bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cementless Total Hip Arthroplasty Using Titanium, Plasma-Sprayed Implants: A Study with 10 to 15 Years of Follow-up
Authors: Sanz-Reig Javier , Lizaur-Utrilla Alejandro , Llamas-Merino Isabel , Lopez-Prats Fernando 
Published: October 2016

Purpose. To evaluate long-term outcomes of total hip arthroplasty (THA) using the Perfecta cementless system. Methods. 73 men and 76 women aged 65 to 88 (mean, 71) years underwent 168 THAs using the Perfecta cementless system and were followed up for a mean of 13 (10 to 15) years. 19 patients had bilateral THA. The diagnoses were idiopathic osteoarthritis (n=121), osteonecrosis of the femoral head (n=25), rheumatoid arthritis (n=14), and post-traumatic osteoarthritis (n=8). Patients were evaluated clinically and radiographically before and after THA. Results. The mean Harris hip score improved from 40 to 84 (p<0.001); the score was excellent or good in 130 hips, fair in 17, and poor in 21. The mean Merle D'Aubigne score improved from 4 to 10 (p<0.001); the score was excellent or good in 138 hips, fair in 9, and poor in 21. Poor results were due to aseptic revision of the cup (n=16) or stem (n=3) or deep infection (n=2). Thigh pain that limited activities of daily living was noted in 3 hips. 142 patients could walk without a limp, 5 had a slight limp, and 3 had a moderate limp and used a cane. The mean Short Form-12 score for the physical function was 49 and for the mental health was 56; the mean Western Ontario and McMaster Universities Osteoarthritis Index was 39; the mean visual analogue scale score for satisfaction was 8. Two patients developed deep infection at postoperative months 8 and 50 and were treated with 2-staged revision. Five patients had hip dislocation within 2 months; 3 of whom endured recurrent dislocation and underwent revision surgery; they had acetabular malposition with excessive anteversion despite a correct acetabular angle. 13 other cups were revised because of loosening or extensive osteolysis (n=10) and polyethylene wear (n=3) after a mean interval of 6 (range, 4–10) years. Three stems were revised because of aseptic loosening after a mean interval of 7 (range, 6–9) years. The survivorship at 14 years was 99% for stems and 91% for cups. Conclusion. The long-term outcome of the Perfecta cementless stem was good; most major complications occurred in the cup.
Giant Cell Tumour of the Tendon Sheath of the Hand
Authors: Garg Bhavuk , Kotwal Prakash P 
Published: October 2016

Purpose. To review outcomes of 106 patients after complete excision of the giant cell tumour of the tendon sheath of the hand, with or without postoperative radiotherapy. Methods. Records of 77 women and 29 men aged 11 to 61 (mean, 31) years who underwent excision of giant cell tumours of the tendon sheath of the hand were reviewed. All patients presented with gradually progressive swelling; only 3 of them also presented with pain. The lesions were located on the dorsal aspect (n=11), the palmar aspect (n=66), both aspects (n=10), or circumferentially (n=14). No patient had multiple lesions. Five patients had bony erosion and 3 had neurovascular bundle involvement. Results. The mean follow-up period was 12 (range, 4–22) years. 56 patients with well-encapsulated giant cell tumour in the palmer and/or dorsal aspects were classified as at low risk of recurrence. The remaining 50 patients were classified as at high risk of recurrence and underwent postoperative radiotherapy. None of the patients at low risk had any recurrence; 4 of those at high risk had recurrence despite radiotherapy. No complication was attributable to the irradiation, except that 3 patients had some dark pigmentation around the wound scar. Conclusion. Postoperative radiotherapy may have a role in reducing recurrence of the giant cell tumour of the tendon sheath of the hand.
Delayed Presentation of Cervical Facet Dislocations
Authors: Basu Saumyajit , Malik Farid H , Ghosh Jay Deep , Tikoo Agnivesh 
Published: October 2016

