bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of Bony Union following Surgical Stabilisation for Lumbar Spondylolysis: A Comparative Study between Radiography and Computed Tomography
Authors: Pai VS , Hodgson B 
Published: October 2016

Purpose. To compare the status of bony union seen on plain radiography versus computed tomography (CT) following tension band repair for refractory spondylolysis. Methods. 14 patients (12 men and 2 women; mean age, 23 years; age range, 16–56 years) with a mean follow-up period of 6.35 years were included. All patients were operated on by one senior surgeon using either a Scott procedure (n=2) or van Dam modification of the Scott procedure (n=12). Bony union of the pars was assessed using both plain radiography (anteroposterior, lateral, and oblique views) and reverse gantry CT. The presence of bony union was determined if a bridging bone was shown in the images. The Oswestry Disability Index was measured at 6-year follow-up. Results. 13 (93%) of 14 patients showed bony union on plain/oblique radiographs versus 7 (50%) on CT scan. The mean Oswestry Disability Index was 28 (good to excellent). The high incidence of nonunion shown on CT scanning did not correlate well with clinical results. Conclusion. Bony nonunion is more difficult to visualise on plain radiographs than reverse gantry CT. CT demonstrates more clearly the presence or absence of the bridging bone. Clinical results do not correlate with bony union, indicating that bony union is not required to achieve good results.
Basal Thumb Metacarpal Osteotomy for Trapeziometacarpal Osteoarthritis
Authors: Gwynne-Jones DP , Penny ID , Sewell SA , Hughes TH 
Published: October 2016

Purpose. To review the subjective and functional results of basal thumb metacarpal osteotomy for the treatment of trapeziometacarpal osteoarthritis. Methods. Between July 1993 and November 1998, 35 thumb osteotomies without internal fixation were performed on 33 patients in the Christchurch Hospital, New Zealand. Records of 28 thumbs (13 right and 15 left) of 26 patients (17 women and 9 men) were available for review. Patients were reviewed using strength testing and the Michigan Hand Outcomes Questionnaire. Results. The mean age of the 26 patients was 54 years (range, 30–69 years). Of the 28 thumbs, 22 (21 patients) had good or excellent results, 2 fair, one poor. The remaining 3 thumbs (3 patients) required further revision and were classified as failures. The mean follow-up period of the 25 thumbs (24 patients) not requiring revision was 34 months (range, 12–73 months). Good thumb motion was present in all hands with no trapeziometacarpal instability seen. Compared with the normative data, the strengths of key pinch, pulp pinch, and tripod pinch of our patients were significantly lower (22–32% lower), but not the grip strength. Michigan Hand Outcomes Questionnaire scores increased 28 (range, 1–56) points after surgery, with significant improvement especially in pain (+44 points), activities of daily living (one-handed tasks, +41 points), and satisfaction (+35 points). Conclusion. Basal thumb metacarpal osteotomy is a straightforward, conservative procedure that should be considered for grades II and III trapeziometacarpal osteoarthritis.
Effectiveness of Autologous Fibrin Tissue Adhesive in Reducing Postoperative Blood Loss during Total Hip Arthroplasty: A Prospective Randomised Study of 100 Cases
Authors: Mawatari M , Higo T , Tsutsumi Y , Shigematsu M , Hotokebuchi T 
Published: October 2016

Purpose. To evaluate the effectiveness of autologous fibrin tissue adhesive (auto-FTA) in reducing blood loss during cementless total hip arthroplasty (THA). Methods. From September 2000 to August 2001, 100 patients who predonated 400 ml of autologous blood were randomised to undergo either standard treatment with auto-FTA (auto-FTA group) or standard treatment alone (control group). The volume of postoperative blood loss and the decrease in haemoglobin level were measured. All patients were followed up for 3 years to evaluate the rate of bone ingrowth and heterotopic ossification. Results. The mean postoperative blood loss was 580 ml (standard deviation [SD], 240 ml) in the auto-FTA group and 810 ml (SD, 341 ml) in the control group; the difference was significant (230 ml, p<0.001). The decrease in haemoglobin concentration was 17 g/l (SD, 11 g/l) in the auto-FTA group and 22 g/l (SD, 12 g/l) in the control group. The difference was significant (5 g/l, p=0.03). The percentage of total blood loss of >1200 ml in any single patient was significantly lower in the auto-FTA group (4%) than in the control group (20%) [p=0.01]. Conclusion. Auto-FTA is a safe and effective means of reducing perioperative blood loss in THA.
Oldie but Goldie: Bristow-Latarjet Procedure for Anterior Shoulder Instability
Authors: Matthes G , Horvath V , Seifert J , Ptok H , Stengel D , Schmucker U , Ekkernkamp A , Hinz P 
Published: October 2016

