bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thrombosis Markers in Hip versus Knee Arthroplasty: A Pilot Study
Authors: Reikeras Olav , Clementsen Torkil 
Published: October 2016

Purpose. To compare the thrombosis markers for thrombosis and fibrinolysis in patients undergoing hip versus knee arthroplasty. Methods. Seven women aged 38 to 61 years who underwent total hip arthroplasty (THA) and 7 women aged 57 to 67 years who underwent total knee arthroplasty (TKA) were studied. Thromboprophylaxis was given before and after surgery. In patients undergoing TKA, an automatic pneumatic tourniquet was used. Blood samples were drawn (1) before surgery (control value), (2) at wound closure (immediately before release of the tourniquet in TKA), and (3) 4 hours after surgery. Thrombosis markers (prothrombin fragment 1.2 [F1.2], plasmin/α2-antiplasmin complex [PAP], and D-dimer) of the 2 groups were compared. Results. The F1.2 level increased significantly at wound closure and remained elevated 4 hours after surgery in the THA group, whereas it was unchanged at wound closure but increased significantly 4 hours after surgery in the TKA group. The PAP level was constant peri- and post-operatively in the THA group, whereas it increased significantly 4 hours after surgery in the TKA group. The D-dimer level increased significantly at wound closure and 4 hours after surgery in the THA group, whereas it was unchanged at wound closure but increased significantly 4 hours after surgery in the TKA group. Conclusion. Systemic thrombin generation starts perioperatively in THA and after tourniquet deflation in TKA, indicating that wound blood must reach the systemic circulation to activate the relevant mediators.
Pulse-Lavage Brushing Followed by Hydrogen Peroxide-Gauze Packing for Bone-Bed Preparation in Cemented Total Hip Arthroplasty: A Bovine Model
Authors: Ackland David C , Yap Vincent , Ackland Margaret L , Williams John F , de Steiger Richard 
Published: October 2016

Purpose. To compare the effectiveness of pulse-lavage brushing followed by hydrogen peroxide–gauze packing with either technique alone or normal-saline irrigation in bone-bed preparation for cemented total hip arthroplasty. Methods. 44 fresh-frozen ox femoral canals were prepared for cemented total hip arthroplasty using 4 techniques: normal-saline irrigation, pulse-lavage brushing, hydrogen peroxide–soaked gauze packing, and a combination of the latter 2 techniques. The maximum tensile pull-out force required to separate the prosthesis from the femoral canal was measured as an indicator of the strength of the cement-bone interface. Results. The mean pull-out force to separate the prosthesis from the femoral canal was significantly higher in specimens prepared with pulse-lavage brushing followed by hydrogen peroxide–soaked gauze packing or pulse-lavage brushing alone than those prepared with normal-saline irrigation or hydrogen peroxide–soaked gauze packing alone (p<0.001). Conclusions. Pulse-lavage brushing is more effective at cleansing the femoral canal and increasing mechanical strength at the cement-bone interface than preparation with normal-saline irrigation or hydrogen peroxide–soaked gauze packing.
Outcomes of Total Knee Arthroplasty in English-Versus Non–English-Speaking Patients
Authors: Dowsey Michelle M , Broadhead Matthew L , Stoney James D , Choong Peter F 
Published: October 2016

