bluuebunny/crossref_metadata_2025_split huggingface dataset:
Computed Tomographic Evaluation of the Odontoid Process for Two-Screw Fixation in Type-II Fracture: A Malaysian Perspective
Authors: Yusof MI , Yusof AH , Abdullah MS , Hussin TMAR 
Published: October 2016

Purposes. To measure the diameter of the odontoid process in a Malaysian population using computed tomographic (CT) scan and determine the feasibility of treating type-II odontoid fractures using 2 cortical screws. Methods. CT images of the odontoid process of 85 patients aged 18 to 80 years were analysed; 69 (81%) were male (mean age, 44 years) and 16 (19%) were female (mean age, 48 years). Both anteroposterior (AP) and transverse diameters of the odontoid process were measured via axial CT images at 3 different levels: the base of the odontoid process and 1.2 mm and 2.4 mm above the base. Results. The mean AP and transverse diameters of the odontoid process in men were 11.3 (range, 10.0–12.6; standard deviation [SD], 0.7) mm and 10.2 (range, 8.5–12.3; SD, 0.8) mm respectively, whereas in women were 10.9 (range, 9.4–13.2; SD, 0.8) mm and 10.1 (range, 7.9–11.6; SD, 0.9) mm respectively. The difference in corresponding mean dimensions between men and women was not statistically significant. The mean AP diameter was significantly larger than the mean transverse diameter. At the base and 1.2 mm and 2.4 mm above the base, the respective transverse diameters of 4 (5%), 13 (15%), and 24 (28%) of the patients were <9.0 mm. None had an odontoid AP diameter of <9.0 mm at any level. Conclusion. Two 3.5-mm cortical screws appear too big for fixation in one third of our sample presenting with type-II odontoid fracture. Fixation by two 2.7-mm screws is recommended for Malaysians and other Asian populations.
Osteosynthesis for Intra-Articular Calcaneal Fractures
Authors: Jain V , Kumar R , Mandal DK 
Published: October 2016

Purpose. To correlate treatment results of intra-articular calcaneal fractures with their computed tomographic (CT) classification. Methods. 36 men and 4 women with 48 intra-articular calcaneal fractures (8 bilateral) underwent open reduction and internal fixation with bone grafting via an extensile lateral approach. Based on 2-dimensional CT scans, the fractures were categorised using the Sanders classification. There were 16 type-II, 20 type-III, and 12 type-IV fractures. Radiographs and Maryland foot scores were used for evaluation of the results at a mean of 38 (range, 26–66) months. Results. Anatomic reduction of the posterior calcaneal facet was achieved in 38 of 48 fractures. The Bohler and Gissane angles were restored to between 92 and 99% of normal, respectively. Despite this, the mean functional scores were 84 in type-II, 83 in type-III and 67 in type-IV fractures. Conclusion. Surgical results were superior in type-II and -III fractures. Type-IV fractures fared poorly, despite excellent restoration of calcaneal anatomy; subtalar arthrodesis should have been considered.
Resistance of Disposable Drapes to Bacterial Penetration
Authors: Blom AW , Barnett A , Ajitsaria P , Noel A , Estela CM 
Published: October 2016

Purpose. To test the bacterial penetrability of disposable non-woven drapes used specifically for total hip arthroplasty. Methods. 12 round agar plates were inoculated with 107 colony-forming units/ml of coagulase-negative staphylococci (CNS) and incubated in air at 37°C for 18 hours to obtain a semi-confluent growth of organisms. Six brands of disposable drapes were tested; each was assigned to 2 plates. Each disposable drape was placed between a round agar plate and an inverted square agar plate filled with blood agar. After 30 and 90 minutes, the square agar plates were removed and incubated for 48 hours and inspected for growth of CNS. Results. Bacterial penetration was time dependant. Certain brands of drapes were more impenetrable than others; none was impenetrable at all time points, but most remained so or allowed passage of fewer than 100 colony-forming units at 90 minutes. Conclusion. It is recommended that drapes be rigorously tested with regard to their resistance to bacterial penetration.
Does Flexion Contracture Continue to Improve up to Five Years after Total Knee Arthroplasty?
Authors: Cheng K , Dashti H , McLeod G 
Published: October 2016

