bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum Intact-Parathyroid Hormone Level following Total Knee Arthroplasty
Authors: Papavasiliou Kyriakos A , Nikopoulou Aggeliki , Kenanidis Eustathios I , Potoupnis Michael E , Kyrkos Margaritis J , Sayegh Fares E , Kapetanos George A 
Published: October 2016

Purpose. To evaluate short-term parathyroid hormone (PTH) secretion following total knee arthroplasty (TKA). Methods. 119 Caucasian postmenopausal women aged 49 to 81 (mean, 69.8) years who underwent TKA for end-stage knee osteoarthritis were included. Serum levels of intact-PTH, calcium, phosphorus, and creatinine were evaluated pre- and post-operatively (on days −1 and 7). Creatinine clearance was also calculated. Results. In 67 of the patients, serum intact-PTH levels decreased after TKA; this sample proportion was not significant (p=0.82). In 16 of the patients, such levels elevated abnormally (above normal range). In the remaining 36 patients, such levels elevated within the normal range. Therefore, the mean serum intact-PTH level of all patients increased slightly after TKA (45.4 vs. 45.3, p=0.162). The serum intact-PTH level did not correlate to body weight ( r=–0.045, p=0.624), patient age ( r=–0.061, p=0.508), serum creatinine level ( r=0.084, p=0.366), and clearance of creatinine ( r=–0.037, p=0.692). Conclusion. In most postmenopausal women, the serum intact-PTH level decreased moderately following TKA, but in some, the level was abnormally elevated. This may interfere the prosthesis incorporation process.
Comparison of Cross-Sections of Different Femoral Components for Revision Total Knee Replacement
Authors: Zietz Carmen , Bergschmidt Philipp , Fritsche Andreas , Kluess Daniel , Mittelmeier Wolfram , Bader Rainer 
Published: October 2016

Purpose. To compare the inner contour of the femoral component of 10 total knee replacement (TKR) designs for possible exchange in use. Methods. Inner contours of the femoral components of 10 cemented, cruciate-retaining TKR designs (e.motion, Genesis, Genia, Innex, LCS, Multigen Plus, NexGen, PFC, Scorpio, Vanguard) were scanned and reconstructed to 2-dimensional contours. Their cross-sections were compared by superimposition and aligning at the distal and anterior cuts. The patellar notch and outer contour were not analysed. Results. The maximum deviation was 5 mm in the posterior and posterior oblique cuts and 10 mm in the anterior oblique cut. Based on similarity of the inner contour, LCS and Innex was classified as group I, e.motion, Genesis, Scorpio, Vanguard, and Multigen Plus as group II, and Genia, NexGen, and PFC as group III. All 2 designs in group I were not compatible with the other 8 designs. Four of the 5 designs in group II showed good compatibility. All 3 designs in group III significantly differed in the posterior and oblique cuts. Conclusion. A standardised inner contour of the femoral component can increase compatibility of different TKR systems in revision surgery and reduces the extent of bone resection.
Anterior Deltopectoral Approach for Axillary Nerve Neurotisation
Authors: Jerome J Terrence Jose 
Published: October 2016

Purpose. To report outcome of axillary nerve neurotisation for brachial plexus injury through the anterior deltopectoral approach. Methods. Nine men aged 20 to 52 (mean, 27.8) years with brachial plexus injury underwent axillary nerve neurotisation through the anterior deltopectoral approach. Three of the patients had complete avulsion of C5-T1 nerve roots. The remaining 6 patients had brachial plexus injury of C5-C6 nerve roots, with associated subluxation of the glenohumeral joint, atrophy of the supraspinatus, deltoid and elbow flexors. They had no active shoulder abduction, external rotation, and elbow flexion. The pectoralis major and minor were cut and/or retracted to expose the underlying infraclavicular plexus. The axillary nerve was identified with respect to the available donor nerves (long head of triceps branch, thoracodorsal nerve, and medial pectoral nerve). In addition to the axillary nerve neurotisation, each patient had a spinal accessory nerve transferred to the suprascapular nerve for better shoulder animation. Results. Patients were followed up for 24 to 30 (mean, 26) months. In the 3 patients with C5-T1 nerve root injuries, the mean active abduction and external rotation were 63° and 20°, respectively, whereas the mean abduction strength was M3 (motion against gravity). In the 6 patients with C5-C6 nerve root injuries, the mean active abduction and external rotation were 133° and 65°, respectively, whereas the strength of the deltoids and triceps was M5 (normal) in all. In 4 patients with the pectoralis major cut and repaired, the muscle regained normal strength. Conclusion. The anterior deltopectoral approach enabled easy access to all available donor nerves for axillary nerve neurotisation and achieved good outcomes.
Infection Risk from Surgeons' Eyeglasses
Authors: Butt Umer , Saleem Urfan , Yousuf Kamran , El-Bouni Tarek , Chambler Andrew , Eid Ahmed Shawky 
Published: October 2016

