bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flatfoot in Indian Population
Authors: Pandey Sudhakar , Pal Chandra Prakash , Kumar Deepak , Singh Pulkesh 
Published: October 2016

Purpose. To compare outcomes of different conservative treatments for flatfoot using the foot print index and valgus index. Methods. 150 symptomatic flatfoot patients and 50 controls (without any flatfoot or lower limb deformity) aged older than 8 years were evaluated. The diagnosis was based on pain during walking a distance, the great toe extension test, the valgus index, the foot print index (FPI), as well as eversion/inversion and dorsiflexion at the ankle. The patients were unequally randomised into 4 treatment groups: (1) foot exercises (n=60), (2) use of the Thomas crooked and elongated heel with or without arch support (n=45), (3) use of the Rose Schwartz insoles (n=18), and (4) foot exercises combined with both footwear modifications (n=27). Results. Of the 150 symptomatic flatfoot patients, 96 had severe flatfoot (FPI, >75) and 54 had incipient flatfoot (FPI, 45–74). The great toe extension test was positive in all 50 controls and 144 patients, and negative in 6 patients (p=0.1734, one-tailed test), which yielded a sensitivity of 96% and a positive predictive value of 74%. Symptoms correlated with the FPI (Chi squared=9.7, p=0.0213). Combining foot exercises and foot wear modifications achieved best outcome in terms of pain relief, gait improvement, and decrease in the FPI and valgus index. Conclusion. The great toe extension test was the best screening tool. The FPI was a good tool for diagnosing and grading of flatfoot and evaluating treatment progress. Combining foot exercises and foot wear modifications achieved the best outcome.
Conservative Treatment for Acute Achilles Tendon Rupture: Survey of Current Practice
Authors: Osarumwense Donald , Wright Jonathan , Gardner Kikachukwu , James Laurence 
Published: October 2016

Purpose. To survey the practice of orthopaedic consultants in the Greater London area for treating Achilles tendon ruptures. Methods. 221 orthopaedic consultants working in 28 hospitals within the Greater London area were identified. A questionnaire regarding conservative treatment for acute Achilles tendon ruptures was sent. The choice of immobilisation, the period of immobilisation, the time to weight bearing, the use of heel raises, and the use of diagnostic ultrasonography were enquired about. Results. 62 of 86 respondents treated Achilles tendon ruptures conservatively by below-knee casts (n=51), above-knee casts (n=5), or functional braces (n=6). The most common immobilisation regimen (n=7) was to keep the foot in a sequence of an equinus position, a semi-equinus position, and a neutral position (3 weeks in each position). After cast removal, 45 of respondents preferred to use a heel raise for a median duration of 4 (range, 2–36) weeks. Respectively for foot and ankle specialists (n=24) and other orthopaedic specialists (n=38), the median immobilisation period prescribed was 8 (range, 3–13) and 9 (range, 6–36) weeks, respectively (p=0.625), whereas the median time to weight bearing prescribed was 6 (range, 0–9) and 6 (range, 0–12) weeks, respectively (p=0.402). Conclusion. Functional bracing was not as widely used as below-knee cast immobilisation. There was no consensus on the optimal immobilisation regimen.
The Endolog System for Moderate-to-Severe Hallux Valgus
Authors: Giorgio Luigi Di , Touloupakis Georgios , Simone Simonetta , Imparato Luca , Sodano Luca , Villani Ciro 
Published: October 2016

Purpose. To report the midterm outcome of the Endolog system for correction of moderate-to-severe hallux valgus. Methods. 23 women and 2 men (33 feet) aged 35 to 80 (mean, 52) years underwent minimally invasive surgery for moderate (n=25) and severe (n=8) hallux valgus using the Endolog system. The hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the proximal articular set angle (PASA) were measured on radiographs. The feet were also assessed based on the American Orthopaedic Foot and Ankle Society (AOFAS) scale. Results. The mean follow-up duration was 18.2 (range, 12–36) months. The mean HVA, IMA, PASA, and the mean AOFAS score improved significantly after surgery (all p<0.0001). Periosteal reaction was noted by week 4, and callus formation after 3 months. There were no delayed or non-union or other complications. Conclusion. The Endolog system achieved good outcome for moderate-to-severe hallux valgus.
Proximal Disinsertion of the Common Extensor Tendon for Lateral Elbow Tendinopathy
Authors: Cusco Xavier , Alsina Montserrat , Seijas Roberto , Ares Oscar , Alvarez-Diaz Pedro , Cugat Ramon 
Published: October 2016

