bluuebunny/crossref_metadata_2025_split huggingface dataset:
Internal Fixation and Strut Allograft Augmentation for Periprosthetic Humeral Fractures
Authors: Martinez Angel A , Calvo Angel , Cuenca Jorge , Herrera Antonio 
Published: October 2016

Purpose. To report 6 patients with periprosthetic humeral fractures treated with open reduction and internal fixation with plate and strut allograft augmentation. Methods. 6 women aged 69 to 79 (mean, 73) years underwent open reduction and internal fixation with plate and strut allograft augmentation for periprosthetic humeral fractures (type C) after a fall. They had undergone reverse shoulder arthroplasty for rotator cuff arthropathy. The mean interval between the initial arthroplasty and the fracture was 17 (range, 11–21) months. Results. The mean follow-up period was 14 (range, 12–16) months. The mean time to union was 5.4 (range, 4–6) months. All fractures united without complications. The mean Constant score at the last follow-up was 64 (range, 56–80). The range of shoulder movement and patient satisfaction were restored to pre-fracture status in all patients, except for one who had more pain in the lateral area of the arm (probably because of soft-tissue irritation by the plate and wires). Three patients had evidence of graft-to-host union and 3 others had graft resorption. Conclusion. Internal fixation with plate, cable wires and strut allogaft augmentation achieves satisfactory results for periprosthetic humeral fractures.
Ilizarov Technique of Lengthening and Then Nailing for Height Increase
Authors: Emara Khaled , Farouk Amr , Diab Rami 
Published: October 2016

Purpose. To investigate the risks and types of complications associated with the Ilizarov technique of lengthening and then nailing in persons of normal height. Methods. Records of 26 men and 6 women aged 21 to 47 (mean, 27) years with body height of 160 to 176 (mean, 170) cm who underwent tibial and fibular lengthening and then intramedullary nailing were reviewed. They were skeletally mature healthy persons, with no systemic/local bone disease, deformity or limb length discrepancy. Pain was assessed using the visual analogue scale (VAS). Patient satisfaction in terms of the treatment outcomes and expectations was also assessed. Complications encountered during or after treatment were recorded. Results. The mean lengthening achieved was 7.6 (range, 3.5–12) cm or 26% (range, 10–40%) of the original length. The mean duration of external fixation was 96 (range, 45–135) days. The mean follow-up duration after intramedullary nailing was 38.7 (range, 24–93) months. The mean VAS pain score was 9.3 at week 1, 6.6 at week 4, and 5.7 at week 8. After intramedullary nailing, the mean VAS pain score was 2.6 at week 4, 0.9 at month 6, and 0.3 at year 1. 91% of the patients were satisfied with the outcome at week 6; 81% after intramedullary nailing, and 94% at the one-year follow-up. Four patients had revision operations: one for pin exchange owing to pin bending after a fall, one for adjusting external rotation of the tibia after nailing, one for bone grafting for delayed union, and one for drainage of a haematoma just after nailing. Conclusion. Most complications related to patient discomfort and psychological stress, which were important issues in this type of patients.
Radial Neck Fractures in Children
Authors: Tan Bryan Hsi Ming , Mahadev Arjandas 
Published: October 2016

Purpose. To review records of 108 children with radial neck fractures and develop an algorithm for treatment. Methods. Records of 50 girls and 58 boys aged 2 to 14 (mean, 8.7) years with radial neck fractures were reviewed. The most common injury mechanism was tripping and falling on an outstretched hand while running (n=44), followed by falling from monkey bars (n=11). Fractures were classified into grade 1 (n=25), grade 2 (n=60), grade 3 (n=16), grade 4a (n=6), and grade 4b (n=1). 21 patients had associated fractures involving the olecranon, proximal ulna, and/or the humeral supracondyle. The time from injury to treatment ranged from 0 to 7 days. Treatments included casting without manipulation (n=86), closed reduction and casting (n=8), percutaneous Kirschner wire–assisted reduction and casting (n=7), and open reduction and casting (n=7). Results. Patients were followed up for a mean of 2.7 (range, 1–5) years. Outcome was excellent in 93 patients, good in 11, and fair in 4. Higher fracture grades correlated positively with poorer outcomes (p=0.001) and more invasive treatment (p=0.001). Nonetheless, the post-reduction angles of all the patients were not significantly different (p>0.05). Older children sustained more severe fractures (p=0.04) and had poorer outcomes, even after correction for fracture grade (p=0.007). Patients with associated fractures had significantly poorer outcomes (p<0.05). Two patients developed synostosis of the proximal radioulnar joint. One of whom had an associated olecranon fracture and underwent open reduction and casting. The other had an associated proximal ulnar fracture and underwent repeated percutaneous Kirschner wire–assisted reduction owing to loss of reduction. Five patients developed heterotopic ossification. Four of whom had associated fractures (3 involved the olecranon and one the proximal ulna). 14 patients developed cubitus valgus deformity of 3° to 10°. Conclusion. Open reduction should only be performed after more conservative treatments fail to achieve reduction.
Anterior Cruciate Ligament Reconstruction Using the Medial Third of the Patellar Tendon
Authors: Marimuthu Kanniraj , Joshi Narendra , Sharma Mrinal , Sharma Chandra Sekar , Bhargava Rakesh , Rajawat Ajay Singh , Rangdal Sushil Subash 
Published: October 2016