Purpose. To review treatment outcomes of 19 patients with delayed presentation of cervical facet dislocations. Methods. Records of 17 men and 2 women aged 21 to 63 (mean, 39) years who presented with unilateral (n=14) or bilateral (n=5) cervical facet dislocation after a delay of 7 to 21 (mean, 14) days were reviewed. The most common level of dislocation was C5–C6 (n=9), followed by C4–C5 (n=6), C3–C4 (n=2), and C6–C7 (n=2). The neurological status was graded according to the Frankel classification. One patient (with bilateral facet dislocation) had complete quadriplegia (grade A), 11 had incomplete spinal cord injury (grades C and D), and 7 had nerve root injury. Closed reduction using continuous skull traction for 2 days was attempted. In patients achieving closed reduction, only anterior discectomy and fusion was performed. Those who failed closed reduction underwent posterior partial/complete facetectomy and fixation. If there was traumatic disk prolapse, anterior decompression and fusion was then performed. Results. The mean follow-up was 46 (range, 12–108) months. 10 of 14 patients with unilateral facet dislocation were reduced with traction and then underwent anterior discectomy and fusion. The remaining 4 patients who failed closed reduction underwent posterior facetectomy and fixation; 3 of them had traumatic disk prolapse and thus also underwent anterior discectomy and fusion with cage and plate. Four of the 5 patients with bilateral facet dislocations failed closed reduction and underwent posterior facetectomy and lateral mass fixation, as well as anterior surgery. The remaining patient achieved reduction after traction and hence underwent only anterior discectomy and fusion. All patients achieved pain relief and sufficient neck movement for normal activities. All 7 patients with nerve root injury improved completely; 9 of the 11 patients with incomplete spinal cord injury improved by one Frankel grade, and the remaining 2 by 2 grades. The patient with complete quadriplegia showed no improvement. Conclusion. Preoperative traction is a safe and effective initial treatment for neglected cervical facet dislocation, as it reduces the need for extensive (anterior and posterior) surgery. If closed reduction is successful, anterior discectomy and fusion is the surgery of choice. If not, posterior facetectomy and fusion followed by anterior surgery is preferred.
Discectomy for Primary and Recurrent Prolapse of Lumbar Intervertebral Discs
Authors: Ahsan Kamrul , Najmus-Sakeb Kamrul , Hossain Alamgir , Khan Shahidul Islam , Awwal MA 
Published: October 2016

Purpose. To reviewed 416 patients who underwent discectomy for primary or recurrent prolapse of lumbar intervertebral discs (PLID). Methods. Records of 296 men and 102 women aged 19 to 60 (mean, 39) years who underwent discectomy for a primary PLID, and 14 men and 4 women aged 28 to 50 (mean, 40) years who underwent revision discectomy for a recurrent ipsilateral (n=14) or contralateral (n=4) PLID at L4–5 (n=14), L5-S1 (n=3), or L3–4 (n=1) were reviewed. The pain-free interval, side and degree of herniation, operating time, length of hospital stay, and pre- and post-operative visual analogue score (VAS) for pain were recorded. Clinical outcomes were evaluated using the modified Macnab criteria and the Oswestry Disability Index. Results. Patients were followed up for one to 4 years. The mean operating time was significantly longer in revision discectomy (65 vs. 141 minutes, p<0.001, unpaired t-test). There was no significant difference between revision and primary discectomy in terms of length of hospital stay or clinical improvement rates. Age, gender, smoking, profession, level and extent of herniation, and pain-free interval did not affect clinical outcomes. In the 18 revision cases, the mean pain-free interval until recurrence was 31 (range, 1–42) months. At the one-year follow-up, results were excellent in 8, good in 6, fair in 3, and poor in one. Three of the patients had persistent pain despite taking analgesics. 14 of the patients had returned to their normal daily activities. Complications included foot drop (n=1), dural tear (n=3), and superficial wound infection (n=1). Conclusion. Discectomy achieved satisfactory results for both primary and recurrent PLIDs.
Questionnaire to Assess Treatment Outcomes of Acetabular Fractures
Authors: Borg Tomas , Carlsson Marianne , Larsson Sune 
Published: October 2016

