bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative Outcome of Lumbar Spinal Canal Stenosis after Fenestration: Correlation with Changes in Intradural and Extradural Tube on Magnetic Resonance Imaging
Authors: Yamazaki K , Yosida S , Ito T , Toba T , Kato S , Shimamura T 
Published: October 2016

Purpose. To evaluate the serial changes in clinical results and the intradural and extradural spaces on magnetic resonance imaging (MRI) after bilateral fenestration in 48 patients with lumbar spinal canal stenosis (LSCS). Methods. A prospective interventional study was performed to study the clinical results, magnetic resonance imaging scans among patients who were followed up for more than 3 years. Results. All patients showed improvement in clinical symptoms after operation, but clinical results deteriorated in 9 (19%) patients. Postoperative MRI scans showed that poor dural tube expansion, grouping of the cauda equina, and decrease in the cross-sectional area of the dural tube were factors associated with poor outcomes. The cross-sectional area of the dural tube and images of the cauda equina observed by MRI, before and after fenestration and during follow-up, reflected changes in clinical symptoms involving decompressed segments. Conclusion. Serial changes in the cross-sectional area of the dural tube and images of the cauda equina observed preoperatively, postoperatively, and on follow-up by MRI may be useful when evaluating patients' condition before and after operation. It is also useful for predicting outcomes.
Early Experience of Endoscopy-Assisted Anterior Spinal Surgery
Authors: Adulkasem W , Surangsrirat W 
Published: October 2016

Purpose. Endoscopy-assisted anterior spinal surgery is less invasive, resulting in less tissue trauma. It has a shorter recovery period, leads to less morbidity, and is more cost-efficient than conventional surgery. We report our early experience of endoscopic anterior spinal surgery in Thailand, which was performed with a basic laparoscopic instrument set and self-developed instruments for spinal surgery. Methods. All patients who underwent endoscopic anterior spinal surgery from July 2000 to May 2001 at the Orthopaedic Department, Nakhonpathom Hospital, Nakhonpathom were prospectively documented. The two-portal technique was applied on these patients: the first portal, a 4-cm skin incision, was made as the portal for the surgical instruments; the second portal, a one-cm skin incision, was made as the portal for the endoscope. Results. Nine patients underwent anterior spinal surgery with the minimally invasive technique. The mean patient age was 51.5 years (range, 17–72 years); 3 patients were females and 6 were males. The procedures included thoracoscopy, retroperitoneoscopy, diaphragmatic crus detachment, discectomy, corpectomy, fusion, and instrumentation. The mean operating time was one hour 58 minutes, and the mean estimated blood loss was 372ml; there were no serious complications. Conclusion. Endoscopy-assisted anterior spinal surgery can be performed without spending a high budget; the procedure is not difficult if the surgeon can develop some instruments and has experiences with arthroscopic surgery and anterior spinal surgery.
Brooks' Posterior Stabilisation Surgery for Atlantoaxial Instability: Review of 54 Cases
Authors: Moon MS , Choi WT , Moon YW , Moon JL , Kim SS 
Published: October 2016

Purpose. To assess the effectiveness of Brooks' posterior stabilisation and fusion for the unstable atlantoaxial joint due to congenital dysplastic dens and trauma. Methods. We retrospectively studied records of 54 patients (36 males and 18 females; age range, 3–58 years) who underwent Brooks' posterior stabilisation procedure between March 1975 and December 1999, at the Catholic University of Korea Medical Center and Dong-Shin General Hospital, Seoul. A single-stranded Kirschner wire was used to stabilise the first 19 cases (thin wires in 12 cases and thick wires in 7), and double-stranded wires were used in the next 35 cases (thin wires in 4 cases and thick wires in 31). After surgery, patients were immobilised in bed with light Halter traction of the head, followed by cervical bracing. Results. Fusion was observed by X-ray postoperatively at 15 weeks in 48 patients. Reduction was achieved in 3 luxation cases (including the single case of rotatory fixation). Brooks' fusion failed in 4 patients with dens fractures and 2 with dens anomaly. Four dens fractures in cases of successful Brooks' fusion in Brooks' fusion did not unite. Wire failure occurred in 4 cases of thin single-stranded wire fixation, namely, 2 cases of dens fractures and 2 of dens anomaly. Conclusion. Brooks' procedure is safe and has a high fusion rate when double-stranded strong wire fixation of the atlantoaxial joint is combined with meticulous bone grafting and subsequent cervical bracing.
Salvaging Unstable or Recurrent Dislocating Total Hip Arthroplasty with the Constrained Acetabular Component
Authors: Stanton DA , Bruce WJ , Goldberg JA , Walsh W 
Published: October 2016

