bluuebunny/crossref_metadata_2025_split huggingface dataset:
Difference in Stretching of Sarcomeres between Medial Gastrocnemius and Tibialis Anterior by Tibial Lengthening: An Experiment in Rabbits
Authors: Kurihashi A , Tamai K , Saotome K , Takemura M , Fujiwara A , Fujita S 
Published: October 2016

Purpose. To compare the degree of stretching of sarcomeres—in the medial gastrocnemius versus the tibialis anterior—acutely extended by tibial lengthening. Methods. The right lower legs of 6 New Zealand White rabbits were acutely distracted by 6.3 mm using an external fixator, whereas the left lower legs served as controls. Immediately after distraction, the ankle was dorsiflexed at 50 degrees and the knee flexed at 140 degrees, with respect to the posture of resting on the ground. Both legs were immersed in 10% buffered formalin for fixation, and the medial gastrocnemius and tibialis anterior were removed. Length of the 2 sarcomeres was measured by a laser diffraction technique using isolated muscle fibre bundles. Results. The mean lengths of sarcomeres in the medial gastrocnemius and tibialis anterior were 3.0 μm and 2.3 μm in the lengthened legs, and 2.4 μm and 2.1 μm in control legs, respectively. The degree of stretching of corresponding sarcomeres was therefore 25% and 10%, this difference being significant (p<0.01). Conclusion. Sarcomeres of the medial gastrocnemius are more stretchable than those of the tibialis anterior following tibial lengthening.
Temporary Coracoclavicular Screw Fixation for Displaced Distal Clavicle Fractures
Authors: Fazal MA , Saksena J , Haddad FS 
Published: October 2016

Purpose. To assess the treatment outcome of temporary coracoclavicular screw fixation for displaced distal clavicle fractures. Methods. From January 1995 to December 2003, 30 consecutive patients with Neer type II displaced distal clavicle fractures were treated with open reduction and internal fixation using a coracoclavicular screw. The screw was removed under local anaesthesia after bony union. Patients were evaluated by clinical and radiological examination. Functional outcome was assessed by a simple shoulder test. Results. There was 100% union rate. All patients returned to their pre-injury activity level by 12 months. One patient developed a superficial wound infection, which resolved with oral antibiotics. Two patients had problems with mild backing out of the screw, but both had bony union by the time of screw removal. The mean score of the simple shoulder test of 28 patients was 11. Conclusion. Treatment outcome using temporary coracoclavicular screw fixation for displaced distal clavicle fractures is favourable. The implant is readily available and the technique is simple, safe, cost-effective, and reproducible.
Publication Bias in Abstracts Presented to the Annual Meeting of the American Academy of Orthopaedic Surgeons
Authors: Harris IA , Mourad M , Kadir A , Solomon MJ , Young JM 
Published: October 2016

Purpose. To examine possible causes of publication bias in the orthopaedic literature so as to avoid inappropriate clinical decisions based on reviews of the literature. Methods. Two reviewers independently reviewed abstracts presented to the 1999 American Academy of Orthopaedic Surgeons annual meeting. Data pertaining to sample size, statistical significance, study setting, country of origin, outcome, study type, and sponsorship were extracted from each abstract. The publication rate was measured after 5 years, by electronic searching and author contact. Predictors of publication were identified using logistic regression analysis. Results. Of the 318 abstracts listed in the proceedings, 175 (55%) were published within 5 years. Publication was associated with positive rather than neutral outcomes (odds ratio, 1.62; 95% confidence interval, 1.01–2.59; p<0.05) and with the reporting of statistical significance (odds ratio, 2.05; 95% confidence interval 1.24–3.39; p=0.005). Sponsorship, country of origin, sample size, study setting, and study type did not significantly influence the publication rate. Conclusion. Evidence of publication bias exists in abstracts presented at the 1999 American Academy of Orthopaedic Surgeons annual meeting. Clinical decisions based on the literature may be biased due to an over-representation of studies with positive outcomes.
Neurological Outcome following Early versus Delayed Lower Cervical Spine Surgery
Authors: Sapkas GS , Papadakis SA 
Published: October 2016