Purpose. To evaluate the mid-term outcome of anterior cruciate ligament (ACL) reconstruction using the medial third of the patellar tendon as the bone-patellar tendon-bone (BPTB) graft. Methods. 79 men (34 right knees and 45 left knees) aged 20 to 52 (mean, 28) years underwent ACL reconstruction using the medial third of the patellar tendon with bone plugs and were followed up for a minimum of 3 years. Stability was assessed using the Lachman test and the pivot shift test. The range of motion, donor-site symptoms, Lysholm knee score, and International Knee Documentation Committee (IKDC) score were also recorded. Results. In terms of stability, only 4 patients had a grade-2 laxity postoperatively, compared to all having a grade-2 or −3 laxity preoperatively. Regarding the range of motion, extension loss was <3° in 76 patients and 3° to 5° in 3, whereas flexion loss was <5° in 73 patients, 5° to 15° in 5, and 16° to 25° in one. No patient had patellar tendon rupture/shortening, patellar fracture, or patellar maltracking. The mean Lysholm knee score improved from 48 to 92 (p<0.0001); scores were excellent (>90) in 46 patients and good (83–90) in 32 patients. The overall IKDC score was grade A (normal) in 9 patients, grade B (near normal) in 66, and grade C (abnormal) in 4. Three of the latter patients had osteoarthritic changes and pain on minimal physical activity. Only one patient had a sensation of partial giving way during moderate physical activity. 20% of the patients had anterior knee pain. Conclusion. Outcome of ACL reconstruction using the medial third of the patellar tendon was comparable to that using the central third of the patellar tendon. In addition, there were no instances of patellar tendon rupture/shortening, patellar fracture, or patellar maltracking.
High-Flexion versus Conventional Total Knee Arthroplasty: A 5-Year Study
Authors: Endres Stefan 
Published: October 2016

Purpose. To compare mid-term outcomes of a high-flexion prosthesis with a conventional prosthesis. Methods. Records of 107 consecutive patients who underwent total knee arthroplasty (TKA) for primary osteoarthritis by a single surgeon were reviewed. 21 men and 36 women (mean age, 65 years) used a high-flexion prosthesis (NexGen CR-Flex Mobile, Zimmer), whereas 38 men and 12 women (mean age, 67 years) used a conventional prosthesis (Genesis II, Smith & Nephew) that preserves the posterior cruciate ligament, with mobile-bearing polyethylene inlay. The Knee Society knee and functional scores and the range of motion (especially maximum passive flexion) were assessed. Radiographs were evaluated to identify radiolucent lines at the bone cement interface, patella tracking, tibiofemoral alignment, and implant positioning. Results. The mean follow-up period was 68 (range, 51–70) months. In terms of the mean Knee Society scores and range of motion, the difference between groups was not significant (p>0.05), but the improvement in both groups after TKA was significant (p<0.005). Respectively in the high-flexion and conventional TKA groups, 2 and one of the patients developed deep vein thrombosis and were treated with anticoagulants for 3 months. One and 5 of the patients had an unsatisfactory range of motion (<60°) in week 1, which was resolved with mobilisation under general anaesthesia in combination with a peridural catheter for analgesia. No patient developed implant-specific complications such as aseptic loosening (osteolysis, progressive radiolucent lines, implant deviation) or dislocation of the polyethylene insert. Conclusion. The high-flexion prosthesis revealed no significant advantages over the conventional prosthesis in terms of the Knee Society scores and range of motion. Long-term studies are needed to determine whether the high-flexion implant is superior to the conventional implant in terms of polyethylene wear and aseptic loosening.
Predictors of Early Stem Loosening after Total Hip Arthroplasty: A Case-Control Study
Authors: Melloh Markus , Eggli Stefan , Busato Andre , Roder Christoph 
Published: October 2016

