bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patellar Clunk Syndrome in Fixed-Bearing Posterior-Stabilised versus Cruciate-Substituting Prostheses
Authors: Tang Yan Ho , Wong Wing Keung , Wong Hok Leung 
Published: October 2016

Purpose. To compare the outcome of fixed-bearing posterior-stabilised versus cruciate-substituting prostheses in 46 patients who underwent primary bilateral total knee replacement (TKR). Methods. Records of 35 women and 11 men aged 54 to 78 (mean, 67) years who underwent primary bilateral TKR for osteoarthritis (n=44) and rheumatoid arthritis (n=2) were retrospectively reviewed. A fixed-bearing posterior-stabilised prosthesis (Zimmer NexGen Legacy flex [LPS-Flex]) was used in one knee, and a fixed-bearing cruciate-substituting prosthesis (Depuy Press Fit Condylar Sigma CS [PFC CS]) was used in the contralateral knee. The mean time interval between the 2 operations was 34 (range, 4–60) months. All operations were performed by the same group of surgeons using standardised techniques. The medial parapatellar approach was used, and the patella was resurfaced. Rehabilitation was also standardised. Outcome measures included the pre- and post-operative active range of movement and the American Knee Society Score. Postoperative complications were documented. Results. At one year, the mean fixed flexion contracture, maximum flexion, and American Knee Society scores in knees with PFC CS and LPS-Flex prostheses were comparable. Three knees with the PFC CS prosthesis developed the patellar clunk syndrome, compared to none with the LPS-Flex prosthesis (p=0.24). The onset of the patellar clunk syndrome was around one year after surgery. Despite this, the axial alignment and rotation of the femoral and tibial components were good. Conclusion. Both prostheses produce good clinical outcome. The PFC CS prosthesis is more likely to be associated with the patellar clunk syndrome.
The Dorr Type and Cortical Thickness Index of the Proximal Femur for Predicting Peri-Operative Complications during Hemiarthroplasty
Authors: Nash William , Harris Andrew 
Published: October 2016

Purpose. To assess the Dorr proximal femoral types and the cortical thickness index for predicting peri-operative complications during hemiarthroplasty. Methods. Records of 53 male and 147 female elderly who underwent cemented or uncemented monopolar hemiarthroplasty for displaced intracapsular femoral neck fractures were reviewed. Any intra-operative fracture and postoperative dislocation within 30 days was recorded. The cortical thickness index was defined as the ratio of cortical width minus endosteal width to cortical width at a level of 100 mm below the tip of the lesser trochanter. Higher values indicated thicker cortices. The Dorr proximal femur morphology was classified into types A, B, and C. Results. 28 patients were excluded. The proximal femurs of the remaining 172 patients (mean age, 85 years) were categorised as Dorr type A (n=29), type B (n=75), and type C (n=68). The respective mean cortical thickness indices were 1.10, 0.79, and 0.65. Lower cortical thickness indices correlated with worse Dorr types (p<0.05). There were 18 intra-operative fractures; 8 and 10 occurred in Dorr types B and C femurs versus none in Dorr type A femurs (p=0.046). There were 5 postoperative dislocations; 3 and 2 occurred in Dorr types B and C femurs versus none in Dorr type A femurs (p=0.591). The mean cortical thickness index was significantly lower in those with a fracture (n=18) than those without a fracture (n=154) [0.59 vs. 0.81, p=0.0003]. Conclusion. Dorr types B and C proximal femurs were at greater risk of intra-operative fracture.
Intra-Articular Injection of Tranexamic Acid to Reduce Blood Loss after Total Knee Arthroplasty
Authors: Jang Bob , Kao Mark , Bohm Martin T , Harris Ian A , Chen Darren B , MacDessi Samuel J 
Published: October 2016

