bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoprosthetic Replacement for Giant Cell Tumour of the Proximal Femur
Authors: Khan Shah Alam , Kumar Ashok , Inna Prashanth , Bakhshi Sameer , Rastogi Shishir 
Published: October 2016

Purpose. To evaluate the functional and oncological outcomes of 12 patients with giant cell tumour (GCT) of the proximal femur treated with customised endoprosthesis. Methods. Nine men and 3 women aged 26 to 52 (mean, 36) years with Campanacci stage-III GCTs of the proximal femur were included. All underwent a wide excision of the tumour with clear margins and replacement using a customised, bipolar, cemented proximal femoral megaprosthesis. Functional outcomes were evaluated using the Musculoskeletal Tumor Society functional scores. Results. The mean follow-up period was 4.8 (range, 4–6) years. There were no instances of recurrence, dislocation, aseptic loosening, deep infection, or death. At the end of 4 years, 8 patients were walking unassisted, 2 used a cane to support during outdoor activities, one used a walking frame at home and outdoors, and one was lost to follow-up. The mean pain relief score was 5.0, the mean functional score was 4.3, the mean emotional acceptance of the procedure and its outcome was 4.7, the mean lower extremity score for support use was 4.7, for walking ability was 4.5, and for gait was 4.3, and the mean total score was 28.3 (out of the maximum of 30). Conclusion. Endoprosthetic replacement for Campanacci stage-III GCT of the proximal femur achieves good to excellent functional and oncological outcomes.
Non-Emergency Management of Hip Fractures in Older Patients
Authors: Adie Sam , Harris Ian A , Thorn Lyndall , McEvoy Lynette , Naylor Justine M 
Published: October 2016

Purpose. To evaluate the effects of a policy change from emergency to scheduled management of hip fractures in older patients. Methods. 91 and 107 patients aged 50 years or older with hip fractures were scheduled for operation on the emergency and orthopaedic lists, respectively. Cancellation rates, consultant supervision rates, after-hour operation rates, 30-day mortality, and preoperative and total length of hospital stay were compared. Results. When older patients with hip fractures were scheduled on orthopaedic lists rather than emergency lists, the cancellation rates owing to lack of theatre time (4% vs 54%, p<0.001), the supervision rates (45% vs 24%, p=0.002), and after-hour operation rates (1% vs 25%, p<0.001) were significantly better. The 30-day mortality rates decreased from 4.4% to 1.9% (p=0.3). The median preoperative length of hospital stay significantly increased from 2 to 4 days (p=0.046), but the increase in total length of hospital stay was non-significant (6 to 10 days, p=0.14). Conclusions. Non-emergency management of hip fractures in older patients resulted in fewer cancellations and after-hour operations, and increased consultant supervision. Nonetheless, extra time slots for operating theatres are required to avoid an associated increase in preoperative and total length of hospital stay.
Tibiotalocalcaneal Arthrodesis Using a Supracondylar Femoral Nail for Advanced Tuberculous Arthritis of the Ankle
Authors: Gavaskar Ashok S , Chowdary Naveen 
Published: October 2016

Purpose. To review 7 patients with advanced osteoarticular tuberculous arthritis of the ankle who underwent arthrodesis using a supracondylar femoral nail. Methods. All patients showed gross destruction of the articular cartilage of the tibiotalar joint with severe periarticular rarefaction on radiographs. Their pre- and one-year post-operative Foot and Ankle Outcome Scores (FAOS) were compared. All patients underwent joint debridement, complete synovial excision, and arthrodesis using a supracondylar femoral nail, followed by multidrug chemotherapy for 12 months (isoniazid, rifampicin, pyrazinamide, and ethambutol for 3 months, and isoniazid and rifampicin for 9 months). Results. All patients achieved fusion in a mean of 13 weeks and regained their preoperative level of independence. No patient had a relapse, major complications, or hardware failure. At postoperative year one, the mean FAOS for pain improved to 85 from 26, whereas the mean FAOS for quality of life improved to 60 from 5. Conclusion. Tibiotalocalcaneal arthrodesis using a supracondylar femoral nail, combined with debridement and multidrug therapy, enabled a reliable one-stage solution for advanced osteoarticular tuberculosis and early return to function.
Discrepancy between Anatomical Axis and Stem Position of Various Femoral Components in Japanese
Authors: Ueno M , Urabe Ken , Fujita Mamou , Aikawa Jun , Kobayashi Akimasa , Itoman M 
Published: October 2016