Purpose. To compare outcomes of total knee arthroplasty (TKA) in English- versus non–English-speaking patients. Methods. 193 women and 85 men (mean age, 72 years) underwent 117 left and 161 right primary TKAs. 237 and 41 patients were English and non–English speaking, respectively. Interpretation was provided. Pre- and post-operative functional outcomes were measured using the International Knee Society (IKS) score. Results. Most non–English-speaking patients were female (38 vs 3 of 41, p<0.001). The mean body mass index of non–English-speaking patients was significantly higher (34 vs 31 kg/m2, p=0.003). 14 foreign languages were spoken among the 41 non–English-speaking patients, of which Greek and Italian were the most common. Non–English-speaking patients had significantly worse IKS scores both preoperatively and at the 12-month follow-up. The proportions of poor postoperative IKS scores were significantly higher in non–English-speaking patients (58% vs 27%, p<0.001), in whom pain was also significantly worse (p=0.017). In a multiple logistic regression analysis, being non–English speaking was the only predictor of poor functional outcome at the 12-month follow-up (odds ratio=2.77, confidence interval=1.25–6.14, p=0.012). Conclusion. The non–English-speaking background of a patient is a predictor of less favourable functional outcome after TKA.
The Influence of the Acromioclavicular Joint Degeneration on Supraspinatus Outlet Impingement and the Acromion Shape
Authors: Roidis Nikolaos T , Motamed Soheil , Vaishnav Suketu , Ebramzadeh Edward , Karachalios Theofilos S , Itamura John M 
Published: October 2016

Purpose. To assess the anatomic association of acromioclavicular joint degeneration to supraspinatus outlet impingement and the acromion shape. Methods. Sagittal oblique magnetic resonance images of 49 shoulders in 49 patients were reviewed. 29 of them (mean age, 59 years) underwent surgery for impingement with or without rotator cuff tear (group 1), whereas the 20 controls (mean age, 27 years) were treated for shoulder instability without rotator cuff disease or acromioclavicular joint derangement (group 2). The supraspinatus outlet and the acromion shape of the 2 groups were compared. Results. The difference in the mean supraspinatus outlet between groups 1 and 2 was 11% (514 vs 577 mm2, p=0.095) and between the subgroup (of group 1) with full thickness rotator cuff tears and group 2 was 17% (481 vs 577 mm2, p=0.036). Six of the acromions in group 1 were type III (hooked) compared to none in group 2. Conclusion. In severe acromioclavicular degeneration, distal clavicular excision is recommended, even in cases with an asymptomatic acromioclavicular joint, so as to prevent further osteophyte formation.
Lower-Limb Alignment and Posterior Tibial Slope in Pakistanis: A Radiographic Study
Authors: Khattak Mujahid Jamil , Umer Masood , Davis Edward T , Habib Munira , Ahmed Mehmood 
Published: October 2016

Purpose. To assess the lower-limb alignment and posterior tibial slope in Pakistanis. Methods. 40 male and 19 female healthy Pakistanis aged 20 to 45 years were recruited. A full weight-bearing anteroposterior radiograph of the entire lower limb of each subject was obtained. The axial alignment was measured based on the centres of the femoral head, knee, and ankle. The tibiofemoral (TF) angle, knee joint line obliquity angle (angle J), and posterior tibial slope were determined. Results. The mean TF angle was more varus in men than women (178.4° vs. 180.0°, p<0.001). The mean angle J was more medially inclined in men than women (93.4° vs. 91.4°, p=0.007). The mean medial tibial slope was greater in women than men (16.0° vs. 12.5°, p<0.001). The posterior tibial slope was greater in women than men (14.1° vs. 12.5°, p=0.02), and was greater than the 5° to 10° commonly reported. Conclusions. Knee alignment and geometry vary in different population subsets. With regard to total knee arthroplasty, the more medially inclined angle J in Pakistani men suggests that an anteroposterior cut of the distal femur should be in increased external rotation, compared with Pakistani women. Whereas the greater posterior tibial slope in Pakistanis suggests that a proximal tibial cut with a greater posterior tibial slope may reduce the chance of tibial loosening and increase postoperative knee range of motion, especially when using posterior cruciate ligament–retaining designs.
Condylar Buttress Plate versus Fixed Angle Condylar Blade Plate versus Dynamic Condylar Screw for Supracondylar Intra-Articular Distal Femoral Fractures
Authors: Petsatodis George , Chatzisymeon Apostolos , Antonarakos Petros , Givissis Panagiotis , Papadopoulos Pericles , Christodoulou Anastasios 
Published: October 2016

