bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Warfarin Reversal for Early Hip Fracture Surgery
Authors: Moores Thomas Steven , Beaven Alastair , Cattell Andrew Edwin , Baker Charles , Roberts Philip John 
Published: October 2016

Purpose. To evaluate our hospital protocol of low-dose vitamin K titration for preoperative warfarin reversal for early hip fracture surgery. Methods. Records of 16 men and 33 women aged 63 to 93 (mean, 81) years who were taking warfarin for atrial fibrillation (n=40), venous thromboembolism (n=9), cerebrovascular accident (n=3), and prosthetic heart valve (n=3) and underwent surgery for hip fractures were reviewed. The 3 patients with a prosthetic heart valve were deemed high risk for thromboembolism and the remainder low-risk. The international normalised ratio (INR) of patients was checked on admission and 6 hours after administration of vitamin K; an INR of <1.7 was considered safe for surgery. Results. No patient developed venous thromboembolism within one year. The 30-day and one-year mortality was 8.2% and 32.6%, respectively. For the 46 low-risk patients, the mean INR on admission was 2.6 (range, 1.1–4.6) and decreased to <1.7 after a mean of 2.2 (range, 0–4) administrations of 2 mg of vitamin K. Their INR was <1.7 within 18 hours (mean, 14 hours). 78% of patients underwent surgery within 36 hours. In the 22% of patients who did not undergo surgery within 36 hours, the delay was due to insufficient operative time or the patient being medically unfit for surgery. The 3 high-risk patients underwent bridging therapy of low-molecular-weight heparin and received no vitamin K; their mean INR on admission was 3.2 (range, 3.1–3.3) and the mean time to surgery was 5.3 (range, 3–8) days. Two low-risk patients and one high-risk patient died within 5 days of surgery. Conclusion. The low-dose intravenous vitamin K protocol is safe and effective in reversing warfarin within 18 hours. Hip fracture surgery within 36 to 48 hours of admission improves morbidity and mortality.
Bicycle and Motorcycle Wheel Spoke Injury in Children
Authors: Mak CY , Chang JHT , Lui TH , Ngai WK 
Published: October 2016

Purpose. To review bicycle and motorcycle wheel spoke injuries around the foot and ankle in 24 children. Methods. Medical records of 12 boys and 12 girls aged 2 to 11 (mean, 5.3) years who presented with an isolated posterior heel injury caused by wheel spokes of a motorcycle (n=9) or bicycle (n=15) were reviewed. Results. All 9 motorcycle injury patients and 8 of 15 bicycle injury patients had lacerations. The remaining 7 bicycle injury patients had abrasions and developed skin necrosis and ulcerations, with 5 requiring debridement. The most common site of laceration was the posterolateral heel; 7 of these patients had deep soft tissue injury, and in 5 the Achilles tendon was partially cut or completely severed. The mean number of operations was 2.2 in the motorcycle group and 1.3 in the bicycle group. Seven patients with severe skin loss required skin grafting or flap surgery for wound coverage. The mean time from injury to definitive treatment was 8.2 days. The mean length of hospital stay was 18.4 days in the motorcycle group and 8.1 days in the bicycle group. Delayed definitive treatment was associated with more operations (r=0.499, p=0.013) and longer hospital stay (r=0.567, p=0.004). Conclusion. Wheel spoke injuries may result in severe soft tissue damage and bony trauma. Poor prognostic factors included high-energy injury, contamination and infection, and delayed treatment.
Blood Management Protocol for Total Knee Arthroplasty to Reduce Blood Wastage and Unnecessary Transfusion
Authors: Lee Qunn-Jid , Mak Wai-Ping , Yeung Sze-Tsun , Wong Yiu-Chung , Wai Yuk-Leung 
Published: October 2016

