bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sterile Surgical Helmet System in Elective Total Hip and Knee Arthroplasty
Authors: Singh Vinay Kumar , Hussain Shazeena , Javed Sadaf , Singh Ivor , Mulla Rohinton , Kalairajah Yegappan 
Published: October 2016

Purpose. To evaluate the sterility of the sterile surgical helmet system (SSHS) during elective total hip and knee arthroplasty in theatres with (n=20) and without (n=20) laminar flow. Methods. Three surgeons performed 14 total knee arthroplasties (TKAs) and 6 total hip arthroplasties (THAs) in a laminar flow theatre and 15 TKAs and 5 THAs in a non-laminar flow theatre. An SSHS was used in all the procedures. Samples were taken from the hood at 30-minute intervals during surgery. Swabs were then broken into cooked meat broths for cultivation of organisms. The broths were then directly inoculated onto blood agar and fastidious anaerobic agar for culture of aerobic and anaerobic bacteria, respectively. After 24 hours, these plates were reinoculated with broths that had been incubated for 24 hours. Microbial growth was quantified as 0 (none), 1 (mild), 2 (moderate) and 3 (heavy). Bacterial contamination in the 2 groups at 30, 60 and 90 minutes was compared. Results. Respectively in the laminar and non-laminar flow theatres, 0 and 9 of the SSHSs showed bacterial growth after direct inoculation, and 14 and 18 of the SSHSs grew 18 and 24 types of organisms in the swab cultures after 24 hours of incubation. Respectively at 30, 60, and 90 minutes, the degree of contamination from direct incubation was significant, but the degree of contamination on swabs after 24 hours of inoculation was not significant. The mean time-dependent contamination after direct inoculation was 0 for the laminar flow group and 0.5, 0.75, and 1.0 for the non-laminar flow group, whereas the corresponding values after 24 hours of incubation were 1.8, 1.8, and 2.6, and 2, 2.75, and 2.95. Coagulase negative Staphylococcus aureus was the most common organism in both groups. Conclusion. 80% of SSHSs used were contaminated intra-operatively. Direct contact with the SSHS should be avoided by the operating team during surgery. Routine changing of gloves in case of contact with the SSHS should be practised.
Exeter Small Femoral Stem for Patients with Small Femurs
Authors: Chiu Kwok-Hing , Cheung Kin-Wing , Chung Kwong-Yin , Shen Wan-Yiu 
Published: October 2016

Purpose. To report the long-term results of total hip arthroplasty (THA) using small size Exeter femoral stems. Methods. Eight men and 34 women aged 60 to 83 (mean, 70) years underwent 45 THAs using the Exeter small stem with offsets of 30 mm (n=3), 33 mm (n=15), and 35.5 mm (n=27). The Harris hip score was assessed pre- and post-operatively. Stem alignment and axial subsidence of the stem were measured. Radiolucent lines around the femur were recorded at 14 Gruen zones. Completeness and thickness of the cement mantle and cement fractures were also noted. Ectopic ossification, if present, was graded. Stem loosening was based on the Olsson definitions. Results. The mean follow-up was 9 (range, 5–12) years. The mean Harris hip score improved from 37 (range, 13–61) to 80 (range, 47–96) [p<0.001]. At the latest follow-up, the score was excellent (90–100) in 8 (18%) of the hips, good (80–89) in 21 (47%), fair (70–79) in 9 (20%), and poor (<70) in 7 (16%). All hips had a complete cement mantle of ≥2 mm. All stems were inserted without intramedullary reaming. 11 (24%) of the hips developed stem subsidence of <2 mm; all stabilised within 2 years. None of these patients had pain or other radiological signs of loosening. Six stems showed radiolucent lines of <1 mm in the upper zones, which were not progressive. No cement fracture or subsidence was noted. Using revision for any cause as an endpoint, the overall survival rate of Exeter small femoral stem was 100% at 10 years and 89% at 12 years. Conclusion. The results of Exeter small stems for patients with small femurs are good.
Displaced Tibial Intercondylar Eminence Fractures
Authors: Kieser David Christopher , Gwynne-Jones David , Dreyer Stephan 
Published: October 2016

