bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sacral Insufficiency Fractures
Authors: Schindler OS , Watura R , Cobby M 
Published: October 2016

Purpose. To highlight difficulties in the diagnostic process and the validity of imaging techniques for sacral insufficiency fractures. Methods. Records of 25 women aged 68 to 95 years with sacral insufficiency fractures were reviewed. Baseline blood biochemistry and haematology test results were obtained. Pelvic anterior/posterior radiography was undertaken for all patients; additional computed tomography, technetium bone scanning, and magnetic resonance imaging were used in some. Treatments were based on the severity of the injury and the patient's mobility and cooperativeness. Results. Among the 25 women, 11 had bilateral and 14 had unilateral vertical sacral fractures. Associated fractures included horizontal sacral fracture, fractures of the os pubis and ilium. Symptoms included lower back or buttock pain, abdominal pain, and those emulating radiculopathy and myelopathy, including leg weakness, sciatica, and urinary retention. The mean delay in diagnosis was 9 (range, 1–28) days. The mean recovery time between bilateral and unilateral fractures was significantly different (22 [range, 12–33] vs 14 [range, 8–36] weeks, p=0.01). No patient with bilateral fractures regained her pre-injury mobility, compared to 43% among those with unilateral fractures (p=0.02, Fisher's exact test). Computed tomography was the most reliable imaging technique; technetium bone scanning was highly sensitive but non-specific; magnetic resonance images of the fractures may mimic metastatic disease. Conclusion. With the increase in the elderly population, sacral insufficiency fractures may become epidemic in future. Primary and secondary osteoporoses are common causes. Once a diagnosis is established, in most cases treatment is simple but recovery may be protracted and full mobility curtailed.
Dynamic Hip Screw and Compression Plate Fixation of Ipsilateral Femoral Neck and Shaft Fractures
Authors: Abalo A , Dossim A , Bangna AF Ouro , Tomta K , Assiobo A , Walla A 
Published: October 2016

Purpose. To evaluate surgical outcomes of ipsilateral femoral neck and shaft fractures. Methods. Between April 1997 and September 2004, 29 men and 8 women (mean age, 37 years) underwent fixation of femoral neck and shaft fractures using a dynamic compression plate plus a dynamic hip screw or screws. There were 30 femoral neck and 7 pertrochanteric fractures. Functional results were assessed according to the Friedman and Wyman classification. Results. The mean follow-up period was 49 months. Of the femoral neck fractures, 34 united in a mean of 4 months; 33 of them healed anatomically and one with a 6° varus angulation. No osteonecrosis of the femoral head was noted. Of the femoral shaft fractures, 32 united in a mean of 6 months, 5 were non-unions (2 persisted even after revision surgery). Seven patients developed infections (5 superficial and 2 deep), which resolved with debridement and antibiotic treatment. Functional results were good in 29 patients, fair in 5, and poor in 3. Conclusion. The use of dynamic hip screws and compression plates for ipsilateral femoral neck and shaft fractures is reliable in achieving bone union with few complications.
Anthropometry of the Patellar Tendon in Chinese
Authors: Luk KMS , Wong NM , Cheng JCK 
Published: October 2016

Purpose. To assess the length of the patellar tendon in Chinese and its correlation with patient age, gender, and operated side. Methods. 109 men and 11 women aged 15 to 45 (mean, 25) years underwent arthroscopic bone-tendon-bone reconstruction for anterior cruciate ligament (ACL) insufficiency. 55 (46%) injured the left side, and 65 (54%) the right side. Each patient's age, gender, and operated side were recorded. The length of the patellar tendon harvested was measured. Results. The mean length of the patellar tendon graft was 42.6 (standard deviation, 4.6; range, 30–54) mm. There was no correlation between the length of the patellar tendon and patient's age (p=0.147), gender (p=0.076), or operated side (p=0.466). Conclusion. The length of the patellar tendon in the Chinese is comparable to that in Caucasians. Because of the shorter ACL but similar patellar tendon length, graft-tunnel mismatch may be more common in Chinese than Caucasian patients.
Septic Arthritis in Haemodialysis Patients: A Seven-Year Multi-Centre Review
Authors: Al-Nammari SS , Gulati V , Patel R , Bejjanki N , Wright M 
Published: October 2016