Purpose. To evaluate the discrepancy between the anatomical axis of the distal femur of Japanese patients and the stem position of 5 types of femoral components. Methods. Lateral radiographs of 12 men and 88 women aged 31 to 83 (mean, 59) years with rheumatoid arthritis were evaluated. The discrepancy between the anatomical axis of the distal femur and the stem position of 5 types of femoral components (Nexgen LCCK, Press-Fit Condylar, Scorpio, Total Stabilizer, and Rotating Hinge) was determined by superimposing the template of each model over each lateral radiograph. Results. The anatomical axis varied widely among our patients, as did the stem position of the 5 femoral components. Stems of all 5 femoral components tended to be more posterior than the anatomical axis. The discrepancy was smallest in the Nexgen LCCK, followed by the Press-Fit Condylar components. It was >3 mm in the other 3 models. In 35% of the patients, none of the prosthesis could be placed in an appropriate position. Smaller-size prostheses appear necessary for the Japanese. Conclusion. The stem position should be an important factor guiding selection of the appropriate model. The currently available femoral components may not be appropriate for the Japanese. Prostheses with appropriately positioned stems for Japanese patients with rheumatoid arthritis should be developed.
Evaluation of Soft-Tissue Balance during Total Knee Arthroplasty
Authors: Sasanuma Hideyuki , Sekiya Hitoshi , Takatoku Kenzo , Takada Hisashi , Sugimoto Naoya 
Published: October 2016

Purpose. To evaluate soft-tissue balance during versus after total knee arthroplasty (TKA). Methods. 18 men and 75 women aged 52 to 85 (mean, 68) years who had moderate-to-severe varus deformity underwent TKAs using the Scorpio non-restrictive geometry posterior-stabilised system (Stryker Howmedica Osteonics; Allendale, [NJ], USA). All surgeries were performed by a single surgeon using the medial parapatellar approach. After the bony and soft-tissue procedures, soft-tissue balance was measured intra-operatively using a tensor/balancer device. The coronal laxity—angles between the cut surfaces of the femur and tibia—were measured at 0° (in extension) and 90° (in flexion). The central gap was also measured. Immediate postoperative soft-tissue balance was measured using an arthrometer, while anteroposterior stress radiographs were being taken. A valgus or varus force was applied just above the knee on the lateral or medial side, with the knee counter-supported and at 15° flexion. Results. Intra-operatively, the mean coronal laxity at 0° (in extension) and 90° (in flexion) was 2.1° and −1.6°, and the mean central gaps were 21.2 and 23.5 mm, respectively. Immediate postoperative mean coronal laxity was 2.9°, indicating that lateral laxity was greater than medial laxity. The postoperative coronal laxity was positively corrected to the intra-operative coronal laxity at 0° ( r=0.304, p=0.003), but not to the intra-operative coronal laxity at 90° ( r= −0.07, p=0.47). Conclusion. Slightly greater lateral laxity was observed after TKA, although equal medial-lateral balance was achieved intra-operatively.
Static Progressive Stretching Using a Turnbuckle Orthosis for Elbow Stiffness: A Prospective Study
Authors: Bhat Anil K , Bhaskaranand Kumar , Nair Surej Gopinathan 
Published: October 2016

Purpose. To assess the effectiveness of a turnbuckle orthosis as a means of improving the range of motion in patients with elbow stiffness. Methods. 17 males and 11 females aged 8 to 68 (mean, 32) years underwent static progressive stretching using a turnbuckle orthosis for elbow stiffness secondary to trauma or surgery. Patients were instructed to wear the orthosis during the daytime for a mean of 15 hours and remove it during sleep as well as at breakfast, lunch, and dinner. One hour of range-of-motion exercise was performed during each break. Patients were followed up every month and the range of motion was recorded with a standard goniometer. The use of orthosis was discontinued when there was no further improvement. Range-of-motion exercise was encouraged thereafter to maintain the results. The extent of flexion contracture and range of motion before and after the treatment were compared. Results. The mean duration of orthosis use was 5 (range, 3–8) months. The mean flexion contracture reduced from 59° to 27° and the range of motion improved from 57° to 102°. 19 of the patients achieved a functional range of motion. Improvement in the range of motion was excellent in 6 patients, good in 11, satisfactory in 7; at the end of follow-up (mean, 29 months), the results were maintained or improved further in 20 patients (even in those with long-standing contractures). Conclusion. Static progressive stretching using a turnbuckle orthosis is reliable and cost-effective for treating elbow stiffness.
Infection Rate of Percutaneous Kirschner Wire Fixation for Distal Radius Fractures
Authors: Lakshmanan Palaniappan , Dixit Varun , Reed Mike R , Sher Joel Lester 
Published: October 2016

