bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complex Regional Pain Syndrome Complicating Total Knee Arthroplasty
Authors: Burns AWR , Parker DA , Coolican MRJ , Rajaratnam K 
Published: October 2016

Purpose. To compare the long-term outcome of patients diagnosed with complex regional pain syndrome–type 1 (CRPS-1) after total knee arthroplasty (TKA) with those of uncomplicated TKA knees and preoperative osteoarthritic knees. Methods. Medical records of 1280 patients who underwent TKA for osteoarthritis were retrospectively reviewed; 8 were diagnosed as having symptoms and signs consistent with CRPS after TKA. Patients with primary inflammatory arthritis, signs of component loosening, malpositioning, or of infected arthroplasty were excluded. No patient had signs of CRPS prior to operative intervention. The 8 patients were compared with 2 groups of age- and sex-matched controls: uncomplicated TKA knees and preoperative osteoarthritic knees. Patients were followed up for a mean of 54 (range, 13–111) months and their range of movement, Western Ontario and McMaster Universities Osteoarthritis Index, SF-36 questionnaire scores, and Knee Society scores were assessed and compared. Results. After appropriate treatment, most CRPS complicated patients had similar scores on SF-36, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee Society scores when compared with uncomplicated TKA patients. Scores for CRPS complicated patients were significantly improved when compared with preoperative osteoarthritic patients. The incidence of CRPS after TKA was 0.7%. Conclusion. When managed early, patients complicated with CRPS after TKA have a similar prognosis to patients with uncomplicated TKA.
Neurological Recovery after Occipitocervical Fixation
Authors: Tan KJ , Hee HT 
Published: October 2016

Purpose. To report on 14 consecutive cases of occipitocervical fixation. Methods. Records of 8 men and 6 women aged 40 to 81 (mean, 57) years who underwent occipitocervical fixation and were followed up for a minimum of 2 years were retrospectively reviewed. Neurological grading was assessed before and after surgery using the Ranawat grade. Intra-operative somatosensory evoked potentials were monitored. Results. The main indications for surgery were rheumatoid arthritis (n=6) and cervical metastasis (n=4). 77% of the patients demonstrated neurological improvement. Four out of the 5 non-ambulatory patients (Ranawat grade IIIB) regained ambulatory status postoperatively. No patient had neurological deterioration or evidence of vertebral artery or spinal cord injury. One endured a superficial wound infection and 2 had implant breakage. Conclusion. Although occipitocervical fixation is technically challenging and there are risks of serious neurologic or vascular complications, it remains a viable option with favourable results in patients requiring stabilisation of the craniocervical junction.
Management Outcome and the Role of Manipulation in Slipped Capital Femoral Epiphysis
Authors: Lim YJ , Lam KS , Lim KBL , Mahadev A , Lee EH 
Published: October 2016

Purpose. To examine and compare treatment outcomes for slipped capital femoral epiphysis (SCFE). Methods. 24 patients with acute or acute-on-chronic SCFE underwent preoperative traction, 13 of them followed by in situ screw fixation (group A), and the remaining 11, manipulation with screw fixation (group B). Their treatment outcomes (according to the Aadalen criteria) and complications were compared. Results. There were 2 treatment failures and one poor outcome in patients with acute SCFE (2 had avascular necrosis and one had slight pain with mild limitation of hip movement). The risk of developing avascular necrosis was significantly higher in patients with acute rather than acute-on-chronic or chronic slips. No significant differences were evident between groups A and B with regard to age, sex, ethnicity, outcomes, and preoperative and postoperative changes in the Southwick headshaft angle. Conclusion. Patients with acute or acute-on-chronic SCFE can be safely managed with straight-leg traction for up to 6 days, followed by in situ screw fixation without manipulation. Manipulation is not recommended in such slips, due to a higher avascular necrosis risk.
Limb Salvage Surgery Complimented by Customised Mega Prostheses for Malignant Fibrous Histiocytomas of Bone
Authors: Natarajan MV , Mohanlal P , Bose JC 
Published: October 2016

