bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mini-Incision Total Hip Replacement—Surgical Technique and Early Results
Authors: Chung WK , Liu D , Foo LSS 
Published: October 2016

Purpose. To compare the results of mini-incision total hip replacement (MITHR) to the standard posterior approach and evaluate the advantages and disadvantages of MITHR. Methods. 60 patients with osteoarthritis of the hip underwent total hip replacement utilising a mini-incision technique. They were compared to a matched cohort of patients who received the standard posterior approach. The average follow-up period was 14 months. The patients were compared with respect to the length of the incision, surgical time, intra-operative blood loss, narcotic requirements, length of hospital stay, requirement for walking aids, Harris hip score, and complications. Results. The length of the skin incision for MITHR, at an average of 9.2 cm, was half that of the standard approach. Statistically significant differences were found between the 2 groups in terms of intra-operative blood loss, length of hospital stay, and use of walking aids, all in favour of MITHR. There were no differences between the two approaches with regard to operating time, narcotic requirements, or Harris hip score. There were no cases of component malpositioning or major complications in the MITHR group. Conclusion. Uncemented total hip replacement can be effectively performed through a smaller incision utilising MITHR without increased risk of complications. Significant benefits include less intra-operative blood loss, shorter hospitalisation, and cosmesis.
Does Routine Blood Bone Biochemistry Predict Vitamin D Insufficiency in Elderly Patients with Low-Velocity Fractures?
Authors: Singh SK , Manjure S , Stott P , Shetty A , Iversen SA , Williams CR 
Published: October 2016

Purpose. Vitamin D deficiency impairs bone mineralisation and can predispose individuals to fractures. This study aimed at testing whether measurement of plasma calcium, alkaline phosphatase, and phosphate levels could detect vitamin D insufficiency. Methods. During a 10-week winter period from December 2000 to February 2001, all elderly patients presenting to a general hospital in Brighton—a British seaside town—with a fracture of the proximal femur and without known bone mineralisation problems were invited to participate in the study. Results. 23 (63.9%) of the 36 eligible patients had insufficient levels of vitamin D, with a plasma concentration of less than 30 nmol/L. The mean parathyroid hormone level was 56 pg/mL (range, 12–193 pg/mL). 11 of the 36 patients had an elevated level of parathyroid hormone and were insufficient in vitamin D. The mean plasma concentration of calcium was 2.30 mmol/L (range, 2.05–2.98 mmol/L). The mean phosphate level was 0.98 mmol/L (range, 0.40–1.79 mmol/L), and the mean alkaline phosphatase level was 91 IU/L (range, 46–127 IU/L). There was poor correlation between vitamin D insufficiency and plasma calcium, alkaline phosphatase, or phosphate levels. Conclusion. Plasma calcium, alkaline phosphatase, and phosphate testing cannot detect vitamin D insufficiency. We recommend that vitamin D and calcium supplementation be considered for patients with low-energy hip fractures.
Effects of Ethane-1-Hydroxy-1,1-Diphosphonate on Ossification of the Posterior Longitudinal Ligament in Zucker Fatty Rats
Authors: Yamamoto K , Imakiire A , Shishido T , Masaoka T 
Published: October 2016

Purpose. Using Zucker fatty rats as an animal model, we evaluate the effectiveness of ethane-1-hydroxy-1, 1-diphosphonate on ossification of the posterior longitudinal ligament by histopathologically investigating the prodromal, early, and advanced stages of ossification of the spinal ligaments. Methods. 73 Zucker fatty rats were allocated to the ethane-1-hydroxy-1,1-diphosphonate group (n=33) and the control group (n=40). The former group was fed ethane-1-hydroxy-1,1-diphosphonate daily. The feed was given starting 2 months after birth and continued until the rats were killed at 3 to 18 months later. Chemical analysis of the blood, radiographic tests, and histopathological examination were then conducted for both groups. Results. The results showed that ossification of the spinal ligaments involved excessive cartilage cell proliferation around areas affected by enthesitis; enlargement of the fibrocartilage tissue layer; ligament thickening; calcification of the matrix around the cartilage cells; and ossification of the spinal ligaments through enchondral ossification. Radiographic examinations showed that osteoproliferation in vertebral bodies in rats receiving ethane-1-hydroxy-1, 1-diphosphonate was generally suppressed compared with controls, whereas histopathological examinations found no clear difference in cartilage cell proliferation in areas affected by enthesitis between the two groups, indicating the absence of calcification or osteoproliferation in areas affected by enthesitis for the rats receiving ethane-1-hydroxy-1,1-diphosphonate. Conclusion. Ethane-1-hydroxy-1,1-diphosphonate is effective in suppressing progressive ligament ossification.
Clinical and Immunohistochemical Characteristics of Benign Giant Cell Tumour of Bone with Pulmonary Metastases: Case Series
Authors: Osaka S , Sugita H , Osaka E , Yoshida Y , Ryu J , Hemmi A , Suzuki K 
Published: October 2016