Purpose. To assess bacterial contamination of 20 eyeglasses from surgeons. Methods. 40 samples were taken from the nose pad (n=20) and earpiece (n=20) of 20 eyeglasses from orthopaedic surgeons using a sterile swab stick soaked in sterile distilled water. Swabs were incubated and inoculated onto 3 plates: Staphylococcus/Streptococcus agar plate, Mannitol salt plate, and Chromogenic agar plate. Organisms isolated were identified. Results. Of 20 eyeglasses, 19 were contaminated with Staphylococcus epidermidis (3 of them additionally grew S haemolyticus or S xylosus) and the remaining one grew S aureus. Conclusion. Eyeglasses are a source of surgical infection. Contamination can be caused by direct contact of the eyeglasses to the wound and indirect contact by the surgeon's fingers, splashes from saline irrigation, and through air. Therefore, disinfection should be performed for eyeglasses of surgeons. The use of surgical visor masks or filtered exhaust helmets (space suits) are alternatives.
Medium-Term Results of Oxford Phase-3 Medial Unicompartmental Knee Arthroplasty
Authors: Clement Nicholas David , Duckworth Andrew David , MacKenzie Sam Peter , Nie Yuan Xin , Tiemessen Christopher Henricus 
Published: October 2016

Purpose. To review medium-term results of 49 consecutive patients who underwent Oxford phase-3 medial unicompartmental knee arthroplasty by a single surgeon. Methods. Records of 28 women (mean age, 71 years) and 21 men (mean age, 68 years) who underwent minimally invasive Oxford phase-3 medial unicompartmental knee arthroplasty by a single surgeon were retrospectively reviewed. The Oxford knee score and visual analogue scale (VAS) scores for pain and satisfaction were assessed at the latest follow-up by an independent observer, as were postoperative radiographs for implant position, osteoarthritic changes in the non-replaced compartments, and radiolucent lines of >2 mm or implant subsidence. The survival rate was calculated using Kaplan-Meier survival analysis. Patient demographics, postoperative alignment (varus/valgus), Oxford knee scores, and the progression of osteoarthritis in the other compartments were included in a multiple logistic regression (MLR) analysis to identify significant factors affecting the probability of being satisfied (VAS scores for satisfaction of ≤2). Results. The mean follow-up duration was 7.2 years. No patient was lost to follow-up. Two patients with no knee symptoms died (unrelated to surgery) before the 5-year follow-up. The cumulative survival rate at the 9-year follow-up was 91.2% (95% confidence interval, 87.6–94.5%). There were 4 early failures (before 4 years). One patient early in the series developed avascular necrosis of the lateral femoral condyle with an over-corrected tibiofemoral valgus of 12° at 8 months; the other 3 complained of anterior knee pain, without signs of osteoarthritis. All 4 patients underwent revision with total knee arthroplasty. There were 43 patients with more than 5 years of follow-up and without revision of the prosthesis. Patients who were not satisfied (n=6) were more likely to be <65 years old (n=4, adjusted odds ratio [OR], 3.1; MLR p=0.002) and male (n=4; adjusted OR, 2.3; MLR p=0.02). Six of the 43 patients had lucent lines on radiographs, all of which were partial and under the tibial component. Progression of the arthritis in the patellofemoral and/or lateral compartments was worse in 5 patients. Conclusion. Careful patient selection and good surgical technique contributed to good outcome. Younger male patients should be counselled regarding the higher chance of limited satisfaction.
Screw and Wire Fixation for Lisfranc Fracture Dislocations
Authors: Ghate Sushant D , Sistla Vidyasagar M , Nemade Vijay , Vibhute Dinesh , Shahane Sunil M , Samant Ashwin D 
Published: October 2016