Purpose. To determine relevant demographics, clinical features, and outcomes for septic arthritis in patients on haemodialysis for end-stage renal failure. Methods. A multi-centre retrospective review was performed from 1999 to 2005. Results. 15 cases were identified. The mean age of the patients at diagnosis was 67 (range, 23–89) years and 11 were male. All had multiple co-morbidities and additional risk factors for sepsis. The primary sources of sepsis were dialysis access–related (n=12), unknown in 2, and unrelated soft tissue infection in one. All patients presented with acute mono-articular symptoms; the knee joint was affected in 11 patients. The white cell count, neutrophil count, and C-reactive protein concentration were elevated in 10, 10, and 15 patients, respectively. All patients had positive synovial fluid cultures and blood cultures were positive in 14. Organisms isolated were all skin commensals, being staphylococcal in 13 and streptococcal in 2. Six patients had concomitant rheumatological disease (gout in 4, pseudogout in one, and rheumatoid arthritis in one). Two had urate crystals in the synovial fluid (noted by microscopy). All patients underwent antimicrobial therapy for a mean of 36 days, together with joint washouts and debridement. 12 patients were cured of infection; 2 developed chronic sepsis secondary to localised osteomyelitis; and one died of sepsis. Conclusion. Septic arthritis is a potentially devastating condition. Early and aggressive joint lavage and debridement combined with appropriate antimicrobial therapy is imperative. A high index of suspicion is necessary in haemodialysis patients; the diagnosis of septic arthritis must be presumed until proven otherwise.
Composite Ceramic Bone Graft Substitute in the Treatment of Locally Aggressive Benign Bone Tumours
Authors: Schindler OS , Cannon SR , Briggs TWR , Blunn GW 
Published: October 2016

Purpose. To report the use of a composite ceramic bone graft substitute containing calcium sulphate and hydroxyapatite (HA) in the treatment of large expansive osteolytic benign bone tumours. Methods. 4 women and 9 men aged 8 to 49 (mean, 22) years with aneurysmal bone cysts (n=6) or giant cell tumours (n=7) in the epi- or meta-physeal areas of the lower limbs underwent curettage, phenolisation, and filling with bone graft substitute containing calcium sulphate and HA. The mean tumour size was 38.5 (range, 18–65) ml. The patients were followed up for a mean of 41 (range, 33–52) months. Range of movement, Musculoskeletal Tumor Society Rating Score (MTSRS), and haematological and blood biochemical parameters were measured. Results. Two patients had recurrence at 7 and 9 months, both progressed to grade-III giant cell tumours. One underwent revision with an iliac crest autograft, whereas the other underwent en bloc excision and prosthetic replacement. The 11 other lesions displayed clinical and radiological consolidation at a mean of 4.6 (range, 3–7) months. No restriction of range of movement was observed, except in the patient undergoing prosthetic replacement. The mean MTSRS was 96% (range, 83–100%) of that expected for normal function. During the follow-up period, haematological and blood biochemical parameters stayed within normal limits. Conclusion. Composite bioceramic osteoconductive grafts, which combine porous HA with calcium sulphate, provide a framework for human osteogenesis and avoid donor-site morbidity (autologous bone graft harvesting). Tumour recurrence remains a major concern especially in young patients, as revision invariably requires removal of additional bone, potentially compromising joint integrity.
Preoperative Embolisation in Benign Bone Tumour Excision
Authors: Lee VN , Nithyananth M , Cherian VM , Amritanand R , Venkatesh K , Sundararaj GD , Raghuram LN 
Published: October 2016

Purpose. To assess the role of preoperative embolisation in benign bone tumour excision. Methods. 3 men and 3 women aged 19 to 35 (mean 23) years with either a giant cell tumour or an aneurysmal bone cyst in limb girdle sites underwent preoperative embolisation a day prior to wide local excision by the same surgeon. Tumour size, blood loss, wound healing, infection, and tumour recurrence were assessed. Results. The mean total blood loss was 391 (range, 100–980) ml. No blood transfusion was needed. No patient had any surgery- or embolisation-associated complication. No tumour recurred within a minimum 5-year follow-up. All patients had satisfactory limb function. Conclusion. Preoperative embolisation is useful in the management of vascular and aggressive bone tumours located at limb girdle sites where a tourniquet cannot be used.
Needle Aponeurotomy for Dupuytren's Contracture
Authors: Cheng HS , Hung LK , Tse WL , Ho PC 
Published: October 2016