Purpose. To determine whether the timing of surgery affects neurological outcome in patients with lower cervical spine trauma. Methods. 29 patients with a fracture and 38 with a fracture-dislocation of C3 to C7 cervical vertebrae were treated operatively during the inclusive period January 1987 to December 2000. Surgery was performed as soon as the patient's medical condition allowed, within 72 hours in 31 and more than 72 hours after the injury in 36. Results. Only patients with incomplete spinal cord injury had neurological improvement after surgery. There was no statistically significant difference in final neurological outcomes in patients having early as opposed to delayed surgery. Conclusion. Surgical intervention for cervical injuries is safe, as no postoperative neurological deterioration was recorded. Timing of surgery does not affect neurological outcome.
Reconstructions of the Shoulder following Tumour Resection
Authors: Kitagawa Y , Thai DM , Choong PFM 
Published: October 2016

Purpose. To review and compare the postoperative outcomes of 3 types of shoulder reconstructions: prosthetic arthroplasty, clavicula pro humero reconstruction, and allograft arthrodesis. Methods. Records of 25 shoulder reconstructions following tumour resection were retrospectively reviewed. Perioperative data, oncological prognoses, postoperative complications, and functions were assessed. Results. We performed 10 prosthetic arthroplasties, 7 clavicula pro humero procedures, 4 allograft arthrodeses, and 4 soft tissue reconstructions. Eight patients died of their diseases. Three developed complications and underwent revision surgery. 19 patients achieved stable shoulders. Ten patients attended for functional assessments. Respective mean scores using the Musculoskeletal Tumor Society-International Symposium on Limb Salvage and the Toronto Extremity Salvage Score were: 77% and 82% for prosthetic arthroplasties, 67% and 62% for clavicula pro humero procedures, 83% and 70% for allograft arthrodeses, and 93% and 98% for soft tissue reconstructions. Conclusion. A stable construct is the treatment goal for shoulder reconstructions, as it enables effective function of the arm and hand.
Orthopaedic Trauma Surgery Performed by Unsupervised and Supervised Trainees: Complication Rates Compared
Authors: Harris IA , Lin C 
Published: October 2016

Purpose. To compare the complication rates associated with orthopaedic trauma surgery performed by unsupervised and supervised trainees. Methods. In our hospital, 6361 orthopaedic trauma operations were performed between 1 January 1998 and 31 December 2002. Data pertinent to the surgeon's supervision and postoperative complications were collected. Elective operations were excluded, as consultants were almost always present. Complication rates ensuing in unsupervised and supervised groups were compared using the Chi squared test. Results. Of 6361 orthopaedic trauma operations performed, 3754 (59%) were by unsupervised trainees of varying experience, whereas 2494 (39%) were by supervised trainees or consultants. In 113 (2%) of the operations, the supervision status was not recorded. The complication rate was significantly higher in the supervised than unsupervised group (5.3 vs 3.3%, χ2=15, df=1, p=0.0001). Conclusion. The complication rate was not higher for operations performed by unsupervised trainees than those performed in the presence of a consultant.
Intramedullary Nailing versus Fixed Angle Blade Plating for Subtrochanteric Femoral Fractures: A Prospective Randomised Controlled Trial
Authors: Rahme DM , Harris IA 
Published: October 2016

Purpose. To compare closed intramedullary nailing to open reduction and internal fixation using a fixed angle blade plate for the management of subtrochanteric femoral fractures. Methods. 58 patients were equally randomised to undergo either an intramedullary nailing (IN) or fixed angle blade plating (BP). Results. There were no significant differences between the 2 groups with regard to age, time to surgery, operating time, receipt of blood transfusions, duration of hospital stay, or fracture classification. The revision rate was 28% (8/29) in the BP group and none in the IN group; the difference was statistically significant. Conclusion. Internal fixation using a fixed angle blade plate for subtrochanteric femoral fractures has higher implant failure and revision rates, compared to closed intramedullary nailing.
Less Invasive Stabilisation System Plating for Distal Femoral Fractures
Authors: Kanabar P , Kumar V , Owen PJ , Rushton N 
Published: October 2016

