bluuebunny/crossref_metadata_2025_split huggingface dataset:
Musculoskeletal Oncology Training during Residency
Authors: Burke Neil G , Moran Cathal J , Hurson Brian , Dudeney Sean , O'Toole Gary C 
Published: October 2016

Purpose. To evaluate the efficacy of a musculoskeletal oncology training module during residency. Methods. 24 orthopaedic residents with differing years of experience were recruited. 12 of them received musculoskeletal oncology training for 6 months. The remaining 12 were controls who did not attend the training and had no clinical experience in a musculoskeletal oncology unit but had at least 3 years of postgraduate surgical training. Upon completion, residents in both groups were assessed by a knowledge test and then an objective structured clinical examination (OSCE). Results. Residents who attended the training module had better mean knowledge test scores (48 vs 25 out of 58, p<0.0001) and OSCE scores (32 vs 22 out of 42, p<0.004), compared to those who did not attend. No residents who attended the training module marked an inappropriate biopsy site that would have compromised definitive surgery, compared to 5 (42%) of the untrained residents who marked an inappropriate biopsy site that may have resulted in an unnecessary amputation. All residents who attended the training module agreed that such a module should be included in the orthopaedic residency programme. Conclusion. Residents who attended the training module were more aware of the biopsy principles and risks. A training module for musculoskeletal oncology should be included in the orthopaedic residency programme.
Pyogenic Discitis following Discectomy
Authors: Moon Myung-Sang , Kim Sung-Soo , Lee Bong-Jin , Moon Jeong-Lim , Sihn Jang-Cheol , Moon Seog In 
Published: October 2016

Purpose. To assess the treatment outcome for disc infection in 35 patients. Methods. Records of 23 men and 12 women aged 36 to 62 (mean, 43) years who underwent treatment for pyogenic discitis after open discectomy were reviewed. All patients had single-level disc herniation of L4–5 (n=28) or L5-S1 (n=6), except for one who had 2-level disc herniation of L4-S1. Single antibiotic was given one day prior to discectomy and continued for 2 days. All excised discs were found to be sterile. Discitis was classified into acute (n=26), subacute (n=7), and chronic (n=2). Antibiotic therapy was started immediately when the clinical diagnosis was made. 31 patients were treated with antibiotics alone; the remaining 4 underwent surgery entailing simple posterior superficial wound drainage (n=1), anterior radical surgery (n=2), or posterior instrumentation and posterolateral fusion for post-discectomy syndrome (n=1). Six of the 12 patients who had percutaneous disc space aspiration underwent disc space irrigation. Results. The initial symptoms included mild-to-moderate fever (n=4), severe back pain (n=27), back muscle spasms (n=26), back pain radiating to the limb (n=2), Gower sign (n=11), and a draining wound (n=1). The wound aspirates of the 12 patients grew organisms, although blood cultures were negative in all. After antibiotic therapy, symptoms gradually subsided in parallel with normalisation of white blood cell count and inflammatory markers. Surgery was indicated only when symptoms worsened and the disease progressed. Spontaneous intercorporal fusion did not occur. Conclusion. Early diagnosis and treatment with appropriate antibiotics is important for post-discectomy discitis.
Continuous Femoral Nerve Block versus Patient-Controlled Analgesia following Total Knee Arthroplasty
Authors: Ng Fu-Yuen , Chiu Kwong-Yuen , Yan Chun Hoi , Ng Kwok-Fu Jacobus 
Published: October 2016

Purpose. To compare total knee arthroplasty (TKA) patients who received continuous femoral nerve block (FNB) with local anaesthetics through a catheter versus patient-controlled analgesia (PCA) with intravenous morphine. Methods. 50 women and 10 men aged 51 to 84 years with matched characteristics underwent TKA and received either continuous FNB with local anaesthetics through a catheter (n=30) or PCA with intravenous morphine (n=30). None of the patients had had previous knee surgery. All operations were performed according to the standard protocol. Daily mean pain numerical rating scale at rest (NRS-R) and during movement (NRS-M), requirement of extra pain control, complications related to pain control, and overall patient satisfaction in both groups were compared. Results. Both groups were similar in terms of pain NRS-R and NRS-M, overall satisfaction, and length of hospital stay. Within each group, pain NRS-M score was significantly higher than pain NRS-R score. In the FNB group, 3 patients had dislodgement of the femoral catheter on day 1 and switched to PCA with intravenous morphine. Two of them had fair satisfaction. Patients in the PCA group had significantly more side-effects (nausea, vomiting, dizziness, and pruritis); 2 of the 5 patients with nausea and vomiting had fair satisfaction. No patients had any surgical complication. Conclusion. Both FNC and PCA provide reliable pain control.
Acutrak versus Herbert Screw Fixation for Scaphoid Non-Union and Delayed Union
Authors: Oduwole Kayode O , Cichy Benedikt , Dillon John P , Wilson Joan , O'Beirne John 
Published: October 2016