Purpose. To assess mid-term outcome of screw and wire fixation for Lisfranc fracture dislocations to determine the risk factors of post-traumatic arthritis. Methods. 15 men and 4 women aged 21 to 58 (mean, 41) years with Lisfranc fractures underwent open/closed reduction and internal fixation (using screw and wire). Fractures were classified as homolateral (n=7), isolated (n=7), and divergent (n=5). Six patients had open fractures; 8 patients injured 5 tarsometatarsal joints; and 6 patients had pure ligamentous injury. Outcome (pain, function, and cosmesis) was assessed using the Maryland foot score and the American Orthopedic Foot and Ankle Society (AOFAS) score. Weight-bearing radiographs were evaluated for non-union, subluxation, malalignment, and post-traumatic arthritis. Results. Patients were followed up for 24 to 40 (mean, 30) months. Patients with anatomic reduction (n=14) achieved higher mean AOFAS foot score (79.3 vs. 67.5, p=0.0007) and Maryland foot score (80.4 vs. 69.4, p=0.0009) than did patients with non-anatomic reduction (n=5). Post-traumatic arthritis occurred significantly more often in patients with non-anatomic than anatomic reduction (3/5 vs. 1/14, p=0.037). Four patients developed post-traumatic arthritis, one of whom also developed lateral subluxation after implant removal. Two patients developed fat foot. Two patients had severe symptoms that limited function, one of whom underwent an arthrodesis. Two patients with compound fractures developed superficial infections. Three patients had broken screws. Conclusion. Anatomic reduction is the main predictor of outcome in patients with Lisfranc fracture dislocations.
Conservative Treatment for Juvenile Osteochondritis Dissecans of the Talus
Authors: Lam Kai Yet , Siow Hua Ming 
Published: October 2016

Purpose. To assess outcome of 6 juvenile patients with osteochondritis dissecans (OCD) of the ankle treated conservatively. Methods. Records of 4 males and one female aged 10.8 to 14.1 (mean, 12.3) years who underwent cast immobilisation and/or restriction of physical activities for OCD of the talus (4 on the left and 2 on the right) were reviewed. OCD lesions were graded using the Berndt and Harty classification. Functional outcome was assessed using the ankle-hindfoot score of the American Orthopaedic Foot and Ankle Society. Clinical and radiographic outcomes were assessed according to the Higuera classification. Results. The mean follow-up period was 30.5 (range, 11–63) months. The mean ankle-hindfoot score was 90 (range, 86–100). Radiological resolution of OCD was noted in 2 ankles, although all ankles showed some degree of healing. All patients had resolution of pain after a mean of 7 (range, 3–12) months. According to the Higuera classification, clinical outcome was excellent in one and good in 5 ankles, whereas radiological outcome was excellent in 2, good in 2, and fair in 2 ankles. In one patient, the OCD of the right posteromedial talar dome resolved spontaneously. Conclusion. Almost all patients achieved good functional outcome after conservative management, regardless of the presence of radiological evidence of healing. Surgery should only be performed if the OCD is unstable.
Distraction Osteogenesis Using a Monolateral External Fixator for Infected Non-Union of the Femur with Bone Loss
Authors: Arora Sumit , Batra Sumit , Gupta Vikas , Goyal Aman 
Published: October 2016

Purpose. To review records of 15 patients who underwent distraction osteogenesis/bone transport using a monolateral external fixator for infected nonunion of the femoral shaft. Methods. 13 men and 2 women aged 18 to 47 years underwent adequate debridement and resection of nonviable bone, followed by bone transport using a monolateral external fixator for infected non-union of the femoral shaft with bone loss. All patients had a bone defect of >5 cm. The lengthening index, radiographic consolidation index, functional status, bone healing, and various problems, obstacles and complications encountered during the treatment were assessed. Results. The patients had undergone a mean of 2.9 (range, 1–7) surgical procedures before presentation. The mean duration from trauma to presentation was 7.7 (range, 6–18) months. The mean bone defect after adequate resection/debridement was 7.9 (range, 5.5–17) cm. The mean treatment duration was 7.3 (range, 5–15) months. The mean lengthening index was 12.3 (range, 11.5–15) days/cm. The mean treatment index was 27.9 (range, 24–40) days/cm. The mean follow-up duration was 19.3 (range, 15–41) months. Functional outcome was excellent in 5, good in 8, and fair in 2 patients. All patients achieved bone union and eradication of infection. Bone healing was excellent in 12 and good in 3 patients. All the patients were satisfied with the procedure. None had neurovascular complications, joint subluxations, or refracture of the regenerated bone. True complications encountered included knee stiffness (n=6) and knee flexion contracture (n=1). Three patients with an initial bone defect of >10 cm had delayed union and underwent bone grafting. Conclusion. Bone transport using a monolateral external fixator is safe and effective for treating infected non-union of the femoral shaft.
Mycobacterium Marinum Infection of the Hand and Wrist
Authors: Cheung Jason Pui Yin , Fung Boris , Ip Wing Yuk , Chow Shew-Ping 
Published: October 2016