Purpose. Giant cell tumour of bone with pulmonary metastases is rare. However, some patients die of pulmonary metastases, and histological examination cannot distinguish between benign tumour and malignant metastases. In this study, we present clinical and immunohistochemical findings associated with giant cell tumour of bone with pulmonary metastases. Methods. Five patients with benign giant cell tumour of bone with pulmonary metastases (one man and 4 women) were studied. Patients' ages ranged between 20 and 23 years (mean age, 21.8 years). Tumours were in the distal femur in 2 cases, and in the proximal tibia, distal tibia, and lumbar spine in one case each. The tissue specimens from primary tumours, recurrent tumours, and pulmonary metastases were studied using immunohistochemical techniques. Results. Three of the 5 primary tumours were of the spontaneous regression or growth cessation type, or the continuously slow-growing type, showing 4.2% to 6.2% of positive cells for Ki-67 after immunohistochemical staining. However, 2 patients with the rapid-growing type of disease died of pulmonary metastases; their primary, recurrent, and metastatic tumour specimens contained 9.0% to 11.5% of positive cells for Ki-67. Conclusion. Three of the 5 primary tumours had a benign clinical pattern and immunohistochemistry. Two of the 5 patients died of pulmonary metastases, which had an aggressive clinical pattern and a high prevalence of positive cells in Ki-67. Examination of Ki-67 should be carried out for aggressive type of giant cell tumour.
Single Photon Emission Computed Tomography Scanning in the Diagnosis of Knee Pathology
Authors: Vellala RP , Manjure S , Ryan PJ 
Published: October 2016

Purpose. To evaluate the role of single photon emission computed tomography (SPECT) bone scan for the diagnosis of knee lesions in routine clinical practice. Methods. 40 consecutive case records were examined in patients who underwent a SPECT scan prior to knee arthroscopy in routine clinical practice. The accuracy of clinical examination, SPECT scan results, and arthroscopic findings (as the gold standard) in diagnosing knee lesions were compared. Results. The sensitivity of SPECT scans in detecting medial meniscal, lateral meniscal, anterior cruciate ligament lesions, osteochondral defects, and chondromalacia patellae was 77%, 14%, 33%, 50%, and 74%, respectively. The specificities for the same structural lesions were high at 89%, 94%, 97%, 94%, and 69%, respectively. Conclusion. SPECT bone scan appears to be useful in the diagnosis of knee pathology in routine practice and in selecting patients for arthroscopy, especially most useful for the diagnosis of medial meniscal tears.
Ilizarov Ring Fixation and Fibular Strut Grafting for C3 Distal Femoral Fractures
Authors: Ramesh LJ , Rajkumar SA , Rajendra R , Rajagopal HP , Phaneesha MS , Gaurav S 
Published: October 2016