Purpose. To review the efficacy and safety of needle aponeurotomy for Dupuytren's contracture in Chinese patients. Methods. Seven men and one woman aged 50 to 80 (mean, 67) years underwent needle aponeurotomy for Dupuytren's contracture. Five were manual workers and the other 3 were retired. Their chief complaints were difficulty moving the fingers, clumsiness of the hand, and occasional pain in the palm. No patient had any family history of Dupuytren's contracture. Results. 41 points were released in 13 fingers (3 middle, 3 ring, and 7 little). Immediately after release, the respective mean flexion contracture correction of the metacarpophalangeal and proximal interphalangeal joints were 50 (from 50 to 0) and 35 (from 46 to 11) degrees. At 22-month follow-up, the respective mean residual flexion contracture of both joints were 12 and 27 degrees; the corresponding long-term improvements were 70 and 41%. No patient had a wound complication or neurovascular injury. All had a normal score for Disabilities of the Arm, Shoulder, and Hand. Conclusion. For Chinese patients with Dupuytren's contracture, needle aponeurotomy is safe and effective. Long-term correction is better maintained in metacarpophalangeal than proximal interphalangeal joints (70 vs 41%).
Twin Hook Fixation for Proximal Femoral Fractures
Authors: Hagino T , Ochiai S , Wako M , Sato E , Maekawa S , Hamada Y 
Published: October 2016

Purpose. To report results of twin hook fixation for proximal femoral fractures in comparison to those fixed with the conventional lag screw. Methods. Between August 2005 and July 2006, 2 men and 15 women aged 74 to 94 (mean, 85) years with proximal femoral fractures underwent open reduction and internal fixation using the twin hook system. The tip-apex distance was compared with that in 20 patients treated with the sliding hip screw between August 2004 and July 2005. Results. In the 17 patients, the hook was inserted into the centre of the femoral head. Bone union was achieved and no intra- or post-operative cut-out or device failure was encountered. In patients using the twin hook and sliding hip screw respectively, the mean tip-apex distance was 22.3 mm and 14.6 mm (p<0.001). Conclusion. Using the twin hook system requires more surgical skill than using the sliding hip screw, because failure to insert the pin into the centre of the femoral head risks intra-articular perforation by the hooks.
V Osteotomy and Ilizarov Technique for Residual Idiopathic or Neurogenic Clubfeet
Authors: Segev E , Ezra E , Yaniv M , Wientroub S , Hemo Y 
Published: October 2016

Purpose. To report the treatment outcomes of V osteotomy and Ilizarov technique for residual idiopathic or neurogenic clubfeet. Methods. 13 patients (14 feet) aged 8 to 18 years underwent V osteotomy via the calcaneus and talus, followed by gradual distraction of soft tissue and bone for foot reconstruction. Eight of the clubfeet were idiopathic and had undergone previous surgeries. The remaining 6 were neurogenic and their pathologies were: Charcot-Marie-Tooth disease (n=2), myelomeningocele (n=2), neurofibromatosis (n=1), and distal arthrogryposis (n=1). Three of them had undergone previous surgeries. The Ilizarov frames were retained for 3 to 6 months and the patients were followed up for 1.8 to 8.9 years. Range of movement of the ankle and foot, appearance and position, gait, pain, function, and patient satisfaction were assessed according to the modified clubfoot grading system. The talo-1st metatarsal angle was measured on anteroposterior radiographs. Results. Scores associated with the appearance and position of the foot, and thus patient satisfaction were significantly improved, but not for range of movement, pain, and function. The mean preoperative and final talo-1st metatarsal angles were 39.7 and 8.7 degrees, respectively (p<0.01). Ten feet achieved the plantigrade position, one had residual equinus, and 3 had residual adduction and supination. Conclusion. Patient satisfaction improved significantly despite no major improvement in pain, function, and range of movement of the ankle and foot. This reflects the importance of the appearance and position of the foot, and justifies the decision to undergo this long and demanding procedure.
Autologous versus Pooled Human Serum for Articular Chondrocyte Growth
Authors: Munirah S , Ruszymah BHI , Samsudin OC , Badrul AHMY , Azmi B , Aminuddin BS 
Published: October 2016