Purpose. To assess functional and oncological outcomes of patients with malignant fibrous histiocytomas of bone, after limb salvage surgery complimented by a customised prosthesis. Methods. Between May 1991 and December 2002, 15 men and 5 women (mean age, 42 years) with histologically proven malignant fibrous histiocytoma of bone underwent treatment involving limb salvage surgery complimented by a customised mega prosthesis. Most of the tumours were stage II according to the Enneking system, and located around the knee. Wide resection margins were achieved in 18 patients. Results. Following a mean follow-up of 58 months, 4 patients underwent amputation for local recurrence and 5 died of the disease. Two patients had prosthesis fractures; revision of the prosthesis was carried out in one. The functional result was excellent in 5 and good in 9 patients. The Kaplan-Meier 5-year survival rates of the patients treated without chemotherapy and with chemotherapy were 50% and 76%, respectively. Conclusion. Limb salvage surgery with chemotherapy is a viable treatment option for patients with malignant fibrous histiocytoma of bone. It achieves higher survival rates than resection alone. Such therapy improves quality of life and provides a useful and functional limb.
Neurological Deficit and Canal Compromise in Thoracolumbar and Lumbar Burst Fractures
Authors: Mohanty SP , Bhat NS , Abraham R , Keerthi C Ishwara 
Published: October 2016

Purpose. To assess whether canal compromise determines neurological deficit in thoracolumbar and lumbar burst fractures. Methods. 105 patients aged 17 to 60 (mean, 34) years who had burst fractures in the thoracolumbar (n=82) and lumbar (n=23) regions were included. Fractures were classified according to the Denis classification. The extent of spinal canal compromise was assessed by computed tomography, and the neurological status according to the modified Frankel grading for traumatic paraplegia. Results. 19 (18%) of the patients had no neurological deficit. Of the remaining 86 (82%) with a deficit, 26 had complete paraplegia. The correlation between the type of the burst fracture and the severity of neurological deficit was not significant (Chi squared=10.57, p=0.835). The mean extent of spinal canal compromise in patients with deficits was 50%, whereas in patients with no deficit it was 36%. The difference between the extent of canal compromise and the severity of neurological deficit at the thoracolumbar and lumbar spine was not significant (p=0.08). Further sub-analysis revealed a significant correlation at T11 and T12 (p=0.007) but not at the L1 (p=0.42) level. Conclusion. When studying neurological deficit, T11 and T12 injuries should be analysed separately from L1 injuries.
Sleeve Fracture of the Patella in Children
Authors: Gao GX , Mahadev A , Lee EH 
Published: October 2016

Purpose. To report the diagnosis, treatment, and outcomes of sleeve patellar fractures in children. Methods. Records of a consecutive series of patients with sleeve patellar fractures were retrospectively reviewed. Results. Of the 11 children (8 boys and 3 girls; mean age, 12 years), 6 had minimally displaced fractures (1–2 mm) and were managed by cylindrical plaster of Paris immobilisation, whereas the other 5 with severely displaced fractures underwent open reduction with tension band wiring. The mean follow-up period was 10 (range, 3–36) months. All patients obtained full extension of the knee except one (with an extension lag of 10 degrees). No patient complained of pain or discomfort of the involved knee. Conclusion. Sleeve patellar fractures in children are uncommon. Diagnosis can be missed, especially in those with a very small avulsed bony fragment. For undisplaced fracture, conservative management can achieve good results. For severely displaced fractures, early surgical intervention is effective.
Quality of Life after Infection in Total Joint Replacement
Authors: Cahill JL , Shadbolt B , Scarvell JM , Smith PN 
Published: October 2016

Purpose. To compare the health-related quality of life and functional outcomes of patients with and without periprosthetic infection after total joint replacement (TJR). Methods. 62 uncomplicated TJRs and 34 TJRs complicated with deep infection were compared using a visual analogue scale for satisfaction, the Western Ontario and McMaster Universities Osteoarthritis Index, Assessment of Quality of Life, and Short Form-36. Results. Patients with complicated TJR had significantly poorer satisfaction in outcome (p<0.0001) and disease-specific functional outcomes (p<0.0001). Six of the 8 health-related quality-of-life scores were also significantly poorer (p<0.05). These results persisted after controlling for age, sex, and follow-up period in a multiple regression analysis. Conclusion. Infection following TJR reduces patient satisfaction and seriously impairs functional health status and health-related quality of life. When hospitals are balancing the costs of preventative measures with the costs of treating infection in TJR, the effect on patients' quality of life must be considered. Our findings argue strongly for allocation of health care resources to minimise the occurrence of infection after TJR.
Proximal Femoral Nail Failures in Extracapsular Fractures of the Hip
Authors: Ballal MSG , Emms N , Ramakrishnan M , Thomas G 
Published: October 2016

