bluuebunny/crossref_metadata_2025_split huggingface dataset:
Post-Thrombotic Syndrome after Total Hip or Knee Arthroplasty: Incidence in Patients with Asymptomatic Deep Venous Thrombosis
Authors: Schindler OS , Dalziel R 
Published: October 2016

Purpose. To measure the risk of developing signs of post-thrombotic syndrome 15 to 24 months after total hip or knee arthroplasty in patients with asymptomatic deep venous thrombosis (DVT). Methods. A total of 85 total knee arthroplasty patients and 47 total hip arthroplasty patients were postoperatively screened for asymptomatic DVT using colour duplex ultrasound. Results. The rate of asymptomatic DVT was 37.6% (n=32) in knee patients and 34.0% (n=16) in hip patients. All 32 DVT cases in the knee group had thrombi located below the knee, whereas 6 of the 16 DVT cases in the hip group had thrombi located above the knee, the remaining 10 were below the knee. Patients with proximal thrombi were treated with warfarin for 3 months, whereas patients with distal DVT received 300 mg aspirin daily for the same period. All DVT cases were monitored for up to 12 weeks using repeated colour duplex scans. Signs of thrombus resolution were present at around 6 weeks (range, 4–12 weeks). Clot propagation was observed in 3 cases. In a mean of postoperative 18 months (range, 15–24 months), 28 of the 32 knee patients with asymptomatic DVT were available for follow-up: 11 had transient calf and ankle swelling, 6 had persistent oedema, and the remaining 11 were symptom free. 14 of the 16 hip patients with asymptomatic DVT were available for follow-up: 6 had transient calf and ankle swelling, 4 had persistent oedema, and 4 remained symptom free. 17 patients reported ongoing problems and were re-examined. Signs of mild-to-moderate post-thrombotic syndrome were recorded in 4 knee patients and 3 hip patients. Conclusions. Patients with above-knee DVT were much more likely to have post-thrombotic syndrome. Despite thromboprophylaxis with low-molecular-weight heparin, asymptomatic DVT is common after total joint arthroplasty and is responsible for the development of post-thrombotic venous insufficiency and post-thrombotic syndrome in a considerable proportion of patients. Once symptomatic or asymptomatic DVT is established, treatment appears incapable of preventing the occurrence of post-thrombotic syndrome, especially in cases of above-knee DVT. Efforts should hence concentrate on combating DVT propagation and improving DVT prevention.
Arthroscopic Reconstruction of the Anterior Cruciate Ligament Using Bone-Patellar Tendon-Bone Autograft: Experience of the First 100 Cases
Authors: Chaudhary D , Monga P , Joshi D , Easwaran R , Bhatia N , Singh AK 
Published: October 2016

Purpose. To review the results of patients who underwent arthroscopic reconstruction of the anterior cruciate ligament (ACL) via a single incision technique using a bone-patellar tendon-bone autograft. Methods. Patients with ACL-deficient knees who were symptomatic and wanted to maintain an active lifestyle or continue sporting activities were included. ACL reconstruction using the bone-patellar tendon-bone graft was performed on 100 patients. One-year follow-up was completed in 78 patients who were then reviewed. The mean age of patients reviewed was 26.8 years (range, 21–39 years), of whom 35 (44.9%) were aged between 26 and 30 years. There were 73 men and 5 women (ratio, 14.6:1). Injuries on the right side outnumbered those on the left (44 versus 34). Sports injuries accounted for 66.7% (n=52) of patients, motor vehicle accidents and household injuries accounted for 30.8% (n=24) and 2.6% (n=2), respectively. Results. Excellent and good-to-excellent results were achieved in 7 (9%) and 61 (78.2%) of patients. Residual anterior knee pain (n=18) was the most common complication, followed by difficulty in regaining full range of motion (n=10) and divergence of femoral screw (n=9). Conclusion. This procedure provides consistent and reproducible results in carefully selected patients and allows them an early return to sporting activities with minimal residual morbidity.
Fusion Rate of Anterior Cervical Plating after Corpectomy
Authors: Cheng NS , Lau PY , Sun LK , Wong NM 
Published: October 2016