Purpose. To analyse the functional and radiological outcomes of the Bristow-Latarjet procedure in patients with recurrent anterior glenohumeral instability. Methods. Records of 29 patients were reviewed retrospectively. Date of first dislocation, injury mechanism, and number of recurring dislocations before and after surgery were recorded. The overall function and stability of the shoulder was evaluated. Results. 24 (83%) of the glenohumeral instabilities were caused by trauma. The mean number of recurring dislocations was 8 (95% confidence interval [CI], 0–18); one patient had had 40 recurrences. No dislocation ensued postoperatively. The overall functional outcome was good, with a mean Rowe score of 90 points (95% CI, 78–100). Scores of 17 (59%) of the patients were excellent, 7 (24%) were good, 3 (10%) were fair, and 2 (7%) were poor. Conclusion. The Bristow-Latarjet procedure is a good surgical treatment for recurrent anterior-inferior instability of the glenohumeral joint.
Coronal Bowing of the Femur and Tibia in Chinese: Its Incidence and Effects on Total Knee Arthroplasty Planning
Authors: Yau WP , Chiu KY , Tang WM , Ng TP 
Published: October 2016

Purposes. To study the incidence of femoral or tibial bowing in the coronal plane in a Chinese population, and how it affects the accuracy of bone cuts for total knee replacement when an intramedullary alignment system is used. Methods. Standing radiographs of the entire lower limb of each patient with end-stage primary osteoarthritis of the knee were analysed. All radiographs were digitised and the extent of bowing in the coronal plane measured. A bowing was marked if an angulation was more than 2 degrees. The projected error of cutting was then calculated. Results. Of 93 lower limbs, 58 (62%) of the femurs had marked bowing in the coronal plane; 41 (44%) had a mean lateral bowing of 5.3 (standard deviation [SD], 3.2) degrees; 17 (18%) had a mean medial bowing of 4.4 (SD, 1.9) degrees. Marked tibial bowing in the coronal plane was less common (30 tibias, 32%). If a cutting error of more than 2 degrees was considered unacceptable, significantly more unacceptable cuts would ensue in the groups with marked bowing (p=0.003 for femurs and p<0.001 for tibia, respectively). Conclusion. The incidence of femoral or tibial bowing in the coronal plane was high in a Chinese population with end-stage osteoarthritis of the knee. This phenomenon may increase bone cut errors in total knee replacement if an intramedullary alignment system is used and the extent of bowing is not recognised.
Uncemented Primary Press-Fit Total Hip Arthroplasty: A 3 to 6 Years of Experience
Authors: Vidyadhara S , Rao SK 
Published: October 2016

Purpose. To analyse the 3 to 6 years' clinicoradiological outcome of 45 uncemented total hip arthroplasties performed in 37 patients using cementless Spotorno stem and St Nabor cup. Methods. The main indications for surgery were avascular necrosis of the femoral head and rheumatoid arthritis. Younger patients with good bone quality and a trumpet-shaped femur were eligible. A single surgeon performed all the operations using a posterolateral approach. Patients were reviewed at 6 weeks, 3 months, 6 months, and yearly thereafter. The clinical status was recorded using the Harris Hip Score. All radiographs were analysed by 2 independent blinded observers on 2 separate occasions. Results. The mean follow-up period was 49 months and the mean Harris Hip Score at the latest follow-up was 94. Osseointegration in the form of trabeculae running from the endosteum to the prosthesis surface along with tropism of the calcar was evident in 73% of the hips. None of the remaining hips showed any continuous radio-opaque lines suggestive of a lack of bone ongrowth. Patients with endosteal condensation had better Harris Hip Scores. Intra-operative stability of the implants could fairly predict outcome. Conclusion. Initial clinicoradiological results of uncemented total hip arthroplasty are promising in younger patients with good bone quality and a trumpet-shaped femur.
Delayed Onset of Deep Infection after Total Knee Arthroplasty: Comparison Based on the Infecting Organism
Authors: Joshy S , Gogi N , Thomas B , Mahale A , Singh BK 
Published: October 2016