Purpose. To evaluate the effect of intra-articular tranexamic acid (TXA) on blood loss after total knee arthroplasty (TKA). Methods. Medical records of 73 men and 93 women (mean age, 68 years) who underwent primary TKA for osteoarthritis and received intra-articular TXA 1500 mg (n=56) or 3000 mg (n=56) or not at all (n=54) were reviewed. Reduction in haemoglobin levels on days 1 and 2 was measured, as were the rates of venous thromboembolism (VTE) and blood transfusion. Results. Reduction in haemoglobin levels on day 2 was significantly greater in controls (35±11 g/dl) than the 1500 mg TXA group (29±9 g/dl, p=0.005) and the 3000 mg TXA group (23±10 g/dl, p±0.001). The difference between the 2 TXA groups was also significant (p=0.002). There was a dose-dependent effect of TXA on blood loss. The rates of VTE and blood transfusion did not differ significantly between groups. Conclusion. Intra-articular administration of TXA is effective in reducing blood loss after TKA, without increasing the risk of VTE.
Correlation between Radiographic and Arthroscopic Findings in Asian Osteoarthritic Knees
Authors: Razak Hamid Rahmatullah Bin Abd , Heng Hwee Yee Christian , Cheng Ke Yi , Mitra Amit Kanta 
Published: October 2016

Purpose. To evaluate the correlation between radiographic and arthroscopic findings for severity of knee osteoarthritis (OA) in 119 Asians. Methods. Medical records of 52 men and 67 women aged 33 to 70 (mean, 51) years who had complaints of chronic mechanical knee pain for >3 months and were arthroscopically diagnosed with articular cartilage degeneration of the knee were reviewed. The severity of knee OA was classified using the Kellgren-Lawrence (K&L) scale and the modified Outerbridge classification. The highest grade in any compartment of the knee was used to represent the severity of OA. The correlation between the radiographic and arthroscopic findings for severity of knee OA was evaluated. Results. 17 of the 119 patients with no radiographic evidence of OA (K&L grade 0) had articular cartilage degeneration arthroscopically (mean grade, 1.14). In general, higher K&L grades correlated with more severe articular cartilage degeneration. The Pearson correlation coefficient was 0.32, indicating that the association between the radiographic and arthroscopic findings for severity of knee OA was weak. Conclusion. The K&L scale correlated poorly with arthroscopic findings of articular cartilage degeneration in an Asian population with knee OA.
Measured Resection versus Gap Balancing Technique for Femoral Rotational Alignment: A Prospective Study
Authors: Nikolaides Anastasios P , Kenanidis Eustathios l , Papavasiliou Kyriakos A , Sayegh Fares E , Tsitouridis Loannis , Kapetanos George A 
Published: October 2016

Purpose. To compare the measured resection technique and the gap balancing technique for correction of the femoral rotational alignment. Methods. 57 women and 6 men (mean age, 70 years) with end-stage osteoarthritis and ±15° malalignment and ±10° flexion contracture of the knee underwent primary total knee arthroplasty through the medial approach using the measured resection technique (n=34) or the gap balancing technique (n=29). Femoral rotational alignment was evaluated before and 7 days after surgery using computed tomography by referencing the 2 posterior condyles to the transepicondylar axis. Results. The 2 groups did not differ significantly in terms of correction of the femoral rotational alignment (3.4°±1.4° vs. 3.5°±3.1°, p=0.817). Conclusion. The measured resection and the gap balancing techniques achieved comparable correction of femoral rotational alignment.
Fixation with Cancellous Screws and Fibular Strut Grafts for Neglected Femoral Neck Fractures
Authors: Pal Chandra Prakash , Kumar Binod , Dinkar Karuna Shankar , Singh Pulkesh , Kumar Harish , Goyal RK 
Published: October 2016

Purpose. To review the outcomes of fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures. Methods. 44 men and 28 women aged 17 to 50 years with neglected femoral neck fractures of the subcapital (n=12), transcervical (n=57), or basal (n=3) types underwent closed (n=39) or open (n=33) reduction and fixation with a single cancellous screw with double fibular strut grafts (n=24) or fixation with double cancellous screws with a single fibular strut graft (n=48). The mean time from injury to surgery was 10 weeks; the delay was 22 to 35 days in 43 patients and >35 days in 29 patients. Double fibular strut grafts were used for 18 patients with longer delay and resorption of the femoral neck, and 18 patients with posterior comminution of the femoral neck. The outcome was assessed using the Harris hip score. Results. Patients were followed up for a mean of 3 years. The time to bone union was 3 to 4 months in 48 patients, 4 to 5 months in 15, and 5 to 6 months in 5; nonunion was noted in 4 patients. In 18 patients with resorption of the femoral neck, bone union took a longer time. The Harris hip score was excellent (90–100) in 30 patients, good (80–89) in 20, fair (70–79) in 15, and poor (±70) in 7. Of the latter, 4 had nonunion and 3 developed avascular necrosis of the femoral head; they had persistent pain and restriction of hip joint movement. Conclusion. Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures is cost-effective and technically less demanding, and associated with good outcomes.
Locking Plate Fixation with and without Inferomedial Screws for Proximal Humeral Fractures: A Biomechanical Study
Authors: Burke Neil G , Kennedy Jim , Cousins Grainne , Fitzpatrick David , Mullett Hannan 
Published: October 2016

