bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconstruction of the Distal Radius with Non-Vascularised Fibular Graft after Resection of Giant Cell Tumour of Bone
Authors: Humail Syed Mujahid , Ghulam Mustaff KK , Zaidi Itaat Hussain 
Published: October 2016

Purpose. To evaluate outcomes of wide resection and reconstruction of the distal radius with non-vascularised autogenous fibular grafts for giant cell tumour (GCT) of bone. Methods. Medical records of 7 men and 5 women aged 22 to 47 (mean, 31) years who underwent wide resection of the distal radius and reconstruction with non-vascularised autogenous fibular grafts for GCT of bone were reviewed. The mean length of the resected radius was 9 (range, 7–11) cm. The ipsilateral proximal fibula with a small portion of attached ligament was harvested. The articular surface of the graft was fixed to the scapholunate articular surface by Kirschner wires, and the ligament of the fibular head was sutured to the carpal ligaments. The graft was fixed to the proximal radius with a small dynamic compression plate. Iliac cancellous bone graft was added. Pain, instability, and functional status were assessed. Wrist joint movements were measured using a goniometer. The grip strength was measured. The operated and contralateral sides were compared. Results. The mean follow-up was 24 (range, 20–27) months. All patients achieved radiological union after a mean of 16 (range, 14–20) weeks. The mean active range of movement in the operated wrists was 32° dorsiflexion, 38° palmar flexion, 15° radial deviations, 12° ulnar deviations, 50° supination, and 60° pronation. Compared with the contralateral wrists, the operated wrists regained 60% of the function, with satisfactory grip strength, and normal finger and thumb movements and hand sensation. No patient had recurrence after 2 years. Two patients had minor dorsal subluxation, which was resolved with a wrist brace. Three patients had superficial infection, which was resolved with intravenous antibiotics and dressings. Two patients had peroneal nerve palsy, which recovered completely in 12 weeks. Conclusion. Non-vascularised fibular grafts for reconstruction of the distal radius after resection of a GCT of bone achieved good cosmetic and functional outcomes.
Radiographic Changes in Nutritional Ricket Hips in Children in Response to Treatment
Authors: Agarwal Anil , Talwar Jatin 
Published: October 2016

Purpose. To review radiographic changes in the proximal femurs of children of different ages during the course of treatment for nutritional rickets. Methods. Pelvic radiographs of 161 children aged ≤13 years with nutritional rickets were retrospectively reviewed. Patients were treated with dietary counselling and vitamin D and calcium supplementation. Patients were followed up at week 3 and thereafter at a 2-month interval until ulnar convexity was achieved. Sequential radiographs of the hips in children of different ages were reviewed for each growth plate in terms of (1) the direction of growth, (2) active areas, (3) contribution of growth, and (4) the structure of the epiphysis. Radiographs were superimposed for comparison by matching the triradiate cartilage and the ischial portion of the obturator foramen. Results. The direction of growth of the growth plates was from the physeal plate that is the longitudinal growth plate of the neck (LGP), the femoral neck isthmus (FNI), and the trochanteric growth plate (TGP) to the diaphyseal region, and from the perichondrium to the ossification centre in the proximal femoral epiphysis. Before the age of one year, the growth zone of the proximal femur was homogenous, with no differentiation between the LGP, FNI, and TGP. By the age of 2 years, the differentiation was more clearly established; the FNI was usually smaller than the TGP and LGP. By the age of 3 years, the FNI became prominent and the TGP remained small. By the age of 4 years, the ossification centre of the greater trochanter appeared, and the LGP extended medially as a medial overhang (MOH). During the children's growth, the LGP, FNI, or TGP remained active to a variable extent and were distinct until the age of 6 years. Gradually, the periphery of the LGP became less active than the centre of the LGP and gave rise to the ‘eye sign’. The MOH generally ceased to be active beyond the age 9 years. By the age of 12 years, the TGP and FNI were minimally active and only the centre of the LGP remained active. Conclusion. The mineralisation process of healing rickets provides a useful biological marker for patterns of growth. Knowledge of the quantitative contribution of various growth plates of the proximal femur in childhood may increase the understanding of the pathomechanism of hip deformations.
Prevalence and Factors of Burnout among Australian Orthopaedic Trainees: A Cross-Sectional Study
Authors: Arora Manit , Diwan Ashish D , Harris Ian A 
Published: October 2016