Purpose. To review patients with proximal femoral nails (PFNs) in our hospital that developed complications and needed revision. Methods. Between January 2000 and June 2006, records of 216 patients with PFN fixations for traumatic extracapsular trochanteric fractures (n=160), pathological fractures (n=23), and as a prophylactic measure for metastasis (n=33) were retrospectively reviewed. The injury mechanism, reduction technique and quality, and time to and cause of implant failure were recorded. Results. 12 PFNs failed: 8 in the trauma group, 3 in the pathological group, and one in the prophylactic nailing group. Two PFNs broke at the proximal lag screw level at a later stage secondary to non-union of the pathological fractures. One broke at the level of the distal locking screw at an early stage, as the locking holes were too close to the fracture. Conclusion. Poorly reduced fractures tend to fail early, whereas late failures are due to non-union. Good reduction with minimal dissection, the use of appropriate nail length, and proper positioning of the nail and screws are necessary to avoid failure or revision.
Conventional Muscle-Reflection Approach versus Mini-Incision Muscle-Splitting Approach in Dynamic Hip Screw Fixation
Authors: Leung WY , Tsang WL 
Published: October 2016

Purpose. To compare the short-term results of conventional versus mini-incision approaches to dynamic hip screw (DHS) fixation. Methods. 41 geriatric patients with either basal femoral neck or intertrochanteric fractures (Kyle types I to III) who underwent closed reduction and DHS fixation by a single surgeon were retrospectively reviewed. From January 2001 to June 2005, 6 men and 19 women aged 60 to 94 (median, 83) years underwent DHS fixation through a conventional muscle-reflection approach with a skin incision of ≥10 cm. From July 2005 to March 2006, 9 men and 7 women aged 67 to 95 (median, 81) years underwent DHS fixation through a mini-incision (4 cm) approach at the lower border of the lesser trochanter. Operating time, drain output and duration of drain placement, decrease in haemoglobin level and receipt of blood transfusions, deterioration in ambulation status, analgesic intake, duration of hospital stay, and bone healing time for the 2 groups were compared. An independent observer retrospectively assessed the fracture pattern, reduction quality, and bone healing time. Results. Compared to patients in the conventional group, those in the mini-incision group had shorter operating times (50 vs 43 minutes, p=0.02), a higher proportion whose drain was removed within 24 hours (28% vs 69%, p=0.01), and consumed fewer dosages of oral analgesics within 48 hours (8 vs 5, p=0.001). Classification of the fracture pattern in 21 of 38 patients were consistent between the surgeon and observer. The Kappa value for agreement was 0.32, denoting marginal agreement (p=0.003). Reduction quality (p=0.66) and bone healing time (p=0.73) assessed by the observer were not significantly different between the 2 groups. Conclusion. The short-term clinical outcome of mini-incision DHS fixation for geriatric pertrochanteric fractures was favourable.
Open Intramedullary Kirschner Wire versus Screw and Plate Fixation for Unstable Forearm Fractures in Children
Authors: Kose O , Deniz G , Yanik S , Gungor M , Islam NC 
Published: October 2016

Purpose. To compare the outcomes of intramedullary Kirschner wire versus screw and plate fixation for unstable forearm fractures in children aged older than 10 years. Methods. Records of 32 children aged 10 to 15 (mean, 12) years with displaced fractures of the radius and ulna were retrospectively reviewed. 17 boys and 4 girls underwent intramedullary Kirschner wiring, whereas 10 boys and one girl underwent plating. All patients had been initially treated with closed reduction and casting. Indications for surgical intervention were fractures with angulation of >10° and total displacement. Patients were followed up for a mean of 24 (range, 13–40) months. Angulation and range of movements of the elbow, wrist, and forearm, as well as clinical and cosmetic results were compared. Results. Both treatments achieved excellent clinical outcomes, but intramedullary Kirschner wiring resulted in better cosmesis, shorter operating times, easier hardware removal, and lower implant costs. Conclusion. Intramedullary Kirschner wiring is a better option than plating for the treatment of unstable forearm fractures in older children.
The Use of Qualitative Cultures for Detecting Infection in Open Tibial Fractures
Authors: D'Souza A , Rajagopalan N , Amaravati RS 
Published: October 2016