Purpose. To construct a questionnaire to assess outcomes in patients who underwent internal fixation for acetabular fractures. Methods. 27 female and 100 male consecutive patients (mean age, 50 years) who underwent internal fixation for acetabular fractures were included. Patients were asked to report their outcomes at months 6, 12, and 24 using a questionnaire. The initial questionnaire was constructed by an expert group. There were 11 closed questions, each came with 6 responses from ‘no discomfort’ to ‘very severe discomfort’. Three open questions were added to cover topics that were not included. The content validity and relevance of the 11 closed questions was determined using factor analysis to determine the number of factors involved. Factorability of the correlation matrix was measured via the Bartlett test of sphericity and Kaiser-Meyer-Olkin (KMO) measure of sampling sufficiency. Factor loadings of >0.50 were considered acceptable for factor representation. Reliability in terms of internal consistency was expressed as Cronbach alpha coefficients. The responses to the 3 open questions were analysed and categorised by a single assessor. Results. 120 (94%) of the patients completed at least one questionnaire, and 92 (72%) completed all 3 questionnaires during the follow-up period. Based on responses to the 6-month questionnaire, responses to the 11 closed questions were significantly inter-correlated (Spearman 0.17–0.80). After factor analysis and analysis of responses to open questions, the number of questions was reduced to 6 and included questions related to pain, walking, hip motion, leg numbness, sexual life, and operation scar. Reliability of the questionnaire was estimated to α=0.89. Criterion validity was adequate with a high correlation with the Short Form 36 ( r=0.56–0.80). Conclusion. Patients treated with acetabular fractures can be adequately assessed using the 6-item questionnaire and one global question concerning impact on activities of daily living.
Total Knee Arthroplasty for Rheumatoid Arthritis Patients with Large Tibial Condyle Defects
Authors: Yamanaka Hajime , Goto Kenichiro , Suzuki Munetaka 
Published: October 2016

Purpose. To review clinical results of total knee arthroplasty (TKA) in rheumatoid arthritis (RA) patients with large bone defects of the tibial condyle. Methods. Records of 33 knees in 27 women and 3 men aged 44 to 80 (mean, 63.6) years who underwent primary TKA for RA with large tibial bone defects were reviewed. 16 knees had peripheral defects extending to the bone cortex, whereas 17 knees had central defects that did not extend to the bone cortex. The femorotibial angle (FTA) was <170° in 15 knees, 170° to 180° in 3 knees, and >180° in 15 knees. The mean duration of RA was 13.5 (range, 3–35) years. In 14 knees with severe bone defects, bone grafts (harvested from articular surfaces of knee bones and fixed without screws or Kirschner wires) and/or metal wedges (for peripheral defects) were used to fill the defects. Clinical outcome was assessed pre- and post-operatively using Knee Society scores. Results. The mean follow-up duration was 6.3 (range, 2.3–13.2) years. The mean depth of tibial bone defects was 11.2 (range, 1–25) mm, whereas the mean width ratio of the bone defects was 36.5% (range, 16.4–76.9%). Mean extension and flexion (range of motion) improved from −12.5° and 113.4° to −5.1° and 115.6°, respectively. The mean Knee Society knee score improved from 35 (range, 21–59) to 85 (range, 49–95), whereas the mean Knee Society function score improved from 30 (range, 25–53) to 80 (range, 44–97) [p<0.001, Wilcoxon signed rank test]. The cruciate retention prosthesis was used in 6 knees; the posterior stabilised prosthesis was used in 27 knees; and the constrained condylar knee prosthesis was used in 3 knees. No patient had any infection or implant loosening. Conclusion. TKA achieved favourable outcome for RA patients with large tibial bone defects. The type of prosthesis used and the use of bone grafts and/or metal wedges were based on the depth and width ratio of the bone defects.
Arthroscopic Synovectomy for Rheumatoid Wrists and Elbows
Authors: Chung Chor-Yat Stephen , Yen Chi-Hung , Yip Man-Lung Ronald , Koo Siu-Cheong Jeffrey Justin , Lao Weng-Nga Virginia 
Published: October 2016

Purpose. To evaluate the treatment outcome of wrist and elbow arthroscopic synovectomy for patients with rheumatoid arthritis. Methods. 3 men and 18 women aged 27 to 71 (mean, 54) years underwent arthroscopic synovectomy for rheumatoid arthritis of the wrist (n=12) and elbow (n=13). All patients had received multiple medications including non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and steroids, as well as physiotherapy and splintage for 6 months, but the joint pain and disability persisted. The median duration of rheumatoid arthritis was 89 (range, 24–156) and 108 (range, 36–360) months for the wrist and elbow joints, respectively. According to the Larsen grading, the radiographic stages of the wrists and elbows were classified as grade 1 (n=4+4), grade 2 (n=4+5), and grade 3 (n=4+4). Visual analogue scale for pain, the wrist and elbow flexion-extension arcs, grip strength, key pinch strength, inflammatory markers, disability and symptoms were compared pre- and post-operatively. Results. The median follow-up period was 30 (range, 18–78) and 34 (range, 18–78) months for wrists and elbows, respectively. There was significant improvement in pain, joint motion, inflammatory markers, and disability score. All patients were satisfied with the surgery. There was no neurovascular or wound complication. No patient was taking long-term pain-control drugs. One patient underwent a second arthroscopic synovectomy after 15 months owing to exacerbation of arthritis. Conclusion. Arthroscopic synovectomy is recommended for patients with rheumatoid arthritis who fail conservative treatment.
Factors Associated with Persistent Sequelae after Fasciotomy for Acute Compartment Syndrome
Authors: Dover Mary , Memon Adeel R , Marafi Hanan , Kelly Gabrielle , Quinlan John F 
Published: October 2016