Purpose. To evaluate the neurological recovery and fusion rate of patients with myelopathy who were treated with anterior corpectomy and anterior cervical plating. Methods. The results of 17 cervical myelopathy patients who underwent decompression and anterior cervical plating were retrospectively reviewed at a mean follow-up of 2 years. Results. By Kurokawa score, 82.4% of patients showed excellent-to-good results. The fusion rates of 2-level and 3-level anterior cervical corpectomy, and of anterior plate fixation were 100%. There were no implant- or graft-related complications. Transient dysphagia in 9 (52.9%) patients resolved after a mean of 3 months (range, 1–9 months). Conclusion. The use of anterior cervical plating after anterior corpectomy and fusion with autologous bone graft greatly enhances arthrodesis. The improved fusion rate and low complication rate associated with anterior cervical plating may justify its use in the treatment of cervical spondylotic myelopathy.
Pyogenic Vertebral Osteomyelitis: A Review of 14 Cases
Authors: Nather A , David V , Hee HT , Thambiah J 
Published: October 2016

Purpose. To review and evaluate the management of 14 patients with pyogenic vertebral osteomyelitis at National University Hospital, Singapore between 1998 and 2001. Methods. Demographic pattern, predisposing factors, clinical presentation, co-morbidities, microbiology, treatment, and complications of 14 patients were retrospectively reviewed. Results. The mean age at presentation was 62.5 years and the male to female ratio was 6:1. The mean follow-up duration was 12.5 months. The most common predisposing condition was diabetes mellitus (n=5). The most common site of infection was the lumbar spine (n=8), followed by the thoracic (n=4) and cervical (n=2) spine. Staphylococcus aureus was the most common causative organism isolated (n=9), followed by methicillin-resistant S aureus (n=3), Pseudomonas pseudomallei (n=1), and Streptococcus agalactiae (n=1). 12 patients were treated surgically: 8 by an anterior approach, 3 by a posterior approach, and one by a combination of the 2. The mean period of antibiotic use was 11.4 weeks. One patient with melioidosis involving the T9 to T11 vertebrae caused by P pseudomallei died of empyema and septicaemia 22 months after presentation. Conclusion. Pyogenic vertebral osteomyelitis is not uncommon in the elderly, especially those with predisposing conditions such as diabetes mellitus. Computed tomography–guided needle biopsy is recommended to investigate causative micro-organisms. Aggressive surgical debridement and prolonged antibiotic therapy were necessary in patients with methicillin-resistant S aureus, P pseudomallei, and S agalactiae.
Dall-Miles Cable and Plate Fixation System in the Treatment of Periprosthetic Femoral Fractures: A Review of 20 Cases
Authors: Sandhu R , Avramidis K , Johnson-Nurse C 
Published: October 2016

Purpose. To assess the effectiveness of Dall-Miles cables and plates in the treatment of periprosthetic femoral fractures around hip arthroplasties. Methods. We r etrospectively reviewed 20 cases of periprosthetic femoral fracture treated with the Dall-Miles cable and plate system between November 1999 and December 2002 in James Paget Hospital in the United Kingdom. Demographic data, fracture type, and surgical outcome of the patients were reviewed and assessed. Results. Of the 20 cases of periprosthetic femoral fracture, one was of Vancouver type A, 15 were of type B1, and 4 were of type C. The mean age at operation was 78.5 years (range, 68–90 years) with a male to female ratio of 11:9. The mean time to union was 3.9 months (range, 3–8 months), and the mean follow-up period was 19.4 months (range, 1–4 years). 15 patients achieved satisfactory results, including 2 delayed unions that healed with a residual varus deformity of 15 degrees in the femoral component. Three patients developed deep-seated wound infections. No nonunion of fractures or fixation system failures occurred. Conclusion. The Dall-Miles cable and plate fixation system alone is a sufficient treatment for most periprosthetic femoral fractures. In the management of B1 fractures, there was no significant difference in clinical outcome, despite the various combinations of cables and screws used for stabilisation of the plate. However, in cases of comminution at the fracture site, junctional grafting with morsellised autograft may be used in addition to internal fixation to accelerate union.
Sensory Innervation of Temporomandibular Joint Disk
Authors: Asaki S , Sekikawa M , Kim YT 
Published: October 2016