Purpose. To review the outcome of less invasive stabilisation system (LISS) plating for complex distal femoral fractures. Methods. Records of 6 men and 11 women who underwent LISS plating for complex distal femoral fractures from September 2001 to August 2005 were reviewed. One patient who died 12 months after surgery due to a cardiac problem was excluded. The mean age of the remaining patients was 61 years and the mean follow-up period was 12 months. Four patients, 3 of whom had open fractures, had sustained high-energy trauma. According to the AO classification, 8 fractures were type 33A and 9 type 33C. Results. The mean time to union was 17 weeks. Two patients with non-union underwent a second LISS plating and bone grafting, resulting in a satisfactory final outcome. Delayed radiographic union was observed in one patient, but clinically he was asymptomatic and mobile. The fracture finally united at 9 months. Conclusion. LISS plating is useful in treating complex distal femoral fractures, resulting in reduced blood loss and low infection rates, while achieving early mobility due to primary stability of the construct.
Idiopathic Scoliosis and Pineal Lesions in Australian Children
Authors: Day GA , McPhee IB , Tuffley J , Tomlinson F , Chaseling R , Kellie S , Torode I , Sherwood M , Cutbush K , Geddes AJ , Brankoff B 
Published: October 2016

Purpose. To determine whether treatment of pineal lesions in children is associated with development of idiopathic scoliosis. Methods. 38 boys and 10 girls with pineal lesions were identified. Their mean age at presentation was 10 years. The pineal pathology varied from cysts and epidermoid to teratoma, germinoma, pineocytoma, and glioblastoma. Treatment ranged from biopsy/extirpation to radiotherapy. Results. 12 patients died. No scoliosis was found in any females or any of the deceased. Two boys had scoliosis: one had a 12-degree right upper thoracic curve with 32-degree kyphosis and the other had a 60-degree right thoracolumbar idiopathic curve, requiring a 2-stage arthrodesis. Conclusion. Pineal ablation is not related to the development of idiopathic scoliosis in humans.
Curettage and Allograft Reconstruction for Giant Cell Tumours
Authors: Morii T , Yabe H , Morioka H , Suzuki Y , Anazawa U , Toyama Y 
Published: October 2016

Purpose. To evaluate treatment outcomes in patients with giant cell tumours after curettage and allograft reconstruction and to identify the risk factors for poor oncological and functional outcome. Methods. 29 patients with giant cell tumours of bone who underwent curettage and allograft reconstruction were retrospectively reviewed. The adjuvants used were heat treatment by electrocautery and hot water. Types of allograft used, time to bone union, complications, functional outcomes, and risk factors for poor function were analysed. Results. The mean time to bone union was 2.8 (range, 1–5) months. In 7 patients the tumours recurred (6 within 2 years); the 5-year recurrence-free survival rate was 77%. Three recurrences were classified as grade III and 4 as grade II; recurrence and the Campanacci grade showed a trend towards association (p=0.06). Tumour in the distal femur was a risk factor for postoperative fracture (p=0.02). Functional outcomes were excellent in 20 patients, good in 6, fair in 2, and a failure in one. The risk factors for poor function were recurrence (p=0.002) and joint instability (p=0.008) but not the Campanacci grade (p=0.10) or postoperative fracture (p=0.76). Lung metastasis, infection, and non-union were not encountered. Conclusion. Despite a relatively high recurrence rate (24%), 26 (90%) of the 29 patients had excellent/good functional outcomes. We recommend the use of adjuvants and allografts for the management of giant cell tumours.
“S” Quattro External Fixation for Complex Intra-Articular Thumb Fractures
Authors: Byrne AM , Kearns SR , Morris S , Kelly EP 
Published: October 2016

Purpose. To report outcomes in 10 patients who underwent dynamic “S” Quattro external fixation for complex fractures of the base of the thumb. Methods. Nine men and one woman aged 18 to 69 (mean, 31) years underwent “S” Quattro external fixation for complex fractures of the base of the thumb. The dominant hand was involved in 8 patients. Three patients had Bennett fractures, 5 had Rolando fractures, one had an open multi-fragmented fracture, and one had a fracture-subluxation. Four of them had had prior (failed) treatment with splints and/or Kirschner wires. The “S” Quattro external fixator was applied for a mean of 4.9 weeks. Patients were followed up in an out-patient setting for a mean of 10.7 months until bone union and removal of the external fixator. Finger flexor function was assessed based on total active movement (TAM). Functional outcomes were assessed using the Disability of Arm, Shoulder and Hand (DASH) questionnaire. Results. No pin-site infection, malunion, or non-union was encountered. Mean loss of TAM was 7.5 degrees. Five patients lost 10 degrees or more, 2 of whom lost 20 degrees (one with an open comminuted fracture and one was elderly). Four patients regained full TAM and 6 attained more than 75% TAM compared to the contralateral thumb. At the 3-year follow-up, the mean DASH score was 3.4. Four patients reported no functional disability. Poorer outcomes were reported in the 2 patients who once had lost 20 degrees of TAM. Conclusion. The “S” Quattro external fixator is recommended as a primary and definitive treatment modality for complex intra-articular thumb fractures when conservative and other surgical interventions have failed.
Tumour Volume and Lung Metastasis in Patients with Osteosarcoma
Authors: Munajat I , Zulmi W , Norazman MZ , Faisham WI Wan 
Published: October 2016