Purpose. To compare outcomes of 2 cohorts of patients who underwent total knee arthroplasty (TKA) before and after the introduction of a blood management protocol. Methods. Records of 97 and 96 consecutive patients who underwent unilateral TKA before and after introduction of the blood management protocol, respectively, were reviewed. Before introduction of the protocol, patients were cross-matched for blood before surgery. Transfusion after surgery was at the discretion of the surgeons or the on-call doctors. After introduction of the protocol, only patients with a preoperative haemoglobin level of <110 g/l underwent ‘type and screening’ of blood group. 2 units of blood were cross-matched preoperatively when multiple red-cell antibodies were identified or postoperatively when blood transfusion was required. Only patients with a postoperative haemoglobin level of <80 g/l or being symptomatic received blood transfusion until the haemoglobin level reached >100 g/l. Those with a postoperative haemoglobin level of 80 to 100 g/l were given iron sulphate 300 mg twice daily for a month. Results. The 2 groups did not differ significantly in age, sex ratio, pre- and post-operative haemoglobin levels, and drain output. Comparing outcome before and after introduction of the protocol, the transfusion rate (10.3% vs. 3.1%, p=0.046), cross-match rate (100% vs. 3.1%, p<0.001), and cross-match to transfusion ratio (9.7:1 vs. 1:1, p<0.001) decreased. Among transfused patients, the decreased postoperative haemoglobin level indicated a lower transfusion trigger point (100 g/l vs. 75 g/l, p<0.006) No patient developed infection, cardiovascular or cerebrovascular complications within 30 days. Conclusion. The blood management protocol for TKA is effective in reducing unnecessary allogeneic blood transfusions and wastage of unused blood, without an increase in postoperative complications.
Gait Parameters in Women with Bilateral Osteoarthritis after Unilateral versus Sequential Bilateral Total Knee Arthroplasty
Authors: Mine Takatomo , Ihara Koichiro , Kawamura Hiroyuki , Kuriyama Ryutaro , Date Ryo 
Published: October 2016

Purpose. To compare gait parameters in women after unilateral total knee arthroplasty (TKA) versus sequential bilateral TKA to determine the need for sequential TKA. Methods. 35 women aged 60 to 74 (mean, 70) years with bilateral varus knee osteoarthritis (OA) underwent unilateral (n=23) or sequential bilateral (n=12) TKA by a single surgeon. All patients underwent unilateral TKA; 12 patients then underwent sequential TKA after 3 to 6 months of the first TKA. Gait parameters (step length, step width, gait velocity, single support phase value, and the maximum centre of gravity ratio) were compared before and after TKA, and between patients with unilateral versus bilateral TKA. Results. Patients with sequential bilateral TKA had more severe OA in their contralateral knee than patients with unilateral TKA. In patients with unilateral and sequential bilateral TKA respectively, the mean step width differed at postoperative one month (12.9 vs. 19.1, p<0.01) and 3 months (11.9 vs. 16, p=0.03), and the mean maximum centre of gravity ratio differed at postoperative 3 months (2.43 vs. 1.75, p=0.02), whereas the mean step length, mean gait velocity, and mean single support phase values did not differ significantly between groups. Conclusion. After unilateral TKA, contralateral TKA may not be necessary in some patients whose gait has improved.
Morphology and Fixation Pitfalls of a Highly Unstable Intertrochanteric Fracture Variant
Authors: Tan Bryan Yijia , Lau Adrian Cheng Kiang , Kwek Ernest Beng Kee 
Published: October 2016

Purpose. To describe a variant of intertrochanteric fracture not well-characterised in the existing classification systems. Methods. 10 women and 2 men aged 59 to 98 (median, 80) years with intertrochanteric fractures characterised by a low intertrochanteric fracture, a basicervical fracture fragment, and a thin or fractured lateral wall with greater trochanteric comminution were reviewed. Results. The 12 fractures were classified as A2.1 (n=1), A2.2 (n=7), A2.3 (n=1), and A3 (n=3) according to the AO/OTA classification, and as type 3 (n=2), type 5 (n=7), and type 6 (n=3) according to the Evans classification. The fractures were characterised by greater trochanter comminution and a coronal plane fracture extending into the greater trochanter resulting in a loss of superolateral support. Patients were treated with the Proximal Femoral Nail Antirotation (n=5), the Proximal Femur Locking Plate (n=6), or the reversed Less Invasive Stabilization System for distal femur (n=1). Within the mean follow-up period of 6 months, 3 patients with plating and one patient with nailing had mechanical failure defined as loss of alignment of >10° or screw cutout. Conclusion. This intertrochanteric fracture variant is highly unstable with a high failure rate. Loss of superolateral support rather than the medial calcar buttress is the main contributing factor to mechanical failure. Computed tomography is important in preoperative planning. Intramedullary nailing is more appropriate than extramedullary plating for such unstable fractures.
Osteoporotic Hip Fractures: 10-year Review in a Singaporean Hospital
Authors: Tan Wei Loong Barry , Low Siew Leng , Shen Liang , De Shamal Das 
Published: October 2016