Purpose. To compare the efficacy of locking plate fixation with and without inferomedial screws in maintaining the reduction of a proximal humeral fracture. Methods. 22 synthetic humerus models were used. A standardised 3-part proximal humeral fracture with a 4-mm wedge segment was created and fixed with a locking plate and screws with (n=11) and without (n=11) inferomedial screws. The intrafragmentary motion of the construct at 250, 500, 750, and 1000 cycles of 532 N loading, and the load to failure of the 2 groups were compared. Results. Locking plate fixation with inferomedial screws reduced the mean intrafragmentary motion in all cycles (p±0.01) and increased the load to failure (1452 N vs. 1159 N, p±0.001), compared to fixation without inferomedial screws. Conclusion. Additional inferomedial screws provide medial column support for fracture healing. This may reduce intrafragmentary motion and thus implant complications resulting from varus malalignment such as screw perforation or loss of reduction.
Modified Boytchev Procedure for Recurrent Anterior Dislocation of Shoulder
Authors: Chandra Rajesh , Sharma VK , Mahajan Sumit , Bansal Manish , Arora Sumit 
Published: October 2016

Purpose. To evaluate results of the modified Boytchev procedure for recurrent anterior dislocation of the shoulder in 60 patients. Methods. Medical records of 45 men and 15 women aged 20 to 44 years who underwent the modified Boytchev procedure for recurrent anterior dislocation of the right (n=44) and left (n=16) shoulders were reviewed. The mean number of dislocations was 14. Outcome was evaluated using the Burkhead and Rockwood criteria. Results. The mean follow-up period was 56 months. Outcome was excellent in 32 patients, good in 21, and fair in 7. None had poor outcome. The mean external rotation deficit at 0° and 90° of abduction improved from 14° to 7° (p=0.04) and 18° to 7° (p=0.03), respectively. Two patients had fragmentation of the coracoid process, which was fixed with non-absorbable suture. Two patients had traction injury to the musculocutaneous nerve, which recovered after 6 months. One patient had recurrent dislocation that ruled out the chance of revision surgery. Conclusion. The modified Boytchev procedure is a viable and simple treatment for recurrent anterior shoulder dislocation.
Associations between Isolated Bundle Tear of Anterior Cruciate Ligament, Time from Injury to Surgery, and Clinical Tests
Authors: Fok August Wai-Ming , Yau WP 
Published: October 2016

Purpose. To evaluate the associations between isolated anteromedial (AM) or posterolateral (PL) bundle tear of the anterior cruciate ligament (ACL), the time from injury to surgery, and various clinical tests. Methods. 36 women and 189 men aged 16 to 52 (mean, 26.4) years underwent ACL reconstruction of the right (n=107) and left (n=118) knees. Patients were evaluated for the International Knee Documentation Committee Subjective Knee Score, Cincinnati Knee Rating System Score, anterior drawer test, Lachman test, pivot shift test, KT1000 arthrometer measurement, isokinetic muscle tests of the extensors, and functional tests (single leg hop and timed hop test). Examination under anaesthesia (EUA) was also performed, followed by diagnostic arthroscopy. The integrity of the ACL bundles was tested using a probe. The AM and PL bundles were morphologically intact if structurally present, and functionally intact if not lax on probing. Results. Of the 225 patients, 8 had isolated AM bundle tears, 2 had isolated PL bundle tears, and 215 had complete ACL tears in terms of function. The corresponding numbers were 30, 13, and 182 in terms of morphology. Compared with patients with complete ACL tear, the mean time from injury to surgery was significantly shorter in patients with isolated AM or PL bundle tear in terms of function (17.5 vs. 5.6 months, p±0.001) and morphology (17.5 vs. 8.8 months, p±;0.001). Compared with patients with complete ACL tear, those with a functionally intact PL bundle had a higher rate of negative pivot shift test in preoperative evaluation (1% vs. 17%, p=0.002) and EUA (1% vs. 63%, p±0.001), and had a higher rate of negative Lachman test in EUA (1% vs. 25%, p=0.02). Conclusion. The time from injury to surgery was shorter in patients with isolated bundle ACL tear. In patients with ACL deficiency, the pivot shift test was useful in detecting an intact PL bundle.
Diagnostic Value of Magnetic Resonance Imaging in Thoracic Outlet Syndrome
Authors: Singh Vinay Kumar , Jeyaseelan Luckshmana , Kyriacou Steve , Ghosh Subhojit , Sinisi Marco , Fox Michael 
Published: October 2016

