bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mid-Term Outcome of a Modular, Cementless, Proximally Hydroxyapatite-Coated, Anatomic Femoral Stem
Authors: Cossetto David J , Goudar Anil 
Published: October 2016

Purpose. To report the mid-term outcome of a modular, cementless, proximally hydroxyapatite-coated, anatomic femoral stem in total hip arthroplasty (THA). Methods. 160 consecutive patients aged 42 to 92 (mean, 70) years underwent 185 cementless THAs for primary osteoarthritis or femoral neck fractures. All procedures were performed by a single surgeon using the same modular, cementless, proximally hydroxyapatite-coated, anatomic femoral stem, regardless of age and bone quality. Clinical evaluation (pain, range of movement, and ability to walk) was based on the Merle d'Aubigne and Postel scores. Radiological assessment was based on criteria by Engh et al. in the 7 Gruen zones with regard to the presence of radiolucent lines, osteolysis, cancellous condensation, cortical hypertrophy or atrophy, reactive lines, and pedestal formation. Failure of the stem was defined as revision or impending revision because of aseptic loosening or pain. Results. Of the 160 patients, 21 died and none were lost to follow-up. In 3 of the 21 patients, the femoral stems were revised for periprosthetic fractures after a fall at 6 weeks, 10 months, and 3.8 years. 138 patients (162 THAs) completed a mean follow-up of 7.8 (range, 5.5–10.4) years. Their overall mean Merle d'Aubigne and Postel scores increased from 7.09 preoperatively to 16.36 postoperatively. The mean Engh score was 24.9 out of 27, with the mean score for femoral stem fixation 10 out of 10 and 14.9 out of 17 for femoral stem stability. No reactive lines at the bone-stem interfaces and no subsidence or osteolysis were evident in any of the radiographs. There were 5 periprosthetic femoral fractures, 2 deep infections, 3 dislocations, and 2 aseptic loosening (one each for the femoral stem and acetabular socket). Survivorship of the femoral stem at 10 years was 99% when revision secondary to only aseptic loosening of the stem was the endpoint. It was 96% when failures due to all causes (infection, periprosthetic fracture, and aseptic loosening) were the endpoints. Conclusion. The MBA femoral prosthesis provides a predictably stable fixation, with excellent mid-term outcome.
Radiographic Assessment of the Safe Zone for Medial Oblique Opening Wedge High Tibial Osteotomy
Authors: Siripisitsak Thana , Vanadurongwan Bavornrat , Harnroongroj Thos , Harnroongroj Thossart 
Published: October 2016

Purpose. To compare different cephalocaudal angles of the X-ray beam in measuring internal rotation of the proximal tibia that best demonstrates the safe zone. Methods. 10 pairs of embalmed, disarticulated knee joints from 10 cadavers were used. Soft tissues around the proximal tibia and the proximal tibiofibular joint (PTFJ) were dissected to reveal the articular cartilage. A narrow area between the end of the articular cartilage of the posterolateral proximal tibia and of the PTFJ was identified as the safe zone with a U-shape metal used as a radiographic marker. Translation of the proximal tibia was controlled during internal rotation of the proximal tibia. Internal rotation of the proximal tibia that best demonstrated the safe zone (the U-shape metal at its most outermost point) was measured at 0°, 5°, 10°, 15°, 20°, and 25° cephalocaudal angles of the X-ray beam. Results. The mean internal rotation of the proximal tibia that best demonstrated the safe zone at 0°, 5°, 10°, 15°, 20°, and 25° cephalocaudal angle of the X-ray beam were 50°, 45°, 37°, 32°, 23°, and 19°, respectively. Conclusion. The safe zone was best demonstrated with 50° and 45° internal rotation of the proximal tibia at 0° and 5° cephalocaudal angles of the X-ray beam, respectively.
Non-Contrast Magnetic Resonance Imaging for Diagnosing Shoulder Injuries
Authors: Arnold Heino 
Published: October 2016

