bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional Outcome of the Hand following Flexor Tendon Repair at the ‘No Man's Land’
Authors: Chan TK , Ho CO , Lee WK , Fung YK , Law YF , Tsang CY 
Published: October 2016

Purpose. To evaluate the functional outcome of the hand following flexor tendon repair at ‘no man's land’ using 2 strands of a modified Kessler core suture and combined controlled motion rehabilitation protocol. Methods. Records of 31 zone-2 flexor tendon injuries in 21 digits of 16 patients between July 2000 and June 2005 were reviewed retrospectively. The injured tendons were repaired within 24 hours using 2 strands of a modified Kessler core suture, reinforced by a continuous circumferential epitendon suture. All patients completed a rehabilitation protocol that included active extension against a rubber band, passive flexion, and controlled passive extension and passive flexion exercises. Functional outcome of the fingers was assessed using the Buck-Gramcko II score. Hand grip strength, rehabilitation period, and rupture rate were also measured. Results. 17 (81%) out of 21 digits in 15 out of 16 patients achieved an excellent-to-good functional grade. The remaining patient with concomitant injuries to 4 (19%) digits attained a poor functional grade, attributable to poor compliance with the rehabilitation protocol. The mean rehabilitation period was 130 days and the mean grip strength was 78% that of the uninjured side. Concomitant digital nerve injury did not adversely affect the final outcome. Only one (4.8%) patient experienced a rupture. Conclusion. The surgical method and rehabilitation protocol used for zone-2 flexor tendon injury is safe and results in a reasonably good functional outcome.
Treatment for Unstable Intertrochanteric Fractures in Elderly Patients: Internal Fixation versus Cone Hemiarthroplasty
Authors: Kayali C , Agus H , Ozluk S , Sanli C 
Published: October 2016

Purpose. To evaluate the effectiveness of internal fixation versus cone hemiarthroplasty for the treatment of unstable intertrochanteric fractures in elderly patients. Methods. The choice of treatment was based on the year of admission: between 2001 and 2003, 42 patients (mean age, 73 years) underwent cone hemiarthroplasty using a cementless press fit through a posterior approach, whereas between 1999 and 2001, 45 patients (mean age, 75 years) underwent internal fixation using a dynamic hip screw through a lateral approach in a supine position. Patients with stable fractures with intact lesser trochanter, immobility before injury, age younger than 60 years, or with associated injuries (such as another fracture) were excluded. Patients were encouraged active rehabilitation in bed. Bony union was determined by clinical and radiological examinations. Patients were followed up at 6-week intervals in the first sixth months and every 3 months thereafter until bony union was achieved. In the final follow-up, 32 cone hemiarthroplasty patients and 38 internal fixation patients were available for evaluation according to Merle d'Aubigne and Postel criteria. Results. There were no significant differences between the 2 groups in terms of sex, age, fracture type, Singh index, follow-up period, hospital stay, operating time, and receipt of blood transfusions. Clinical results of both groups were similar. Hemiarthroplasty patients were allowed full weight bearing significantly earlier than the internal fixation patients. Conclusion. Cone hemiarthroplasty can be an alternative treatment for unstable intertrochanteric fractures in elderly patients so as to achieve earlier mobilisation.
Elderly Patients with Two Episodes of Fragility Hip Fractures Form a Special Subgroup
Authors: Ip D , Ip FK 
Published: October 2016

Purpose. To identify the demographic features of patients aged 65 years or older admitted with 2 episodes of fragility hip fractures. Methods. From July 2003 to December 2004 inclusive, 50 consecutive elderly patients underwent surgery for a second episode of hip fracture. Patients in a very poor physical condition and therefore unfit for surgery were excluded. Risk factors of fractures in both episodes and whether risk factors were corrected after the first episode were analysed. Detailed radiological assessment and charting of elderly mobility scores and Barthel index were completed and the one-year mortality rate documented. The rehabilitation periods for the 2 episodes of hip fracture were compared. Results. Most patients were female and had trochanteric fractures. In patients aged 65 to 75 years, the incidence of femoral neck fracture occurred as often as trochanteric fracture; while trochanteric fracture was predominant in older patients. Subclinical osteomalacia and undiagnosed hyperthyroidism was found in 3 of the 7 younger patients. Only 30% of them were on treatment for osteoporosis after the first fracture, which underlines the importance of osteoporosis treatment in these patients. Conclusion. Elderly patients with 2 episodes of fragility hip fractures form a special subgroup among geriatric hip fracture patients. Fall prevention programmes and treatment for osteoporosis are recommended.
Intra-Operative Error during Austin Moore Hemiarthroplasty
Authors: Weinrauch P 
Published: October 2016