Purpose. To evaluate the diagnostic value of magnetic resonance imaging (MRI) in thoracic outlet syndrome (TOS). Methods. Medical records of 30 women and 10 men aged 18 to 68 (mean, 38) years who presented with unilateral (n=35) and bilateral (n=5) TOS and underwent 42 surgical decompressions of the right (n=23) and left (n=19) sides were reviewed. MRI findings were compared with intra-operative findings to evaluate the diagnostic value of MRI. Results. MRI findings correlated poorly with intraoperative findings. Of the 42 cases, MRI and intraoperative findings were matched in 17 and not matched in 25. MRI appeared normal but intraoperative findings were in fact positive for TOS in 23 of 24 cases. The sensitivity and specificity of MRI in diagnosing TOS were 41% and 33%, respectively, whereas its positive and negative predictive values were 89% and 4%, respectively. Conclusion. Sensitivity and specificity of MRI in diagnosing TOS are low. Diagnosis should be based on a holistic approach including history, clinical examination, and radiological findings.
Proximal Femoral Locking Compression Plate for Proximal Femoral Fractures
Authors: Lee Wei Ting , Murphy Diarmuid , Kagda Fareed HY , Thambiah Joseph 
Published: October 2016

Purpose. To review short-term outcomes of proximal femoral locking compression plate (PF-LCP) fixation for proximal femoral fractures in terms of postoperative complications and failure rates. Methods. Medical records of 21 men and 5 women aged 22 to 85 (mean, 49.7) years who underwent internal fixation with the PF-LCP for proximal femoral fractures were reviewed. Younger patients (mean age, 38.7 years) were more commonly involved in high-energy trauma with multiple musculoskeletal injuries, whereas older patients (mean age, 67.7 years) were more commonly involved in low-energy trauma. Fractures were classified into: multi-fragmentary pertrochanteric fractures (n=13), transtrochanteric fractures (n=6), and subtrochanteric/proximal diaphyseal fractures (n=7). Results. Patients were followed up for a mean of 14.7 months. Seven patients developed complications including loosening of locking screws (n=4), delayed union (n=2), and infection (n=1); 4 of them required additional surgeries. Conclusion. The PF-LCP is appropriate for complex proximal femoral fractures with poor bone quality, revision surgeries, and multi-fragmentary subtrochanteric/proximal diaphyseal fractures. For intertrochanteric fractures, the sliding hip screw system should be used to avoid failure.
Early versus Late Flap Coverage for Open Tibial Fractures
Authors: Chua Weiliang , De Soumen Das , Lin Wong Keng , Kagda Fareed , Murphy Diarmuid 
Published: October 2016

Purpose. To compare early versus late flap coverage for open tibial fractures. Methods. Medical records of 83 men and 6 women (mean age, 38 years) who underwent fixation for open tibial fractures (Gustilo grades IIIB and IIIC) followed by flap coverage within (n=30) or after (n=59) 72 hours were reviewed. All fractures were treated within 24 hours. Outcome measures included bone union, infection, flap failure, the need for secondary procedures to achieve union, and eventual amputation. The early and late flap coverage groups were compared. Results. Early flap coverage was associated with shorter length of hospitalisation (31.4 vs. 55.8 days, p<0.01), lower deep infection rates (23% vs. 54%, p<0.01), and smaller number of surgical procedures (6.4 vs. 9.2, p=0.01). The 2 groups did not differ significantly in terms of the time to bone union, flap failure, amputation, and the need of secondary procedures to facilitate bone union. Conclusion. In severe open tibial fractures, early soft-tissue coverage (within 72 hours) was associated with more favourable outcomes in terms of length of hospitalisation and infection.
Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures
Authors: Devkota Pramod , Khan Javed A , Shrestha Suman K , Acharya Balakrishnan M , Pradhan Nabeesman S , Mainali Laxmi P , Khadka Padam B , Manandhar Hemanta K 
Published: October 2016