Purpose. To assess the prevalence and factors of burnout among Australian orthopaedic trainees. Methods. 236 orthopaedic registrars of the Australian Orthopaedic Association were invited to participate in a 32-item survey by email. The questionnaire assessed potential factors associated with burnout, satisfaction with the choice of orthopaedics as a career and work-life balance, and subjective overall health, as well as 3 subscales of the Maslach Burnout Inventory – Human Services Survey for assessing burnout: emotional exhaustion, depersonalisation, and personal accomplishment. Participants with high levels of either emotional exhaustion or depersonalisation were defined as having burnout. Those with and without burnout were compared. Results. 51 (22%) of the 236 trainees completed the questionnaire. Of whom, 88% were satisfied with their choice of orthopaedics as a career, whereas 27% were satisfied with their work-life balance. 27 (53%) respondents were considered burned out. Compared with those who did not burn out, those who burned out were less satisfied with their careers (p=0.004) and work-life balance (p=0.021). Conclusion. 53% of Australian orthopaedic trainees were burned out. Burnout trainees were more likely to be dissatisfied with their career choice and work-life balance. Active interventions to combat burnout and improve work-life balance are needed.
Zancolli Lasso Procedure for Correction of Paralytic Claw Hands
Authors: Gupta Vikas , Consul Ashu , Swamy MKS 
Published: October 2016

Purpose. To evaluate the outcome of 20 claw hands corrected with the Zancolli lasso procedure. Methods. 20 patients aged 7 to 48 (mean, 28) years with claw hand deformity for a mean of 33.3 months secondary to leprosy (n=17), traumatic ulnar nerve injury (n=2), or tardy ulnar nerve palsy (n=1) underwent the Zancolli lasso procedure, in which the flexor digitorum superficialis (FDS) of the middle finger was divided in to 4 slips (one for each finger) and reattached to itself after passing through the proximal pulley. Deformity, power, movement, and function of the hands were evaluated before and after surgery. Results. The mean duration of surgery was 58.4 (range, 50–107) minutes. The mean duration of follow-up was 18 (range, 12–24) months. Deformity correction was good in 15 patients, fair in 3, and poor in 2. The mean angle improvement was maximum in the little finger, followed by the ring, index, and middle fingers. The transverse metacarpal arch (compared with the normal hand) was increased/reversed in 7 patients and decreased in 13 patients. The grip and pinch strength increased in 13 patients, remained unchanged in 6, and decreased in one. Motion and function of the hand was good in 12 patients, fair in 6, and poor in 2. One patient developed swan neck deformity in the little finger owing to suture tension of the transferred slip, and another had paraesthesia over the index finger. They underwent reoperation using the FDS of the ring finger; no sensory or motor recovery was achieved. Conclusion. The Zancolli lasso procedure is easy to perform and does not require extensive postoperative training. It restores synchronous finger flexion and spares other superficialis tendons, thus avoiding swan neck deformity of the fingers.
Effects of Anticoagulants on Outcome of Femoral Neck Fracture Surgery
Authors: Ginsel Bastiaan L , Taher Ahmad , Whitehouse Sarah L , Bell Jack J , Pulle Chrys R , Crawford Ross W 
Published: October 2016

Purpose. To review records of 330 patients who underwent surgery for femoral neck fractures with or without preoperative anticoagulation therapy. Methods. Medical records of 235 women and 95 men aged 48 to 103 years (mean, 81.6; standard deviation [SD], 13.1) who underwent surgery for femoral neck fractures with or without preoperative anticoagulation therapy were reviewed. 30 patients were on warfarin, 105 on aspirin, 28 on clopidogrel, and 167 were controls. The latter 3 groups were combined as the non-warfarin group and compared with the warfarin group. Hospital mortality, time from admission to surgery, length of hospital stay, return to theatre, and postoperative complications (wound infection, deep vein thrombosis, and pulmonary embolism) were assessed. Results. The warfarin and control groups were significantly younger than the clopidogrel and aspirin groups (80.8 vs. 80.0 vs. 84.2 vs. 83.7 years, respectively, p<0.05). 81% of the patients underwent surgery within 48 hours of admission. The overall mean time from admission to surgery was 1.8 days; it was longer in the warfarin than the aspirin, clopidogrel, and control groups (3.3 vs. 1.8 vs. 1.6 vs. 1.6 days, respectively, p<0.001). The mean length of hospital stay was 17.5 (SD, 9.6; range, 3–54) days. The overall hospital mortality was 3.9%; it was 6.7% in the warfarin group, 3.8% in the aspirin group, 3.6% in the clopidogrel group, and 3.6% in the control group (p=0.80). Four patients returned to theatre for surgery: one in the warfarin group for washout of a haematoma, 2 in the aspirin group for repositioning of a mal-fixation and for debridement of wound infection, and one in the control group for debridement of wound infection. The warfarin group did not differ significantly from non-warfarin group in terms of postoperative complication rate (6.7% vs. 2.7%, p=0.228) and the rate of return to theatre (3.3% vs. 1%, p=0.318). Conclusion. It is safe to continue aspirin and clopidogrel prior to surgical treatment for femoral neck fracture. The risk of delaying surgery outweighs the peri-operative bleeding risk.
Salvage of Infected Non-Union of the Tibia with An Ilizarov Ring Fixator
Authors: Khan Muhammad Shahid , Rashid Haroon , Umer Masood , Qadir Irfan , Hafeez Kamran , Iqbal Arshad 
Published: October 2016