Purpose. To review records of 2702 patients with osteoporotic hip fractures in a Singaporean hospital. Methods. Medical records of 1905 women and 797 men, aged 50 to 112 (median, 78) years, who were admitted to a Singaporean hospital with an osteoporotic hip fracture (ICD9 820) between January 2000 and December 2010 were reviewed. Results. Female patients were significantly older than male patients (p<0.0005). The trend for the median patient age over the 10-year period has increased significantly in women ( r=0.826, p=0.002) but not in men. Of the hip fractures, 49.4% were femoral neck fractures and 50.6% were intertrochanteric/basicervical fractures. The rate of intertrochanteric/basicervical fractures was higher in men than women (61.2% vs. 46.1%, p<0.0005). Increased age, ischaemic heart disease, Parkinson's disease, and being Malay or Caucasian or Sikh were more likely to have intertrochanteric/basicervical fractures than femoral neck fractures. Femoral neck fractures were usually treated with hemiarthroplasty (68.8%), cancellous screw fixation (20.6%), and conservative methods (20.5%), whereas intertrochanteric/basicervical fractures were usually treated with dynamic hip screw fixation (76.3%) and conservative methods (15.6%). 84 women and 26 men sustained a subsequent osteoporotic hip fracture on the contralateral side after a median interval of 2 (range, 0–8) years. 11 of these 110 patients were already on osteoporosis medication. Conclusion. The rate of osteoporotic hip fractures has increased, particularly among women, over the 10-year period. The rate of intertrochanteric/basicervical fractures was higher in men than women.
Local Infiltration Analgesia versus Standard Analgesia in Total Knee Arthroplasty
Authors: Suthersan Mayuran , Pit Sabrina , Gordon Loris , Loman Mark , Pezzutti Brian , Freihaut Richard 
Published: October 2016

Purpose. To compare outcome and cost following local infiltration analgesia (LIA) versus standard analgesia in total knee arthroplasty (TKA). Methods. 13 men and 33 women (mean age, 67.5 years) underwent TKA by a single surgeon and received LIA (n=24) or standard analgesia (n=22), depending on the availability of the senior anaesthetist. Results. The 2 groups were comparable at baseline in terms of age, gender, body mass index, American Society of Anesthesiologists score, and range of motion. Compared with the standard analgesia group, the LIA group resulted in a shorter mean length of hospital stay (4.9 vs. 2.7 days, p<0.0001) and higher proportion of patients able to straight leg raise on discharge (38% vs. 86%, p=0.0011), as well as lower pain scores in the first 3 days and greater range of motion at all time points. Respectively in the standard analgesia and LIA groups, the mean cost per patient for all analgesic medication was A$129.25 and A$153.63, the mean cost per patient for all nights spent in hospital was A$1600.36 and A$901.50, and thus the mean total cost per patient was A$1729.61 and A$1055.13. Conclusion. Compared with standard analgesia, LIA results in greater pain relief and improvement in range of motion immediately after TKA, and lower hospital costs.
Intra-Operative Fractures in Cementless Bipolar Hemiarthroplasty
Authors: Kuo Chung-Liang , Tan Si Heng Sharon , Lee Haw Chou 
Published: October 2016

Purpose. To compare patients with or without intra-operative fracture during cementless bipolar hemiarthroplasty. Methods. Records of 76 men and 202 women who underwent cementless bipolar hemiarthroplasty for femoral neck fractures were reviewed. Patients with and without intra-operative fractures and patients with different types of intra-operative fractures were compared. Results. Two men and 22 women aged 62 to 93 (mean, 80) years sustained intra-operative fractures at the lesser trochanter (n=18), the greater trochanter (n=5), and the subtrochanter (n=1). All 18 lesser trochanteric fractures and 4 of the greater trochanteric fractures were recognised intra-operatively and managed with cerclage wiring (n=21) or conversion to cemented hemiarthroplasty with cerclage wiring (n=1). The remaining 2 fractures were recognised postoperatively on radiographs and managed conservatively or with revision surgery and cerclage wiring and plating on day 4. Intra-operative fractures correlated with female gender (p=0.03) and operative delay to optimise patients (p=0.02), whereas the fracture site correlated with the time of fracture recognition (p=0.01). Postoperatively, 5 patients were allowed partial weight bearing and 18 were instructed to mobilise with a wheelchair for at least 6 weeks. One patient died from an unrelated cause. At one year, 21 patients reported no hip pain and 2 reported minimal pain. 17 could walk with or without aids and 6 were wheelchair-bound. Conclusion. Surgeons should be familiar with the size difference in trial and actual implants used in bipolar hemiarthroplasty in order to better estimate the extent of broaching required. In most patients with an intra-operative fracture, the one-year outcome was not compromised, despite the poorer short-term outcome.
Arthroscopic Fixation for Acute Acromioclavicular Joint Disruption Using the TightRope Device
Authors: Chaudhary Deepak , Jain Vineet , Joshi Deepak , Jain Jitesh Kumar , Goyal Ankit , Mehta Nitin 
Published: October 2016