Purpose. To investigate the nerve endings of the adult temporomandibular joint disk, in particular the presence and configuration of the sensory nerve endings by silver staining and electron microscopy. Methods. 20 cadaveric temporomandibular joints impregnated with silver stain were studied using an optical microscope; 2 other joints were studied using a transmission electron microscope. Results. Free nerve endings were found in the disk parenchyma of all joints. Golgi-Mazzoni corpuscles, Ruffini corpuscles, and articular corpuscles were also observed as sensory nerve end organs. Myelinated and nonmyelinated nerve fibres were visualised in the disk parenchyma using the transmission electron microscope. Conclusion. Free nerve endings and sensory nerve end organs are present in the disk parenchyma of the human temporomandibular joint and are associated with sensation and proprioception, just as they are in the acetabular labrum, glenoid labrum, triangular fibrocartilage complex, and meniscus.
Acetabular Morphometry for Determining Hip Dysplasia in the Singaporean Population
Authors: Umer M , Thambyah A , Tan WTJ , De S Das 
Published: October 2016

Purpose. To assess and evaluate the usefulness of 7 morphological measurements of the acetabulum in establishing the prevalence of acetabular dysplasia in the Singaporean population. Methods. Standardised plain anteroposterior radiographs of 522 hip joints of 261 asymptomatic patients (mean age, 60 years; range, 16–99 years) were evaluated. The 7 morphological measurements were centre-edge angle, acetabular angle, depth-to-width ratio, roof obliquity, extrusion index, lateral subluxation, and peak-to-edge distance. Results. 19 (7.3%) patients were acetabular dysplastic (centre-edge angle of <20 degrees). The mean centre-edge angle was 31.2 degrees (range, 5–52 degrees), acetabular angle 39.46 degrees (range, 10–58 degrees), depth-to-width ratio 0.32, roof obliquity 7.86 degrees, extrusion index 0.18, lateral subluxation 9.9 mm, and the peak-to-edge distance 15.65 mm. Conclusion. Centre-edge angle was the most useful measurement and correlated significantly with acetabular angle, extrusion index, peak-to-edge distance, and roof obliquity. These preliminary results show a relatively higher rate (7.3%) of acetabular dysplasia in the Singaporean population, compared with other similar but larger Asian studies performed in Hong Kong (1.1%) and Korea (1.8%).
Bone Remodelling after Total Hip Arthroplasty Using an Uncemented Anatomic Femoral Stem: A Three-Year Prospective Study Using Bone Densitometry
Authors: Panisello JJ , Herrero L , Herrera A , Canales V , Martinez A , Cuenca J 
Published: October 2016

Purpose. To evaluate the clinical, radiological, and densitometric changes in the bone-remodelling patterns of femoral stems aligned in neutral, valgus, or varus positions. Methods. Between February and October 2000, 70 patients underwent unilateral total hip arthroplasty for primary osteoarthritis using an uncemented Anatomique Benoist Girard (ABG) II stem. 69 patients (30 males and 39 females) with a mean age of 59 years (range, 38–76 years) and a mean body weight of 79.3 kg (range, 29–110 kg) completed 3 years' follow-up on bone remodelling. The clinical, radiological, and densitometric changes of the neutral, valgus, and varus groups were evaluated, and the difference in bone-remodelling patterns between the 3 groups was analysed. Results. 54 patients had neutrally placed stems, while varus and valgus malalignment occurred in 6 and 9 patients, respectively. Clinical and radiological evaluations were very similar among the 3 groups. Only densitometry could detect traceable changes resulting from the differing biomechanics of the neutral, varus, and valgus stem alignments. Conclusion. The ABG II stem design made moderate errors in alignment biomechanically tolerable. Alignment defects had no clinical consequences and resulted in minimal differences in bone remodelling.
Safeness of Simplex-Tobramycin Bone Cement in Patients with Renal Dysfunction Undergoing Total Hip Replacement
Authors: Forsythe ME , Crawford S , Sterling GJ , Whitehouse SL , Crawford R 
Published: October 2016

