bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic Results of Acromioclavicular Joint Dislocation Complicated by Rotator Cuff Tear
Authors: Takase K , Yamamoto K , Imakiire A 
Published: October 2016

Purpose. To evaluate the operative findings and postoperative results of one-stage repair on patients with acromioclavicular joint dislocation complicated by rotator cuff tear. Methods. Between 1992 and 1999, one-stage repair was performed on 5 patients with acromioclavicular joint dislocation complicated by rotator cuff tears. Modified Cadenat procedure for acromioclavicular joint dislocation, and McLaughlin procedure for rotator cuff tear, were performed on these patients. Postoperative results at the final examination were assessed according to the criteria for therapeutic effects on shoulder joint disorders of the Japanese Orthopaedic Association. Results. There was partial-thickness cuff tear in one patient, and full-thickness cuff tear in the remaining 4 patients. In all patients, tears were located only in the supraspinatus tendon, and were medium or small ones with maximal diameter of 3 cm or less. After a mean follow-up period of 56 months (range, 36–79 months), all patients were assessed to have excellent results. No patient showed a good reduction of the acromioclavicular joint. Conclusion. For patients successfully treated by one-stage repair, satisfactory results were obtained without pain or disturbance in activities of daily living.
Musculoskeletal Tissue Banking in Singapore: 15 Years of Experience (1988–2003)
Authors: Nather A 
Published: October 2016

Purpose. To report 15 years' experience of musculoskeletal tissue banking by the National University Hospital Tissue Bank. Methods. This study describes the development of Singapore's national bone bank since its establishment in 1988. The bone bank's protocol follows guidelines recommended by the American Association of Tissue Banks and the European Association of Tissue Banks using strict donor selection criteria. Informed consent is obtained from all potential donors for tissue procurement and laboratory tests. Detailed medical history, thorough clinical examination, and chart review is performed for consenting donors. Suitable donors are subjected to tests for hepatitis B, hepatitis C, syphilis, and culture/sensitivity test of tissue for aerobic and anaerobic organisms. For living donors, repeat testing for AIDS and hepatitis C is performed at least 180 days after procurement. Tissue procurement is performed under sterile conditions. Small tissues are procured using the ‘sterile double jar technique’ and long bones using the ‘sterile triple wrap technique’, both developed by the author. Deep-frozen bones are gamma irradiated at 25 kilograys. Morsellised bones are lyophilised and gamma irradiated. Meticulous preparation for grafts is performed during transplantation. Antibiotic prophylaxis is used for 2 weeks. Results. The bank maintains a good quality control. In January 2003, it was accredited ISO 9001 status. Up to June 2003, it has procured 440 bones from 440 living donors and 1055 allografts from 63 deceased donors. 854 musculoskeletal transplantations have been performed using tissues processed by the bank. Complication rate encountered was only 2.2%. Conclusion. The tissue bank provides high-quality allografts for safe tissue transplantations.
New Modified Technique of Osteotomy for Hallux Valgus
Authors: Oh IS , Kim MK , Lee SH 
Published: October 2016

Purpose. To improve the technique of osteotomy for hallux valgus (bunion). Methods. 38 cases of a new modified osteotomy procedure for hallux valgus were performed for 22 patients (21 women and one man). During a 3-year (range, 2–5 years) follow-up, the patients underwent physical examination; and their American Orthopedic Foot and Ankle Society hallux-metatarso-phalangeal-interphalangeal scale scores and standard foot radiographic measurements were recorded. Results. 20 of the 22 patients (38 cases) had no pain, achieved good cosmesis, and were completely satisfied with the results of the operation. The remaining 2 patients had occasional mild discomfort. The mean hallux-metatarso-phalangeal-interphalangeal scale score was 93 points (range, 78–100 points). The mean preoperative and postoperative metatarsophalangeal angles were 34 degrees and 11 degrees, respectively. The mean postoperative reduction of the inter-metatarsal angle and metatarsophalangeal angle were 6 degrees and 23 degrees, respectively. Conclusion. The new technique of osteotomy achieved even greater stability and accurate correction of the deformity in our 38 cases. Furthermore, it was more effective than conventional ‘chevron’ osteotomy in terms of correction of the deformity. Therefore, it should be used more widely.
Blood Salvage in Total Hip and Knee Arthroplasty in a Community Hospital: A Retrospective Study
Authors: Jain R , Jain S 
Published: October 2016

