bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Risedronate on Bone Resorption during the Consolidation Phase of Distraction Osteogenesis: A Rabbit Model
Authors: Heidari Pedram , Abbaspour Aziz , Baghdadi Taghi , Espandar Ramin , Farzan Mahmoud , Amanpour Saeid , Rasouli Mohammad Reza , Mohagheghi Mohammad Ali , Amiri Hamid Reza , Yasui Natsuo 
Published: October 2016

Purpose. To evaluate the effects of continuous local injection of risedronate in the prevention of bone resorption in a lengthened segment. Methods. 11 male rabbits underwent subperiosteal osteotomy of the left tibia and an external fixator was applied anteromedially. After a lag phase of one week, a 2-week distraction phase and a 5-week consolidation phase followed. Risedronate was continuously injected into the centre of the distracted segment at a rate of 10 μg/kg/day during the first 14 days of consolidation by a subcutaneously implanted osmotic pump. A control group received purified buffer solution (PBS) using the same protocol. The lengthened bone segments were evaluated using radiography, quantitative computed tomography, and 3-point bending mechanical test. Results. Risedronate injection prevented osteopenia as compared to PBS injection. The mean bone mineral content, volumetric density and cross-sectional area of the lengthened segments were significantly higher in the risedronate group than in controls (as much as 65%, 30%, and 25%, respectively). There was no significant difference between the 2 groups regarding the ultimate load to failure. Conclusion. Continuous local injection of risedronate into the lengthened segment can prevent osteopenia during distraction osteogenesis but fails to enhance mechanical strength of newly distracted segments.
The Ten-Year Pattern of Hip Diseases in Singapore
Authors: Singh Gurpal , Krishna Lingaraj , De Shamal Das 
Published: October 2016

Purpose. To review patients with hip diseases undergoing total hip arthroplasty (THA) during 2 different periods. Methods. During the periods 1994 to 1996 and 2004 to 2006, 12 men and 28 women (mean age, 57 years) and 55 men and 78 women (mean age, 62 years) underwent THA for hip diseases, respectively. The aetiologies of the hip diseases were classified. Pre-and post-operative radiographs of the pelvis and hip were reviewed. The femoral head-tilt ratio (FHR) was measured. Results. The number of patients undergoing THA increased 3-fold over 10 years; the proportion of different aetiologies was similar. Respectively, the most common aetiologies were acetabular dysplasia (33% vs. 40%) and avascular necrosis (33% vs. 42%). Only <5% of the patients had advanced osteoarthritis with no demonstrable cause, most of whom being Caucasians. The overall mean FHR was 1.07. There was no significant difference between male and female subjects. Conclusion. The pattern of hip diseases in Singapore remained similar over the 10-year interval, but the number of patients undergoing THA had increased 3-fold.
Serum Levels of Bone Turnover Markers following Total Joint Arthroplasty
Authors: Kenanidis Eustathios I , Potoupnis Michael E , Papavasilioul Kyriakos A , Sayegh Fares E , Petsatodis George E , Kapetanos George A 
Published: October 2016

Purpose. To evaluate changes in serum levels of bone turnover markers during the first year following a total hip or knee arthroplasty (THA or TKA, respectively). Methods. 34 women and 13 men (mean age, 68 years) with idiopathic hip or knee osteoarthritis underwent elective THA or TKA. The serum levels of (1) osteoprotegerin, (2) nuclear factor-kappa B ligand (RANKL), (3) osteocalcin, and (4) bone-specific alkaline phosphatase (b-ALP) were determined in each patient on preoperative day 1 and postoperative day 3 and 7, and month 2, 4, 6, 8, 10, and 12. Results. All 4 markers changed significantly over the 12-month period. At month 12, values of all markers did not return to their preoperative levels uniformly. At month 8, the serum levels of osteoprotegerin, osteocalcin, and b-ALP remained higher than their respective preoperative values. The serum levels of RANKL gradually decreased after month 2, rendering this marker a potential index for fixation. Conclusions. Bone turnover markers change following arthroplasties. Postoperative month 8 seems to be a milestone in the normal course of these markers.
Medium-Term Outcome of Total Hip Replacement for Dysplastic Hips in Singapore
Authors: Kumar Jajodia Nirmal , Kumar Jain Sumit , Wang Victor TJ , De Shamal Das 
Published: October 2016