Purpose. To review records of 166 patients who underwent treatment for Mycobacterium marinum tenosynovitis of the hand and wrist to identify factors associated with functional outcome. Methods. Records of 97 men and 69 women aged 13 to 85 (mean, 50) years who underwent treatment for suspected M marinum tenosynovitis of the hand and wrist were retrospectively reviewed. All underwent open biopsy; synovectomy was performed when florid synovitis was present. Rifampicin and ethambutol were usually prescribed. Clarithromycin, minocycline and/or levofloxacin were used as adjuvants if there was drug intolerance, allergy, or relapse. The duration of antibiotic treatment depended on the clinical recovery. Patients were followed up for one year after completion of drug treatment. Functional outcome was considered excellent for those with >195° total active motion (TAM) and >75% return of motion, good for those with 130° to 195° TAM and 50 to 75% return of motion, fair for those with 65° to 129° TAM and 25 to 49% return of motion, and poor for those with <65° TAM and <25% return of motion. Results. The mean delay in presentation was 4.9 (0.3–120) months. 93 of the patients presented with disabilities (fexion deformity or reduced range of motion), 64 of whom presented one month after injury. 37 (22%) of the patients had received intralesional steroids prior to admission, 30 of whom presented one month after injury. 32 (19%) patients were treated with antibiotics alone, whereas 134 (81%) patients underwent debridement in addition to antibiotic treatment. The mean duration of antibiotic treatment was 7.2 (range, 0–29) months. Of the 156 patients who completed the follow-up, functional outcome was satisfactory in 128 (82%) and unsatisfactory in 28 (17%). Steroid injections and late presentation led to worse functional outcome. Patients with unsatisfactory outcome were more likely to have received intralesional steroid injections (43% [16/37] vs. 10% [12/118], p<0.001, Pearson Chi squared test), have presented >2 months after injury (27% [21/79] vs. 9% [7/77], p=0.004, Pearson Chi squared test), and have undergone synovectomy (23% [28/124]) vs. 0% [0/32], p=0.001, Fisher's exact test). Worse functional outcome correlated with late presentation ( r=0.218) and the greater number of debridement procedures ( r=0.453). Conclusion. Delayed antibiotic treatment of M marinum infections and steroid injections were associated with unsatisfactory outcome. Clinicians must have a high index of suspicion for this condition and avoid inappropriate management such as intralesional steroid injections. Public awareness to this condition should be raised.
Single Screw-Rod Anterior Instrumentation for Thoracolumbar Burst Fractures with Incomplete Neurological Deficit
Authors: Sharma Siddhartha , Singh Dara , Singh Manjeet , Kohli Arvind , Singh Gurjit , Arora Mohit 
Published: October 2016

Purpose. To evaluate the outcome of single screw-rod anterior instrumentation for thoracolumbar burst fractures with incomplete neurological deficit. Methods. 16 men and 5 women aged 22 to 55 (mean, 34) years underwent single screw-rod anterior instrumentation for thoracolumbar burst fractures with incomplete neurological deficit. The vertebrae involved were T10 (n=2), T11 (n=2), T12 (n=7), L1 (n=8), and L2 (n=2). No patient had disruption of the posterior ligament complex. Postoperatively, a thoracolumbar sacral orthosis was used until solid fusion. Outcome measures included neurological recovery, degree of kyphosis, complications, and pain and functional status of the patients. Results. The mean follow-up duration was 36 (range, 13–50) months. All patients recovered neurologically by at least one grade. Of the 21 patients, 6 improved from grade B to grade C (n=4) or grade D (n=2), 13 from grade C to grade D, and 2 from grade D to grade E. The mean degree of kyphosis improved from 23°±5° to 7°±3°. Seven patients had complications including ipsilateral basal atelectasis (n=3), urinary tract infection (n=1), haematuria (n=1), postoperative ileus (n=1), and superficial wound infection (n=1). None had iatrogenic visceral or vascular injury, pseudoarthrosis or hardware-related complications. Only one patient had severe back pain persistently. Conclusion. Single screw-rod anterior instrumentation supplemented with an orthosis can be an alternative for double screw-rod anterior instrumentation for thoracolumbar burst fractures in patients with smaller vertebral bodies.
Complications and Their Risk Factors following Hip Fracture Surgery
Authors: Poh Keng Soon , Lingaraj K 
Published: October 2016