Purpose. To determine the role of qualitative cultures for detecting infection in open tibial fractures. Methods. From January 2003 to December 2004, 95 men and 13 women (mean age, 34 years) with open tibial fractures in one or both limbs and without any other sites of infection were prospectively studied. Patients who had been treated with intravenous or oral antibiotics before presentation and/or had undergone debridement or other surgery were excluded. Results. Infection was not correlated with age, sex, interval from injury to debridement, and cause of fracture. The association of infection with predebridement cultures was stronger (odds ratio=12.5) than that with postdebridement cultures (odds ratio=4.7). Conclusion. Pre- and post-debridement cultures have a role in detecting infection in open tibial fractures. For detecting infection, predebridement cultures have better sensitivity, while postdebridement cultures have better specificity.
Cone Femoral Prosthesis for Osteoarthritis of the Hip with Femoral Dysplasia
Authors: Pak P , de Steiger R 
Published: October 2016

Purpose. To assess the clinical and radiological outcomes of total hip replacement (THR) using the cone femoral prosthesis. Methods. Four men and 15 women (26 hips) aged 19 to 78 (mean, 45) years underwent THR for osteoarthritis of the hip with femoral dysplasia using the cone femoral prosthesis. Only 17 patients (24 hips) were available for review. Pain and functional limitation were assessed using the Oxford hip score. Stable fixation by bone ingrowth was defined as no subsidence or radiolucent lines around the prosthesis. Results. The mean follow-up duration was 50 (range, 25–92) months. The mean Oxford hip score improved from 44 (range, 32–54) preoperatively to 17 (range, 12–28) at the latest follow-up. Prosthesis survival was 100%. All prostheses showed stable integration with bony ingrowth and no measurable subsidence. 15 hips had excessive anteversion of 25° to 90°. No patient had venous thromboembolism, deep prosthetic infections or dislocations. Conclusion. The cone prosthesis is less complex and expensive than the modular prosthesis. The early functional and radiological outcomes were excellent, with marked improvement in pain and function. This constitutes effective treatment for osteoarthritis of the hip with femoral dysplasia.
Anterior versus Modified Combined Instrumentation for Burst Fractures of the Thoracolumbar Spine: A Biomechanical Study in Calves
Authors: Tezeren G , Gumus C , Bulut O , Tukenmez M , Oztemur Z , Sever G 
Published: October 2016

Purpose. To compare stability after anterior instrumentation alone versus modified combined anterior and posterior instrumentation for burst fractures of the thoracolumbar spine in calves. Methods. Thoracolumbar spines of 10 calves were used. An axial compression force was applied on each specimen using a material-testing machine, until there was a burst fracture at T12 or L1. Five specimens were fixed with anterior instrumentation alone, using 2 rods connected by 2 screws above and 2 screws below the fractured vertebra plus one tranverse connector. Another 5 were fixed with our modified technique of combined anterior and posterior instrumentation. This entailed one rod connected with one screw above and one screw below the fractured vertebra anteriorly, and another rod connected with one transpedicular screw above and one transpedicular screw below the fractured vertebra posteriorly. After instrumentation, the experiment was conducted again on each specimen and the compressive stiffness and vertebral height loss between the 2 groups compared. Results. The mean compressive stiffness was significantly greater after modified combined anterior and posterior instrumentation than anterior instrumentation alone (5508 vs 2888 N, p=0.0256), whereas the respective vertebral height losses were 37 and 33 mm (p=0.3808). Conclusion. Our modified technique of combined anterior and posterior instrumentation provides greater stability than traditional anterior instrumentation alone.
Acute Invaginating Docking for Infected Nonunions of the Humerus
Authors: Dhar SA , Kawoosa AA , Butt MF , Ali MF , Mir MR , Halwai MA 
Published: October 2016

Purpose. To assess the efficacy of acute invaginating docking for infected non-unions of the humerus. Methods. Eight men and 3 women aged 17 to 59 years with infected non-unions of the humerus underwent acute invaginating docking with shortening and Ilizarov fixation. Results. The mean shortening was 2.9 cm owing to additional debridement. The mean time to external fixator removal was 14.9 (range, 8–28) weeks. The final bone result was excellent in 1, good in 8, and fair in 2. The functional result was excellent in 7 and good in 4. Conclusion. This modality enables simultaneous treatment of infected non-unions, axial alignment, vascularity, stability, and function.
Pelvic Ewing's Sarcoma: A Review from Scottish Bone Tumour Registry
Authors: Bhagat S , Sharma H , Pillai DS , Jane MJ 
Published: October 2016