Purpose. To determine whether flexion contracture continues to improve up to 5 years after total knee arthroplasty (TKA). Methods. Records of 200 women and 123 men (mean age, 72 years) with osteoarthritis and preoperative flexion contracture were reviewed. 155 (48%) involved the left knee and 168 (52%) the right knee. Patients were assessed clinically before TKA and one and 5 years later, by a single researcher using a goniometer to measure flexion contracture, range of movement, maximum flexion, and the Knee Society Score. In all patients the same prosthesis design was used. The surgical technique was standard and involved a medial parapatellar approach with bone resection. Results. All variables improved significantly from pre-TKA to one-year post-TKA and from one-year post-TKA to 5-year post-TKA; respectively the mean flexion contracture decreased from 11° to 3° to 2°; the mean knee range of movement increased from 90° to 103° to 107°; the mean maximum flexion increased from 101° to 106° to 109°; and the mean Knee Society Scores increased from 39 to 87 to 90. Conclusion. Functional outcome and flexion contracture may continue to improve up to 5 years after TKA.
Anatomic Study of the Middle Genicular Artery
Authors: Salaria H , Atkinson R 
Published: October 2016

Purpose. To study the anatomy of the middle genicular artery and thus mitigate the risk of vascular injury in knee surgery. Methods. The course, anatomic relations, and variations of the middle genicular artery in 8 cadavers (4 men and 4 women) were studied. Results. The middle genicular artery originated from the anterolateral surface of the popliteal artery in the popliteal fossa, 3 to 5 cm proximal to the joint line either alone or having a common origin with the lateral genicular artery. Its diameter varied from 2 to 4 mm and it was 3 to 5 cm long. It was accompanied by 2 venae comitantes. This vascular bundle, including the middle genicular artery, ran distally, anterior to the popliteal artery, and posterior to the joint capsule, sandwiched between them. Distally it pierced the posterior joint capsule and became intra-articular. The relation of the middle genicular artery to the popliteal artery altered with the position of the knee joint. This alteration was secondary to the distal gliding of the popliteal artery with knee flexion. The middle geniculate artery formed an angle of 15° to 30° to the popliteal artery when the knee was extended, which became almost a right angle when the knee was flexed past 90°. Conclusion. Care must be taken when arthroscopic or open intra-articular surgery is performed in the posterior part of the knee joint using chondrotomes and saws, particularly with limited vision. Sharp dissection and diathermy under direct vision should be safer.
Anterior Spinal Fusion versus Laminoplasty for Cervical Spondylotic Myelopathy: A Retrospective Review
Authors: Cheng Sze-Chung , Yen Chi-Hung , Kwok Tik Koon , Wong Wing-Cheung , Mak Kan-Hing 
Published: October 2016

Purpose. To compare outcomes of anterior spinal fusion (ASF) versus laminoplasty for cervical spondylotic myelopathy (CSM). Methods. Records of 26 women and 37 men aged 34 to 83 (mean, 67) years who underwent ASF or laminoplasty for CSM were reviewed. Patient demographics, duration of symptoms, pre- and postoperative Japanese Orthopaedic Association (JOA) scores, Hirabayashi recovery rate, and radiographic features (including anteroposterior canal diameter, Pavlov ratio, and number of levels compressed) were compared. Results. The mean duration of symptoms was 9 months. The mean follow-up period was 40 months. Patients who underwent laminoplasty were older (p=0.015) and had more levels compressed (p<0.001) than those who underwent ASF. Patients with C3/4 compression were older than those without it (p=0.044). Younger patients had higher Hirabayashi recovery rate (p=0.043). Conclusion. The surgical decision for ASF or laminoplasty mainly depends on the number of levels compressed and patient age. Laminoplasty is usually reserved for older patients with multiple-level involvement. Age is the main predictive factor for surgical outcome.
Incidence of Secondary Hyperparathyroidism among Postmenopausal Women with End-Stage Knee Osteoarthritis
Authors: Papavasiliou Kyriakos A , Kenanidis Eustathios I , Potoupnis Michael E , Sarris Ioannis K , Kirkos John M , Kapetanos George A 
Published: October 2016