Purpose. To review medium-term outcomes of 46 patients who underwent total hip replacement (THR) for osteoarthritis secondary to dysplastic hips. Methods. Records of 58 hips in 6 men and 40 women aged 32 to 76 (mean, 62) years who underwent THR for osteoarthritis secondary to dysplastic hips and had been followed up for a mean of 4 (range, 2–8) years were retrospectively reviewed. The hips were classified according to the Crowe's grading, Sharp's acetabular angle, and centre-edge angle. The radiological uncoverage of acetabular cup (RUAC) index was calculated. The outcomes of THR were evaluated in terms of cup inclination, RUAC index, cup migration, lysis or loosening (radiolucency), heterotopic ossification, component incorporation and positioning, thigh pain, and subsidence. Results. 51 of the hips were Crowe's type I, 6 were type II, and one was type IV. The mean acetabular angle was 46.3° and the mean centre-edge angle was 15.4°. The mean cup, head, and stem sizes were 50.4 mm, 28.7 mm, and 10.9 mm, respectively. The mean RUAC index was 16.9% and the mean cup inclination was 40.7°. Radiolucency of 1 mm in the acetabular zone I was observed in 16 cases, but only one failed. For cemented and uncemented stems, the most common positioning was neutral and valgus, respectively. Five patients had complications of greater trochanter fracture, aseptic loosening, split calcar, stem loosening, and/or heterotopic ossification. Conclusion. Conventional THR can achieve good medium-term results in low-grade dysplastic hips.
The Practice of Unicompartmental Knee Arthroplasty in the United Kingdom
Authors: Schindler Oliver S , Scott W Norman , Scuderi Giles R 
Published: October 2016

Purpose. To survey the current practice of unicompartmental knee arthroplasty (UKA) in the United Kingdom. Methods. Questionnaires were sent to all 341 local members of the British Association for Surgery of the Knee to inquire into their practice of UKA, including clinical indications, preoperative investigations, surgical approach, preferences in implant design, and the role of UKA in relation to high tibial osteotomy. Result. 56% of respondents performed less than 16 UKAs per year, whereas 16.5% performed over 30 per year. 89.5% of the respondents used anteroposterior radiographs as their main investigation tool. Only 30% and 16.5% used posteroanterior 30° flexion and varus/valgus stress radiographs, respectively, despite being better investigation tools. 57% considered arthroscopy, despite its invasive nature. The main contra-indications to UKA were anterior cruciate ligament deficiency with instability (95%), focal grade-III osteoarthritis in the contralateral compartment (87%), and osteoporosis with rheumatoid arthritis (80.5%), but only 59% of respondents considered an inability to passively correct a pre-existing varus or valgus deformity as a contra-indication. 51.5% of respondents preferred minimally invasive approach, 96% preferred cemented fixation, and over two thirds used the mobile bearing design. 72% of respondents expressed preference for total knee arthroplasty over UKA in localised lateral compartment osteoarthritis. Conclusion. Modern UKA has gained popularity in properly selected patients with localised medial compartment osteoarthritis, provided the knee is not anterior cruciate ligament deficient and any deformity is passively correctable.
Changing Prophylactic Antibiotic Protocol for Reducing Clostridium Difficile—Associated Diarrhoeal Infections
Authors: Al-Obaydi Waleed , Smith Chris D , Foguet Pedro 
Published: October 2016

Purpose. To determine whether a change in prophylactic antibiotic protocol for orthopaedic surgeries may reduce the frequency of Clostridium difficile–associated diarrhoeal infections. Methods. Records of 1331 patients who underwent trauma or elective surgeries involving implantation of metalwork were reviewed. 231 trauma and 394 elective patients who received intravenous cefuroxime–based antibiotic prophylaxis between August 2006 and January 2007 were compared with 216 trauma and 490 elective patients who received a single dose of gentamicin and flucloxacillin or teicoplanin for antibiotic prophylaxis between August 2007 and January 2008. Diarrhoeal faecal specimens of 148 (33%) trauma patients and 106 (12%) elective patients were examined. The outcome variables were the rates of C difficile infection and early deep wound infection. Results. There were 32 cases of C difficile–associated diarrhoeal infection and 28 cases of early deep wound infection. The frequency of C difficile–associated diarrhoeal infection decreased after use of the new antibiotic protocol (from 4 to 1%, p=0.004), particularly in the trauma patients (from 8 to 3%, p=0.02); in the elective patients the difference was not significant (from 1 to 0.5%, p=0.27). The change of antibiotic protocol did not significantly affect the incidence of deep wound infections in the trauma (p=0.46) or elective (p=0.90) patients. The rate of C difficile infection was 8-fold higher in the trauma than elective patients, both before and after the change of protocol. Conclusion. Changing antibiotic protocol is one way of reducing the incidence of C difficile–associated diarrhoeal infections in orthopaedic patients, without increasing the rate of deep wound infections.
Intramedullary Nailing for Displaced Proximal Humeral Fractures
Authors: Kumar Vinod , Datir Sandeep , Venkateswaran Balachandran 
Published: October 2016