Purpose. To compare the pharmacokinetic profile of tobramycin in blood, urine, and at the operative site following the use of Simplex-tobramycin bone cement in primary total hip replacement between patients with and without renal dysfunction. Methods. Six patients with renal dysfunction underwent cemented primary total hip replacement for osteoarthritis. The elution characteristics of Simplex-tobramycin bone cement in the 6 patients with renal dysfunction were compared with 9 patients who had normal renal function. Blood, urine, and drainage fluid specimens were collected for 72 hours postoperatively. Results. Very high concentrations of tobramycin were seen in the drainage fluid of the 2 groups. Mean serum tobramycin levels peaked at postoperative 3 hours, and declined rapidly to negligible levels at 72 hours in both groups. Mean urinary tobramycin concentrations peaked at postoperative 12 hours and declined rapidly until 48 hours in both groups. Urinary tobramycin was excreted significantly more slowly in renal dysfunction group in the first 12 hours, but not thereafter. Although serum creatinine levels of the renal dysfunction group were higher throughout the study period, the difference was not significant. Both groups achieved excellent local delivery of the antibiotic with minimal systemic concentrations. Conclusion. Simplex-tobramycin bone cement appears to be an effective and safe means to deliver antibiotic for patients with renal dysfunction who undergo total hip replacement.
Early Results of Prosthetic Hip Replacement for Femoral Neck Fracture in Active Elderly Patients
Authors: Wazir NN , Mukundala VV , Choon DSK 
Published: October 2016

Purpose. To evaluate the short-term clinical and functional outcomes of total hip arthroplasty performed for physiologically active elderly patients with Garden type-3 or -4 femoral neck fracture. Methods. Records of 47 consecutive patients (40 female, 7 male) with type-3 or -4 femoral neck fracture (Garden classification) who underwent cemented total hip arthroplasty at our hospital during January 1999 to December 2002 were reviewed. Radiological and clinical (Harris functional hip score and Oxford hip score) assessments of 38 patients were measured with a mean follow-up period of 21 months (range, 4–48 months). Results. The mean age of the 47 patients was 75 years (range, 62–89 years). Records of 9 patients were excluded because of death, lost to follow-up, and development of deep infection that necessitated implant removal and excision arthroplasty. The mean Harris hip score of the 38 patients was 83 (range, 59–97), whereas the mean Oxford hip score was 25.2 (range, 14–33). Pain in the hips was absent in 30 patients, 6 had slight pain occasionally, and 2 patients had mild-to-moderate hip discomfort. No signs of aseptic loosening or change in implant position were noted on radiographic assessment. Two cases of dislocation were reduced by closed reduction. Two patients had deep wound infection and were treated with debridement, implant removal, and conversion to girdle stone. Conclusion. This short-term study showed that total hip arthroplasty for femoral neck fracture had good postoperative results in functional hip and pain scores. More attention should be paid to coexisting medical illness (e.g. diabetes mellitus, hypertension, and ischaemic heart disease) and prevention of infection.
Comparison of Early Postoperative Rehabilitation Outcome following Total Knee Arthroplasty Using Different Surgical Approaches and Instrumentation
Authors: Weinrauch P , Myers N , Wilkinson M , Dodsworth J , Fitzpatrick P , Whitehouse S 
Published: October 2016

Purpose. To assess early postoperative rehabilitation outcome following computer-assisted total knee arthroplasty (TKA) or standard instrumentation TKA using a medial parapatellar or subvastus approach. Methods. A prospective controlled trial of 70 consecutive patients undergoing TKA with a low contact stress rotating platform prosthesis was conducted. Patients were randomised to receive surgery with either computer navigation or standard instrumentation. A medial parapatellar or subvastus approach was used according to the surgeons' preference. Outcome measures included preoperative knee function, intra-operative factors, and postoperative rehabilitation. Results. Duration of surgery was significantly longer when using computer navigation; however, operating time decreased with greater experience. A higher incidence and duration of early postoperative quadriceps dysfunction was associated with computer-assisted TKA through the medial parapatellar approach than through the subvastus approach or TKA performed with standard instrumentation. No patient who received surgery through the subvastus approach had a lag of more than 20 degrees, at 48 hours postoperatively, regardless of the instrumentation used. Conclusion. Computer-assisted TKA through a medial parapatellar approach was associated with delayed recovery of the quadriceps during early postoperative rehabilitation. This was due to the additional quadriceps dissection required to place the femoral tracking array. The subvastus approach is therefore recommended for computer-assisted TKA.
Extracorporeal Shock Wave Treatment for Defective Nonunion of the Radius: A Rabbit Model
Authors: Bulut O , Eroglu M , Ozturk H , Tezeren G , Bulut S , Koptagel E 
Published: October 2016

