bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous Infiltration of Local Anaesthetic following Total Knee Arthroplasty
Authors: Ong Johnny CA , Lin Chin Pak , Fook-Chong Stephanie MC , Tang Andrew , Ying Yang Kuang , Keng Tay Boon 
Published: October 2016

Purpose. To determine whether continuous infiltration of local anaesthetic can reduce the pain score and morphine use over 48 hours after total knee arthroplasty (TKA). Methods. 11 men and 43 women aged 50 to 82 years who underwent unilateral TKA for osteoarthritis were recruited. They were randomised into 3 groups. In group 1, 17 patients who acted as controls received patient-controlled analgesia (PCA) with intravenous morphine for 48 hours. In group 2, 16 patients received continuous infiltration of bupivacaine to the subcutaneous tissue and intra-articular space for 48 hours, in addition to PCA. In group 3, 21 patients received an intra-articular injection of local anaesthetic, followed by continuous infiltration of bupivacaine to the subcutaneous tissue and intra-articular space for 48 hours, in addition to PCA. For each patient, a visual analogue score (VAS) for pain was recorded postoperatively at 2, 4, 6, 12, 24, 36, and 48 hours. The total amount of morphine used was recorded at 24 and 48 hours. Results. Over 48 hours, the VAS for pain and morphine use was significantly higher in controls than patients in groups 2 and 3. Conclusion. Continuous infiltration of local anaesthetic into the intra-articular space and subcutaneous tissues, in addition to PCA with intravenous morphine, provides significantly more pain relief and reduces morphine use.
Resection and Arthrodesis of the Knee Joint for Giant Cell Tumours of Bone
Authors: Saikia KC , Bhuyan SK , Saikia SP , Rongphar R , Jitesh P 
Published: October 2016

Purpose. To evaluate functional outcomes and complications following resection and arthrodesis of the knee for giant cell tumours (GCTs) of bone, in comparison to treatment by endoprosthetic replacements reported elsewhere. Methods. 18 men and 14 women aged 18 to 40 (mean, 28) years underwent resection and arthrodesis of the knee for GCTs of bone involving the distal femur (n=17) and proximal tibia (n=15). After wide resection, 2 struts were fashioned from the harvested fibula/fibulae and inserted into the medullary canal at the resected ends of the tibia and femur. The corresponding ends of the struts were inserted into peg holes made in the unaffected condyles in a divergent fashion. The knee was arthrodesed in 5° to 10° of flexion, with the limb kept 1 cm short. A 95° AO condylar blade-plate (10–12 holes) was fixed at the resected ends, with a minimum of 8 cortices purchase. Cancellous bone grafts were placed transversely along the struts and circumferentially over the host-graft junctions. Outcomes and complications were evaluated and compared with those of endoprosthetic arthroplasty reported elsewhere. Results. Patients were followed up for a mean of 8 (range, 3–12) years. The mean size of the tumours was 10times;8×6 cm. All patients achieved arthrodesis and full weight bearing without pain within 6 to 10 (mean, 6) months. No shortening, loss of alignment, loosening, implant breakage ensued. One patient had a deep infection and absorption at the host-graft junction. Another had a stress fracture of the fibular strut after plate removal. Two patients had a transient peroneal nerve palsy. One patient had local recurrence and extensive fungation and underwent amputation. The mean functional score was 26 (87% of the full score), compared to 66 to 85% in endoprosthetic arthroplasty reported elsewhere. Conclusion. Arthrodesis is a viable alternative to customised arthroplasty and provides a long-lasting and cost-effective reconstruction for average patients in developing countries.
Risk Factors Leading to Total Hip Arthroplasty in Patients with Subchondral Insufficiency Fractures of the Femoral Head
Authors: Miyanishi Keita , Ishihara Kohei , Jingushi Seiya , Torisu Takehiko 
Published: October 2016