Purpose. To review the infection rate in 43 patients who underwent percutaneous Kirschner wire fixation for distal radius fractures. Methods. Records of 13 men and 30 women aged 25 to 86 (mean, 49) years who underwent closed reduction and percutaneous Kirschner wire fixation for unstable distal radius fractures were reviewed. Each fracture was fixed with 2 to 3 wires of 1.6-mm diameter. Kirschner wires were left protruding through the skin for easy removal, with their ends bent outside the skin to prevent migration. Wounds were cleaned and dressed with gauze and a plaster-of-Paris cast was applied. The severity of the pin tract infection was graded according to the modified Oppenheim classification. Results. Nine (21%) of the patients developed pin tract infection (3 grade 1, 3 grade 2, 2 grade 3, and one grade 4). Three patients underwent early removal of the Kirschner wires at week 3. Conclusion. The infection rate after percutaneous Kirschner wire fixation is unacceptable. Kirschner wires should be buried under the skin to decrease the infection rate.
A Multidisciplinary Rehabilitation Programme for Patients with Chronic Low Back Pain: A Prospective Study
Authors: Luk Keith Dip Kei , Wan Thomas Wai Man , Wong Yat Wa , Cheung Kenneth Man Chee , Chan Keith Ying Kei , Cheng Aldous Chun Shing , Kwan Mike Wing Wang , Law Karlen Kar Pui , Lee Peter Wing Ho , Cheing Gladys Lai Ying 
Published: October 2016

Purpose. To examine the effectiveness of a multidisciplinary rehabilitation programme for patients with chronic low back pain in Hong Kong, and to identify factors associated with work resumption. Methods. 57 men and 8 women aged 20 to 56 (mean, 39) years who had a >3-month history of low back pain and were unresponsive to >6 months of conventional treatment participated in a 14-week multidisciplinary rehabilitation programme involving physical conditioning, work conditioning, and work readiness. Training protocols entailed flexibility and endurance training, hydrotherapy, weight lifting, and work stimulation. Patients were assessed at baseline (week 1), week 7, week 14, and month 6 with regard to the intensity of low back pain, self-perceived disability, range of lumbar motion, isoinertial performance of the trunk muscles, and depression level. Patient demographics that influenced work resumption were identified using a prediction model. Patients who did and did not return to work were compared. Results. Of the 54 patients who completed all follow-up assessments, 28 returned to work and 26 did not. The latter was significantly older (37 vs. 42 years, p=0.038) and absent from work longer (11 vs. 22 months, p=0.029) than the former. The rehabilitation programme helped patients regain physical function and the ability to work. Patients who returned to work showed greater improvement in self-perceived disability and physical function. Conclusion. This rehabilitation programme facilitated regain of physical functioning and the ability to return to work. The pre-programme employment status, duration of absence from work, and patient age were the most important predictors for work resumption.
Cementing Polyethylene Liners into Non-Modular Acetabular Components in Revision Total Hip Arthroplasty
Authors: Khanuja Harpal S , Aggarwal Ajay , Hungerford Marc W , Hungerford David S , Jones Lynne C , Mont Michael A 
Published: October 2016

Purpose. To review mid-term results after replacing the polyethylene liner in a well-fixed acetabular shell. Methods. 22 patients underwent replacement of the polyethylene liner in a well-fixed acetabular shell using cementation. The inner surface of the metal shell was scored with grooves (1 to 2 mm deep) for cement interdigitation. Trial liners were used to assess the appropriate size, with an aim to provide at least 2 mm of an even cement mantle behind the polyethylene liner. None of the liners were constrained or lipped. Clinical and radiographic outcomes were evaluated, and Harris Hip Scores obtained. Radiographic loosening of the acetabular shell was recorded. Implant survival was evaluated using the Kaplan-Meier estimator. Results. After a mean follow-up of 70 (range, 21–189) months, 17 patients had stable hips and their mean Harris Hip Score was 89 (range, 72–93). Four patients underwent re-revision after 28 to 108 months for aseptic loosening of the acetabular shell (n=2) and recurrent dislocation (n=2). One patient showed radiographic evidence of acetabular migration but was stable. The femoral components of all patients were stable. 92% of patients had good-to-excellent results. Implant survival at 60 months was 81% (95% confidence interval [CI], 51–94%); it became 91% (95% CI, 61–99%) if reductions for dislocations were excluded. Conclusion. Cementation of an undersized polyethylene liner into a non-modular shell is one option for revision of a well-fixed acetabular shells. Nonetheless, further follow-up is required to determine if it remains a viable option in the long term. If there is any doubt about the stability of the acetabular shell, a complete revision should be performed.
Mortality after Hip Fracture in Japan: The Role of Nutritional Status
Authors: Miyanishi Keita , Jingushi Seiya , Torisu Takehiko 
Published: October 2016