Purpose. To compare preoperative non-contrast magnetic resonance imaging (MRI) with arthroscopy findings in diagnosing labral and rotator cuff tears. Methods. 86 men and 60 women aged 21 to 70 (mean, 52) years underwent non-contrast MRI before arthroscopic operations on the glenohumeral joint. Slices were made in a transvese, parasagittal, and paracoronar orientation. The sequences used were T2- and proton-weighted for paracoronar imaging, T1- and T2-weighted for transverse and parasagittal imaging, and T2-weigthed sequences with fat suppression and short tau inversion recovery sequences. MRI was evaluated with the surgeon to eliminate interobserver bias. Arthroscopic surgery was performed by a single surgeon. If a labral or rotator cuff tear was found, surgery was performed using corkscrew anchors. Results. For full thickness rotator cuff tears, MRI and arthroscopy detected them in 76 and 82 patients, respectively. One such tear found by MRI could not be confirmed by arthroscopy. MRI missed 4 subscapularis and 3 supraspinatus tears. The sensitivity and specificity of MRI in diagnosing full thickness rotator cuff tears were 0.90 and 0.91, respectively. For labral tears, MRI and arthroscopy detected them in 16 and 31 patients, respectively. One anterior labral tear detected by MRI could not be verified by arthroscopy. All 16 labral tears detected by MRI were Bankart type-I tears (of the anterior glenoid) except for one superior labral tear from anterior to posterior (SLAP tear). All 13 SLAP tears (10 type 2 and 3 type 3) except for one could be found by arthroscopy only. The sensitivity and specificity of MRI in diagnosing labral tears were 0.52 and 0.89, respectively. Conclusion. Non-contrast MRI is reliable only for diagnosing full thickness rotator cuff tears and anterior labral tears. Direct or indirect contrast enhancement is recommended for more differentiation. Special scan orientation is necessary for SLAP tears.
Total Wrist Arthroplasty Using the Universal 2 Prosthesis
Authors: Morapudi Syam PK , Marlow William J , Withers Daniel , Ralte Peter , Gabr Ayman , Waseem Mohammad 
Published: October 2016

Purpose. To report outcomes of 21 total wrist arthroplasties (TWA) using the Universal 2 prosthesis. Methods. Five men and 14 women aged 44 to 82 (mean, 62) years underwent 21 total wrist arthroplasties for rheumatoid arthritis (n=19) and post-traumatic arthritis (n=2) by a single surgeon using the Universal 2 prosthesis. Pre- and post-operative pain and function were assessed by a single surgeon using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the patient-rated wrist evaluation (PRWE) score. Range of motion, stability, dislocation rate, and neurovascular status were also assessed. Radiographs were evaluated for implant alignment and fit, screw positioning, and implant loosening. Results. The mean time to assessment of the range of motion was 3.1 (range, 1.8–3.9) years, and the mean time to assessment of the PRWE score was 4.8 (range, 2.1–7.3) years. The range of motion in each direction and the mean DASH and PRWE scores improved significantly following TWA. Two patients had restricted range of motion, which was treated by manipulation under anaesthetic (after 6 months in one and 8 weeks in the other). One patient underwent excision of a palmar bony bridge. One patient endured extensor pollicis longus rupture and underwent tendon transfer after 5 months. Radiographs revealed no evidence of implant loosening, migration, or malalignment. There was no sign of osteonecrosis in the remaining carpals or metacarpals. Conclusion. The Universal 2 TWA achieved significant improvement in range of motion and functional outcome of the wrist, with reduced rates of early joint instability, dislocation, and implant loosening, compared to previous implants. The small implant size and cementless design reduce bone loss and osteonecrosis.
C-Reactive Protein and Interleukin-6 Levels in the Early Detection of Infection after Open Fractures
Authors: Douraiswami Balaji , Dilip Patro K , Harish BN , Jagdish Menon 
Published: October 2016

Purpose. To measure C-reactive protein (CRP) and interleukin-6 (IL-6) levels in 30 patients with open fractures and correlate the levels with infection. Methods. 29 men and one woman aged 9 to 70 (mean, 37) years presented with open fractures of the upper or lower extremity within 12 hours of injury and underwent debridement and external fixation 3 to 40 (mean, 16) hours after injury. Serum CRP and IL-6 concentrations were measured preoperatively and on postoperative days 2 and 4. CRP was measured using latex agglutination and nephelometry, and IL-6 by enzyme-linked immunosorbent assay. The mean CRP and IL-6 levels in infected and non-infected patients were compared. The trend of CRP and IL-6 levels within the infected group was analysed. Correlations between CRP and infection, and between IL-6 and infection were analysed. Results. 11 of the 30 patients developed wound infection. The day-2 CRP levels of 30 patients were positive (range, 7–28 μg/ml). In 27 patients, the CRP levels were higher on day 2 than preoperation. On day 4, CRP levels declined sharply in patients without infection (mean, 8 μg/ml) but were persistently elevated in patients with infection (mean, 17 μg/ml). The sensitivity and specificity of the CRP test were 100% and 42%, respectively. In the 11 patients with infection, the IL-6 concentrations were elevated at day 2 (mean, 689 pg/ml) and decreased progressively at day 4 (mean, 175 pg/ml). The sensitivity and specificity of the IL-6 test were 90% and 100%, respectively. Infection correlated with CRP and IL-6 levels. Conclusions. Serial serum measurements of IL-6 and CRP levels help in the early diagnosis of infections after open fractures before they are clinically evident.
Medium-Term Outcome of Mosaicplasty for Grade III-IV Cartilage Defects of the Knee
Authors: Reverte-Vinaixa Maria Mercedes , Joshi Nayana , Díaz-Ferreiro Eugenio Wenceslao , Teixidor-Serra Jordi , Domínguez-Oronoz Rosa 
Published: October 2016