Purpose. To compare the treatment outcome of Acutrak versus Herbert screw fixation for scaphoid non-union and delayed union. Methods. Records of 132 patients who underwent Herbert screw fixation (n=61) or Acutrak screw fixation (n=71) with or without bone grafting for scaphoid non-union and delayed union by a single surgeon were reviewed. The most common fracture site was the waist of the scaphoid (n=95), followed by the proximal pole (n=31) and the distal pole (n=6). Screw placement was considered accurate (n=120) when the screw was placed in the central one-third (axially) of the scaphoid; otherwise it was eccentric (n=12). Bone union was assessed radiographically and clinically. Functional outcome was assessed using the modified Mayo wrist score. Results. Respectively in the Herbert and Acutrak screw groups, the mean patient ages were 25.3 and 27.3 years (p=0.28), the mean intervals between injury and screw fixation were 12.2 and 17 months (p=0.38), the mean durations to bone union were 2.1 and 1.8 months (p=0.63), and the union rates were 77% and 93% (p=0.01). The union rate was significantly higher in fractures of the waist of the scaphoid than in the proximal and distal poles (94% vs. 71% vs. 33%, p=0.001). The union rate was significantly higher when the screw was placed accurately (axially) than eccentrically (Herbert screw: 84% vs. 40%, p=0.006; Acutrak screw: 96% vs. 0%, p=0.004). 84% of the Herbert screws were placed axially, compared to 97% for the Acutrak screws. Respectively, 67% and 85% of patients had satisfactory functional outcomes (p=0.03), whereas 23% and 7% of the patients had persistent non-union (p=0.05). Conclusion. The Acutrak screw enabled more accurate screw placement and achieved higher union rates and modified Mayo wrist scores than the Herbert screw did.
Ultrasonographic Evaluation of Achilles Tendons in Clubfeet before and after Percutaneous Tenotomy
Authors: Agarwal Anil , Qureshi Nadeem Akhtar , Kumar Pawan , Garg Amit , Gupta Neeraj 
Published: October 2016

Purpose. To measure the size of the Achilles tendons in congenital clubfeet using ultrasonography before and after percutaneous tenotomy. Methods. 15 boys and 12 girls (39 feet) aged one to 11 (mean, 5) months with idiopathic clubfeet underwent percutaneous tenotomy (Ponseti method). The size of each Achilles tendon was measured ultrasonographically by a single radiologist before and after surgery. In patients with unilateral clubfoot, the normal foot was used as a referent. Longitudinal scans assessed the echotexture, echogenicity, and continuity of the tendon. Transverse scans assessed the shape, echotexture, echogenicity, thickness, and width of the tendon. The size of the Achilles tendon was estimated as an elliptical area using the formula: π(thickness)x(width)/4. Results. Before tenotomy, homogenous, hyperechoic, and linear continuous shadows were noted in longitudinal scans of both the normal and affected Achilles tendons. In transverse scans, the tendons were elliptical, homogenous, and echogenic in appearance. Four weeks after tenotomy, the tendons appeared as heterogeneous, linear continuous shadows with regular margins irrespective of patient age. There was decreased echogenicity in the treated foot. The transverse section of the tendons was elliptical with a heterogeneous echotexture that was predominantly hypoechoic. There was no significant difference in normal, unilateral, and bilateral tendons before and after tenotomy. Conclusion. The study reasserts functional continuity of the Achilles tendons 4 weeks after tenotomy using clinical and ultrasonographic methods.
Comparison of Tibial Bone Coverage of 6 Knee Prostheses: A Magnetic Resonance Imaging Study with Controlled Rotation
Authors: Wernecke Gregory C , Harris Ian A , Houang Michael TW , Seeto Bradley G , Chen Darren B , MacDessi Samuel J 
Published: October 2016