Purpose. To determine factors associated with persistent sequelae after fasciotomy for acute compartment syndrome. Methods. Records of 57 men and 3 women aged 8 to 84 (mean, 31.9) years who underwent fasciotomy of the lower (n=48) or upper (n=12) limbs for acute compartment syndrome following limb trauma were retrospectively reviewed. 58 of the fasciotomies were therapeutic and 2 were prophylactic. The mean follow-up was 3.9 (range, 1–8) years. Patients were assessed through a telephone survey for persistent sequelae (parasthaesia, dysasthaesia, and/or motor weakness), using a scale of one to 4 to indicate asymptomatic, mild, moderate, and severe, respectively. Associations of persistent sequelae with the aetiology, mechanism of injury, site of fasciotomy, time to fasciotomy (from admission to anaesthesia induction), number of operations, method of closure, time to closure, and perioperative complications were assessed. Results. 18 patients were asymptomatic and 42 reported having persistent sequelae including motor weakness (n=26), parasthaesia (n=28), and dysasthaesia (n=30). In terms of severity, these sequelae were mild (n=10), moderate (n=12), or severe (n=20). Persistent sequelae were associated with higher number of operations, post-fasciotomy complications, closures with skin grafting, and increased time to closure. Conclusion. To reduce the risk of persistent sequelae after fasciotomy, careful preoperative planning and meticulous perioperative care is needed to avoid multiple operations and post-fasciotomy complications. Patients whose wounds healed by secondary intention showed the best outcome.
Safety of Peri-Operative Low-Dose Aspirin as a Part of Multimodal Venous Thromboembolic Prophylaxis for Total Knee and Hip Arthoplasty
Authors: Cossetto David J , Goudar Anil , Parkinson Karen 
Published: October 2016

Purpose. To examine whether it is safe to continue low-dose (100 mg/day) aspirin perioperatively as a part of standard multimodal venous thromboembolic prophylaxis for total hip arthroplasty (THA) or total knee arthroplasty (TKA). Methods. 79 women and 60 men aged 52 to 91 years who underwent THA (n=50) or TKA (n=89) were prospectively studied. Preoperatively, 63 of the patients were on 100 mg of aspirin every morning for various medical reasons and continued in the perioperative period, except for the operation day. The remaining 76 patients were controls. Pre- and post-operative haemoglobin levels, postoperative blood drainage, and the amount of reinfused drained blood were recorded. Intra-operative blood loss and operative times were recorded for THA only. These parameters for the aspirin and control groups were compared. Results. All the parameters, namely blood loss (intraoperative and postoperative), operative time, surgical wound healing, and drop in the haemoglobin level (determined on day 3) did not differ significantly between the 2 groups. Conclusion. It is safe to continue low-dose (100 mg/day) aspirin in the perioperative period as a part of multimodal prophylaxis against deep vein thrombosis.
Functional Outcome after Computer-Assisted Total Knee Arthroplasty Using Measured Resection versus Gap Balancing Techniques: A Randomised Controlled Study
Authors: Singh Vinay Kumar , Varkey Ranjive , Trehan Ravi , Kamat Yogeesh , Raghavan Ramakrishna , Adhikari Ajeya 
Published: October 2016