Purpose. To evaluate the influence of patient characteristics on stem loosening after cemented or uncemented total hip arthroplasty (THA) using a matched case-control study. Methods. Consecutive records of 4372 cemented (716 cases and 3656 controls) and 809 uncemented (115 cases and 694 controls) primary THAs between 1981 and 2003 in 30 hospitals in 8 European countries were reviewed. Cases and controls were defined as patients with and without stem loosening, respectively. In cases of bilateral THA, patients were their own controls. Cases and controls were matched for hospital, date of surgery, date of follow-up, stem type, and head size. Patient characteristics such as gender, age, weight, height, body mass index (BMI), diagnosis, presence of previous surgery on the affected hip, and walking restrictions according to the Charnley classification were recorded. Results. Male patients were at higher risk of cemented stem loosening (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.4–2.2). Older patients were at lower risk of cemented stem loosening; the odds decreased by 3% per year older (OR, 0.97; 95% CI, 0.96–0.98). Regarding BMI, the odds of cemented stem loosening increased by 3% for each additional unit of BMI over 25 kg/m2 (OR, 1.03; 95% CI, 1.004–1.05). Patients in Charnley class B had a lower risk of cemented stem loosening (OR, 0.75; 95% CI, 0.61–0.93). Conclusion. Advanced age, female gender, and Charnley class B (as a proxy measure of reduced walking activity) have a protective effect on survival of cemented stems, whereas a higher BMI was a risk factor.
Lower Limb Alignment in Anterior Cruciate Ligament–Deficient versus –Intact Knees
Authors: Chung Stephen Chor-Yat , Chan Wai-Lam , Wong Sze-Hung 
Published: October 2016

Purpose. To compare anatomic lower limb features of anterior cruciate ligament (ACL)–deficient versus –intact knees in Chinese subjects. Methods. Anatomic lower limb features (mechanical axis, tibiofemoral angle, posterior tibial slope, notch width index, and hip neck-shaft angle) of 25 men and 3 women aged 18 to 39 (mean, 26) years with ACL-deficient knees, and 16 men and 4 women aged 24 to 31 (mean, 28) years with ACL-intact knees were compared using radiography. Results. The notch width index (0.26 vs. 0.29, p=0.02) was significantly smaller in ACL-deficient than ACL-intact knees. Conclusion. Small notch width was associated with a thin ACL and can be regarded as an anatomic intrinsic risk factor for ACL injuries.
Correlation between Metal Allergy and Treatment Outcomes after Ankle Fracture Fixation
Authors: So Sarah , Harris Ian A , Naylor Justine M , Adie Sam , Mittal Rajat 
Published: October 2016

Purpose. To determine correlation between metal hypersensitivity and long-term foot and ankle function and pain after internal fixation using stainless steel implants. Methods. 60 men and 46 women (mean age, 47 years) who underwent internal fixation for ankle fractures completed a questionnaire 13 to 38 (mean, 26) months after surgery to assess their existing medical condition, history of metal hypersensitivity, problems and outcome of the implant (revision or removal), and the American Academy of Orthopaedic Surgeons (AAOS) foot and ankle score. A subset of 12 men and 15 women then underwent patch testing for metal hypersensitivity to molybdenum, chromium, iron, manganese, and nickel. Patients with positive and negative reactions were compared. Results. 21 of the 106 patients underwent removal of the metal implants. The AAOS score was not associated with any of the variables, except for a history of metal hypersensitivity from dental implants and irritation around the surgical scar. Multiple linear regression analysis showed that only irritation around the surgical scar remained associated with poorer AAOS scores. Five of the 27 tested patients had a positive reaction. The mean AAOS scores did not differ significantly between patients with positive and negative reactions (34 vs. 31, p=0.73). Gender was not associated with the test results (p=0.63). None of the 5 patients with a positive reaction underwent revision surgery or reported any history of asthma or metal hypersensitivity. Of the 27 patients, one of the 8 who reported itching, irritation, redness or rash around the surgical scar had a positive reaction, compared to 4 of 19 patients who reported no such symptoms (p=1). Two of the 27 patients reported development of eczema after fixation, one of whom had a positive reaction. Only one of the 27 patients reported a history of metal hypersensitivity to jewellery, but had a negative reaction‥ Conclusion. Neither a history of metal hypersensitivity nor positive patch testing correlated with poor outcomes after internal fixation for ankle fractures using stainless steel implants.
Factors Influencing Mortality in Patients on Antiplatelet Agents Presenting with Proximal Femoral Fractures
Authors: Maheshwari Rohit , Acharya Mehool , Monda Maureen , Pandey Radhakant 
Published: October 2016