Purpose. To compare the extent of tibial bone covered by the tibial tray in 6 most commonly used total knee arthroplasty designs in order to strike a balance between mediolateral cortical fit and optimal tibial component rotation. Methods. In 74 men and 27 women aged 17 to 60 (mean, 32) years with suspected soft-tissue injuries, their magnetic resonance images of the knee in full extension were superimposed with scans of the tibial trays of the 6 designs (one asymmetric and 5 symmetric). The tibial coverage by the tray and any posterolateral/posteromedial overhang/underhang were measured. Results. All 6 tray designs achieved tibial bone coverage of over 80%. Only 28% of all trays achieved optimal posterolateral fit, whereas 49% had posterolateral overhang enough to cause popliteal tendon impingement. Although the asymmetric tray provided highest tibial coverage (88%), its rates of relative and absolute posterolateral and posteromedial overhang were also highest (64%). Conclusion. The asymmetric tray provided improved tibial coverage at the expense of posterolateral and posteromedial overhang of the tibial tray.
Gender-Specific High-Flexion Knee Prosthesis in Indian Women: A Prospective Randomised Study
Authors: Singh Harjoban , Mittal Vivek , Nadkarni Biren , Agarwal Shekhar , Gulati Divesh 
Published: October 2016

Purpose. To compare outcomes in Indian women who underwent total knee arthroplasty (TKA) using the standard Legacy Posterior Stabilised (LPS) versus the gender-specific LPS high-flexion knee prosthesis. Methods. 100 women (200 knees) aged 60 to 80 years with an arc of flexion of ≥90° underwent simultaneous sequential TKA for primary osteoarthritis of both knees. They were randomised to receive the standard NexGen LPS prosthesis (n=50) or the gender-specific NexGen LPS High-Flex prosthesis (n=50). Both knees in each patient received the same prosthesis. The resected bone from the posterior femoral condyle was 2 mm greater when the gender-specific prosthesis was used. Patients were followed up at 3, 6, 12, and 24 months. Range of motion, Knee Society score, and Hospital for Special Surgery score were evaluated pre- and post-operatively by a single assessor. Results. The mean follow-up duration was 2.1 (range, 1.6–2.5) years. Respectively for the standard and gender-specific groups, the mean range of motion was 111° and 112° preoperatively and 120° and 123° at the latest follow-up. The gender-specific group gained approximately 3° more in range of motion (p=0.007). The Knee Society score and the Hospital for Special Surgery score between groups were not significantly different pre- and post-operatively. Conclusion. The perceived advantage of a gender-specific prosthesis over a standard prosthesis did not translate into better clinical and functional outcome scores.
Rates of Pin Site Infection during Distraction Osteogenesis Based on Monthly Observations: A Pilot Study
Authors: Saw Aik , Chua Yeok Pin , Hossain Golam , Sengupta Subir 
Published: October 2016

Purpose. To assess the monthly rates of infection of individual pin sites in 7 patients during distraction osteogenesis. Methods. Five men and 2 women aged 15 to 35 (mean, 23) years underwent distraction osteogenesis for 8 tibias using the Ilizarov ring external fixator or Taylor Spatial Frame. Patients were taught to perform standard daily pin site care at home, and were evaluated monthly for pin site infection by a single observer using a standardised grading system. Results. Of 1334 observations made on 110 pin/wire sites, there were 83 (6%) pin site infections; 44 (3%) were grade 1 and 39 (3%) were grade 2. The risk of infection was higher at half pin than wire sites. The highest rates occurred in the distal segment. Conclusion. Monthly evaluation of individual pin sites enables comparison between studies
The Male Osteoporosis Risk Estimation Score and the Osteoporosis Self-Assessment Screening Tool for Indonesian Men
Authors: Fransiska Yuliana , Tiksnadi Bambang , Chaidir Rizal , Ismiarto Yoyos Dias 
Published: October 2016

