bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between the Forearm plus Little Finger Length and the Femoral Length
Authors: Naik Monappa A , Sujir Premjit , Tripathy Sujit Kumar , Goyal Tarun , Rao Sharath K 
Published: October 2016

Purpose. To assess the correlation between the forearm plus little finger length and the femoral length in 100 volunteers. Methods. The forearm plus little finger length and the ipsilateral femoral length of 68 male and 32 female volunteers aged 19 to 55 (mean, 35.8) years were measured using a measuring tape. The forearm plus litter finger length was measured from the tip of the olecranon to the tip of the little finger, whereas the femoral length was measured from the tip of the greater trochanter to the level of proximal pole of the patella over the outer aspect of thigh. Two observers made the measurements on 2 separate occasions. Intra- and inter-observer variations were calculated. A value of ≥0.75 indicated excellent agreement. Results. The mean forearm plus little finger length and femoral length were 39.87 (SD, 2.73) and 39.85 (SD, 2.44) cm, respectively. The mean difference between these 2 measurements was 0.028 (95% CI, −0.109 to 0.165) cm. The correlation between these 2 measurements was 0.861 (p<0.001). Patient age, sex, and body mass index did not affect this correlation. The intra- and inter-observer reliability was excellent. Conclusion. The forearm plus little finger length correlated with the femoral length. This method is simple, radiation-free, and can be applied in day-today practice.
Resemblance of Valgus Malalignment of the Distal Tibia in 15-Degree Craniocaudal Radiographs
Authors: McArthur John R , Makrides Panos , Wainwright David 
Published: October 2016

Purpose. To describe and quantify a radiological phenomenon where the distal tibial plafond appears in valgus malalignment in intra-operative fluoroscopy owing to 15° craniocaudal angulation of the X-ray beam. Methods. The lateral distal tibial angle (LDTA) of 14 male and 9 female skeletally mature patients was measured by a single reviewer using 2 types of anteroposterior radiographs, in which the X-ray beam was projected at 0° (orthogonal to the ankle) and then at 15° (in a craniocaudal direction). The LDTA was the angle between the long axis of the tibia and a line drawn across the most radiodense part of the tibial plafond. The paired t-test was used to compare the LDTA of the 2 measurements. Results. The mean LDTA on the 0° orthogonal radiographs was 89° (range, 87°-92°), whereas the mean LDTA on the 15° craniocaudal radiographs was 79° (range, 77°–81°). The mean difference was 10° (range, 9°-12°; p<0.0001). In the 15° craniocaudal radiographs, the ankle joint appeared to have valgus malalignment. Conclusion. During intramedullary nailing of the tibia, the knee is usually flexed and the image intensifier may not swing over far enough. This can result in well-aligned reduction being incorrectly viewed as having valgus malalignment or a varus-malaligned fracture being incorrectly viewed as reduced.
Periprosthetic Fractures after Total Knee Arthroplasty
Authors: Agarwal Saurabh , Sharma Rajeev K , Jain Jitesh Kumar 
Published: October 2016

Purpose. To evaluate outcome in 20 patients treated for periprosthetic fractures after total knee arthroplasty (TKA). Methods. Records of 14 women and 6 men aged 45 to 85 (mean, 67) years who underwent operative (n=18) or conservative (n=2) treatment for periprosthetic fractures of the supracondylar femur (n=15), patella (n=3), and tibia (n=2) following minor falls (n=18) or high-velocity injury (n=2) were reviewed. The mean time from TKA to fracture was 43 (range, 14–98) months. Of the 15 supracondylar femoral fractures, 2 were managed with immobilisation in a long leg cast, 11 with internal fixation using locked compression plating, and 2 with revision arthroplasty. All 3 patellar fractures were managed with tension band wiring. Both tibial fractures were managed with revision arthroplasty. Radiographic and functional outcomes (the Knee Society scores) were assessed. Results. The mean follow-up was 35 (range, 24–48) months. All fractures healed after a mean of 15 (range, 12–38) weeks. One patient had delayed union. Postoperative alignment was satisfactory in all patients except one (with 5° varus). The mean tibiofemoral angle was 4° valgus. The mean range of motion was 98.5°. The mean Knee Society knee score was 85 (range, 75–89) and the functional score was 76 (range, 70–85). No patient had implant failure, loss of reduction, deep infection, deep vein thrombosis, or pulmonary embolism. Conclusion. The locked compression plate is effective in managing periprosthetic femoral fractures. Periprosthetic patellar and tibial fractures are uncommon. The latter often warrant revision arthroplasty owing to the loose implant.
Flexible Hinge Silicone Implant with or without Titanium Grommets for Arthroplasty of the First Metatarsophalangeal Joint
Authors: Kanzaki Noriyuki , Nishiyama Takayuki , Fujishiro Takaaki , Hayash Shinya , Hashimoto Shingo , Kuroda Ryosuke , Kurosaka Masahiro 
Published: October 2016