Purposes: To assess the results of postoperative and intra-operative blood salvage in patients undergoing total knee and hip arthroplasty, respectively, and to determine if both methods of blood salvage reduce allogeneic transfusion. Methods: Of 229 patients who attempted blood salvage, 114 of 152 patients who underwent total knee arthroplasty received the salvaged blood postoperatively, 35 of 77 patients who underwent total hip arthroplasty received the salvaged blood intra-operatively. Various data were collected to assess whether certain factors resulted in autologous and/or allogeneic blood transfusions. Results: Patients that received postoperative salvaged blood after total knee arthroplasty generally had higher postoperative levels of haemoglobin and haematocrit compared to those who did not. Patients with autologous blood transfusion following cemented knee surgery were less likely to require allogeneic blood transfusion. For hip arthroplasty patients, postoperative levels of haemoglobin and haematocrit were similar in both groups who received and did not receive salvaged blood. Lower preoperative haemoglobin and haematocrit levels correlated with a greater likelihood of autologous and/or allogeneic blood transfusion for both knee and hip arthroplasty patients. Conclusions: Although total knee arthroplasty patients who received salvaged blood had higher haemoglobin levels on the first postoperative day, the receipt of salvaged blood did not significantly reduce the incidence of allogeneic blood transfusion, because salvaged blood was a kind of blood loss. However, reinfusion of salvaged blood may reduce the number of units of allogeneic blood used. Given the short supply of allogeneic blood and its risks of transmitting disease, intra-operative and postoperative blood salvage carries clear advantages.
Does the Self-Centering Mechanism of Bipolar Hip Endoprosthesis Really Work in vivo?
Authors: Tsumura H , Kaku N , Torisu T 
Published: October 2016

Purposes. To examine radiographically the component motion in a bipolar prosthesis and to determine whether the self-centering mechanism really works in vivo. Methods. 38 patients with 41 bipolar hip endoprostheses (30 for coxarthrosis and 11 for osteonecrosis of femoral head) were included in this study. Two radiographs of each case were taken to evaluate the self-centering mechanism. The first anteroposterior radiograph of both hip joints was taken at the maximum abduction while the patient standing on the endoprosthetic leg. The second radiograph was taken after the patient returned to neutral position while standing on 2 legs. In the present study, the order in which the radiographs were taken differed from previously reported studies. The radiographs were analysed using the method similar to that of Drinker and Murray. The adductive motion from abduction to a neutral position is within the range of inner bearing oscillation. Results. The outer head alignment changed from 23 degrees to 12 degrees in the patients with osteonecrosis. However, the valgus position of the outer head (36 degrees) remained unchanged in the patients with coxarthrosis standing on 2 legs in the neutral position. Conclusion. The self-centering mechanism of the bipolar endoprosthesis functioned in the patients with osteonecrosis, but did not work in the coxarthrosis group.
Debridement and Continuous Irrigation for the Treatment of Pyogenic Arthritis Caused by the Use of Intra-Articular Injection in the Osteoarthritic Knee: Indications and Outcomes
Authors: Tsumura H , Ikeda S , Torisu T 
Published: October 2016

Purpose. To discuss the indications and therapeutic outcomes of synovectomy, debridement, and continuous irrigation for the treatment of pyogenic arthritis caused by intra-articular injection used in the treatment of osteoarthritis of the knee. Methods. Records of 41 patients with infectious arthritis of the knee who presented to our hospital from 1981 were reviewed. 11 of them had a history of intra-articular injection. They underwent synovectomy, debridement, and continuous irrigation using a Salem double-lumen tube after confirmation that one side of the femorotibial joint cartilage was basically healthy. Results. The infection was successfully treated in 9 of the 11 patients. Of these 9 patients, one died after 3 years and 2 underwent total knee arthroplasty after 3 and 8 years. The remaining 6 patients were followed up for 5 to 15 years. Five of them had deteriorating arthropathy, and the condition was unchanged in the others. Two of these 6 patients had pain while walking, and their Japanese Orthopaedic Association scores were 70. The remaining 4 had good knee function and reduction of pain, with a mean Japanese Orthopaedic Association score of 91 and a mean range of motion of 131 degrees. Conclusion. Arthrodesis is frequently considered the treatment for osteoarthritis if the joint destruction has affected the weight-bearing surface. However, in our experience, even when inflammatory granulation develops in the cartilage surface of one side of the femorotibial joint, good results can still be obtained by synovectomy, debridement, and continuous irrigation. After the pyogenic arthritis has subsided, if osteoarthritis has advanced and bowleg has exacerbated, further treatment options are available, such as tibial resection and even joint replacement. Continuous irrigation should be considered a feasible treatment option for pyogenic arthritis.
Reconstructive Treatment following Resection of High-Grade Soft-Tissue Sarcomas of the Lower Limb
Authors: Leow AM , Halim AS , Wan Z 
Published: October 2016

