bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scarf Osteotomy with or without Proximal Phalangeal Osteotomy for Severe Hallux Valgus Deformity
Authors: Marudanayagam Ashok , Appan Sadai V 
Published: October 2016

Purpose. To report outcome of Scarf osteotomy with or without proximal phalangeal osteotomy for correction of severe hallux valgus deformity. Methods. Records of 48 women and 4 men aged 28 to 68 (mean, 52) years who underwent 57 Scarf osteotomies with or without proximal phalangeal osteotomy for severe hallux valgus by a single surgeon were reviewed. The patients had a hallux valgus angle (HVA) of up to 55°. An additional proximal phalangeal osteotomy was performed in 11 of the patients whose hallux valgus persisted (HVA >10°). The American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, the HVA and intermetatarsal angle (IMA) on radiographs, and the complication rate were assessed. Results. The mean follow-up period was 26 (range, 24–36) months. The mean AOFAS hallux score improved from 57.4 (range, 49–64) to 91.6 (range, 75–100). The mean HVA improved from 38.1° (range, 28°–52°) to 12.8° (range, 5°–20°). The mean IMA improved from 17.0° (range, 13°–24°) to 6.8° (range, 3°–10°). One patient developed chronic regional pain syndrome. There were no instances of non-union, delayed union, or malunion of the osteotomy site. Conclusion. Scarf osteotomy with or without proximal phalangeal osteotomy is an effective treatment for correcting severe hallux valgus deformity.
Repair of Achilles Tendon Ruptures with Peroneus Brevis Tendon Augmentation
Authors: Singh Amarjeet , Nag Kushal , Roy Shuvendu P , Gupta Ramesh Chandra , Gulati Vaibhav , Agrawal Nikunj 
Published: October 2016

Purpose. To report 22 patients who underwent repair of compound Achilles tendon ruptures with peroneus brevis tendon augmentation. Methods. Records of 6 women and 19 men aged 21 to 42 (mean, 28) years who underwent repair of compound Achilles tendon ruptures with peroneus brevis tendon augmentation were reviewed. All the wounds were transverse/oblique, minimally contaminated, and could be closed primarily. Patients were evaluated at months 3, 9, and 12, using the Foot and Ankle Outcome Score (FAOS) questionnaire. Results. Of the 22 patients, 3 developed superficial skin complications that healed gradually, and 2 developed a superficial discharging sinus and underwent minor debridement. No patient had a re-rupture of the Achilles tendon. At the one-year follow-up, all patients achieved good functional outcome in terms of the FAOS. Conclusion. Repair of Achilles tendon ruptures with peroneus brevis tendon augmentation achieved good functional outcome.
Enhancing Soft-Tissue Reattachment in Proximal Humeral Endoprosthetic Reconstruction
Authors: Ji Tao , Tang Xiaodong , Guo Wei 
Published: October 2016

Purpose. To report on the use of the Ligament Advanced Reinforcement System (LARS) to enhance joint stability and functional outcome in proximal humeral endoprosthesis reconstruction. Methods. Two men and 5 women aged 16 to 66 (mean, 28) years underwent wide resection of tumour and endoprosthesis reconstruction of the proximal humerus using the LARS, as the rotator cuff and/or deltoid muscle could be preserved. The preserved muscles were reattached to anatomic positions to regain function. Shoulder range of motion and Musculoskeletal Tumour Society scores were evaluated. Results. The mean follow-up was 26 (range, 14–36) months. All the 7 patients were alive without disease. The mean active abduction was 77° (range, 60°–100°), and the mean active flexion was 74° (range, 50°–100°). The mean Musculoskeletal Tumour Society score was 86% (range, 80–93%). One patient had instability of the glenohumeral joint at one year. Conclusion. The LARS may enhance soft-tissue reattachment and improve shoulder stability after proximal humeral endoprosthetic reconstruction.
Accuracy of Preoperative Templating in Total Hip Arthroplasty
Authors: Riddick Andrew , Smith Adam , Thomas D Phill 
Published: October 2016