Purpose. To retrospectively evaluate factors leading to total hip arthroplasty (THA) in patients with subchondral insufficiency fractures (SIF) of the femoral head. Methods. 5 men and 22 women aged 51 to 85 (mean, 72) years with SIF of the femoral head initially underwent conservative treatment. THA was later performed for 13 patients, as the hip pain became worse secondary to joint space narrowing and/or femoral head collapse. Patient demographics and radiological variables were retrieved. Risk factors leading to THA in patients with SIF of the femoral head were identified. Receiver operating characteristic curves were used to determine optimal cut-off values for the significant risk factors. Results. 2 men and 11 women aged 62 to 85 (mean, 74.9) years underwent THA and were followed up for 0.2 to 62 (mean, 13) months. The remaining 3 men and 11 women aged 51 to 81 (mean, 68) years underwent conservative treatment and were followed up for 9 to 93 (mean, 28) months. Patient age was the only risk factor for THA (p=0.047, odds ratio=1.13), the cut-off value being 71 years (sensitivity, 77%; specificity, 64%). The survival rate was significantly lower in patients aged ≥71 years than in those aged <71 years (p<0.05). Conclusion. Elderly patients with SIF of the femoral head are at higher risk of undergoing THA.
Percutaneous Vertebroplasty for Osteoporotic Compression Fractures Using Calcium Phosphate Cement
Authors: Ishiguro Shigeo , Kasai Yuichi , Sudo Akihiro , Iida Koji , Uchida Atsumasa 
Published: October 2016

Purpose. To compare percutaneous transpedicular vertebroplasty using calcium phosphate cement (CPC) versus conservative treatment for osteoporotic vertebral fractures. Methods. Eight men and 28 women aged 61 to 99 (mean, 80) years with osteoporotic vertebral fractures underwent percutaneous transpedicular vertebroplasty using CPC. During the same period, 6 men and 32 women aged 53 to 93 (mean, 77) years underwent conservative treatment. The indication for vertebroplasty was a painful unstable fracture, with mobility of the vertebral body shown on flexion and extension lateral radiographs. Fractures without mobility despite deformity were treated conservatively. Results. In the vertebroplasty group, all patients benefited from reduced back pain immediately after surgery, and pain relief was maintained at the latest follow-up. However, correction loss continued until one month after the operation. The mean visual analogue score for pain decreased significantly from preoperation to one day after surgery (9.3 vs. 6.2, p=0.02), and further decreased to 2.8 (p=0.04) on day 3 or 4 when ambulation began, and to 1.5 at the one-month follow-up and 1.4 at the final follow-up (mean, 14 months). The mean duration of analgesic treatment was significantly shorter in the vertebroplasty than conservatively treated group (10.2 vs. 63.5 days). All patients in the vertebroplasty group achieved bone union, with no adjacent vertebral fractures. However, in patients having conservative treatment, there were 2 adjacent vertebral fractures and 4 pseudarthroses, and the collapse continued for several months. Conclusion. Percutaneous transpedicular vertebroplasty using CPC achieves immediate pain relief and reduces the risk of vertebral body collapse and pseudarthrosis among elderly patients with osteoporotic vertebral compression fractures.
Neglected Femoral Neck Fractures in Adults
Authors: Kainth Gurvinder Singh , Yuvarajan P , Maini Lalit , Kumar Vinod 
Published: October 2016

Purpose. To assess treatment outcomes in adults with neglected femoral neck fractures, and propose a treatment protocol based on bone quality measured by the Singh index. Methods. 16 men and 6 women aged 18 to 48 (mean, 33) years presented with neglected (>3 weeks old) femoral neck fractures. Those with good bone quality (Singh index, >3) underwent closed reduction and valgus osteotomy and fixation with 120° double angle blade plates (group 1, n=8), whereas those with poor bone quality (Singh index, <3) and/or communition of the posterior femoral neck underwent fibular grafting and internal fixation with one or two 7-mm cannulated cancellous screws (group 2, n=14). Functional outcome was assessed at the 6-month follow-up, according to modified Askin and Bryan criteria. Results. The mean delay in surgery was 12 (range, 4–21) weeks. Patients were followed up for a mean of 19 (range, 12–24) months. The mean time to union was 20 (range, 12–52) weeks. The mean time to full weight bearing was 18 (range, 12–40) weeks. All patients achieved bone union except one in group 1 who had non-union and breakage of the blade plate at week 20 and underwent total hip arthroplasty. Other complications included slippage of fibular graft (n=1), delayed union (n=1), avascular necrosis of the femoral head (n=2, Fig. 6), limb length discrepancy (n=3), and superficial infection (n=1). Functional outcome was excellent in 2 patients, good in 17, and poor in 3. Conclusion. Valgus osteotomy and double angle blade plate fixation, and fibular grafting and cancellous screw fixation appeared to be appropriate treatments for neglected femoral neck fractures in adults.
Day Surgery for Major Paediatric Foot and Ankle Procedures
Authors: Jagodzinski Nikolas Alan , Gul Rubena , Khanum Samia , Prem Hari 
Published: October 2016