Purpose. To evaluate the male osteoporosis risk estimation score (MORES) and the osteoporosis self-assessment screening tool (OST) score as a means of screening for osteoporosis in men. Methods. Records of 113 Indonesian men aged 50 to 91 (mean, 71) years who underwent evaluation of bone mineral density (T-score) using Dual-energy X-ray absorptiometry were retrospectively reviewed. The MORES was determined by 3 osteoporosis risk factors: age (in years), body weight (in kg), and chronic obstructive pulmonary disorder. A MORES of ≥6 indicated osteoporosis and corresponded to a T-score of ≤-2.5. The OST score was calculated as body weight (in kg) minus age (in years) multiplied by 0.2. An OST score of ≤2 indicated osteoporosis and corresponded to a T-score of ≤-2.5. Sensitivity, specificity, and positive and negative predictive values of the MORES and the OST score were determined. Results. Respectively for the MORES and the OST score, sensitivity values were 100% and 74%, specificity values were 7% and 41%, positive predictive values were 25% and 28%, and negative predictive values were 100% and 83%. Using receiver operating characteristic curves, the area under curve was 0.535 for the MORES and 0.574 for the OST score. Conclusion. The MORES and the OST score should be used together to screen for osteoporosis in men.
Kirschner Wire Fixations for Scapholunate Dissociation: A Cadaveric, Biomechanical Study
Authors: Jakubietz Michael G , Zahn Robert , Gruenert Joerg G , Waschke Jens , Meffert Rainer H , Jakubietz Rafael G 
Published: October 2016

Purpose. To compare 5 different Kirschner wire fixation techniques in terms of the failure loads seen as scapholunate (SL) dissociation in a cadaveric, biomechanical study. Methods. 10 fresh-frozen, finger-amputated wrists with sectioned SL ligaments from 3 male and 2 female cadavers were tested. The change of SL angle, SL dissociation, and the load to failure of the 5 different Kirschner wire fixation techniques (using 1.4-mm Kirschner wires) were compared using an axial loading testing machine. The techniques were: (1) SL fixation (using one wire), (2) SL fixation (using 2 wires), (3) SL and scaphocapitate (SC) fixation, (4) SL, SC, and capitolunate (CL) fixation, and (5) CL fixation alone. Results. There was no significant difference between SL fixations using one or 2 wires. The force for SL dissociation was significantly greater in the SL-SC fixation than the SL fixation using one wire (p=0.003). The SL-SC-CL fixation was not significantly stronger than the SL-SC fixation. Conclusion. The SL-SC fixation achieved adequate stabilisation of both carpal rows with minimal biological impairment.
Magnetic Resonance Arthrography for Assessing Severity of Glenohumeral Labroligamentous Lesions
Authors: Jana Manisha , Srivastava Deep Narayan , Sharma Raju , Gamanagatti Shivanand , Nag HL , Mittal Ravi , Upadhyay Ashish Dutt 
Published: October 2016

Purpose. To compare magnetic resonance (MR) arthrography and arthroscopy as a means of assessing the severity of labral tear in anterior glenohumeral instability. Methods. 52 patients presenting with traumatic recurrent anterior shoulder instability were evaluated using MR arthrography; 30 shoulders with a labroligamentous lesion were treated with arthroscopic Bankart repair. Their MR arthrographic images were interpreted by 3 senior musculoskeletal radiologists, and a radiological diagnosis was reached by consensus. The sensitivity and positive predictive values of MR arthrography for detecting a labral tear were determined. Agreement between MR arthrography and arthroscopy in terms of the width and depth of the labral tear was analysed. Results. On arthroscopy, a labroligamentous lesion (Bankart lesion and its variants) was present in all the 30 shoulders. Agreement between the MR arthrography and arthroscopy in terms of the width and depth of the labral tears was good. Conclusion. MR arthrography is an accurate means of assessing the severity of anterior labroligamentous lesions and yields a good correlation with arthroscopy.
Minimally Invasive Plate Osteosynthesis Using a Locking Compression Plate for Diaphyseal Humeral Fractures
Authors: Malhan Sachit , Thomas Simon , Srivastav Shekhar , Agarwal Shekhar , Mittal Vivek , Nadkarni Biren , Gulati Divesh 
Published: October 2016