Purpose. To review outcomes of 24 patients who underwent Ilizarov ring fixation for infected non-union of the tibia. Methods. Medical records of 21 men and 3 women aged 13 to 74 (mean, 38) years who underwent Ilizarov ring fixation for infected non-union of the tibia were reviewed. The mean bone defect was 3.3 (range, 2–5) cm. The mean time from injury to presentation was 11.9 (range, 1–36) months. The mean number of previous surgeries was 2 (range, 0–14). A local flap was used in 2 patients and a free flap was used in one patient. Nine of the patients underwent Ilizarov ring fixation without soft tissue and bony resection, as inadequate stability was the reason for non-union. Patients were assessed using the Association for the Study and Application of the Method of Ilizarov criteria. Results. Patients were followed up for a mean of 11 (range, 8–46) months. Functional outcome was excellent in 8 patients, good in 12, fair in 2, and failure in one, whereas bone union outcome was excellent in 6 patients, good in 14, fair in one, and poor in 2. The mean time to union was 8 (range, 3–31) months. The mean external fixation index was 4.2 (range, 1.5–15.7) cm/month. Complications encountered were pin tract infection (n=5), re-fracture (n=2), soft tissue impingement by Ilizarov rings (n=2), recurrence of wound infection (n=1), mal-union (n=1), and mortality (n=1). Conclusion. Ilizarov ring fixation is a viable option for infected non-union of the tibia. Adequate assessment of bone union is crucial before removal of fixator to prevent re-fracture.
Infection Rates in Singaporeans with and without Complicated Diabetes after Ankle Fracture Surgery
Authors: Tan Tong Leng , Oh Jacob YL , Kwek Ernest Beng Kee 
Published: October 2016

Purpose. To compare infection rates in Singaporeans with and without complicated diabetes after ankle fracture surgery. Methods. Medical records of 18 men and 27 women aged 38 to 84 (mean, 62) years with complicated (n=12) or uncomplicated (n=33) diabetes who underwent internal fixation for closed ankle fractures were reviewed. Complicated diabetes was defined as having end organ dysfunction. The control of diabetes was categorised as good (n=19), fair (n=10), and poor (n=16), based on HbA1c level within 4 months before or after surgery. Patients were followed up at weeks 2, 6, 12, and 24, with bone union as the end point. Results. The mean follow-up period was 9 (range, 4–12) months. 2 (6%) of 33 patients with uncomplicated diabetes and 6 (50%) of 12 patients with complicated diabetes developed superficial or deep infection. No patient died or underwent amputation secondary to infection. In multivariable logistic regression analysis after adjusting for co-morbidities, only complicated diabetes was a risk factor for postoperative infection (odds ratio=11.85, p=0.01). The odds of postoperative infection was 11.85 times higher in patients with complicated diabetes than with uncomplicated diabetes. Conclusion. In patients with complicated diabetes, careful patient selection, peri-operative precaution, and closer monitoring are recommended if surgery is necessary.
Preoperative Antibiotics for Septic Arthritis in Children: Delay in Diagnosis
Authors: MacLean Simon BM , Timmis Christopher , Evans Scott , Lawniczak Dominik , Nijran Amit , Bache Edward 
Published: October 2016