Purpose. To review outcomes in 19 children who underwent major foot and ankle procedures as day cases. Methods. A consecutive series of 24 major foot and ankle procedures in 19 children performed as day cases by a single surgeon were reviewed in terms of the immediate postoperative pain relief, severe swelling (necessitating cast removal), and complications. Parental satisfaction was assessed using a telephone survey with respect to pain relief of the patients, and their views on management as day cases. Results. The 24 procedures comprised tendon transfers (n=18), posterior releases (n=3), and excisions of a tarsal coalition (n=3). During the post-discharge 24 hours, no patient developed complications that entailed hospital services. All parents of the patients were satisfied with the overall service provided. The analgesia prescribed at discharge was sufficient to control pain in 20 out of the 22 procedures. In the remaining 2 procedures (under caudal and general anaesthesia), the parents considered the analgesia insufficient, but did not contact the helpline for advice. One child bled through the bandages to a minor extent. Conclusion. Some major paediatric foot and ankle procedures can be safely performed as day cases and achieved adequate analgesia with appropriate advice. More such procedures can be added to the day case list, even on an afternoon list.
Fixation Techniques for Non-Union of the Scaphoid
Authors: Raju PK , Kini Sunil Gurpur 
Published: October 2016

Purpose. To compare outcomes of 3 fixation modalities for scaphoid non-union. Methods. 27 men and 6 women aged 20 to 48 (mean, 28) years with non-union of the scaphoid involving the proximal pole (n=13), waist (n=12), and distal pole (n=8) were randomised to undergo the Herbert screw fixation (n=11), the Matti Russe bone grafting (n=9), or the Kohlman modification of vascularised muscle pedicle graft procedure (n=13). The mean duration of non-union was 10 (range, 6–30) months. Results. The mean follow-up duration was 28 months. 30 of 33 achieved correction of both scapholunate and radiolunate angles. The mean range of motion increased from 112° to 155°. The mean grip strength increased by 30%. Functional outcomes of the 3 groups were comparable; they were excellent in 13 patients, good in 10, fair in 6, and poor in 4. There was no hardware failure or any iatrogenic fracture during pedicle dissection. One patient had a superficial infection, which was resolved after antibiotic treatment. At the 6-month follow-up, in the respective 3 groups, 8, 6 and 11 patients achieved scaphoid union after mean intervals of 17, 16, and 15 weeks. Conclusion. The time to union was earliest in the Kohlman modification of vascularised muscle pedicle graft procedure, which is recommended for patients with old non-union (>1 year) or proximal pole fractures.
Sensitivity, Specificity and Accuracy of Magnetic Resonance Imaging for Differentiating Vertebral Compression Fractures Caused by Malignancy, Osteoporosis, and Infections
Authors: Abdel-Wanis ME , Solyman Mohamed Tharwat Mahmoud , Hasan Nahla Mohamed Ali 
Published: October 2016

Purpose. To evaluate the sensitivity, specificity and accuracy of various magnetic resonance imaging (MRI) features in differentiating vertebral compression fractures caused by malignancy, osteoporosis, and infections. Methods. 35 men and 45 women aged 40 to 78 (mean, 59) years underwent MRI to assess the underlying pathology of already diagnosed vertebral compression fractures (n=152). The interval from presentation to imaging ranged from 7 to 95 (mean, 62) days. MRI features of each vertebral compression fracture were assessed. The sensitivity, specificity, and accuracy for each of the MRI features were calculated. Association between each MRI feature and various underlying pathologies (malignancy, osteoporosis, and infections) of vertebral compression fractures was evaluated. Results. Regarding these 80 patients, the MRI diagnosis was correct in 78 and inconclusive in 2 with malignancy. MRI features suggestive of malignant fractures were a convex posterior border of the vertebral body, pedicle involvement, posterior neural element involvement, an epidural mass, a paraspinal mass, and other spinal metastases. MRI features suggestive of osteoporotic fractures were retropulsion, low signal intensity band, spared normal marrow signal intensity, and the fluid sign. MRI features suggestive of infective fractures were contiguous vertebral involvement, end plate disruption, disc involvement, and paraspinal and epidural abscesses. Conclusion. Combination of several MRI features can provide clues to differentiate between malignant, osteoporotic, and infective vertebral compression fractures.
Hemiarthroplasty for Comminuted Proximal Humeral Fractures
Authors: Babhulkar Ashish , Shyam Ashok K , Sancheti Parag K , Shah Koshish , Rocha Steve 
Published: October 2016

