bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distal Femoral Rotational Axes in Indian Knees
Authors: Mullaji Arun B , Sharma Amit K , Marawar Satyajit V , Kohli Anirudh F , Singh Dharmendra P 
Published: October 2016

Purpose. To measure the angular relationships of distal femoral rotational axes in 100 normal Indian knees. Methods. 42 men and 8 women aged 26 to 40 (mean, 31) years, with 100 normal non-arthritic knees were recruited. Anatomic landmarks were measured using computed tomography. They included the posterior condylar axis, the transepicondylar axis, the anteroposterior axis (Whiteside's line), the posterior condylar angle (PCA), the Whiteside-epicondylar angle (W-EP), and the Whiteside-posterior condylar angle (W-PC). Results. The mean PCA, W-EP, and W-PC were 5°, 90.8°, and 95.8°, respectively. The mean femorotibial alignment was 179.6°. The differences between the left and right sides were significant only for the W-EP and W-PC. Only the PCA and W-EP were weakly correlated ( r=0.338, p=0.001). Conclusion. There are differences in distal femoral rotational axes among Indian, Caucasian, and Japanese knees. Our data can be used to evaluate changes in those axes in ageing or arthritic patients.
Intramedullary Nailing and Plate Osteosynthesis for Fractures of the Distal Metaphyseal Tibia and Fibula
Authors: Krishan Ajay , Peshin Chetan , Singh Dara 
Published: October 2016

Purpose. To assess the results of concurrent intramedullary nailing plus plate osteosynthesis for fractures of the distal tibia and fibula. Methods. 15 men and 10 women (mean age, 35 years) with concurrent fractures of the distal tibia and fibula underwent intramedullary nailing (for the tibia) and plate osteosynthesis (for the fibula). 17 fractures were type A1, 6 type A2, and 2 type A3. Compound type IIIB or more extensive fractures were excluded. Results. The mean follow-up duration was 2 years. The mean time to bone union was 20 weeks. Six patients underwent dynamisation and 4 bone grafting. Two patients had malalignment (angulation of >5° in any plane), but none was rotational. No patient had shortening, hardware breakdown, or deep-seated infection. Two patients had superficial cellulitis at the site of the distal locking screws. Conclusion. Concurrent intramedullary nailing and plate osteosynthesis for fractures of the distal tibia and fibula is effective in preventing malalignment. Plate osteosynthesis for the fibula provides additional stability even when a single distal locking bolt is used to fix the intramedullary nail to the tibia.
Radiofrequency Coblation for Chronic Foot and Ankle Tendinosis
Authors: Yeap Ewe Juan , Chong Keen Wai , Yeo William , Rikhraj Inderjeet Singh 
Published: October 2016

Purpose. To evaluate outcomes of radiofrequency coblation for chronic tendinosis of the foot and ankle tendons. Methods. Records of 7 men and 8 women (16 feet) aged 27 to 65 years who underwent radiofrequency coblation for chronic tendinosis (combined with other procedures for other pathology) of the Achilles, posterior tibial, and peroneal tendons were retrospectively reviewed. The visual analogue scale (VAS) for pain status, the Short Form (SF-36) questionnaire for quality of life, and the American Orthopaedic Foot and Ankle Society (AOFAS) scores for functional status of the patients were determined pre- and post-operatively. Results. All patients reported significant reduction in pain at 3 months, with more than 63% attaining VAS scores of 0 at 6 months. AOFAS scores were significantly improved at both 3 and 6 months. Most components of SF-36 scores improved at 6 months except those for general health and role emotional; only those for bodily pain improved significantly. At postoperative month 3 and 6 respectively, 93 and 100% of the patients had their expectations met, whereas 93 and 88% had good-to-excellent satisfaction. There were no major complications. Conclusions. Radiofrequency coblation for chronic tendinosis of the foot and ankle achieves good short-term outcomes and pain relief. It may be combined with other procedures for maximal benefit.
Eleven-Year follow-up of Second-Generation Metal-on-Metal Total Hip Arthroplasty
Authors: Park Myung-Sik , Chung Woo-Chul , Yoon Sun-Jung , Cho Hong-Man , Kwon Suk-Hyun 
Published: October 2016

