bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exposure in Difficult Total Knee Arthroplasty Using Coronal Tibial Tubercle Osteotomy
Authors: Bruce WJ , Rooney J , Hutabarat SR , Atkinson MC , Goldberg JA , Walsh WR 
Published: October 2016

Exposure in a total knee arthroplasty can be challenging regardless of whether it is a difficult primary or a revision. Various techniques both proximal and distal to the patella have been described and implemented to gain exposure and improve knee flexion.3,6,12 When patella eversion is not possible due to previous surgery or severe preoperative knee flexion contracture, a coronal tibial tubercle osteotomy may be utilized.15,16 We present successful results utilizing the coronal tibial tubercle osteotomy procedure. The technique involved in this series is based on that described by Whiteside.15,16 It involves the development of a long lateral musculoperiosteal flap incorporating the tibial tubercle and anterior tibia, and leaving the proximal tibial cortex intact. This is extended along the tibia distally for 10 cm. It finishes by gradually osteotomising the anterior surface of the tibial crest. The tubercle is reattached with wires at the end of the procedure. This technique minimizes complications that have been associated with the tibial tubercle osteotomy.10,11,17 The 10 knees in 9 patients, who had total knee arthroplasty with a coronal tibial tubercle osteotomy, were reviewed pre and postoperatively. All knees were assessed using the Hospital for Special Surgery knee score (HSS). The scores averaged 43.6 preoperatively (range, 29–57) and 79.2 postoperatively (range, 67–90), and the mean range of motion was 59.5° preoperatively and 78.0° postoperatively. There were no cases of extension lag. Fixed flexion deformity was present in 3 cases postoperatively. Average time to union at the proximal and distal ends of the osteotomy was 8 and 24 weeks respectively. There was no evidence of nonunion and no other significant complications occurred.
Calcium Absorption Measured by Stable Calcium Isotopes (42Ca & 44Ca) among Northern Chinese Adolescents with Low Vitamin D Status
Authors: Lee Warren T K , Cheng Jack C.Y. , Jiang Ji , Hu Pei , Hu Xiaopeng , Roberts David C K 
Published: October 2016

An adequate calcium intake and vitamin-D status is important for bone mineralization in adolescents. In Northern China, calcium intake and plasma vitamin-D level of adolescents is low due to low consumption of dairy foods and inadequate sunshine exposure. True fractional calcium absorption (TFCA) in Chinese adolescents has never been performed. This study aims to evaluate nutritional adaptation namely, TFCA and urinary calcium excretion among Chinese adolescents in northern China.
Retroperitoneal Giant Schwannomas: Report on Two Cases and Review of the Literature
Authors: Schindler Oliver S , Dixon John H , Case Patrick 
Published: October 2016

The occurrence of massive retroperitoneal schwannomas is extremely rare and their presence may only be expressed by insidious onset of non-specific and misleading symptoms with a predominance of lower back pain. MRI scan as the imaging procedure of choice will demonstrate the tumour location and its relation to the surrounding structures, but due to heterogeneity and degeneration in some tumours, it may mimic malignancy. Hence tissue sampling through needle biopsies are essential to verify the diagnosis prior to surgery. Tumour excision in toto is considered the treatment of choice, but it can be hazardous especially if the tumour is adherent to the presacral venous plexus. Severe bleeding complications due to the damage of venous structures have to be encountered, and establishing lasting haemostasis may pose considerable difficulties. Hence surgery should be attempted with full precautions, and preoperative counseling of the patient. If malignancy can safely be excluded, laparoscopic ‘piecemeal’ excision should be considered as an alternative treatment as recurrence is unlikely. Definition of the originating nerve might not always be possible and a minor degree of neurological impairment has therefore to be anticipated.
Prognostic Indicators for Outcome following Rotator Cuff Tear Repair
Authors: Feng S , Guo S , Nobuhara K , Hashimoto J , Mimori K 
Published: October 2016

