximal humeral fractures. Methods. Medical records of 19 men and 27 women aged 26 to 84 (mean, 63) years who underwent fixation using a standard Polarus nail (n=34) or Polarus plus nail with shaft extension (n=12) for proximal humeral fractures of 2 and 3 parts (n=34) and 2-part with extension to the shaft (n=12) were reviewed. Fracture union, neck shaft angle, and hardware complications were evaluated using radiographs. Outcomes were assessed using the Constant score, the visual analogue scale for pain, and subjective satisfaction. The range of motion, grip strength, and ability to return to work were also recorded. Results. The mean follow-up was 20 (range, 15–28) months. The mean humeral neck shaft angle was 137.2°.44 (96%) patients achieved fracture union after a mean of 14 (range, 11–16) weeks. Two patients with 3-part fractures did not unite; one of them underwent hemiarthroplasty and the other consented for nail removal only. Complications included temporary radial nerve palsy (n=2), impingement symptoms caused by the prominent metal work (n=10), and missing of the proximal screws in the nail (n=4). Respectively in patients aged ±60 (n=15) and ⩾60 years (n=31), the mean Constant scores were 79 and 67 (p=0.04). The mean pain score improved from 93 to 15.5 at 12 months. 16 patients were very satisfied, 22 were satisfied, and 8 were not satisfied with the outcome. Of the latter, 3 were aged ±60 years and 5 were aged ⩾60 years. Conclusion. Polarus nail fixation for displaced proximal humeral fractures achieved good fracture union and satisfactory functional outcome, particularly in younger patients and those in active employment, but elderly dependent patients tended to have poor functional results. The rates of minor hardware problems and non-union in 3-part fractures were relatively high.
Modified Weaver-Dunn Procedure versus the Use of a Synthetic Ligament for Acromioclavicular Joint Reconstruction
Authors: Kumar Vinod , Garg Sunil , Elzein Lhab , Lawrence Tom , Manning Paul , Wallace W Angus 
Published: October 2016

Purpose. To compare the subjective outcome of acromioclavicular joint (ACJ) reconstruction using the modified Weaver-Dunn procedure versus the Surgilig synthetic ligament. Methods. 55 patients aged 19 to 72 (mean, 42) years underwent ACJ reconstruction of Rockwood grade 3 (n=38), grade 4 (n=8), and grade 5 (n=9) using the modified Weaver-Dunn procedure (n=31) or the Surgilig synthetic ligament (n=24), based on the surgeon's preference. The mean period from injury to surgical treatment was 39 months. Subjective outcomes were assessed before and after surgery using the Oxford Shoulder score and Nottingham Clavicle score. The time required to return to work and sports was also recorded. Results. After a mean follow-up period of 40 months, the mean Oxford Shoulder scores improved from 28 to 42 in the Weaver-Dunn group (p=0.009), and from 26 to 45 in the Surgilig group (p=0.007), whereas the respective mean Nottingham Clavicle scores improved from 53 to 81 (p=0.047) and from 51 to 93 (p=0.023). The Surgilig group achieved significantly better postoperative Oxford Shoulder score (p=0.008) and Nottingham Clavicle score (p=0.007), and could also return to work (14 vs. 6 weeks, p±0.001) and sports (25 vs. 12 weeks, p±0.001) sooner than the Weaver-Dunn group. Three patients in the Weaver-Dunn group and one patient in the Surgilig group had persistent pain and/or functional deficit with evidence of ACJ dislocation. Conclusion. Chronic ACJ reconstruction using the Surgilig synthetic ligament achieved better Oxford Shoulder score and Nottingham Clavicle score and earlier return to work and sports, compared with the modified Weaver-Dunn procedure.
Outcome of Fixation for Nonunion of Extremities
Authors: Niikura Takahiro , Lee Sang Yang , Sakai Yoshitada , Nishida Kotaro , Kuroda Ryosuke , Kurosaka Masahiro 
Published: October 2016

Purpose. To review the outcomes of 102 consecutive patients who underwent fixation for nonunion of extremities. Methods. Medical records of 71 men and 31 women aged 16 to 82 (mean, 45; standard deviation [SD], 19) years who underwent fixation for nonunion of the upper (n=31) and lower (n=71) extremities were reviewed. The nonunion types included oligotrophic (n=47), hypertrophic (n=22), atrophic (n=17), defect (n=12), and comminuted (n=4). 13 of the nonunions were infected. 10 patients had concomitant injuries of the brain (n=2), abdomen (n=5), chest (n=1), and spine (n=2). 43 patients were smokers, and 19 had diabetes mellitus. 80 patients had had previous surgery, and 3 had undergone previous radiotherapy. The mean time from injury to nonunion surgery was 19 (SD, 25.6; range, 6–180) months. Outcome measures included bone union, ability to return to original work, pain, gait, and loss of range of motion. Results. The mean follow-up period was 26.6 (SD, 19.9; range, 8–121) months. 100 patients achieved bone union. 83 of them achieved bone union after a single surgery in a mean of 5.6 (SD, 2.9) months. The remaining 17 patients underwent multiple surgeries, 13 of whom had infected nonunions. Two patients did not achieve bone union. Of 64 patients who had work, 47 returned to their original work and 17 did not. Outcome was unsatisfactory in 5 patients who had persistent pain and/or no improvement in gait. Conclusion. Bone union is not necessarily associated with adequate recovery of function.
Rate of Venous Thromboembolism after Complex Lower-Limb Fracture Surgery without Pharmacological Prophylaxis
Authors: Niikura Takahiro , Sakai Yoshitada , Lee Sang Yang , Iwakura Takashi , Kuroda Ryosuke , Kurosaka Masahiro 
Published: October 2016