Purpose. To evaluate the medium-term outcome of mosaicplasty for full-thickness cartilage defects of the knee joint in 17 patients. Methods. Records of 12 men and 5 women aged 16 to 57 (mean, 35) years who underwent mosaicplasty for grade III/IV osteochondral defects in the lateral (n=14) or medial (n=3) femoral condyle were reviewed. 12 of the patients had undergone knee surgeries. The mean size of the defects was 3.4 (range, 1–4) cm2. Three patients had defects of >2 cm2. All operations were performed by a single surgeon using mini-arthrotomy. The lateral edge of the trochlea was the donor site. Graft integration and the presence of any abnormality at the articular surface were assessed using magnetic resonance imaging (MRI). In addition, patients were evaluated using the International Knee Documentation Committee (IKDC) rating scale, the SF-36 health questionnaire, visual analogue scale (VAS) score for pain. Results. Two of the 17 patients developed necrosis and cystic degeneration of the grafts and underwent conversion to unicompartmental knee arthroplasty within 2 years. They were older than 45 years and had defects of >2 cm2. Respectively in years 4 and 7, one and 4 patients were lost to follow-up, the mean IKDC score was 75% and 88%, the SF-36 score was 83% and 90%, and the VAS score was ≤3 in 13 of 14 patients at year 4 and in all 11 patients at year 7. At the 7-year follow-up, patient satisfaction with mosaicplasty was excellent in 8 patients, good in 3, and poor in 2 (who underwent unicompartmental knee arthroplasty). At year 4, MRI showed integration of the cartilage repair tissue and incorporation of the osseous portion of the graft into the bone in 13 of the 14 patients. The remaining patient had osteoarthritis at the graft donor site. At year 7, MRI showed good integration of the implant in all 11 available patients, but fissures were seen on the cartilage surface in 3 patients. Conclusion. The medium-term outcome of autologous mosaicplasty for symptomatic osteochondral defects in the femoral condyle is good. Longer follow-up is needed to determine the structural and functional integrity of the graft over time.
Simultaneous Bilateral Total Knee Replacement: A Prospective Study of 150 Patients
Authors: Jain Sanjeev , Wasnik Sandeep , Mittal Amber , Sohoni Sameep , Kasture Sarang 
Published: October 2016

Purpose. To evaluate the safety of simultaneous bilateral total knee replacement (TKR). Methods. 124 women and 26 men (mean age, 66 years) underwent simultaneous bilateral TKR for tricompartmental osteoarthritis using a posterior-stabilised, high-flexion implant. All patients underwent dobutamine stress echocardiography for detection of any silent cardiac comorbidity by a cardiologist. None had any adverse effect after testing. Five patients had positive outcome and underwent coronary angiography to detect any significant coronary blockage. Functional outcome was evaluated using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Tranexamic acid was given intravenously to reduce peri-operative blood loss. Femoral blocks and patient-controlled analgesia were used to facilitate early recovery. Aggressive physiotherapy was allowed. Patients were followed up at months 3, 6, and 12, and yearly thereafter. Results. At the 2-year follow-up, the mean range of motion improved from 95° to 129° (p=0.032), the mean KSS from 120 to 158 (p<0.001), and the WOMAC from 51 to 88 (p=0.002). One patient developed patellar crepitus at week 6, which resolved with conservative treatment. Another patient developed infection in both knees at month 6. Despite salvage procedures, infection recurred after 3 months and the patient underwent bilateral arthrodesis. No patient developed deep vein thrombosis or pulmonary embolism, myocardial infarction, atrial fibrillation, or other cardiac event. Conclusion. Simultaneous bilateral TKR is safe for properly selected patients.
Reliability of Two-Dimensional Computed Tomography for Measuring Hip Anatomy
Authors: Boyle Matthew J , Yassaie Omid , Grieve Philip P , Frampton Christopher MA 
Published: October 2016

