bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interlaminar Discectomy and Selective Foraminotomy in Lumbar Disc Herniation
Authors: Garg Manish , Kumar Sudhir 
Published: October 2016

Our objective was to assess the clinical outcome of interlaminar discectomy in patients suffering with degenerated lumbar disc lesions. We made a prospective study of 50 consecutive patients who underwent limited lumbar discectomy. The clinicoradiological parameters, type of surgery performed and the post-operative follow up were assessed. We found that interlaminar discectomy without laminotomy was adequate in 33 cases (66%). Most patients requiring laminotomy (17 cases −34%) for discectomy had associated lumbar canal stenosis, herniation at proximal levels (L3–4) and/or sacralization of L5 vertebra. Selective foraminotomy in addition to discectomy was performed in 28 cases (56%). The post-operative results were good in 43 (86%) fair in 6 (12%) and poor subjective in 1 case (2%). No patient was classified as poor objective. In conclusion, interlaminar discectomy without laminotomy is a safe, effective and reliable surgical technique for treating properly selected patients with herniated lumbar disc at L4–5 and L5–S1 levels.
Retrograde Femoral Interlocking Nail in Complex Fractures
Authors: Anup Khare , Mehra M. M. 
Published: October 2016

Retrograde interlocking nail was used as the method of fixation in 35 different cases of combination of complex femoral fractures. We performed this procedure in fractures of femoral shaft associated with fracture neck femur, pathological fractures of proximal third of femur with trochanteric pathology, ipsilateral fracture of femur and tibia in polytrauma cases with multiple other injuries, in highly obese patients with fracture shaft femur. This technique was also used in cases of pregnancy with fracture shaft femur and in unstable pelvic fracture or dislocation hip associated with fracture shaft femur. Operative technique involved with retrograde insertion of un-reamed, non-cannulated custom made nail through entrance portal in intercondylar notch was applied for fixation of the shaft femur fracture. The other associated fracture around hip was stabilized separately using suitable implant according to type of fracture. In cases of ipsilateral fracture of femur and tibia, femur was stabilized by retrograde interlocking nail and tibia was stabilized by antigrade interlocking nail through same incision at the same sitting. The case was followed up for three years; the average union time was 12 to 18 weeks. Out of 35 cases, 31 cases regained full knee movement. Out of the remaining 4 cases, 2 cases could regain up to 90° of movement, these were old fractures and noncooperative patients. In one case, patellofemoral arthritis was developed because of an operative error where a nail was not put inside the articular surface. Mal-union was observed in an early case of the series and implant failure was nil. Retrograde interlocking nail was used as the method of fixation in complex fracture problems. Multiple fractures of long bones can be stabilized in one stage, preventing multiple operations at different stages in polytraumatized patients. This resulted in early recovery, lesser hospital stay, and early rehabilitation of patient with good results and is economical also.
Local Osteopenia Associated with Management of Intra-Articular Distal Radial Fractures by Insertion of External Fixation Pins in the Distal Fragment: Prospective Study
Authors: Mehta JA , Slavotinek JP , Krishnan J 
Published: October 2016

Purpose. To assess the restoration of the bone mass of the distal radius following the use of implants in the distal radial fragment. Highly comminuted Frykman type 7 and 8 fractures were studied to determine whether the use of fixation pins in the comminuted distal radial fragment leads to osteopenia in the distal radial fragment after healing of the fracture. Methods. As part of a clinical trial, 30 patients with comminuted intra-articular fractures of the distal radius were treated with closed reduction, external non-bridging fixation, and early postoperative mobilisation. To detect local osteopenia, bone density measurements were taken at the distal metaphysis and mid-diaphysis following healing of the fractured radius and the contralateral unaffected radius in 12 patients. Results. The mean age of the 12 patients for whom bone density measurements were recorded was 52.5 years (range, 39–87 years). There were 9 females and 3 males included in the study. Seven patients had a Frykman type 8 fracture and 5 patients had a Frykman type 7 fracture. Significant osteopenia was absent despite the use of four 2.5-mm fixation pins in the distal fragments of the healed distal radial fracture. The median value of the maximal step was 2.8mm (range, 0–9.1mm). The median value of the intra-articular interfragmentary gap was 1.8 mm (range, 0–13.4mm). Conclusion. The findings of this study do not suggest long-term osteopenia following the use of four 2.5-mm pins in the distal fragments. The non-bridging fixator, by allowing early physical activity, possibly led to satisfactory functional and structural results.
Use of Reconstruction Nails to Manage Ipsilateral Displaced Femoral Neck-Shaft Fractures: Assessment of a New Approach
Authors: Lin SH , Lo CW , Cheng SC , Kuo MY , Chin LS 
Published: October 2016

