bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safe Zone for Retractor Placement to the Lumbar Spine via the Transpsoas Approach
Authors: Spivak Jeffery M , Paulino Carl B , Patel Ashish , Shanti Nael , Pathare Neil 
Published: October 2016

Purpose. To measure anatomic variations of the lumbar plexus within the psoas in relation to the L2/3, L3/4, and L4/5 disc spaces and to delineate a safe zone to avoid nerve injury during retractor placement via the transpsoas approach. Methods. Six male and 6 female cadavers (24 psoas/lumbar plexuses) aged 35 to 74 years were dissected. The lumbar plexus was isolated bilaterally. The L2, L3, and L4 nerve roots were identified and isolated without disturbing their natural anatomic course. The anteroposterior (AP) diameter of each intervertebral disc at L2/3, L3/4, and L4/5 was used as a reference. Four measurements were made using a caliper: the AP and mediolateral (ML) diameters of the psoas and AP and ML excursions of each nerve root. Percentages were calculated for the 4 measurements using the reference of the AP diameter of the intervertebral disc at each level. Comparison between left and right sides, between males and females, and between excursions of nerve roots were made. Results. The AP diameter of the psoas increased from L2 to L4, with a mean vertebral body coverage of 80%, 86%, and 85% at L2/3, L3/4, and L4/5, respectively. Both the L2 and L3 nerve roots demonstrated substantial anterior trajectories as they coursed distally in the lumbar spine. No nerve root encroached anteriorly beyond 33% of the intervertebral disc space at L2 to L5. Conclusion. The lumbar plexus area corresponding to the anterior half of the intervertebral disc was the safe zone. Procedures to the lumbar spine via the transpsoas approach should be performed within the safe zone to avoid nerve injury.
Telangiectatic Osteosarcoma
Authors: Colomina Jordi , Peiro Ana , Trullols Laura , Gracia Isidre 
Published: October 2016

Purpose. To review records of 8 patients with telangiectatic osteosarcoma (TOS) and determine whether pathologic fractures correlate with recurrence and survival. Methods. Records of 4 men and 4 women aged 17 to 44 (mean, 28) years treated for TOS were reviewed. Results. Of the 8 patients, 4 developed a pathologic fracture and 4 did not. In each group, 2 patients underwent limb salvage surgery and 2 underwent amputation. All patients received neoadjuvant and adjuvant chemotherapy with a combination of at least 2 of the following drugs: doxorubicin, methotrexate, cisplatin, and vincristin. After a mean follow-up of 5.6 (range, 2–16) years, all 4 patients with a pathologic fracture and 2 of the 4 patients without a pathologic fracture were still alive and disease-free. For the remaining patients, one died after 31 months from progression of a lung metastasis, and the other was alive with the disease and had had 2 recurrences, a lung metastasis, and an infection with Klebsiella oxytoca that eventually led to an amputation. Conclusion. The presence of a pathologic fracture in patients with TOS was not associated with worse outcome in terms of recurrence and survival.
Effect of Calcium Triphosphate Cement on Proximal Humeral Fracture Osteosynthesis: A Finite Element Analysis
Authors: Kennedy Jim , Feerick Emer , McGarry Patrick , FitzPatrick David , Mullett Hannan 
Published: October 2016

Purpose. To measure the effect of void-filling calcium triphosphate cement on the loads at the implant-bone interface of a proximal humeral fracture osteosynthesis using a finite element analysis. Methods. Finite element models of a 3-part proximal humeral fracture fixed with a plate with and without calcium triphosphate cement augmentation were generated from a quantitative computed tomography dataset of an intact proximal humerus. Material properties were assigned to bone fragments using published expressions relating Young's modulus to local Hounsfield number. Boundary conditions were then applied to the model to replicate the physiological loads. The effect of void-filling calcium triphosphate cement was analysed. Results. When the void was filled with calcium triphosphate cement, the pressure gradient of the bone surrounding the screws in the medial fracture fragment decreased 97% from up to 21.41 to 0.66 MPa. Peak pressure of the fracture planes decreased 95% from 6.10 to 0.30 MPa and occurred along the medial aspect. The mean stress in the screw locking mechanisms decreased 78% from 71.23 to 15.92 MPa. The angled proximal metaphyseal screw had the highest stress. Conclusion. Augmentation with calcium triphosphate cement improves initial stability and reduces stress on the implant-bone interface.
Joint Hypermobility and Anterior Cruciate Ligament Injury
Authors: Vaishya Raju , Hasija Rohit 
Published: October 2016

