bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of Core Needle Biopsy for Musculoskeletal Tumours
Authors: Seng Chusheng , Png Wenxian , Tan Mann Hong 
Published: October 2016

Purpose. To evaluate the sensitivity and specificity of core needle biopsy in determining musculoskeletal tumours in our hospital. Methods. Records of 134 patients who underwent core needle biopsy followed by definitive surgery were retrospectively reviewed. Results of the core needle biopsy were compared with those of the final histology. Histology was classified into benign versus malignant, and bony versus soft-tissue lesions. The sensitivity and specificity of core needle biopsy were calculated. Results. Based on final histology, there were 33 bone tumours (3 benign and 30 malignant), 74 soft-tissue tumours (6 benign and 68 malignant), 11 schwannomas (7 benign and 4 malignant), and 16 inflammatory/necrotic (benign) lesions. For 118 (88%) tumours, the biopsy results matched the final histological results. For 7 tumours, biopsy results were non-diagnostic, as the amount of tissue obtained was insufficient. For 9 tumours, biopsy results did not match the final histological results; 5 considered benign but turned out to be malignant, one considered malignant but turned out to be benign, and 3 were correctly identified as malignant but incorrectly subtyped. The sensitivity and specificity of core needle biopsy were 95% (97/102) and 97% (31/32), respectively, assuming that the 7 non-diagnostic tumours were correctly diagnosed. Conclusion. Core needle biopsy is an accurate and reliable diagnostic tool for musculoskeletal tumours if performed by skilled persons and adequate tissue is obtained.
Comparison of Different Warfarin Reversal Protocols on Surgical Delay and Complication Rate in Hip Fracture Patients
Authors: Leonidou Andreas , Rallan Rishi , Cox Nancy , Pagkalos Joseph , Luscombe Jonathan 
Published: October 2016

Purpose. To compare the effects of different warfarin reversal protocols on surgical delay and complication rate in hip fracture patients. Methods. Records of 7 men and 17 women aged 68 to 93 (mean, 82) years who were on warfarin and underwent surgery for femoral neck fractures were reviewed. The time to surgery, complication rate, and mortality were recorded, as were the International Normalised Ratio (INR) on admission and the day of operation, as well as the dose, route, and time of administration of vitamin K for reversing the anticoagulation effect of warfarin. Patients were divided into 4 groups based on the warfarin reversal treatment. Group 1 (n=4) included patients who did not receive reversal treatment, as their admission INR was ≤1.5. Group 2 (n=6) included patients who did not receive reversal treatment even though their INR was >1.6. Group 3 (n=5) included patients who received inappropriate reversal treatment (late or low-dose oral administration). Group 4 (n=9) included patients who received appropriate reversal treatment in terms of dose, route, and time of administration. Results. Among the 4 groups, the mean INR was 2.2 (range, 1.3–4.6) on admission and 1.4 (range, 1.0–1.6) on the day of surgery. Group 1 was excluded from further analysis. Respectively in groups 2, 3, and 4, the mean times to surgery were 2.3, 2.6, and 1.2 days, and the complication rates were 67%, 20%, and 11%. Conclusion. Early administration of intravenous vitamin K for hip fracture patients on warfarin is recommended to ensure early operative management and avoid postoperative complications.
Withholding Clopidogrel for 3 to 6 versus 7 Days or More before Surgery in Hip Fracture Patients
Authors: Khudairy Ammar Al , Al-Hadeedi O , Sayana MK , Galvin R , Quinlan John F 
Published: October 2016

Purpose. To compare morbidity and mortality after hip fracture surgery in patients withholding clopidogrel for 3 to 6 days versus ≥7 days. Methods. Records of 16 men and 31 women aged 49 to 92 (mean, 80.2) years who underwent hip fracture surgery after withholding clopidogrel for 3 to 6 days (n=24) versus ≥7 days (n=23) were compared. The patients were taking clopidogrel owing to ischaemic heart disease (n=37), cerebrovascular disease (n=7), and intolerance to aspirin (n=3). Patient demographics, American Society of Anesthesiologists status, preoperative delay, length of hospital stay, perioperative haemoglobin reduction, receipt of blood and platelet transfusions, morbidity, and mortality were recorded. Results. Respectively in the early-surgery and delayed-surgery groups, the mean surgical delay was 4.2 and 8.0 days, the mean length of hospital stay was 21.1 and 28.7 days, the mean peri-operative haemoglobin reduction was 1.5 and 1.1 g/dl, the mean units of blood transfusion per patient was 0.8 and 0.7. No severe intra-operative bleeding or wound haematoma was encountered in either group. Two patients in each group died within one month, and 2 more in the delayed-surgery group died within 3 months. The main cause of death was cardiovascular. Conclusion. Withholding clopidogrel for <7 days before surgery conferred no increased risk in hip fracture patients.
Effect of Calcium Triphosphate Cement on Proximal Humeral Fracture Osteosynthesis: A Cadaveric Biomechanical Study
Authors: Kennedy Jim , Molony Diarmuid , Burke Neil G , FitzPatrick David , Mullett Hannan 
Published: October 2016