Purpose. To investigate the effect of extracorporeal shock wave treatment (ESWT) on bony union using volume analysis of the callus mass by computed tomography and histology. Methods. Both radii of 13 rabbits were osteotomised and a defective bony nonunion created by placing a polyethylene pad between the osteotomy site for 40 days. Nonunion was confirmed by radiography using Lane-Sandhu criteria. ESWT (14 kW, 0.46 mJ/mm2, 1000 shock waves) was applied to the right radius of the rabbits. The left radius served as a control. Five rabbits were killed 4 weeks after ESWT (group 1) and 8 after 6 weeks (group 2). Volume analysis of the callus mass was performed using computed tomography and the bone healing process was assessed by histology. Results. In group 1, callus volume on the treated side was invariably greater than that on the control side; the difference being statistically significant (p=0.032). In group 2, the callus volume of the treated side was greater than that of the control side, except in rabbits 4 and 9. Only after excluding the findings from the latter did the difference attain statistical significance (p=0.020). Histology confirmed that the bone-healing process was faster in the treated side. Conclusion. ESWT enhanced the bone-healing process by increasing both volume and speed of callus formation.
Pelvic Reconstruction Using Saddle Prosthesis following Limb Salvage Operation for Periacetabular Tumour
Authors: Kitagawa Y , Ek ET , Choong PFM 
Published: October 2016

Purpose. To assess the clinical results of pelvic reconstruction using a saddle prosthesis following limb salvage operation for periacetabular tumour. Methods. 12 patients with sarcoma and 4 with metastasis involving the pelvis were treated using the saddle prosthesis between 1995 and 2003 inclusive. Wide pelvic resection was performed for all patients with sarcoma and one with a metastatic lesion; intralesional excision of the acetabulum was undertaken for the remaining 3 patients with metastatic lesions. Oncologic prognosis, operation time, postoperative function, and complications were assessed retrospectively. Results. Of the 12 patients with sarcomas, 5 were alive without evidence of recurrence after a mean follow-up of 37 months, one was alive with disease, 3 died of the disease, and 3 of other medical conditions. Respective mean postoperative functional scores according to the Musculoskeletal Tumor Society–International Symposium on Limb Salvage system and the Toronto Extremity Salvage Score were 53 and 64% in patients undergoing wide acetabular resection, and 30 and 42% in patients undergoing intralesional excision of the acetabulum. In patients undergoing wide acetabular resection and intralesional excision of the acetabulum, the mean operation times were 391 and 162 minutes respectively, whereas the mean times to ambulation were 7 and 4 days respectively. Major complications included infection and dislocation. Conclusion. Saddle prosthesis arthroplasty is a useful option for pelvic reconstruction following resection of acetabular malignancies. It is associated with a short operation time, rapid recovery, and moderately good postoperative function, but a relatively high risk of complications.
Factors That Affect the Healing Index of Metacarpal Lengthening: A Retrospective Study
Authors: Bozan ME , Altinel L , Kuru I , Maralcan G , Acar M , Durmaz H 
Published: October 2016

Purpose. To determine factors that affect healing index and consolidation time following lengthening of congenitally short metacarpals (brachymetacarpia). Methods. 18 metacarpals of 8 young women (mean age, 18.6 years) were lengthened using the callus distraction technique. The results, including healing index and consolidation time, were analysed and compared with those in the literature. Results. The mean length increase was 16.5 mm (55% of the original length of 30 mm). Age was positively correlated with healing index and consolidation time: younger patients healed faster than older patients. Healing index differed significantly between patients aged 0 to 18 years and those aged 19 to 30 years (p=0.002). Comparison of our results with 9 previous studies confirmed that increased age was associated with a greater healing index and consolidation time. Conversely, the faster the distraction rate, the less the healing index and consolidation time. Conclusion. Age has the most effect on healing index and consolidation time. Metacarpal lengthening using callus distraction is recommended. Adolescence is the most appropriate time to perform distraction lengthening of a congenitally short metacarpal. This will avoid additional lengthening of normal metacarpals prior to epiphyseal closure.