Purpose. To assess the accuracy of templating in total hip arthroplasty (THA). Methods. Anteroposterior pelvic radiographs of 20 men and 33 women aged 17 to 80 (mean, 60) years who underwent uncemented THA of the right (n=24) and left (n=29) sides using a single prosthesis were reviewed. A 30-mm–diameter scaling ball was placed between the patient's legs for calculating the magnification factor (MF) of the radiographs. The planned THA was templated using computer software. The positioning of the scaling ball was measured. The preoperative MF was calculated as the size of the ball on radiograph divided by the true size of the ball times 100. The true MF was calculated as the size of the cup on radiograph divided by the true size of the cup times 100. The accuracy of the preoperative MF was calculated as the preoperative MF divided by the true MF times 100. Results. The cup size and stem size were predicted correctly (within one size error) in 87% and 92% of the patients, respectively; no template size was greater than 3 size errors. The overall mean pre-and post-operative MFs differed significantly (122% vs. 127%, p±0.001), as did the mean postoperative MFs between males and females (126% vs. 128%, p=0.006). Assuming the MF was constant, and the postoperative measurement was the most accurate, the mean accuracy of preoperative MF was 96% (range, 89.6–99.9%), whereas the relative mean height of the scaling ball was 30 (range, 1–90) mm away from the correct height. The accuracy of the preoperative MF did not correlate with body mass index, the scaling ball position, and the accuracy of cup and stem templates. Conclusion. If the MF of 127% is constant across different patients, using a MF of 127% is more accurate than using the scaling ball technique.
Informed Consent Documentation for Total Hip and Knee Replacement Using Generic Forms with Blank Spaces
Authors: Mussa Mohamed Altayeb , Sweed Tamer Ahmed , Khan Aazer 
Published: October 2016

Purpose. To analyse informed consent documentation of 100 patients undergoing elective primary total hip replacement (THR) or total knee replacement (TKR) using generic forms with blank spaces. Methods. Informed consent documentation of 57 men and 43 women (mean age, 54 years) undergoing elective primary THR (n=50) or TKR (n=50) using generic forms with blank spaces were analysed. The consent forms were explained to the patients mostly on the morning of surgery by a consultant surgeon (n=21), specialist registrar (n=23), or senior house officer (n=56). Data on patient demographics, planned procedure, benefits and risks of surgery, and the grade of the surgeon were collected. Results. In the consent forms for THR, the most frequently documented complications included infection (98%), bleeding (96%), deep vein thrombosis (94%), nerve damage (94%), blood vessel damage (94%), and pain (90%). Common complications (2–5% of occurrence) that were less frequently documented included prosthesis wear or loosening (76%), dislocation (68%), and leg length discrepancy (62%). In the consent forms for TKR, the most frequently documented complications included infection (96%), bleeding (92%), deep vein thrombosis (90%), nerve damage (90%), and blood vessel damage (90%). Common risks (2–5% of occurrence) that were less frequently documented included pain (84%), prosthesis wear or loosening (54%), and knee stiffness (40%). Conclusion. Documentation of all clinically significant complications was insufficient when generic informed consent forms with blank spaces were used. The use of standardised procedure-specific consent forms is recommended.
Surgeons' Knowledge about the Costs of Orthopaedic Implants
Authors: Rohman Lebur , Hadi Saifullah , Whitwell George 
Published: October 2016

Purpose. To investigate consultant surgeons' knowledge about the costs of implants for various joint surgeries. Methods. Questionnaires were distributed to consultant orthopaedic surgeons at 2 hospitals. Respondents were asked to estimate the implant costs of any brand for low-demand and high-demand total hip replacement (THR), total knee replacement (TKR), uni-compartmental knee replacement, arthroscopy shaver blade, total anterior cruciate ligament (ACL) fixation, and meniscal repair. The actual cost of each implant was obtained from the manufacturer. Results. 16 consultant surgeons completed the questionnaires. The respective mean estimated and actual costs for a low-demand THR implant were £1714 (range, £600–3000) and £1448 (range, £985–2335), with an overestimation of 18.4%. The respective costs for a high-demand THR implant were £2172 (range, £600–6000) and £1737 (range, £1192–2335), with an overestimation of 25%. The respective costs for a TKR implant were £1550 (range, £600–6000) and £1316 (range, £995–1535), with an overestimation of 17.8%. The respective costs for a uni-compartmental knee replacement implant were £1040 (range, £600–2000) and £1296 (range, £698–1470), with an underestimation of 19.7%. The respective costs for an arthroscopy shaver blade were £110 (range, £75–150) and £94 (range, £80–100), with an overestimation of 16.6%. The respective costs for a total ACL fixation implant were £246 (range, £80–500) and £306 (range, £272–335), with an underestimation of 19.4%. The respective costs for a meniscal repair implant were £153 (range, £50–250) and £242 (range, £170–260), with an underestimation of 37%. Conclusion. The knowledge among consultant orthopaedic surgeons about implant costs was poor. To reduce implant costs, cooperation between surgeons and hospital managers and measures to increase surgeons' awareness about cost-reduction programmes are needed.
Hospital Mortality after Arthroplasty Using a Cemented Stem for Displaced Femoral Neck Fractures
Authors: Ginsel Bastiaan L , Taher Ahmad , Ottley Michael C , Jayamaha Sepalika , Pulle Chrys R , Crawford Ross W 
Published: October 2016