Purpose. Owing to unpredictable femoral neck reduction, reconstruction nails are not suitable for fixation of group 3 ipsilateral femoral neck-shaft fractures. We developed a new one-step fixation technique to overcome this problem. This study aims to assess this new technique at the Orthopaedic Department, Chi-Mei Foundation Medical Center, Tainan. Methods. Of 31 consecutive patients with femoral fractures treated by reconstruction nails, five patients had group 3 ipsilateral femoral neck-shaft fractures, 4 of whom were treated by a new surgical technique. Two 5.0-mm drills were firstly inserted to tether the trochanter fragment, and distal locking screws were secondly applied to immobilise the shaft fracture. The neck-shaft angle was then restored in a closed fashion and proximal cephalomedullary screws were attached. Patients were followed up by post-operative radiography. Results. All 5 cases of group 3 ipsilateral femoral -neck-shaft fracture obtained radiographic union without significant surgical sequelae. Three of the patients had implants removed. No patients presented with osteonecrosis at the 3-year follow-up. Conclusion. The new approach to manage ipsilateral femoral neck-shaft fractures by using reconstruction nails obtains relatively good clinical results.
Use of Wagner Cementless Self-Locking Stems for Massive Bone Loss in Hip Arthroplasty
Authors: Lyu SR 
Published: October 2016

Purpose. To assess the use of Wagner cementless self-locking stems for massive bone loss in hip arthroplasty. Methods. 22 patients with severe proximal femoral bone loss either due to prosthetic loosening or comminuted fracture were treated by Wagner cementless self-locking revision stems between November 1993 and June 1995. Results. Radiographic evidence of early bony incorporation was found by 1 month in most cases. At a mean follow-up of 7.1 years, the mean Harris hip score increased from 30 to 84 points. It was less than 80 points in 4 patients, 2 of whom experienced severe thigh pain due to marked progressive subsidence of the stems (by 13 mm and 20 mm), which were revised 2 and 3 years later respectively. Conclusion. Implantation of a Wagner cementless self-locking revision stem provided satisfactory results for 82% of patients. Hence, in some difficult conditions, this device is a good choice of management.
The Relationship between Nerve Conduction Study and Clinical Grading of Carpal Tunnel Syndrome
Authors: Ogura T , Akiyo N , Kubo T , Kira Y , Aramaki S , Nakanishi F 
Published: October 2016

Purpose. To conduct a median nerve conduction study on patients with carpal tunnel syndrome and investigate the relationship between nerve conduction study parameters and clinical grading. Methods. A nerve conduction study was performed on 60 upper limbs of 37 patients with idiopathic carpal tunnel syndrome, and the relationship between the clinical grade and various study parameters was assessed. Results. The amplitude of the sensory nerve action potential and the motor nerve action potential differed according to clinical grading, but this pattern was not seen for sensory nerve conduction velocity, motor nerve conduction velocity, or motor nerve terminal latency and clinical grading. Conclusion. The amplitude of the sensory nerve action potential and motor nerve action potential reflect the functional state of axons, and are useful parameters for assessing clinical grading based on nerve conduction velocity.
Operative Treatment of Bilateral Hip Dislocation in Children with Arthrogryposis Multiplex Congenita
Authors: Asif S , Umer M , Beg R , Umar M 
Published: October 2016