Purpose. To evaluate treatment outcome following surgical repair of C3 distal femoral fractures using autogenous fibular strut, cortico-cancellous bone grafting, and Ilizarov ring fixation. Methods. A total of 15 patients with type C3 fractures (supracondylar and intercondylar fractures, with multiplane articular injury) underwent surgical repair at St. John's Medical College Hospital between 1994 and 2001, using autogenous fibular strut, cortico-cancellous bone grafting, and Ilizarov ring fixation. 13 were seen for ongoing follow-up and assessment. Definitive surgery was undertaken at a mean of 3 weeks after admission. Postoperatively, weight-bearing and mobilisation exercise were begun in 2 to 4 weeks. Results. The mean follow-up period was 47 months. Union was achieved in all 13 cases by an average time of 19 weeks. At the last follow-up, the mean range of knee motion was 77°. Assessment of functional outcome (using Neer's scoring criteria) revealed 10 cases with good or satisfactory outcomes, and 3 cases with poor or unsatisfactory results. Conclusion. Surgical repair with a fibular strut, cortico-cancellous bone graft and Ilizarov ring fixation appears a suitable treatment option for C3 distal femoral fractures.
Perioperative and Rehabilitation Outcome after Lower-Limb Amputation in Elderly Chinese Patients in Hong Kong
Authors: Leung HB , Wong WC , Wu FCJ , Guerin JS 
Published: October 2016

Purpose. Major amputation of the lower limb is considered the last resort when limb salvage is impossible. The aim of this study is to determine the morbidity, mortality, and rehabilitation outcome of patients that underwent a lower-limb amputation. Methods. A retrospective cohort study was conducted among 100 elderly patients who underwent a total of 120 lower-limb amputations in a regional hospital in Hong Kong from 1996 to 2001. Results. The mean age of the amputees was 77.9 years; 58 were female. 95% of the amputations were performed because of infection with or without vascular compromise; 55 transfemoral and 60 transtibial amputations contributed 96% of the case mix. Some 43% of patients experienced early complications and 12% required re-amputation. The early (30-day) mortality rate was 15%. Only 55% of the amputees survived after 4 years. A 44% return-home rate was achieved. However, only 11% of the amputees could walk without help from other people. Although prostheses were issued to 42% of the survivors, compliance was only 53%; 24% of the survivors lost their remaining leg within 2 years. Conclusion. The outcome of major lower-extremity amputation remains poor. Efforts should be made to retain these limbs. When it is proven impossible, one should strive to preserve the knee joint whenever feasible.
Autologous Blood Transfusion in Total Hip Arthroplasty
Authors: Yamamoto K , Imakiire A , Masaoka T , Shinmura K 
Published: October 2016

Purpose. To determine the possibility of avoiding homologous blood transfusion during total hip arthroplasty, and to clarify the problems associated with autologous blood transfusion. Methods. A total of 253 patients received autologous blood transfusion during total hip arthroplasty between April 1990 and December 2000. Patients were assessed for the volume of haemorrhage during surgery, possibility of avoidance of homologous blood transfusion, and the disposal of autologous blood. Results. There were no significant differences in the mean volume of haemorrhage among different underlying diseases. The mean total volume of haemorrhage was 2039 (standard deviation, 992) ml in revision surgery and 1673 (717.3) ml in primary surgery (p<0.05). The rate of avoidance of homologous blood transfusion was 75% among patients who underwent primary surgery, and 61% among those who underwent revision surgery. The rate was 95% in cases in which a combination of preoperative blood pooling and intra-operative recovery was used, 49% in cases where the preoperative blood pooling system alone was used, and 42% in those in which the intra-operative recovery system alone was employed. The autologous blood had to be disposed of in 3 (1%) cases, all of which were revision procedures with replacement of the polyethylene liner alone. Conclusion. Combined use of the preoperative blood pooling and intra-operative recovery systems is effective for avoiding homologous blood transfusion.
Total Hip Arthroplasty: The Relationship between Posterolateral Reconstruction, Abductor Muscle Strength, and Femoral Offset
Authors: Yamaguchi T , Naito M , Asayama I , Ishiko T 
Published: October 2016