Purpose. To investigate the cause of failure in matte-surface cemented stems in second-generation metal-on-metal total hip arthroplasty (THA). Methods. Records of 26 men and 11 women (39 hips) aged 29 to 72 years who underwent primary cementless THAs by a single surgeon using second-generation metal-on-metal prostheses and were followed up for a mean of 122 (range, 120–141) months were reviewed. Two types of femoral stems were used: a cementless Ti-alloy stem (n=21) and a matte-surface, iron-based alloy, cemented stem (n=18). Clinical outcomes were measured using the Harris hip score. Radiographs were assessed for stem loosening and osteolysis. Patient activity levels were graded. Surfaces of the retrieved femoral stems and periprosthetic tissue samples were examined. Metallic and cement particles were studied. Hypersensitivity to metal was tested. Results. None of the cementless stems were revised; no osteolysis or stem loosening occurred. In contrast, 7 of 18 matte-surface cemented stems were revised owing to stem loosening or osteolysis. Periprosthetic tissues revealed abundant cement-related particles; 90% were zirconium oxides but a few were iron particles. Histological examination of periprosthetic tissues showed perivascular infiltration of lymphocytes and macrophages containing tiny foreign materials. Metal hypersensitivity was not associated with aseptic loosening. Conclusion. Metal-on-metal THA with cementless components could be recommended for young, active patients to prevent wear and osteolysis. The matte-surface cemented stem is more likely to fail owing to friction during the earlier stage and cement-related biological processes during the later stage.
Open Interlocking Nailing and Bone Grafting for Neglected Femoral Shaft Fractures
Authors: Gavaskar Ashok S , Kumar Ramesh 
Published: October 2016

Purpose. To review the treatment outcome of patients with neglected femoral shaft fractures. Methods. Records of 22 men and 3 women aged 20 to 55 (mean, 36) years who underwent open interlocking nailing and bone grafting for neglected (≥2-month-old) closed femoral shaft fractures were reviewed. 21 had nonunion and 4 had malunion. All patients had deformed, shortened, and wasted lower limbs, with knee stiffness. The mean delay in presentation was 3 (range, 2–7) months. Results. Patients were followed up for a mean of 18 (range, 14–30) months. The mean time for radiological union was 5 (range, 4–7) months. Three patients had delayed union (≥6 months) and underwent secondary procedures (dynamisation or bone marrow injection). None had non-union. All had some degree of shortening; in 3 it was >2 cm. None had neurological injury following acute gain in length. None had deep infections; 2 had superficial wound infections and 6 had pin tract infections. Mean knee flexion improved 50° (from 70° to 120°) and the mean extensor lag decreased 7° (from 15° to 8°). After a mean of 18 weeks, 23 of the patients were able to return to their work. Conclusion. Open interlocking nailing and bone grafting coupled with aggressive rehabilitation can achieve acceptable results for patients with neglected femoral shaft fractures.
Anatomic Variations of Neurovascular Structures of the Ankle in Relation to Arthroscopic Portals: A Cadaveric Study of Chinese Subjects
Authors: Woo Siu-Bon , Wong Tak-Man , Chan Wai-Lam , Yen Chi-Hung , Wong Wing-Cheung , Mak Kong-Ling 
Published: October 2016

Purpose. To investigate anatomic variations of neurovascular structures in the ankle and the safety margin for arthroscopic portals. Methods. 11 left and 12 right ankles from 8 female and 15 male fresh cadavers of Chinese ethnicity aged 53 to 88 (mean, 68) years were used. The ankle was standardised in a plantigrade position, zero-degree inversion, and neutral rotation. Four ankle portals, namely anteromedial (AM), anterolateral (AL), posteromedial (PM) and posterolateral (PL), were identified using 23-gauge needles. Skin and subcutaneous fat were dissected from the underlying fascia to visualise neurovascular structures. Distances were measured from: (1) the AM portal to the saphenous vein and nerve and its branches, (2) the AL portal to branches of the superficial peroneal nerves, of which the lateral one was labelled as the intermediate dorsal cutaneous branch and the medial one as the medial dorsal cutaneous branch, (3) the PM portal to the posterior tibial neurovascular bundles, and (4) the PL portal to the sural nerve. Results. The distances from (1) the AM portal to branches of the great saphenous vein and nerve, and (2) the AL portal to the intermediate dorsal cutaneous branch of the superficial peroneal nerve were short and may be an anatomic hazard. Variations were significant among the cadavers in terms of distances of the portals to the neurovascular structures. Conclusion. In Chinese cadavers, variations of neurovascular structures are significant. Care must be taken to avoid inadvertent injury during ankle arthroscopy.
Effect of Lag-Screw Positions on Modes of Fixation Failure in Elderly Patients with Unstable Intertrochanteric Fractures of the Femur
Authors: Wu Chi-Chuan , Tai Ching-Lung 
Published: October 2016