Purpose. To evaluate surgical outcomes of disinsertion of the common extensor tendon for lateral elbow tendinopathy. Methods. Records of 277 men and 128 women who underwent surgery for lateral elbow tendinopathy were reviewed. The indication for surgery was insufficient improvement of pain and inability to return to work after 3 weeks of physiotherapy (stretching, ultrasound) and local corticosteroid injections. According to the Tavernier technique, the origin of the tendons of the extensor carpi radialis brevis and extensor digitorum communis was located, and proximal disinsertion of the common extensor tendon was performed. Results. Outcome was excellent in 344 (85%) of the patients, good in 46 (11.5%), regular in 9 (2%), and poor in 2 (0.5%). The mean time to return to work was 29 (range, 5–93) days. Immediate complications included infection (n=1), seroma (n=1), cicatricial fibrosis (n=10), radial neuritis (sensory) [n=4], and reactive dermatitis (n=2). Late complications included Frohse's arcade syndrome (n=1) and carpal tunnel syndrome (n=2). Conclusion. Disinsertion of the proximal common tendon is a good option for treating lateral elbow tendinopathy.
Surgical Outcome for Hip Fractures in Patients with and without Parkinson's Disease
Authors: Yuasa Takahito , Maezawa Katsuhiko , Nozawa Masahiko , Kaneko Kazuo 
Published: October 2016

Purpose. To compare surgical outcome of hip fractures (in terms of the ability to walk and complications) in patients with and without Parkinson's disease (PD). Methods. Records of 207 patients who underwent surgery for femoral neck fractures were reviewed. Of whom, 9 men and 26 women with PD aged 58 to 89 (mean, 76.8) years underwent hemiarthroplasty for subcapital fractures (n=22) or internal fixation for intertrochanteric fractures (n=13). The remaining 36 men and 136 women with no PD aged 61 to 96 (mean, 81.8) years underwent hemiarthroplasty (n=108) or internal fixation (n=64) for subcapital (n=120) or intertrochanteric (n=52) fractures. None of the patients had pathological fractures, and all had been ambulatory prior to the fracture. According to the Columbia classification system, severity of PD was grade II in 11, grade III in 11, and grade IV in 13 patients. Results. Respectively for the patients with and without PD at the one-year follow-up, 68.2% and 79.6% of those treated with hemiarthroplasty and 46.2% and 62.5% of those treated with internal fixation were able to walk with or without assistive devices. 81.8%, 63.6%, and 38.5% of the patients with grade-II, -III, and -IV PD, respectively, were able to walk at the one-year follow-up, compared to 73.3% of the patients without PD. Conclusion. Surgical treatment for hip fractures was appropriate for patients with grade-II or -III PD.
Blocking Screws: An Adjunct to Retrograde Nailing for Distal Femoral Shaft Fractures
Authors: Gavaskar Ashok S , Chowdary Naveen 
Published: October 2016

Purpose. To review records of 11 patients who underwent retrograde nailing in conjunction with blocking screws to aid fracture reduction for distal femoral shaft fractures. Methods. Records of 8 men and 3 women aged 27 to 60 (mean, 41) years who underwent retrograde nailing with the use of blocking screws for distal femoral shaft fractures were reviewed. Two of the fractures were open and graded as Gustilo-Anderson grade II. The mean surgical delay was 2 (range, 1–5) days. Results. All fractures united after a mean of 14 (range, 11–16) weeks without malalignment. There was no screw breakage, screw bending, or wound infection. Conclusion. Blocking screws increase the stability of the construct and thereby minimise macro-motion at the fracture site.
Revision Total Knee Arthroplasty for Septic versus Aseptic Failure
Authors: Rajgopal Ashok , Vasdev Attique , Gupta Himanshu , Dahiya Vivek 
Published: October 2016

Purpose. To compare the medium-term outcome of revision total knee arthroplasty (TKA) for septic versus aseptic failure. Methods. Records of 142 patients who underwent revision TKA by a single senior surgeon for septic (n=65) or aseptic (n=77) failure were reviewed. In the septic group, 67 knees in 42 women and 23 men were included. In the aseptic group, 88 knees in 51 women and 26 men were included. The Knee Society Score was measured. The Kaplan Meier survival curve at months 36, 60, and 95 was plotted, with revision as the end point. The survival rates at each specific time point between the 2 groups were compared using the Z test. Results. The Knee Society Scores improved 18% from 51 to 69 in the septic group and 18% from 52 to 70 in the aseptic group (p=0.72). The range of motion improved 30% from 72° to 102° in the septic group and 39% from 62° to 100° in the aseptic group (p<0.001). Conclusion. Results of the 2 groups were similar in terms of the Knee Society Score, range of motion, and the Kaplan-Meier survivorship.
Correlation between Trochlear Dysplasia and the Notch Index
Authors: Botchu Rajesh , Obaid Haron , Rennie WJ 
Published: October 2016