Purpose. To review the role of free tissue transfer in reconstructive surgery following resection of high-grade soft-tissue sarcomas of the lower limb. Methods. Medical records of all consecutive patients with high-grade soft-tissue sarcomas of the lower limbs between August 1997 and September 2003 were reviewed. Results. Of 8 patients (6 women and 2 men) aged between 19 and 65 years, 4 had malignant fibrous histiocytoma, one had malignant peripheral nerve sheath tumour, one had synovial sarcoma, one had recurrent liposarcoma, and one had epitheloid sarcoma. The tumour sizes ranged from 132 cm2 to 483 cm2. The soft-tissue defects following tumour extirpation ranged from 153 cm2 to 896 cm2. The flaps used were 3 free latissimus dorsi flaps, 2 free osteoseptocutaneous fibula flaps (one vascularised fibula flap and one ‘double barrel’ fibula flap), one free rectus abdominis flap, 2 free mini-transverse rectus abdominis flaps, and one pedicled rectus abdominis flap. Five patients did not have local recurrence and systemic metastases. Conclusion. Tissue transfer allows early adjuvant therapy facilitating the multimodal approach for the high-grade soft-tissue sarcomas of the lower extremity.
Capsulolabral Augmentation by Blood Injection Increases the Intrinsic Stability Provided by the Glenoid
Authors: Tan AHC , Kiesau CS , Gibbs KB , Matsen FA 
Published: October 2016

Purpose. To test the hypothesis that the intrinsic stability of the cadaveric glenoid can be augmented by the injection of blood into the labrum. Methods. The intrinsic stability of 10 fresh frozen cadaveric glenoids was assessed by measuring the balance stability angle. Pretreatment values of 8 directions in each glenoid were obtained. The labrum was then injected with blood freshly drawn from a volunteer. After the injected blood clotted, measurements of the balance stability angle of the 8 directions were again obtained. Results. The mean pre-injection balance stability angle for 7 of the 8 directions were significantly increased by the injection of blood: anterosuperior, from 25 to 35 degrees (p<0.005); anterior, from 27 to 34 degrees (p<0.01); anteroinferior, from 36 to 39 degrees (p<0.005); inferior, from 38 to 41 degrees (p<0.02); posteroinferior, from 35 to 42 degrees (p<0.01); posterior, from 27 to 35 degrees (p<0.0005); and posterosuperior, from 26 to 29 degrees (p<0.005). Cross-sections of injected labra demonstrated a firm clot within the labrum with substantial increases in thickness. Conclusion. The intrinsic stability of cadaveric glenoids can be significantly augmented by the injection of blood into the labrum. It is possible that blood injection may be a useful primary or adjunct procedure in the open or arthroscopic management of glenohumeral instability.
Clinical Results of Modified Mitchell's Osteotomy for Hallux Valgus Augmented with Oblique Lesser Metatarsal Osteotomy
Authors: Yamamoto K , Imakiire A , Katori Y , Masaoka T , Koizumi R 
Published: October 2016