Purpose. To assess the association between tumour volume and occurrence of lung metastasis in patients with osteosarcoma and to determine the cut-off value. Methods. Records of 70 patients with histopathologically confirmed primary osteosarcoma in the extremities who had magnetic resonance imaging and computed tomography of the thorax less than one month before treatment were reviewed, with reference to the official report of tumour dimensions and lung metastasis by radiologists. The status of lung metastasis was assessed. Tumour volume was measured using the formula for an ellipsoidal mass. Results. Of the 70 patients with osteosarcoma, 33 (47%) had evidence of lung metastasis. Tumour volume was directly associated with occurrence of lung metastasis (p=0.048). The proportion having lung metastasis when the primary tumour volume exceeded 371 cm3 was 69%, compared to 34% in those with smaller tumours. Conclusion. Larger tumours are more likely to correlate with lung metastasis. Both features are predictive of patient survival and prognosis.
Intra-Operative Somatosensory-Evoked Potential Monitoring
Authors: Chandanwale AS , Ramteke AA , Barhate S 
Published: October 2016

Purpose. To evaluate the usefulness of intra-operative somatosensory-evoked potentials (SSEPs) in monitoring spinal cord status via the posterior tibial nerve. Methods. 84 men and 28 women aged 16 to 66 years (72% were aged 20 to 40 years) with spinal trauma (63 in the lumbar and 49 in the thoracic spine) underwent posterior instrumentation and fusion using bone grafts. All 63 patients with lumbar spinal injury and 35 of the patients with thoracic spinal injury were treated with pedicular screws. The remaining 14 patients had their thoracic spinal injury fixed with sublaminar wires. Cortical scalp recordings were used. Baseline tracings were obtained prior to surgical intervention and after establishment of anaesthesia. If changes persisted for more than 15 to 20 minutes or if they did not show definite signs of resolution, event reversal was considered. Results. Of the 112 patients, 74 (66%) had no changes in Cz-Fpz patterns and neurological status, whereas 14 (13%) showed improved patterns (2 of them had the same neurological status postoperatively) and 24 (21%) displayed deteriorated patterns prompting intervention. Of the 24 patients prompting intervention, 20 improved substantially (19 had no new neurological deficits and one had deteriorated neurological status) and 4 improved minimally (2 had no new deficit and 2 had new deficits), with 88% sensitivity and 78% specificity. 15 patients were true-positives with an identifiable cause; 21 were false-positives with no neurological deterioration or recognisable cause. Conclusion. Intra-operative SSEP monitoring helps identify acute neurological and systemic (hypoxia or hypotension) impairment and enables prompt correction. This makes surgery available to high-risk patients and enables surgeons to carry out more extensive procedures. It also provides valuable documentation in the event of medico-legal dispute.
Staple versus Locking Compression Plate Fixation after Lateral Closing Wedge High Tibial Osteotomy
Authors: Agarwala S , Shah SB 
Published: October 2016

Purpose. To compare the results of staple versus locking compression plate fixation after closing wedge high tibial osteotomy. Methods. A group of 23 patients (24 knees) who underwent box high tibial osteotomy and staple fixation was compared with another group of 19 patients (22 knees) who underwent a similar procedure but with locking compression plate fixation. Both groups were followed up for 3 years. The range of movement, Hospital for Special Surgery (HSS) Knee Score, time to full weight bearing, incidence of delayed union, femorotibial angle, and stage of osteoarthritis were compared. Results. At 6 months after the operation, the median HSS score and the proportion of patients with excellent or good scores were significantly higher in the locking compression plate than the staple fixation group (76 vs 62, p=0.003; 75% vs 42%, p=0.0354), but not at one and 3 years. The range of movement was significantly greater in the locking compression plate fixation group in the short term (6 weeks, 3 and 6 months), but not after one year. The median time to full weight bearing was significantly shorter in the locking compression plate fixation group (86 vs 116 days, p<0.001). There were fewer delayed unions in the locking compression plate fixation group but not significantly (1 vs 5, p=0.198), possibly because of the small numbers involved. There was no difference, within the limits of measurement error, in the femorotibial angle or correction loss between the 2 groups. Conclusion. Locking compression plate fixation obviates the use of plaster casts, enables early mobilisation and bone union, and reduces the numbers with delayed union and the time to full weight bearing. Longer-term studies are needed to evaluate its effect on revarisation and arthropathy.
Avulsion Fractures of the Tibial Tubercle
Authors: Abalo A , Akakpo-Numado KG , Dossim A , Walla A , Gnassingbe K , Tekou AH 
Published: October 2016