Purpose. To compare the rates of joint hypermobility in patients with and without anterior cruciate ligament (ACL) injury. Methods. Records of 135 men and 75 women (mean age, 24.6 years) who underwent ACL reconstructions were reviewed and compared with 55 male and 35 female controls with no knee injury. Joint hypermobility was evaluated by 2 examiners using the Beighton score. The maximum score was 9, and a score of ≥4 was defined as hypermobility. Results. The mean time from injury to presentation was 18 days. A non-contact mechanism of injury was more common. The inter-observer reliability was 0.7. 127 (60.5%) of the patients with ACL injury and 23 (25.5%) of the controls had hypermobility (p<0.01). Among them, 58% and 24% were men and 65% and 29% were women, respectively. Female gender was associated with hypermobility. Patients with ACL injury were more likely to have joint hypermobility with an odds ratio of 4.46. Conclusion. Joint hypermobility was more common in patients with ACL injury.
Using the Transverse Acetabular Ligament as a Landmark for Acetabular Anteversion: An Intraoperative Measurement
Authors: Inoue Masahiro , Majima Tokifumi , Abe Satomi , Nakamura Takayuki , Kanno Taiki , Masuda Takeshi , Minami Akio 
Published: October 2016

Purpose. To measure the transverse acetabular ligament (TAL) anteversion in hips with severe deformity, using fluoroscopy–computed tomographic navigation. Methods. 31 hips in 10 men and 19 women aged 40 to 78 (mean, 58.7) years who underwent total hip arthroplasty for primary osteoarthritis (n=6) or osteoarthritis secondary to developmental hip dysplasia (n=19) or congenital hip dislocation (n=6) were included. The severity of hip dislocation was classified according to the Crowe classification; 15 hips were grade 1, 7 were grade 2, 3 were grade 3, and 6 were grade 4. The TAL anteversion was measured using fluoroscopy–computed tomographic navigation. The difference in TAL anteversion between non-dislocated hips (Crowe grade 1, n=15) and dislocated hips (Crowe grades 2–4, n=16) was compared. Results. In all 31 hips, the TAL could be visualised intra-operatively. No patient reported severe pain, early wear, loosening, or dislocation after 2 years. The mean TAL anteversion and inclination angles measured by the navigation system were 26.5° (SD, 8.9°; range, 8°–42°) and 41.5° (SD, 4.6°; range, 32°–49°), respectively. 22 of the 31 hips were in the safe zone. TAL anteversion in non-dislocated and dislocated hips was not significantly different. Inter- and intra-observer mean absolute differences in TAL anteversion were 0.3° and 0.4°, respectively. Conclusion. The TAL is a useful anatomic landmark for total hip arthroplasty in dislocated hips.
Computed Tomography-Guided Core Needle Biopsy versus Incisional Biopsy in Diagnosing Musculoskeletal Lesions
Authors: Kiatisevi Piya , Thanakit Voranuch , Sukunthanak Bhasanan , Boonthatip Mayura , Bumrungchart Saraporn , Witoonchart Kiat 
Published: October 2016

Purpose. To compare computed tomography (CT)– guided core needle biopsy (CNB) with incisional biopsy in diagnosing musculoskeletal lesions. Methods. 62 men and 50 women aged 12 to 83 (mean, 45) years who underwent a CT-guided CNB were compared with 31 men and 33 women aged 9 to 81 (mean, 53) years who underwent an incisional biopsy. All specimens had final pathology report to compare with. Comparisons were made in terms of (1) diagnostic rate, (2) accuracy in distinguishing benign from malignant lesions, (3) accuracy in distinguishing low- from high-grade sarcomas, (4) accuracy for histological diagnosis, and (5) complication and repeated biopsy rates. Results. The diagnostic rate of CT-guided CNB and incisional biopsy was not significantly different (92.9% vs. 96.9%, p=0.33), nor were the accuracy in distinguishing benign from malignant lesions (100% vs. 98.4%, p=0.37), the accuracy in distinguishing low- from high-grade sarcomas (100% vs. 100%, p=1.00), the accuracy for specific diagnosis (75.9% vs. 85.2%, p=0.17), the repeated biopsy rate (6.3% vs. 4.7%, p=0.75), and the complication rate (0.9% vs. 4.7%, p=0.14). The accuracy for specific diagnosis was higher for bone than soft-tissue lesions for both CT-guided CNB (87.0% vs. 59.5%, p=0.002) and incisional biopsy (87.0% vs. 77.3%, p=0.43). The accuracy of CT-guided CNB for specific diagnosis of benign soft-tissue tumours as well as infection and inflammation was relatively low. Conclusion. CT-guided CNB is safe, easy to perform, efficient, and less invasive, and should be considered as a first-line biopsy for musculoskeletal lesions.
Collagen Expression in Various Degenerative Meniscal Changes: An Immunohistological Study
Authors: Mine Takatomo , Ihara Koichiro , Kawamura Hiroyuki , Date Ryo , Umehara Keitaro 
Published: October 2016