Purpose. To identify the organisms causing delayed deep infection following primary total knee arthroplasty (TKA) and to compare the differences in outcome based on the infecting organism. Methods. Between the period April 1998 and March 2004 inclusive, patients presenting with delayed deep infection following primary TKA and/or those who underwent a salvage procedure (amputation or arthodesis) were retrospectively studied. Results. Organisms were isolated in 27 patients; 44% were methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. When the organism was resistant, the mean number of surgical procedures per patient was significantly higher and the proportion of patients with satisfactory outcomes was significantly lower. Conclusion. Deep infection with methicillin-resistant S aureus or S epidermidis is increasing. Strict infection control measures must be in place to combat such problems.
Periprosthetic Femoral Fractures Treated with a Modular Distally Cemented Stem
Authors: Zaki SH , Sadiq S , Purbach B , Wroblewski BM 
Published: October 2016

Purpose. To assess the treatment outcome of revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures using a modular distally cemented stem. Methods. 22 men and 14 women (37 hips) aged 66 to 79 (mean, 70) years underwent revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures. The indication for surgery was periprosthetic fracture with stem loosening and loss of proximal bone stock. The patients were referred from other hospitals after previous surgeries had failed: 8 with 3 previous surgeries, 19 with 2, and 9 with one. Using a transtrochanteric approach, the existing prosthesis was removed and a modular proximal femoral replacement stem was inserted, bypassing the area of proximal femoral fracture and bone loss. The stem was distally cemented. Patients were immobilised within 48 hours of surgery. Results. Patients were followed up for a mean of 14 (range, 8–18) years. The mean Harris hip score improved from 29 (range, 5–40) to 78 (range, 56–88); 24 patients attained excellent or good scores (>80), 10 attained fair, and 2 attained poor scores. The mean healing time was 7 (range, 6–14) months; there was no non-union. Improvement in proximal bone stock was noted on serial radiographs. None of the stems had cement fracture or migration, requiring revision. Two (5%) of the patients had dislocations. Conclusion. Vancouver type B3 periprosthetic femoral fractures can be successfully treated with a distally cemented modular proximal femoral replacement prosthesis.
The Effectiveness of Capsular Decompression for Internal Fixation of Intracapsular Hip Fractures
Authors: Wong TC , Yeung SH , Ip FK 
Published: October 2016

Purpose. To compare the results of screw fixation plus capsular decompression versus screw fixation alone for managing intracapsular hip fractures. Methods. Of 201 patients with intracapsular hip fractures, 99 underwent screw fixation with capsular decompression (capsular decompression group) and 102 underwent screw fixation alone (control group). The incidence and time to development of avascular necrosis of the femoral head, union rate, time to union, and other clinical parameters were compared. Results. In patients with displaced fractures, the incidence of avascular necrosis was significantly higher in the control than capsular decompression group, whereas the time to development of this complication was significantly shorter. Conclusion. Capsular decompression did not improve the union rate and time to union in undisplaced intracapsular hip fractures, but in displaced fractures it appeared to reduce the incidence and delay the onset of avascular necrosis.
Coracoclavicular Ligament Reconstruction Using a Gracilis Tendon Graft for Acute Type-III Acromioclavicular Dislocation
Authors: Law KY , Yung SH , Ho PY , Chang HT , Chan KM 
Published: October 2016

Purpose. To review the functional and radiological results of patients after coracoclavicular ligament reconstruction. Methods. Five patients aged 21 to 50 (mean, 37) years with acute Rockwood type-III acromioclavicular dislocation underwent coracoclavicular ligament reconstruction with autogenous gracilis tendon grafts. Patients were either active in sports or heavy manual workers. Assessments on shoulder function (using the Constant score), wound size, pain (using a visual analogue scale), and reduction (using radiographs of both acromioclavicular joints) were made. Results. The mean follow-up period was 26 (range, 15–43) months; the mean time to return to work or sports was 14 (range, 12–20) weeks. The mean Constant score was 94 (range, 90–98). The mean donor-site scar size was 3 cm and the mean pain score was 0. No major complication or donor-site morbidity was noted. There was one subluxation. Conclusion. Coracoclavicular ligament reconstruction using an autogenous gracilis tendon graft was safe in physically active patients having acute type-III acromioclavicular dislocation.
Intramedullary Fixation Using Multiple Kirschner Wires for Forearm Fractures: A Developing Country Perspective
Authors: Abalo A , Dossim A , Assiobo A , Walla A , Ouderaogo A 
Published: October 2016