Purpose. To review outcomes of 37 patients who underwent arthroplasty of the first metatarsophalangeal joint using flexible hinge silicone implants with or without titanium grommets. Methods. 36 women and one man (63 feet) underwent arthroplasty of the first metatarsophalangeal joint for rheumatoid arthritis (RA) using Swanson flexible hinge silicone toe implants with or without titanium grommets. 20 women (35 feet) aged 31 to 72 (mean, 52) years with Steinbrocker grade II (n=4), grade III (n=6), and grade IV (n=10) RA of the feet were treated with the implant without grommets, whereas 16 women and one man (28 feet) aged 48 to 73 (mean, 60) years with Steinbrocker grade III (n=4) and grade IV (n=13) RA of the feet were treated with the implant with grommets. Pain levels were self-rated. Degenerative changes and the presence of osteophytes or deformity were recorded, as were breakage or deformation of the implants, radiolucencies around the implant, implant loosening, silicone-induced synovitis, and sclerosis around the implant. Results. All patients reported pain relief from severe to mild or moderate. Respectively for the feet with and without grommets, the rates of implant deformation were 25% and 63% (p=0.031), whereas the rates of moderate-to-severe radiolucencies (>2 mm) were 4% and 34% (p=0.004). Sclerosis developed around the implant in all feet. Conclusion. Titanium grommets appear to protect the implant and improve clinical outcomes.
Flexibility of the Transverse Arch of the Forefoot
Authors: Kudo Shintarou , Hatanaka Yasuhiko , Naka Kenichirou , Ito Kazuhiro 
Published: October 2016

Purpose. To measure the percentage of the transverse arch length (%TAL) in 2 positions using a 3-dimensional motion capture system to determine the flexibility of the transverse arch of the forefoot. Methods. 19 men and 10 women with no lower extremity injury or deformity were included. The %TAL of the left foot was measured using a digital caliper in the standing position and the lower leg maximum anterior tilting (LMAT) position. The difference in the %TAL between the 2 positions (δ%TAL) was calculated. 10 markers were mounted on skin over each metatarsal head and base of the left foot. Motion was captured using a 3-dimensional motion capture system. Coordinates of each marker were manually digitised. The percentage of the transverse arch height (%TAH) and angle between the first and fifth metatarsals (M1M5) were calculated, and differences in each forefoot parameter in the 2 positions were defined as δ%TAL, δ%TAH, δM1M5, and the fore foot flexibility magnitude (FFM) was calculated. Subjects were divided into 3 groups based on their δ%TAL: <25th percentile (hypo-flexibility group, n=7), >26th percentile to <74th percentile (control group, n=15), and >75th percentile (hyper-flexibility group, n=7). The 3 groups were compared in terms of the δ%TAL. δ%TAH, δM1M5, and FFM. Results. The δ%TAL correlated with δM1M5 ( r=0.61, p<0.001) and FFM ( r=0.60, p=0.001). For the δM1M5, the hyper-flexibility group differed significantly from other groups (p=0.01). For the FFM, the hyper-flexibility group differed significantly from the hypo-flexibility group (p=0.02). Conclusion. Measurement of the %TAL in both the standing and LMAT positions provides a simple and quantitative method of assessing the flexibility of the transverse arch of the forefoot.
Calcaneoplasty and Reattachment of the Achilles Tendon for Insertional Tendinopathy
Authors: Lin Heng An , Chong Keen Wai , Yeo William 
Published: October 2016