Purpose. To evaluate the effect of autologous human serum (AHS) versus pooled human serum (PHS) versus foetal bovine serum (FBS) for growth of articular chondrocytes and formation of chondrocyte-fibrin constructs. Methods. Experiments with monolayer culture expansion of human articular chondrocytes were performed using basic culture media supplemented with 10% AHS, PHS, or FBS. Growth kinetics and specific phenotypic expression of the serially expanded chondrocytes were evaluated. Large-scale culture expansion was used to obtain about 30 million cells to form chondrocyte-fibrin constructs. All constructs were implanted subcutaneously at the dorsum part of athymic nude mice for 8 weeks. The in vivo constructs were evaluated using histological and gene expression studies. Results. The morphology of primary cultured chondrocytes (P0) was polygonal and became more elongated and larger after serial passages (P1, P2, and P3). This was comparable for AHS, PHS, and FBS. Total cell yields accumulated for AHS (28 million) and PHS (41 million) were significantly higher than those for FBS (4 million). After 8 weeks of implantation, in vivo chondrocyte-fibrin constructs demonstrated a glistening white and firm texture, comparable to normal hyaline cartilage. All constructs exhibited histo-architectural characteristics of well-distributed cartilage-isolated cells embedded within basophilic ground substance. Presence of accumulated proteoglycans cartilage-rich matrix was indicated by positive orange-red Safranin O staining. During monolayer culture expansion, collagen type II gene expression was down-regulated, while collagen type I gene expression was up-regulated. Collagen type II—the specific chondrogenesis marker—was re-expressed in the in vivo chondrocyte-fibrin construct. Conclusion. AHS and PHS are better than FBS for in vitro cultivation of human articular chondrocytes.
Autologous Chondrocyte Transplantation in the Repair of Full-Thickness Focal Cartilage Damage in Rabbits
Authors: Kamarul T , Selvaratnam L , Masjuddin T , Ab-Rahim S , Ng C , Chan KY , Ahmad TS 
Published: October 2016

Purpose. To compare the efficacy of autologous chondrocyte transplantation (ACT) versus non-operative measures for cartilage repair in rabbits. Methods. Nine New Zealand white rabbits were used. Identical focal defects were created in the articular cartilage of both knees. One month later, the right knee was repaired via ACT, while the left knee was left untreated (control group). The quality of cartilage tissues in both knees was compared 3 months later, according to the quantitative analysis of glycosaminoglycan (GAG) in the cartilage and macroscopic examination of histology using the Brittberg/International Cartilage Research Society (ICRS) score. Results. Microscopic examination showed enhanced regeneration following ACT repair. Quantification analysis revealed significantly higher cellular expression of GAG in the ACT-treated knees (1.12 vs 0.81 μg GAGs/mg protein, p=0.008). The mean Brittberg/ICRS score was significantly higher in the treated knees (6.00 vs 1.89, p=0.007). Conclusion. ACT is superior to non-operative measures for repairing focal cartilage defects, as determined by favourable histological and immunohistological outcomes at the cellular level.
Morphologic Differences of the Distal Femur between Caucasian and Japanese Women
Authors: Urabe K , Mahoney OM , Mabuchi K , Itoman M 
Published: October 2016

Purpose. To compare the morphology of the distal femur between Caucasian and Japanese women. Methods. 30 Caucasian women aged 41 to 84 (mean, 67) years and 70 Japanese women aged 54 to 86 (mean, 70) years who underwent total knee arthroplasty for osteoarthritis were randomly selected. Morphologic measurements of the distal femur were compared using lateral radiographs. Both race and height influenced the morphology. To adjust for the influence of height on morphology, each measurement was divided by the patient's height and the ratios were compared. Results. Caucasian women were generally taller and heavier (p<0.001) and had higher body mass index (p=0.03) than the Japanese women. Each morphologic measurement of the distal femur was significantly longer in the Caucasian women. In both groups, anteroposterior width of the condyle correlated more with height than weight. In women of equal height, the anteroposterior and metaphyseal widths of the femur and the anterior and resected condyles were longer in Caucasian women, but the posterior condyle was longer in Japanese women. Conclusion. Both the size of the femur and the anterior and posterior condyles are significantly larger in Caucasian than Japanese women.
Inter- and Intra-Observer Errors in Identifying the Transepicondylar Axis and Whiteside's Line
Authors: Yan CH , Yau WP , Ng TP , Lie WH , Chiu KY , Tang WM 
Published: October 2016

Purpose. To assess inter- and intra-observer errors in identifying the transepicondylar axis and Whiteside's line in a cadaveric model mimicking total knee arthroplasty. Methods. Four cadaveric knees with intact soft tissues were used. The knees were exposed anteriorly using the Insall approach, with the patella everted laterally. Three observers (2 surgeons and one trainee) took turns to identify the anatomic landmarks of the transepicondylar axis and Whiteside's line. Each observer repeated the process 20 times. Each identification was photographed and referenced with the true values obtained from the knees after they were stripped of all soft tissue. Inter- and intra-observer errors in the anatomic landmarks were compared. Results. Inter-observer error was significant with both the transepicondylar axis and Whiteside's line (p<0.001, one-way ANOVA). The intra-observer variation was greater for Whiteside's line than the transepicondylar axis (standard deviation, 4.2° vs 2.5°). The maximum potential errors in the transepicondylar axis and Whiteside's line were 13° and 24°, respectively. Conclusion. The accuracy of rotational alignment of the transepicondylar axis and Whiteside's line were operator-dependent, and their intra-operative reproducibility was low.
Prosthesis Design and Stress Profile after Hip Resurfacing: A Finite Element Analysis
Authors: Heijink A , Zobitz ME , Nuyts R , Morrey BF , An KN 
Published: October 2016