Purpose. To compare outcomes of 3 fixation techniques for intra-articular distal femoral fractures. Methods. Records of 59 men and 49 women aged 16 to 80 (mean, 47) years who underwent internal fixation for 116 type-C (complete intra-articular) distal femoral fractures were retrospectively reviewed. According to the AO classification, 25 fractures were type C1 (23 closed and 2 open), 71 type C2 (69 closed and 2 open), and 20 type C3 (16 closed and 4 open). Based on implant availability at the time, all surgeries were performed by a single surgeon using a condylar buttress plate (n=38), a fixed angle (95°) condylar blade plate (n=24), or a dynamic condylar screw (n=54). The mean follow-up period was 11 (range, 4–19) years. At the latest follow-up, functional outcome was classified according to Schatzker and Lambert criteria. Results. Functional outcomes were excellent in 64 (55%) of the fractures, good in 37 (32%), moderate in 9 (8%), and poor in 6 (5%). Outcomes in patients treated by the dynamic condylar screw were significantly superior to those treated by the condylar buttress plate (p=0.016) or condylar blade plate (p=0.001). Good-to-excellent results were achieved in 96% vs 84% vs 71% of these patients, respectively. Complication rates were lower in the dynamic condylar screw group than the other 2 groups (pseudarthrosis, 5% vs 11% vs 25%; varus deformity, 4% vs 26% vs 25%; knee stiffness, 0% vs 5% vs 8%, respectively). No implant failure was encountered. Conclusion. Dynamic condylar screw fixation for distal femoral fractures achieves better functional outcomes and lower complication rates.
Bone versus Soft-Tissue Sarcomas in the Elderly
Authors: Torigoe Tomoaki , Terakado Atsuhiko , Suehara Yoshiyuki , Kurosawa Hisashi , Yazawa Yasuo , Takagi Tatsuya 
Published: October 2016

Purpose. To compare survival rates in the elderly with bone versus soft-tissue sarcomas. Methods. Records of 12 men and 8 women aged 70 to 91 (mean, 77) years with bone or soft-tissue sarcomas were retrospectively reviewed. The grade, size, location, and stage of the sarcomas, as well as their surgical margins, treatment modalities, local recurrence, metastasis, and prognosis were recorded. The mean follow-up period was 37 (range, 2–137) months. Their 5-year survival rates were estimated using the Kaplan-Meier method, and compared with 110 younger controls aged 9 to 69 (mean, 45) years during the same period. There was no significant difference between the older patients and younger controls regarding tumour grading (p=0.068, Chi squared test), stage, and pathological diagnosis. Results. Six patients had bone and 14 had soft-tissue sarcomas. Of the 6 bone sarcomas, 3 were malignant fibrous histiocytomas, 2 were osteosarcomas, and one was a chordoma; all were high grade, except for the chordoma. Of the 14 soft-tissue sarcomas, 9 were malignant fibrous histiocytomas, 3 were myxofibrosarcomas, one was a liposarcoma and one an extraskeletal osteosarcoma; all were high grade except for 2 of the myxofibrosarcomas and the liposarcoma. Of the 110 younger controls, 30 had bone and 80 had soft-tissue sarcomas; 44 were low grade and 66 were high grade. The 5-year survival rate was significantly lower in older patients than in younger controls (35% vs 65%, p=0.048). Regarding bone versus soft-tissue sarcomas, the 5-year survival rate was not significantly different among older patients (0% vs 52%, p=0.068) or younger controls (61% vs 66%, p=0.863). The difference was also not significant for older patients versus younger controls with bone sarcomas (0% vs 61%, p=0.284) or soft-tissue sarcomas (52% vs 66%, p=0.368), for older patients with high- versus low-grade sarcomas (17% vs 100%, p=0.314), for older patients with sarcomas located in the limbs versus the trunk (39% vs 38%, p=0.233), as well as for older patients versus younger controls with low-grade sarcomas (100% vs 92%, p=0.512) or high-grade sarcomas (17% vs 46%, p=0.269). Conclusion. Survival rates tend to be lower in older patients with sarcomas, especially when the sarcoma is of bone and high grade.
Effect of Gamma Sterilisation and Deep-Freezing on Length and Strength of Fascia Latae
Authors: Kayurapan Agawit , Makadelok Sahachart , Waikakul Saranatra 
Published: October 2016