Purpose. To evaluate the incidence of secondary hyperparathyroidism (SH) among postmenopausal women with end-stage knee osteoarthritis scheduled for total knee replacement (TKR). Methods. 283 Caucasian postmenopausal women aged 49 to 81 (mean, 70) years with end-stage idiopathic knee osteoarthritis were scheduled to undergo primary TKR. They had been menopausal for 7 to 31 (mean, 19) years. Their preoperative serum levels of intact parathyroid hormone (I-PTH), calcium, phosphorus, creatinine, and the clearance of creatinine were evaluated. Results. 100 patients had abnormally elevated serum I-PTH. The overall incidence of SH was 35%. Serum levels of calcium and phosphorus were elevated in 33 and 12 patients, respectively. The serum level of I-PTH correlated positively with patient age ( r=0.158, p=0.008) and serum creatinine level ( r=0.138, p=0.021) and negatively with clearance of creatinine ( r= −0.169, p=0.004). Conclusion. SH is common among elderly postmenopausal women and may affect bone healing and implant fixation. Preoperative screening/evaluation of the serum PTH level in postmenopausal women scheduled for TKR is recommended.
A Reciprocating Ledge Technique in Closing Wedge Osteotomy for Genu Valgum in Adolescents
Authors: Dhar Shabir Ahmed , Butt Mohammed Farooq , Mir Mohammed Ramzan , Dar Tahir Ahmed , Sultan Asif 
Published: October 2016

Purpose. To describe a technique that preserves anterior and posterior alternate ledges in a closing wedge osteotomy. Methods. Five patients aged 14 to 19 years underwent a closing wedge osteotomy for genu valgum in 8 limbs using a reciprocating ledge technique. A unicortical wedge of bone was removed, with the anterior and posterior cortices spared. The anterior cortex at the proximal level and the posterior cortex at the distal level were cut through. With a wobbling action, the osteotomy site was rotated, and the distal fragment externally rotated. Manual force was applied to close the osteotomy site ensuring overlapping of the reciprocal ledges. The distal fragment was translated laterally to prevent club deformity. The osteotomy site was held with one or 2 staples. Stability was tested by flexion and extension of knee. Results. All 8 limbs attained bone union within 12 weeks, and full range of motion within a mean of 13 (range, 12–15) weeks. The mean correction of the tibiofemoral angle was 13°. At a mean follow-up of 12 months, all patients were pain-free and none developed club deformity. Conclusion. Sparing reciprocal ledges in a closing wedge osteotomy for genu valgum may increase stability in the flexion-extension axis, enable early range-of-motion exercises, and facilitate early bone union.
Cost Comparison of Femoral Head Banking versus Bone Substitutes
Authors: Leung Hon-Bong , Fok Margaret Woon-Man , Chow Lorraine Chi-Yan , Yen Chi-Hung 
Published: October 2016

Purpose. To compare the costs of femoral head banking versus bone substitutes. Methods. Records of femoral head banking from 1998 to 2008 were reviewed. The cost of allogenic cancellous bone graft was calculated by estimating the direct expenditure of femoral head procurement, screening tests, and storage, and then divided by the amount of bone harvested. Results. 326 females and 141 males (mean age, 80.3 years) donated 470 femoral heads. Each transplantable femoral head costs US$978. Each gram of transplantable allogenic bone graft costs US$86, compared with US$9 to 26 per gram for commercially available bone substitutes. Conclusion. Compared with bone substitutes, femoral head banking in Hong Kong was less economical. Unless allografts yield superior outcomes, harvesting femoral heads for general usage (such as filling bone voids for fresh fractures) is not justified from a financial perspective, especially in banks dedicated to procuring bone from femoral heads only.
Wrist Arthrodesis for Brachial Plexus Palsy Using an External Fixator and a Cannulated Screw (Ioannina Technique)
Authors: Vekris Marios D , Pakos Emilios E , Soucacos Panayotis N , Gavriilidis Iosif , Beris Alexandros E 
Published: October 2016

Purpose. To present a new technique for wrist arthrodesis and review its treatment outcomes in 33 patients with brachial plexus palsy. Methods. 26 men and 7 women (mean age, 26 years) with global brachial plexus palsy underwent wrist arthrodesis using an external fixator and a cannulated screw. All surgeries were performed under local anaesthesia by a single senior surgeon. An external fixator was applied to the radius and the metacarpal of the index finger. The articular surfaces of the radius, scaphoid, lunate, and capitate were debrided, and a cannulated screw inserted from the base of the radial styloid to the carpo-metacarpal joint of the ring finger. Cancellous allografts mixed with demineralised bone matrix were added to the decorticated wrist bones. The external fixator was removed at week 8 and the wrist protected with a short-arm splint until solid wrist fusion. Results. All patients achieved wrist fusion after a mean of 14 (range, 12–16) weeks. Two patients had delayed fusion and slight wrist instability, because the shorter screw was embedded in the cancellous bone and not self-tapped to the cortex. Fusion was achieved after replacement with a longer screw. No patient developed a superficial or deep wound infection; 2 developed pin track infections. All patients were satisfied with the outcome and able to perform simple daily activities after one year. Conclusion. Our new technique for wrist arthrodesis is less invasive. Blood loss, the risk of postoperative infection, and adhesions at the extensors are decreased.
Predictive Factors for Recurrence of Simple Bone Cyst of the Proximal Humerus
Authors: Teoh Kar Hao , Watts Adam C , Chee Yu-Han , Reid Robin , Porter Daniel Edward 
Published: October 2016