Purpose. To review cases of implantation of constraining acetabular components for unstable or recurrent dislocating total hip arthroplasty at the Department of Orthopaedics, Concord Hospital, Sydney. Methods. A retrospective analysis was performed on prospectively collected data of 13 consecutively enrolled patients. Results. From 1989 to 2000, 13 constraining acetabular components were implanted into 13 patients as a revision procedure. The surgical approach for the implantation of the constrained liner was posterolateral in 11 cases; a modified Hardinge approach was applied in 2 cases. The mean clinical follow-up duration was 43 months (range, 14–121 months) and the mean age at the time of surgery was 73 years (range, 52–84 years). No patients were lost to follow-up. Indications for using the constrained acetabular component were recurrent dislocation in revision hip replacements (n=8), and intra-operative instability (n=5). There were no episodes of dislocation of the constrained arthroplasty. In 7 cases, the constrained component was implanted into a previously well-fixed shell. Conclusion. We recommend the judicious use of the constrained component in cases of hip instability during or after total hip arthroplasty when other methods are not successful.
Comparison of Bone Mineral Density among Residents of a Mountain Village and a Fishing Village in Japan
Authors: Sudo A , Miyamoto N , Kasai Y , Yamakawa T , Uchida A 
Published: October 2016

Objective. To compare the bone mineral density of residents of a mountain village with that of residents of a fishing village in Mie Prefecture, Japan. Methods. Microdensitometry was used to measure bone mineral density of the second metacarpal bone of 202 participants living in a mountain village and of 852 participants living in a fishing village to identify contributory factors for osteoporosis. The participants were interviewed using a questionnaire on alcohol consumption, fish intake, milk intake, and daily activity. Results. Analysis of covariance revealed that bone mineral density was significantly higher among the participants living in a fishing village than among those living in a mountain village (2.5–2.9 versus 2.1–2.7 mmAl; p<0.001). A higher proportion of women in the fishing village than of those in the mountain village consumed alcohol (17% versus 10%; p<0.05). Conclusion. Nutrition may be a contributory factor to the lower incidence of osteoporosis among residents of the fishing village compared with those of the mountain village.
Reaming Bone Grafting to Treat Tibial Shaft Aseptic Nonunion after Plating
Authors: Wu CC 
Published: October 2016

Purpose. To investigate the effects of using intramedullary reaming to provide cancellous bone graft, and reamed intramedullary nail stabilisation to provide fragment stability on treating tibial shaft aseptic nonunions after plating. Methods. 31 consecutive patients with tibial shaft aseptic nonunions after plating were prospectively treated. Indications for this technique included a tibial shaft nonunion with an inserted plate, a fracture level fit for traditional or locked nail stabilisation, absence of suspected infection and segmental bony defect at the time, and shortening of less than 2 cm. The plate was removed and the marrow cavity was reamed as widely as possible. A stable unlocked or locked intramedullary nail was then inserted. No extra cancellous bone graft was supplemented. Results. 28 patients were followed up for a median period of 2.2 years (range, 1.0–5.2 years). All patients achieved solid union. The median union period was 4.5 months (range, 3.0–7.5 months). There were no significant complications. Conclusion. When reamed intramedullary nails are used to treat tibial shaft aseptic nonunions after plating, supplemented cancellous bone grafting can be spared. Despite the technique being simplified, the success rate is high. We therefore recommend its wide use to treat all suitable cases.
An Age- and Sex-Controlled Matched Pair Analysis of T Scores in Ethnic Indians with Hip Fractures
Authors: Vaidya SV , Dholakia D , Yadav S 
Published: October 2016