Purpose. To review outcomes of 19 patients with tibial eminence fractures. Methods. Records of 10 female and 9 male patients with type II (n=3) and type III (n=16) displaced tibial intercondylar eminence fractures were reviewed. Nine of whom were skeletally immature aged 6 to 15 (mean, 12) years; the remaining 10 patients were aged 19 to 55 (mean, 32) years. 14 involved the left knee. All patients presented with a painful haemarthrosis and reduced range of movement. Results. The most common activity causing this injury was skiing (n=7, primarily in adult females [n=5]), followed by cycling or motocrossing (n=6) and falling or other sporting activities (n=6). The injury mechanisms entailed forced flexion with rotation (n=7), hyperextension with rotation (n=7, primarily in skeletally immature males [n=4]), and direct trauma (n=5, primarily in adult males [n=4]). Eight patients (60% of adults and 22% of children) had associated injuries of the knee, which commonly occurred after direct trauma. Two patients were treated in a cast or brace after closed or open reduction without fixation. Two patients underwent arthroscopic reduction and internal fixation, and 15 underwent open reduction and internal fixation (2 after failed arthroscopic reduction and 11 proceeded directly). Postoperatively, 7 patients had a positive Lachman test, but none complained of subjective instability. Ten patients had knee stiffness; all except one had been immobilised for 4 to 6 weeks. Seven patients had extension impingement; 6 of them had been treated with open reduction and internal fixation. Two patients underwent further surgery for debridement and screw removal at years 1 and 3. One patient developed arthrofibrosis and underwent arthrolysis at month 6, but knee stiffness remained. No patient underwent subsequent anterior cruciate ligament reconstruction. Conclusion. Tibial eminence fractures are as common in adults as in children. Female skiers are at higher risk. Stiffness is a more common complication than laxity. Early range-of-motion exercise may reduce stiffness and extension impingement.
Staged Arthroscopic Reconstructive Surgery for Multiple Ligament Injuries of the Knee
Authors: Subbiah M , Pandey Vivek , Rao Sharath K , Rao Sripathi 
Published: October 2016

Purpose. To review treatment outcome of our staged protocol for multiple ligament injuries of the knee. Methods. 21 men who were treated for multiple ligament injuries of the knee and had completed at least one year of rehabilitation were evaluated. Patients were examined under anaesthesia and then by diagnostic arthroscopy. Arthroscopic reconstructive procedures for injured cruciate ligaments were performed after a minimum 110° flexion and full extension were regained. Collateral ligaments injuries were treated first, followed by posterior cruciate ligament (PCL) and then anterior cruciate ligament (ACL) tears. Outcome was evaluated using the Lysholm knee score and International Knee Documentation Committee (IKDC) knee ligament evaluation form. Results. 19 patients aged 24 to 55 (mean, 36) years were followed up for a mean of 22 (range, 14–33) months. The mean Lysholm score was 92. The mean scores for patients treated within and after 3 weeks were 93 and 90, respectively. The overall IKDC grading was B in 15 knees and C and D each in 2 knees. For the 2 patients with grade D, one presented 19 months after the injury and had persistent posterior sag (secondary to capsular contracture). His Lysholm score was 82. The second patient developed a deep infection and endured a flexion loss of 30° but had a satisfactory Lysholm score of 94. There was no significant difference between early and delayed treatments and between low- and high-velocity injuries in terms of the Lysholm score, the IKDC grade, the range of movement, and the functional outcome. Conclusion. Staged management of multiple ligament injuries of the knee enabled satisfactory restoration of function, stability, and range of movement in most of our patients. By staging the procedures, the need for subsequent ACL reconstruction can be better evaluated, as ACL reconstruction is not necessary in patients not undertaking strenuous activities.
Closed Reduction and Percutaneous Screw Fixation for Tibial Plateau Fractures
Authors: Sament Radheshyam , Mayanger JC , Tripathy Sujit Kumar , Sen Ramesh Kumar 
Published: October 2016