Purpose. To evaluate the reliability (inter- and intra-observer variability) of 4 hip anatomies using 2-dimensional pelvic computed tomography (CT). Methods. Two-dimensional pelvic CT of 10 men and 10 women aged 33 to 89 (mean, 69) years presenting with non-orthopaedic conditions within one month were evaluated by 3 observers. The centre-edge angle of Wiberg, the Sharp angle, the acetabular depth ratio of Murray, and the acetabular anteversion angle of every hip were measured by each observer. After 6 weeks, these measurements were repeated. Reliability was evaluated using intraclass correlation coefficient (ICC), which represents the variation between patients as a percentage of the variation from all 3 sources (patients, inter-observers, and intra-observers). The ICC was classified as poor (<0.20), fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80), and excellent (0.81–1.00). Results. Reliability was substantial for the Sharp angle (ICC=0.74), the acetabular anteversion angle (ICC=0.69), and the acetabular depth ratio of Murray (ICC=0.62), and was fair for the centre-edge angle of Wiberg (ICC=0.40). Conclusion. The Sharp angle, the acetabular anteversion angle, and the acetabular depth ratio of Murray could be reliably measured using 2-dimensional CT. These measurements are appropriate for population-based studies of hip anatomy.
Tibiotalocalcaneal Arthrodesis in a Singaporean Hospital
Authors: Tan Bryan Yijia , Ng Sean Yung Chuan , Chong Keen Wai , Rikhraj Inderjeet Singh 
Published: October 2016

Purpose. To report 18 patients who underwent tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail or cannulated screws. Methods. 10 men and 8 women (19 ankles) aged 36 to 70 (mean, 52) years underwent tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail (n=13) or cannulated screws (n=6). Indications for arthrodesis were severe cavovarus deformity secondary to polio or charcot-marie-tooth disease (n=7), severe osteoarthritis in the ankle and subtalar joints (n=6), Charcot joint deformity (n=3), failed fusion procedures (n=2), and foot drop secondary to T12 tumour surgery (n=1). The visual analogue score (VAS) for pain was assessed, as were the American Orthopaedic Foot and Ankle Society (AOFAS) scores (for subjective and objective pain, function, and stability of the ankle), short form 36 (SF-36), and patient expectation and satisfaction scores. Results. The mean follow-up period was 35.6 (range, 11–144) months. 13 of 18 patients returned for assessment of scores. 18 of the 19 ankles achieved fusion after a mean period of 5.9 (range, 3–11) months. The mean VAS scores for pain, AOFAS scores, and SF-36 scores all improved. 11 patients had good-to-excellent satisfaction and expectation scores. Two patients had severe wound infections and underwent implant removal (after bone union), debridement, and intravenous antibiotic therapy. Two other patients had superficial wound infections. One patient with retrograde intramedullary nailing had a pseudoarthrosis and underwent implant removal, redebridement, re-autografting, and cannulated screw fixation. Fusion was achieved subsequently. Conclusion. Tibiotalocalcaneal arthrodesis improved the pain score and quality of life, despite a high risk of complications.
Percutaneous Autologous Bone Marrow Injections for Delayed or Non-Union of Bones
Authors: Singh Ashok K , Shetty Sanat , Saraswathy Jayadeep J , Sinha Amit 
Published: October 2016

Purpose. To evaluate 12 patients with delayed or nonunion of bones treated with bone marrow injections. Methods. 6 men and 6 women aged 15 to 70 (mean, 45) years underwent bone marrow injections for delayed union (n=2) or atrophic non-union (n=10) of the ulna (n=6), femur (n=3), humerus (n=2), or metacarpal (n=1). Bone marrow was aspirated from the anterior iliac crest and injected to the delayed and non-union sites. Two injections were given for children and adolescents, and 3 for adults. The interval between the injections was 6 to 8 weeks. The amount of bone marrow injected was 30 to 40 ml for long bones and 20 ml for metacarpals. Results. Ten of the 12 delayed or non-union of bones healed after bone marrow injections. The mean time for callus formation was 5.8 (range, 3–10) weeks, for clinical union was 7 (range, 4–12) weeks, and for radiological union was 16 (range, 10–24) weeks. Conclusion. Multiple injections of low-volume bone marrow can be used for treatment of delayed or nonunion of bones.
Prevention of Knot Slippage with the Use of Cyanoacrylate Glue: A Mechanical Study
Authors: Smith George H , McEachan JE , McLean A , Huntley JS 
Published: October 2016