Purpose. To evaluate early functional outcomes of hemiarthroplasty for 3- or 4-part proximal humeral fractures. Methods. 16 men and 11 women aged 27 to 83 (mean, 56) years underwent hemiarthroplasty for comminuted 3-part (n=13) or 4-part (n=14) proximal humeral fractures. All the patients reported normal shoulder function prior to injury. The range of shoulder motion and muscle power were evaluated, as were subjective pain and satisfaction (using the UCLA scoring system). Results. At the final follow-up, the mean maximum abduction was 111° (SD, 47°; range, 30°–180°), and the mean maximum forward flexion was 143° (SD, 41°; range, 45°–180°). All patients had radiographic union of the tuberosities. The mean UCLA score was 28; 21 patients attained good-to-excellent scores (≥27), whereas 6 attained lower (fair-to-poor) scores. The mean UCLA score was higher in patients aged <60 (n=13) than those who were older (n=14) [30 vs. 26, p=0.008] and in patients operated after 7 days (n=6) than those operated before 7 days (n=21) [32 vs. 27, p=0.02], but did not differ significantly in terms of gender and fracture type and side. Patient age and gender, fracture type, and injury-to-surgery interval did not have a significant impact on maximum forward flexion and abduction. Conclusion. Early functional outcomes of hemiarthroplasty for comminuted proximal humeral fractures is good in medically fit and cooperative patients.
Screening for Developmental Dysplasia of the Hip in Hong Kong
Authors: Tong Sara HY , Eid Mohamed AM , Chow Wang , To Michael KT 
Published: October 2016

Purpose. To review records of children referred to ousr hospital for developmental dysplasia of the hip (DDH) and evaluate the effectiveness of hip screening in Hong Kong. Methods. Records of children suspected of DDH and referred to our hospital between 1 January 2005 and 31 March 2010 were reviewed. The diagnosis was based on static and dynamic ultrasonography of the hips and/or radiographic features of hip subluxation, dislocation, and pelvic dysplasia. The age of the children at presentation was recorded. Late diagnoses were those presenting after the age of 6 months. Late presentations were those presenting after the walking age. Results. Of 213 referred children, 33 were diagnosed to have DDH. Their mean age at presentation was 90.8 (range, 9–559) days. The female-to-male ratio was 2.9:1, and the mean follow-up duration was 25.1 (range, 4.2–50.3) months. 30 of the DDH infants were diagnosed before the age of 6 months, one at 8 months, and 2 were late presenters. Hence, the failure rate of the hip screening was 0.09 per 1000 live births. The remaining 180 were confirmed to be normal and followed up until the walking age. The point prevalence of DDH on Hong Kong Island was 0.87/1000 live births. Conclusion. In light of the low point prevalence of DDH in Hong Kong born children, the protocol of universal clinical assessment and selective ultrasonographic screening of suspected cases is justified.
Predictors of Length of Hospital Stay after Total Hip Replacement
Authors: Abbas Kashif , Umer Masood , Qadir Irfan , Zaheer Jaweria , ur Rashid Haroon 
Published: October 2016

Purpose. To identify variables affecting length of hospital stay after total hip replacement (THR) while controlling for potential confounders. Methods. Records of 199 consecutive elective unilateral THRs were reviewed. Clinical and demographic data including age, gender, body mass index, comorbidities, surgical factors (surgical approach, type of prosthesis, use of cement, operating time), anaesthetic factors (type of anaesthesia, ASA physical status), and length of hospital stay were recorded. Results. 64% of patients left hospital within 12 days, 28% within 3 weeks, and 8% after 3 weeks. The median length of hospital stay was longer in women than men (11.5 vs. 9 days, p=0.009), in patients aged >65 years than those younger (13 vs. 9 days, p<0.0001), and in those with American Society of Anesthesiologists (ASA) grades 3 and 4 than grades 1 or 2 (14 vs. 9 days, p<0.0001). A greater proportion of women than men (45% vs. 27%, p=0.007), patients aged >65 years than those younger (61% vs. 37% or 24%, p<0.0001), and those with ASA grades 3 and 4 than grades 1 and 2 (68% vs. 25%, p<0.0001) stayed 12 days or longer. In the multiple regression analysis, the predictors for prolonged hospital stay (≥12 days) were patient age >65 years (p<0.003), female gender (p<0.05), and ASA grades 3 and 4 (p<0.0001). Of the 72 patients with prolonged stay, 7% had no, 26% had one, 42% had 2, and 25% had all 3 predictors. Conclusion. Prolonged hospital stay after THR is largely predetermined by case mix. Our study helps to identify individuals who need longer rehabilitation and more care.
Multifocal Osteoarticular Tuberculosis in Children
Authors: Agarwal Anil , Khan Shariq Azam , Qureshi Nadeem Akhtar 
Published: October 2016