Purpose. To report the one-year outcome of 44 patients treated with a novel technique of calcaneoplasty and reattachment of the Achilles tendon. Methods. 15 men and 29 women (mean age, 53 years) with insertional tendinopathy of the Achilles tendon underwent calcaneoplasty, retrocalcaneal bursa excision, debridement and reattachment of the Achilles tendon with suture anchors via a lateral approach. Outcome was measured using the visual analogue score (VAS) for pain, the SF-36 health survey, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores. Patient expectation and satisfaction were also assessed. Results. Of the 44 patients, 37, 43, and 21 were followed up at 3, 6, and 12 months. The mean VAS for pain and AOFAS ankle-hindfoot score improved significantly up to 6 months. The mean SF-36 score improved significantly up to 6 months for physical functioning, role functioning (physical), and bodily pain. Patient expectation and satisfaction also improved significantly. No patient had postoperative infections or rupture. Three patients had delayed wound healing, which resolved after simple dressings. Conclusion. Calcaneoplasty and reattachment of the Achilles tendon via a lateral approach for insertional tendinopathy enables early weight bearing and achieves good outcome and pain relief.
Revision Anterior Cruciate Ligament Reconstruction Using Tibial or Hamstring Tendon Allografts
Authors: Reverte-Vinaixa Maria Mercedes , Minguell Joan , Joshi Nayana , Díaz-Ferreiro Eugenio Wenceslao , Duarri Gemma , Carrera Lluís , Castellet Enric 
Published: October 2016

Purpose. To report outcomes of revision anterior cruciate ligament (ACL) reconstruction using tibial or hamstring tendon allografts and to compare with another study using non-irradiated fresh-frozen bone-patellar tendon-bone allografts. Methods. Records of 12 men and 7 women aged 18 to 53 (mean, 33) years who underwent revision ACL reconstructions using tibial tendon (n=17) or hamstring tendon (n=2) allografts were retrospectively reviewed. At the time of primary ACL reconstruction, hamstring autografts (n=8) and bone-patellar tendon-bone allografts (n=11) were used. The mean time interval between surgeries was 93 (range, 11–225) months. The causes of failure were traumatic injury (n=7) and technical or biological reasons (n=12). The physical activity level was high in 2 patients, medium in 10, and low in 7. For clinical assessment, the Lysholm test, International Knee Documentation Committee (IKDC) scale, and visual analogue scale (VAS) for pain were used. Patient satisfaction was also assessed. Results. Four of the patients had laxity and were dissatisfied or very dissatisfied with the outcome; the failure rate was 21%. The mean IKDC score was 63% (range, 25–100%), and the mean Lysholm score was 74% (range, 30–100%). Comparing our patients with those in another study using bone-patellar-bone allografts, there was no significant difference in terms of the VAS for pain, IKDC score, and Lysholm score. Comparing our patients with and without chondral and/or meniscal lesions, there was significant difference in terms of the Lysholm score only (86±11 vs. 57±28, p=0.043). Comparing patients who had used hamstring tendon autografts at the primary ACL reconstruction with those who had used bone-patellar tendon-bone autografts, there was significant difference in terms of the VAS for pain only (4.4±3.1 vs. 1.6±1.0, p=0.020). Conclusion. Revision ACL reconstruction using tibial or hamstring tendon allografts provided acceptable results, similar to those using the bone-patellar tendon-bone allografts.
Disease Activity, Knee Function, and Walking Ability in Patients with Rheumatoid Arthritis 10 Years after Primary Total Knee Arthroplasty
Authors: Nishikawa Masataka , Owaki Hajime , Takahi Koichiro , Fuji Takeshi 
Published: October 2016

Purpose. To evaluate disease activity, knee function, and walking ability of patients with rheumatoid arthritis (RA) over 10 years after total knee arthroplasty (TKA). Methods. Four men and 26 women (mean age, 59.9 years) underwent 42 TKAs for RA with a mean duration of 151.3 months and were followed up for a mean of 142.3 months. Preoperatively, disease activity was assessed by C-reactive protein (CRP) level only, and the range of knee motion was recorded. At the final follow-up, tender joint count, swollen joint count, visual analogue scale of RA symptoms, and the Modified Health Assessment Questionnaire (MHAQ) score were assessed. Disease activity was evaluated using CRP, matrix metalloproteinase-3, and Disease Activity Score. Range of motion and Knee Society knee and function scores were also assessed. Results. The use of methotrexate increased from 4 patients preoperatively to 20 patients at the final follow-up (p<0.001), and the mean dose increased from 3.9 to 6.3 mg/week (p<0.001). Among the 30 patients, the mean CRP level decreased from 2.63 mg/dl preoperatively to 0.61 mg/dl at the final follow-up (p<0.001). Disease activity was controlled. At the final follow-up, disease activity was in remission in 10 patients, low in 11, and moderate in 9. The mean Knee Society knee score was excellent (91.0), but the mean function score was poor (57.0) and diverse. Severe walking disability (function score, <40) was noted in 8 patients (11 TKAs). Knee and function scores did not correlate. Conclusion. Walking ability in patients with RA after TKA was generally poor. Poor function was associated with a history of spinal or lower extremity fracture surgery and the MHAQ score.
Posterior Tension Band Wiring and Instrumentation for Thoracolumbar Flexion-Distraction Injuries
Authors: Hasankhani EG , Omidi-Kashani F 
Published: October 2016