Purpose. To investigate the effect of lag-screw positions in the femoral head on modes of fixation failure. Methods. 591 patients aged ≥65 years underwent sliding compression screw fixation for type A1 (n=249) and type A2 (n=342) intertrochanteric fractures of the femur after low-energy injuries. There were 18 cases of fixation failure; in 13 (group 1) the lag screw was placed in the central-central area, and in 5 (group 2) in the inferior 1/3-central area. Clinical variables of the 2 groups were compared. Results. All 18 cases of fixation failure were actually type A23 and misinterpreted as type A22 fractures. In 13 cases, failure was attributable to cut-out of the lag screws at the superolateral edge of the femoral head. In 3 cases, failure was attributable to telescoping and >2 cm shortening of the femur. In one case, failure was due to penetration of the lag screw into the acetabulum. In another case, failure was due to plate loosening with breakage of cortical screws. In the 13 cases with cut-out of the lag screw (group 1), the lag screw was placed in the central-central area (p<0.001). In the remaining 5 cases with no cut-out (group 2), the lag screw was placed in the inferior 1/3–central area (p<0.01). Complications occurred significantly earlier in group 1 than in group 2 patients (2.6 vs. 4.6 months, p=0.02). The tip-apex distance was significantly shorter in group 1 than in group 2 patients (19 vs. 30 mm, p<0.001). Conclusion. Misinterpretation of type A23 fractures as type A22 may lead to fixation failure. Operative treatment should not be delayed once complications occur. The positions of the lag screw may affect the mode of fixation failure.
Bicycle-Spoke Injuries of the Foot in Children
Authors: Agarwal Anil , Pruthi Manish 
Published: October 2016

Purpose. To evaluate the characteristics of bicycle-spoke injuries in a suburban Indian population. Methods. 30 male and 11 female children aged 4 to 12 (mean, 6) years with bicycle-spoke injuries were prospectively studied. Data collected included patient age, gender, position at the time of injury, site, type, and characteristics of the injury. According to the Oestern and Tscherne classification, soft-tissue injuries were classified into grades 0 to 3. Results. 37 patients injured the right foot, and 4 the left foot; 34 by the rear wheel and 7 by the front wheel. All front-wheel injuries involved the forefoot and midfoot. 73% of injuries involved the lateral aspect of the ankle. The most common injury site was the posterior ankle (n=30), followed by the medial midfoot (n=7), and the forefoot (n=3). Partial avulsion of heel flap and an exposed Achilles tendon were each noted in 2 patients. 10, 13, 14, and 4 patients sustained soft-tissue injuries of grades 0, 1, 2, and 3, respectively. Eight patients had associated fractures. All fractures healed uneventfully. Marginal necrosis of the wound was noted in 5 patients, but none required a skin graft. No patient had functional impairment or residual tenderness of the foot. Conclusion. Bicycle-spoke injuries usually affected the ankle region, and the wound was usually deeper than it appeared on initial examination. Reassessment of the wound after 48 hours is recommended. Severity of soft-tissue injury was the determinant of overall function; bone fractures by themselves did not alter the duration of recovery. To prevent bicycle-spoke injuries, spoke guards and foot rests should be used, and children being carried on a bicycle should wear proper shoes. Education on injury mechanism, severity, and preventive measures is also important.
Corresponding Scapular Pain with the Nerve Root Involved in Cervical Radiculopathy
Authors: Mizutamari Masaya , Sei Akira , Tokiyoshi Akinari , Fujimoto Toru , Taniwaki Takuya , Togami Wakana , Mizuta Hiroshi 
Published: October 2016