Purpose. To evaluate the effect of filling a central humeral bone void with calcium triphosphate cement on the strength and stability of an osteosynthesis in elderly cadavers. Methods. 14 fresh cadaveric shoulder specimens obtained from 11 donors (mean age, 91.5 years; mean body weight, 61 kg) were divided into 2 age- and sex-matched groups. A standardised 3-part proximal humeral fracture with a central bone void was created in each specimen. Each specimen was reduced and fixed with a locking plate. In half the specimens the central bone void was packed with calcium triphosphate cement. The intra-fragmentary motion and the load and mode of failure were recorded. Results. Respectively in the test group and controls, the intra-fragmentary motion was 1.0 and 6.4 mm, and the peak displacement at the 500 N load was 1.8 and 9.1 mm. The Cohen's d was 1.6 to 2.7 for all load steps, indicating a large effect of the calcium triphosphate cement on strength and stability. The mean difference in the failure load was 300 N (p<0.05). Conclusion. Construct stability and failure load improved significantly when the central humeral bone void was filled with calcium triphosphate cement.
Open Reduction and Kirschner Wire Fixation with Triceps Lengthening for Neglected Elbow Dislocations
Authors: Kapukaya Ahmet , Ucar Bekir Yavuz , Gem Mehmet 
Published: October 2016

Purpose. To evaluate outcome of open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations. Methods. Records of 6 women and 14 men aged 7 to 60 (mean, 20) years who underwent open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations were reviewed. The dislocations were posterolateral (n=11), posterior (n=4), and posteromedial (n=5). No patient had a neurologic deficit. Elbow stiffness was the main indication for surgery. The duration of dislocation was 25 to 45 days in 11 patients and >45 days in 9; the mean was 47 days. The Mayo Elbow Performance Index (MEPI) was used to assess outcome at the final follow-up. The maximum score was 100. Scores of 90 to 100 were considered excellent, 75 to 89 good, 60 to 74 fair, and <60 poor. Results. The mean follow-up period was 39.1 months. At the final follow-up, the mean MEPI score was 79.3; outcome was excellent in 6 patients, good in 8, fair in 4, and poor in 2. The mean MEPI was 86.4 and 70.6 for patients with ≤45 and >45 days of dislocation, respectively. The mean range of movement improved from 20° to 84.5° (p<0.001). The 2 groups were significantly different in terms of MEPI (p=0.005) and range of movement (p=0.001). The MEPI correlated negatively with the duration of dislocation ( r= −0.562, p=0.01). The range of movement correlated negatively with patient age ( r= −0.649, p=0.002). Conclusion. Open reduction and Kirschner wire fixation with triceps lengthening, together with active postoperative elbow movements achieved favourable results for neglected elbow dislocations, especially in younger patients and those in whom the duration of dislocation was <45 days.
Chromium Level of Salvaged Blood in Patients Undergoing Revision Hip Arthroplasty
Authors: Maezawa Katsuhiko , Yuasa Takahito , Aritomi Kentaro , Ogawa Seiki , Maruyama Yuichiro , Nozawa Masahiko , Kaneko Kazuo 
Published: October 2016