Purpose. To evaluate treatment outcomes of closed reduction and percutaneous screw fixation for tibial plateau fractures. Methods. 48 men and 8 women aged 19 to 61 (mean, 36) years underwent closed reduction and percutaneous screw fixation for closed tibial plateau fractures with <5 mm depression. According to the Schatzker classification, patients were classified into type I (n=9), type II (n=22), type IV (n=5), and type V (n=20). Closed reduction was achieved using manual ligamentotaxis with traction in extension under image intensifier control. Reduction was fixed percutaneously with cancellous screws (6.5 mm) and washers. Functional outcome (pain, walking capacity, extension lag, range of motion, and stability) was evaluated using the Rasmussen score. A total score of 28 to 36 was considered as excellent, 20 to 27 as good, 10 to 20 as fair, and >10 as poor. Results. Patients were followed up for a mean of 2.8 (range, 1–4) years. The mean length of hospital stay was 5 (range, 2–15) days. All the fracture united radiographically after a mean of 3 (range, 2.5–4.2) months. Respectively in Schatzker types-I, -II, -IV, and -V fractures, outcomes were excellent in 6, 10, 2, and 2 patients, good in 2, 9, 3, and 14 patients, fair in 1, 3, 0, and 2 patients, and poor in 0, 0, 0, and 2 patients. Outcome was satisfactory (good-to-excellent) in 89%, 86%, 100%, and 80% of the respective fracture types of patients. The mean Rasmussen score was 25.7 for all patients; it was 27.7 for type I, 26.3 for type II, 28.6 for type IV, and 23.4 for type V fractures. The mean Rasmussen score was significantly lower in 12 patients with ligament injury than in 44 patients without ligament injury (19.8 vs. 27.3, p<0.001). No patient had any complication (infection, wound dehiscence or hardware problem). Conclusion. Closed reduction and percutaneous screw fixation for tibial plateau fractures is minimally invasive. It reduces the length of hospital stay and costs, enables early mobilisation with minimal instrumentation, and achieves satisfactory outcomes.
Antegrade Interlocking Nailing for Distal Femoral Fractures
Authors: Kulkarni Sunil Govind , Varshneya Ankit , Kulkarni Govind Shivram , Kulkarni Milind Govind , Kulkarni Vidisha Sunil , Kulkarni Ruta Milind 
Published: October 2016

Purpose. To assess outcomes of antegrade interlocking nailing for supracondylar or intercondylar fractures of the distal femur. Methods. Records of 10 women and 20 men aged 20 to 70 (mean, 48.7) years who underwent antegrade interlocking nailing for distal femoral fractures were reviewed. 23 patients had closed fractures and 7 had open fractures; 6 had associated fractures of the forearm or tibia. According to the AO/ASIF system, fractures were classified as types A1 (n=13), A2 (n=6), A3 (n=3), and C1 (n=8). The affected leg was put in an extension shoe for traction, and reduction was achieved with the help of percutaneous lag screws. The nail was inserted from the tip of the greater trochanter and centred in both anteroposterior and lateral planes. The nail was modified to have 3 screw slots in the mediolateral plane and one screw slot in the anteroposterior plane distally for stability in multiple directions. Postoperatively early mobilisation and partial weight bearing were allowed. Patients were assessed using the modified knee-rating scale of the Hospital for Special Surgery. Results. The mean time to bone union was 13.1 (range, 10–18) weeks. The mean follow-up period was 18.8 (range, 11–30) months. Three patients were lost to follow-up; outcomes in the remaining patients were excellent in 20 and good in 7. The mean range of knee flexion was 106° (range, 90°–120°). One patient developed a flexion deformity of 10°. All patients attained full quadriceps strength. No patient had ligamentous instability, nerve injuries, superficial or deep infections, or implant failure. Three patients had malunion, which was located in the meta-diaphyseal segment and not in the intra-articular segment. Hence, there was no functional problem or shortening. The mechanical axis was not deviated. Conclusion. Antegrade interlocking nailing achieved good-to-excellent outcomes for distal femoral fractures
Percutaneous Tension Band Wiring for Patellar Fractures
Authors: Rathi Akhilesh , Swamy MKS , Prasantha I , Consul Ashu , Bansal Abhishek , Bahl Vibhu 
Published: October 2016

Purpose. To evaluate outcome of percutaneous tension band wiring for transverse fractures of the patella. Methods. 16 men and 7 women aged 27 to 65 (mean, 40) years underwent percutaneous tension band wiring for transverse fractures of the patella with a displacement of >3 mm. Pain, operating time, mobility, functional score, and complications were evaluated. Results. 20 patients underwent successful percutaneous tension band wiring. The remaining 3 patients in whom closed reduction failed underwent open reduction and tension band wiring. The mean operating time was 46 (range, 28–62) minutes. The mean follow-up period was 20 (range, 15–30) months. At the latest follow-up, all patients had regained full extension. The objective score was excellent in 20 patients and good in 3, whereas the subjective score was excellent in 17, good in 5, and fair in one. All patients had radiological union at week 8. One patient had patellofemoral arthritis (secondary to a postoperative articular step). Two patients developed superficial infections, which resolved after antibiotic therapy. Mean thigh muscle wasting was 0.7 (range, 0.4–1) cm. Three patients encountered hardware problems (impingement/irritation of the skin over the knee) necessitating implant removal. Conclusion. Percutaneous tension band wiring is a viable option for transverse fractures of the patella.
Aneurysmal Bone Cysts of the Vertebrae
Authors: Lim Jason Beng Teck , Sharma Himanshu , Reid Robin , Reece Anthony Tony 
Published: October 2016