Purpose. To identify factors predicting one-year mortality in patients on clopidogrel presenting with proximal femoral fractures. Methods. 9 men and 22 women aged 64 to 97 (mean, 81; standard deviation, 8) years who had been taking clopidogrel for ischaemic heart disease (n=15), cerebrovascular disease (n=6), or both (n=10) presented with proximal femoral fractures. The time from injury to operation, type of anaesthesia, treatment method, and postoperative complications were reviewed. One-year mortality was analysed using the Kaplan-Meier curve. Factors predicting one-year mortality were identified. Results. The fracture configurations of the 31 patients included intracapsular femoral neck fracture (n=17), intertrochanteric fracture (n=13), and subtrochanteric fracture (n=1). 30 of the patients underwent hemiarthroplasty (n=16), dynamic hip screw fixation (n=9) or intramedullary hip screw fixation (n=5). The remaining patient underwent conservative treatment owing to metastatic prostate cancer. Of the 30 patients who underwent surgery, clopidogrel was discontinued at least 7 days prior to surgery, with the mean delay to surgery being 8.4 (range, 2–16) days. No patient had excessive blood loss at operation, although 7 patients received a blood transfusion postoperatively. 13 (43%) patients developed postoperative complications. The one-year mortality was 26% (8/31). Univariate analysis showed that factors predicting one-year mortality were spinal anaesthesia (p=0.04), postoperative blood transfusion (p=0.03), postoperative complications (p=0.03), and delay to surgery (p=0.03). Multiple regression analysis showed that delay to surgery (p=0.03) was the only independent predictor of one-year mortality, with a hazard ratio of 1.357 (95% confidence interval, 1.03–1.79). Conclusion. Surgery should be performed as soon as possible in medically fit patients having proximal femoral fractures who are taking clopidogrel, as delay to surgery is associated with increased one-year mortality.
Monitoring the Use of Halo Fixation Device through an Assessment Form
Authors: Ho Chin-Hung , Li Ka-Kin , Chin Raymond Ping-Hong , Lee Helen Wai-Man , Kwong William Yan-Yee , Kwan Hung-Hei 
Published: October 2016

Purpose. To compare the use of the halo fixation device in our hospital before and after implementation of a new compliance protocol. Methods. From 2003 to 2008, 17 (47%) of 36 patients had dislodgement of their halo fixation device. All rings and vests and some of the pins were reused. Documentation of poundage assessment and change of skull pins before dislodgement was lacking. There was no protocol for assessing superstructure throughout the course of the application. To improve the standard of care, knowledge about the application of the halo fixation device in orthopaedic and orthotic departments was reinforced and compliance documented. From September 2008 to April 2010, 15 patients used the halo fixation device for cervical immobilisation. Patients were reminded to minimise shoulder shrugging and report any discomfort. Poundage checking was strictly observed during and after application. The integrity of the device was regularly checked by orthotists. The conditions of the skull pins, halo ring, and vest were also documented after removal. Results. Two (13%) of the 15 patients had ring dislodgement. One occurred a day after application owing to malposition of a posterior skull pin, and the other was related to a fall in a toilet at week 4. Both involved reused skull pins. 45% of the skull pins were new, whereas 44% were found defective after removal of rings. Compliance with the new assessment form was satisfactory. Conclusion. Clinical audit improved outcome achieved with the halo fixation device. Reuse of titanium skull pins should be avoided. Re-torquing of the pin should be avoided when the tip is blunted or hooked. The new assessment form enabled compliance with the principle of application by orthotists and patients.
Cervical Transpedicular Fixation Aided by Biplanar Flouroscopy
Authors: Kotil Kadir , Sengoz Ahmet , Savas Yildiray 
Published: October 2016