Purpose. To review the records of 50 children who underwent open joint washout for septic arthritis with (n=25) or without (n=25) preoperative antibiotics. Methods. Records of 50 children who underwent open joint washout for presumed septic arthritis with (n=25) or without (n=25) preoperative antibiotics were reviewed. 17 boys and 8 girls aged 3 weeks to 16 years (median, 1.5 years) who were prescribed preoperative antibiotics before joint washout were compared with 12 boys and 13 girls aged one month to 14 years (median, 2 years) who were not. Following arthrotomy and washout, all patients were commenced on high-dose intravenous antibiotics. Patients were followed up for 6 to 18 months until asymptomatic. Results. Patients who were referred from places other than our emergency department were twice as likely to have been prescribed preoperative antibiotics (p=0.0032). Patients prescribed preoperative antibiotics had a longer median (range) time from symptom onset to joint washout (8 [2–23] vs. 4 [1–29] days, p=0.05) and a higher mean erythrocyte sedimentation rate (93.1 vs. 54.3 mm/h, p=0.023) at presentation. Nonetheless, the 2 groups were comparable for weight bearing status, fever, and positive culture, as well as the mean (range) duration of antibiotic treatment (4.9 [4–7] vs. 4.7 [1–8] weeks, p=0.586). Conclusion. Preoperative antibiotics should be avoided in the management of septic arthritis in children. Their prescription delays diagnosis and definitive surgery, and leads to additional washouts and complications. A high index of suspicion and expedite referral to a specialist paediatric orthopaedic unit is needed if septic arthritis is suspected.
Tuberculosis of the Calcaneus in Children
Authors: Agarwal Anil , Kant Kumar Shashi , Suri Tarun , Gupta Neeraj , Verma Indreshwar , Shaharyar Abbas 
Published: October 2016

Purpose. To review 10 children with calcaneal tuberculosis in terms of presentation, healing, and functional outcome. Methods. Medical records of 7 boys and 3 girls aged 7 to 12 (mean, 9.8) years who presented with calcaneal tuberculosis were reviewed. The erythrocyte sedimentation rate of all patients was elevated. All patients presented with pain and swelling around the lateral malleolus and a ‘heal-up’ sign; 7 of them presented with an additional discharging sinus. Three patients had palpable lymph nodes in the right inguinal or left popliteal region. Symptoms had lasted for one month to 1.5 years. Two patients had healed tuberculosis in the lungs; 8 patients had no pulmonary involvement. Seven patients had a single lytic lesion in the calcaneal body (n=1), tuberosity (n=3), and extension to anterior process (n=3). Three patients had multiple lytic lesions in the calcaneum; one of them had bilateral involvement who had lesions in the phalanges, lumbar spine, and ulna. Two patients had subtalar joint involvement. Results. The mean follow-up period was 17 (range, 8–60) months. The erythrocyte sedimentation rate returned to normal after 3 months in 7 patients and after >6 months in 3 patients. The subtalar range of movement was normal in all except for 2 patients. One patient developed subtalar ankylosis. Sinuses healed in a mean of 10 (range, 2–16) weeks. No patient had pain on level walking after treatment. At 3 months, remineralisation of bone was evident in all patients. Sclerosis of cavity margins and sequestra resorption was noted from 6 to 9 months. No patient experienced recurrence. Conclusion. The ‘heel up’ sign was common in children with calcaneal tuberculosis in this endemic region. The central granuloma-type presentation was the most common. Pathological fractures and involvement of the subtalar joint were not common. Subtalar joint involvement was a poor prognostic factor.
Effects of Thermoablation with or without Caffeine on Giant Cell Tumour of Bone
Authors: Pimolsanti Rapin , Wongkajornsilpa Adisak , Chotiyarnwong Pojchong , Asavamongkolku Apichart , Waikakul Saranatra 
Published: October 2016

Purpose. To evaluate the effect of caffeine on the apoptosis rate of giant cell tumour of bone cells during thermoablation. Methods. Giant cell tumour of bone tissue (2 cm3) was collected from 10 patients. Cells were incubated at 37°C, 40°C, 45°C, 50°C, 52.5°C, and 55°C for 20 minutes (3 tubes for each temperature). Caffeine was added to the tubes in amounts of 0 μg/ml (control), 50 μg/ml, and 100 μg/ml. The apoptotic effect of thermoablation with or without caffeine was evaluated. Results. In all test conditions, the apoptotic rate of tumour cells increased when the temperature increased. Compared with controls (no caffeine), adding 50 or 100 μg/ml of caffeine did not increase the apoptotic rate significantly at 40°C to 52.5°C. Caffeine had no enhancing effect at any temperature. Conversely, at 55°C, the apoptotic rate was lower when 100 μg/ml of caffeine was added than when no or 50 μg/ml of caffeine added (p=0.045). Conclusion. Thermoablation at 40°C to 52.5°C for 20 minutes increased the apoptosis rate of giant cell tumour of bone cells. Caffeine had no enhancing effect at any temperature. Conversely, at 55°C, caffeine had cytoprotective effects on the tumour cells against thermoablation.
Development of a Pelvic Discomfort Index to Evaluate Outcome following Fixation for Pelvic Ring Injury
Authors: Borg Tomas , Hernefalk Bjorn , Carlsson Marianne , Larsson Sune 
Published: October 2016