Purpose. To evaluate treatment outcome of tension band wiring followed by posterior spinal fusion and instrumentation for thoracolumbar flexion-distraction injury (FDI). Methods. 36 men and 12 women aged 21 to 56 (mean, 36) years underwent tension band wiring followed by posterior spinal fusion and instrumentation using pedicular screws for FDI of the thoracolumbar spine. The injured vertebral levels were T11 (n=2), T12 (n=12), T11-T12 (n=1), T12-L1 (n=1), L1 (n=28), and L2 (n=4). Anterior vertebral body height and kyphosis were measured before and after surgery. Neurologic status was assessed using the American Spinal Injury Association (ASIA) scale. The Oswestry Disability Index questionnaire and visual analogue scale for pain were also used. Results. The mean follow-up was 38 (range, 26–72) months. At final follow-up, the mean visual analogue scale for pain was 1.7, and the median Oswestry Disability Index was 4% (range, 0–32%). The mean anterior vertebral body height improved from 20.5 to 38.8 mm (p<0.001). The mean kyphosis improved from 20.4° to 1.5° (p<0.001). Four patients had persistent neurologic deficit: ASIA scale C (n=2) and D (n=2); their ASIA scales improved by one grade. All patients returned to their original work at 6 months. There were no intra-operative complications or implant failures. Conclusion. Posterior tension band wiring followed by posterior spinal fusion and instrumentation for thoracolumbar FDIs achieved good outcome.
Percutaneous Release of the Al Pulley Using a Modified Kirschner Wire: A Cadaveric Study
Authors: Saengnipanthkul Sukit , Sae-Jung Surachai , Sumananont Chat 
Published: October 2016

Purpose. To evaluate the outcome of percutaneous release of the A1 pulley in 40 cadaveric fingers using a modified Kirschner wire. Methods. A 2.5-mm-diameter Kirschner wire measuring >12 cm in length was used. One end of the wire was sharpened into a ‘J’ shape using a grinder. The J-shaped tip featured a blunt, elongated lower tip, a sharp J-shaped curve, and a blunt upper tip. Completeness of A1 pulley release and injuries to the A2 pulley, flexor tendon, and neurovascular structures were evaluated in 40 cadaveric fingers. Results. Complete release of the A1 pulley was achieved in 8 index, 7 middle, 8 ring, and 8 little fingers, whereas incomplete release of the distal part was noted in 2 index, 2 middle, 2 ring, and one little fingers; release was missed in one middle and one little fingers. Injury to the A2 pulley was noted in 2 index fingers; the injury was minimal and limited to the proximal 2 mm of the A2 pulley. There was no flexor tendon or digital nerve injury in any finger.
Prognostic Factors Associated with Clear Cell Sarcoma in 14 Chinese Patients
Authors: Lee HL , Ho WY , Lam YL , Ng TP , Li KH , Shek T , Mak KL , Fong ST , So YC , Ngan RKC , Lau PPL , Chan ACL 
Published: October 2016

Purpose. To identify prognostic factors associated with clear cell sarcomas in 14 Chinese patients. Methods. Medical records of 7 men and 7 women (mean age, 36 years) with histologically confirmed clear cell sarcoma of tendons and aponeuroses were reviewed. Patient demographics, tumour characteristics, and treatment modalities were retrieved. Prognostic factors associated with favourable 5-year survival were determined. Results. The most affected sites were the thigh (n=5) and the foot (n=4); the mean time from symptom onset to diagnosis was 9.5 months. The tumour stage at diagnosis was IIA in 8 patients, IIB in 2, and III in 4. The mean tumour size was 4.5 cm in diameter. One patient was lost to follow-up. For the remaining 13 patients, the mean time to disease-related mortality was 2.5 years. Nine patients had distant metastases; the most common sites were lungs and pleura (n=7), followed by distant lymph nodes (n=4), bone (n=2), pericardium (n=2), and brain (n=1). All patients underwent surgical excision. Three women and one man (mean age, 27 years) attained 5-year disease-free survival. All had stage IIA tumours at diagnosis. Their mean tumour size was 1.75 cm in diameter, which was significantly smaller than that of all patients (4.5 cm). Tumour size of ⩽2.5 cm in diameter (p=0.004) and stage IIA tumour at diagnosis (p=0.04) were significant prognostic factors for 5-year survival. Conclusion. Tumour size of ⩽2.5 cm and early stage tumour are associated with 5-year disease-free survival. Early detection is crucial for the prognosis of clear cell sarcomas.
Association of Surgeon Factors with Outcome Scores after Total Knee Arthroplasty
Authors: Tan Sok-Chuen , Chan Yiong-Huak , Chong Hwei-Chi , Chin Pak-Lin , Yew Andy , Chia Shi-Lu , Tay Darren , Lo Ngai-Nung , Yeo Seng-Jin 
Published: October 2016

