bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proximal Femoral Medullary Canal Diameters in Indians: Correlation between Anatomic, Radiographic, and Computed Tomographic Measurements
Authors: Sen Ramesh Kumar , Tripathy Sujit Kumar , Kumar Raj , Kumar Amit , Dhatt Sarvdeep , Dhillon Mandeep Singh , Nagi ON , Gulati Madhu 
Published: October 2016

Purpose. To compare anatomic, radiographic, and computed tomographic (CT) measurements of the proximal femur in an Indian population. Methods. 26 left and 24 right dried cadaveric femurs were obtained. Each femur was divided into segments at 10 cross-sectional levels from proximal to distal. At each level, anteroposterior (AP), lateral, 45° internal oblique, and 45° external oblique diameters of the medullary canal weremeasured using radiography and CT. To minimise magnification, the femur was placed over the film/board. The neck shaft angle, femoral head offset, neck length, and femoral head diameter were also measured. For anatomic measurements, the cross-sections of the medullary canal at levels 3 to 10 were measured using a calliper. Anatomic measurements were compared with radiographic and CT measurements, and the distortion calculated. Correlation between the 3 modalities was calculated using the Pearson correlation coefficient. Accuracy index of the 2 diagnostic modalities was measured, based on the differences between anatomic and radiographic/CT measurements. Lower accuracy indices indicated higher accuracy. Results. On AP radiographs of all femurs, the mean femoral head diameter was 45 mm, the mean neck shaft angle was 132°, the mean femoral head offset was 42 mm, and the mean neck length was 63 mm. With regard to medullary canal diameters, the radiographic and CT measurements were smaller than anatomic measurements at proximal levels, but similar at distal levels. Variations between femurs and between the 4 diameters at the same level were greater at proximal levels. Conclusions. Combined use of radiography and CT is recommended for preoperative assessment of implant size, particularly in uncemented arthroplasty where an optimal fit is essential for biological fixation.
Morphology of the Proximal Femur in a Pakistani Population
Authors: Umer Masood , Sepah Yasir Jamal , Khan Afrasyab , Wazir Ali , Ahmed Mahmood , Jawad Muhammad Umar 
Published: October 2016

Purpose. To measure the morphology of the proximal femur in a Pakistani population. Methods. Standardised anteroposterior pelvic radiographs of 116 male and 20 female healthy volunteers aged 20 to 50 (mean, 33) years were taken. Morphologic dimensions of the proximal femur were measured, including canal flare index (CFI), morphological cortical index (MCI), femoral head offset, femoral head diameter, and femoral head position. Results. Based on the CFI, 67% of the subjects had normal canal shapes (CFI, 3.0–4.7), whereas 1% and 33% of the subjects had stovepipe shapes (CFI, <3) and champagne-flute shapes (CFI, 4.7–6.5), respectively. Based on the MCI, 29% of the subjects had cylindrical shapes (MCI, <2.7) and 71% had trumpet shapes (MCI, >2.7). Conclusion. Morphology of the proximal femur in our study population differed significantly from those in western populations, indicating regional variation. It could also be due to the younger age of our population.
Revision Total Hip Arthroplasty with Femoral Impaction Bone Grafting
Authors: Yan Chun Hoi , Chiu Kwong Yuen , Ng Tsz Pui , Ng Fu Yuen 
Published: October 2016

Purpose. To report the radiological and clinical results of revision total hip arthroplasty (THA) with femoral impaction bone grafting (IBG). Methods. 4 men and 9 women (15 hips) aged 38 to 84 years underwent revision THA with femoral IBG using Elite plus stems for aseptic loosening or infection. Results. The mean follow-up duration was 7.7 years. The Harris hip score improved from 61.7 to 83.7. There was no pain in 11 hips and slight pain in 4. The mean subsidence was 5.7 mm. The mean change of alignment was 1.2°. There was no radiological evidence of stem loosening. One stem was revised due to a peri-prosthetic fracture. Cortical healing was noted in 11 hips, and trabecular incorporation in 10. Conclusion. Although intra- and post-operative complications were not uncommon, femoral IBG is a safe procedure in carefully selected patients and offers good medium-term results.
Arthroscopic Repair of Rotator Cuff Tears Using Absorbable Anchors with a Single-Row Technique
Authors: Russo Raffele , Cautiero Fabio , Giudice Gerardo , Ciccarelli Michele , Visconti Valeria 
Published: October 2016