Purpose. To compare the length and strength of fascia latae after gamma sterilisation and different durations of deep-freezing. Methods. 50 pieces of fresh porcine fascia latae were randomly divided into 5 groups. Group 1 acted as controls, which were not gamma irradiated and deep-frozen. In groups 2 to 4, fascia latae were incubated in phosphate buffer solution for 4 hours, and then gamma irradiated at 25 kGy. They were preserved at −70°C for one to 3 months, respectively. In group 5, fascia latae were preserved for 3 months, and during the whole process they were fixed on a wooden board to maintain their original length. The maximum tensile strength of each fascia lata was tested at a displacement rate of 1 cm per minute until failure. Results. The maximum tensile strength was not significantly different among groups 1 to 4, but was significantly higher in group 5. Conclusion. Gamma sterilisation and deep-freezing had no effect on the strength of fascia latae, but fixation on a board could increase strength.
Plate Osteosynthesis for Severe Olecranon Fractures
Authors: Munoz-Mahamud Ernesto , Fernandez-Valencia Jenaro A , Riba Josep 
Published: October 2016

Purpose. To review outcomes of 10 patients who underwent plate osteosynthesis for severe olecranon fractures. Methods. Records of 7 men and 3 women aged 33 to 73 years who underwent plate osteosynthesis for severe olecranon fractures were reviewed. All had some degree of soft-tissue injury; 6 presented with associated fractures. Seven patients were treated with a limited contact dynamic compression plate, and the remaining 3 received a locking compression plate. Patients were followed up for fracture healing, range of motion, nerve damage, heterotopic ossification, infection, hardware complaints, and the need of a secondary surgical procedure. The Mayo Elbow Performance Score (MEPS) was determined at the final follow-up. The patient-answered questionnaire (PAQ) portion of the Liverpool Elbow Score (LES) was evaluated 2 to 37 months later by telephone. Results. All patients had bone union. None had nerve damage or heterotopic ossification. Patients 4, 6, and 8 with type-IIIB fractures developed deep infections and severe soft-tissue swelling; all had been treated with the limited contact dynamic compression plate. Four patients underwent plate removal owing to hardware complaints. One patient underwent a secondary procedure to restore complete range of elbow motion. The mean MEPS score was 84 (range, 35–100); 5 patients attained excellent scores, one good, 2 satisfactory, and 2 unsatisfactory. The mean PAQ portion of the LES score was 31 (range, 23–36). Conclusion. Plate osteosynthesis achieves satisfactory results for severe olecranon fractures. The deep infection rate is higher in patients with severe soft-tissue injury.
Cemented Thompson versus Cemented Bipolar Prostheses for Femoral Neck Fractures
Authors: Bauer Stefan , Isenegger Patrick , Gautschi Oliver P , Ho Kwok M , Yates Piers J , Zellweger Rene 
Published: October 2016

