bluuebunny/crossref_metadata_2025_split huggingface dataset:
Collagen Membranes for Host-Implant Integration: A Pilot Clinical Study
Authors: Nathan Saminathan Suresh , Guerzon Edwin Ravanzo , Bhavanam Kishore , Tan Lay Hong , Zarchi Khin , Pereira Barry P 
Published: October 2016

Purpose. To evaluate host-implant integration with collagen membranes in 14 patients who underwent limb salvage surgery for musculoskeletal oncological disease. Methods. 8 females and 6 males aged 10 to 69 (mean, 30) years underwent limb savage surgery with collagen membranes (Tutomesh; Tutogen Medical, Germany) for osteosarcoma (n=7), chondrosarcoma (n=3), giant cell tumour (n=1), malignant fibrous histiocytoma (n=1), arteriovenous malformation (n=1), and pigmented villonodular synovitis (n=1). The procedures performed were proximal humeral resection (n=3), partial scapulectomy (n=1), proximal femoral resection (n=2), total femoral resection (n=2), proximal tibial resection (n=3), and wide resection of soft tissues of the knee (n=3). In addition, 10 patients underwent endoprosthesis reconstruction. Reconstruction of musculoskeletal defects was classified into type I (intercalary, n=2), type II (joint, n=4), and type III (both, n=8). Graft incorporation and local recurrence were monitored. Clinical outcome measures entailed the Short Form-36, Toronto Extremity Salvage Score (TESS), and Musculoskeletal Tumor Society Score (MSTS). Results. Two patients with proximal tibial resection and one with total femoral resection had wound healing problems. No patient had any infection or any foreign body reaction necessitating implant removal. Eight patients with type II or III reconstruction were followed up for a mean of 11 (range, 1–23) months. Their scores in the Short Form-36, TESS, and MSTS were similar to those who had undergone reconstructions without the membrane, with the exception of type II reconstructions for which the membrane conferred good results. Conclusion. The Tutomesh membrane facilitated host-implant integration and provided a feasible anatomic reconstruction for ligaments in the shoulder, knee, and hip.
Long-Term Outcome of Total Hip Replacement in Patients with or without Femoral Head Contamination
Authors: Ibrahim Talal , Aswad Mayyar Ghazal , Dias Joseph J , Brown Andrew R , Esler Colin N 
Published: October 2016

Purpose. To compare long-term outcomes of total hip replacement (THR) in patients with or without contamination of the femoral head. Methods. After a mean period of 12 (range, 8–17) years, 104 female and 71 male THR patients aged 47 to 96 (mean, 77) years were reassessed via a self-administered questionnaire, and 25 other THR patients were reassessed by review of case notes. The questionnaires comprised the 12-item Oxford hip score and the European Quality Of Life (EuroQOL). 87 and 88 patients had positive and negative cultures in the donated femoral heads, respectively. The 2 groups were compared with respect to the Oxford hip score, the EuroQOL, and rates of complication and revision surgery. Results. Long-term outcomes of THR patients with or without femoral head contamination were not significantly different. Respectively, the mean Oxford hip scores were 36 and 39 (p=0.4); 16 and 14 patients had the maximum score of 48; 2 and 3 patients scored <10 (mostly owing to aseptic loosening). The respective mean visual analogue scale score of the EuroQOL were 65 and 73 (p=0.07); only the dimension of self care was significantly different between groups (p=0.04). Respectively, 14 and 12 patients had complications (16% vs. 15%, χ2=0.05, p=0.8), whereas 11 and 5 patients had revision surgery (13% vs. 6%, χ2=2.2, p>0.1). Conclusion. Microbiological screening of donated femoral heads plays no role in predicting long-term failure of THR in the donors.
Patellar Tracking during the Gait Cycle
Authors: Abbas Ghulam , Diss Ceri 
Published: October 2016