Objective. The first study to predict peritrochanteric fractures by the use of T scores amongst the Indian population was performed. This study aimed to assess the risk of fracture around the hip in peri-menopausal and postmenopausal women, and in men over the age of 35 years using dual energy X-ray absorptiometry, and to analyse whether the result, i.e. the T score, can predict an impending hip fracture. Methods. T scores of the unaffected hip in 30 patients with peritrochanteric fractures were determined, and matched pair analysis was done using a control group without fracture. All patients were from a single centre and were evaluated using the same scanner. Results. The mean T score of the 30 patients in the fracture group was −3.34 (range, −1.2 to −5.1; standard deviation [SD], 1.032), compared with the mean T score of the 30 control subjects which was −2.41 (range, 0.6 to −5.0; SD, 1.378). T scores of patients from the fracture group were significantly lower than those in the control group. Conclusion. We infer that T scores are the best predictors for fracture risk. A score of −2.5 or lower effectively defines patients at risk and is useful for predicting fracture risk in the Indian population. In patients with osteoporosis, whether a fall precedes the fracture or the fracture precedes a fall may not be an issue of debate, but can serve as a basis for prevention of additional fractures by instituting appropriate measures in patients at risk.
Surgical Management of Malignant Soft Tissue Tumours in Patients Aged 65 Years or Older
Authors: Osaka S , Sugita H , Osaka E , Yoshida Y , Ryu J 
Published: October 2016

Objective. With the aim to determine the most effective treatment for primary malignant musculoskeletal tumours in patients aged 65 years or older, we reviewed cases of low- and high-grade neoplasms, surgical margins, surgical methods, and the prognoses of elderly and aged patients at our institution. Methods. Records of 25 patients aged 65 years or older who had malignant soft tissue tumours from December 1986 to February 1997 were reviewed. Low- and high-grade neoplasms accounted for 8 and 17 patients, respectively. 11 patients were aged 65 to 69 years, while 14 were 70 years or older. Surgical margins were wide in 19 cases, marginal in 4, and intralesional in 2. Reconstruction was done using 6 musculocutaneous flaps and/or 4 vessel grafts. As adjuvant therapy, radiotherapy was used in 5 cases and chemotherapy in 3. There was no recurrence in patients with wide surgical margins (determined on the basis of gross inspection of the excised tumour and the cut surface); but there was recurrence in 4 patients with marginal margins, and one patient with intralesional margin. Two patients with intralesional, 4 with marginal, and 2 with wide margins, died from recurrence at the primary site and metastasis, or from metastasis without recurrence at the primary site. Results. Follow-up periods ranged from 4 months to 180 months (mean, 91.6 months). The overall 5-year survival rate was 79.6%; for low- and high-grade neoplasms, the figures were 100% and 69.7%, respectively; for those aged 65 to 69 years and in their 70's or older, the figures were 90.9% and 70.1%, respectively. Conclusion. For geriatric patients, wide surgical margins are required to manage both low- and high-grade neoplasms, in order to avoid multiple surgeries.
Stabilisation of Fractured Thoracic and Lumbar Spine with Cotrel-Dubousset Instrument
Authors: Moon MS , Choi WT , Moon YW , Kim YS , Moon JL 
Published: October 2016

Objective. To evaluate the effectiveness of 2 different types of Cotrel-Dubousset instrument systems in stabilising thoracolumbar and lumbar spine fractures. Methods. Between January 1989 and December 1993, 45 fractures in 42 patients with unstable fracture or fracture dislocation of the thoracolumbar and lumbar spines were randomly assigned to 2 surgical treatments with Cotrel-Dubousset instrumentation—using either a long segment (Group 1) or a short segment (Group 2)—and short posterolateral fusion. Results. Consolidation of the fractured vertebral body and posterolateral fusion were achieved at a mean time of 4.5 months; fusion rates were 75% in Group 1 and 83% in Group 2. The average collapses of anterior vertebral body height in Group 1, in the immediate postoperative period and at the final follow-up, were 15% and 17%, respectively; and in Group 2, the figures were 16% and 24%, respectively. The correction of vertebral height and kyphosis at the last follow-up were lost more in Group 2 (5.7°) than in Group 1 (4.4°). There were neurological recoveries in 6 of the 9 cases of incomplete paraplegics, including complete recovery in 5, and one-Frankel grade increase in one. There were 15 instrument failures in 12 patients, including screw breakage in 3 Group 1 cases and 6 Group 2 cases. The plug dislodged in 3 Group 1 cases, and the hook dislodged in 3 Group 2 cases. In other words, instrument failures were more common in Group 2. Conclusion. Cotrel-Dubousset stabilisation of the fractured spine achieves fracture consolidation, but does not maintain the restored height and sagittal curve completely until fusion. The long rod and short fusion construct was more effective for all fracture types than was the short rod and fusion construct, although it leads to wider immobilisation of normal segments.
Use of Antibiotic-Loaded Polymethyl Methacrylate Beads in the Management of Musculoskeletal Sepsis — A Retrospective Study
Authors: Mohanty SP , Kumar MN , Murthy NS 
Published: October 2016