Purpose. To review records of 14 patients with aneurysmal bone cysts (ABCs) of the spine. Methods. Using the Scottish Bone Tumour Registry for the period of October 1952 to November 2005, records of 9 females and 5 males aged 8 to 63 (mean, 25.3) years who had ABCs of the spine and were followed up for a mean of 7.1 years were reviewed. Results. The most commonly involved site was the lumbar vertebrae (n=6), followed by the thoracic (n=4), cervical (n=3), and sacral (n=1) vertebrae. The mean duration of symptoms at presentation was 8.8 (range, 0.3–24) months. The symptoms included gradually increasing pain in the back (n=14), a palpable spinal mass (n=4), spinal deformity (n=2), and neurological defcits (n=5). All the patients underwent surgery: intra-lesional excision (curettage) without bone grafting (n=3), excision (n=7, 2 of whom had adjuvant radiotherapy), and open excisional biopsy (n=4, 2 of whom had iliac crest bone grafting). One patient with a cervical ABC underwent preoperative angiographic embolisation. Another patient with a sacral ABC underwent percutaneous sclerotherapy. Two patients had recurrence. One had recurrence within 4 months and underwent adjuvant radiotherapy; another had recurrence 16.8 years later and underwent repeat curettage. No major complications were encountered. Conclusion. Most ABCs of the spine occurred in young females. Intra-lesional excision was an effective treatment.
Antegrade Interlocking Nailing versus Dynamic Compression Plating for Humeral Shaft Fractures
Authors: Kulkarni Sunil G , Varshneya Ankit , Jain Mohit , Kulkarni Vidhisha S , Kulkarni Govind S , Kulkarni Milind G , Kulkarni Ruta M 
Published: October 2016

Purpose. To compare antegrade interlocking nailing with dynamic compression plating for humeral shaft fractures in terms of functional outcomes, union and complication rates. Methods. 34 men and 22 women aged >18 years with fresh humeral shaft fractures (up to grade IIIa) with or without neurological deficits underwent either antegrade interlocking nailing (n=31) or dynamic compression plating (n=25). Functional outcome of the upper limbs (according to the American Shoulder and Elbow Surgeons [ASES] score), pain, rates of union, and complications in the 2 groups were compared. Results. Respectively in the nailing and plating groups, mean operating times were 65 and 112 minutes (p<0.001), mean blood loss volumes were 20 and 232 ml (p<0.001), mean ASES scores were 31.4 and 29.0 (p=0.448), complication rates were 20% (6/31) and 24% (6/25) [p=0.900], non-union rates were 13% (4/31) and 8% (2/25) [p=0.625], and delayed union rates were 7% (2/31) and 4% (1/25) [p=0.787]. Conclusion. Both techniques were appropriate for treating humeral shaft fractures.
Tension Band Wiring versus Knowles Pinning for Non-Union of Type-2 Distal Clavicle Fractures
Authors: Wu Chi-Chuan 
Published: October 2016

Purpose. To compare tension band wiring (TBW) with Knowles pinning for non-union of type-2 distal clavicle fractures. Methods. 22 men and 6 women aged 23 to 62 (mean, 39) years underwent TBW (n=17) or Knowles pinning (n=11) for non-union of type-2 distal clavicle fractures. Both techniques were supplemented with autogenic cancellous bone grafting. Functional outcome of the shoulder was evaluated using the Constant scoring system (maximum score, 100). Excellent (≥90) and good (≥80) scores were defined as satisfactory. Results. Of the 28 patients, 25 were followed up for a mean of 2.6 (range, 1.1–4.2) years, whereas 3 were lost to follow-up. The median times to union were not significantly different between the TBW (n=15) and Knowles pinning (n=10) groups (4.0 vs. 4.3 months, p=0.94). Five non-unions treated with TBW had migration of the Kirschner wires, which was resolved by further restriction of shoulder motion. There were no other complications such as deep infection, non-unions, or malunions. All 25 patients achieved satisfactory full range of shoulder motion with minimal pain. Conclusion. Both techniques achieved high rates of satisfactory outcome. TBW may result in Kirschner wire migration but is preferred for cases with a small distal fragment.
Does a Mixed Training Course on the Oxford Unicompartmental Knee Arthroplasty Improve Non-Technical Skills of Orthopaedic Surgeons?
Authors: Alvand Abtin , Gill Harinderjit S , Price Andrew J , Dodd Christopher AF , Murray David W , Rees Jonathan L 
Published: October 2016

