bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increase in Quality and Quantity of Orthopaedic Studies from 2002 to 2012
Authors: Little Zoe , Newman Simon , Dodds Alex , Spicer Dominic 
Published: October 2016

Purpose. To compare the level of evidence of orthopaedic studies published in 2002 and 2012 to determine whether the quality and quantity of studies have increased. Methods. The top 10 orthopaedic journals in 2002 and 2012 were identified, according to the Thomson Reuters impact factor. The level of evidence of each clinical article between January and June in 2002 and 2012 were determined by 2 senior orthopaedic trainees, according to the Oxford Centre for Evidence-based Medicine 2011 Levels of Evidence. Basic science articles, case reports, and non-systematic reviews were excluded. The proportions of papers designated to each level of evidence in 2002 and 2012 were compared, as was the mean level of evidence of studies in 2002 and 2012. Results. In 2002, 379 clinical articles were identified and their level of evidence was level 1 (n=3), level 2 (n=67), level 3 (n=71), and level 4 (n=238). In 2012, 642 clinical articles were identified and their level of evidence was level 1 (n=26), level 2 (n=113), level 3 (n=167), and level 4 (n=336). The proportion of level 4 articles decreased from 62.8% in 2002 to 52.3% in 2012 (p=0.001), whereas the proportion of level 1 articles increased from 0.8% to 4.1% (p=0.002) and level 3 articles increased from 18.7% to 26.0% (p=0.008). The mean level of evidence improved from 3.44 in 2002 to 3.27 in 2012 (p=0.002). Conclusion. The quality and quantity of orthopaedic studies have increased from 2002 to 2012, but most studies remained of a low level of evidence.
Clinical and Financial Benefits of Intra-Articular Tranexamic Acid in Total Knee Arthroplasty
Authors: Goyal Navendu , Chen Darren B , Harris Ian A , Rowden Neville , Kirsh George , MacDessi Samuel J 
Published: October 2016

Purpose. To determine whether intra-articular tranexamic acid (TXA) use after total knee arthroplasty (TKA) results in decreased postoperative blood transfusion and length of hospital stay. Methods. Medical records of 1981 patients (mean age, 69.2 years) who underwent primary TKA with (n=1006) or without (n=975) TXA use by any of 4 knee arthroplasty surgeons were reviewed. TXA (3000 mg/30ml) was administered via an epidural catheter into the knee joint after wound closure. Postoperative blood transfusion was given to patients with haemoglobin (Hb) level <80 g/dl on days 1 and 2 or with symptoms of acute anaemia. Results. Intra-articular TXA use after TKA resulted in a lower blood transfusion rate (4.5% [45/1006] vs. 14.8% [144/975], p<0.0001), fewer units of blood transfused (86 vs. 313 units, p<0.0001), fewer units of blood transfused per 100 patients (8.5 vs. 32.1, p<0.0001), and shorter length of hospital stay (4.7±2.3 vs. 5.3±2.7 days, p<0.0001). Total cost savings with respect to the reduction in blood transfusion was AU$143.68 per patient. When the change in length of hospital stay and TXA costs were included, the overall saving was AU$631.36 per patient. Conclusion. Intra-articular TXA use can reduce costs as a result of decreased blood transfusion rate and length of hospital stay in patients undergoing TKA.
Quality of Cementation in Conventional versus Minimally Invasive Total Knee Arthroplasty
Authors: Ang Chia-Liang , Yeo Seng-Jin 
Published: October 2016

Purpose. To review the immediate postoperative radiographs of 108 patients following conventional or minimally invasive total knee arthroplasty (TKA) to assess the quality of cementation in terms of cement voids and retained cement. Methods. Records of 20 male and 88 female consecutive patients aged 50 to 83 (mean, 67.5) years who underwent conventional TKA (n=56) or computer-assisted minimally invasive TKA (n=52) for osteoarthritis by a single senior surgeon were reviewed. Immediate postoperative radiographs were assessed by a single blinded assessor for the quality of cementation in terms of cement void and retained cement in different zones of the femoral, tibial, and patellar components along the prosthesis-bone interface using the Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Results. The 2 groups were comparable in terms of baseline demographics as well as cement void and retained cement on the femoral, tibial, and patellar components, except that in the minimally invasive group, cement void beneath the anterior flange of the femoral component was wider (0.32 vs. 0 mm, p=0.001), and retained cement in the posterior or lateral aspects of the tibial component was more common (50.0% vs. 28.6%, p=0.018). Conclusion. Minimally invasive TKA resulted in a wider cement void beneath the anterior flange of the femoral component and a higher rate of retained cement around the tibial component.
Standard Preoperative Analgesia with or without Fascia Iliaca Compartment Block for Femoral Neck Fractures
Authors: Williams Huw , Paringe Vishal , Shenoy Shrisha , Michaels Phil , Ramesh Balasundaram 
Published: October 2016