Purpose. To review records of 16 children with multifocal osteoarticular tuberculosis. Methods. Records of 7 girls and 9 boys aged one to 14 (mean, 6) years with multifocal osteoarticular tuberculosis were reviewed. Haematological tests and radiographs of the chest, whole spine, pelvis, knees, elbows, hands, and feet were taken. The diagnosis was confirmed histologically. Patients were treated with standard 4-drug antitubercular chemotherapy (isoniazid, rifampicin, ethambutol, pyrazinamide) for 2 months, followed by a 2-drug regimen (isoniazid and rifampicin) for 10 months. Supportive treatment (deworming and nutritional advice) was also provided. Results. All 16 patients were immunocompetent. Pain and swelling around the lesions were the main symptoms; fever was not common (2 cases only). No patient reported weight loss or night sweats. The mean number of bony lesions was 3.4 (range, 2–15) per patient. Appendicular (hands and feet) involvement was more common than axial (spinal) involvement. Radiological appearances of the lesions were cystic, irregular, lytic, and with or without sequestrum/periosteal reaction. Some lesions were asymptomatic and detected incidentally on radiographs. Only one patient had active chest lesions. Five patients had spinal involvement but no neurological deficit. No patient underwent any surgical intervention, except for diagnostic biopsy. The mean follow-up period was 18 (range, 6–24) months. All patients showed complete healing within one year of chemotherapy. There were residual deformities and restriction of joint movement in patients with advanced articular and axial osteoarticular involvement. Conclusion. Children with multifocal osteoarticular tuberculosis were usually immunocompetent. Appendicular involvement was common, but concomitant chest involvement was uncommon. Standard multidrug antitubercular therapy and nutritional supplementation achieved good outcome.
Serum 25-Hydroxy-Calciferol Level and Failed Back Surgery Syndrome
Authors: Waikakul Saranatra 
Published: October 2016

Purpose. To assess the association of serum 25-hydroxy-calciferol levels with pain and low back function in patients with failed back surgery syndrome. Methods. Records of 6 men and 3 women aged 25 to 54 (mean, 39.2) years who had failed back surgery syndrome after pedicular screw and rod instrumentation for lower lumbar degenerative diseases were reviewed. They had moderate-to-severe pain (visual analogue scale [VAS] score of >6) and low back function disability (Japanese Orthopaedic Association [JOA] back score of <10). In all patients, the serum 25-hydroxy-calciferol level was <30 ng/ml, indicating vitamin D deficiency. Vitamin D2 (20 000 IU per day) was given for 10 days, and vitamin D3 (600 IU per day) was given for maintenance. Patients were followed up at months 3 and 6. Three men and 4 women aged 27 to 55 (mean, 41.3) years who were age- and disease-matched but achieved good outcomes (VAS score of 0–1 and mean JOA low back score of 14.7) were used as indirect referents. All 7 matched patients except one had a normal serum 25-hydroxy-calciferol level (mean, 40.6 ng/ml). Results. In the 9 patients with failed back surgery syndrome, the mean duration of chronic pain was 2.6 years; the mean VAS score for pain was 7.7; the mean JOA low back score was 7.6; the mean number of reoperations was 2.2; and the mean serum 25-hydroxy-calciferol level was 17.0 ng/ml. Two male patients had grade-IV motor weakness and decreased sensory function based on the pin prick test. One patient had a history of prolonged (>3 months) antibiotic use after primary surgery, but had no evidence of infection. Six months after vitamin D2 and vitamin D3 supplementation, the mean serum 25-hydroxy-calciferol level improved significantly (17.0 vs. 42.5 ng/ml), as did the mean pain score (7.7 vs. 4.2) and mean JOA back score (7.6 vs. 11.1). Seven of the patients had a pain score of <6 and a JOA back score of >10, the remaining 2 patients had neurological deficits and only slight improvement. Conclusion. Vitamin D supplementation may be used as an adjuvant treatment for patients with failed back surgery syndrome.