Purpose. To examine the prognostic indicators associated with outcome following rotator cuff surgery. Methods. A retrospective evaluation of records on 1120 shoulders (1067 patients) with rotator cuff tear treated by surgery was performed. Preoperative, intra-operative and postoperative factors were analysed by Kendall's Tau-b correlation analysis and logistic regression analysis. Results. Positive correlations were seen between the type of tear and the number of tendons involved, retraction, age, degeneration, subacromial bone spur, surgical technique, preoperative and postoperative muscle power, surgical outcome, and preoperative abduction on Kendall's Tau-b analysis. There was a positive correlation seen between degenerative change and age, number of tendons involved, retraction, preoperative pain, tear type, and preoperative muscle power on logistic regression analysis. Additionally, positive correlations were seen between good surgical postoperative outcome and postoperative activities of daily living, preoperative pain, postoperative muscle power, preoperative activities of daily living, tear type, preoperative external rotation, preoperative muscle power, number of tendons involved, preoperative pain, and duration of symptoms. Conclusion. Ageing was found to be the major factor in progressive degeneration of the rotator cuff, and should be considered the single most important contributing factor in the pathogenesis of rotator cuff tears. In addition, degenerative tendonopathy appeared the primary pathology in rotator cuff tear, preceding hypertrophic spur formation. Rotator cuff tears are therefore unlikely to be initiated by impingement; rather, they develop as an intrinsic degenerative tendonopathy.
Clinical Pathways in Total Knee Arthroplasty: A New Zealand Experience
Authors: Pennington JM , Jones DPG , McIntyre S 
Published: October 2016

Purpose. To ascertain the effects of a clinical pathway in our institution. Methods. This retrospective and comparative study was performed on all patients undergoing total knee arthroplasty over a 5-year period. This period covered the 30 months prior to the introduction of the pathway (group 1), and the 30 months following its introduction (group 2). Results. There was a significant reduction in the duration of hospital stay of group 2 patients (p<0.0001), with 62.8% of these patients staying less than 8 postoperative days. There was a reduction in the number of patients with thromboembolic complications (p<0.05) and no increase in overall complications or readmission rate. There was a trend to increased use of rehabilitation services among group 2 patients. Conclusion. Clinical pathway implementation resulted in a significant reduction in the length of stay, and achieved a more efficient management of hospitalised patients without compromising outcome.
Role of Joshi's External Stabilisation System Fixator in the Management of Idiopathic Clubfoot
Authors: Suresh S , Ahmed A , Sharma VK 
Published: October 2016

Purpose. To explore the role of Joshi's external stabilisation system fixator in correcting cases of clubfoot peculiar to India, we studied cases of neglected clubfoot, dropout cases of plaster-of-paris cast treatment, or failed surgical procedures that had been followed for a minimum period of 2 years. Methods. 26 children underwent 44 Joshi's external stabilisation system procedures at the Central Institute of Orthopaedics at the Safdarjung Hospital, New Delhi, between January 1998 and December 1999 for the conditions of interest. Three-dimensional correction was achieved by use of the distractor device. Results. Excellent results were obtained in 77% of the cases, good results in 13%, and poor results in 9% of the cases. Complications in half of the cases were -pintract infections, which eventually healed on an out-patient basis without any residual sequelae. Conclusion. The Joshi's external stabilisation system frame is ideally suited for the child in whom clubfoot deformities remain uncorrected by plaster-of-paris casts and manipulation, as well as for recurrent clubfoot. Casting after complete correction not only protects the osteopenic bones while the pin-tracts heal, but also maintains correction and allows gradual weightbearing.
Changing Epidemiology of Neonatal Septic Arthritis
Authors: Deshpande SS , Taral N , Modi N , Singrakhia M 
Published: October 2016