Purpose. To evaluate outcomes of 28 patients who underwent intramedullary nailing for displaced proximal humeral fractures. Methods. 24 women and 4 men aged 38 to 87 (mean, 65) years underwent intramedullary nailing for displaced proximal humeral fractures. 17 (61%) of them were aged >70 years. Fractures were classified into 2-part (n=8), 3-part (n=17), and 4-part (n=3), and corresponded to AO 11 A3 (n=8), B1 (n=3), B2 (n=9), and C2 (n=8) types. The Constant and Oxford scores were assessed at the final follow-up. Results. All patients had bone union except for one who had tuberosity failure. 23 (82%) patients had satisfactory-to-excellent and 5 had poor Constant scores; outcomes were worse with more complex fractures. 20 (71%) patients had satisfactory Oxford scores. Seven (25%) patients had impingement of a nail tip. Other complications included avascular necrosis (n=1), proximal locking screw back-out (n=1), and screw penetration into the joint (n=1). Conclusion. Intramedullary nailing provides a stable fixation with minimal soft tissue dissection for displaced proximal humeral fractures. It enables early mobilisation and functional recovery.
Intramedullary Nailing for Diaphyseal Forearm Fractures in Children after Failed Conservative Treatment
Authors: Ali Ayman Mohamed , Abdelaziz Mohamed , El-Lakanney Mohamed Reda 
Published: October 2016

Purpose. To evaluate treatment outcomes after intramedullary nailing using Ender nails for diaphyseal forearm fractures. Methods. 11 male and 9 female patients aged 6 to 15 (mean, 12) years underwent intramedullary nailing using Ender nails plus cast immobilisation for fractures of both the radius and ulna after conservative treatment had failed. Results. After a mean follow-up of 24 (range, 12–30) months, results were excellent in 14 patients, good in 5, and fair in one. None was poor. The mean operating time was 36 minutes. The mean time to bone union was 10 (range, 7–12) weeks. The mean time in the cast was 6 (range, 4–11) weeks. The mean time to implant removal was 8 (range, 6–10) months. All patients regained a full range of elbow movement, except in one who had limited supination and pronation (<20°) due to a degree of malrotation. Two patients had pain owing to nail protrusion. One patient had a superficial infection. One patient had transient neurapraxia. Conclusion. Intramedullary nailing using Ender nails plus cast immobilisation is effective for diaphyseal forearm fractures in children after conservative treatment has failed.
Unipolar versus Bipolar Uncemented Hemiarthroplasty for Elderly Patients with Displaced Intracapsular Femoral Neck Fractures
Authors: Sabnis Bhushan M , Brenkel Ivan J 
Published: October 2016

Purpose. To compare outcomes of unipolar versus bipolar uncemented hemiarthroplasty and determine factors affecting outcomes. Methods. 433 and 274 elderly patients with displaced intracapsular femoral neck fractures underwent uncemented unipolar hemiarthroplasty and uncemented bipolar hydroxyapatite-coated hemiarthroplasty, respectively. Surgical options were based on the patient's general condition and preinjury mobility status. In the respective groups, the mortality of 377 and 242 patients and the mobility of 270 and 217 patients were reviewed at the 4-month follow-up. Patient age, sex, American Society of Anesthesiologists [ASA] score, mobility, and mortality of the 2 groups were compared. Results. Patients who underwent unipolar hemiarthroplasty were significantly older, less fit, and less mobile (p<0.001). Patients who underwent bipolar hemiarthroplasty achieved better outcomes for mortality and mobility (p<0.001). Among patients who were able to walk unaided before injury, more of those having bipolar hemiarthroplasty were able to do so at month 4 than those having unipolar hemiarthroplasty (13% vs. 33%, p<0.001). Mortality within 4 months was associated with age, male gender, and ASA score. When patients were stratified according to age groups, mortality within 4 months was lower in patients having bipolar hemiarthroplasty. Conclusion. In elderly patients with femoral neck fractures who were fit and physiologically young, uncemented bipolar hemiarthroplasty seemed to achieve better functional outcome.
Risk Factors of Venous Thromboembolism in Indian Patients with Pelvic-Acetabular Trauma
Authors: Sen Ramesh Kumar , Kumar Amit , Tripathy Sujit Kumar , Aggarwal Sameer , Khandelwal N 
Published: October 2016