Purpose. To review outcome after arthroscopic fixation for acute acromioclavicular (AC) joint dislocation using the TightRope device. Methods. Records of 15 men and 2 women aged 19 to 52 (mean, 35) years who underwent arthroscopic fixation using the TightRope device for acute (<3 weeks) AC joint dislocation of Rockwood type III (n=6), type IV (n=1), and type V (n=10) were reviewed. Outcome was evaluated using the Constant score. The coracoclavicular (CC) distance before and after surgery was compared. Results. The mean follow-up period was 22.1 (range, 12–37) months. The mean time to return to work was 4 (range, 1.5–12) months, excluding one failure. The mean postoperative Constant score was 86.4 (range, 63–96). The CC distance decreased from 21.5±5.2 mm preoperatively to 9.8±3.5 mm at 6 months and to 10±3.2 mm at one year. There was no over-correction. All patients had satisfactory outcome except for one who had rupture of the TightRope suture at 6 months. Two patients had partial loss of reduction (≥2 mm) after 3 to 6 months secondary to osteolysis at the clavicular button site. Conclusion. Arthroscopic fixation using the TightRope device for acute AC joint dislocation achieves satisfactory outcome.
Single Tendon Transfer of the Flexor Carpi Ulnaris for High Radial Nerve Injury
Authors: Sankaran Ajeesh , Thora Ankit , Arora Sumit , Dhal Anil 
Published: October 2016

Purpose. To evaluate the outcome after single tendon transfer of the flexor carpi ulnaris (FCU) to the digital extensors for high radial nerve palsy. Methods. Records of 10 patients aged 16 to 43 (median, 27) years who underwent single tendon transfer of the FCU to the digital extensors for high radial nerve palsy secondary to closed (n=4) or open (n=4) diaphyseal humeral fractures or deltoid injection (n=2) were reviewed. Two of the patients with open fractures also underwent treatment for non-union in a staged manner. Grip strength (power grip and precision grip) was measured monthly using an automated dynamometer. The range of motion of the wrist, and metacarpophalangeal joints of the thumb and fingers was measured monthly using a goniometer. Results. All patients were followed up for at least one year. Preoperatively, the overall power grip strength of the injured hands was about 1/5 of the normal hands. At 12 months, the mean improvement was 202.5% for overall power grip strength and 43% to 57% for precision grip strength parameters. Compared with the normal hands, the mean deficit of the operated hands was 39% for overall power grip strength and 32% to 37% for precision grip strength parameters. At 12 months, mean wrist extension was 50.4°, with about 10° lag in finger and thumb extension. The mean total active motion was 86.7° in the operated wrists and 128.1° in normal wrists. The decrease in wrist flexion and ulnar deviation was 7.8° and 6.8°, respectively. Conclusion. Single tendon transfer of the FCU is a viable option to restore hand function and strength following high radial nerve injuries.
Open Carpal Tunnel Decompression by Specialist versus Nurse Practitioner
Authors: Patel Nimesh , Roberton Andy , Batten Timothy , Millyard Cathy , Birdsall Paul 
Published: October 2016

Purpose. To compare the outcome after open carpal tunnel decompression by specialists versus a nurse practitioner. Methods. Of 1361 cases of open carpel tunnel decompression under local anaesthesia from 1996 to 2008, 807 were performed by specialists (consultant, specialist registrar, or specialty and associate specialist) and 554 by a nurse practitioner (since May 2006). The 2 groups were compared in terms of surgical time, total theatre time, postoperative pain, and patient satisfaction with the service. Results. The mean surgical time was shorter in cases performed by specialists (13 vs. 18 minutes, p<0.0001), as was the mean total theatre time (26 vs. 29 minutes, p=0.0154). The rate of postoperative pain was higher in cases performed by specialists (31.5% vs. 24.5%, p=0.0125), as was the rate of patient dissatisfaction (1.6% vs. 0.18%, 0.0113). Nonetheless, since May 2006, outcome was comparable for specialists and the nurse practitioner. This could be due to the change from short-acting to long-acting/mixed local anaesthetic, and the technique for infiltration. The waiting time for surgery reduced from a mean of 16 to 3 weeks. Conclusion. Specialists and the nurse practitioner achieved comparable outcome after open carpal tunnel decompression.
Trends in the Incidence of Atypical Femoral Fractures and Bisphosphonate Therapy
Authors: Clout Andrew , Narayanasamy Naveen , Harris Ian 
Published: October 2016

