bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Management for Late Presentation of Supracondylar Humeral Fracture in Children
Authors: Tiwari A , Kanojia RK , Kapoor SK 
Published: October 2016

Purpose. To report the results of surgical management for late-presenting displaced supracondylar fractures of the humerus in children. Methods. Between February 2002 and June 2003, 40 children (mean age, 7 years) with late presentation (range, 2–12 days) of displaced supracondylar humeral fractures were prospectively recruited. Gentle closed manipulation under image intensification was attempted in all patients, except one with a compound open fracture. Manipulation was successful in 25 patients and percutaneous skeletal stabilisation with Kirschner wires was performed. The remaining 15 patients were treated with open reduction and Kirschner wire fixation, using a mediolateral approach. Results. The mean delay in presentation was approximately 4 days. No patients presenting more than 7 days after injury had the fracture reduced by closed manipulation. The mean hospital stay was 41 hours. At the final follow-up (mean, 18 months), 88% of the patients had a satisfactory result, according to Flynn's criteria. Conclusion. Operative treatment for late presentation of supracondylar humeral fractures in children is effective. It minimises the risk of complications and the need for continuous traction or corrective osteotomy.
Computed Tomographic Measurement of Cervical Pedicles for Transpedicular Fixation in a Malay Population
Authors: Yusof MI , Ming LK , Abdullah MS 
Published: October 2016

Purpose. To measure the cervical pedicles and assess the feasibility of transpedicular fixation in a Malay population. Methods. 960 computed tomography (CT) scans of bilateral C2 to C7 pedicles of 80 Malays were compared. 22 men and 24 women aged <60 (mean, 37.3; range, 18–56) years were defined as young patients, whereas 18 men and 16 women aged ≥60 (mean, 63.9; range, 60–76) years as elderly patients. An inner diameter of <3.0 mm (85% of a 3.5-mm screw) was defined as ‘unfeasible’ and a medial or lateral wall thickness of <1.0 mm as ‘unsafe’ for cervical pedicle screw fixation. Results. In the respective young versus elderly groups, the inner diameters ranged from 1.94 to 2.80 mm versus 2.51 to 3.37 mm in men, and from 1.52 to 2.31 mm versus 1.64 to 2.46 mm in women. Medial wall thickness ranged from 1.25 to 1.46 mm versus 1.13 to 1.48 mm in men, and from 1.28 to 1.72 mm versus 1.10 to 1.24 mm in women. Lateral wall thickness ranged from 0.80 to 0.90 mm versus 0.66 to 0.88 mm in men, and from 0.85 to 0.99 mm versus 0.59 to 0.86 mm in women. Conclusion. The cervical spine of Malays may not be adequate to accommodate a 3.5-mm pedicle screw for transpedicular fixation, as this procedure may risk adjacent vital structures.
Arthroscopic Subacromial Decompression for Stage-II Impingement
Authors: Lim KK , Chang HC , Tan JL , Chan BK 
Published: October 2016

Purpose. To evaluate outcomes of arthroscopic subacromial decompression for stage-II impingement. Methods. Records of 42 consecutive patients with stage-II impingement treated by arthroscopic subacromial decompression from January 2000 to February 2002 were reviewed. Clinical outcomes were measured using the UCLA shoulder rating scale, and radiological outcomes using anteroposterior and supraspinatus outlet shoulder radiographs. Results. The mean follow-up period was 14.6 (range, 12–30) months. Using the UCLA scale, 14 (33%) patients had an excellent result, 21 (50%) had a good result, 4 (10%) had a fair result, and 3 (7%) had a poor result. Mean component scores for the UCLA scale were: 8.0 for pain, 8.8 for function, 4.5 for forward flexion, and 4.5 for strength. The mean extent of resection was 2.9 mm in the anteroposterior and 2.0 mm in the supraspinatus outlet radiographs. There was no correlation between the extent of acromial resection and the UCLA shoulder rating scores. Conclusion. Short-term results of arthroscopic subacromial decompression for stage-II impingement are favourable.
A Combined Use of a Free Vascularised Flap and an External Fixator for Reconstruction of Lower Extremity Defects in Children
Authors: Segev E , Wientroub S , Kollender Y , Meller I , Amir A , Gur E 
Published: October 2016