Purpose. To evaluate the effect of prosthesis design on stress profile in the proximal femur after hip resurfacing. Methods. The von Mises stress profile of the native femur was simulated and compared with that of resurfaced femurs using various prosthetic materials (titanium, cobalt-chrome, ceramic), stem lengths (normal, half, short, and no stem), and femoral head coverage (shell size) [260°, 220°, 180°, and 140°]. Results. Hip resurfacing altered the stress profile of the cancellous (but not cortical) bone of the femoral neck. Maximal cortical stresses were observed at the posterior half of the medial femoral neck. The stress profile of the native femur was most similar to that of the resurfaced femur made of titanium, with a short or no stem and 260 degrees of femoral head coverage (shell size). Conclusion. Optimising prosthesis design by minimising biomechanical alterations seems a valid approach to achieving favourable long-term outcomes. Cadaveric and in vivo studies are needed to confirm the clinical relevance and feasibility.
Philos Plate Fixation for Displaced Proximal Humeral Fractures
Authors: Fazal MA , Haddad FS 
Published: October 2016

Purpose. To evaluate the treatment outcome of Philos plate fixation for displaced proximal humeral fractures in 27 consecutive patients. Methods. 6 men and 21 women aged 22 to 85 (mean, 56) years underwent Philos plate fixation for displaced proximal humeral fractures. 11 patients were aged ≤60 years and 16 >60 years. All fractures were closed with no associated injuries and classified as 2-part (n=13), 3-part (n=12), and 4-part (n=2), according to the Neer classification. Patients were assessed radiologically and functionally using the Constant shoulder score. Results. Patients were followed up for 6 to 24 (mean, 13) months. All the fractures united except in a 76-year-old woman with a 3-part fracture in whom there was fracture collapse and screw penetration of the humeral head at 6 weeks. She subsequently developed non-union and avascular necrosis. The mean Constant shoulder score was 70 (range, 28–88). 11 patients had a score exceeding 75, 13 were scored between 50 and 75, and 3 were below 50. Conclusion. Philos plate fixation provided stable fixation, minimal metal work problems and enabled early range-of-motion exercises to achieve acceptable functional results.
Ligamentotaxis for Barton's and Paediatric Distal Radial Fractures
Authors: Lakshmanan P , Sayana MK , Purushothaman B , Sher JL 
Published: October 2016

Purpose. To establish a consensus regarding immobilisation of the wrist following reduction of Barton's and paediatric distal radial fractures. Methods. Questionnaires were distributed to orthopaedic surgeons at the European Federation of National Associations of Orthopaedics and Traumatology meeting in Lisbon in 2005. Questions included the surgeon's country of practice, hospital, professional grade, years of experience, sub-specialty, and preferred position of wrist immobilisation after (1) a volar Barton's fracture, (2) a dorsal Barton's fracture, (3) a paediatric Salter-Harris type-II injury to the distal radius with volar displacement, and (4) the same injury but with dorsal displacement. Results. Of 148 questionnaires distributed, 118 were returned. The specialist-to-trainee ratio was 45:73. In volar Barton's fractures, only 20% (29% specialists and 15% trainees) would immobilise the wrist in palmar flexion, as per recommendations. In dorsal Barton's fractures, only 25% (33% specialists and 21% trainees) would immobilise the wrist in dorsiflexion, as per recommendation. In paediatric Salter Harris type-II injury to the distal radius with volar displacement, 87% (100% specialists and 79% trainees) would immobilise the wrist in dorsiflexion or in a neutral position, as per recommendation. In the same injury but with dorsal displacement, 84% (89% specialists and 81% trainees) would immobilise the wrist in palmar flexion or in a neutral position, as per recommendation. In all 4 types of fractures, 26% to 30% of respondents would immobilise the wrist in a neutral position. Conclusion. Most respondents deviate from the recommended immobilisation positions in treating Barton's fractures. Understanding of the anatomy or biomechanics of ligamentotaxis are crucial for conservative treatments.