Purpose. To assess outcomes of minimally invasive plate osteosynthesis (MIPO) using a locking compression plate (LCP) for 42 humeral shaft fractures. Methods. 28 men and 14 women aged 18 to 68 (mean, 34; median, 29) years underwent closed reduction and MIPO using a LCP for type 12-A (n=26) and type 12-B (n=16) humeral shaft fractures. Eight of the patients were aged ≥50 years. Patients were followed up monthly until radiological union in at least 3 of the 4 cortices. Functional assessment was based on the Disabilities of Arm, Shoulder and Hand (DASH) score. Results. The mean follow-up period was 25 (range, 14–35) months. The mean DASH score was 35.1 at month 3 and improved to 8.9 at month 6 and 5.2 at year 1. The mean angulation was 4° in the coronal plane and 7° in the sagittal plane. All fractures united after a mean of 14 weeks. Two patients with transverse fractures had delayed union and received bone marrow injections at 12 or 13 weeks; they achieved union at week 20. One patient developed a radial nerve palsy immediately after surgery and underwent surgical exploration through the anterolateral approach. The plate was re-applied, and the nerve recovered in 48 hours with full power in all the muscle groups. Conclusion. MIPO with LCP is a safe and effective technique for fixation of diaphyseal humeral fractures, and results in faster bone union, better cosmesis, and minimal complications.
Intramedullary Nailing Supplemented with Poller Screws for Proximal Tibial Fractures
Authors: Kulkarni Sunil G , Varshneya Ankit , Kulkarni Shreenath , Kulkarni Govind S , Kulkarni Milind G , Kulkarni Vidhisha S , Kulkarni Ruta M 
Published: October 2016

Purpose. To evaluate outcome of intramedullary nailing supplemented with Poller screws for proximal tibial fractures using small diameter nails. Methods. 50 men and 20 women (75 fractures) aged 18 to 65 (mean, 33) years underwent intramedullary nailing supplemented with Poller screws for acutely displaced fractures (n=60) or for delayed union (n=10) or mal-union (n=5) of the proximal metadiaphyseal tibia. 88% of the fractures were caused by road traffic accidents. 54 cases had closed fractures and 21 had grade I or II compound fractures. Clinical and radiological outcome was evaluated. Results. In 69 cases, healing occurred after a mean of 4.2 (range, 3–9) months. In 5 cases, there was nonunion, which was resolved by bone grafting. One case was mal-united. 63 patients recovered a full range of knee motion (0°–130°), and the remaining 7 attained flexion of 0° to 90°. According to the knee rating scale of the Hospital for Special Surgery, outcome was excellent in 50 patients, good in 14, poor in 3, and failed in 3 at month 12, and remained so after a mean follow-up of 30.8 months. Postoperatively, 74 cases had <5° of varus or valgus malalignment, and only one developed varus of +7°. 65 cases exhibited no deformity, 7 had a deformity of <3°, and 3 had a deformity of 4° to 9°. Conclusion. Poller screws help maintain fixation of intramedullary nailing and alignment of fractures.
Benefits of Using Modern Cementing Techniques in the Acetabulum: The Rim Cutter
Authors: Darmanis Spyros N , Hubble Matthew JW , Howell Jonathan R , Whitehouse Sarah L , Timperley A John 
Published: October 2016

Purpose. To compare radiological records of 90 consecutive patients who underwent cemented total hip arthroplasty (THA) with or without use of the Rim Cutter to prepare the acetabulum. Methods. The acetabulum of 45 patients was prepared using the Rim Cutter, whereas the device was not used in the other 45 patients. Postoperative radiographs were evaluated using a digital templating system to measure (1) the positions of the operated hips with respect to the normal, contralateral hips (the centre of rotation of the socket, the height of the centre of rotation from the teardrop, and lateralisation of the centre of rotation from the teardrop) and (2) the uniformity and width of the cement mantle in the 3 DeLee Charnley acetabular zones, and the number of radiolucencies in these zones. Results. The study group showed improved radiological parameters and were closer to the anatomic centre of rotation both vertically (1.5 vs. 3.7 mm, p<0.001) and horizontally (1.8 vs. 4.4 mm, p<0.001) and had consistently thicker and more uniform cement mantles (p<0.001). There were 2 radiolucent lines in the control group but none in the study group. Conclusion. The Rim Cutter resulted in more accurate placement of the centre of rotation of a cemented prosthetic socket, and produced a thicker, more congruent cement mantle with fewer radiolucent lines.