Purpose. To examine the frequency of technical errors during implantation of the Austin Moore prosthesis in a public hospital. Methods. Radiographs and charts of 147 consecutive uncemented Austin Moore hemiarthoplasty patients were retrospectively reviewed with particular reference to intra-operative errors associated with early failure of the prosthesis. Results. 48% of the patients had at least one error pertinent to implantation and 14% sustained intraoperative fractures. The error rates between relatively junior doctors and consultants were not significantly different. Conclusion. The uncemented Austin Moore prosthesis is a technically demanding prosthesis that is difficult to implant well. Greater selectivity should be exercised when considering its use for femoral neck fractures.
Modified Ilizarov Technique for Infected Nonunion of the Femur: The Principle of Distraction-Compression Osteogenesis
Authors: Krishnan A , Pamecha C , Patwa JJ 
Published: October 2016

Purpose. To evaluate the treatment outcome of the modified Ilizarov technique in infected nonunion of the femur. Methods. Between 1989 and 2002, records of 20 patients with infected nonunion of the femur treated with the modified Ilizarov technique were retrospectively reviewed. The modified Ilizarov frame was fixed after necrectomy of the dead infected bone and tissues. A proximal or distal corticotomy was performed following biological principles. For regeneration of gap, segmental transport was performed in 11 patients with a gap of more than 5 cm; acute docking followed by lengthening at the corticotomy site was performed in 9 patients with a gap of smaller than 5 cm. Mobilisation was started early with active participation of the physical therapist and the patients. Bone and functional results were measured and complications were categorised according to the Association for the Study and Application of the Method of Ilizarov guidelines. Results. The mean follow-up period was 62.8 months. Bony union and eradication of the infection was achieved in all patients except one who underwent amputation due to uncontrolled infection. Bone results were excellent in 13 patients, good in 4, fair in one, poor in one, and treatment failure (amputation) in one. Functional results were excellent in 3 patients, good in 9, fair in 3, poor in 4, and failure in one. A total of 71 complications occurred: 35 problems, 6 obstacles, and 30 true complications. The mean healing index was 38.3 day/cm (standard deviation, 1.6 day/cm). Conclusion. The Ilizarov technique is a good salvage operation for infected nonunion of the femur. Limb salvage is preferable to prosthesis if the limb is viable, adequately innervated and the patient is mentally and financially committed to save the limb.
Acute Compression and Lengthening by the Ilizarov Technique for Infected Nonunion of the Tibia with Large Bone Defects
Authors: Magadum MP , Yadav CM Basavaraj , Phaneesha MS , Ramesh LJ 
Published: October 2016

Purpose. To assess the Ilizarov technique in treating large infected tibial defects by resection of the infected focus, its acute compression, and gradual distant site lengthening. Methods. 27 men (mean age, 39 years) with infected nonunion and large bone defects of the tibia underwent complete resection of the nonunion site, debridement, sequestrectomy, lavage, and Ilizarov ring fixator application. Patients underwent acute compression of the defect site, followed by distant site metaphyseal corticotomy for simultaneous lengthening. The mean length of resection was 10 (range, 6–17) cm. The mean follow-up was 27 (range, 25–39) months. Results. The mean lengthening achieved was 10 cm, mean union time 6.3 months, and mean duration of consolidation 10.2 months. Functional results were excellent in 19 patients and good in 5. The union time was longer in older patients. Conclusion. Acute compression and simultaneous lengthening can be used safely for treatment of large bone defects in the tibia. This avoids secondary operations at the docking site and reduces the duration of treatment.
Diagnosis of Post-Traumatic Complex Regional Pain Syndrome of the Hand: Current Role of Sympathetic Skin Response and Three-Phase Bone Scintigraphy
Authors: Pankaj A , Kotwal PP , Mittal R , Deepak KK , Bal CS 
Published: October 2016