Purpose. To evaluate the relationship between posterolateral reconstruction, abductor muscle strength, and femoral offset following total hip arthroplasty. Methods. Of 28 patients (56 limbs) we assessed, 12 underwent posterolateral reconstruction (reconstruction group) and 16 did not (non-reconstruction group). Isometric abductor muscle strength was measured with a handheld dynamometer. Each patient's muscle strength was converted into a force to body weight ratio, and this ratio was used in the comparisons. Results. The reconstruction group showed a higher value in abductor muscle strength than the non-reconstruction group (p<0.05). Significant correlation between abductor muscle strength and femoral offset was found in the reconstruction group (p=0.016; r=0.674). Conclusion. Posterolateral reconstruction and appropriate reconstruction of femoral offset following total hip arthroplasty are important to improve the abductor muscle strength.
Unreamed Interlocking Nailing in Open Fractures of Tibia
Authors: Joshi D , Ahmed A , Krishna L , Lal Y 
Published: October 2016

Purpose. To assess the clinical outcome of unreamed intramedullary interlocking nailing in open fractures of tibia, and to evaluate the incidence of complications in these open fractures as a result of the unreamed intramedullary nailing. Methods. Between June 1999 and May 2000, a total of 60 cases of open tibial shaft fractures were operated on with unreamed interlocking nails at Safdarjung Hospital, New Delhi, India. Records of 56 patients (4 women and 52 men) were available for study. Only injuries associated with the tibial shaft were included. Traffic accidents were the cause of fractures in all patients. All fractures were classified according to Gustilo and Anderson system for open fractures. There were 30 (53.6%) type-I, 18 (32.1%) type-II, 4 (7.1%) type-IIIA, and 4 (7.1%) type-IIIB fractures. After thorough debridement under anaesthesia, an unreamed interlocking nail was inserted with assistance by an image intensifier. All nails were statically locked with one screw each proximally and distally. Results. The patients were followed up for a mean period of 20 months (range, 18–24 months) and were evaluated according to the modified Ketenjian's criteria. Results were good to excellent in 85.8% cases, and poor in 10.7% cases. Only 2 of 8 patients with type-III fractures had good results. Two of 4 type-IIIA and all 4 type-IIIB fractures had chronic osteomyelitis. Of 56 patients, 6 had early infection, 6 had delayed union, 6 had infected non-union, 2 had nail breakage, 8 had screw breakage, and 10 had anterior knee pain. Conclusion. Unreamed interlocking tibial nailing can be safely used for type-I and type-II open injuries even with delayed presentation. Use of unreamed nailing in those type-III fractures with delayed presentation was not recommended, because of high incidence of complications.
Open Reduction and Internal Fixation of Volar Barton's Fractures: A Prospective Study
Authors: Aggarwal AK , Nagi ON 
Published: October 2016

Purpose. To assess the functional and clinical outcomes of open reduction with internal fixation in the treatment of Barton's fracture of the wrist. Methods. From January 1997 to July 2003, a total of 19 cases of volar Barton's fracture were operated on by open reduction and internal fixation at the Nehru Hospital, Chandigarh, India. Records of 16 cases were available for study. Special care was taken during surgery to achieve articular congruity. The injury was caused by motor vehicle accidents in 13 cases and by a fall in 3. All cases were type-B3 fractures: 10 were of the B3.3 subtype, 4 of the B3.2 subtype, and 2 of the B3.1 subtype. Most (12) cases were operated on within one week of injury, 3 in one to 2 weeks, and one in 2 to 3 weeks. Results. All patients were assessed clinically and radiographically after a mean follow-up duration of 32.4 months (range, 12.0–65.0 months). Fractures healed after 7.0 to 10.0 weeks (mean, 8.8 weeks). Results of evaluations according to functional criteria were excellent in 9 cases, good in 5, and fair in 2. Radiocarpal osteoarthrosis developed secondary to trauma in 2 cases. There was no involvement of the median nerve in any of the 16 cases. Conclusion. Open reduction and internal fixation of volar Barton's fracture can restore articular congruity and result in good to excellent function.
Morphological Studies on the Ageing and Osteoarthritis of the Articular Cartilage in C57 Black Mice
Authors: Yamamoto K , Shishido T , Masaoka T , Imakiire A 
Published: October 2016