Purpose. To review outcomes of arthroscopic repair of rotator cuff tears using absorbable anchors with a single-row technique. Methods. 66 patients underwent arthroscopic repair for rotator cuff tears using absorbable anchors with a single-row technique. 51 of them aged 37 to 73 (mean, 57) years had been followed up for a mean of 29 (range, 20–37) months. The extent of the tear was classified as large, medium or small. Functional outcome was assessed using the Constant score. Constant scores and re-tear rates in 3 patient groups (classified by patient age and tear size) were compared. Results. Among the 66 patients, there were 24 large, 29 medium and 13 small cuff tears, and a total of 48, 37, and 18 anchors were used, respectively. Among the 51 patients, the median Constant score improved significantly after arthroscopy (30 vs. 73, p<0.0001). Six shoulders had complete re-tears; their median Constant score was 48 and their adjusted Constant score was 65%. Complete re-tears occurred more often in patients aged >60 years than in those aged 50 to 59 years and <50 years (4/15 vs. 1/22 vs. 1/14), and more often in patients with large tears than in those with medium and small tears (4/24 vs. 2/29 vs. 0/13). Conclusion. Arthroscopic repair of rotator cuff tears using absorbable anchors with a single-row technique is reliable in patients aged <60 years with small or medium tears.
Anatomy of L4 to S3 Nerve Roots
Authors: Waikakul Saranatra , Chandraphak Supichya , Sangthongsil Pichet 
Published: October 2016

Purpose. To study the course of L4 to S3 nerve roots and their distance with the ala of the sacrum and the sacroiliac joint. Methods. The embalmed left half pelvis of 25 male and 27 female cadavers aged 30 to 91 (mean, 68) years were studied. The ventral rami of the L4, L5, S1, S2, and S3 nerve roots were dissected along their courses from the corresponding intervertebral foramina to the lesser pelvis. The distances between each nerve root and the most anterior and inferior parts of the sacroiliac joint were measured in both coronal and sagittal planes. Results. There were 3 locations of fusion of L4 and L5 nerve roots: above, on, or below the level of the most anterior part of the sacroiliac joint. Fusion of S1 and S2 nerve roots at the most inferior part of the sacroiliac joint was encountered in 10% of pelvises. Most S1 and S2 nerve roots lay medial to the sacroiliac joint and closed to the anterior cortex of the ala of the sacrum. Conclusion. Sacral nerve roots may fuse at different levels. Most L4 to S3 nerve roots lie close to the anterior surface of the sacroiliac joint and the ala of the sacrum. To prevent nerve root injury, dissection with a sharp instrument should be avoided at such area and 5 to 7 mm medial to the sacroiliac joint.
Management of Musculoskeletal Injuries after the 2009 Western Sumatra Earthquake
Authors: Pang Hee-Nee , Lim Wilfred , Chua Wei-Chong , Seet Benjamin 
Published: October 2016

Purpose. To report injury patterns and management of musculoskeletal injuries after an earthquake. Methods. 94 male and 161 female patients aged 17 to 90 (mean, 53) years underwent surgery for musculoskeletal injuries. Their injury patterns, anaesthesia administered, surgeries undertaken, and development of postoperative complications were reviewed. Results. Of the 255 patients, 155 sustained superficial lacerations with minor soft-tissue contusion, whereas 100 sustained injuries that necessitated surgery under anaesthesia. The injuries involved the tibia/ankle (n=90), the hand (n=48), the pelvis/femur (n=41), the radius/ulnar (n=36), the foot (n=20), the humerus (n=10), and the spine (n=10). 30 (12%) of the patients had multiple injuries. The most common procedure performed was debridement (n=58), followed by open reduction and internal fixation with plates and screws for closed fractures (n=20), Kirschner wiring (n=11), external fixation (n=8), and general surgery and others (n=6). Repeated debridements were performed for 19 open fractures; 10 involved the distal tibia. 63 procedures were carried out under anaesthesia or sedation. General anaesthesia involved 2 patients; one had a right hemi-colectomy for an ischaemic bowel and another had an appendicectomy. Regional anaesthesia included sub-arachnoid block for lower-limb surgeries (n=21), axillary brachial plexus block for upper-limb surgeries (n=11), and femoral and sciatic nerve blocks for a lower-limb surgery (n=1). The remaining 28 procedures involved conscious sedation. The mean number of debridements for open fractures was 2.8 (range, 2–5). The mean follow-up duration was 10.4 (range, 7–14) days. Only one patient developed a postoperative wound infection. Conclusion. Our team was effective in managing orthopaedic injuries after an earthquake. The postoperative complication rate was low. Regional and spinal anaesthesia are relatively safe alternatives to general anaesthesia when carried out under such austere circumstances. The success of the mission depended on collaboration with the local health care workers and external agencies.
Cervical Spine Injury Recovery Prediction Scale: A Means of Predicting Neurological Recovery in Patients with Acute Subaxial Cervical Spine Injury
Authors: Kumar Ramesh , Arora Sumit , Mohapatra Dattatrey 
Published: October 2016