Purpose. To determine risk factors of venous thromboembolism (VTE) in Indian patients undergoing surgery for pelvic-acetabular fractures. Methods. 48 men and 8 women aged 17 to 61 (mean, 36) years who underwent open reduction and internal fixation for pelvic-acetabular fractures were evaluated for VTE in the postoperative period. Pulmonary angiography and indirect computed tomographic venography were used in the hospital, whereas colour Doppler ultrasonography was used in an outpatient setting until postoperative week 6. Patients with evidence of VTE were treated according to the American College of Chest Physician guidelines. Correlations between VTE and putative variable were assessed, and risk factors determined. Results. 16 patients developed VTE. Six patients with proximal DVT had associated pulmonary embolism (PE). There were 12 cases of proximal deep vein thrombosis (DVT), 2 cases of distal DVT, and 10 cases of PE. The rate of VTE was significantly higher in patients who had predominantly posterior injury (as opposed to anterior injury) [13/27 vs. 3/29, p=0.003], who were operated on in the lateral position (as opposed to the supine position) [13/30 vs. 3/26, p=0.016], or via the Kocher-Langenbeck or combined approach (as opposed to others) [13/30 vs. 3/26, p=0.016]. Patients were more likely to develop VTE when they had predominantly posterior injuries (7.8 fold) or were operated on in a lateral position (2.96 fold) or via the Kocher-Langenbeck approach (2.27 fold). Conclusion. Pelvic-acetabular trauma is a significant risk factor for VTE, even in Indians. Patients who have posterior injuries or are operated on in the lateral position, or via the Kocher-Langenbeck approach have a significantly higher risk of VTE.
Correlation of Kyphosis and Wedge Angles with Outcome after Percutaneous Vertebroplasty: A Prospective Cohort Study
Authors: Khurjekar Ketan , Shyam Ashok K , Sancheti Parag K , Sonawane Darshan 
Published: October 2016

Purpose. To evaluate the correlation of kyphosis and wedge angles with pain relief and functional outcome after percutaneous vertebroplasty (PV). Methods. 15 men and 19 women aged 41 to 85 (mean, 62) years who presented with osteoporotic wedge compression fractures of the dorsolumbar spine below T5 and had failed conservative treatment were included. Patients were assessed before and one year after PV. Kyphosis and wedge angles were measured on standardised radiographs. Pain and function were assessed using the visual analogue scale (VAS) score and the Ronald Morris Disability Questionnaire (RMDQ) score, respectively. Patients were dichotomised based on their preoperative kyphosis (≤10° vs. >10°) and wedge angles (≤7° vs. >7°). Outcomes were classified as excellent, fair, and poor in terms of VAS scores (<3, 3–6, >6) and RMDQ scores (<8, 8–16, >16). Correlations between the kyphosis and wedge angles and VAS and RMDQ scores were assessed. Results. VAS and RMDQ scores correlated positively with the kyphosis and wedge angles; the highest correlation was between the VAS score and kyphosis angle ( r=0.93). A significantly greater proportion of excellent outcomes (in terms of RMDQ and VAS scores) were noted in patients with preoperative kyphosis and wedge angles of ≤10° and ≤7°, respectively. Conclusion. PV is a viable treatment for vertebral compression fractures with regard to pain relief and improvement of function. Preoperative kyphosis and wedge angles were predictive of post-PV outcomes in terms of VAS and RMDQ scores.
Resumption of Car Driving after Total Hip Replacement
Authors: Abbas Ghulam , Waheed Abdul 
Published: October 2016

Purpose. To assess periods required for resuming car driving in 130 patients who had undergone total hip replacement (THR). Methods. 80 men and 50 women aged 39 to 80 years who had been driving automatic (n=49) or manual (n=81) cars in the previous 3 months and underwent unilateral primary THR of the right (n=85) or left (n=45) hip were recruited. Patients were advised to resume driving after 6 weeks if they felt comfortable to do so. Results. 105 (81%) patients were able to resume driving at week 6 to 8; 67 (64%) had had a right THR and 65 (62%) were manual car drivers. 22 (17%) patients were able to do so at week 12. The remaining 3 (2%) patients were not confident to drive even at week 12. No patient reported deterioration in driving ability, whereas 48 (38%) felt a subjective improvement in their driving ability. Conclusion. The time to resume driving varies in different patients. The advice should be individualised, depending on the patient's recovery and confidence level.
Blood Reinfusion Combined with Femoral Nerve Block in Total Knee Replacement for Patients with Increased Risk of Bleeding
Authors: Simonsen OH , Gorst-Rasmussen A , Simonsen AB , Jorgensen MB , Rathleff MS , Lundbye-Christensen S 
Published: October 2016