Purpose. To evaluate the role of sympathetic skin response (SSR) and three-phase bone scintigraphy (TPBS) in the diagnosis of complex regional pain syndrome (CRPS). Methods. 60 patients with CRPS of the hand were recruited. TPBS was performed using a bolus injection of 20 mCi of Tc-99m methylene diphosphonate in an antecubital vein and blood flow (first phase) image, blood pool (second phase) image, and delayed (third phase) image obtained. Patients were considered to have CRPS when the blood pool and blood flow images showed diffuse asymmetric uptake, or when the delayed image indicated increased asymmetric periarticular uptake. SSR was measured simultaneously in the affected and unaffected hands. Standard surface electromyogram disc electrodes were applied to the palm and dorsum of both hands. Electrical stimuli were applied to the skin at the base of little and ring fingers of the unaffected hand. Patients were considered abnormal when response was absent or the peak-to-peak amplitude was <50% of the contralateral hand in at least 2 readings. Results. The delayed phase of TPBS tested positive in all; the first and second phases tested positive in 54 (90%) and 56 (93%) of the patients, respectively. Four of the 6 patients with a negative first phase had had symptoms persisting for more than 6 months, and the other 2 for about 3 to 6 months. No patient presenting within 3 months had a negative scan. SSR was absent in 16 (27%) patients and normal in 44 (73%). 11 (79%) of 14 patients who presented more than 6 months after symptom onset displayed an abnormal SSR, while only 10% of those presenting within 3 to 6 months and 11% of those presenting within 3 months had an abnormal SSR. 12 (75%) of the 16 patients with abnormal SSR had associated decreased sweating, compared with 2 (4.5%) of the 44 patients with a normal SSR. Conclusion. TPBS is a very sensitive corroborative test to confirm the clinical suspicion of CRPS during the initial stages, but not in late cases. SSR can be used to document the sympathetic dysfunction in cases having an associated sweating abnormality and may have some diagnostic value in late cases of CRPS, when TPBS is less reliable.
Thumb Polydactyly: Clinical Outcome after Reconstruction
Authors: Yen CH , Chan WL , Leung HB , Mak KH 
Published: October 2016

Purpose. To evaluate clinical and cosmetic outcomes of reconstruction in thumb polydactyly and prognostic value of the Wassel classification. Methods. Between 1993 and 2000 inclusive, out of the patients with thumb polydactyly (involving 80 thumbs) operated on, 34 patients (36 thumbs) were available for review and underwent clinical and radiological assessment. Outcomes in terms of the Tada score and complications were recorded. Results. The mean age of patients at the time of operation was 2.8 (range, 0.6–47) years. The mean follow-up period was 5 (range, 2.4–10) years. According to the Wassel classification, 12 were type-II thumb polydactyly, 3 type-III, 11 type-IV, 6 type-V, one type-VI, and 3 type-VII. There was no perioperative mortality or wound infection. More than 88% of the patients were satisfied or very satisfied with functional and cosmetic outcomes. Postoperative complications such as scar hypertrophy, pulp atrophy, joint deformity, and instability were common but minor. Ridge nail deformity after the Bilhaut Cloquet procedure was amenable to secondary corrective procedures. All types of operated thumb polydactyly achieved similar mean Tada scores (14.7–16.6 out of 20). The Wassel classification category, age, and surgical procedures were found to have no prognostic value with regard to the Tada score and presence of complications. Conclusion. Surgery on thumb polydactyly is rewarding. The Wassel classification category can be used as a guide for treatment, although it fails to predict the occurrence of postoperative complications or Tada scores. Our patients' results can serve as guidelines of expected outcomes after reconstructive procedures in different sub-types of thumb polydactyly.
One-Stage Lateral Rhachotomy and Posterior Spinal Fusion with Compression Hooks for Pott's Paralysis in the Elderly
Authors: Wang B , Ozawa H , Tanaka Y , Matsumoto F , Aizawa T , Kokubun S 
Published: October 2016