Purpose. To review various treatment modalities on outcome of patients with pelvic Ewing's sarcoma. Methods. Between January 1948 and December 2004, 18 male and 15 female patients aged 3 to 48 (mean, 20) years with pelvic Ewing's sarcoma were retrospectively reviewed from the Scottish Bone Tumour Registry. Results. The commonest site involved was the ilium. The main presenting symptom was pain, followed by swelling and restricted hip movements. Treatments included surgery, radiotherapy, chemotherapy, or any of them in combination. Patients who had no metastasis at presentation (p<0.01) and underwent chemotherapy with ifosfamide (p<0.01) had significantly longer survival. Age (p=0.09), gender (p=0.95), delay in presentation (p=0.31), tumour site (p=0.9), surgery (p=0.73), and radiotherapy (p=0.23) were not predictive of survival in the univariate analysis. The 5-year event-free survival rate in patients with no metastasis at presentation was 35%. Conclusion. Intense multi-agent neo-adjuvant chemotherapy including ifosfamide followed by wide excision and postoperative radiation are recommended. Local therapy should not take precedence over or interfere with systemic chemotherapy.
Thromboembolic Prophylaxis for Total Knee Arthroplasty in Asian Patients: A Randomised Controlled Trial
Authors: Chin PL , Amin MS , Yang KY , Yeo SJ , Lo NN 
Published: October 2016

Purpose. To compare the efficacy and safety of different modes of thromboembolic prophylaxis for elective total knee arthroplasty (TKA) in Asian patients. Methods. 440 low-risk patients undergoing TKA were randomised into 4 equal groups: (1) no prophylaxis (control), (2) graduated compression stockings (GCS), (3) intermittent pneumatic compression (IPC), and (4) low-molecular-weight heparin (enoxaparin). Duplex ultrasonography was used as an assessment tool. Results. The deep vein thrombosis point prevalence was highest in the control group (22%), which was significantly higher than in patients receiving IPC (8%, p=0.032) or enoxaparin (6%, p=0.001). One patient each in the control and GCS groups developed a non-fatal pulmonary embolism. Patients on enoxaparin received more blood transfusions and 2 of them had major bleeding complications. Conclusion. IPC is the preferred method of thromboprophylaxis for TKA in Asian patients.
Active Unicameral Bone Cysts in the Upper Limb are at Greater Risk of Fracture
Authors: Tey Inn Kuang , Mahadev Arjandas , Lim Kevin Boon Leong , Lee Eng Hin , Nathan Saminathan Suresh 
Published: October 2016

Purpose. To elucidate the natural history of unicameral bone cyst (UBC) and risk factors for pathological fracture. Methods. 14 males and 8 females (mean age, 9 years) diagnosed with UBC were reviewed. Cyst location, symptoms, and whether there was any fracture or surgery were recorded. Cyst parameters were measured on radiographs, and included (1) the cyst index, (2) the ratio of the widest cyst diameter to the growth plate diameter, and (3) the adjusted distance of the cyst border from the growth plate. Results. There were 11 upper- and 11 lower-limb cysts. 13 patients had pathological fractures and 9 did not. 20 patients were treated conservatively with limb immobilisation; 2 underwent curettage and bone grafting (one resolved and one did not). Seven cysts resolved (5 had fractures and 2 did not). The risk of fracture was higher in the upper than lower limbs (100% vs 18%, p<0.001). Fractured cysts were larger than unfractured cysts (mean cyst index, 4.5 vs. 2.2, p=0.07). Active cysts were more likely to fracture. Conclusion. Conservative management had a 30% resolution rate. Surgery should be considered for large active cysts in the upper limbs in order to minimise the fracture risk.
Low Back Pain and Cervical Spondylotic Myelopathy
Authors: Kawakita Eiji , Kasai Yuichi , Uchida Atsumasa 
Published: October 2016

Purpose. To determine characteristics responsible for improvement of low back pain after cervical laminoplasty for cervical spondylotic myelopathy. Methods. 18 men and 10 women aged 38 to 88 (mean, 71) years who had a low back pain visual analogue scale (VAS) score of 5 or more before cervical laminoplasty were included. In 12 patients the VAS score improved to ≤1 after surgery and remained so at 2 years, but in 16 it remained unimproved. Patient characteristics of the 2 groups were compared. Results. Preoperatively 11 of the 12 patients with improved VAS score had continuous low back pain all day, compared to 3 of the 16 who remained unimproved (p<0.01). Conclusion. In some patients, low back pain may be improved following cervical laminoplasty.