Purpose. To review hospital mortality after hemiarthroplasty or total hip arthroplasty (THA) using a cemented stem for displaced femoral neck fractures. Methods. Medical records of 284 hips in 70 men and 209 women aged 45 to 106 (mean, 81.3) years who underwent hemiarthroplasty (n=232) or THA (n=52) with a cemented stem using third-generation cementing techniques (including use of a plug, lavage, and cement pressurisation) for displaced femoral neck fractures were retrospectively reviewed. According to the American Society of Anesthesiologists (ASA) grading, 6 patients were classified preoperatively as grade 1, 77 as grade 2, 148 as grade 3, 47 as grade 4, and one as grade 5. Patients were operated on within 48 hours. Patients were rehabilitated in the hospital until discharge. The primary outcome measure was hospital mortality, including the cause of death. Results. The mean length of hospital stay was 9.2 (standard deviation, 4.1) days. The hospital mortality was 5.7% (n=16). Of the 16 patients who died, 3 were classified preoperatively as ASA grade 2, 6 as grade 3, and 7 as grade 4. One patient died during the operation. One patient died in the recovery room within 6 hours. Both died from a cardiac arrest and were classified as ASA grade 4. Six patients died within the first 5 days. The causes of death were aspiration pneumonia (n=5), cardiac arrest (n=3), bowel perforation (n=2), multiple organ failure (n=3), type 2 respiratory failure (n=1), heart failure (n=1), and subarachnoid bleeding after a hospital fall (n=1). Conclusion. Hemiarthroplasty or THA using a cemented stem resulted in low hospital mortality in our hospital dedicated to the treatment of geriatric hip fractures. Hospital mortality was higher in patients with ASA grade 3 or higher.
Cancellous Screw Fixation for Undisplaced Femoral Neck Fractures in the Elderly
Authors: Manohara Ruben , Liang Shen , Huang Deborah , Krishna Lingaraj 
Published: October 2016

Purpose. To review the outcomes of cancellous screw fixation for undisplaced femoral neck fractures in elderly patients and to identify the risk factors associated with poor outcomes. Methods. Medical records of 100 patients aged 61 to 94 (mean, 78) years who underwent internal fixation with cancellous screws for undisplaced femoral neck fractures were reviewed. According to the Garden classification, 85 fractures were type 1 (impacted fractures) and 15 were type 2 (complete, undisplaced fractures). Postoperative mobility and pain were assessed through a telephone survey. Outcome measures included the length of surgery, length of hospital stay, perioperative complications, postoperative pain, pre- and post-operative mobility status, and rates and causes of implant revision and mortality. Results. Of the 96 patients followed up for a mean of 39 (range, 25–76) months, 8 underwent revision surgery for avascular necrosis of the femoral head (n=5) or non-union/implant failure (n=3). Of the 68 patients assessed for postoperative pain and mobility, 15 had pain on movement, whereas 55 could ambulate independently with or without walking aids (out of 61 that could do so preoperatively). Overall, 30 patients had a decrease in their mobility status. Patients aged >75 years (compared with those aged ≤75 years) were associated with longer length of hospital stay (12.7 vs. 10.2 days, p=0.047) and higher mortality rate (23% vs. 7%, p=0.044). The length of hospital stay was also associated with presence of ischaemic heart disease/cerebrovascular accident (14.4 vs. 11.04 days, p=0.002). Pain, mobility, and rates of complication and revision were not associated with any of the variables. Conclusion. Cancellous screw fixation for undisplaced femoral neck fractures in elderly patients was associated with relatively low complication and revision rates.
Femoral and Tibial Tunnel Positioning on Graft Isometry in Anterior Cruciate Ligament Reconstruction: A Cadaveric Study
Authors: Smith James O , Yasen Sam , Risebury Mike J , Wilson Adrian J 
Published: October 2016