Purpose. To evaluate the correlation between trochlear dysplasia and the notch index. Methods. Magnetic resonance images (MRI) of 95 knees in 54 male and 36 female patients aged 4 to 74 (mean, 28) years were reviewed by 2 musculoskeletal radiologists. Standard MRI sequences were used. Based on the Dejour classification of trochlear dysplasia, the knees were classified into normal or types A, B, C, and D. A notch index of <0.2 was considered narrow. Normal knees and knees with trochlear dysplasia were compared. Results. 60 of the 95 knees had trochlear dysplasia, of which 39 were Dejour type A, 13 were type B, 7 were type C, and one was type D. Dejour types B, C, and D were combined as non-type A. Inter-observer agreement in assessing the notch index was good (Kappa=0.6). The mean notch indices in normal knees and knees with trochlear dysplasia were comparable (0.161 vs. 0.157, p=0.18), as were in Dejour type A and non-type A knees (0.154 vs. 0.160, p=0.54) and in Dejour types A, B, C, and D knees (0.154 vs. 0.165 vs 0.153 vs. 0.2, p=0.17–0.7). The rate of ACL injuries was similar in patients with normal knees and those with type-A trochlear dysplasia. A low notch index (narrow notch) was not associated with ACL injury. Conclusion. The notch index and trochlear morphology are 2 independent entities. A narrow notch does not imply a shallow trochlear grove.
Grafted Tendon Healing in Femoral and Tibial Tunnels after Anterior Cruciate Ligament Reconstruction
Authors: Nakase Junsuke , Kitaoka Katsuhiko , Toratani Tatsuhiro , Kosaka Masahiro , Ohashi Yoshinori , Tsuchiya Hiroyuki 
Published: October 2016

Purpose. To evaluate tendon-to-bone healing after anterior cruciate ligament (ACL) reconstruction in the fibrous interzone (FIZ) of the femoral and tibial tunnels using magnetic resonance imaging (MRI). Methods. Five men and 5 women (mean age, 29 years) underwent arthroscopic ACL reconstruction by a single surgeon, using the semitendinosus and gracilis tendon. The tendon-to-bone healing in the FIZ was evaluated using sagittal and coronal MRI at 1, 3, 6, 9, 12, and 24 weeks, with the knee flexed at 60° and the tendon graft straight in both images. The signal intensity of the FIZ was visually assessed by comparing it with anatomic landmarks in the same patient's knee, and classified into 4 grades. It was grade 3 when similar to that of the patellar tendon, grade 2 when similar to that of skeletal muscle, grade 1 when greater than that of muscle but less than that of joint fluid, and grade 0 when similar to that of joint fluid. At 24 weeks, subjective and objective functional outcomes were evaluated using the Lysholm score and the International Knee Documentation Committee score. Results. At 24 weeks, no patient had knee laxity. All patients had an International Knee Documentation Committee score of A, and their mean Lysholm score was 98.5. In the femoral tunnel, the FIZ did not change during the first 9 weeks (in particular the anterior part), but healing occurred rapidly thereafter. In the tibial tunnel, the FIZ healed over time in all locations, and healing was complete in the lateral and posterior parts at 12 weeks, and in all locations at 24 weeks. The mean signal intensity grade was significantly higher in the tibial than femoral FIZ at 3 to 12 weeks (p<0.01). Conclusion. After ACL reconstruction, the tendon-to-bone healing in the FIZ of the tibial tunnel was faster than that of the femoral tunnel.
Fixation of Delayed Union or Non-Union Posterior Cruciate Ligament Avulsion Fractures
Authors: Singla Rohit , Devgan Ashish , Gogna Paritosh , Batra Amit 
Published: October 2016