Purpose. To describe a combined use of a free vascularised flap and an external fixator for reconstruction of lower extremity defects in children, and correction of equinus contracture developed after removal of the external fixator using a circular dynamic frame. Methods. Seven children (4 males) aged 4 to 12 (mean, 8) years were treated with 9 free vascularised flaps for 8 limbs (bilaterally in one patient and for a failed flap in another). Patient pathologies included: 3 soft tissue degloving injuries, one soft tissue and bone avulsion, one severe burn contracture, one resurfacing of soft tissue and bone necrosis, and one osteosarcoma resection defect. Free flap reconstruction was delayed in 6 patients (range, 3 weeks to 4 years). Static external fixators were used to stabilise the free vascularised flaps at the time of reconstruction, with the ankle in a neutral position. Results. The mean follow-up was 5 (1–10) years. All flaps but one survived; the failed one was immediately reconstructed with a contralateral, latissimus dorsi flap. One anastomosis following a Kirschner-wire injury was successfully revised. Six patients had pin tract infections and were treated with oral antibiotics. Two patients developed equinus contracture 6 and 3 years later, after removal of the external fixator, and were corrected by distraction, using a dynamic Ilizarov frame. Conclusion. The combined use of a free flap and an external fixator for salvage of lower extremities is useful in children. Late development of equinus contracture can be safely corrected by distraction, without compromising flap viability.
Dynamic Treatment for Proximal Phalangeal Fracture of the Hand
Authors: Rajesh G , Ip WY , Chow SP , Fung BKK 
Published: October 2016

Purpose. To assess a protected mobilisation programme (dynamic treatment) for proximal phalangeal fracture of the hand, irrespective of the geometry. Methods. Clinical and radiological results of 32 consecutive patients with proximal phalangeal fracture of the hand treated from January 2001 to February 2007 were evaluated. Our supervised rehabilitation programme was strictly followed to gain full range of movement of the proximal interphalangeal joint and to prevent the development of an extension lag contracture. Patients were followed up for a mean period of 15 (range, 13–16) months. Results were evaluated using the Belsky classification. Results. The results were excellent in 72% of the patients, good in 22%, and poor in 6%. Some patients defaulted follow-up, which made long-term assessment difficult. The poor results may have been related to patient non-compliance or default from rehabilitation. Many good results upgraded to excellent following further rehabilitation. Conclusion. Skeletal stability, not rigidity, is necessary for functional movements of the hand. Proximal phalangeal fractures can be effectively treated by closed methods, using the stabilising effect of soft tissues (zancolli complex–metacarpophalangeal retention apparatus) and external devices (metacarpophalangeal block splint), thus enabling bone healing and movement recovery at the same time.
Anti-Platelet Agents and Surgical Delay in Elderly Patients with Hip Fractures
Authors: Harty JA , McKenna P , Moloney D , D'Souza L , Masterson E 
Published: October 2016

Purpose. To assess the risk of surgical delay in elderly hip fracture patients on anti-platelet agents. Methods. Records of 180 patients aged over 65 years with either an intertrochanteric or femoral neck fracture were reviewed. The clopidogrel group included 10 patients on clopidogrel alone and 11 others on clopidogrel and aspirin, whereas the control group included 69 on aspirin alone and the remaining 90 not on any anti-coagulants. The 2 groups were compared with regard to time to surgery, preoperative American Society of Anesthesiologists (ASA) score, pre- and post-operative haemoglobin levels, in-patient complication rates, duration of hospital stay, and 30-day mortality. Results. In the clopidogrel and control groups respectively, the mean times to surgery were 7.2 and 2.1 days (p=0.03, t-test), the mean preoperative ASA scores were 3.35 and 2.8 (p=0.29, t-test), the mean preoperative haemoglobin levels were 119 and 115 g/l (p=0.5, t-test), the mean postoperative haemoglobin levels were 98 and 96 g/l (p=0.68, t-test), the mean durations of hospital stay were 7.4 and 3.1 days (p=0.02, t-test). The 30-day mortalities were 6/21 (29%) and 6/159 (4%) [p=0.0003, Fisher's exact test]. Conclusion. Surgical delay in elderly patients on anti-platelet agents with hip fracture was associated with higher mortality. Despite the risk of increased blood loss, we suggest early surgery be carried out by an experienced surgeon to expedite the operating time. Pooled platelets should be given intravenously one to 2 hours preoperatively.
Salter Innominate Osteotomy for Treatment of Developmental Dysplasia of the Hip
Authors: Tukenmez M , Tezeren G 
Published: October 2016