Purpose. To study the changing epidemiological pattern of micro-organisms as an aetiology of septic arthritis, and to correlate the pattern with the outcome of neonatal septic arthritis, in terms of joint function and morphology. Methods. 15 consecutive cases of neonatal septic arthritis of hip admitted between 1999 and 2002 were studied. Diagnosis of septic arthritis was made on the basis of Morrey's criteria. All patients were treated by arthrotomy after aspiration of purulent fluid from the joint. Patients were followed up for a mean period of 2.4 years. Clinical and radiological examinations were performed at follow-up. Results. The mean age of the 15 patients was 20.35 days. 13 (87%) patients had primary septic arthritis, while only 2 (13%) had associated osteomyelitis. Culture reports revealed that the spectrum consisted of 33% gram-negative organisms, 7% fungal, and only 20% gram-positive organisms— Staphylococcus aureus in 3 patients, Klebsiella in 2 patients, one each of Proteus, Candida, Escherichia coli, and Enterobactor. Six patients were pus-cell positive with negative culture. No organism was found in 6 (40%) cases. Investigations showed leukocytosis, raised C-reactive protein and erythrocyte sedimentation rate in all 15 patients. 12 patients had normal clinical and radiological parameters at follow-up. Three patients had delayed surgical drainage of more than 72 hours due to late presentation, and showed various radiological sequelae with terminal restriction of joint movements. Conclusion. There are more cases of primary septic arthritis than secondary septic arthritis. Clinicians should be alert of the aetiology shift to gram-negative organisms, in addition to fungal and gram-positive ones. Arthrotomy to drain pus from the joint should not be delayed. Better long-term results can be achieved by early surgical drainage and immediate antibiotic coverage.
Extensively Coated Femoral Components in Revision Hip Arthroplasty: Follow-up Study of 23 Patients
Authors: Ng FY , Chiu KY , Yau WP , Ng TP , Tang WM 
Published: October 2016

Purpose. To review the outcome of revision hip arthroplasty using extensively coated femoral components. Methods. We reviewed the results of revision involving 24 extensively porous-coated cementless femoral components in 23 patients, whose mean age was 52.4 years (range, 28.0–79.0 years). Most revisions were performed for aseptic loosening of the previously cemented femoral component. All patients were followed up for a minimum period of 24.0 months (mean, 61.1 months). Results. Of the 24 femoral stems, 20 showed bone ingrowth, 3 showed stable fibrous ingrowth, and one was unstable because of deep infection. Intra-operative anterior femoral diaphyseal perforation occurred in 2 hips during the insertion of straight femoral components of 200 mm. Postoperative radiographs displayed marked cortical erosion in 3 other hips and cortical perforation in one. Conclusion. The results from the use of extensively coated femoral components were promising. Nevertheless, anterior cortical perforations were also common, which may be related to more bowing of the femora among the Chinese patients. Caution must be exercised when inserting a long, straight, extensively coated femoral component.
Comparing Wound Complication Rates following Closure of Hip Wounds with Metallic Skin Staples or Subcuticular Vicryl Suture: A Prospective Randomised Trial
Authors: Shetty AA , Kumar VS , Morgan-Hough C , Georgeu GA , James KD , Nicholl JE 
Published: October 2016

Purpose. To compare 2 methods of wound closure—metallic staples or 3–0 undyed vicryl—according to postoperative wound complication rates. Methods. Patients who underwent surgery for proximal femoral fractures were randomised to have wound closure with metallic staples or with subcuticular vicryl suture. Wounds were regularly examined postoperatively and only those with positive wound swabs were regarded as wound infections. Results. Five infections and one superficial wound dehiscence occurred in the patients who had wound closure with metallic staples. The complication rate was significantly higher for this group compared with the group who had wound closure with subcuticular vicryl suture (p<0.025). Conclusion. Superficial wound complication rates are higher for wounds closed with metallic staples compared to wounds closed with subcuticular vicryl.
Correlation between Magnetic Resonance Imaging and Radiographic Measurement of Cervical Spine in Cervical Myelopathic Patients
Authors: Wong TM , Leung HB , Wong WC 
Published: October 2016

Purpose. To correlate the radiographic measurement, cord diameter shown on magnetic resonance imaging (MRI), and clinical hand sign of cervical myelopathic patients. Methods. Patients with clinical cervical myelopathy who had had MRI in Kwong Wah Hospital between January 2001 and December 2002 were enlisted. Their cervical spine radiographs and clinical records were reviewed. Results. Of 36 patients with a complete set of MRI films, cervical spine radiographs, and clinical notes; 18% did not have Hoffman's sign, 47% had normal supinator reflex, 39% had unimpaired 10-second test, and 45% showed no finger escape sign. The presence of myelopathic hand signs was not correlated to any radiological assessment, cord diameter, or presence of myelomalacia at any level. Conclusion. Cervical spine radiography cannot predict the level and degree of cervical spinal cord compression. Myelopathic hand signs are not diagnostically fail-safe and cannot predict the level and degree of cord compression.
Modified Calcaneal Index: A New Screening Tool for Osteoporosis Based on Plain Radiographs of the Calcaneum
Authors: Pande KC , Pande SK , de Takats D , McCloskey EV 
Published: October 2016