Purpose. To correspond scapular pain with the nerve root involved in cervical radiculopathy. Methods. In the anatomic study, 11 Japanese adult cadavers were dissected to examine the numbers and courses of the cutaneous nerves from C3 to C8 dorsal rami. In the clinical study, 14 men and 11 women aged 34 to 77 years who presented with scapular pain as well as pain, numbness or motor weakness in the upper limbs secondary to cervical radiculopathy were assessed. The involved nerve roots were identified based on the symptoms and signs in the arm and/or fingers, the radiological diagnosis, and the pain response to cervical nerve root blocks. The sites and characteristics of radicular pain were assessed. Results. In the anatomic study of 22 cutaneous nerves from medial branches of dorsal rami, 18 involved the C5 nerve root, 0 the C6 root, one the C7 root, and 8 the C8 root. In the clinical study, the radicular pain often occurred in the suprascapular region involving the C5 root, in the suprascapular to posterior deltoid region involving the C6 root, in the interscapular region involving the C7 root, and in the interscapular and scapular regions involving the C8 root. All patients with C5 or C8 radiculopathy had both superficial and deep pain, whereas almost all patients with C6 or C7 radiculopathy had deep pain only. No patient had superficial pain only. Conclusion. Cervical radiculopathy can cause scapular pain. Pain sites and characteristics are related to the affected nerve root.
Conservative Treatment for Mild Femoroacetabular Impingement
Authors: Emara Khaled , Samir Wail , Motasem EL Hausain , Ghafar Khaled Abd EL 
Published: October 2016

Purpose. To report early results of conservative treatments (including modifications in activities of daily living) for mild femoroacetabular impingement. Methods. 27 male and 10 female athletic patients aged 23 to 47 years presented with unilateral hip pain secondary to femoroacetabular impingement and an alpha angle of <60°. Patients were instructed to adapt to their safe range of movement and perform activities of daily living with minimal friction. The Harris Hip Score and non-arthritic hip score before and after treatment were compared. Open or arthroscopic hip surgery to remove the impinging bone was indicated when conservative treatment failed. Results. Patients were followed up for 25 to 28 months. Of the 37 patients, 4 underwent surgical treatment after conservative management failed. For the remaining 33 patients, the mean Harris Hip Score improved significantly from 72 before treatment to 91 at the 24-month follow-up. The mean non-arthritic hip scores improved from 72 to 91, and the mean visual analogue scores for hip pain from 6 to 2. Six of the 33 patients had recurrent hip pain and discomfort but not severe enough for surgical treatment. Conclusion. Conservative treatment did not improve the range of hip movement, despite improvement in function and symptoms. Yet it achieved good early results, as long as the patients could modify activities of daily living to adapt to their hip morphology.
Long-Term Results of Total Knee Arthroplasty for Valgus Knees: Soft-Tissue Release Technique and Implant Selection
Authors: Rajgopal Ashok , Dahiya Vivek , Vasdev Attique , Kochhar Hemanshu , Tyagi Vipin 
Published: October 2016

Purpose. To report long-term results of total knee arthroplasty (TKA) for valgus knees. Methods. 34 women and 19 men aged 39 to 84 (mean, 74) years with valgus knees underwent primary TKA by a senior surgeon. Of the 78 knees, 43, 29, and 6 had type-I, type-II, and type-III valgus deformities, respectively. A preliminary lateral soft-tissue release was performed, and the tibia and femur were prepared. The tight lateral structures were released using the pie-crusting technique. In 92% of the knees, cruciate-retaining implants were used. In knees with severe deformity and medial collateral ligament insufficiency, the posterior cruciate ligament was sacrificed and constrained implants were used. The Hospital for Special Surgery (HSS) knee score was assessed, as were tibiofemoral alignment, range of motion, stability, and evidence of loosening or osteolysis. Results. Patients were followed up for 8 to 14 (mean, 10) years. All knees had a good patellar position and were clinically stable in both mediolateral and anteroposterior planes. No radiolucency was noted. The mean HSS knee score improved from 48 to 91 (p<0.001). The mean tibiofemoral alignment improved from valgus 20° to 5° (p<0.001). The mean range of motion improved from 65° to 110° (p<0.001). One patient developed a deep infection at year 4, and 2 had periprosthetic fractures at years 6 and 8. Conclusion. Adequate lateral soft-tissue release is the key to successful TKAs in valgus knees. The choice of implant depends on the severity of the valgus deformity and the extent of soft-tissue release needed to obtain a stable, balanced flexion and extension gap, in order to achieve minimal constraint with maximum stability.
Shoulder Ultrasonography versus Arthroscopy for the Detection of Rotator Cuff Tears: Analysis of Errors
Authors: Singisetti Kiran , Hinsche Andreas 
Published: October 2016