Purpose. To evaluate the chromium level of the salvaged blood in patients undergoing revision total hip arthroplasty (THA). Methods. Records of 7 women and one man aged 54 to 83 (mean, 64.3) years who underwent revision THA for aseptic loosening of the acetabular component (n=6), osteolysis of the acetabulum (n=1), or migration of the outer head (n=1) were reviewed, as were 2 controls who underwent primary THA. The initial THA entailed a metal-on-metal prosthesis (n=4), a metal-on-polyethylene prosthesis (n=3), and a bipolar head prosthesis (n=1). Chromium levels in the preoperative peripheral blood and intraoperative salvaged blood were measured using atomic absorption analysis. Results. For controls and the patient with a bipolar head prosthesis, the mean chromium level in salvaged blood was 0.4 (range, 0.2–0.6) μg/l, which was significantly lower than that in the remaining 7 patients undergoing revision THA (mean, 5.6 μg/l; range, 1.2–9.8 μg/l). Conclusion. Salvaged blood of patients with a metal-on-metal prosthesis undergoing revision THA contained higher levels of chromium.
Treating Giant Cell Tumours with Curettage, Electrocautery, Burring, Phenol Irrigation, and Cementation
Authors: Moon Myung-Sang , Kim Sung-Soo , Moon Jeong-Lim , Kim Sung-Sim , Moon Hanlim 
Published: October 2016

Purpose. To report on 23 patients with giant cell tumour (GCT) of the femur or tibia treated with curettage, electrocautery, burring, phenol irrigation, and cementation. Methods. Records of these 14 men and 9 women aged 22 to 38 (mean, 31) years were reviewed. The most common site involved was the distal femur (n=13), followed by proximal tibia (n=8), proximal femur (n=1), and distal tibia (n=1). The lesions were classified as grade I (n=3), grade II (n=18), and grade III (n=2). Based on histology, the tumour stage was classified as grade I (n=5) and grade II (n=18). Two of these patients had recurrences, which were initially treated with simple curettage and bone grafting of the distal femur and distal tibia. Results. The mean follow-up period was 5.7 (range, 2.5–10.1) years. 14 of the 23 patients were followed up for over 10 years. No patient developed any local recurrence, remote metastasis, or complication related to surgery or adjuvant therapy. Conclusion. Combined treatment entailing curettage, electrocautery, burring, phenol irrigation, and cementation was effective in treating GCT of bone.
Bicompartmental versus Total Knee Arthroplasty for Medial and Patellofemoral Osteoarthritis
Authors: Tan Shi Ming , Dutton Andrew Q , Bea Kia Chuang , Kumar V Prem 
Published: October 2016

Purpose. To compare the outcome of bicompartmental knee arthroplasty (BKA) versus total knee arthroplasty (TKA) in patients with medial and patellofemoral knee osteoarthritis. Methods. Records of 17 women and 10 men with medial and patellofemoral osteoarthritis of the knee who underwent BKA (n=15) or TKA (n=12) were reviewed. All surgeries were performed by the same surgeon. Patient haemoglobin level, length of hospital stay, range of motion, and visual analogue score for pain were recorded, as were the Knee Society Score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the SF-36 score. Results. Patients treated with BKA were younger than those treated with TKA (mean age, 52 vs. 60 years; p=0.006). BKA resulted in longer mean operating time (99 vs. 85 minutes, p=0.025), less mean intra-operative blood loss (reduction in haemoglobin level) [1.2 vs. 2.4 g/dL, p=0.003), and greater mean postoperative range of movement (125° vs. 116°, p=0.019). The mean Knee Society scores, WOMAC, and SF-36 scores in both groups were not significantly different. There was no instance of implant loosening, peri-prosthetic fractures, patellar subluxation, and dislocation. Conclusion. Short-term outcome of BKA and TKA was comparable.
Web-Based Information on Minimally Invasive Total Knee Arthroplasty
Authors: Meena Sanjay , Palaniswamy Aravindh , Chowdhury Buddhadev 
Published: October 2016

Purpose. To evaluate information available on the internet regarding minimally invasive total knee arthroplasty (TKA). Methods. The 3 most popular search engines (Google, Yahoo, and MSN) were used to search the keyword ‘minimally invasive knee replacement’. The top 50 websites from each search engine were evaluated for authorship and contents; duplicate websites were not double-counted. Results. Of the 150 websites, 51% were authored by a hospital/university, 26% by private medical groups, 14% were news stories, and 9% were from orthopaedic industry sources. 73% offered the opportunity to make an appointment. 18% described the surgical technique, whereas only 9% explained patient eligibility. 25% described the risks, whereas only 3% made reference to peer-reviewed publications. >82% made specific claims regarding the advantages of minimally invasive surgery. Conclusion. Most websites providing minimally invasive TKA information were insufficient in terms of explaining surgical technique, patient eligibility, and assoicated risks.
Bipolar Hemiarthroplasty for Intracapsular Femoral Neck Fractures in Elderly Patients
Authors: Rajak Manoj Kumar , Jha Ramkinkar , Kumar Pankaj , Thakur Rajesh 
Published: October 2016