Purpose. To develop a comprehensive Cervical Spine Injury Recovery Prediction Scale (CSIRPS) to predict outcomes for patients with acute subaxial cervical spine injury (CSI). Methods. 42 men and 18 women (mean age, 41 years) with acute subaxial (C3–C7) CSI and a neurological deficit were evaluated clinically and radiologically after crutch-field skeletal traction. The comprehensive CSIRPS comprised 5 predictor variables: American Spinal Injury Association (ASIA) impairment scale, maximum cord compression, maximum canal compromise, signal intensity pattern in the cord, and Cervical Spine Injury Severity Score (CSISS). Point values of each predictor were weighted based on consensus and experience, and the total effect was computed using the CSIRPS. A receiver operating characteristic (ROC) curve was plotted with the CSIRPS data to obtain the critical value that can predict walkers from non-walkers. Results. The Chi squared value for CSIRPS was 55.771 and the contingency coefficient was 0.694 (p<0.0001), both of which were highest among each predictor's corresponding values. A ROC curve was plotted with the CSIRPS data. With 100% area under the ROC curve, the critical value of 50 was identified with a sensitivity and specificity of 100%. All the patients with CSIRPS above this level regained the useful functions on follow-up, whereas patients with lower scores did not. Conclusion. The CSIRPS is a practical and accurate means of predicting outcomes in patients with acute subaxial CSI.
Popliteal Angle as an Indicator for Successful Closed Reduction of Developmental Dysplasia of the Hip
Authors: Molony Diarmuid C , Harty James A , Burke Thomas E , D'Souza Lester G 
Published: October 2016

Purpose. To evaluate the use of the popliteal angle as an indicator for successful closed reduction of developmental dysplasia of the hip (DDH) in children with delayed presentation. Methods. 29 patients aged 6 to 18 months underwent successful closed reduction for unilateral DDH under general anaesthesia. Using a graduated goniometer, the popliteal angle was measured with the hip abducted within the safe zone (to avoid redislocation and injury to the femoral capital epiphysis) before and after reduction and after 6 weeks of spica casting. Results. The mean popliteal angles before and after reduction and after 6 weeks of spica casting were 5.1°, 37.5°, and 17.9°, respectively (p<0.0001, paired t test). Because of discomfort, the spica casts were altered in 3 patients (2 at week 1 and one at week 3). Conclusion. Reduction of the hip in DDH results in an increased popliteal angle of >20°. This may be used to indicate the diagnosis and safe closed reduction.
Incidence of Deep Vein Thrombosis following Total Hip Arthroplasty: A Doppler Ultrasonographic Study
Authors: Wong Keng Lin , Daguman Richillo , Lim Kay Hui , Shen Liang , Lingaraj Krishna 
Published: October 2016

Purpose. To investigate the incidence of deep vein thrombosis (DVT) following total hip arthroplasty (THA) in Singaporean patients. Methods. 197 patients (mean age, 60 years) underwent primary THA (n=155) or revision procedure (n=42) without receiving routine chemoprophylaxis. There were 149 Chinese, 25 Malays, 19 Indians, and 4 Eurasians. Duplex ultrasonography to detect DVT was performed on both lower limbs on postoperative day 5. Results. 15 (8%) patients developed DVT, which was proximal in 6 and distal in 9. Only one patient had pulmonary embolism. The presence of DVT did not correlate to age, gender, race, presence of diabetes mellitus, history of malignancy, smoking habit, fixation type, primary versus revision type of surgery, or operating time. Conclusion. The incidence of DVT following THA in Singaporean patients is low, and routine chemoprophylaxis may not be indicated.
The Efficacy of Patient Information Sheets in Wrist Arthroscopy: A Randomised Controlled Trial
Authors: Makki Daoud , Alameddine Manal , Khateeb Hesham Al , Packer Greg 
Published: October 2016