Purpose. To examine changes in acid mucopolysaccharides and collagen expression during meniscal degeneration, tearing, and repair, using menisci excised from knee joint surgeries. Methods. Menisci excised from 23 patients aged 15 to 80 years who underwent meniscal surgery for flap and bucket handle tears (n=11) and total knee arthroplasty (TKA) for osteoarthritis (n=12) were examined histologically. Staining images were converted to greyscale images to measure the mean grey levels, which indicated densitometry. Comparisons were made between acutely injured menisci and menisci with and without degeneration (from patients with osteoarthritis) in terms of acid mucopolysaccharides, collagen types I, II, and III expression. Results. In menisci with no degeneration, acid mucopolysaccharides, collagen types I and II were expressed throughout the entire meniscus except for the circulating area. Collagen type III was intensely expressed at the exterior peripheral border and on the surface. During progression of meniscal degeneration, the expression of acid mucopolysaccharides increased, and the expression of collagen types I, II, and III decreased. In acutely injured menisci, collagen types II and III disappeared first, followed by collagen type I, resulting in the abrogation of fibre construction. Conclusion. In normal menisci, acid mucopolysaccharides and collagen types I, II, and III were well-balanced, and meniscal function was maintained. When the limits of repair were exceeded, the meniscus tissue deteriorated owing to the disappearance of collagen types II and III and a decrease in collagen type I, resulting in the abrogation of meniscus fabric construction.
Total Knee Replacement System with a Ceramic Femoral Component versus Two Traditional Metallic Designs: A Prospective Short-Term Study
Authors: Bergschmidt Philipp , Bader Rainer , Kluess Daniel , Zietz Carmen , Schwemmer Benjamin , Kundt Guenther , Mittelmeier Wolfram 
Published: October 2016

Purpose. To compare the short-term outcome of the Multigen Plus system using a symmetric ceramic femoral component with that of 2 metallic total knee replacement (TKR) systems. Methods. 60 patients (62 knees) with osteoarthritis or rheumatoid arthritis underwent primary TKR using the Genia system (n=20), the Multigen Plus system (n=17), and the Multigen Plus system with a ceramic femoral component (n=25). Outcome was evaluated pre- and post-operatively (at 3, 12, and 24 months) using the Hospital for Special Surgery (HSS) score, the Western Ontario and McMaster Universities (WOMAC) score, and the Short-Form 36 (SF-36) score. Results. The 3 groups did not differ significantly at all 4 time points in terms of the HSS score, WOMAC score, and SF-36 score. The range of motion was significantly less in patients treated with the Genia system. Postoperatively, the HSS and WOMAC scores improved significantly in all 3 groups, whereas the SF-36 score improved significantly (at 12 and 24 months) only in patients treated with the Multigen Plus system with a ceramic femoral component. The implant position in most patients was optimal. All radiolucent lines were within 1 mm and did not progress. Conclusion. The short-term outcome of the 3 TKR systems was comparable. Ceramic femoral components performed comparably to traditional metallic designs.
Ropivacaine versus Bupivacaine for 3-in-l Block during Total Knee Arthroplasty
Authors: Theodosiadis Panagiotis , Sachinis Nick , Goroszeniuk Teo , Grosomanidis Vasilios , Chalidis Byron 
Published: October 2016

Purpose. To compare the use of ropivacaine versus bupivacaine for 3-in-1 block during total knee arthroplasty (TKA) in terms of efficacy and safety (lack of toxicity). Methods. 14 men and 26 women aged 58 to 77 (median, 70) years who had the American Society of Anesthesiologists (ASA) grades I to III physical status were randomised to receive ropivacaine (n=20) or bupivacaine (n=20) of a concentration of 0.5% for 3-in-1 block during TKA. The dosage was 0.5 ml/kg. In addition, a sciatic nerve block (20 ml of prilocaine 1%) was used. The onset of the block, duration of postoperative analgesia, level of motor block, and any side-effects were compared. Results. The median time to onset of block was significantly shorter in those receiving ropivacaine than bupivacaine (13 vs. 17.5 minutes, p<0.001), but the levels of motor blockade were not significantly different (p=0.355). Complete analgesia was achieved throughout the procedure. There was no significant difference between the ropivacaine and bupivacaine groups in terms of the mean duration of analgesia (398 vs. 367 minutes, p=0.62), the mean VAS scores at all time points, and the mean total morphine consumption. One patient in the ropivacaine group developed a joint haematoma and 2 patients in the bupivacaine group had excessive wound drainage. Both conditions resolved after antibiotic use. Conclusion. Ropivacaine and bupivacaine showed similar anesthetic and analgesic effects, but the former had a significantly faster onset time.
Mechanical Failure of the Distal Radius Volar Locking Plate
Authors: Foo Tun-Lin , Gan Aaron WT , Soh Tamara , Chew Winston YC 
Published: October 2016