Purpose. To evaluate factors predictive of recurrence following curettage of simple bone cysts (SBCs) in the proximal humerus. Methods. Records of 29 male and 3 female patients aged 3 to 22 (mean, 11) years who underwent curettage with or without bone grafting for a solitary SBC in the proximal humerus were reviewed. The appearance, size, location, activity level, and fracture pattern of each cyst were recorded. The cyst index indicated the risk of refracture. Recurrence was defined as a refracture or enlargement of the cyst. Results. 31 patients presented with a pathological fracture. The main symptoms were pain (n=30), loss of function (n=22), and mass/swelling (n=15). 25 patients gave a history of trauma. The duration of symptoms was less than one month. 10 patients had recurrence after a mean of 10 (range, 4–27) months; 5 were refractures and another 5 were enlargement of the cysts. Six were treated conservatively and eventually healed, whereas 4 underwent further curettage. Factors predictive of recurrence were patient age ≤5 years (p=0.014), right-sided cyst (p=0.01), larger cyst (p=0.039), multilocular cyst (p=0.004) and unimpacted fracture (p=0.04). Recurrence was not related to gender, cyst location, or cyst activity level. Conclusion. Most SBCs heal even if the fracture is treated expectantly. SBCs should be left alone unless symptomatic. If curettage is performed, grafts or bone substitutes should be used. More aggressive treatment might be necessary for unimpacted fractures to minimise the risk of recurrence.
Mechanical Thromboprophylaxis for Patients Undergoing Hip Fracture Surgery
Authors: Mehta Kinjal V , Lee Haw Chou , Loh James SY 
Published: October 2016

Purpose. To evaluate the rates of deep vein thrombosis (DVT) and pulmonary embolism (PE) in hip fracture patients receiving mechanical thromboprophylaxis. Methods. 123 men and 311 women (mean age, 76 years) admitted to our institution with hip fractures were included. 95% of patient received mechanical prophylaxis using pneumatic calf pumps intermittently for ≥20 hours per day before and after surgery. At the surgeon's discretion, 161 (37%) of them received concomitant chemical prophylaxis in the form of subcutaneous low-molecular-weight heparin (enoxaparin). Signs and symptoms of DVT and PE were monitored daily, as were calf and thigh circumference. Diagnoses were confirmed by duplex ultrasonography of the lower limbs and/or spiral computed tomography scan of the thorax. Results. 13 patients developed symptomatic venous thromboembolism (VTE); 11 were DVT and 2 were PE. Among DVT patients, 2 had proximal and 9 had distal DVT. All these patients underwent anticoagulation and were discharged without any complications. No patients developed complications from pneumatic calf pumps (foot drop, skin abrasions or stasis). Eight patients developed bleeding tendencies during hospitalisation. No patient developed surgical wound infections. 12 patients died during hospitalisation; 8 of them from acute myocardial infarction or pneumonia, and none from PE. The median length of hospital stay was significantly longer in patients with VTE. Conclusion. Routine use of mechanical thromboprophylaxis is recommended in patients undergoing hip fracture surgery.
Strength of the Joshi External Stabilising System
Authors: Kumar Rajeev , Gupta Anupam , Sharma VP , Mishra Sanjay 
Published: October 2016

Purpose. To conduct an in vitro strength test for the Joshi External Stabilising System (JESS) for stabilisation of tibial fractures using a cadaveric tibia and steel rods. Methods. The configuration of the JESS specimens was based on a 62-year-old man with a metaphyseal tibial fracture. Two types of JESS specimens were prepared, using either the tibia of an average male adult cadaver (n=1) or stainless steel cylindrical rods (n=3). The strength of the JESS rather than that of the rods was measured using a universal testing machine. The axial compressive load was gradually increased at 1 mm/min to 35 N. Axial deformation of the fracture fragment was recorded. Each experiment was repeated 3 times in identical manner. A finite element analysis of the JESS was developed. The axial compressive loads and corresponding interfragmentary displacement in the experimental specimens and in the finite element analysis were compared. Results. The mean strength of the JESS was 32.5 N/mm in experiments and 35.3 N/mm in finite element analysis; the difference was 8.4%. The interfragmentary displacement was directly proportional to the axial compressive load. Conclusion. The strength of the JESS is one fourth of that of the Ilizarov fixator, and therefore not suitable for full load bearing activities.
Hemi-Resurfacing versus Total Resurfacing for Osteonecrosis of the Femoral Head
Authors: Kabata Tamon , Maeda Toru , Tanaka Kazunori , Yoshida Hironori , Kajino Yoshitomo , Horii Takeshi , Yagishita Shin-Ichi , Tsuchiya Hiroyuki 
Published: October 2016