Purpose. To evaluate the safety and effectiveness of one-stage lateral rhachotomy and posterior fusion with compression hooks, for the treatment of Pott's paralysis in the elderly. Methods. 11 elderly patients underwent lateral rhachotomy (costotransversectomy and pediculectomy) to debride the tuberculosis focus extending into the epidural space and to decompress the spinal cord. After debridement, the interbody cavity was packed with autologous iliac bone chips. For stabilisation, posterior fusion was performed using a compression lamina hook system. Patients were followed up for at least 2 years for complications. Neurological status was assessed using the Frankel score. The kyphotic deformity was measured on lateral radiographs taken before surgery and at follow-up. Results. During separation of the adhesion around the abscess, a dural tear occurred in one patient and a pleural tear in another. Both tears were successfully repaired. One patient had mild pneumonia after surgery. The Frankel scores of the 11 patients improved from C or D before surgery to D or E after surgery. No relapse of spinal tuberculosis was encountered. The mean deformity angle was 25.5 degrees before surgery and 23.2 degrees at the final follow-up. Spinal fusion was achieved in all patients. Conclusion. Without the need of thoracotomy, one-stage lateral rhachotomy with posterior spinal fusion using compression hooks was an effective option for treating Pott's paralysis in the elderly.
Open Reduction for Late-Presenting Posterior Dislocation of the Elbow
Authors: Mehta S , Sud A , Tiwari A , Kapoor SK 
Published: October 2016

Purpose. To evaluate results of open reduction for late-presenting (more than 3 weeks) posterior dislocation of the elbow in 10 patients. Method. Elbow stiffness was the main indication for surgery. The mean age of the patients was 34 (range, 13–65) years; the mean time since injury was 4 (range, 2–6) months. All patients had non-functional elbow movement for any activity of daily living. Three patients had associated fractures around the elbow joint. Results. At a mean follow-up of 19 (range, 11–28) months, 8 patients regained a functional range of movement for activities of daily living and maintained a median arc of flexion of 100 degrees and a supination-pronation arc of 140 degrees. According to the Mayo Elbow Performance Index, the results of 5 patients were excellent, 3 were good, and 2 were poor. Complications included pin site infection (n=2), ulnar neuritis (n=1), and delayed wound healing (n=1). Conclusion. In patients with late-presenting, unreduced elbow dislocation occurring up to 6 months earlier, open reduction is effective in restoring the joint to a painless, stable and functional state.
Traction and Spica Casting for Closed Femoral Shaft Fractures in Children
Authors: Lee YHD , Lim KBL , Gao GX , Mahadev A , Lam KS , Tan SB , Lee EH 
Published: October 2016

Purpose. To evaluate the treatment outcome of skin traction followed by spica casting for closed femoral shaft fractures in children. Methods. Between September 1997 and December 2001 inclusive, outcomes of 63 children aged one month to 15 (mean, 5.3) years with closed femoral shaft fractures managed with skin traction and spica casting were reviewed. Depending on age, patients were kept in traction from 2 to 15 (median, 9) days, then in spica casts for 2 to 8 (median, 5) weeks. Results. Bony union took 3 to 12 (median, 6) weeks. There were no malunion, nonunion, or rotational deformities. Nor were there any significant limb length discrepancies, pressure sores, or nerve palsies. On no occasion was a spica cast removed and reapplied for loss of fracture reduction. At final follow-up, limb length discrepancy was noted in 14 (22%) of the patients, but none had a discrepancy of greater than 1.5 cm or a short-legged gait. Conclusion. Skin traction followed by spica casting for closed femoral shaft fractures in children is safe, cost-effective and associated with a low complication rate. It is effective in children below 5 years of age and no less effective in older children, except in instances of open fracture, multiple fractures, or older children with large statures, which conditions render them intolerant to spica casts.
Adductor Strain and Hip Range of Movement in Male Professional Soccer Players
Authors: Ibrahim A , Murrell GAC , Knapman P 
Published: October 2016