Purpose. To compare the visual analogue score (VAS) for pain in patients with femoral neck fracture who received standard preoperative analgesia with or without fascia iliaca compartment block (FICB). Methods. In patients with femoral neck fracture, 69 patients who received standard preoperative analgesia (regular paracetamol 1g 4 times a day, codeine 60 mg 4 times a day, and opioid 10 mg 2 hourly as required) were compared with 50 patients who received standard preoperative analgesia plus FICB. VAS for pain at rest and on movement (hip flexion) was assessed before FICB and 15 minutes, 2 and 8 hours after FICB. The amount of additional opioid required and the incidence of opioid overdose (necessitating administration of naloxone) were determined. Results. VAS for pain was significantly lower after standard analgesia plus FICB than standard analgesia alone (p=0.001). The analgesic effect (pre-score minus post-score) of standard analgesia plus FICB did not differ between genders (p=0.57) or fracture patterns (p=0.79). 19 (38%) patients with standard analgesia plus FICB required no additional opioid analgesia. Compared with standard analgesia alone, addition of FICB reduced the mean dose of opioid from 6.2 to 2.0 (p=0.001) and the number of opioid overdose from 7.2% to 0% (p=0.001). No patient had any complication following FICB. Conclusion. In patients with femoral neck fracture, FICB reduced the need for additional opioid analgesia and avoided the risk of opioid overdose and respiratory depression.
Morbidity and In-Hospital Mortality after Hip Fracture Surgery on Weekends versus Weekdays
Authors: Kent Steven John , Adie Sam , Stackpool Gregory 
Published: October 2016

Purpose. To compare morbidity and in-hospital mortality in patients who underwent surgery for femoral neck fracture on weekends versus on weekdays. Methods. Records of 90 men and 225 women (mean age, 80.5 years) who underwent surgery for femoral neck fractures on weekends or public holidays (n=110) or on weekdays (n=205) were retrospectively reviewed. The morbidity and in-hospital mortality of the 2 groups were compared. Results. The 2 groups were comparable in terms of age, sex, and time to surgery, but more hemiarthroplasties were performed on weekdays (35.0% vs. 25.0%, p=0.036). Compared with surgery on weekdays, surgery on weekends was associated with increased in-hospital mortality (3.4% vs. 9.1%, p=0.04). None of the potential confounders (age, type of surgery, presenting hospital, and time to surgery) had a significant effect on in-hospital mortality. Conclusion. In patients with femoral neck fractures, surgery on weekends was associated with increased in-hospital mortality but not with increased morbidity after adjusting for confounders, compared with surgery on weekdays.
Screw Fixation versus Arthroplasty versus Plate Fixation for 3-Part Radial Head Fractures
Authors: Wu Pang Hung , Shen Liang , Chee Yu Han 
Published: October 2016

Purpose. To compare the outcome following headless compression screw fixation versus radial head arthroplasty versus plate fixation for 3-part Mason types III or IV radial head fracture. Methods. Records of 25 men and 16 women aged 21 to 80 (mean, 43.3) years who underwent fixation using 2 to 3 2-mm cannulated headless compression screws (n=16), radial head arthroplasty (n=13), or fixation with a 2-mm Synthes plate (n=12) for 3-part Mason types III or IV radial head and neck fracture were reviewed. Treatment option was decided by the surgeon based on the presence of associated injury, neurovascular deficit, and the Mason classification. Bone union, callus formation, and complications (such as heterotopic ossification, malunion, and nonunion) were assessed by an independent registrar or consultant using radiographs. The Mayo Elbow Performance Score and range of motion were assessed by an independent physiotherapist. Results. The median age of the 3 groups were comparable. Associated injuries were most common in patients with arthroplasty, followed by screw fixation and plate fixation (61.5% vs. 50% vs. 33%, p=0.54). The median time to bone union was shorter after screw fixation than plate fixation (55 vs. 86 days, p=0.05). No patient with screw fixation had nonunion, but 4 patients with plate fixation had nonunion. The 3 groups were comparable in terms of the mean Mayo Elbow Performance Score (p=0.56) and the mean range of motion (p=0.45). The complication rate was highest after plate fixation, followed by screw fixation and arthroplasty (50% vs. 18.8% vs. 15.4%, p=0.048). Excluding 20 patients with associated injuries (8 in screw fixation, 8 in arthroplasty, and 4 in plate fixation), the 3 groups were comparable in terms of the median time to bone union (p=0.109), mean Mayo Elbow Performance Score (p=0.260), mean range of motion (p=0.162), and complication rate (p=0.096). Conclusion. Headless compression screw fixation is a viable option for 3-part radial head fracture. It achieves earlier bone union with fewer complications.
Platelet-Rich Plasma versus Steroid Injection for Subacromial Impingement Syndrome
Authors: Say Ferhat , Gürler Deniz , Bülbül Murat 
Published: October 2016