Purpose. To report the outcome of fixation for delayed union or non-union posterior cruciate ligament (PCL) avulsion fractures. Methods. Seven men and 4 women aged 24 to 35 (mean, 28) years underwent lag screw or suture fixation for non-union or delayed union of avulsion fracture of PCL tibial attachment after a mean delay of 8.6 (range, 4–14) months. Patient satisfaction was assessed using a visual analogue scale (VAS). Functional outcome was evaluated using the Lysholm scale. Results. The mean follow-up period was 17 (range, 8–36) months. The mean Lysholm score improved from 82 preoperatively to 92 at the final follow-up (p=0.34), the mean range of knee motion improved from 82° to 87° (p=0.008), and the mean VAS score for patient satisfaction improved from 4.3 to 7.4 (p=0.0004). All patients but one achieved bone union after a mean of 7.5 (range, 7–9) weeks. Functional outcome was excellent for 6 patients, good for 4, and fair for one. Posterior drawer test was positive (grade 1 laxity) in 3 patients whose outcome was good for 2 and fair for one. The latter had non-union after Ethibond suture repair for a communited fracture. There were no instances of wound complications or implant loosening. Conclusion. Fixation with lag screw or suture combined with bone grafting for delayed union or non-union of PCL avulsion fractures achieves acceptable functional outcome.
Standardised Multidisciplinary Protocol for Haemodynamically Unstable Pelvic Fractures
Authors: Ip Ka Chun , Lee Kin Bong 
Published: October 2016

Purpose. To review treatment results of 29 patients with haemodynamically unstable pelvic fractures after implementation of a standardised multidisciplinary protocol. Methods. Records of 14 men and 15 women aged 14 to 84 (mean, 46) years who were treated for haemodynamically unstable closed (n=27) or open (n=2) pelvic fractures were reviewed. The survival rates before and after implementation of a standardised protocol were compared. Results. Of these 29 patients, 19 survived, 6 died of exsanguination, and 4 died of multi-organ failure. Survival was significantly improved after implementation of the protocol (66% vs. 31%, p=0.0006). Conclusion. A standardised protocol involving a dedicated multidisciplinary team for management of haemodynamically unstable pelvic fractures improved survival.
Insertional Torque and Pullout Strength of Pedicle Screws with or without Repositioning: A Porcine Study
Authors: Tan Chun Ee , Fok Margaret Woon Man , Luk Keith Dip Kei , Cheung Kenneth Man Chee 
Published: October 2016

Purpose. To evaluate the insertion torque and pullout strength of pedicle screws with or without repositioning. Methods. 20 fresh porcine lumbar vertebrae of similar size were used. The entry point was at the site just lateral and distal to the superior facet joint of the vertebra, and to a depth of 35 mm. A 6.2-mm-diameter, 35-mm-long pedicle screw was inserted parallel to the superior end plate on one side as control. On the other side, an identical screw was first inserted 10° caudal to the superior end plate, and then repositioned parallel to the superior end plate. The insertional torque and pullout strength were measured. Results. Three of the specimens were excluded owing to pedicle fractures during the pullout test. Repositioned pedicle screws were significantly weaker than controls in terms of the maximum insertional torque (3.20±0.28 vs. 2.04±0.28 Nm, 36% difference, p±0.01) and pullout strength (1664±378 vs. 1391±295 N, p±0.01). Conclusion. Repositioning pedicle screws should be avoided, especially when the pedicle wall is breached. If repositioning is deemed necessary, augmentation with polymethyl methacrylate or a screw with a larger diameter should be considered.
Early Reimplantation for Open Total Talar Extrusion
Authors: Mohindra Mukul , Gogna Paritosh , Thora Ankit , Tiwari Anurag , Singla Rohit , Mahindra Pankaj 
Published: October 2016

Purpose. To review outcome of early reimplantation for open total talar extrusion in 7 patients. Methods. Medical records of 5 men and 2 women aged 19 to 53 years who underwent reimplantation for open total talar extrusion within 6 hours after road traffic accident (n= 6) or industrial injury (n=1) were reviewed. The talus was first irrigated with 9 to 10 litres of saline solution, followed by 10% povidone iodine. It was then reduced after thorough debridement and fixed with tension band wiring or external fixation. Ankle mobilisation exercises were started at week 6 and full weight bearing at week 14. Outcome was assessed using the American Foot And Ankle Society score. Results. After a mean follow-up of 31.9 (range, 24–46) months, the mean American Foot and Ankle Society score was 81, and the mean dorsiflexion-plantar flexion arc was 36.9° (range, 25°–45°). All patients were able to walk with a balanced, unaided gait with mild-to-moderate pain (n=3) or pain-free (n=4). No patient developed deep infection or instability. Three patients developed avascular necrosis of the talus; restriction of motion was moderate at the ankle joint and severe at the subtalar joint. None of these 3 patients opted for revision surgery, as the pain was tolerable and did not limit their daily activities, but their condition was expected to deteriorate with time. Conclusion. Early reimplantation is recommended for open total talar extrusion, as it restores (to some extent) hind foot mechanics, heel height, and bone stock for activities of daily living and future reconstructive options.
Retrograde Locked Intramedullary Nailing for Aseptic Supracondylar Femoral Nonunion following Failed Locked Plating
Authors: Wu Chi-Chuan 
Published: October 2016