Purpose. To compare patients with increased risk of bleeding who received combined blood reinfusion and femoral nerve block in total knee replacement (TKR) to regular patients treated routinely with respect to pain relief, blood loss, and knee function. Methods. In a consecutive series of 67 patients who underwent unilateral TKR, 12 patients with increased risk of bleeding owing to cardiac disease or previous thromboembolic events received continuous femoral nerve block and blood reinfusion, without tranexamic acid (TA) injection. The remaining 55 patients were controls who received standard postoperative treatment (TA injection, local injection of analgesics, and suction drainage without reinfusion). The volume of blood loss (drained or reinfused), pain score (using a visual analogue scale) and knee function (using the Knee Society Score [KSS]) in the 2 groups were compared. Results. In the study group, patients were 5 years older and tended to have a lower preoperative KSS function score (35 vs. 45, p=0.08) and a higher function-related pain score (6.5 vs. 6, p=0.10). The mean volume of drained blood wasted in the study group did not differ significantly from the mean total volume of drained blood in the control group (235 vs. 300 ml, p=0.14). Similarly, the mean decrease in postoperative haemoglobin concentration did not differ significantly between the respective groups (2.1 vs. 2.1 mmol/l, p=0.97). A significantly greater proportion of patients received allogenic blood transfusion in the study group than in controls (3/12 vs. 2/55, p<0.01). The study group exhibited significantly higher pain scores during training (1.7 vs. 1.4, p=0.03) and lower escape oxycodone consumption (5 vs. 15 mg/kg, p=0.06) on postoperative day 1 (but not other days). The duration of hospitalisation was also longer (5.5 vs. 4 days, p=0.04). Conclusion. In TKR patients with increased risk of bleeding, blood reinfusion combined with femoral nerve block is safe and comparable to standard methods of pain control (local injection of analgesics).
Review Article: Osteochondral Reconstruction and Grafting
Authors: Magill Paul , Byrne Damien P , Baker Joseph F , Mulhall Kevin J 
Published: October 2016

ABSTRACT Osteochondral defects are a challenging problem. Osteochondral reconstruction and grafting techniques potentially benefit both young athletes and elderly osteoarthritis patients. Research on the treatment of osteochondral defects has been carried out, particularly on surgical options, but none shows lasting benefit. More objective evaluation of cartilage injuries and outcomes is needed. We present a review of surgical and non-surgical treatments for osteochondral defects, and their outcomes and costs.
Minimally Invasive Plate Osteosynthesis Using a Locking Compression Plate for Distal Femoral Fractures
Authors: Nayak Ravi M , Koichade Ravi MR , Umre Alok N , Ingle Milind V 
Published: October 2016

Purpose. To evaluate treatment outcomes of minimally invasive plate osteosynthesis (MIPO) for distal femoral fractures in 31 patients. Methods. 22 male and 9 female consecutive patients aged 21 to 65 (mean, 42) years underwent minimally invasive plate osteosynthesis using a locking compression plate (LCP) for distal femoral fractures. The causes of injury were vehicular accidents (n=24), falls (n=6), and assault (n=1). According to the AO classification, the fractures were classified as types A1 (n=10), A2 (n=7), and A3 (n=14). Most fractures were closed; 3 were Gustilo type-II fractures. Clinical and functional outcomes were assessed using the Knee Society Scores. Results. The mean operating time was 70 (range, 60–100) minutes. The mean length of hospital stay was 9 (6–14) days. The mean time to union was 3.7 (range, 2.8–4.6) months. The mean follow-up period was 18 (14–26) months. At the one-year follow-up, 29 of the patients had good or excellent outcomes. No patient had angular or rotational deformity of >10°. One osteoporotic woman with a type-A1 fracture had implant failure at 10 weeks and underwent revision surgery. Another patient with a type-A1 fracture had persistent pain on the lateral aspect of the distal thigh and underwent implant removal at 22 months. No patient developed deep infection, malunion or nonunion. Conclusion. MIPO using a LCP achieves favourable biological fixation for distal femoral fractures with few complications. Bone grafting is not needed even in cases of metaphyseal comminution. Proper patient selection and preoperative planning are essential to prevent complications.