Purpose. To compare the 2-year outcome of total knee arthroplasty (TKA) using the measured resection versus the gap balancing techniques. Methods. 21 men and 31 women aged 41 to 89 (mean, 73) years who underwent primary TKA by a single surgeon for osteoarthritis and had an American Society of Anesthesiologists I or II physical status were prospectively studied. Patients were randomised to undergo computer-assisted TKA using the measured resection technique (n=26) or the gap balancing technique (n=26). At the 2-year followup, patients were assessed by a single orthopaedic registrar blinded to the type of surgery using the Knee Society score (KSS), functional Knee Society score (FKSS), and revised Oxford Knee score (ROKS). Results. In the measured resection group, the mean KSS, FKSS, and ROKS increased from 34.3, 48, and 21 to 85.9, 89.6, and 36.5, respectively. In the gap balancing group, the respective scores increased from 35.4, 50, and 22.5 to 89.1, 92.4, and 40.6. Postoperative with the gap balancing technique; the respective p values were 0.46, 0.44, and 0.12. Conclusion. Improvements in the knee scores were comparable with the 2 techniques.
Pain during Percutaneous Pin Removal in Children with Elbow Fractures
Authors: Tay Guan Tzu , Lokino Elvin Salioc , Ong Ling Ling , Abdullah Sharifah Nazrah Syed , Wong Mee Leng , Boon Kevin , Lim Leong 
Published: October 2016

Purpose. To survey caregivers with regard to the pain they perceived their children were having during the removal of the percutaneous Kirschner wires, as well as the need for analgesia. Methods. 23 male and 18 female patients aged 1 to 15 (mean, 7) years who underwent closed reduction and percutaneous Kirschner wire fixation for elbow fractures and subsequent removal of the wires were included. Before the removal procedure, caregivers of these patients were asked to select one of 4 options for the procedure: no analgesia, paracetamol, sedation, and general anaesthesia. Approximately one month following the procedure, the caregivers were interviewed via telephone to retrospectively score the pain (on a scale of 1 to 10) they perceived their children were having during the removal procedure. Results. The mean retrospective pain score given by these caregivers was 3.88. Of the 41 caregivers, 30 considered analgesia unnecessary, 10 opted for paracetamol, and only one opted for sedation. None considered general anaesthesia necessary. Conclusion. For these children with elbow fractures, most caregivers considered analgesia unnecessary during the removal of percutaneous wires
Allografts with Autogenous Platelet-Rich Plasma for Tibial Defect Reconstruction: A Rabbit Study
Authors: Nather Aziz , Wong Keng Lin , David Vikram , Pereira Barry P 
Published: October 2016

Purpose. To evaluate the effect of autogenous platelet-rich plasma (PRP) for fresh-frozen allografts in tibial defect reconstruction in rabbits. Methods. 40 adult New Zealand white rabbits underwent tibial defect reconstruction with autografts (n=12), allografts without PRP (n=12), or allografts with PRP (n=12) and were observed for 12, 16, and 24 weeks (4 for each period). Tibias of the remaining 4 rabbits were used as donor allografts, and the remaining allografts were procured from recipient rabbits. A 1.5-cm cortical segment of the tibia was osteotomised, and then fixed with a 9-hole mini-compression plate and 2 cerclage wires. Allografts were stripped off the periosteum and soft tissues and medullary contents, and then stored in a freezer at −80°C. All allografts were deep frozen for at least 4 weeks before transplantation. 7 ml of whole blood was drawn to prepare 1 ml of PRP. The PRP was then mixed with 1.0 ml of human thrombin to form a platelet gel. The PRP gel was then packed into the medullary canal of the allograft and applied on the cortical surface before tibial defect reconstruction. Rabbits were sacrificed at 12, 16, and 24 weeks. The specimens were assessed for bone union at host-graft junctions and for bone resorption, new bone formation, callus encasement, and viable osteocyte counts. Results. There were 4 specimens in each group at each observation period. Osteoid bridging the gap at host-graft junctions was noted in all specimens in the autograft and allograft-with-PRP groups at week 12 and in the allograft-without-PRP group at week 24. Bone union in allografts without PRP was delayed. All indices for biological incorporation (resorption index, new bone formation index, callus encasement index, and viable osteocyte count) were significantly greater in the autograft than allograft-without-PRP groups, except for the resorption index at week 24, whereas the differences were not significant between the autograft and allograft-with-PRP groups. The differences between the 2 allograft groups were usually not significant, except for the resorption index. Conclusion. PRP-augmented allografts behaved similarly to autografts for tibial defect reconstruction in rabbits. PRP increased bone union and bone resorption.