Purpose. To assess the use of antibiotic-loaded polymethyl methacrylate beads in the management of chronic osteomyelitis of different aetiologies: infected osteosynthesis, infected open fractures, and haematogenous osteomyelitis. Methods. Records of 49 patients with chronic osteomyelitis who were treated at Department of Orthopaedics, Kasturba Medical College, from 1995 to 1999 were studied retrospectively. The diagnosis of chronic osteomyelitis was made on the basis of clinical and radiographic features. Of the 49 patients, 4 had haematogenous osteomyelitis, which later proved to be tuberculosis, and were thus excluded. Antibiotic-loaded acrylic beads were implanted in the remaining patients after thorough debridement. The implant was removed primarily in 16 patients with infected osteosynthesis, who then underwent decompression and sequestrectomy. All wounds were closed primarily. Peri-operative antibiotics were given for 7 days. Beads were removed at the end of 3 weeks followed by bone grafting in 26 patients. Patients were followed up for an average period of 3.7 years. Results. The infective organisms were sensitive to gentamycin in 26 cases and resistant in 19 cases; 14 cases were sensitive to cefuroxime, 11 to cloxacillin, 8 to ampicillin, and 5 to cotrimoxazole. Seven cases were resistant to all antibiotics tested. Of the 19 patients with gentamycin-resistant infection, only one had a poor result. No adverse systemic side-effects such as ototoxicity or nephrotoxicity were seen. Infection did not recur in 39 patients, but 6 patients had low-grade persistent infection at the last follow-up visit. Conclusion. In chronic infections, especially those following osteosynthesis, antibiotic beads are a valuable adjuvant. The most valuable advantage is that the wound can be closed primarily, thereby reducing the incidence of nosocomial infections and requirement of nursing care.
Decreased Access to Health Care and Social Isolation among Young Adults with Cerebral Palsy after Leaving School
Authors: Ng SY , Dinesh SK , Tay SKH , Lee EH 
Published: October 2016

Objective. T o examine if leaving special schools has a negative impact on the health care and social isolation of young adults with cerebral palsy. Methods. Young adults with cerebral palsy, aged between 15 and 22 years, were divided into 2 cohorts: current students, who were still receiving services from special schools, and school-leavers, who had since been discharged from care. A questionnaire and physical examination were administered to assess the extent of disability, health care received by, and social isolation of these young adults. Results. School-leavers had a greater degree of dissability than did students, although the results were not statistically significant. Health care exposure to specialists, general practitioners, therapists (physiotherapists, occupational therapists, and/or speech therapists), and medical social workers decreased after leaving school; with the exception of contact with general practitioners, these results were significant (p<0.05). The entire cohort was more socially isolated than a control cohort. School-leavers participated in fewer activities outside their homes, but showed less concern about their disability than did current students. Conclusions. Young adults with cerebral palsy continue to have health care and lifestyle needs after leaving school, which are currently not being adequately met.
Autogenous Osteochondral Grafts for Osteonecrosis of the Femoral Condyle
Authors: Kotani A , Ishii Y , Sasaki S 
Published: October 2016

Purpose. To evaluate the long-term outcome following use of osteochondral autografts for the treatment of osteonecrosis of the femoral condyle. Methods. Clinical, radiographic and arthroscopic findings were evaluated at follow-up. Patients were 14 women and 2 men, with a mean age of 64.9 years (range, 58–74 years). The osteochondral lesion was equivalent to Lotke 1-B in 12 knees, and was equivalent to 1-C in 4 knees. Preoperative femoral tibia angle ranged from 178° to 190°. Results. The follow-up period ranged from 28 months to 111 months (mean, 67 months). Functional scores improved from 60 to 75 preoperatively to 80 to 100 postoperatively, and the grafts were satisfactorily accepted. Patients with a femoral tibia angle of less than 180° in particular were found to respond favourably. Conclusion. Transplant surgery using osteochondral autografting appeared effective for the treatment of osteonecrosis of femoral condyle.
Supracondylar Nailing for Difficult Distal Femur Fractures
Authors: Saw A , Lau CP 
Published: October 2016