Purpose. To assess the effect of cyanoacrylate glue on knot slippage and strength in vitro. Methods. Ethibond 3/0 was tested using a tensile tester. A single drop of cyanoacrylate glue was applied to the knots. Seven knot configurations (10 samples each) were tested: (1) a surgeon's knot (S) plus 4 square throws (+4) without glue (control group), (2) S plus one square throw (+1) without glue, (3) S+1 with glue, (4) S with glue, (5) S+1 wet post-tie without glue, (6) S+1 wet pre-tie without glue, and (7) S+1 wet pre-tie with glue. Wet sutures were immersed in normal saline for 24 hours prior to knot tying. Wet pre- and post-tie sutures were immersed for one minute prior to knot tying and tensile testing, respectively. Outcome measures were the mode of failure (knot slippage or suture snapping) and the ultimate tensile strength. Results. All knots without glue failed owing to knot slippage, except for the controls, whereas all knots with glue failed owing to suture snapping. The ultimate tensile strength was significantly higher in knots with glue and controls than in knots without glue. The ultimate tensile strength did not differ significantly between S+4 without glue and S with glue (p=0.48), indicating that glue could reinforce knots and reduce the number of throws needed. Wet suture is protective against failure (p<0.01). Conclusion. Cyanocrylate glue may have clinical applications for flexor tendon repairs for which a reduced knot size is advantageous.
Prevalence of Insomnia in Patients with Chronic Back Pain
Authors: Purushothaman Balaji , Singh Anjani , Lingutla Kiran , Bhatia Chandra , Pollock Raymond , Krishna Manoj 
Published: October 2016

Purpose. To estimate the prevalence of insomnia in patients with chronic back pain, and to correlate insomnia with severity of back pain and disability. Methods. 63 women and 57 men aged 24 to 83 (mean, 55) years who presented with chronic back pain for >6 months were asked to complete a self-administered questionnaire to evaluate the Insomnia Severity Index (ISI), Oswestry Disability Index (ODI), and Numerical Rating Scale (NRS) for back pain. Results. Of the 120 patients, 25 had no insomnia, 39 had sub-threshold insomnia, and 56 had clinically significant insomnia. According to the ODI, disability was minimal in 12 patients, moderate in 38, severe in 43, bed-binding in 26, and crippling in one. Of the 120 patients, 91 rated their NRS for back pain as 5 to 10 and 29 rated it as 1 to 4. Correlation was stronger between ISI and ODI than between ISI and NRS for back pain ( r=0.59 vs. r=0.38). Conclusion. 47% of patients with chronic back pain had insomnia. The ODI was more reliable than the NRS for back pain to detect insomnia. Back pain should be treated early to avoid serious health problems associated with insomnia.
Mortality and Re-Operation Rate after Proximal Femoral Fracture Surgery by Trainees
Authors: Khunda Aiman , Jafari Maya , Alazzawi Sulaiman , Mountain Alistair , Hui Anthony CW 
Published: October 2016

Purpose. To review records of 761 patients who underwent surgery for proximal femoral fractures to determine whether surgeon's experience and volume was associated with 6-month mortality and reoperation rates. Methods. Records of 761 patients who underwent surgery for proximal femoral fractures were reviewed. Patients operated on by a consultant or trainees with supervision of a scrubbed consultant were classified as the consultant group (n=214). Patients operated on by trainees alone (n=516) or trainees with supervision of an unscrubbed consultant (n=31) were classified as the trainee group (n=547). A total of 21 trainees were identified. They had different levels of experience, which was quantified according to the total number of operations performed for proximal femoral fractures from the start of their training to the start of the study. Results. Patients in the trainee group were older (80±12 vs. 77±14 years, p<0.001), and the fractures were more complex in the consultant group. The 6-month mortality rate was 24.2% (n=184). The odds of dying within 6 months after operation was 80% higher in patients operated on by trainees without supervision of a scrubbed consultant (odds ratio, 1.8; 95% confidence interval, 1.1–2.7). Variables associated with the 6-month mortality rate were age (p<0.001), American Society of Anesthesiologists grade (p<0.001), pre-injury activity level (p<0.001), and the surgeon's grade (p<0.05). The 6-month reoperation rate was 3.8% (n=29) and did not differ significantly in the 2 groups. The experience level of the trainees was not associated with the 6-month reoperation rate. Conclusion. The odds of dying within 6 months after a surgery for proximal femoral fractures was 80% higher in patients operated on by trainees without supervision of a scrubbed consultant.