Purpose. To review the outcome of retrograde locked nailing for aseptic supracondylar femoral nonunions following failed locked plating. Methods. Records of 20 men and 4 women aged 20 to 57 (mean, 39) years who underwent retrograde locked intramedullary nailing for aseptic supracondylar femoral nonunion following failed locked plating were reviewed. There were 20 closed and 4 open Gustilo type II or IIIA fractures secondary to motor vehicle accidents (n=21) or falls (n=3). Patients had undergone one to 3 operations. The mean time from injury to the present revision surgery was 1.3 years. No patient had a flexion contracture. The locked plate was removed and replaced with a retrograde dynamic locked nail (with or without buttress plate augmentation) followed by bone grafting. Results. 17 men and 4 women were followed up for a mean of 3.4 years. The rest were lost to follow-up. The 21 patients achieved bone union after a mean of 4.3 months. The mean maximal knee flexion improved from 97.1° to 107.6° (p=0.03). Knee function was excellent in one, good in 15, and fair in 5 knees. The fair outcome was due to extension contracture, varus knee deformity, or knee pain. There were 3 malunions with varus deformity of 7°, 8°, and 9° each. No patient had deep infection causing a nonunion. All 21 patients could walk without aids. Conclusion. Retrograde locked intramedullary nailing for aseptic supracondylar femoral nonunions following failed locked plating achieved a high union rate.
Early Outcome after Total Knee Replacement Using Computed Tomography–Based Patient-Specific Cutting Blocks versus Standard Instrumentation
Authors: Nabavi Arash , Olwill Caroline M 
Published: October 2016

Purpose. To compare early outcome of total knee replacement (TKR) using computed tomography (CT)–based patient-specific cutting blocks versus standard instrumentation. Methods. 40 men and 44 women (90 knees) aged 45 to 88 (mean, 65) years who underwent TKR using standard instrumentation were compared with 39 men and 43 women (90 knees) aged 44 to 85 (mean, 64) years who underwent TKR using CT-based patient-specific cutting blocks. A single surgeon performed all TKRs through the medial parapatellar approach using a cemented prosthesis, with the posterior cruciate ligament retained and the patella resurfaced. Results. Respectively in the standard and patient-specific instrumentation groups, 74 and 70 patients were followed up for a mean of 30 and 14 months. The mean Oxford Knee Score was 19 and 19 preoperatively, 34 and 34 at 3 months, and 37 and 40 at 12 months (p=0.02). 71% and 88% of patients achieved good-to-excellent outcome (Oxford Knee Score of >34) at 12 months (p=0.008). The respective mean EQ-5D score was 54 and 52 preoperatively, 73 and 76 at 3 months, and 77 and 78 at 12 months. 18% and 2% of patients required a blood transfusion (p=0.0002), with a mean blood loss of 292 and 254 g/l (p=0.049). The mean tourniquet time was 45 minutes in both groups. There was no infection or revision in either group. Conclusion. Compared with standard instrumentation, the use of CT-based patient-specific cutting blocks for TKR achieved higher Oxford Knee Score at 12 months and lower blood loss and transfusion rate.
Intra-Operative Fracture in Posterior-Stabilised Total Knee Arthroplasty
Authors: Pun Alex HF , Pun Wai-Ki , Storey Peter 
Published: October 2016

Purpose. To review records of 17 patients who sustained a tibial or femoral intra-operative fracture during primary cemented total knee arthroplasty (TKA) Methods. Records of 1346 primary cemented TKAs using the NexGen LPS fluted tibial component performed by a single surgeon were reviewed. 12 tibial and 5 femoral intra-operative fractures occurred in 5 men and 12 women aged 54 to 83 (mean, 71.6) years. No patient had any condition that may predispose to osteoporosis. Results. All 12 tibial fractures occurred during hammering down of the final tibial component. They were vertical crack fractures of the anterior cortex of the medial tibial plateau with minimal displacement and did not extend beyond the tip of the tibial stem. Four of the 5 femoral fractures were avulsion fractures in the coronal plane of the medial femoral condyles and occurred during removal of the intercondylar notch. The remaining femoral fracture involved the medial cortex of the medial femoral condyle and occurred during removal of a large medial femoral condyle osteophyte. All fractures were immediately fixed with 3.5-mm partially threaded AO cancellous screws. All patients achieved bone union and good function. Conclusion. Intra-operative tibial fractures are more common than femoral fractures; fixation with multiple AO screws achieves good outcome.