Purpose. To compare the results of Salter innominate osteotomy (SIO) for treatment of developmental dysplasia of the hip (DDH) in children. Methods. Between 1994 and 2002, 53 girls and 8 boys with DDH underwent open reduction and SIO; 21 were on the left side, 22 on the right side, 18 bilateral. They were divided into 2 groups: group 1 included 35 patients aged younger than 3 years (46 hips) and group 2 included 26 patients aged 3 years or older (33 hips). Clinical outcomes were assessed using the modified McKay criteria to measure pain symptoms, gait pattern, Trendelenburg sign status, and the range of hip joint movement. Radiographic outcomes were evaluated using the Severin method to measure the Sharp acetabular angle and the centre-edge angle. Results. Group-1 children achieved slightly better reduction and stabilisation of the hip joint empirically, but clinical and radiographic results and complication rates in the 2 groups were not significantly different. Conclusion. Open reduction and SIO without preoperative traction is effective for the management of DDH in children younger than 6 years.
Surgical Management of Metastatic Disease of the Proximal Femur
Authors: Hattori H , Mibe J , Matsuoka H , Nagai S , Yamamoto K 
Published: October 2016

Purpose. To review the surgical treatment for metastatic disease of the proximal femur. Methods. Records of 8 patients who underwent endoprosthetic replacement with tumour resection (group 1) and 8 others who underwent intramedullary nailing without tumour resection (group 2) were reviewed. Treatments were based on the disease progression and patient's condition. Results. In groups 1 and 2, the respective mean survival periods were 16 and 4 months. All patients in group 1 regained preoperative mobility, but only one patient in group 2 was able to walk with crutches. Conclusion. This was a retrospective, rather than comparative study of endoprothetic replacement and intramedullary nailing for metastatic disease of the proximal femur. Both procedures are considered palliative, and not curative. The longer survival period in group 1 was mainly due to selection of patients with better preoperative medical status.
Management of Acute Achilles Tendon Ruptures in the United Kingdom
Authors: Worth N , Ghosh S , Maffulli N 
Published: October 2016

Purpose. To survey the management of acute Achilles tendon ruptures in the United Kingdom. Methods. A questionnaire with 4 different Achilles tendon rupture scenarios affecting patients of different ages and activity levels was sent to orthopaedic consultants specialised in sports trauma, foot and ankle surgery. Their treatment methods including surgical techniques, immobilisation and rehabilitation regimens were surveyed. Results. The response rate was 22% (51/231). Among the 51 respondents, 25 had managed less than 6 such patients in the preceding year. 26 (51%) used clinical examination (e.g. calf squeeze test) to make the diagnosis, 16 (31%) used ultrasonography, and 4 (8%) used magnetic resonance imaging. Surgical management was preferred for younger and more functionally demanding individuals. Open repairs were used more often than percutaneous repairs (72 vs 19%). Across the 4 scenarios, the mean time to return to full activity was 17 (range, 12–32) weeks for conservative to 19 (range, 10–40) weeks for surgical management. Conclusion. Variation in opinion among respondents was wide. Randomised controlled trials are needed to assess optimal treatment.
Anterior Cervical Fusion Using the IntExt Combined Cage/Plate
Authors: Keogh A , Hardcastle P , Ali SF 
Published: October 2016

Purpose. To review our first 30 patients who underwent anterior cervical fusion using IntExt and xenograft. Methods. Records of 23 men and 7 women aged 18 to 83 (mean, 40) years were reviewed by a single researcher. 23 patients had traumatic fracture-dislocations and 7 had degenerative disease. Pain, range of movement, neurological status, return-to-work status, kyphosis, and lordosis were recorded. Radiography and computed tomography were used to assess integration of the xenograft with the host bone, intervertebral fusion around the cage, and any screw loosening. Results. The mean follow-up duration of the 30 patients was 14 (range, 1–47) months. There was no evidence of screw loosening or breakage. 20 of the 28 patients had no neck pain. Radiographs and/or computed tomographic scans of 23 patients showed bone union or clinical evidence of stability. Conclusion. The IntExt is effective in stabilising traumatic fractures. Although the literature does not support single-level plating in degenerative fractures (because of high success rates with autologous bone grafting), the IntExt has advantages of avoiding grafting complications, donor-site morbidity, and resorting to a postoperative collar.
Balloon Kyphoplasty for Vertebra Plana with or without Osteonecrosis
Authors: Becker S , Tuschel A , Chavanne A , Meissner J , Ogon M 
Published: October 2016