Purpose. To assess factors that influence 4-year mortality following hip fracture surgery in a Japanese population. Methods. Records of 129 hips in 24 men and 103 women aged 50 to 103 (mean, 79) years who underwent surgery for femoral neck or trochanteric fractures were reviewed. Clinical data reviewed included age, gender, body mass index (BMI), side of fracture, fracture type, fracture stability, surgery type, interval from admission to surgery, length of hospital stay, number of pre-fracture comorbidities, pre-fracture ambulatory level, pre-fracture place of residence, preoperative dementia, preoperative skeletal traction, blood haemoglobin level, serum albumin level, number of postoperative complications, and postoperative delirium. Univariate and multiple logistic regression analyses were performed to identify the relative contribution of the variables to mortality. Receiver operating characteristic (ROC) curves were used to identify optimal cut-off levels. Results. The 4-year mortality was 48%. Multiple logistic regression analysis showed that serum albumin level (p=0.0004, odds ratio [OR]=5.8541) and BMI (p=0.0192, OR=1.1693) significantly influenced mortality; the cut-off points were 36 g/l and 18.9 kg/m2, respectively, based on the ROC curves. Kaplan-Meier curves showed that survival rates were significantly worse in patients with values below these cut-off points. Conclusion. Serum albumin level and BMI on admission are predictive of mortality after hip fracture surgery.
Knee Joint Effusion following Ipsilateral Hip Surgery
Authors: Christodoulou AG , Givissis P , Antonarakos PD , Petsatodis GE , Hatzokos I , Pournaras JD 
Published: October 2016

Purpose. To correlate patellar reflex inhibition with sympathetic knee joint effusion. Methods. 65 women and 40 men aged 45 to 75 (mean, 65) years underwent hip surgery. The surgery entailed dynamic hip screw fixation using the lateral approach with reflection of the vastus lateralis for pertrochantric fractures (n=49), and hip hemiarthroplasty or total hip replacement using the Watson-Jones approach (n=38) or hip hemiarthroplasty using the posterior approach (n=18) for subcapital femoral fractures (n=28) or osteoarthritis (n=28). Knee joint effusion, patellar reflex, and thigh circumference were assessed in both legs before and after surgery (at day 0.5, 2, 7, 14, 30, and 45). Time-sequence plots were used for chronological analysis, and correlation between patellar reflex inhibition and knee joint effusion was tested. Results. In the time-sequence plot, the peak frequency of patellar reflex inhibition (on day 0.5) preceded that of the knee joint effusion and the thigh circumference increase (on day 2). Patellar reflex inhibition correlated positively with the knee joint effusion ( r=0.843, p=0.035). These 2 factors correlated significantly for all 3 surgical approaches (p<0.0005). All 3 approaches were associated with patellar reflex inhibition on day 0.5 (p=0.033) and knee joint effusion on day 2 (p=0.051). Conclusion. Surgical trauma of the thigh may cause patellar reflex inhibition and subsequently knee joint effusion.
Biopsy of Vertebral Tumour Metastasis for Diagnosing Unknown Primaries
Authors: Buyukbebeci Orhan , Karakurum Gunhan , Tutar Ediz , Gulec Akif , Arpacioglu Omer 
Published: October 2016