Purpose. To evaluate the effects of perioperative information for wrist arthroscopy on postoperative pain, return to daily activities, and patient satisfaction. Methods. 34 women and 21 men aged 19 to 54 (mean, 35) years underwent diagnostic wrist arthroscopy to explore the radiocarpal and midcarpal joints. They were randomised to receive specific preoperative information on the procedure (pictures of the wrist joint anatomy, portal entry sites, and the arthroscope) and written instructions on postoperative care (n=28) or only standard preoperative information and verbal instructions on postoperative care (n=27). The visual analogue score (VAS) for pain and the Quick Dash score for return to daily activities of each patient were recorded before and after wrist arthroscopy. Analgesic intake after wrist arthroscopy was recorded. Results. The mean post-arthroscopic VAS from days 2 to 6 was significantly lower in the experimental group than controls. This was reflected by the decrease in analgesic intake. The mean post-arthroscopic Quick Dash score was significantly lower in the experimental group than controls (40 vs. 47, p=0.02), indicating earlier return to daily activities. Conclusion. Patients who received specific preoperative information on the procedure and written instructions on postoperative care experienced less pain, consumed less analgesics, and had an earlier return to daily activities.
Two-Year Outcomes of Transforaminal Lumbar Interbody Fusion
Authors: Poh Seng-Yew , Yue Wai-Mun , Chen Li-Tat John , Guo Chang-Ming , Yeo William , Tan Seang-Beng 
Published: October 2016

Purpose. To evaluate the outcomes, fusion rates, complications, and adjacent segment degeneration associated with transforaminal lumbar interbody fusion (TLIF). Methods. 32 men and 80 women aged 15 to 85 (mean, 57) years underwent 141 fusions (84 one-level, 27 2-level, and one 3-level) and were followed up for 24 to 76 (mean, 33) months. 92% of the patients had degenerative lumbar disease, 15 of whom had had previous lumbar surgery. Radiographic and clinical outcomes were assessed at 2 years. The short-form 36 (SF-36) health survey, visual analogue scale (VAS) for pain, and the modified North American Spine Society (NASS) Low Back Pain Outcome Instrument were used. Results. Of the 141 levels fused, 110 (78%) were fused with remodelling and trabeculae (grade I), and 31 (22%) had intact grafts but were not fully incorporated (grade II). No patient had pseudoarthroses (grade III or IV). For one-level fusions, poorer radiological fusion grades correlated with higher VAS scores for pain (p<0.01). All components of the SF-36, the VAS scores for pain, and the NASS scores improved significantly after TLIF (p<0.01), except for general health in the SF-36 (p=0.59). Improvement from postoperative 6 months to 2 years was not significant, except for physical function (p<0.01) and role function (physical) [p=0.01] in the SF-36. Two years after TLIF, 50% of the patients reported returning to full function, whereas 72% were satisfied. 26 (23%) of the patients had adjacent segment degeneration, but only 4 of them were symptomatic. Conclusion. TLIF is a safe and effective treatment for degenerative lumbar diseases.
Collagen Membranes for Host-Graft Integration: An Animal Study
Authors: Guerzon Edwin Ravanzo , Pereira Barry P , Bhavanam Kishore , Khin Zarchi A , Nathan Saminathan Suresh 
Published: October 2016

Purpose. To evaluate the biocompatibility of collagen membranes for host-graft integration. Methods. 18 Achilles tendons in 9 rats were used. Five tendons were controls and repaired with prolene 3–0 sutures only. The remaining 13 tendons were cases, and a 10-mm section was excised. A 15×5 mm bovine pericardial collagen membrane (Tutomesh; Tutogen Medical, Germany) was laid circumferentially around the tendon and secured with prolene 3–0 sutures. Tendons were harvested after 4 and 6 weeks. Only the repair interfaces (i.e. cut ends and immediate surrounding tissue) were evaluated. Integration of the membranes to the tendons was evaluated using a semi-quantitative wound maturation scale (1–4) based on the presence of inflammatory cells, vascularisation, fibroblasts, and the amount and alignment of collagen fibrils. The presence of fibroblasts and vascularisation were positive parameters, whereas inflammatory cell ratios were regarded as negative parameters. Immunohistochemical study was also performed. Results. There was no host-graft reaction or wound complication (infection, abscess or seroma). Histological and immunohistochemical assessment confirmed re-approximation of the cut tendon ends and incorporation of the membrane onto the tendon as early as week 4. At week 4, the mean maturation scale scores were 2.7 for controls and 3.3 for cases (p=0.11). At week 6, the corresponding values were 3.8 and 3.0 (p=0.004). A reparative process involving formation of blood vessels and invasion by fibroblasts was noted in both control and case tendons. In controls, T- and B-lymphocytes were present. In cases, inflammatory cells were noted at the junction of the host and membrane without invasion of the graft material. There was no lymphocytic infiltration on the graft. The foreign body reaction was localised and minimal. Conclusion. The collagen membrane achieved favourable host-graft integration as early as week 4, with a minimal foreign body reaction.
Autologous Blood Reinfusion in Patients Undergoing Bilateral Total Hip Arthroplasty
Authors: Gee Albert O , Garino Jonathan P , Lee Gwo-Chin 
Published: October 2016