Purposes. To assess osteoporosis using plain radiography of the calcaneum by studying the performance characteristics of the modified calcaneal index through inter- and intra-observer agreement. To study the correlation of the modified calcaneal index to quantitative ultrasound of the calcaneus and bone mineral density (BMD) of the femoral neck and distal radius. Methods. Lateral calcaneal radiographs of 252 women who participated in a clinical trial for osteoporosis were reviewed. The BMD of the hip and distal radius was measured and the calcanea were assessed using ultrasound. The calcaneal radiographs were graded by 3 clinicians according to a previously described 5-grade calcaneal index. A modified 3-grade calcaneal index was then developed. Results. The highest scores of intra- and inter-observer reliability of the modified calcaneal index were 0.45 and 0.40, respectively, which were higher than those of the 5-grade calcaneal index. The correlation of the modified calcaneal index with other measures was significant (hip BMD, r=0.31; distal radius BMD, r=0.28; calcaneal speed of sound, r=0.20; broadband ultrasound attenuation, r=0.36) [p<0.005]. There were significant differences in hip BMD, distal radial BMD, calcaneal speed of sound, and broadband ultrasound attenuation between the 3 grades of the modified calcaneal index (Kruskal-Wallis 1-way ANOVA; p<0.0001). Conclusion. The modified calcaneal index can be used to measure bone structure and skeletal strength and is a suitable screening tool for osteoporosis in places where advanced approaches to bone-status assessment are not available.
Implications of the Changing Pattern of Bacterial Infections following Total Joint Replacements
Authors: Ip D , Yam SK , Chen CK 
Published: October 2016

Purpose. To retrospectively review the causative organisms isolated from infected hip and knee replacements requiring revision. Methods. We reviewed a consecutive series of 36 patients who underwent revision hip or knee arthroplasties due to bacterial infection at Pamela Youde Nethersole Eastern Hospital in Hong Kong between 1995 and 2003. The male to female ratio was 1:2, and the mean age of patients was 70 years (range, 54–82 years). The mean duration of follow-up was 3.8 years (range, 1.1–8.3 years). No patient was lost to follow-up. All 14 revision knee patients had previously undergone cemented and patella-resurfacing total knee arthroplasties. Of the 22 revision hip patients, 9 had cementless, 6 had cemented, and 7 had hybrid total hip arthroplasties previously. Results. None of the bacteria isolated from 1995 to 1996 were multiple-drug resistant. Subsequently, however, most of the isolates were multiple-drug resistant, with methicillin-resistant Staphylococcus aureus (MRSA) being the most common. Half of the isolates of Staphylococcus epidermidis and Escherichia coli demonstrated multiple-drug resistance. The incidence of positive culture in revision hip patients was 59%, 46% of which were MRSA. All 13 revision hips with positive cultures showed chronic sepsis: 4 occurred within one year and 10 occurred 2 or more years after the index arthroplasty. The incidence of positive culture in revision knee patients was 57%, 46% of which were MRSA. All 8 revision knees with positive cultures showed chronic sepsis: 3 occurred within one year, 5 occurred 2 or more years after the index arthroplasty. Only one patient, who was infected with gram-negative bacilli, required a second revision for residual sepsis. Harris hip scores for the revision hip patients improved from a mean of 65 (range, 55–75) to 85 (range, 75–90). Knee Society knee scores of the revision knee patients improved from a mean of 68 (range, 55–75) to 80 (range, 70–85). There were no radiological signs suggestive of loosening in the 2 groups at the latest follow-up. Conclusion. This study found a definite increase in multiple-drug–resistant bacteria isolated from periprosthetic infections around total hip and knee prostheses.
Comparing 2-Year Outcomes of Anterior Cruciate Ligament Reconstruction Using Either Patella-Tendon or Semitendinosus-Tendon Autografts: A Non-Randomised Prospective Study
Authors: Tow BPB , Chang PCC , Mitra AK , Tay BK , Wong MC 
Published: October 2016