Purpose. To compare early functional outcomes, complications, and mortality in elderly patients treated with the less costly, cemented Thompson prosthesis or the cemented bipolar prosthesis in order to identify factors affecting outcomes. Methods. Records of 303 patients with femoral neck fractures treated with the cemented Thompson monoblock prosthesis (n=206) or the cemented bipolar prosthesis (n=97) were reviewed. The choice of prosthesis was solely determined by surgeon's preference. Data relating to patient demographics, clinical and residential status, mobility, mental function, mortality, and complications during hospitalisation and rehabilitation were collected. Results. After adjusting for confounding variables, independent postoperative indoor mobility was associated with preoperative indoor mobility (p=0.002) and mental function (p=0.001), whereas postoperative outdoor mobility was associated with preoperative outdoor mobility (p=0.003), daily living activity (p=0.02), and mental function (p=0.02). Mortality within 6 months was only associated with poor mental function (p=0.009). At 6-month follow-up, there was no significant difference between the 2 types of prosthesis in terms of functional outcomes, mortality and complication rates. Conclusion. In elderly patients with limited mobility, treatment with the bipolar prosthesis was not associated with better short-term outcomes than those receiving the Thompson prosthesis.
Mid- to Long-Term Outcome of Cementless Total Hip Arthroplasty in Younger Patients
Authors: Almeida Fernando , Pino Laura , Silvestre Antonio , Gomar Francisco 
Published: October 2016

Purpose. To assess mid- to long-term outcomes of cementless primary total hip arthroplasty (THA) in younger patients. Methods. Records of 28 women and 34 men (75 hips) aged 18 to 55 (mean, 38) years who underwent primary THA using a hydroxyapatite-coated stem and a threaded cup and had been followed up for a mean of 10 (6–15) years were reviewed. 13 of the patients had bilateral THAs. Clinical and radiographic outcomes were evaluated. Results. After a minimum follow-up of 7 (range, 7–14) years, 12 (16%) of the hips were revised, of which 8 (11%) were for the cup. The causes for revision were late deep infections (n=2), aseptic loosening of the cup (n=4), and polyethylene wear (n=6). No stem was revised for aseptic loosening. Osteolysis was noted in 24 (38%) hips. Of the 63 unrevised hips, the mean Harris Hip Score was 92 (range, 45–100) and the mean D'Aubigne and Postel score was 17 (range, 9–18). The survival of the threaded cup was 88% at 10 years, using revision surgery as the end point. 27 (41%) of the hips showed signs of polyethylene wear; 15 were >2 mm. Conclusion. In younger patients undergoing THA, rates of polyethylene wear and pelvic osteolysis are high, and thus long-term follow-up is crucial.
Differences in Outcome between Maori and Caucasian Patients Undergoing Total Joint Arthroplasty for Osteoarthritis
Authors: Pai Vasu , Pai Vishal , Wright Sophie 
Published: October 2016

Purpose. To compare differences in outcome between Maori and Caucasian patients undergoing total joint arthroplasty for osteoarthritis. Methods. 45 men and 45 women aged 43 to 87 years who underwent total hip (n=54) or total knee (n=36) arthroplasties by a single surgeon and were followed up for at least one year were prospectively studied. Patients were classified according to American Society of Anesthesiologists (ASA) score. Preoperative comorbidity, length of hospital stay, postoperative complications, and pre- and post-operative outcomes in the 2 groups were compared. Results. Maori patients were more likely than Caucasian patients to be obese (body mass index of >30 kg/m2) [37% vs. 15%], diabetic (15% vs. 5%), and smokers (32% vs. 13%). Postoperative complication rates and the lengths of hospital stay in the 2 groups were not significantly different. The ASA score correlated positively with the length of hospital stay; higher ASA scores predicted more prolonged recovery. Conclusion. Maori patients were more likely than Caucasian patients to have preoperative comorbidities, but their postoperative length of hospital stay and complication rates were not significantly different.
Femoral Tunnel Widening after Quadrupled Hamstring Anterior Cruciate Ligament Reconstruction
Authors: Cheung Philip , Chan Wai-Lam , Yen Chi-Hung , Cheng Sze-Chung , Woo Siu-Bon , Wong Tsz-Kau , Wong Wing-Cheung 
Published: October 2016