Purpose. To compare efficacy of balloon kyphoplasty in restoring vertebral height and correcting kyphosis in patients having vertebra plana with or without osteonecrosis. Methods. 12 women and 3 men (mean age, 76 years), who had a complete vertebra plana with or without osteonecrosis (n=8 vs n=7), underwent balloon kyphoplasty. No external manoeuvres were performed before or during balloon kyphoplasty, except for positioning the patients in a prone posture on the operating table. The anterior, middle, and posterior vertebral height and the kyphotic angle were measured pre- and post-operatively with a digital imaging system. The vertebral height was measured as a percentage of the adjacent normal vertebral height. Results. Respectively in vertebra plana patients with or without osteonecrosis, the mean corrections of (1) kyphosis were 10° and 4° (p=0.099), (2) anterior vertebral height were 33% and 5% (p<0.001), (3) middle vertebral height were 38% and 18% (p=0.004), and (4) posterior vertebral height were 19% and 2% (p=0.031). Conclusion. In patients with vertebra plana, it is important to identify any osteonecrosis, which is an indication for balloon kyphoplasty to restore vertebral height and correct kyphosis.
Dextrose Prolotherapy for Recalcitrant Coccygodynia
Authors: Khan SA , Kumar A , Varshney MK , Trikha V , Yadav CS 
Published: October 2016

Purpose. To present the results of dextrose prolotherapy undertaken for chronic non-responding coccygodynia in 37 patients. Methods. 14 men and 23 women (mean age, 36 years) with chronic coccygodynia not responding to conservative treatment for more than 6 months were included. 27 of them had received local steroid injections. A visual analogue score (VAS) was recorded for all patients before and after injection of 8 ml of 25% dextrose and 2 ml of 2% lignocaine into the coccyx. In 8 patients with a VAS of more than 4 after the second injection, a third injection was given 4 weeks later. Results. The mean VAS before prolotherapy was 8.5. It was 3.4 after the first injection and 2.5 after the second injection. Minimal or no improvement was noted in 7 patients; the remaining 30 patients had good pain relief. Conclusion. Dextrose prolothearpy is an effective treatment option in patients with chronic, recalcitrant coccygodynia and should be used before undergoing coccygectomy. Randomised studies are needed to compare prolotherapy with local steroid injections or coccygectomies.
Chondroblastoma
Authors: Garin IE , Wang EHM 
Published: October 2016

Purpose. To review all patients with chondroblastoma treated in our hospital between 1993 and 2004. Methods. Six men and 4 women aged 13 to 33 (mean, 21) years with histologically proven chondroblastomas were retrospectively reviewed through our tumour registry, patient records, radiographic and histopathologic reports. All patients underwent intralesional curettage and bone grafting with or without bone cement. The mean follow-up period was 5.5 (range, 2–11.8) years. Functional outcome was measured according to the Enneking scoring system. Results. The proximal tibia and femur were the most frequently involved sites. All patients presented with pain but only 2 with joint effusion. In 3 patients the lesions were aggressive, in 3 others it was active, and in 4 it was latent. In 2 patients the lesions recurred at 5 and 28 months; both resolved after repeat surgeries without further recurrence. Functional outcomes were either good or excellent, except for one patient with a compartment syndrome of the contralateral leg. No patients had metastasis to lungs or collapse of articular surfaces. Conclusion. Chondroblastoma is a rare benign bone tumour commonly presenting with pain. Outcomes are usually good after curettage and reconstruction with bone grafting.
Patient Expectations for Hallux Valgus Surgery
Authors: Tai CC , Ridgeway S , Ramachandran M , Ng VA , Devic N , Singh D 
Published: October 2016