Purpose. To assess distance changes between the femoral and tibial attachment points of 3 different anterior cruciate ligament (ACL) tunnel entry positions throughout the range of knee motion in cadaveric knees. Methods. The ACLs of 11 fresh-frozen cadaveric knees (from 6 men and 5 women) were removed using radiofrequency. Three tibial tunnel placements were made using a cannulated awl, and three 2.4-mm pilot tunnels were drilled on the lateral femoral condyle. One end of an inelastic suture was inserted from each of the 3 femoral holes and fixed on the femoral cortex using a suture button in turn, whereas the other end of the suture was passed through the cannulated awl and fixed on each of the 3 tibial placements in turn, with constant tension. Distance changes of the suture throughout the range of knee movement (0°, 90°, and 135° of knee flexion) were measured for each combination of tibial and femoral positions. Results. The distance was minimum when the knee was in full extension (p±0.0001). Most of the distance changes occurred during initial flexion (0°–90°). The most isometric position (mean±standard deviation [SD] distance change, 2.78±0.93 mm; p±0.0001) was noted when the suture was at the anteromedial bundle placement in the femur and anterior in the tibia. The least isometric position (mean±SD distance change, 10.37±2.08 mm; p±0.0001) was noted when the suture was at the mid-bundle position in the femur and at the posterolateral bundle insertion in the tibia. The anatomic position resulted in a mean±SD distance change of 7.63±2.01 mm (p±0.0001). The femoral position had a greater influence on distance change than the tibial position. Conclusion. None of the ACL graft positions was isometric. Anatomic ACL positioning resulted in comparable anisometry to the native ACL. The minimum distance for all graft positions was noted in full extension, in which position the graft should be fixed during anatomic ACL reconstruction.
Curettage and Reconstruction by the Sandwich Technique for Giant Cell Tumours around the Knee
Authors: Saibaba Balaji , Chouhan Devendra Kumar , Kumar Vishal , Dhillon Mandeep Singh , Rajoli Sreekanth Reddy 
Published: October 2016

Purpose. To evaluate outcomes of 36 patients who underwent curettage, use of phenol, and reconstruction using the sandwich technique for giant cell tumour (GCT) of bone around the knee. Methods. 22 women and 14 men aged 19 to 46 (mean, 29.6) years underwent intralesional curettage, use of phenol, and reconstruction using the sandwich technique for GCT of the proximal tibia (n=23) or distal femur (n=13). Two of the cases were recurrences. Two, 18, and 16 tumours were classified as grade I, grade II, and grade III, respectively. Five of the grade III tumours were associated with an extra-articular pathological fracture. Patients underwent intralesional curettage, use of phenol, and reconstruction with allograft, gel foam, and cement (the sandwich technique). Pathological fractures were fixed with plates. Functional outcome was evaluated using the Musculoskeletal Tumor Society (MSTS) score. Results. The mean follow-up period was 5 (2.5–11) years. The mean MSTS score was 27.7 out of 30 (standard deviation, 3; range, 16–30). One patient with a grade III tumour in the proximal tibia had a recurrence detected elsewhere after 3 years. Her MSTS score at 2 years was 26. No patient had malignant transformation. Conclusion. Intralesional curettage, use of phenol, and reconstruction with allograft, gel foam, and cement (the sandwich technique) for GCT of bone achieved good functional outcome and a low recurrence rate.
Anterior Cervical Disc Replacement for Degenerative Disc Disease
Authors: Munigangaiah Sudarshan , McCabe John P 
Published: October 2016

Purpose. To review the outcomes of anterior cervical disc replacement using the Prestige LP system for degenerative disc disease. Methods. Medical records of 12 men and 23 women aged 26 to 66 (mean, 46) years who underwent 48 anterior cervical disc replacements using the Prestige LP system by a single spine surgeon were reviewed. 22 patients underwent one-level disc replacement at C5-C6 (n=13) and C6-C7 (n=9), and 13 patients underwent 2-level disc replacement at C5-C6 and C6-C7 (n=11), C4-C5 and C5-C6 (n=1), and C6-C7 and C7-T1 (n=1). Neck Disability Index (NDI) score, visual analogue scale (VAS) for pain in the neck and arm, and physical and mental component scores of the Short Form 36 were evaluated at week 6 and months 6, 12, 24, 36, and 48. Results. The NDI score, VAS score for neck and arm pain, and physical and mental component scores of the Short Form 36 improved significantly after surgery (p<0.001). 80% of patients were satisfied with the treatment. One patient developed a neck haematoma on day 1 and underwent surgical evacuation. Another patient developed Horner's syndrome and achieved partial recovery at 6 weeks and complete recovery at 6 months. No patient had implant-related complications or reoperation. Conclusion. The Prestige LP cervical disc implant was safe for one- and 2-level cervical disc replacement.
Platelet-Rich Plasma versus Corticosteroid Injection for Recalcitrant Lateral Epicondylitis: Clinical and Ultrasonographic Evaluation
Authors: Gautam VK , Verma Saurabh , Batra Sahil , Bhatnagar Nidhi , Arora Sumit 
Published: October 2016