Purpose. To evaluate the extent of femoral tunnel widening after quadrupled hamstring anterior cruciate ligament reconstruction using femoral cross pin fixation in contrast to bioabsorbable screw fixation augmented with Endopearl. Methods. 16 patients underwent cross pin femoral fixation and the next 15 underwent bioabsorbable screw fixation augmented with Endopearl. The patients were evaluated radiographically for femoral tunnel widening. Standard posteroanterior radiographs of the knee in full extension were taken at postoperative year 2 and 5. The tunnel width was measured at the opening, the widest and the most proximal parts of the femoral tunnel. Results. In the femoral cross pin and bioabsorbable screw fixations, the mean femoral tunnel sizes were 7.6 and 8.0 mm, respectively. The overall mean tunnel widening at all measured sites were 2.7 and 1.8 mm at the 2-year follow-up and were 2.5 and 1.8 mm at the 5-year follow-up, respectively. The femoral tunnel widening was greater in the cross pin than the bioabsorbable screw group, but only the difference in the most proximal part was significant (p=0.01 at year 2 and p<0.001 at year 5). Conclusion. Femoral tunnel widening was greater in femoral cross pin fixation, probably related to the windshield-wiper and bungee-cord effects. It usually occurred in the first 2 years after the operation and remained static thereafter.
Lateral Closing Wedge Osteotomy with or without Medialisation of the Distal Fragment for Cubitus Varus
Authors: Moon Myung-Sang , Kim Sung-Soo , Kim Seong-Tae , Lee Sung-Rak , Lee Bong-Jin , Jin Jong-Mun , Moon Jeong-Lim 
Published: October 2016

Purpose. To compare treatment outcomes after closing wedge osteotomy and plate fixation for cubitus varus deformity undertaken with or without medialisation of the distal fragment. Methods. Records of 21 men and 16 women aged 20 to 34 years who underwent closing wedge osteotomy and plate fixation for cubitus varus deformity with (n=21) or without (n=16) medialisation of the distal fragment were reviewed. A daily alternate flexion-extension splinting was applied for one week for early restoration of full range of motion. The carrying angle and range of motion of the elbow were measured. Results. All patients regained the normal carrying angle and range of motion; none had loss of fixation or limitation in range of motion exceeding 10°. Outcomes were excellent in 23 patients and good in 9. A small bony prominence over the lateral condylar region (‘lazy S’ deformity) was noted in group-1 but not group-2 patients. Conclusion. Closing wedge supracondylar osteotomy with medialisation of the distal fragment was an effective treatment for cubitus varus deformity and minimised the risk of ‘lazy S’ deformity.
Risk Factors for Surgical Wound Infection in HIV-Positive Patients Undergoing Surgery for Orthopaedic Trauma
Authors: Abalo Anani , Patassi Akouda , James Yaovi Edem , Walla Atsi , Sangare Aly , Dossim Assang 
Published: October 2016

Purpose. To identify risk factors associated with surgical wound infection in patients infected with human immunodeficiency virus (HIV) undergoing surgery for orthopaedic trauma. Methods. Records of 29 male and 7 female HIV-positive patients aged 18 to 47 years who underwent surgery for orthopaedic trauma were reviewed. Data on HIV-specific variables (HIV clinical classification, CD4+ lymphocyte count) and highly active antiretroviral therapy were retrieved, as were data on wound class, fracture type, surgery type, surgical wound infections, and outcomes. Possible risk factors associated with surgical wound infection were analysed. Results. The median follow-up period was 27 (range, 19–41) months. Of the 36 patients, 14 (39%) developed surgical wound infections (4 were deep and 10 superficial). 89% and 67% of them were in HIV clinical category B and in CD4+ T-lymphocyte category 3, respectively. 12 of these infections resolved after debridement and prolonged antibiotic treatment, and 2 developed chronic osteomyelitis. Four of the patients had non-union. Surgical wound infections were associated with HIV clinical category B (p<0.001), CD4+ T-lymphocyte category of ≥2 (p=0.041), and contaminated wounds (p=0.003). Conclusion. Identification of risk factors may help minimise morbidity in HIV-positive patients.