Purpose. To identify preoperative factors (including surgeon factors) associated with outcome scores after total knee arthroplasty (TKA). Methods. Medical records of 2848 patients (3458 knees) who underwent primary TKA by 27 orthopaedic specialists were retrieved. Three specialty knee surgeons who had one-year fellowship in TKA performed 1930 TKAs, and 24 general orthopaedic surgeons performed 1528 TKAs. Four of them (including all 3 specialty knee surgeons) were ultra-high-volume (⩾100 TKAs a year), and 21 of them were senior consultants (⩾5 years post residency). At 2 years, 2922 (85%) of knees had complete follow-up data. Oxford Knee Score, Knee Society knee and function scores, and SF-36 quality-of-life score were assessed by independent physiotherapists before and after surgery. Outcomes were compared in terms of dichotomised specialty, seniority, and surgical volume of surgeons. Results. Comparing ultra-high-volume (⩾100 TKAs per year) specialty knee surgeons with general orthopaedic surgeons, the former achieved better outcomes in terms of the Oxford Knee Score at 6 months, Knee Society knee and function scores at 2 years, and SF-36 scores at 6 months and 2 years. Comparing lower-volume (±100 TKAs per year) specialty knee surgeons with general orthopaedic surgeons, the former still achieved better outcome and quality-of-life scores, except for SF-36 Mental Component Score at 2 years. Conclusion. Specialty training and clinical research in TKA improved outcome and quality-of-life scores.
Combined Volar and Dorsal Plating for Complex Comminuted Distal Radial Fractures
Authors: Farhan MFM , Wong JHK , Sreedharan S , Yong FC , Teoh LC 
Published: October 2016

Purpose. To review outcomes of combined volar and dorsal locked plating for AO type-C3 complex comminuted distal radial fractures. Methods. Records of 24 patients aged 17 to 77 (mean, 53.3) years who underwent combined volar and dorsal locked plating for AO type-C3 distal radial fractures with volar and dorsal metaphyseal and intra-articular comminution were reviewed. 21 were closed fractures, and 3 were Gustilo-Anderson type-1 open fractures. Bone union, volar tilt, radial inclination, radial height, range of motion, grip strength, and any complications were assessed by a single hand surgeon. Results. After a mean follow-up of 17 (range, 14–25) months, the mean palmar flexion was 49° (range, 30°–80°), dorsiflexion was 52° (range, 30°–80°), supination was 86° (range, 60°–90°), pronation was 77° (range, 30°–90°), radial deviation was 16° (range, 5°–30°), and ulnar deviation was 27° (range, 10°–50°). The mean grip strength of the injured hand was 69.2% of the uninjured side. The mean time to radiological union was 3.9 (range, 2.5–6.0) months; no patient had non-union. At the time of union, the mean volar tilt was 5° (−22°–14°), radial inclination was 18.6° (8°–28°), and radial height was 8.5 mm (5.0 mm–13.6 mm). One patient had collapse of the dorsal fragment resulting in a dorsal tilt of 22° and limited (30°) forearm pronation. The severity of dorsal metaphyseal comminution had not been recognised and bone grafting was not performed. The patient also had minor complications of little finger flexor tendon irritation and carpal tunnel syndrome. She underwent implant removal and carpal tunnel release at 8 months. One patient had implant-related extensor digitorum communis irritation. Another patient had non-specific chronic wrist pain, which was resolved at one year. No patient had infection, tendon rupture, or complex regional pain syndrome. Four patients underwent implant removal, including 2 who had no implant-related problems. Conclusion. Combined volar and dorsal plating enables early mobilisation and good outcome for certain complex comminuted distal radial fractures.