Purpose. To evaluate treatment results of intramedullary fixation using multiple Kirschner wires for diaphyseal forearm fractures. Methods. Between January 2001 and January 2004, 184 patients (122 men and 62 women) with 288 displaced diaphyseal forearm fractures underwent intramedullary fixation using multiple Kirschner wires. The wires were inserted by opening the fracture site because radiographic facility for closed pinning was unavailable. The time to union, functional recovery, and the complication rates were assessed. Results. 11 patients were lost to follow-up, leaving 173 whose data was analysed. In 167 (97%) of the patients the fractures united, and in 14 (8%) of them union was delayed. The mean time to union for closed fractures was 13 (range, 7–16) weeks and for open fractures it was 15 (range, 12–22) weeks. The mean time in cast was 6 (range, 3–14) weeks. In all, 34/173 (20%) had complications: superficial infection (n=13), deep infection (n=4), cross-union between bones (n=4), open fracture ‘needing’ a skin graft (n=2), radial nerve palsy (n=3), paraesthesia (n=1), and non-union (n=7). Among the 173 analysed patients, the infection rate was 10% and the non-union rate was 4%. 130 (75%) of the patients had the wires removed; no re-fracture occurred after wire removal. Based on the Anderson criteria, 47 (27%) of the patients attained excellent, 78 (45%) satisfactory, and 39 (23%) unsatisfactory results. In 9 (5%) of the patients, union failed (7 plain non-union and 2 due to chronic osteomyelitis). Conclusion. Kirschner wires are much cheaper than plates and screws, and require minimal expertise for insertion and removal. They remain acceptable for stabilising displaced diaphyseal forearm fractures in developing countries.
Combined Pelvic Osteotomy for Deformed Dysplastic Acetabula: A 5-Year Prospective Study
Authors: Rejholec M 
Published: October 2016

Purpose. To assess clinical and radiological results of combined pelvic osteotomy (CPO) for deformed dysplastic acetabula. Methods. Nine girls and 3 boys, aged 28 to 54 months, underwent CPO (combination of innominate osteotomy and Lance acetabuloplasty) to restore both the original shape and the mal-alignment of the acetabulum. They were followed up for at least 5 years. Results. All patients attained concentric stable reduction with good acetabular cover. Conclusion. CPO corrected both deformed and dysplastic acetabula and prevented postoperative subluxation.
Comparative Biomechanical Study of Cervical Spine Stabilisation by Cage Alone, Cage with Plate, or Plate-Cage: A Porcine Model
Authors: Hakalo J , Pezowicz C , Wronski J , Bedzinski R , Kasprowicz M 
Published: October 2016

Purpose. To compare stability and subsidence associated with 3 types of cervical spine stabilisation. Methods. The C3 to C4 vertebrae of 28 Polish pigs were used. Pigs with intact vertebrae (group 1) underwent standard anterior cervical discectomy (group 2), followed by stabilisation using a cage alone (group 3), a cage with plate (group 4), or a plate-cage (group 5). Cervical spine stability and subsidence were compared in all 5 groups. Results. Stability was significantly increased after stabilisation by a cage with plate or a plate-cage, but not by a cage alone. The difference between stabilisation by a cage with plate and a plate-cage was not significant. Subsidence was maximal after the cage-alone stabilisation (3.1 mm), being 1.6 mm after the cage-with-plate and plate-cage stabilisations. Conclusion. Additional plating as a supplement to anterior interbody cervical cage stabilisation significantly improves segmental stability and subsidence.
Association of Intra-Operative Metaphyseal Fractures with Prosthesis Size during Hemiarthroplasty of the Hip
Authors: Barlas KJ , Ajmi QS , Bagga TK , Howell FR , Roberts JA , Eltayeb M 
Published: October 2016

Purpose. To study the possible causes of intra-operative metaphyseal fractures in elderly patients undergoing hemiarthroplasty for displaced intracapsular femoral neck fracture. Methods. 36 men and 228 women aged 61 to 89 years with 273 displaced femoral neck fractures underwent hemiarthroplasty using a hydroxyapatite ceramic–coated Furlong bipolar prosthesis. Anteroposterior and lateral radiographs were taken immediately after surgery to evaluate the presence and type of any intra-operative fractures (classified according to the Vancouver system) and their effect on stem stability or osseointegration. Pain and clinical outcomes were evaluated using a visual analogue scale and the Harris Hip Score. Results. Regarding the 273 surgeries for displaced femoral neck fracture, 28 (10%) were associated with intra-operative metaphyseal fracture (21 Vancouver type AL and 7 type AG). There was a correlation between intra-operative metaphyseal fractures and stem size. A size-9 stem was used in 64 surgeries without any fracture. A size-10 stem was used in 129 surgeries in which 11 (9%) sustained fractures, and a size-12 stem was used in 80 surgeries in which 17 (21%) sustained fractures. Postoperatively, 25 cases developed hip-related problems (thigh pain=14 and periprosthetic fractures=8) after 3 to 18 months. No patient whose metaphyseal fracture was fixed had hip problems. Conclusion. In elderly women with compromised bone quality, extra care is needed to achieve better fitting so as to avoid iatrogenic metaphyseal fractures. Under-sizing or cementing of the prosthesis is recommended when encountering difficulties.
Validation for the Reduced Western Ontario and McMaster Universities Osteoarthritis Index Function Scale
Authors: Whitehouse SL , Crawford RW , Learmonth ID 
Published: October 2016