Purpose. Arthrogryposis multiplex congenita (AMC) is a rare syndrome with multiple joint contractures. It is commonly believed that bilaterally dislocated hips associated with joint contractures should not be reduced, because movement is satisfactory, while open reduction leads to poor results. This report presents our experience with surgical management of bilateral dislocation of hips in children with AMC. Methods. During the period 1990 to 2000, we performed open reduction on 8 hips of 4 children with AMC. The mean age at surgery was 23 months (range, 5–48 months). Open reduction and capsular plication without any bony procedure were performed in 4 hips (2 patients). De-rotation and varus osteotomy of the femur was performed in 4 hips, and Salter osteotomy of the innominate bone in 2 hips. The average acetabular index was 44°, and the mean centre-edge angle was −41° preoperatively. Results. The average follow-up period was 4 years (range, 2–9 years). The average acetabular index and centre-edge angle were 19° and 18°, respectively at the time of last follow-up. All children could walk without support. One child required re-opening for redislocation of hip joint. The clinical results were good in 6 hips and fair in 2 hips, according to Severin's and McKay's classifications. Conclusion. Our experience shows that open reduction for bilateral dislocation of hips in children with AMC is a suitable option with generally good results. Surgery performed at earlier age gives the best functional outcome.
Diagnostic Utility of Waveform Analysis of Compound Muscle Action Potentials for Carpal Tunnel Syndrome
Authors: Ogura T , Mori M , Mikami Y , Hase H , Hayashida T , Kubo T , Kira Y , Aramaki S 
Published: October 2016

Purpose. To determine the diagnostic utility of waveform analysis of compound muscle action potentials (CMAP) for carpal tunnel syndrome (CTS). Methods. A total of 131 hands in 71 patients diagnosed with CTS (grouped according to severity) and 80 hands in 44 normal subjects were evaluated using nerve conduction test through the carpal tunnel combined with waveform analysis of CMAP. Results. Compared to normal subjects, the sensory nerve conduction velocity and mean frequency of the CMAP waveform were significantly reduced in patients with CTS. Compared with distal motor latency and sensory nerve conduction velocity, the mean frequency of the CMAP decreased significantly with increasing clinical severity. Conclusion. This study suggests that waveform analysis of CMAP is of diagnostic value in CTS, and is also of value in objective evaluation of postoperative recovery of carpal median nerve dysfunction.
A New Clinical Test for Radial Tunnel Syndrome—The Rule-of-Nine Test: A Cadaveric Study
Authors: Loh YC , Lam WL , Stanley JK , Soames RW 
Published: October 2016

Purpose. Radial tunnel syndrome refers to pain on the lateral aspect of the forearm as a result of compression of the posterior interosseous nerve within a tunnel with specific anatomical boundaries. Diagnosis of the condition is difficult because of its close association with lateral epicondylitis, which warrants different methods of treatment. Based on a cadaveric study, a new clinical test, the Rule-of-Nine test, is proposed to improve the diagnostic accuracy in radial tunnel syndrome. The test involves constructing 9 equal squares on the anterior aspect of the forearm and noting those squares where tenderness can be elicited. Methods. 19 upper limbs were dissected to delineate the path of the posterior interosseous nerve through the radial tunnel, and the relationship of the path of the nerve with the 9 squares. Results. A consistent mapping of the posterior interosseous nerve to the lateral column of 3 squares was observed. Conclusion. The Rule-of-Nine test is proposed as a reliable method of diagnosing radial tunnel syndrome.
Operative Treatment of Hip Fracture in Haemodialysed Patients
Authors: Sano K , Ito K , Inahata Y , Ueno T , Kou A , Kimura T , Imakiire A 
Published: October 2016

Purpose. To study operative treatment and postoperative clinical outcomes of hip fracture in haemodialysed patients. Methods. In 12 patients (8 men and 4 women) undergoing haemodialysis, 14 hip fractures were treated. Of these, 8 hips were treated with bipolar hip arthroplasty, one hip with total hip arthroplasty, 4 hips with a compression hip screw, and one hip with a gamma nail. The mean duration of dialysis treatment until fracture was 7 years. During a mean postoperative follow-up period of 17 months (range, 1–44 months), the patients' renal condition, type of fracture, and level of activities of daily living before and after surgery were assessed. Results. Of the 7 patients who died during a mean follow-up period of 17 months, 2 died from myocardial infarction, 2 from sepsis, and one each from gastric cancer, pulmonary oedema, and liver failure. Five of the 8 patients with diabetic nephropathy died, whereas 6 of the 8 patients who underwent bipolar hip arthroplasty or total hip arthroplasty died. Most of the patients had declined level of activities of daily living postoperatively. Conclusion. For haemodialysed patients with fractures, it is essential to select the most suitable operating method and to conduct vigilant management before and after the operation.
Detection of High-Energy Phosphates in Cortical Bone as an Indicator of Bone Healing and Remodelling: Use of a Rabbit Model
Authors: Buchholz J , Huber FX , Meeder PJ , Muhr G , Kreitz GK , Herzog L 
Published: October 2016