Purpose. To report outcome of 30 patients who underwent bipolar hemiarthroplasty for intracapsular femoral neck fractures. Methods. 18 women and 12 men aged 56 to 86 (mean, 70) years with Garden type III (n=7) or IV (n=23) intracapsular femoral neck fractures underwent cemented (n=5) or uncemented (n=25) bipolar hemiarthroplasty. Pain was evaluated using the visual analogue score. Mobility status was classified as ambulation with or without aid (a cane or walker). Stability of the prosthesis was classified as stable or unstable. Functional outcome was evaluated using the Harris Hip Score. Results. The mean length of hospital stay was 15.3 (range, 4–29) days. At the 6-month follow-up, 21 patients had no pain, 6 had mild pain, and 3 had moderate pain. The mean Harris Hip Score was 83.1; functional outcome was excellent in 10 patients, good in 13, fair in 5, and poor in 2. The latter 2 were non-ambulatory; one of whom had sustained a periprosthetic fracture intra-operatively, which was managed by encerclage wiring, and the other had a neglected prosthetic dislocation at 3 months, which was converted to an excision arthroplasty. Conclusion. Bipolar hemiarthroplasty conferred good short-term outcome.
Antibiotic Prophylaxis for Hip Fracture Surgery: Three-Dose Cefuroxime versus Single-Dose Gentamicin and Amoxicillin
Authors: Jettoo Prithee , Jeavons Richard , Siddiqui Bobby , O'Brien Shaun 
Published: October 2016

Purpose. To compare a 3-dose cefuroxime regimen with a single-dose gentamicin and amoxicillin regimen as antibiotic prophylaxis for hip hemiarthroplasty in terms of microbiological outcome. Methods. Records of 2 matched groups of patients who underwent hip hemiarthroplasty for femoral neck fractures were reviewed. 29 men and 84 women (mean age, 82 years) who received a 3-dose cefuroxime regimen in 2006 were compared with 23 men and 84 women (mean age, 83 years) who received a single-dose gentamicin and amoxicillin regimen in 2008. Patient demographics, antibiotics prescribed in the peri- and immediate postoperative period, microbiological evidence for Clostridium difficile ‘infection’, length of hospital stay, mortality, as well as biochemical and haematological findings were reviewed. Results. The 3-dose cefuroxime group was significantly higher in terms of the mean length of hospital stay (17 vs. 13 days, p=0.043) and the percentage of patients receiving postoperative antibiotics (88% vs. 68%, p<0.001) and having C difficile ‘infection’ (6% vs. 0%, p=0.016). If patients with C difficile ‘infection’ were excluded, there was no significant difference in the length of hospital stay. Conclusion. The single-dose gentamicin and amoxicillin regimen was associated with a lower C difficile ‘infection’ rate.
Valgus Osteotomy and Repositioning and Fixation with a Dynamic Hip Screw and a 135° Single-Angled Barrel Plate for Un-United and Neglected Femoral Neck Fractures
Authors: Gupta Sameer , Kukreja Sunil , Singh Vivek 
Published: October 2016

Purpose. To review the outcome of 60 patients who underwent valgus subtrochanteric osteotomy and its repositioning for un-united and neglected femoral neck fractures. Methods. 60 patients (mean age, 35 years) underwent valgus subtrochanteric osteotomy and repositioning of the osteotomy and fixation with a dynamic hip screw and a 135° single-angled barrel plate for closed un-united femoral neck fractures after failed internal fixation (n=27) or neglected (>3 weeks) fractures (n=33). The most common fracture type was transcervical (n=48), followed by subcapital (n=6) and basal (n=6). All patients had displaced femoral neck fractures (Garden types 3 and 4). According to the Pauwel angle, 45 fractures were type 2 (30°–70°) and 15 were type 3 (>70°). Results. Patients were followed up for a mean of 3.5 (range, 2–7.5) years. The mean Pauwel angle of the fracture was corrected from 65° (range, 50°–89°) to 26° (range, 25°–28°). Bone union was achieved in 56 patients after a mean of 3.9 (range, 3–5.5) months. The mean Harris hip score improved from 65 to 87.5. Outcome was excellent in 30 patients, good in 24, and poor in 6. Four of the patients developed avascular necrosis; 2 of whom nonetheless achieved a good outcome. Conclusion. Valgus osteotomy and repositioning and fixation with a dynamic hip screw and a 135° single-angled barrel plate was effective treatment for un-united and neglected femoral neck fractures.
Surgical Dislocation of the Hip for Reduction of Acetabular Fracture and Evaluation of Chondral Damage
Authors: Maini Lalit , Batra Sahil , Arora Sumit , Singh Shailendra , Kumar Santosh , Gautam VK 
Published: October 2016