Purpose. To review 9 cases of mechanical failure of the volar locking plate for distal radial fractures. Methods. Records of 374 consecutive patients who underwent volar locking plating for distal radial fractures were reviewed. Mechanical failures of the volar locking plate were defined as plate breakage or bending, screw breakage or loosening, or collapse of articular fragments resulting in intra-articular screw extrusion. Results. Nine mechanical failures occurred between 2 weeks and 3 months in 8 (2.4%) of the patients aged 25 to 82 (median, 74) years with AO fracture types of A3 (n=4), C1 (n=1), C2 (n=1), and C3 (n=3). Mechanical failures included screw pullout (n=5), locking plate bending (n=2), locking screws breakage (n=1), and loosening of locked variable angle screws (n=1). One patient underwent revision of fixation and 2 underwent implant removal. The remainder were treated conservatively. All patients were followed up for a minimum of 12 months; their mean flexion arc was 87° (standard deviation [SD], 17°) and the mean rotation arc was 136° (SD, 29°). According to the Green and O'Brien score, their outcomes were good (n=1), fair (n=4), and poor (n=3). Conclusion. Although mechanical failure of volar locking plate is uncommon, some are potentially preventable.
Early Active Motion Protocol following Triple Kessler Repair for Flexor Tendon Injury
Authors: Rajappa S , Menon PG , Kumar M Mohan , Raj D Gokul 
Published: October 2016

Purpose. To evaluate outcome of 6-strand triple Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation. Methods. 25 men and one woman (36 fingers) underwent 6-strand triple Kessler repair for flexor tendon injuries in zones 2 to 5, followed by early active motion rehabilitation. Rehabilitation was started at days 3 to 5. Patients were instructed to passively flex all the fingers with the uninjured hand and to actively retain this position for 10 seconds. Active extension within the confines of the splint was allowed. At the end of week 8, strength training was commenced until a satisfactory range of motion was regained. Outcome measures included total active motion, grip strength, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Complications such as infection and wound dehiscence were recorded. Results. The mean follow-up was 1.2 (range, 1–2) years. Outcome was excellent in 24 digits, good in 4, and poor in 8. The mean grip strength was 80% (range, 60–100%) of normal in dominant hands and 60% (range, 50–65%) of normal in non-dominant hands. The mean DASH score was 15 (range, 0–52). One patient had wound dehiscence and superficial infection. Conclusion. Six-strand triple Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation yields satisfactory results.
Enhanced Recovery Programme for Total Knee Replacement to Reduce the Length of Hospital Stay
Authors: Dwyer Amitabh J , Thomas William , Humphry Simon , Porter Paul 
Published: October 2016

Purpose. To compare the length of hospital stay in patients undergoing primary total knee replacement (TKR) with or without enhanced recovery (ER) programme. Methods. Medical records of 57 and 55 consecutive patients who underwent primary TKR with or without ER programme, respectively, were reviewed. 17 men and 40 women aged 43 to 87 (mean, 70) years with ER programme were compared with 22 men and 33 women aged 53 to 90 (mean, 73) years without ER programme in terms of the preoperative haemoglobin level, American Association of Anesthesiologists (ASA) physical status grading, body mass index (BMI), and length of hospital stay. Results. The length of hospital stay was significantly shorter in the ER than non-ER groups in overall patients (6 vs. 7.8 days, p=0.0003), in patients with preoperative haemoglobin level of ⩾14 g/dl (5.4 vs. 7.7 days, p=0.02), in patients with preoperative haemoglobin level of ±14 g/dl (6.2 vs. 7.7 days, p=0.02), in patients with ASA grades 1 and 2 (5.6 vs. 7.6 days, p=0.01), in patients with ASA grade 3 (6.4 vs. 8.2 days, p=0.01), in patients with BMI of ±30 kg/m2 (6 vs. 8.1 days, p=0.0061), and in patients with BMI of ⩾30 kg/m2 (5.9 vs. 7.5 days, p=0.0006). Complications were noted in 4 ER patients and 5 non-ER patients. Conclusion. ER programmes are readily transferable to patients undergoing TKR and significantly reduced the length of hospital stay.
Cemented versus Cementless Hemiarthroplasty for Femoral Neck Fractures in the Elderly
Authors: Ng Zhaowen Dennis , Krishna Lingaraj 
Published: October 2016