Purpose. To study high-energy phosphates in cortical bone through experiments on inbred white New Zealand rabbits. Methods. Tibial fractures were induced in 80 rabbits and then stabilised by screw osteosynthesis. After 3 (group A; n=40) or 7 days (groups B; n=40), the defective tissue was covered by local muscle flaps. At increasing intervals (from 1 to 16 weeks), the screws were removed and the animals were euthanised (n=8 per group). The bone was removed and analysed histomorphologically; adenosine triphosphate (ATP) levels were determined by high-performance liquid chromatography. Results. The mean ATP concentration in healthy cortical bone at 16 weeks was 0.092 (standard error, 0.009) nmol/mg dry mass, which was significantly higher than that in the group with delayed healing: 0.081 (0.011) nmol/mg in group A and 0.005 (0.001) nmol/mg in group B (paired t test, p<0.05). Earlier healing led to lower rates of necrosis (0 vs 38; groups A vs B) and osteomyelitis. Conclusion. Early muscle-flap coverage can revascularise the cortical bone, which is reflected in the higher ATP content in the cortical bone measured by high-performance liquid chromatography. Measuring changes of ATP levels can help investigate the metabolism of the pathological bone.
Tennis Elbow—Outcome following the Garden Procedure: A Retrospective Study
Authors: Kumar VS , Shetty AA , Ravikumar KJ , Fordyce MJF 
Published: October 2016

Purpose. From 1993 to 1999, 17 patients (18 elbows) underwent the Garden procedure for clinically diagnosed tennis elbow. Non-operative treatment was ineffective for these patients. Methods. The study group consisted of 10 men and 7 women, with a mean age of 49.6 years. Follow-up duration ranged from 18 months to 6 years, with a mean of 37 months. Patients' pain, activity level, and hand grip strength were evaluated postoperatively. Results. 14 (77.8%) elbows had an excellent or good result, 2 elbows had a fair result, and another 2 elbows had a poor result and required revision surgery. Most patients had immediate relief of elbow pain, returned to work early, and did not notice any weakness of hand grip strength or radial wrist extension. There were no significant complications. Conclusion. The Garden procedure produced good results for tennis elbow with minimal morbidity in an unselected group of patients. This retrospective study supports the view that the underlying lesion in tennis elbow is in the origin of extensor carpi radialis brevis.
Histomorphometric Changes in the Vessel Wall at the Site of Amputation in Diabetic Patients—Do They Influence Healing of the Stump?
Authors: Naidu SVLG , Sengupta S 
Published: October 2016

Purpose. To predict healing of the stump by assessing the microscopic vascular changes at the amputation site. Methods. A cohort study was conducted on 39 patients, 18 of them had below-knee amputation (group A) and 21 had ray amputation of a single toe (group B). Biopsies were taken from the anterior and posterior tibial arteries and the venae comitantes of group A patients. For group B patients, biopsies of the digital artery and dorsal vein of the toe were taken. Results. In group A, 15 patients required no further amputation (group A1) and 3 underwent a further above-knee amputation (group A2). In group B, 16 required no further amputation (group B1) and 5 underwent a below-knee amputation (group B2). Lumen narrowing caused by intimal thickening of the arteries was significantly different between groups A1 and A2 (p<0.05). Lumen narrowing of the dorsal veins between groups B1 and B2 was also significantly different (p<0.05). The proportion of the vessel walls made up of intima and media was significantly different in both A1 and A2 as well as B1 and B2 groups. The proportion of total wall thickness over the total diameter of the vessel was not significantly different between both subgroups of A and B. Conclusion. Intimal thickening and medial thinning in the arteries can be used to predict the stump healing in patients who underwent below-knee amputation. For ray amputation patients, similar changes occurred in the dorsal veins, and this finding can also be used to predict the healing of the stump. However, intimal thickening occurred at the expense of the media; therefore, there is little change in the wall thickness.
Lower-Extremity Amputation: A 6-Year Follow-up Study in Brazil
Authors: de Godoy JMP , de Godoy MF , Batigalia F , Trávolo ARF , Monteiro EHF 
Published: October 2016