Purpose. To determine whether a mixed course on the Oxford unicompartmental knee arthroplasty (UKA) could improve the non-technical (cognitive) skills of performing UKA. Methods. 120 delegates consisting of consultant orthopaedic surgeons and advanced surgical trainees attended a 2-day course. 104 (87%) of the delegates had performed total knee arthroplasties, whereas 79 (66%) had performed UKAs. The course consisted of didactic lectures, interactive surgical demonstrations, and practical dry-bone skills workshops. Cognitive skills were assessed at the start (day 1) and end (day 2) of the course using 10 multiple-choice questions. The maximum test score was 10. Multilevel modelling was used to compare the pre- and post-course test scores. The pairings of pre- and post-course scores were not known because of a confidentiality clause. Results. Of the 120 delegates, 71 (59%) took the pre-course test and 120 (100%) took the post-course test. The median score improved significantly from 2 (interquartile range [IQR], 0.5–3.5) to 6 (IQR, 4.5– 7.5) [bootstrap p<0.0001] for every single one of the randomly allocated pairings. Most delegates had poor cognitive skills for the UKA before the course and improved significantly after the course. Subanalysis of each question topic showed significant improvement in scores for all topics after the course (bootstrap p<0.0001). Nonetheless, the extent to which individual topic scores improved varied widely. The odds ratio for the preversus post-course total test score was 4.36. Conclusion. A mixed continuing medical education course could enhance the non-technical (cognitive) skills for UKA.
Magnetic Resonance Imaging Evaluation of Patellar Tendon Graft Remodelling after Anterior Cruciate Ligament Reconstruction with or without Platelet-Rich Plasma
Authors: Seijas Roberto , Ares Oscar , Catala Jordi , Alvarez-Diaz Pedro , Cusco Xavier , Cugat Ramon 
Published: October 2016

Purpose. To evaluate the stages of patellar tendon graft remodelling using magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) reconstruction with or without platelet-rich plasma (PRP) injection. Methods. 98 patients aged 18 to 65 years with complete rupture of the ACL were randomised to undergo reconstruction with the autologous patellar tendon grafts with or without PRP injection. For the PRP group, 8 ml of PRP was obtained in the surgery room and was percutaneously injected into the suprapatellar joint after portal suture. MRI was obtained at months 4, 6, and 12. Remodelling stages of the grafts were classified as hypointense, mildly hyperintense, moderately hyperintense, severely hyperintense, and diffusely hyperintense by a radiologist blinded to treatment allocation. Results. More patients in the PRP group than controls attained higher stages of remodelling at month 4 (p=0.003), month 6 (p=0.0001), and month 12 (p=0.354). Conclusion. PRP enabled faster remodelling of patellar tendon grafts.
Position of the Patella in Adults in Central India: Evaluation of the Insall-Salvati Ratio
Authors: Upadhyay Sachin , Raza HKT , Srivastava Pranay 
Published: October 2016

Purpose. To assess the Insall-Salvati ratio in normal Indian adults to determine its applicability and the incidence of patella alta and baja in Indian populations. Method. 800 knees in 200 men and 200 women aged 18 to 50 (mean, 30) years were evaluated using lateral radiographs. The knee was set in semi-flexion (30°) to enable good visualisation of the patellar tendon and its insertion into the tibia on radiographs. The length of the patellar tendon (LT) over the length of the patella (LP)—the Insall-Salvati ratio—was measured, using a vernier caliper. Results. The mean LT/LP ratio was 1.14 (standard deviation, 0.18). Based on the 95% confidence interval, the ratio was considered normal if within ±40%. The LT/LP ratio was significantly higher in females than males (1.17 vs. 1.12, p<0.01). The cut-off point of patella alta was significantly greater in our Indian subjects than in western subjects (>1.5 vs. >1.2, p<0.0001). In the present cohort, the frequencies of patella alta (ratio, >1.5) and patella baja (ratio, <0.7) were 2.8% and 1%, respectively. Conclusion. The use of the Insall-Salvati ratio to determine the patellar position is less applicable to Indian populations in which squatting, sitting cross-legged, and kneeling are customs. We propose that the normal range of the ratio for squatters among Indian populations be 0.7 to 1.5.