Purpose. To evaluate the clinical and ultrasonographic changes in the morphology and vascularity of the common extensor tendon after injecting platelet-rich plasma (PRP) or corticosteroid (CS) for recalcitrant lateral epicondylitis (LE). Methods. 30 patients aged 18 to 60 years with recalcitrant (>6 months) LE not responsive to oral medication or non-invasive treatment were randomised to receive PRP (n=15) or CS (n=15) injection. Patients were assessed using the visual analogue scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand Scale (DASH) score, Oxford Elbow Score, modified Mayo Clinic performance index for the elbow (modified Mayo score), and hand grip strength. Ultrasonography was performed by a musculoskeletal ultrasonologist to evaluate for tear at the common extensor origin, oedema at the common extensor origin, cortical erosion, probe-induced tenderness, and thickness of the tendon. Results. The VAS for pain, DASH score, Oxford Elbow Score, modified Mayo score, and hand grip strength all improved significantly from pre-injection to the 6-month follow-up in the PRP and CS groups. However, in the CS group, the scores generally peaked at 3 months and then deteriorated slightly at 6 months indicating recurrence of symptoms, which involved 46.7% of the CS patients. At 6 months, the number of patients positive for various ulrasonographic findings generally decreased. However, in the CS group, the number of patients with reduced thickness of the common extensor tendon increased from 2 to 12, and the number of patients with cortical erosion at the lateral epicondyle increased from 9 to 11. Conclusion. PRP appeared to enable biological healing of the lesion, whereas CS appeared to provide short-term, symptomatic relief but resulted in tendon degeneration.
Cannulated versus Non-Cannulated Cancellous Screw Fixation for Femoral Neck Fractures: A Synthetic Bone Biomechanical Study
Authors: Gardner AW , Toh MZ , Yew KSA , Lie DTT , Chou SM 
Published: October 2016

Purpose. To compare the compressive strength of cannulated versus non-cannulated cancellous screws for undisplaced femoral neck fractures in synthetic bones. Methods. 18 synthetic proximal femurs simulating an AO B1 valgus impacted femoral neck fracture in osteoporotic bone were used. The fracture angles were between 55° and 63° (Pauwels grade 2). Fixation was made using 6.5-mm non-cannulated screws (n=6), 6.5-mm cannulated screws (n=6), or 7.3-mm cannulated screws (n=6). A custom-built jig was designed to guide the insertion of the screws in an identical triangular configuration. Screws were tightened by a single operator using a torque-measuring screwdriver. The femoral head was subjected to progressive axial loading at 5 mm/min. The load to failure and displacement were recorded. Results. The 3 groups did not differ significantly except that the load to failure was higher in the construct with 6.5-mm non-cannulated screws than that with 6.5-mm cannulated screws (1222 N vs 1008 N, p=0.003). Conclusion. The compressive strength of a synthetic bone hip fracture model fixed with non-cannulated screws was higher than that of cannulated screws of the same diameter.
Effect of Soft-Tissue Attachment on Tibial Fracture Healing in Rats
Authors: Reikeras Olav , Winge Mona I , Røkkum Magne 
Published: October 2016

Purpose. To compare tibial fracture healing in rats with or without soft-tissue attachment. Methods. The left tibias of 30 Wistar rats were osteotomised and equally randomised into 3 groups. In the avascular segmental fracture group, an 8-mm bone segment were first removed and then immediately put back. In the vascular segmental fracture group, the 8-mm bone segment was not displaced, with periosteal and muscular attachments. In the simple fracture group, a simple fracture in the middle tibia was made. All tibias were then stabilised with an intramedullary nail through the patellar tendon, and the wound was closed with sutures. After 8 weeks, all left tibias and 9 of the intact right tibias were harvested. Bone mineral content and density of the calluses were assessed using dual energy X-ray absorptiometry scanning. The maximum torsional strength, rigidity, and energy to failure of the tibias were measured. Results. All tibias healed (callus formation), without mal-union or pin migration. The 3 groups did not differ significantly in terms of torsional strength, rigidity, energy to failure, bone mineral content, and bone mineral density. The mean torsional strength of the 9 intact tibias was significantly higher than the healed tibias (14.9 vs. 10.6 Nmm, p=0.021). Conclusion. Soft-tissue detachment from bone segments did not impair bone healing in rats.