Purpose. To report the trends in the incidence of typical and atypical femoral fractures (AFF) in patients aged >50 years from 2009 to 2014 and in the prescription of bisphosphonates for osteoporosis from 2001 to 2013 in Australia. Methods. 175 patients aged >50 years presenting to our hospital with an AO type 32 femoral shaft fracture between October 2009 and October 2014 were identified using a trauma database. Of them, 21 male and 110 female patients with a mean age of 75 years were reviewed. Radiographs were reviewed by 2 investigators blinded to the use of bisphosphonates. The femoral shaft fractures were classified as typical or atypical using the American Society of Bone and Mineral Research definition, and their annual incidence was compared. The trend and number of prescriptions for various bisphosphonates in Australia was determined using the Pharmaceutical Benefits Scheme statistics from 2001 to 2013. Results. Of the 131 femoral shaft fractures, 65 were typical and 66 were atypical subtrochanteric (n=19) or diaphyseal (n=47) fractures that were complete (n=60) or incomplete (n=6). Four patients had sequential bilateral AFF. The 66 AFFs accounted for 5% of hip and shaft fractures. Women accounted for 80% of all femoral shaft fractures and 95% of AFF. The proportion of AFF was higher in women than men (63/110 vs. 3/21, relative risk=3.95, 95% CI=1.37–11.39, p=0.0006). The mean length of hospital stay was 9.7 days shorter in the AFF patients (14.1 vs. 23.8 days, 95% CI=2.6–16.8 days, p=0.008). Patients with AFF were 8 years younger than those with proximal femoral fracture (73 vs. 81 years, p<0.0001). There was no trend in the annual incidence or proportion of AFF from 2009 to 2014 (p=0.70). The bisphosphonate usage was highest in 2007 with 260 000 yearly patient treatments and had declined by 30% by the end of 2013. Conclusion. AFF accounted for half of all femoral shaft fractures in patients aged >50 years. Women accounted for 80% of all femoral shaft fractures and 95% of AFF. The incidence of AFF was no longer increasing possibly related to decreased prescription of bisphosphonates in preceding years.
A Clinical and Ultrasonographic Study of Risk Factors for Elbow Injury in Young Baseball Players
Authors: Tajika Tsuyoshi , Kobayashi Tsutomu , Yamamoto Atsushi , Kaneko Tetsuya , Shitara Hitoshi , Shimoyama Daisuke , Iizuka Yoichi , Okamura Koichi , Yonemoto Yukio , Warita Toshiro , Ohsawa Takashi , Nakajima Ichiro , Iizuka Haku , Takagishi Kenji 
Published: October 2016

Purpose. To determine the risk factors for elbow injury and its association with glenohumeral internal rotation deficit among young baseball players. Methods. 229 baseball players aged 9 to 14 (mean, 11) years completed a self-administered questionnaire with items related to years of playing baseball, hours of training per weekday, days of training per week, and past and present experience of elbow pain. Two orthopaedic surgeons measured the range of motion of both shoulders and elbows. Another 2 orthopaedic surgeons performed ultrasonography to detect any elbow abnormality such as fragmentation of the medial epicondylar apophysis and osteochondritis dissecans of the capitellum. Using univariate and multivariable analyses, participants with or without elbow abnormality were compared to determine the risk factors for elbow abnormality. Results. Elbow abnormality was detected in 100 of the participants and comprised osteochondritis dissecans of the capitellum (n=18) and fragmentation of the medial epicondylar apophysis (n=82). Elbow abnormality was associated with being a pitcher, past and present experience of elbow pain, loss of elbow extension, and the side-to-side internal rotation difference. The 100 participants with elbow abnormality were stratified into symptomatic (n=57) or asymptomatic (n=43) of elbow pain. Those with elbow abnormality and elbow pain was associated with being a pitcher. Conclusion. Being a pitcher was a risk factor for both elbow abnormality and elbow pain. Nonetheless, 43% of baseball players with elbow abnormality were asymptomatic. The use of ultrasonography was effective in detecting elbow abnormality and enabling early treatment.