Purpose. To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients. Methods. Records of 12 patients aged 11 to 17 (mean, 14) years with avulsion fractures of the tibial tubercle presenting to our hospital from April 1998 to September 2004 were studied. Patient age, gender, involved side, injury mechanism, clinical and radiographic records, treatment, complications, and outcomes were reviewed. Results. Eight patients injured the right side, 3 the left side, and one both sides. They all engaged in sports or active play during the injury. Two fractures were type IA, one type IB, 2 type IIB, 5 type IIIA, 2 type IIIB, and one type IV. Three patients with type-I fractures and one with a type-IIB fracture were treated with closed reduction and cast immobilisation for 3 to 4 (mean, 3.8) weeks. The remaining 9 fractures were treated with open reduction and internal fixation. The mean follow-up period was 39 (range, 23–59) months. No complications were noted. Ten patients had excellent results and 2 had fair results. Conclusion. Closed reduction and cast immobilisation for minimally displaced fractures, and open reduction and internal fixation for displaced fractures resulted in favourable outcomes.
Two-Plate Fixation for Humeral Shaft Nonunions
Authors: Martinez Angel Antonio , Cuenca Jorge , Herrera Antonio 
Published: October 2016

Purpose. To review 22 patients who underwent 2-plate fixation for non-union of the humeral shaft. Methods. 13 women and 9 men aged 32 to 76 (mean, 48) years underwent fixation for non-union of the humeral shaft, using a 2-plate construct, together with decortication, debridement, and bone grafting. The two 3.5-mm reconstruction plates were parallel and lying at 90° to each other and fixed with screws purchasing into at least 6 cortices of each fragment for both plates. Fractures were located in the upper third (n=8) or middle third (n=14) of the humerus. Initial treatments included casting (n=9), coaptation splinting (n=8), multiple retrograde pinning (n=4), and Marchetti-Vicenzi nailing (n=1). 18 non-unions were atrophic and 4 were hypertrophic. Shoulder and elbow range of motion as well as functional results were evaluated. Results. The time for union was 4.6 (range, 4–6) months. No implants were loose or broken. No nonunion or infection was noted. Functional results were excellent in 17 and good in 5 patients. One patient had iatrogenic radial nerve palsy that recovered within 3 months. Conclusion. Two-plate fixation achieves good results for humeral shaft non-unions.
Six-Year Experience with the Delta III Reverse Shoulder Prosthesis
Authors: Grassi Federico Alberto , Murena Luigi , Valli Federico , Alberio Riccardo 
Published: October 2016

Purpose. To report the clinical and radiographic results and complications of the Delta III reverse prosthesis. Methods. 24 women and 2 men aged 62 to 84 (mean, 75) years underwent total shoulder replacement using the Delta III reverse prosthesis. Patient diagnoses were massive rotator cuff tear (n=20), disabling sequelae of proximal humeral fractures (n=3), and failure of an unconstrained arthroplasty (n=3). Clinical and functional results were assessed using the Constant scale. Active range of motion (ROM) was measured. Scapular notching and radiolucent lines around the humeral component were evaluated using radiographs. Patient satisfaction of the treatment was evaluated by a direct interview. Results. 23 patients were followed up for 26 to 84 (mean, 42) months. Two patients had loosening of the glenoid component (at 6 months and 5 years) and underwent revision surgery. There were no instances of infection, instability, or acromial fracture. Only active elevation improved significantly after surgery, as did both the absolute and adjusted Constant scores. 12 patients were completely pain-free, 9 complained of slight pain, and one of moderate pain. The severity of scapular notching progressed with time. 15 patients were satisfied with the treatment, 6 were partially satisfied, and 2 were not satisfied. Conclusion. The Delta III prosthesis restores shoulder function but has biomechanical limits. Its use should be limited to elderly patients with severe impairment of the glenohumeral joint. Scapular notching is a main concern for the long-term survival of the implant.