Purpose. To evaluate outcome following supracondylar nailing for distal femur fractures. Methods. The clinical and radiological outcome for 13 patients treated between January 1995 and December 1998 at the University Malaya Medical Center was assessed. Patients were seen for follow-up for a mean duration of 20.2 months. Results. There were no cases of non-union or infection. Overall assessment of clinical outcome based on the criteria of Schatzker and Lambert was graded excellent in 6 patients, good in 3 patients, fair in 3 patients, and one graded as a failure. Conclusion. Supracondylar nailing for fixation of supracondylar (Arbeitsgemeinschaft für Osteosynthesefragen [AO] type A) and less comminuted intercondylar (AO type C1 and C2) fractures is recommended by the authors.
Gait Adaptations in Patients with Longstanding Hip Fusion
Authors: Thambyah A , Hee HT , De S Das , Lee SM 
Published: October 2016

Purpose. To examine the long-term effects of hip arthrodesis in terms of gait adaptations. Methods. Motion analysis was performed on 9 patients who underwent unilateral hip arthrodesis between 1979 and 1991. A standard clinical gait analysis 3-dimensional model for the lower limb was used to calculate the effect of the fused hip on walking, compared with the contralateral normal hip. Results. Significant (p<0.05) gait adaptations noted in the fused side were, compensatory hip hiking during the swing-phase, a 24% reduction in hip adduction moment, a 37% decrease in genu-varus moment, 80% reduced hip power, and excessive pelvic tilt. Conclusion. It appears that the excess pelvic tilt observed was to achieve relative hip extension via increased relative lumbar lordosis, while the decreased coronal plane moments of the hip and knee observed were to reduce joint loading on the affected side.
Medium-Term Results of Cementless Hydroxyapatite-Coated Primary Total Hip Arthroplasty: A Clinical and Radiological Review
Authors: Theis JC , Ball C 
Published: October 2016

Purpose. To evaluate the clinical and radiological outcomes following cementless primary hydroxyapatite-coated total hip arthroplasty. Methods. A retrospective study of 69 patients (82 hips) who underwent uncemented hydroxyapatite-coated Anatomic Benoist Girard total hip replacement between October 1991 and October 1995 at our institution was conducted. Patient records were reviewed. All patients were evaluated clinically using the Merle D'Aubigne hip score, and osteointegration was assessed radiographically by analysing the bone implant interface in the 7 zones of Gruen on follow-up review. Results. The mean follow-up period was 7.3 years. Clinical results were excellent with an improvement seen in clinical score from 9.9 preoperatively to 16.5 at last review. A total of 15% of patients recorded some thigh discomfort, which was intermittent and not functionally limiting, except in 2 cases. There were 3 cases of severe acetabular osteolysis and loosening requiring revision surgery, and 4 cases of localised proximal femoral osteolysis around well-ingrown implants. There were few perioperative complications, with the exception of 5 dislocations of which 3 were recurrent and required a revision procedure. Conclusion. Clinical and radiological outcomes following cementless hydroxyapatite-coated total hip arthroplasty were seen to be favourable in this medium-term retrospective study.
Cementless Total Hip Arthroplasty Using an Autograft of the Femoral Head for Marked Acetabular Dysplasia: Case Series
Authors: Yamaguchi T , Naito M , Asayama I , Shiramizu K 
Published: October 2016

Purpose. To assess the short-term outcome of cementless total hip arthroplasty involving an autograft of the femoral head in Japanese patients. Methods. Cementless total hip arthroplasty with autogenous bone block grafting was performed on 18 hips in 15 patients with marked acetabular dysplasia. The resected femoral head was used as a graft for the superior-lateral region of the true acetabulum. Clinical outcome was correlated with the placement of the acetabular component, as revealed in radiographs. Results. The 13 women and 2 men had a mean age of 60.2 years (range, 37.0–73.0 years) at primary surgery and a mean follow-up duration of 3.3 years (range, 2.0–5.3 years). According to the classification of Crowe, 4 hips were in group I, 3 were in group II, one in group III, and 10 in group IV. The mean Harris Hip Score preoperatively was 45.7 (range, 19–69) and that at follow-up was 82.5 (range, 44–100). All 15 cases showed a good clinical outcome. There were no major intra-operative complications in this series. The grafted bones united in all patients. Two patients need surgical revision because the lateral insertion of the acetabular component resulted in loosening of it. Conclusion. Medial insertion of the acetabular component provides satisfactory short-term outcomes. Lateral insertion of the acetabular component during total hip arthroplasty should be avoided in patients with marked acetabular dysplasia.