Purpose. To develop a pelvic discomfort index (PDI) to evaluate outcome following fixation for pelvic ring injury. Methods. 29 female and 44 male consecutive patients (mean age, 36 years) underwent internal fixation for pelvic ring injury of type B1 (n=10), B2 (n=22), B3 (n=15), C1 (n=18), C2 (n=5), and C3 (n=3), based on the AO/OTA classification. At postoperative 6, 12, and 24 months, patients were asked to assess their discomfort in the pelvis using a 14-item questionnaire. Three questions were open-ended, and responses were categorised by a single assessor. The remaining 11 questions were closed-ended and had 6 ordinal options from ‘no discomfort’ (score=0) to ‘extremely severe discomfort’ (score=5). The content validity and relevance of the 11 closed-ended questions was determined. The 14-item questionnaire was compared with the 36-item Short Form Health Survey (SF-36). Results. Respectively at postoperative 6, 12, and 24 months, 78%, 71%, and 71% of the patients completed the 14-item questionnaire. Based on the factor analysis and responses to the open-ended questions, the number of items was reduced to 6 including pain, walking, mobility of the hips, loss of sensation in the legs, sexual life, and operation scar. Four factors could explain 96% of the total variance. The first factor involved the first 3 items (pain, walking, and hip motion) and addressed ‘pelvis’, whereas 3 factors involved the remaining items and each addressed peripheral neurology, sexual life, and operation scar. A PDI was developed using these 6 items. The PDI had high internal reliability (α=0.89), adequate content and criterion validity, and moderate correlation with the SF-36 total score or scores of physical function, bodily pain, and general health ( r=0.50–0.77). Conclusion. The PDI provides valid, specific, and relevant information to assess outcome following fixation for pelvic ring injury.
Screw Length in Volar Locking Plate Fixation for Distal Radial Fractures
Authors: Yuen Grace , Yee Dennis KH , Fang Christian , Lau Tak-Wing , Leung Frankie 
Published: October 2016

Purpose. To develop a reference for the distal screw length in volar locking plate fixation for distal radial fractures in an East Asian population. Methods. 12 pairs of forearm specimens from 11 male and one female East Asian cadavers were scanned using computed tomography. On sagittal images of the distal radius, the mean cortex-to-cortex distance of 8 quadrants was measured as a reference for the distal screw length. In addition, intra-operative 3-dimensional fluoroscopy of 10 male and 10 female patients who underwent volar locking plate fixation for distal radial fractures was used to validate the distal screw length in the cadaveric reference. 76 distal locking screws were applied in the 8 quadrants; their cortex-to-cortex distances were measured. Results. The mean cortex-to-cortex distances at quadrants A, B, C, D, E, F, G, and H were 15.4 mm, 19.6 mm, 20.8 mm, 20.0 mm, 13.3 mm, 18.0 mm, 18.8 mm, and 17.4 mm, respectively. In 45% of the specimens, the 2 screws inserted at quadrants C and D were longest. Distal screws (quadrants A to D) were significantly longer than proximal screws (quadrants E to H) [p=0.02]. In intra-operative 3-dimensional fluoroscopic images, 2 of the 76 distal locking screws penetrated the dorsal cortex (one in quadrant A and one in quadrant F). The mean screw length was 88.0% of the cortex-to-cortex distance. Referenced to the cadaveric data, 88.2% of the screws could be safely inserted without penetrating the dorsal cortex, and the remaining 11.8% of screws (5 at quadrant D, one at quadrant B, and 3 at quadrant C; all in female patients) could potentially cause dorsal cortex penetration of 2 to 4 mm. In male patients, the mean screw length was 76.1% of the cortex-to-cortex distance based on the cadaveric reference. In female patients, when the screw length was 4 mm less than the cadaveric reference, the mean screw length would be 72.0% of the referenced cortex-to-cortex distance, with no dorsal cortex penetration. Conclusion. In female patients, the screw length should be 4 mm less than the cadaveric reference to avoid dorsal cortex penetration.