Purpose. To compare the 6-week and 6-month outcome in 60 patients who received a single-dose injection of platelet-rich plasma (PRP) or steroid for subacromial impingement syndrome (SIS). Methods. 22 men and 38 women (mean age, 49.7 years) opted to receive a single-dose injection of PRP (n=30) or steroid (n=30) for SIS that had not responded to conservative treatment for >3 months. The PRP or a mixture of 1 ml 40 mg methylprednisolone and 8 ml prilocaine was administered via a dorsolateral approach through the interval just beneath the dorsal acromial edge. Both groups were instructed to perform standard rotator cuff stretching and strengthening exercises for 6 weeks. The use of non-steroid anti-inflammatory drugs was prohibited. Patients were evaluated before and 6 weeks and 6 months after treatment using the Constant score, visual analogue scale (VAS) for pain, and range of motion (ROM) of the shoulder. Results. No local or systemic complication occurred. Improvement in the Constant score and VAS for pain at week 6 and month 6 was significantly better following steroid than PRP injection. The difference in the Constant score was greater than the mean clinically important difference of 10.4. Nonetheless, the 2 groups were comparable for improvement in ROM of the shoulder. Conclusion. Steroid injection was more effective than PRP injection for treatment of SIS in terms of the Constant score and VAS for pain at 6 weeks and 6 months.
Single versus Double Blade Technique for Skin Incision and Deep Dissection in Surgery for Closed Fracture: A Prospective Randomised Control Study
Authors: Trikha Vivek , Saini Pramod , Mathur Purva , Agarwal Abhinav , Kumar Senthil V , Choudhary Budhhadev 
Published: October 2016

Purpose. To compare blade cultures in surgery for closed fracture using a single or double blade technique to determine whether the current practice of double blade technique is justified. Methods. 155 men and 29 women aged 20 to 60 (mean, 35) years who underwent surgery for closed fracture with healthy skin at the incision site were included. Patients were block randomised to the single (n=92) or double (n=92) blade technique. Blades were sent for bacteriological analysis. Outcome measures were early surgical site infection (SSI) within 30 days and cultures from the blades. Results. The 2 groups were comparable in baseline characteristics. In the single blade group, 6 surgical blades and 2 control blades showed positive cultures; 4 patients developed SSI, but only one had a positive culture from the surgical blade (with different organism isolated from the wound culture). In the double blade group, 6 skin blades, 7 deep blades, and 0 control blade showed positive culture; only 2 patients had the same bacteria grown from both skin and deep blade. Five patients developed SSI, but only one patient had a positive culture from the deep blade (with different organism isolated from the wound culture). The difference in incidence of culture-positive blade or SSI between the 2 groups was not significant. The relative risk of SSI in the single blade group was 0.8. Positive blade culture was not associated with SSI in the single or double blade group. Conclusion. The practice of changing blade following skin incision has no effect on reducing early SSI in surgery for closed fracture in healthy patients with healthy skin.
Transfibular Ankle Arthrodesis Using Burring, Curettage, Multiple Drilling, and Fixation with Two Retrograde Screws through a Single Lateral Incision
Authors: Lee Hyun-Joo , Min Woo-Kie , Kim Ji-Su , Yoon Seong-Dae , Kim Dong-Hyun 
Published: October 2016