Purpose. To determine preoperative patient expectations and their relative importance for hallux valgus surgery using a patient-derived questionnaire, and whether such expectations are influenced by age, gender, or occupation. Methods. Two patient-derived questionnaires were developed using open-ended interviews. The 19 most commonly stated expectations were included in the Patient Expectation Questionnaire: 2 related to improvement in appearance, 2 to pain reduction, and 15 to functional improvements in performing daily and recreational activities. The top 9 expectations were included in the Patient Priority Questionnaire for prioritising. Results. 153 eligible patients aged 16 to 79 (mean, 47) years completed the questionnaires; 29 (19%) aged less than 40 years, 84 (55%) aged 40 to 60 years, and 40 (26%) aged more than 60 years. 86% were women and 81% were Caucasian. 62% were housewives or retired pensioners. Overall, the most important expectation was improved walking, followed by reduced pain over the bunion and wearing daily shoes. These expectations varied according to age and gender but not occupation. Conclusion. Patient expectations differ from those of surgeons, and vary according to patient age and gender. Understanding preoperative patient expectations is crucial to achieve better clinical outcomes and satisfaction by selecting the most appropriate operation for each patient.
Understanding of Informed Consent and Surgeon Liability by the Public and Patients
Authors: Amarasekera SS , Lander RO 
Published: October 2016

Purpose. To evaluate understanding of the fundamental concepts of informed consent by the public and patients. Methods. Questionnaires were distributed to any persons (aged more than 16 years) attending the Palmerston North Hospital (excluding in-patients). The first 1000 completed questionnaires were analysed using the Chi squared test. Results. The fundamental concepts of informed consent were not appreciated by most respondents; only 18%, 13%, and 5% of them agreed with its implications in terms of self-autonomy, confidentiality, and battery, respectively. 64% of respondents preferred to take sole responsibility to decide which procedure to undergo, 31% preferred to be guided by the surgeon, and 5% by a brief explanation only. 21% of the respondents considered the surgeon liable in the event of an unmentioned rare complication, 43% considered the surgeon not liable, and 34% were undecided. Conclusion. Understanding of medico-legal implications of informed consent (e.g. self-autonomy, confidentiality, and battery) by the public and patients is poor. Their expectations regarding self-autonomy seem unrealistic. It is time for surgeons, legal experts, and the public to confer and make informed consent a practical, user-friendly tool rather than the legal obstacle that it is today.
Effect of the Deyo Score on Outcomes and Costs in Shoulder Arthroplasty Patients
Authors: Humphries W , Jain N , Pietrobon R , Socolowski F , Cook C , Higgins L 
Published: October 2016

Purpose. To evaluate the effect of preoperative comorbidity status (defined by the Deyo index) on hospital mortality, postoperative complications, length of hospital stay, and hospital costs for shoulder arthroplasty patients. Methods. The overall mean hospital mortality and postoperative complication rates, and length of hospital stay and hospital costs stratified by the Deyo score were compared using the Pearson Chi squared test and the F-test, respectively. The effects of the Deyo score on hospital mortality and postoperative complications were estimated using multiple logistic regression. The length of hospital stay and hospital costs were estimated using multiple linear regression. The magnitude of the estimated effects of the Deyo score on the 4 outcomes were expressed as crude odds ratios (ORs) and adjusted ORs for age, race, gender, surgeon volume, and hospital volume. Results. Higher Deyo scores tended to be associated with higher hospital mortality, length of hospital stay, postoperative complications, and hospital costs. Compared with the referent group (Deyo score=0), patients with the highest Deyo scores (5–36) exhibited adjusted ORs of 11.8 for hospital mortality (p=0.011) and 1.1 for developing postoperative complications (p=0.098), and had the highest length of hospital stay (mean, 4.1 days) and hospital costs (mean, US$18 549). Conclusion. The Deyo score was a predictor of outcomes and costs in the shoulder arthroplasty population. By identifying relevant factors, health care providers can better determine who should be referred for shoulder arthroplasty and what should be considered when assessing risks and benefits.
Harris-Galante II Acetabular Cup: A Survival Analysis
Authors: Curry HG , Lynskey TG , Frampton CM 
Published: October 2016

Purpose. To determine the survival rate of the Harris-Galante (HG) II cup and identify factors contributing to failure. Methods. 271 primary total hip arthroplasties (THAs) performed between 1992 and 1999 in our hospitals using the HG II acetabular cup were retrospectively reviewed due to a high incidence of liner dissociation. Results. 48 THAs were revised, 32 (67%) of which were due to liner dissociation. The Kaplan-Meier 10-year survival rate was 73%. Dislocation (p<0.001) and acetabular size (p=0.042) were independent predictors of acetabular component failure in the Cox's regression model. Conclusion. The long-term outcome of the HG II cup is unsatisfactory. Although the HG II cup is no longer produced, numerous patients have this prosthesis in situ and should be reviewed regularly, as liner dissociation and retroacetabular osteolysis may occur.