Purpose. To examine patients with vertebral tumour metastasis using transpedicular biopsy for diagnosing unknown primary tumours. Methods. 13 men and 8 women aged 41 to 80 (mean, 61) years with vertebral tumour metastasis of unknown primary origin underwent transpedicular biopsy of the affected vertebra. Results. The origins of the primary tumours were lung cancer (n=6), prostate cancer (n=5), colorectal cancer (n=5), kidney cancer (n=4) and lymphoma (n=1). All the specimens matched pathological characteristics of their corresponding primary tumours, except in one patient. This 42-year-old man had stage-4 colon cancer, in whom the pathologic findings could not enable differentiation between colon and prostate cancer. Conclusion. Transpedicular biopsy of the vertebra is a cost-effective diagnostic tool for evaluating unknown primary tumours.
Microendoscopic versus Open Discectomy for Lumbar Disc Herniation: A Prospective Randomised Study
Authors: Garg Bhavuk , Nagraja Upendra Bidre , Jayaswal Arvind 
Published: October 2016

Purpose. To compare the outcomes of microendoscopic discectomy (MED) versus open discectomy for lumbar disc herniation. Methods. 80 men and 32 women aged 26 to 57 (mean, 37) years with a single-level disc herniation were randomised to undergo MED (n=55) or open (fenestration/laminotomy) discectomy (n=57). Patients were assessed pre- and post-operatively (at week 6, month 6, and year one). The 2 groups were compared with respect to surgical time, anaesthesia time, duration of hospital stay, intra-operative blood loss, weight of disc material removed, and self-evaluated low back pain and functional outcome (using the Oswestry low back pain disability questionnaire). Results. Surgical and anaesthesia times were significantly longer, but blood loss and hospital stay were significantly reduced in patients having MED than open discectomy. The improvement in the Oswestry score in both groups was significant at week one, but not at other follow-ups. The complication rate was similar in both groups. One patient with MED had a recurrence of disc herniation after 7 months and was treated with open discectomy. Conclusions. Both methods are equally effective in relieving radicular pain. MED entailed shorter hospital stay, less morbidity, and earlier return to work. Nonetheless, it is a demanding technique and should not be attempted without specific instruction and training.
Open Wedge Osteotomy of the Proximal Medial Tibia for Malunited Tibial Plateau Fractures
Authors: Singh Harpreet , Singh Vikas Rajesh , Yuvarajan P , Maini Lalit , Gautam VK 
Published: October 2016

Purpose. To review outcomes of open wedge osteotomy of the proximal medial tibia for malunited tibial plateau fractures. Methods. Seven men (mean age, 36 years) underwent open wedge osteotomy of the proximal medial tibia for instability secondary to malunited tibial plateau fractures of Schatzker types IV (n=3), V (n=1), and VI (n=3). Five patients had been treated conservatively and 2 surgically. Results. Patients were followed up for 12 to 30 months. Five patients achieved complete correction of the deformity, whereas 2 had residual articular surface depression of <2 mm. All patients were satisfied with their improvement in stability and knee function. One patient developed anterior cruciate ligament deficiency and instability and underwent anterior cruciate ligament reconstruction. No patient developed any complication related to wound healing. No delayed loss of correction was observed. Conclusion. Open wedge osteotomy of the proximal medial tibia is recommended for young adults with instability of the knee joint secondary to malunited proximal tibial plateau fractures. The technique is simple and does not require specialised training or any specific instrumentation.
Medium-Term Outcome of Titanium Uncemented Stems in Revision Total Hip Arthroplasty
Authors: Murray Rachel C , Horne J Geoffrey 
Published: October 2016

Purpose. To assess the medium-term outcome of titanium uncemented modular tapered stems in revision total hip arthroplasty (THA). Methods. A questionnaire was mailed to 421 patients who underwent revision THA using a titanium uncemented modular tapered stem. 66 of whom underwent re-revision THA. The questionnaire was composed to reveal the Charnley classification, the modified 12-item Oxford hip score, and the Devane patient activity level. Results. 323 (77%) of the patients responded. The mean follow-up time was 6.6 years. 12 patients underwent bilateral revision THA. The mean Oxford hip score was 35.7, compared to 35.8 for all-component revision at postoperative month 6 in the New Zealand Joint Registry. The median Oxford hip scores for the subgroups of the stem-only revision (n=92), all-component revision (n=215), and re-revision (n=16) were 38, 39.9, and 30, respectively. The difference was significant between all-component revision and re-revision (adjusted p=0.003), and between stem-only revision and re-revision (adjusted p=0.037). Regarding patient distribution according to the Charnley class and the Devane patient activity level, the difference was significant between the mean Oxford hip scores of Charnley classes B and C (adjusted p=0.017), and between the Devane patient activity levels of Charnley classes A and C (adjusted p=0.043). Conclusion. The medium-term outcome of revision THA using a titanium uncemented modular tapered stem was comparable to that reported for other stems.