Purpose. To compare shoulder ultrasonography with arthroscopy for detecting specific rotator cuff tears. Methods. 96 shoulders in 56 men and 34 women aged 28 to 65 (mean, 42) years with rotator cuff problems underwent a shoulder ultrasonography by a single radiologist, and then a shoulder arthroscopy by a single surgeon. The ultrasonographic and arthroscopic findings were compared with regard to tendon-specific tears and disparities in diagnosis. Results. For detection of supraspinatus tendon tears, ultrasonography attained a sensitivity of 89%, specificity of 43%, positive predictive value of 76%, and negative predictive value of 100%. For detection of subscapularis tendon tears, ultrasonography attained a sensitivity of 30%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 78%. Sensitivity, specificity, and predictive values were good in larger full-thickness tears, but were significantly reduced in sub-centimetre and partial-thickness tears, particularly of the subscapularis tendon. Conclusions. Surgeons should be aware of the potential disparities between ultrasonographic and arthroscopic findings and be prepared to adjust the surgical procedure during arthroscopy.
Alendronate-Associated Femoral Insufficiency Fractures and Femoral Stress Reactions
Authors: Wang Kemble , Moaveni Afshin , Dowrick Adam , Liew Susan 
Published: October 2016

Purpose. To report characteristics and outcomes of 8 patients who underwent intramedullary nailing for alendronate-associated femoral insufficiency fractures. Methods. Records of 7 women and one man aged 54 to 91 (mean, 72) years who underwent intramedullary nailing for spontaneous or low-energy, alendronate-associated femoral insufficiency fractures were retrospectively reviewed. Contralateral femurs were assessed for stress reactions. Results. All patients had at least 4 (range, 4–10) years of alendronate use. Five patients had experienced prodromal pain lasting one day to 5 months. Five patients had received concurrent glucocorticoid therapy. At the 6-month follow-up, 6 patients had bony union, one had hypertrophic non-union and underwent dynamisation and nail exchange and eventually achieved union at month 16, and one had fixation loss and underwent nail exchange and bone grafting and eventually achieved union at month 9. In 3 patients, the contralateral femurs were painful, and cortical stress reactions were noted. They underwent prophylactic intramedullary nailing. Radiographs showed no evidence of new stress reactions or fractures. Conclusion. Contralateral involvement in patients with alendronate-associated femoral insufficiency fractures is not uncommon. Early prophylactic intramedullary nailing may provide effective pain relief and prevent progression to a fracture.
Factors Predicting Progression in Early Degenerative Lumbar Scoliosis
Authors: Kohno Shinsuke , Ikeuchi Masahiko , Taniguchi Shinichirou , Takemasa Ryuichi , Yamamoto Hiroshi , Tani Toshikazu 
Published: October 2016

Purpose. To review early radiographs of patients with de novo degenerative lumbar scoliosis to determine factors predicting early scoliosis progression. Methods. Standing anteroposterior and lateral radiographs of 7 men and 20 women aged 48 to 83 (mean, 63) years with Cobb angles between >5° and <20° were reviewed. They were followed up for a mean of 12 (range, 10–18) years. Radiographic variables measured included (1) the Cobb angle, (2) the grade of rotation of the apical lumbar vertebra, (3) the presence of a lateral vertebral translation of ≥3 mm, (4) the degree of osteoporosis, and (5) the Harrington factor (the degree of scoliosis divided by the number of vertebrae involved). Results. During the follow-up period, the mean Cobb angle increased 5.3° from 10.1° to 15.4°, representing an increase of 0.4° per year. In initial radiographs, the apical vertebral rotation was rated as grade 0 in 3 patients, grade 1 in 19, grade 2 in 4, and grade 3 in one. A lateral vertebral translation of ≥3 mm was noted in 9 patients. The degree of osteoporosis was rated as grade 0 in 9 patients, grade 1 in 11, grade 2 in 5, and grade 3 in 2. The mean Harrington factor was 2.4. In the multiple regression analysis, only the grade of apical vertebral rotation was significantly correlated with scoliosis progression (regression coefficient=0.502, p=0.009). Conclusion. Apical vertebral rotation may help predict the scoliosis progression and determine the timing of surgical intervention in patients with early degenerative lumbar scoliosis.