Purpose. To determine whether hip range of movement (ROM) can predict the occurrence of adductor strain among male professional soccer players. Methods. 120 subjects were prospectively selected from 6 professional soccer clubs in Australia. Internal rotation, external rotation, and ROM of the hip were measured using a goniometer before and during the course of a soccer season (2003–2004). When adductor strain occurred, further assessments of the hip were performed. Injured subjects' hip ROMs were measured again at the end of the season. Results. Eight of the 120 subjects had 9 adductor strains (one bilateral). There was a correlation between preseason decreased hip ROM and occurrence of adductor strain. The mean preseason hip ROM was 44.7 degrees in the injured group and 53.7 degrees in the uninjured group. Once the subjects were able to resume playing soccer, their hip ROM increased to near pre-injury levels. Conclusion. Decreased hip ROM may be considered an aetiological factor in the occurrence of adductor strain in male professional soccer players.
Small Wire External Fixation for High-Energy Tibial Plateau Fractures
Authors: Kataria H , Sharma N , Kanojia RK 
Published: October 2016

Purpose. To assess results of small wire external fixation using a ligamentotaxis technique for high-energy tibial plateau fractures. Methods. Between April 2002 and May 2004, 38 consecutive patients aged 21 to 60 (mean, 32) years underwent small wire external fixation for high-energy tibial plateau fractures. 15 involved the right and 23 the left knee. 34 were closed and 4 were open injuries. Fractures were classified according to Schatzker's staging system. After a minimal of 2 years' follow-up (range, 24–42 months), each affected knee was evaluated using Rasmussen's (1) 30-point clinical grading system and (2) radiological evaluation. Results. There were 22 type-VI and 16 type-V Schatzker tibial plateau fractures. Complications consisted of: 2 superficial infections, 3 pin site infections, and 4 peroneal nerve palsies. No soft tissue necrosis or devitalisation occurred. The mean range of knee movement was 132°. The mean Rasmussen radiological score was 14 (range, 10–18): excellent in 6, good in 26, and fair in 6. The mean Rasmusssen functional score was 26 (range, 17–30): excellent in 19 patients, good in 17, and fair in 2. Clinical results did not parallel the radiological results. Conclusion. Small wire external fixation allows anatomical reconstruction of the articular surface, stable fixation of fracture fragments, early movement of the joint, and care of associated soft tissue injuries, without a high rate of complications.
Medial Humeral Epicondylar Fracture in Children and Adolescents
Authors: Ip D , Tsang WL 
Published: October 2016

Purpose. To assess treatment outcomes of young patients with medial epicondylar fracture of the elbow using standard operative protocols. Methods. 24 consecutive patients with medial humeral epicondylar fracture underwent surgery by one of the 3 methods: (1) 2 parallel Kirschner wires, (2) 2 parallel Kirschner wires plus a tension-band wire, and (3) a screw plus an anti-rotation Kirschner wire. Fractures displaced less than 5 mm were treated conservatively (casting for 3 weeks). Outcome was assessed clinically and radiologically. The Mayo Clinic Elbow Performance Index was measured. Results. The 3 patients with undisplaced fractures had good radiological results and scores. One patient with a displaced fracture refused surgery and subsequently developed pseudarthrosis and cubitus valgus. All operatively treated patients had good scores, but 2 treated with 2 parallel Kirschner wires alone developed pseudarthrosis. Patients in this group needed longer rehabilitation to attain a functional range of movement than those in other groups (treated together with a tension-band wire or screw). Conclusion. Surgery is recommended for children with displaced medial epicondylar fractures of more than 5 mm. The use of a tension-band wire, instead of a screw, together with Kirschner wires is the preferred treatment for younger children.
Treatment of Flexion-Type Supracondylar Humeral Fracture in Children
Authors: Garg B , Pankaj A , Malhotra R , Bhan S 
Published: October 2016

Purpose. To assess the results of treatment for flexion-type supracondylar humeral fracture in children. Methods. The treatment of 14 children with flexion-type supracondylar humeral fracture was reviewed. Severity was classified according to the Gartland system for extension-type fractures. Type-I fractures were treated with immobilisation in an extension cast. For type-II and -III fractures, closed reduction was first attempted followed by percutaneous pinning. If closed reduction failed, open reduction and internal fixation was performed. Results. Patients were followed up for at least one year (range, 14–36 months). Treatment results were excellent in 7 patients, good in 4, fair in 3, and poor in none. Patients were pain-free and satisfied and none suffered any activity restriction. Conclusion. Closed reduction and percutaneous pinning is a good treatment option for type-II and -III flexion-type supracondylar humeral fractures.