Purpose. To review the outcome of 23 ankle arthrodeses using burring, curettage, multiple drilling, and fixation with 2 retrograde screws through a single lateral incision. Methods. Records of 22 consecutive patients aged 39 to 79 (mean, 62.4) years who underwent 23 ankle arthrodeses for end-stage ankle arthritis were reviewed. Through a single lateral incision, articular cartilage was removed using burring and curettage, and multiple holes were drilled using a Kirschner wire, followed by fixation with 2 retrograde screws. The resected distal fibula was fixed to the distal part of the talus and tibia. The position of the ankle and subtalar joint arthrosis was assessed by 2 orthopaedic specialists. Pre- and post-operative American Orthopaedic Foot and Ankle Society (AOFAS) scores were evaluated. Results. The mean operating time was 122 minutes. The mean follow-up period was 41 months. The mean postoperative ankle alignment was suboptimal: 2.7° varus, 6.7° plantar flexion, and 2.9° internal rotation. The mean AOFAS score improved from 30 to 71 (p<0.01). The postoperative varus ankle alignment was not associated with the AOFAS score ( r= −0.13, p=0.569). Of the 23 cases, one was nonunion and 22 achieved bone union after a mean of 5.4 (range, 2–16) months; 3 of them were delayed union. Despite bone union, 7 patients complained of persistent pain; 4 of them had progressive arthrosis of the adjacent subtalar joints (n=2) or subtalar and talonavicular joints (n=2). Conclusion. Ankle arthrodesis using burring, curettage, multiple drilling, and fixation with 2 retrograde screws achieved a high union rate and acceptable functional score without serious complications.
3-D CT Analysis of Screw and Suture-Button Fixation for Syndesmosis Repair
Authors: Schon Jason M. , Williams Brady T. , Venderley Melanie B. , Backus Jonathon D. , Dornan Grant J. , Turnbull Travis L. , Laprade Robert , Clanton Thomas O. 
Published: October 2016

Category: Sports. Introduction/Purpose: Historically, unstable injuries to the distal tibiofibular syndesmosis have been repaired with syndesmotic screws. However, newer repair techniques with inherently flexible implants, including suture-button constructs, may be less susceptible to malreduction and more reliably restore the native anatomy. The purpose of this study was to compare the anatomic accuracy of reduction between a syndesmotic screw and suture-button constructs for syndesmosis repair using a pre- injury and postoperative 3-D model assessment. We hypothesized significant differences would be observed among repair techniques and suture-button constructs would most accurately restore the pre-injury syndesmotic volume. Methods: Twelve matched pairs of cadaveric specimens were dissected to identify the syndesmotic ligaments. Specimens were imaged with CT prior to the creation of a complete syndesmosis injury. The disrupted syndesmosis of each specimen was subsequently reduced using one of three randomly assigned repair techniques: (1) tri-cortical syndesmosis screw (3.5 x 50 mm), (2) one suture-button construct and (3) two suture-button constructs. Specimens were imaged postoperatively with CT. 3-D models of all scans and tibiofibular joint space volumes were created to assess restoration of the native syndesmosis (Figure 1). Volumetric joint space measurements were made starting at the distal aspect of the tibiofibular articulation and extended proximally with four 1 cm sections measured separately. Results: For each of the three fixation methods, the adjusted least squares means for total post-operative volumes of the syndesmosis were significantly decreased relative to the intact state. Total overall decreases in volume compared to the intact state for the one suture-button construct, two suture-button constructs, and syndesmotic screw were -561 mm3, -964 mm3 and - 377 mm3, respectively. Fixation with one suture-button construct was not significantly different from screw or two suture-button fixations. However, the total decrease in volume was significantly greater with the two suture-button repair compared to screw fixation (p < .05). Conclusion: The most important finding of this study was that fixation with one suture-button construct was not significantly different from screw or two suture-button fixations. All repairs significantly reduced the volume of the syndesmosis postoperatively compared to the intact state. Fixation with two suture-buttons resulted in significantly greater decreased volume than screw fixation. The data from the present study suggests that syndesmotic over-compression at time zero, particularly when using multiple suture-button implants, may be another potential factor contributing to malreduction of syndesmosis injuries that deserves further investigation.
Co-Morbidities Are Associated with Increased Cost, Infection Rates, and Duration of Treatment after Primary Achilles Tendon Repair
Authors: Dombrowski Malcolm E. , Murawski Christopher D. , Yasui Youichi , Chen Antonia F. , Kennedy John G. , Hogan MaCalus V. 
Published: October 2016