Purpose. To compare the rate and unit of allogeneic blood transfusion in one-stage bilateral total hip arthroplasty (THA) in patients with and without autologous blood reinfusion. Methods. Records of a consecutive series of 43 men and 33 women aged 25 to 83 (mean, 55) years who underwent one-stage sequential bilateral THA by a single surgeon were reviewed. Their risks of cardiopulmonary complications were minimal. At least 4 weeks prior to surgery, 38 of the patients donated 2 units of autologous blood in 2 stages (one to 2 weeks apart). The remaining 38 patients did not donate blood owing to personal preferences or logistical reasons. All pre-donated autologous blood was transfused back to the patients in the recovery room. Estimated blood loss volume, blood salvaged volume, and complications were recorded, as were pre- and post-operative haemoglobin levels. The 2 groups were compared with respect to the rate and unit of allogeneic blood transfusion. Results. The mean estimated blood loss was 939 (SD, 448; range, 200–2500) ml. The mean volume of blood salvaged was 302 (SD, 196; range, 0–850) ml, representing a collection rate of 32%. In patients with and without autologous blood reinfusion, 16 (42%) and 33 (87%) patients received allogeneic blood transfusion of 0.9 and 2.4 units, respectively (p<0.0001). Four patients developed major cardiopulmonary complications. None had deep venous thrombosis or pulmonary embolism. No complications resulted from blood transfusion. The 2 groups were not significantly different in complication rate (13% vs. 18%, p=0.54) and discharge haemoglobin levels. Conclusion. Autologous blood reinfusion was effective in reducing the rate and unit of allogeneic blood transfusion in patients undergoing one-stage bilateral THA.
Tuberculosis of the Foot and Ankle in Children
Authors: Agarwal Anil , Qureshi Nadeem Akhtar , Khan Shariq Azam , Kumar Pawan , Samaiya Sachin 
Published: October 2016

Purpose. To report manifestations and management of tuberculosis of the foot and ankle in 21 children. Methods. Records of 12 girls and 9 boys aged 3 to 14 (mean, 7) years with tuberculosis of the foot and ankle were reviewed. The mean delay in presentation was 4.7 (range, 0.5–14) months. All the patients had local swelling, tenderness, and antalgic gait; 16 were limping; 5 had an antecedent trauma; 11 had an abscess; and 6 had a discharging sinus. The diagnosis was based on a smear positive for acid-fast bacilli (n=2), histopathology (n=15), or clinicoradiological findings (n=4). Nine patients had osteoarticular tuberculosis in other parts of the body. None had evidence of pulmonary tuberculosis. Lesions were classified into synovial (articular) and osseous. All 3 synovial lesions occurred in the ankle, 2 of which were at an advanced stage. Osseous lesions occurred in the calcaneus (n=5), metatarsal (n=5), talus (n=3), cuboid (n=3), medial cuneiform (n=1), and phalanx (n=1), and were sub-classified into stages 1 (n=3), 2 (n=5), and 3 (n=10) according to disease progression. All the patients were treated conservatively with splintage and chemotherapy. Results. The mean follow-up period was 21 (range, 7–51) months. All the 3 patients with stage 1 osseous lesions showed healing within 6 weeks and had complete recovery of function. Four of the 5 patients with stage 2 lesions also showed complete recovery of function and reformation of bony trabeculations; radiological incorporation of sequestrum was obvious by 6 months in most patients. In patients with stage 3 lesions, healing was delayed and there was residual alteration in bony architecture and joint changes. Sclerotic changes and joint involvement also increased the likelihood of poor outcomes. However, none of our patients had any residual tenderness or foot deformity at the final follow-up. Conclusion. Outcome after non-operative treatment is good, provided the lesions are treated early.