Purpose. To assess the criterion validity, repeatability, and the missing value protocol of the reduced Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scale (‘reduced scale’). Methods. Three separate studies were performed: a cross-over study to compare the full- and reduced-scale scores in 66 UK patients for validity, a test-retest study for repeatability in 103 Australian patients, and a study for the missing value protocol of the reduced-scale questionnaire. Results. There was no significant difference between scores for the full- and reduced-scale questionnaires in both cross-over and test-retest studies. For the missing value protocol of the reduced-scale questionnaire, when 3 or more of the 7 items were missing, the patient's response was regarded as invalid and the sub-scale score was eliminated from further analysis; when 2 or fewer items were missing, the mean value of the sub-scale was substituted for the missing values. Conclusions. The reduced-scale questionnaire retains excellent validity and repeatability. Its use is recommended along with the original pain dimension in studies of total joint replacement.
Mini-Incision Dynamic Condylar Screw Fixation for Comminuted Subtrochanteric Hip Fractures
Authors: Rohilla R , Singh R , Magu NK , Siwach RC , Sangwan SS 
Published: October 2016

Purpose. To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures. Methods. 29 men and 14 women aged 25 to 65 (mean, 44) years with comminuted subtrochanteric femoral fractures underwent indirect reduction and mini-incision DCS fixation. Fractures were classified according to the AO classification (10 type 32B and 33 type 32C) and Seinsheimer classification (6 type III, 15 type IV, and 22 type V). Functional outcomes were assessed using the Harris hip score and Merle d'Aubigne score. Results. The mean time to full weight bearing was 11 (range, 8–19) weeks. The mean time to union was 16 (range, 13–22) weeks. There were no cases of non-union or implant failure after a mean follow-up period of 25 (range, 18–30) months. Seven patients had a mean limb length discrepancy of 1.5 (range, 1–2) cm. Two patients had coxa vara and persistent limp. According to the Harris hip score, functional results were excellent in 12 and good in 31 patients. The mean Harris hip score was 88 (range, 80–99) and the mean Merle d'Aubigne score was 17 (range, 14–18). There was no deep infection or avascular necrosis of the femoral head. Restriction of knee flexion beyond 90 degrees was noted in 2 patients. Conclusion. Results of indirect reduction and mini-incision DCS fixation for comminuted subtrochanteric femoral fractures are favourable. Proper planning and execution of the technique is required to achieve good functional outcomes and avoid complications. Preservation of vascularity of the medial fragments leads to rapid callus formation and early union and hence avoids implant failure and secondary bone grafting.
Computed Tomography–Guided Radiofrequency Ablation of Osteoid Osteomas
Authors: Khan SA , Thulkar S , Shivanand G , Kumar A , Varshney MK , Yadav CS , Rastogi S , Sharma DN 
Published: October 2016

Purpose. To report on 14 patients with osteoid osteomas treated by computed tomography–guided radiofrequency ablation. Methods. Nine males and 5 females aged 13 to 45 (mean, 25) years with osteoid osteomas were included. The proximal tibia was the commonest site involved. A bipolar 18-gauge radiofrequency probe with a 9-mm active tip was used. A 4.5-mm hollow drill was introduced into the nidus. Energy application was started at 2 W and increased to a maximum of 5 W. Heat was applied for 4 to 6 minutes at 90 degrees Celsius. Results. 12 (86%) of the 14 patients had prompt pain relief; the remaining 2 underwent a repeat ablation. After a mean follow-up period of 19 (range, 9–25) months, no patient had pain recurrence. Conclusion. Radiofrequency ablation is a minimally invasive and cost-effective treatment for osteoid osteomas.