Purpose. To study the cause and mechanism of joint degeneration in osteoarthritis, through histopathological and ultrastructural-histochemical experiments on the articular cartilage of the knees of the C57 black mouse. Methods. 192 C57 black mice and a control group of 64 C57BL/6J mice were used in this study. The left and right knee articular capsules of the joints were removed and stained. Each articular cartilage sample was examined and osteoarthritic changes were assessed using a transmission electron microscope. The severity of osteoarthritis in the knee joint cartilage of C57 black mice was histologically assessed using a classification system described by Okabe, based on Maier's system. Results. The incidence and the severity of osteoarthritis gradually increased with age; the incidence increased from 20% at 2 months to 80% at 16 months. Irreversible changes appeared at an advanced stage, and the process of degeneration was quite similar to that in human osteoarthritis. Through transmission electron microscopy, we observed poorly developed Golgi apparatus, markedly increased intracellular microfilaments, decreased proteoglycan granules, and broken collagen networks in all stages of osteoarthritis. By contrast, Golgi apparatus and other organelles were well developed in histologically normal mice of all ages. Proteoglycan granules, which mainly consisted of keratan sulphate, were observed; collagen networks were maintained. Conclusion. Disturbed protein transport and sugar synthesis in chondrocytes, caused by the deficient development of the Golgi apparatus, could result in degenerative changes in articular cartilage. The structure and function of the matrix were maintained mainly because of the continued presence of keratan sulphate.
The Need for Multidisciplinary Management of Patients with Upper Thoracic Spine Fractures Caused by High-Velocity Impact: A Review of 32 Surgically Stabilised Cases
Authors: Quinlan JF , Harty JA , O'Byrne JM 
Published: October 2016

Purpose. To analyse the characteristics of patients who underwent surgery for fractures of the upper thoracic spine (T1–T6) in our institution. The thoracic spine is supported by the rib cage and associated ligaments; therefore, displacement and fracture of the upper thoracic spine in healthy young adults require a great force. The relatively narrow spinal canal around the spinal cord in this area could result in severe neurological deficit should fractures occur. Methods. The treatment course of 32 patients (26 men and 6 women) who underwent surgery for fractures of the upper thoracic spine between February 1995 and March 2001 was retrospectively reviewed. Parameters of injuries and treatment methods were evaluated. Results. Of the 32 patients, 29 were injured in traffic accidents (15 motorcycle and 14 vehicle), 2 in falls, and one by a heavy door falling on his back. 29 patients had spinal fractures at more than one level. 23 patients had complete, 7 had incomplete, and 2 had no neurological deficit. 30 patients required multiple modalities of radiological imaging (in addition to plain radiography) for diagnosis. 20 patients sustained other injuries apart from spinal fractures, 15 of them had associated chest injuries. Conclusion. High-velocity fractures of the upper thoracic spine are injuries with devastating consequences, and can result in severe neurological deficit and concomitant injuries. These patients are best treated by a multidisciplinary approach.
Microvascular Density of Rapidly Destructive Arthropathy of the Hip Joint
Authors: Yamakawa T , Sudo A , Tanaka M , Uchida A 
Published: October 2016

Purpose. To assess the vascularity of the femoral head and determine how it is related to the destruction of the arthritic hip joint. The process of destructive arthropathy in arthritic hip joints is variable. Some patients with osteoarthritis of the hip have rapidly progressive destructive changes resulting in the disappearance of the femoral head. Method. Six femoral heads from patients diagnosed with rapidly destructive arthropathy and 6 femoral heads from patients with secondary osteoarthritis caused by acetabular dysplasia were analysed to reveal the association between blood capillaries and osteoclasts. The von Willebrand Factor immunostaining and counterstaining with Mayer's haematoxylin were used to label the microvessels and osteoclasts in formalin-fixed, paraffin-embedded specimens of femoral heads. The numbers of immunostained microvessels and osteoclasts in selected regions were counted. Result. The microvascular density of the bone surfaces of rapidly progressive arthritic hips was hypervascular. Osteoclasts were also found in increased numbers on the bone surfaces of rapidly progressive arthritic hips. The higher microvascular density coincided with extensive bone destruction and with the increased osteoclast count. Conclusion. These findings suggested that hypervascularity of the granulation in the femoral head may be associated with bone and joint destruction.