Purpose. To assess normal patellar tracking during walking using the 9-camera infrared system. Methods. Four men and 6 women aged 25 to 33 (mean, 29) years each performed 16 walking trials on one occasion. They had prominent patellae with minimal soft tissues (minimising skin artefacts), and their knees and lower limbs were normal and symmetrical. 12 retro-reflective markers (2.5 cm in diameter) were taped to anatomic landmarks of the lower body. Two additional markers (1.4 cm in diameter) were first placed on the medial and lateral points and then proximal and distal points of the patella. Patellar motion relative to the centre of the knee joint was defined as angles between the centre of the knee joint and the 2 sets of patellar markers (medial-lateral and proximal-distal). The mean, maximum, and minimum values of these angles in a standing position were recorded, as was patellar tracking during walking. The X, Y, and Z coordinates for each marker were smoothed out throughout the capturing time. A single gait cycle per trial was chosen for analysis. Results. During walking, the centre of the knee joint and the patella did not move in unison, and the extent of separation was subject dependent. In 70% of the participants, the maximum angle between the centre of the knee joint and each set of markers occurred in the swing phase (0–43%) of the gait cycle. When analysing both sets of markers together, the percentage of participants became 60%. The extent of knee flexion was subject dependent. There was more medial-lateral motion (shift) of the patella than proximal-distal (tilt) motion during the gait cycle. These indicated that the maximum amount of patellar shift and tilt occurred in the swing and early stance phases of the gait cycle and that abnormal patellar motion can be detected if excessive shift or tilt occurs outside of these phases. Conclusion. Patella mal-tracking could be attributed to the position of the lower body segments rather than the absorption or generation of forces.
Posterior Interbody Grafting and Instrumentation for Spondylodiscitis
Authors: Endres Stefan , Wilke Axel 
Published: October 2016

Purpose. To report outcomes of 7 patients with bacterial spondylodiscitis treated through a posterior approach. Methods. Five men and 2 women aged 40 to 80 years underwent one–stage posterior interbody debridement and instrumentation for single-segment bacterial spondylodiscitis of lumbar (n=5) or thoracic (n=2) vertebrae. The Oswestry Disability Score, the Frankel classification, the Cobb angle, and the visual analogue scale (VAS) for pain as well as bone union on radiographs were assessed. Results. Patients were followed up for 19 to 36 months. None had relapses or complications. Postoperatively, 5 patients had no pain or used analgesics only occasionally; their VAS scores varied from 0 to 20. The remaining 2 patients had residual symptoms and received regular peripheral pain medication and opiates; their VAS scores ranged from 30 to 50. The mean Oswestry Disability Score improved to 21 (range, 12–38). The mean Cobb angle improved from 13.1° to 11.1°. The segments were probably fused in 5 patients and questionable in 2. Conclusion. Posterior debridement and instrumentation was adequate for single-segment spondylodiscitis and achieved good outcomes.
Minimally Invasive Plate Osteosynthesis for Tibial Plateau Fractures
Authors: Raza Hasnain , Hashmi Pervaiz , Abbas Kashif , Hafeez Kamran 
Published: October 2016

Purpose. To evaluate radiological and clinical outcome of minimally invasive plate osteosynthesis (MIPO) for tibial plateau fractures. Methods. 35 men and 6 women aged 19 to 75 (mean, 40; standard deviation [SD], 14) years underwent MIPO for displaced tibial plateau fractures. According to the Schatzker system, the tibial plateau fractures were classified as types I (n=3), II (n=9), III (n=11), IV (n=6), V (n=7), and VI (n=5). Six patients had open fractures; 2 of them underwent debridement before MIPO. 10 patients needed additional bone grafting. Radiological (at immediate postoperation) and clinical (at the 12-month follow-up) assessments based on the Rasmussen anatomic and functional scoring system were recorded using a proforma. Patients with acceptable and unacceptable outcomes were compared in terms of age. Results. The mean Rasmussen anatomic score was 15.1 (SD, 2.2; range, 10–18); the mean Rasmussen functional score was 25.3 (SD, 3.2; range, 14–29); and the mean range of knee motion was 118° (SD, 10°; range, 90°–140°). Anatomic outcome was excellent in 10, good in 28, and unacceptable in 3 patients (one each had Schatzker type-I, -II, and -III fractures). 27 (71%) of the 38 patients with acceptable anatomic outcome were aged ≤45 years, whereas 2 (67%) of the 3 patients with unacceptable anatomic outcome were aged ≥60 years (p=0.001). Functional outcome was excellent in 18, good in 19, and unacceptable in 4 patients (2 had Schatzker type-III and another 2 had Schatzker type-I or -II fractures). 37 of the patients had a range of knee motion of ≥120°; 27 (73%) of them were age d ≤45 years, whereas 3 (75%) of the 4 patients with unacceptable functional outcome were aged ≥60 years (p=0.001). Conclusion. MIPO for tibial plateau fractures achieved good outcome with minimal soft-tissue complications. Older age was the predictor of unacceptable outcome.
Fixation Using Cannulated Screws and Fibular Strut Grafts for Fresh Femoral Neck Fractures with Posterior Comminution
Authors: Zahid Mohammad , Sabir Aamir Bin , Asif Naiyer , Julfiqar Mohammad , Khan AQ , Ahmad Sohail , Siddiqui Yasir S 
Published: October 2016