Purpose. To compare mid-term outcomes of hemi-resurfacing arthroplasty (HRA) and total resurfacing arthroplasty (TRA). Methods. Seven men and 5 women (16 hips) aged 33 to 72 (mean, 50) years underwent HRA, whereas 7 men and 3 women (16 hips) aged 23 to 52 (mean, 40) years underwent metal-on-metal TRA; all were for osteonecrosis of the femoral head. In the HRA and TRA groups respectively, 10 and 8 hips were steroid-induced, whereas 6 and 8 hips were related to alcohol abuse. Surgery for 12 and 4 hips entailed the posterolateral approach, whereas 4 and 12 hips entailed the Hardinge approach. Usually, HRA was performed for early stages of the disease, and TRA for more advanced stages. 12 and 6 hips were classified as JOA stages 1 to 3A, whereas 4 and 10 hips as stages 3B to 4. All the hips were JOA types C1 or C2. Results. In the HRA and TRA groups respectively, the mean follow-up period were 6.5 and 5.5 years. The mean total JOA hip scores were 57 and 54 preoperatively, 93 and 97 at one year, and 84 and 96 at the final follow-up (p<0.01). The higher score in the TRA patients was mainly attributed to improvement in the pain score. In the HRA group, 12 hips developed groin pain or groin discomfort while walking, though only 4 of them showed apparent joint-space narrowing. Five patients underwent revision surgeries (conversion to total hip arthroplasty) owing to a femoral neck fracture, acetabular protrusio, osteoarthritic change, and severe groin pain. Patients having TRA had no revision surgery and did not complain of groin pain. Implants in both groups were radiographically stable. Conclusion. TRA were superior to HRA in terms of pain relief and implant survival, even though the former procedure was used for more advanced cases.
Predicting Leg-Length Change after Total Hip Arthroplasty by Measuring Preoperative Hip Flexion under General Anaesthesia
Authors: Fujishiro Takaaki , Nishiyama Takayuki , Hayashi Shinya , Hashimoto Shingo , Kurosaka Masahiro , Kanno Taiki , Masuda Takeshi 
Published: October 2016

Purpose. To measure preoperative hip flexion under general anaesthesia in patients with developmental dysplasia of the hip and analyse its correlation with leg-length change. Methods. 79 women and 6 men aged 27 to 82 (mean, 59) years underwent 92 total hip arthroplasties for severe developmental dysplasia of the hip of Crowe types II (n=60), III (n=17), and IV (n=15). All such patients had severe pain and/or considerable difficulty in walking and performing daily activities. 16 of the hips were treated with transverse subtrochanteric shortening osteotomy, whereas the remaining 76 had no femoral osteotomy. Preoperative passive hip flexion was measured under general anaesthesia with a goniometer by a single investigator. Its mean value in patients with Crowe type-III deformity was 60.3°. Therefore, >60° of flexion was defined as high. Postoperative leg-length change was measured radiographically. The distraction of the greater trochanter was equal to the leg-length change in patients treated without femoral osteotomy, whereas leg-length change was calculated by subtracting the amount of resection of the femur from the distraction of the greater trochanter in patients treated with femoral osteotomy. Results. Of the 16 hips treated with a transverse subtrochanteric shortening femoral osteotomy, 2, 2, and 12 were Crowe types II, III, and IV, respectively. In these 16 hips, hip flexion was high in 10 (mean, 86°) and low in 6 (mean, 36°). Leg-length change was significantly greater in the high than low flexion groups (31 vs. 13 mm, p<0.01). In the 76 hips without osteotomy, hip flexion was high in 54 (mean, 85°) and low in 22 (mean, 40°). Leg-length change was significantly greater in the high than low flexion groups (25 vs. 19 mm, p=0.016). Preoperative hip flexion under general anaesthesia correlated with leg-length change in hips with osteotomy ( r=0.850, p=0.0002) and without osteotomy ( r=0.267, p=0.019). Conclusion. Preoperative hip flexion measured under general anaesthesia may predict leg-length change after THA.