Purpose. To evaluate postoperative results of modified Mitchell's osteotomy and its combination with oblique metatarsal osteotomy for the treatment of hallux valgus. Methods. A total of 93 feet of 53 patients (2 men and 51 women) with hallux valgus underwent modified Mitchell's osteotomy and were followed up for at least 5 years. Patients' age ranged from 17 to 83 years, and the duration of follow-up ranged from 5 years one month to 18 years 4 months. Modified Mitchell's osteotomy was performed on 53 feet in 31 patients (group A), whereas modified Mitchell's osteotomy augmented with oblique lesser metatarsal osteotomy was performed to the remaining 40 feet in 22 patients (group B). Postoperative results were assessed using a clinical assessment system developed by the Tokyo Medical University based on 5 categories: pain in the first metatarsophalangeal, deformity of the metatarsophalangeal, plantar callosity and/or metatarsalgia of lesser metatarsals, the use of commercially available shoes, and local inflammatory symptoms. Results. Mean total score improved from 3.8 to 7.9 on a 10-point scale. Scores for 2 categories—plantar callosity and/or metatarsalgia and the use of commercially available shoes—were significantly higher in group B at postoperative 5 years. Before surgery, at postoperative 3 weeks, and at postoperative 5 years, respectively, the mean hallux valgus angles were 34.2°, 12.0°, and 17.1°; mean M1–M2 angles were 16.7°, 7.4°, and 8.7°; mean M1–M5 angles were 34.9°, 25.8°, and 26.6°; and mean sesamoid bone shifts were 8.7 mm, 4.3 mm, and 5.9 mm. Conclusion. Modified Mitchell's osteotomy shortens the length of the first metatarsal bone and thus relieves tension in soft tissues such as the adductor hallucis. Nonetheless, the procedure can induce metatarsophalangeal joint malalignment and metatarsalgia, and plantar callosity may develop or persist after surgery. Combining oblique metatarsal osteotomy of the lesser metatarsal bones is useful in patients with uneven metatarsal bone lengths and metatarsophalangeal joint malalignment.
Alkalinisation of Local Anaesthetics Prescribed for Pain Relief after Surgical Decompression of Carpal Tunnel Syndrome
Authors: Ozer H , Solak S , Oguz T , Ocguder A , Colakoglu T , Babacan A 
Published: October 2016

Purpose. To compare the duration of analgesia achieved following administration of buffered prilocaine versus plain prilocaine to patients undergoing surgical decompression of the median nerve. Methods. 40 (32 female and 8 male; mean age, 50.5 years) patients who underwent surgical decompression of carpal tunnel syndrome were recruited. Patients were randomly allocated to 2 groups: the alkalinised group was given 10 ml of prilocaine hydrochloride 2% buffered with 1 ml of sodium bicarbonate 8.4%, whereas the non-alkalinised group received 10 ml of plain prilocaine hydrochloride 2% solution. Patients were asked to rate their comfort level at the operation site in the first 6 hours following surgery and after discharge from hospital using a visual analogue scale (VAS). The duration of analgesic effect was evaluated every 3 hours. Additional oral analgesia in the form of paracetamol 500 mg tablets was available to patients if required for breakthrough pain. Results. Significantly lower VAS scores were reported by the alkalinised group during the first postoperative 12 hours. The change of VAS scores over time was significantly higher in the non-alkalinised group. The mean analgesic requirement for paracetamol tablets in the alkalinised and non-alkalinised groups was 4 and 34, respectively. Conclusion. Buffered prilocaine provided a longer postoperative pain-free period for patients undergoing surgical decompression of the median nerve. It is easy, safe, and cost-effective.
Prevalence and Surgical Significance of a High-Origin Anterior Tibial Artery
Authors: Tindall AJ , Shetty AA , James KD , Middleton A , Fernando KWK 
Published: October 2016

Purpose. To assess the prevalence of proximal high-origin anterior tibial artery and its surgical significance. Methods. 100 knees were prospectively studied using colour Doppler ultrasonography. No patient had a history of lower-limb arterial pathology or previous knee surgery. All ultrasound images were assessed by a single experienced vascular technician to eliminate inter-observer variability. Results. The mean age of the patients was 56 years (range, 21–96 years). Prevalence of the high-origin anterior tibial arterial pattern was 6%, greater than that reported by previous angiographic or cadaveric studies. In all patients with high-origin anterior tibial artery, the artery was in direct contact with the posterior cortex of the tibia. Conclusion. This highlights the danger of using sharp instruments in knee procedures that involve extension of osteotomy to the posterior tibial cortex, particularly high-tibial osteotomy and total knee replacement. Knowledge of the anatomical variations in the branching of the popliteal artery is important because damage to its branches can be limb- or life-threatening.
Open Medial Placement of Kirschner Wires for Supracondylar Humeral Fractures in Children
Authors: Barlas K , George B , Hashmi F , Bagga T 
Published: October 2016