Purpose. To compare the results of anterior cruciate ligament (ACL) reconstructions using either a patella-tendon autograft or a semitendinosus-tendon autograft. Methods. Based on surgeon experience and preference, 68 patients underwent ACL reconstruction using either a quadruple-strand semitendinosus autograft (n=34) or a central one-third bone-patella tendon-bone autograft (n=34). Each patient was assessed preoperatively and postoperatively at 3, 6, and 24 months using the International Knee Documentation Committee (IKDC) knee score, Biodex muscle strength and endurance testing, and the KT1000 instrumented arthrometer test of knee laxity to anterior translation. All assessments at the 2-year follow-up were performed by the same physician and physiotherapist. Results. While ACL reconstruction improved knee stability and IKDC knee scores significantly, there was no statistically significant difference between semitendinosus- and patella-tendon autograft reconstructions in terms of long-term knee score or laxity to anterior translation. Semitendinosus graft reconstruction was associated with less donor-site morbidity and hamstring weakness. Meniscectomy was associated with poorer long-term knee scores. Conclusion. ACL reconstruction is associated with a significantly better IKDC knee score and laxity measurement at 2-year follow-up. However, we were unable to demonstrate a significantly better long-term outcome in knee score or laxity to anterior translation with either a patella-tendon autograft or a semitendinosus-tendon autograft.
Magnetic Resonance Imaging Study of the Craniocervical Junction
Authors: Tassanawipas A , Mokkhavesa S , Chatchavong S , Worawittayawong P 
Published: October 2016

Purposes. To confirm the accuracy of the standard parameters of Chamberlain's line, McGregor's line, McRae's line, and Ranawat's line in the diagnosis of basilar impression in a normal Asian population using magnetic resonance imaging (MRI) scans of the craniocervical junction, and to evaluate the use of MRI in the initial diagnosis of basilar impression. Methods. We retrospectively reviewed MRI scans of the craniocervical junction in 114 Thai patients (61 men and 53 women) aged 20 to 89 years to assess the lines of Chamberlain, McGregor, McRae, and Ranawat. Patients with injury, tumour, or metastasis in the craniocervial junction; congenital anomalies; or clinical symptoms and signs of basilar impression were excluded. Results. 39 of the 114 patients had the odontoid tip extended above Chamberlain's line by 1 mm to 9 mm (mean, 2.89 mm). Only 7 men and 5 women had the tip of the odontoid process extended beyond the normal range of 5 mm. The mean distance of the odontoid tip extended past McGregor's line in male and female subjects was 0.33 mm (standard deviation [SD], 1.2 mm) and 0.17 mm (SD, 0.7 mm), respectively, markedly less than those reported previously, although one male patient's odontoid tip extended 8 mm above the McGregor's line. Regarding McRae's line, no patient had the odontoid tip extended above the foremen magnum. The mean Ranawat's line in male and female subjects was 15.75 mm (range, 12–19; SD, 1.71 mm) and 14.09 mm (range, 11–17; SD, 1.38 mm), respectively. Conclusion. After using MRI to confirm the standard parameters of basilar impression as previously formulated from lateral skull radiographs, we recommend using McRae's line and Ranawat's line in the initial screening for basilar impression for the Asian population. Chamberlain's line and McGregor's line are viable alternatives, but clinicians must be aware of the potential for false positives.
Posterior Lumbar Interbody Fusion versus Intertransverse Fusion in the Treatment of Lumbar Spondylolisthesis
Authors: Inamdar DN , Alagappan M , Shyam L , Devadoss S , Devadoss A 
Published: October 2016

Purpose. To compare 2 methods of fusion in the treatment of lumbar spondylolisthesis: posterior lumbar interbody fusion (PLIF) and intertransverse fusion (ITF). Methods. 20 patients with lumbar spondylolisthesis were randomly allocated to one of 2 groups: decompression, posterior instrumentation, and PLIF (n=10) or decompression, posterior instrumentation, and ITF (n=10). The Oswestry low back pain disability questionnaire was used for clinical assessment. Radiography was performed preoperatively and postoperatively to assess the reduction of spondylolisthesis or slip. Results. In the PLIF and ITF groups, 87.5% and 100% had a satisfactory clinical result, and 48% and 39% had reduced spondylolisthesis, respectively. Both had a fusion rate of 100%. PLIF showed better reduction of spondylolisthesis, although ITF achieved a better subjective and clinical outcome. Conclusion. Morbidity and complications are much higher following PLIF than ITF. ITF is recommended because of the simplicity of the procedure, lower complication rate, and good clinical and radiological results.