Purpose. To evaluate the rate of venous thromboembolism (VTE) after complex lower-limb fracture surgery without pharmacological prophylaxis. Methods. Between July 2005 and April 2009, 11 men and 6 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 3 femoral and 20 tibial fractures. Patients were screened for VTE using contrast-enhanced computed tomography (CT) when the D-dimer value was beyond normal range. Between May 2009 and December 2012, 18 men and 4 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 8 femoral and 20 tibial fractures. Patients were routinely screened for deep vein thrombosis (DVT) using ultrasonography and for pulmonary embolism (PE) using contrast-enhanced CT (in high-risk patients with multiple injuries or pelvic and acetabular fractures). In both groups, pharmacological prophylaxis was not used; only mechanical prophylaxis was used. Results. The 2 groups were comparable in terms of age, sex, and proportion of bilateral external fixation, open fracture, and associated injury, except that the duration of external fixation was longer in the early group (29.8±28.0 vs. 11.6±4.0 days, p=0.001). Of the 17 patients in the early group, 5 developed VTEs (3 DVTs and 2 PEs) at a mean of 13.6 (range, 6–20) days after injury; 2 of whom developed VTE during the external fixation period. Of the 22 patients in the later period, 10 developed VTEs (10 DVTs and 4 PEs) at a mean of 13 (range, 5–33) days after injury; 7 of whom developed VTE during the external fixation period. Conclusion. The rate of VTE was high in patients undergoing complex lower-limb fracture surgery without pharmacological prophylaxis.
Complete Blood Count before and after Total Hip or Knee Arthroplasty
Authors: Jagow Devin M , Yacoubian Shahan V , Yacoubian Stephan V 
Published: October 2016

Purpose. To validate our transfusion protocol based on pre- and post-operative complete blood count (CBC) data in patients undergoing primary total hip or knee arthroplasty (THA or TKA). Methods. Records of 113 men and 205 women aged 32 to 94 (mean, 70) years who underwent primary uncemented THA (n=123) or cemented TKA (n=195) for osteoarthritis by 2 senior surgeons were reviewed. A post-surgical drain was used in 29 THA patients and 74 TKA patients, based on the surgeon's preference. CBC was assessed preoperatively, during postanaesthesia care, and at the beginning of postoperative days 1, 2, and 3 to determine their predictive power for transfusion rate. According to our transfusion protocol, blood was transfused when the haemoglobin (Hb) level was <80 g/l, or when hypotension, tachycardia, light-headedness, dizziness, or syncope occurred. Results. Respectively in 123 and 195 patients who underwent THA and TKA, the transfusion rates within 3 days were 31.7% (n=39) and 25.6% (n=50). No patient required transfusion during postanaesthesia care; the transfusion rates of all patients during day 1 to day 2 and day 2 to day 3 were 15.1% (n=48) and 12.9% (n=41), respectively. The transfusion rate was higher in women than men (36.6% vs. 12.4%, p<0.001), but did not differ significantly in patients with or without a post-surgical drain (29.1% vs. 27.4%, p=0.754). Respectively for the Hb level of <130 g/l, 130–150 g/l, and >150 g/l, the overall transfusion rates were 48.5%, 22.0%, and 4.3% based on the preoperative level; 32.6%, 7.6%, and 0% based on the postanaesthesia care level; and 28.9%, 8.3%, and 0% based on the day 1 level. The predictive power of the preoperative Hb level was highest, followed by that during postanaesthesia care and the on day 1. Conclusion. CBC during postanaesthesia care is no more predictive than preoperative CBC. Preoperative optimisation and close monitoring of the Hb level from day 1 to day 3 is recommended.
Relationship among Cervical, Thoracic, and Lumbopelvic Sagittal Alignment in Healthy Adults
Authors: Endo Kenji , Suzuki Hidekazu , Sawaji Yasunobu , Nishimura Hirosuke , Yorifuji Makiko , Murata Kazuma , Tanaka Hidetoshi , Shishido Takaaki , Yamamoto Kengo 
Published: October 2016

Purpose. To evaluate the association between cervical sagittal alignment and thoracic/lumbopelvic sagittal alignment in healthy Japanese adults. Methods. 30 male and 22 female healthy adults aged 22 to 50 years were recruited. Spinal parameters were measured on radiographs, including the cervical sagittal vertical axis, sagittal vertical axis, C7 tilt angle, Ishihara index for cervical lordosis, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence. Results. The C7 tilt angle positively correlated with the Ishihara index ( r=0.52, p<0.0001) and thoracic kyphosis ( r=0.53, p<0.0001). The Ishihara index positively correlated with thoracic kyphosis ( r=0.34, p=0.01) and C7 tilt angle ( r=0.52, p<0.0001). Pelvic incidence positively correlated with sacral slope ( r=0.45, p=0.001), lumbar lordosis ( r=0.26, p=0.07), and pelvic tilt ( r=0.29, p=0.03). Compared with men, women had a smaller Ishihara index (0.07 vs. 0.001, p=0.03), thoracic kyphosis (30.5° vs 24.1°, p=0.02), and C7 tilt angle (23.1° vs. 16.8°, p=0.02). Women had less cervical lordosis and thoracic kyphosis, that is, a straighter cervico-thoracic sagittal alignment. Conclusion. In healthy Japanese adults, cervical sagittal alignment is associated with thoracic sagittal alignment but not with lumbopelvic alignment.