Purpose. To assess the efficacy of our protocol for treatment of displaced Gartland type-3 supracondylar fractures of the humerus in children. Methods. Records of 43 children with displaced Gartland type-3 supracondylar fractures of the humerus admitted from October 1997 to October 2003 were reviewed. Patients were treated within 12 hours of admission by closed reduction (n=33) or open reduction (n=10). Crossed medial and lateral Kirschner wires through a medial approach were used in all patients. A 3-cm incision was made medially to identify the correct entry point of the medial wire, and thus prevent ulnar nerve injury. The incision was extendable for open reduction if closed reduction was unsuccessful. Results. The mean age of the 43 patients was 7.2 years (range, 2–14 years). The mean follow-up period was 48 months (range, 12–84 months). 83% of the fractures occurred in boys. All fractures were closed, extension type, with 28 (65.1%) involved the right elbow. No patient had iatrogenic ulnar nerve injury. All patients showed satisfactory results according to Flynn criteria. Conclusion. If closed reduction is unsuccessful, open reduction and open medial placement of crossed Kirschner wires can provide reliable results. The small medial incision provides a viewing point for entry of the wire and prevents iatrogenic injury of the ulnar nerve. It is cosmetically more acceptable and can be extended to facilitate open reduction.
Repair of Acute Achilles Tendon Rupture Using a Double-Ended Needle
Authors: Ng ES , Ng YO , Gupta R , Lim F , Mah E 
Published: October 2016

Purpose. To compare the results of Achilles tendon repair using a standard open procedure or a minimally invasive technique using a double-ended needle, and to determine whether the latter technique reduces the incidence of sural nerve injury and soft-tissue complications. Methods. Between the period February 1995 and September 2000 inclusive, 68 consecutive patients with acute Achilles tendon rupture underwent surgical repair in our hospitals. A standard open repair was performed on 43 patients (mean age 36 years and range 17–74 years, 30 males), while 25 patients (mean age 34 years and range 19–68 years, 17 males) elected to undergo the minimally invasive procedure involving a double-ended needle. Postoperative protocols were identical for the 2 groups. Patients were assessed for re-rupture, calf muscle strength, calf atrophy, wound healing, and ability to return to pre-injury activity. The mean follow-up period was 65.5 (range, 34–90) months. Results. One late re-rupture and one sural nerve injury occurred in the standard open repair group. No re-rupture or sural nerve injury occurred in those having minimally invasive surgery, they also reported fewer complications related to wound healing and a shorter hospital stay. Calf atrophy was also significantly less in this group (p<0.05). Conclusion. This double-ended needle repair technique is simple and reproducible. The needle is easy to make using a standard mini Steinmann pin with minimal cost. Combined with appropriate rehabilitation, the technique achieves good results and is associated with a low morbidity and complications.
Hand Grip Strength in the Adult Malaysian Population
Authors: Kamarul T , Ahmad TS , Loh WYC 
Published: October 2016

Purpose. To measure the hand grip strength of Malaysians aged 18 to 65 years. Methods. Between January and April 2003, 412 subjects (200 women and 212 men) were recruited from staff, students, and visitors of the University of Malaya Medical Centre. Socioeconomic, general health, and lifestyle data were collected from each subject using a standard questionnaire. Weight and height were measured prior to testing. Standardised positioning and instructions based on several hand grip protocols were used. Data were collected using the LIDO kinetic work set. Results. 93% of the subjects were right-hand dominant and 7% were left-hand dominant. Hand grip strength was significantly correlated with hand dominance, gender, occupation, height, and weight, but not body mass index. No significant differences in grip strength were noted with regard to race or level of income. Men were stronger than women in all age-groups, with a ratio of 1.75:1. In both right- and left-hand dominant groups, the dominant hand was consistently stronger than the non-dominant side, with a ratio of 1.12:1 in the right-hand dominant group and 1.05:1 in the left-hand dominant group. The strongest hand grip strength in the right-hand dominant group occurred in the age-group of 25 to 34 years; in the left-hand dominant group it was in the age-group of 18 to 24 years. In western populations, the mean grip strength can be as much as 1.5 times greater than in the Malaysian population. Conclusion. Data derived from western populations cannot be applied to a comparable Malaysian population. Gender, hand dominance, age, occupation, weight, and height must be considered when establishing normal values for grip strength.