Purpose. To review the outcomes of 53 patients who underwent minimally invasive plate osteosynthesis (MIPO) for distal tibial fractures. Methods. Medical records of 31 men and 22 women aged 22 to 78 (mean, 51) years who underwent MIPO using a locking compression plate for distal tibial fractures of the left (n=28) and right (n=25) legs with or without intra-articular extension were reviewed. Results. Patients were followed up for a mean of 26 (range, 24–38) months. The mean time from injury to surgery was 9 (range, 3–12) days. The mean operating time was 105 (range, 75–180) minutes. The mean hospital stay was 16 (range, 8–25) days. Non-weight bearing walking with a crutch was started after a mean of 5.7 (range, 3–9) days. The mean time to callus formation was 12 (range, 8–15) weeks. The mean time to full weight bearing was 15 (range, 8–22) weeks. The mean time to bone union was 25 (range, 20–30) weeks. All except 2 fractures united anatomically. At 10 months, the range of motion of the ankle joint in all patients was similar to the contralateral side. Two patients had malunion but this was not clinically significant. Five patients had superficial infection, and 2 patients had persistent pain. Conclusion. MIPO is effective for closed, unstable fractures of the distal tibia. It reduces surgical trauma and preserves fracture haematoma.
Clavicular Hook Plate for Grade-III Acromioclavicular Dislocation
Authors: Steinbacher Gilbert , Sallent Andrea , Seijas Roberto , Boffa Juan Manuel , Espinosa Wenceslao , Cugat Ramón 
Published: October 2016

Purpose. To review the outcomes of clavicular hook plate fixation for grade-III acromioclavicular (AC) dislocation in young athletes. Methods. Medical records of 14 male and 5 female athletes aged 18 to 49 (mean, 29) years who underwent fixation with a 3.5-mm-thick, 15-mm-long clavicular hook plate for acute grade-III AC dislocation were reviewed. The visual analogue score for pain and the Constant shoulder score were assessed. Results. The mean follow-up was 4.2 years. The mean visual analogue score for pain was 1.8 (range, 1–3). The Constant shoulder score was excellent (≥90) in 14 patients and good (83–89) in 5 patients. All patients achieved range of motion equal to that of the contralateral side at week 5. Sports activities were resumed by month 6 at the latest. Conclusion. The clavicular hook plate for grade-III AC dislocation enables quick return to sports activities and achieves good-to-excellent functional outcome.
Fixation Strength at the Interface between Kerboull-Type Plate and Bone Cement
Authors: Kaku Nobuhiro , Hara Katsutoshi , Tabata Tomonori , Tsumura Hiroshi 
Published: October 2016

Purpose. To evaluate the fixation strength at the interface between the Kerboull-type plate and bone cement in 6 experimental conditions. Methods. Experimental materials comprised a simulated acetabular block, a simulated Kerboull-type plate, a pressuriser cover, a pressuriser arm, and bone cement. The simulated Kerboull-type plate was placed on the simulated acetabular block, with the pressuriser cover. Bone cement was added and the pressuriser arm was inserted. After 6 days of curing, pulling tests were performed to measure the fixation strength at the interface between the plate and the bone cement. Six experimental conditions were evaluated. In condition 1, a 1-mm plate was used with no gap between the plate and the acetabular block. In condition 2, a 2.5-mm plate was used with no gap. In condition 3, a 2.5-mm plate was used with a 2-mm gap. In condition 4, the plate was not used. In condition 5, condition 2 was tested with the model rotated 45°. In condition 6, condition 3 was tested with the model rotated 45°. Results. The maximum fixation strengths in conditions 1, 2, 3, 5, and 6 were 44.4 N, 59.1 N, 122.5 N, 86.9 N, and 185.2 N, respectively. The most important factor affecting the maximum fixation strength was bone cement at the interface between the plate and the acetabular block, followed by 45° rotation during testing, and then thickness of the plate. Conclusion. To enhance fixation of the Kerboull-type plate with cemented acetabular cup, penetration of cement into the outer side of the Kerboull-type plate should be minimised.