Purpose. To assess the outcome of open reduction and internal fixation combined with surgical dislocation of the hip for displaced acetabular fractures. Methods. 20 men and 2 women aged 20 to 55 (mean, 28) years underwent open reduction and internal fixation combined with surgical dislocation of the hip for displaced acetabular fracture. The most common fracture pattern was bicolumnar (n=12), followed by transverse (n=6) and T-type (n=4). Femoral head chondral lesions were classified as grade 0 (no defect) to grade 4 (osteochondral defect). Fracture fragments were fixed with titanium plates and screws, and the femoral head was redislocated to inspect for intra-articular screws. The association between functional status and acetabular fracture pattern and femoral head chondral lesions was explored. Results. Nine patients had chondral lesions in the femoral head (mostly in the anterosuperior zone), but none in the acetabulum. All femoral heads were viable. Reduction was anatomic in 6 patients and satisfactory in 16. Functional outcome was very good in 6 patients, good in 13, medium in 2, and fair in one. No patient developed avascular necrosis of the femoral head. Four patients had iatrogenic sciatic nerve palsy. One patient developed early degenerative hip arthritis and underwent total hip arthroplasty 14 months later. Conclusion. Surgical dislocation of the hip facilitated anatomic reduction and inspection of any chondral lesions. It did not result in avascular necrosis of the femoral head.
Negative-Pressure Wound Therapy over Surgically Closed Wounds in Open Fractures
Authors: Suzuki Takashi , Minehara Akihiro , Matsuura Terumasa , Kawamura Tadashi , Soma Kazui 
Published: October 2016

Purpose. To evaluate the outcome of open fracture surgery with negative-pressure wound therapy (NPWT) applied directly over surgical wounds. Methods. Medical records of 10 men and 4 women aged 6 to 70 (mean, 43.7) years who underwent internal fixation, external fixation, or splint application for open fractures of the lower leg (n=7), foot and ankle (n=5), or knee (n=2), and NPWT were reviewed. The NPWT was applied directly over the surgical wound without a non-adherent contact layer. The foam was changed every 3 days. The standard negative pressure was 125 mm Hg. The NPWT was stopped when the wound discharge became <50 ml per day. The duration of NPWT and the level of negative pressure were recorded, as were wound condition, reasons for NPWT, and outcome. Results. The mean duration of NPWT was 9.1 (range, 3–24) days. Four patients developed maceration of the skin under the foam, whereas 2 patients developed skin blisters under the drape. No necrosis of flap skin or infection occurred, and all the fractures eventually united. Conclusions. Maceration of the skin was seen in some cases but did not affect the overall outcome. NPWT directly over the skin surface had no deleterious effect on wound and fracture healing.
First Metatarsophalangeal Joint Fusion Using a Fyxis Plate
Authors: Marudanayagam Ashok , Appan Sadai V 
Published: October 2016

Purpose. To report the outcome of fusion of the first metatarsophalangeal joint (MTPJ) using the Fyxis plate and compression screws. Methods. Medical records of 12 men and 39 women (54 feet) aged 28 to 74 (mean, 58) years who underwent primary fusion of the first MTPJ using the Fyxis plate and compression screws for hallux rigidus (n=38), severe hallux valgus (n=8), or rheumatoid arthritis (n=8) were reviewed. The outcome measures included the fusion rate, time to fusion, complication rate, hallux valgus angle, dorsiflexion angle, and the American Orthopaedic Foot and Ankle Society (AOFAS) scale. Results. The mean follow-up was 14.8 (range, 12–20) months. The mean time to fusion was 3.2 months. 48 feet achieved complete fusion at 3 months, 5 at 6 months, and one had non-union at 12 months, which was treated with revision surgery. The mean hallux valgus angle improved from 23° to 12°. The mean dorsiflexion angle improved from 22° to 23°. The mean AOFAS scale score improved from 31 to 86. 98% of the feet achieved a score of >72. One patient with non-union had a score of 59. Two feet developed superficial wound infection, which resolved with antibiotic treatment. Two other feet developed numbness over the medial aspect of the great toe, which persisted after one year. Conclusion. The outcome of fusion of the first MTPJ using the Fyxis plate and compression screws was good.