Category: Sports. Introduction/Purpose: The purpose of this study was to assess the rate of surgical site infection (SSI) and surgical irrigation and debridement (I&D) after primary Achilles tendon repair. Secondary objectives were to assess the potential effect(s) of medical comorbidities on cost and duration of treatment of SSI after Achilles tendon repair. Methods: De-identified patient insurance records within the government and private national insurance orthopaedic datasets were searched between 2005-2012. The Current Procedural Terminology (CPT) code was used to identify primary Achilles tendon repair and I&D. Subsequently, post-operative SSIs and comorbidities were examined by searching corresponding International Classification of Disease Ninth Revision, Clinical Modification (ICD-9-CM) codes. Results: 24,269 primary Achilles tendon repairs were identified. Overall, there was a significantly increased rate of SSI if a medical comorbidity was present at the time of surgery compared to those without a comorbidity (17.96% vs. 5.96%, p < 0.0001). Patients with diabetes and vascular complications had the highest SSI rate (OR 7.85, CI 6.25-9.86, p < 0.001), followed by peripheral vascular disease, diabetes with peripheral neuropathy, history of drug abuse, fluid and electrolyte abnormalities, obesity, and uncomplicated diabetes. There was higher rate of surgical I&D in patients with cardiac arrhythmias and uncomplicated hypertension. There was a significant increase in cost of SSI treatment ($6,004.09 vs. $4,184.62, p=0.006) and duration of treatment (8.41 days vs. 5.54 days, p < 0.001) if a medical comorbidity was present in Achilles tendon patients with SSI. Conclusion: An analysis of a large cohort of patients undergoing Achilles tendon reconstruction revealed that having certain medical comorbidities conferred a significantly greater risk for developing SSI, which increased both the cost of subsequent care and duration of treatment. Furthermore, with the advent of “value”/outcomes based care being linked to reimbursement, SSI is a one measure being used by the Centers for Medicare & Medicaid Services and private insures to determine appropriate orthopaedic care. Thus, patients with modifiable risk factors should be referred for medical management prior to surgery or deferred to a non-operative treatment program to reduce the risk of SSI after Achilles tendon repair.
Biomechanical Analysis of a Semitendinosus Allograft versus Achilles Turndown for Reconstruction of Large Segmental Achilles Defects
Authors: Aynardi Michael , Atwater Lara C. , Parks Brent G. , Melvani Roshan T. , Miller Stuart D. 
Published: October 2016

Category: Sports. Introduction/Purpose: Large segmental Achilles tendon defects present a difficult problem to treating surgeons. Multiple procedures have been utilized to reconstruct these defects, but no studies have evaluated the comparative tensile strength of the various repair methods. Our institution has recently described the use of a dual semitendinosus allograft for Achilles reconstruction. Advantages of this procedure include eliminating donor site morbidity and providing an increased surface area for healing and tendon incorporation. Our study investigated the tensile strength of this novel technique as compared to a standard myofascial turndown procedure. We hypothesized that no differences in biomechanical properties would be found between dual semitendinosus reconstruction and Achilles myofascial turndown reconstruction. Methods: An 8-cm segmental Achilles defect was created in both specimens of nine matched pair, cadaveric lower extremities. The specimens in each pair were randomly assigned to undergo allograft or turndown reconstruction. The myofacial turndown was secured distally with modified Kessler sutures of 0 braided polyester sutures through bone tunnels in the calcaneus and proximally with multiple interrupted figure-of-8 polyester braid sutures. Semitendinosus grafts were anchored proximally with a Pulvertaft weave and then distally through two bone tunnels within the calcaneus and sutured together around the posterior heel with similar polyester sutures. The foot was disarticulated through the subtalar joint and the Achilles was dissected free of excess soft tissues. The constructs were mounted onto a load frame and differential variable reluctance transducers were applied to the construct. Specimens were preconditioned and then loaded axially. Tensile forces were recorded at 10 mm of displacement and at failure Results: Semitendinosus allograft failure occurred via calcaneal bone bridge fracture in 8 of 9 specimens, and all myofascial turndowns failed through suture pullout through the fascial tissue at its insertion. None of the specimens failed at the MTS grip sites or via de novo tendon substance rupture. Average ultimate tensile strength of the semitendinosus allograft reconstruction was 290.9± 83.2 N compared to that of the turndown repair which was 140.7± 43.5 N. At 10 mm of displacement, average tensile strength of the allograft repair was 156.9 ± 29.7 N versus the turndown repair at 101.2 ± 20.0 N. Strength differences between the two repairs were significant at both failure and 10 mm displacement (p < 0.001). Conclusion: Dual semitendinosus allograft reconstruction demonstrates superior tensile strength properties when compared to myofascial turndown in a cadaveric model of large Achilles tendon defects.