Purpose. To evaluate the 6-year mortality in 50 patients following lower-limb amputation. Methods. The cumulative survival rate of 50 (28 men, 22 women) amputees aged 54 to 94 years (mean, 67.3; median, 73.5) was retrospectively studied from 1993 to 1998. Indications for above- or below-knee amputation were trauma (n=2), vasculitis (n=2), and critical ischaemia of the lower limbs (n=46). Leg amputation was performed after anamnesis, physical examination, and angiography. All patients were followed up for 6 years by phone or domiciliary visit. A death certificate was verified when a patient was lost to follow-up. Statistical analysis was expressed by the actuarial survival curve. Results. Of 50 amputees, 36 died in the 6 years following leg amputation: 22 in the first year, 3 in the second year, 5 in the third year, 2 in the fourth year, 2 in the fifth year, 2 in the sixth year; 14 remained alive after 6 years. Conclusion. Patients who underwent lower-limb amputation had a high 6-year mortality. Most deaths occurred in the first year.
Inducing Peripheral Sympathetic Nerve Activity by Therapeutic Electrical Stimulation
Authors: Mikami Y , Ogura T , Kubo T , Kira Y , Aramaki S 
Published: October 2016

Purpose. To examine whether the activity of peripheral sympathetic nerves in animals with spinal cord injury can be controlled using therapeutic electrical stimulation. Methods. The spinal cords of 6 Wistar rats were severed at T12/T13 disk level and were given continuous therapeutic electrical stimulation. Microneurography was used to record sympathetic nerve activity at 24, 48, and 72 hours after severing the spinal cord. Results. Integrated values of muscle sympathetic nerve activity after 72 hours of therapeutic electrical stimulation revealed significantly larger potentials on the stimulated side than the non-stimulated side. Skin sympathetic nerve activity showed no difference between the 2 sides. Conclusion. Therapeutic electrical stimulation was found to have a facilitatory effect on the muscle sympathetic nerve activity, whereas regulatory function was activated by the sympathetic nerves.
Schwannomas of the Hand and Wrist: Long-Term Results and Review of the Literature
Authors: Ozdemir O , Kurt C , Coskunol E , Calli I , Ozsoy MH 
Published: October 2016

Purpose. To review the long-term results of 14 cases of histopathologically confirmed schwannoma of the hand and wrist treated with intracapsular tumour removal. Methods. All operations were performed under loupe magnification and microsurgical dissection, and the tumour was removed after capsular (including endoneurium) incision. Patients were assessed for any residual symptoms. Sensory testing of light touch and pain was carried out. Results. The mean age of the patients at the time of operation was 38.4 years (range, 11–78 years), and the mean follow-up period was 12.6 years (range, 3–36 years). Ten of the tumours were located in the median nerve distribution, whereas 4 in the ulnar nerve distribution. Four tumours were at the wrist level, 3 at the palm level, and 7 at the digital level (3 in the index finger). Only 5 patients were correctly diagnosed preoperatively. Neurological loss was not recovered in one patient in whom the tumour was resected with the digital nerve. No recurrence or muscle atrophy was noted at the latest follow-up. Conclusion. Meticulous dissection with magnification can achieve complete tumour removal without neurological loss or recurrence. Intracapsular tumour removal provides good results with a low complication rate.
Mechanical Failure in Intramedullary Interlocking Nails
Authors: Bhat AK , Rao SK , Bhaskaranand K 
Published: October 2016

Purpose. To study clinical and mechanical factors that predispose to failure of interlocking nails. Methods. Between October 1996 and December 2002, 286 femoral fractures, 211 tibial fractures, and 47 humeral fractures were repaired using variously designed interlocking nails. Fracture pattern, level and site, nail size and type, weight bearing after nailing, and union status were reviewed after a mean follow-up of 22 months. Results. Nail failure occurred in 27 fracture repairs (17 femoral, 9 tibial, and one humeral; 13 from our institution and 14 referred from elsewhere). In 55% of failed repairs, the fracture was distal. A high rate of tibial nail failure was noted. Conclusion. Distal fractures and stress concentration at the distal screws predispose to interlocking nail failure and can be prevented by protected weight bearing combined with the use of longer and larger nails. Routine supplementary cancellous bone grafting is unnecessary during renailing surgery when adequate reaming and a larger nail are used.