Purpose. To evaluate various postoperative complications and their risk factors in hip fracture patients. Methods. 207 female and 87 male consecutive patients (mean age, 78.1 years) who underwent surgical (n=242) or conservative (n=52) treatment for closed fractures of the femoral neck (n=157) or peritrochanter (n=137) were prospectively studied. The types of complication and outcome were recorded. The comorbidity status of the patients was categorised based on the American Society of Anesthesiologists (ASA) classification. Complications and their associations with various risk factors and mortality were analysed. Results. For all patients, the mean length of hospitalisation was 14.6 days. For the 242 patients who underwent surgical treatment after a mean of 3.6 days, 56.8% of them had at least one complication. Acute urinary retention (39.3%) and urinary tract infection (24.0%) were most common. Patients with ASA grade III or higher had 2.3 fold higher risk of developing complications than those with lower-grade comorbidity, whereas patients with delayed operation (>48 hours after presentation) had 1.8 fold higher risk of developing complications than those without delayed operation. Four patients died in hospital: 2 from myocardial infarction and 2 from upper gastrointestinal bleeding. Conclusion. Complications after hip fracture surgery were common. Advanced age, high ASA status, and delay in surgery were associated with higher complication rates. Operations should be performed on medically fit patients as early as possible.
Correlation between Trochlear Dysplasia and Anterior Cruciate Ligament Injury
Authors: Botchu Rajesh , Obaid Haron , Rennie WJ 
Published: October 2016

Purpose. To evaluate the correlation between trochlear dysplasia and anterior cruciate ligament (ACL) injury Methods. Magnetic resonance images (MRIs) of 95 knees in 54 males and 36 females aged 4 to 74 (mean, 28) years who had anterior knee pain and suspected ligamentous injury were reviewed. The MRIs were independently reviewed by 2 musculoskeletal radiologists on 2 occasions. According to the Dejour classification, trochlear dysplasia was classified into types A, B, C, and D. Intra-articular injuries/disorders of the patients included patellofemoral osteoarthritis, chondromalacia patella, meniscal tears, and ligamentous injuries. Intra- and inter-observer variability was calculated. Results. 58 of the knees had trochlear dysplasia, 38 of which were Dejour type A. The intra- and inter-observer variability was good to excellent (Kappa=0.76–1). ACL tear was the most common injury (n=13). No ACL injury occurred in patients without trochlear dysplasia. The odds of having sustained an ACL injury were 8.8 fold greater in Dejour type-A knees than in non–type-A knees (p=0.023). Conclusion. Dejour type-A trochlear dysplasia was associated with ACL injuries.
One-Stage Long-Stem Total Knee Arthroplasty for Arthritic Knees with Stress Fractures
Authors: Mittal Amber , Bhosale Pradeep B , Suryawanshi Ashish V , Purohit Shaligram 
Published: October 2016

Purpose. To evaluate the outcome of one-stage long-stem total knee arthroplasty (TKA) for patients with arthritic knees and tibiofemoral stress fractures. Methods. Records of 11 men and 18 women aged 47 to 78 (mean, 66) years who underwent fixed-bearing posterior-stabilised TKA for osteoarthritis or rheumatoid arthritis of the knee with tibial (n=31) and femoral (n=3) stress fractures were reviewed. All the tibial fractures involved the proximal half. There were 7 associated fibular stress fractures. Of the 31 knees with tibial stress fractures, 26 and 5 manifested varus and valgus deformity, respectively. Results. The mean follow-up period was 51 (range, 24–96) months. The mean tibiofemoral angle improved from 23.2° to 1.9° varus. The mean Knee Society knee score improved from 38.5 (range, 15–63) to 89.6 (range, 80–95) [p<0.05]. The mean Knee Society functional score improved from 25.5 (range, 0–40) to 86.5 (range, 60–100) [p<0.05]. All fractures were united at the last follow-up. No complications were encountered. Conclusion. One-stage long-stem TKA restores limb alignment and facilitates fracture healing, with excellent outcome.