Purpose. To compare cemented versus cementless bipolar hemiarthroplasty in terms of operating time, blood loss, pain, functional outcome, morbidity, and mortality. Methods. Medical records of 207 patients aged ⩾60 years who underwent bipolar hemiarthroplasty for displaced femoral neck fracture using a cemented (n=96) or cementless (n=111) prosthesis were reviewed. Postoperative thigh pain, ambulatory status, and complications were assessed. Results. The cemented group had significantly longer operating time (p=0.017) and greater intraoperative blood loss (p=0.024). Postoperative thigh pain was significantly higher in the cementless group (p=0.023). Conclusion. Cementless hemiarthroplasty is preferred over cemented hemiarthroplasty because of reduced operating time and intra-operative blood loss. It was associated with increased postoperative thigh pain, but functional outcomes, complications, and mortality were similar between the 2 groups.
Audit of Operation Notes in an Orthopaedic Unit
Authors: Sweed Tamer Ahmed , Bonajmah Abdallah Aly , Mussa Mohammed Altayeb 
Published: October 2016

Purpose. To audit operation notes of 50 patients according to the guidelines of the Royal College of Surgeons. Methods. Proforma operation notes of 50 consecutive patients treated in an orthopaedic department were audited by a single reviewer, according to the guidelines of the Royal College of Surgeons in terms of date and time of surgery, name of surgeon, procedure, operative diagnosis, incision details, signature, closure details, tourniquet time, postoperative instructions, complications, prosthesis used, and serial numbers. Results. There were 45 trauma cases and 5 elective cases. The operating surgeons were consultants (32%), senior registrars (36%), and registrars (32%). 28% and 72% of the operation notes were written by operating surgeons and assistants, respectively. Of the 14 operating surgeons who wrote their own notes, one was a consultant, 6 were senior registrars, and 7 were registrars representing 6%, 33%, and 44% of the respective grades of surgeons. All the notes were handwritten; 20% had illegible parts (all in the description of the operative technique). Documentation was good for date and time of surgery (100%), name of surgeon (100%), procedure (100%), duration of surgery (94%), operative diagnosis (92%), incision details (84%), and signature (84%). Documentation was poor for tourniquet time (32%; pneumatic tourniquet was used in 25 patients, only 8 of whom were documented), closure details (16%), and postoperative instructions (24%). Conclusion. Documentation of operative details in our department was generally good, except for closure details, tourniquet time, and postoperative instructions.
Prevalence and Risk Factors of Lateral Epicondylitis in a Mountain Village in Japan
Authors: Tajika Tsuyoshi , Kobayashi Tsutomu , Yamamoto Atsushi , Kaneko Tetsuya , Takagishi Kenji 
Published: October 2016

Purpose. To determine the prevalence and risk factors of lateral epicondylitis in a mountain village in Japan. Methods. 176 men and 246 women aged 24 to 86 (mean, 61) years from a mountain village in Japan underwent regular medical examination and completed a self-administered questionnaire with items related to gender, weight, height, dominant hand, heaviness of labour (no job, light, intermediate, and heavy), presence of elbow pain 2 weeks before examination, and smoking and drinking experience. The diagnosis of lateral epicondylitis was based on self-reported symptoms and clinical signs. Results. The prevalence of lateral epicondylitis in a mountain village in Japan was 3.8% (95% confidence interval [CI], 2.2%-6.1%). Of the 422 subjects, 47 had elbow pain and 16 of them were diagnosed to have definite lateral epicondylitis. 15 of them were right-handed and had involvement of the left (n=8) and right (n=7) sides; the remaining one was left-handed and had involvement of the left side. The dominant hand was not associated with the affected side (p=1.00). Heaviness of labour was not associated with the elbow pain scores. The prevalence was highest in subjects aged 50 to 59 years (9% [95% CI, 3.8%-17.1%]) and those with no job (14% [95% CI, 1.1%-44.1%]). Conclusion. Lateral epicondylitis was not associated with gender, age, body mass index, dominant hand, heaviness of labour, smoking, or drinking.