Purpose. To evaluate the accuracy of fluoroscopy-assisted cervical transpedicular fixation in different pathologies. Methods. 28 men and 17 women aged 34 to 65 (mean, 41) years underwent 210 one-stage cervical transpedicular fixations. The indications were trauma (n=35), degenerative disease leading to cervical spondylotic myelopathy (n=4), tumours (n=4), and Pott's disease (n=2). Regarding the 35 trauma patients, fractures were at C5–C6 (n=22), C4–C5 (n=8), and C3–C5 (n=5); 16 of them had dislocated vertebrae, of whom 13 had cervical disc herniation. Two of the patients with degenerative disease underwent additional laminectomy. Both anterior and posterior surgeries were performed for the 2 of the patients with tumours; all other patients underwent posterior surgery only. The length, diameters, and frontal, sagittal, and longitudinal angles of all pedicle screws were calculated. The dominant vertebral artery was detected using Doppler ultrasonography. Biplanar fluoroscopy was also used. Postoperatively, patients were allowed to mobilise at day 1; a collar was not used. The position of the pedicle screws was graded. Results. The mean operating time was 105 (range, 90–155) minutes. The mean follow-up period was 26 (range, 17–34) months. Of the 210 pedicles fixed, 192 (91%) were at the correct screw position (grade I), 16 (8%) were at an acceptable position (grade II), and 2 (1%) were completely perforated but without morbidity (grade III). The overall perforation rate was 9%. There were no neurovascular injuries or instrumentation-associated complications (failure of implant components, screw loosening, or lucent zone formation around the pedicle screws). The fusion rate was 100%. Conclusion. Cervical transpedicular fixation provides strong stabilisation. With the aid of biplanar fluoroscopy, the risk of pedicle perforation was about 8%, but no neurovascular injury was ensued.
Non-Vascularised Fibular Graft as an Intramedullary Strut for Infected Non-Union of the Humerus
Authors: Gopisankar G , Justin Arockiaraj SV , Nithyananth Manasseh , Cherian Vinoo M , Lee VN 
Published: October 2016

Purpose. To review outcomes of 7 patients who underwent revision surgery for infected non-union of the humerus using a fibular graft as an intramedullary strut. Methods. Records of 7 men aged 29 to 59 (mean, 40) years with humeral diaphyseal infected nonunion who underwent fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut were reviewed. The mean number of previous surgeries was 2.7 (range, 2–4). Three of the patients had active draining sinuses previously. Their C-reactive protein levels were normal and tissue cultures negative. The remaining 4 patients had active draining sinuses. They first underwent implant removal and debridement. Tissue cultures confirmed infection in 3 of them. The mean duration between debridement and the index surgery was 5 (range, 3–10) months. Results. The mean length of the fibulae harvested was 13 (range, 12–15) cm. All 7 non-unions healed. The mean time to healing was 5.4 (range, 4–8) months. The mean follow-up period was 15 (range, 13–24) months. All patients had weakness of the extensor hallucis longus, which improved to near normal at month 3. There was no donor-site morbidity. Three patients with active infection at presentation underwent repeat surgery. Two of them had wound washouts, and their non-unions went on to heal successfully; one underwent implant removal after union due to an active sinus. Six of the patients returned to their pre-injury activity level, and one endured a brachial plexus injury. Conclusion. Fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut achieved good outcome for infected non-union of the humerus despite prior multiple failed surgeries.
Cannulated Cancellous Screw Fixation for Capitellum Fractures in Adolescents
Authors: Ong Kee Leong , Mahadev Arjandas 
Published: October 2016

Purpose. To review the outcome of 9 adolescents treated with 2 to 3 cannulated cancellous screws for type-1 capitellum fractures. Methods. Records of 8 boys and one girl aged 12 to 14 (mean, 14) years with type-1 capitellum fractures were reviewed. The mechanism of injury was a fall on the flexed elbow. No patient had associated injuries or neurovascular compromise. In 2 patients, the fracture was minimally displaced and treated with a cast. The remaining 7 patients with displaced fractures underwent open reduction and internal fixation using 4.0-mm cannulated partially threaded cancellous screws inserted in a posterior-to-anterior direction. In one patient, a Kirschner wire was added to fix a small comminuted fragment. Elbow pain, range of motion, stability, and function were evaluated using the Mayo Elbow Performance Index. Results. The mean follow-up period was 7 (range, 2–18) months. The mean Mayo Elbow Performance Index score was 100, indicating excellent outcome. No patient developed avascular necrosis or heterotrophic ossification. All patients achieved anatomic bone union. All implants were removed after a mean of 4.7 (range, 2–7) months. Conclusion. The fixation of type-1 capitellum fractures with 2 to 3 cannulated cancellous screws inserted posteroanteriorly achieved excellent functional outcome.