Purpose. To evaluate the use of fibular grafting for fresh femoral neck fractures with posterior comminution. Methods. 18 women and 15 men aged 20 to 60 years underwent osteosynthesis and fibular strut grafting supplemented with 7.0-mm cannulated hip screws for Garden grades III (n=21) and IV (n=12) femoral neck fractures associated with posterior comminution. All fractures were reduced by closed methods, and no hip was aspirated. Clinical and radiological outcomes were evaluated. Results. The mean delay in presentation after injury was 3.2 (range, 1–12) days. The mean delay in operation was 8.8 (range, 5–21) days. The mean follow-up period was 2 (range, 1–4) years. According to the Harris hip score, outcome was good to excellent in 20 patients, fair in 7, and poor in 6. 27 of the 33 patients achieved bone union after a mean of 4.7 (range, 4.2–7) months. In 5 patients, the bone was united with a mean of 10° of varus collapse and a mean of 1 cm of shortening. Six patients had nonunion. Other complications included screw migration in the joint space (n=1), graft migration into the joint space (n=3), and screw pullout (n=5). No patient had avascular necrosis of the femoral head. Conclusion. Osteosynthesis and fibular grafting for freshly displaced femoral neck fractures with posterior comminution is an inexpensive and technically less demanding procedure for retaining a stable, painless, mobile, and functional hip.
Dynamic Hip Screw Blade Fixation for Intertrochanteric Hip Fractures
Authors: Leung Frankie , Gudushauri Paata , Yuen Grace , Lau Tak-Wing , Fang Christian , Chow Shew-Ping 
Published: October 2016

Purpose. To assess the one-year outcome of a dynamic hip screw (DHS) blade in the treatment of AO/OTA 31-A1 and 31-A2 intertrochanteric hip fractures. Methods. 35 men and 65 women aged 47 to 100 (mean, 83) years underwent fixation with a DHS blade for A1 (n=47) and A2 (n=53) intertrochanteric hip fractures after a low-energy injury. Patients were operated on within 48 hours of admission. Anteroposterior and lateral radiographs were examined for the tip-apex distance and femoral shortening. Potential complications were looked for, including implant migration, cut-out, loosening, or breakage. Functional outcome was based on the Parker mobility score. Results. The 30-day and one-year mortality rates were 5% and 20%, respectively. At the one-year followup, 81 patients were available, and all fractures had healed without varus deformity. The mean tip-apex distance was 14.1 (range, 5.7–31.1; SD, 4.3) mm. The mean femoral shortening was 4.9 (range, 0–20.2; SD, 4.8) mm. The mean Parker score decreased to 3.8 at one-year follow-up from 5.9 before injury (p<0.001). There was one loss of fixation secondary to a nontraumatic subcapital fracture at 3 months, for which a bipolar hemiarthroplasty was performed. Conclusion. The DHS blade system is effective in treating AO/OTA 31-A1 and 31-A2 intertrochanteric hip fractures and results in a low complication rate.
Nutritional Status and Short-Term Outcome of Hip Arthroplasty
Authors: Nicholson Jamie A , Dowrick Adam S , Liew Susan M 
Published: October 2016

Purpose. To review nutritional status and outcome of 90 patients who underwent total hip arthroplasty (THA) or hemiarthroplasty. Methods. Records of 51 women and 39 men aged 26 to 96 (median, 71) years who underwent elective THA (n=48) for osteoarthritis, or trauma-related THA (n=10) or hemiarthroplasty (n=32) for subcapital femoral neck fractures using an uncemented femoral stem were retrospectively reviewed. Patient demographics and intra- and post-operative complications were recorded. Patient co-morbidities were assessed according to the Charlson grading system. Nutritional status was assessed using haematological markers of serum albumin (ALB) level and total lymphocyte count (TLC). Samples were taken on the day of the operation and within 24 hours of operation. Suboptimal nutrition was defined as a serum ALB level of <3.5 g/dl and a TLC of <1.50 cells/mm. Results. 86% of trauma patients and 30% of elective patients were malnourished preoperatively (p<0.001). Preoperatively, more males than females had suboptimal ALB levels (28% vs. 8%, p=0.033) and TLC (82% vs. 31%, p<0.001). Age was inversely proportional to preoperative ALB and TLC values; patients older than 75 years had significantly lower values. Of those staying >7 days in hospital, 67% were aged >75 years as opposed to 31% were aged ≤75 years (p=0.001). Male gender, old age, and presentation with trauma were risk factors for suboptimal nutritional parameters (p<0.001 for all). Patients with suboptimal ALB and TLC values had a significantly longer stay in hospital (p=0.032 and p=0.021, respectively). Conclusion. The rate of malnourishment was significantly higher in patients having trauma-related surgery than in those having elective surgery. Malnourished patients are at greater risk of prolonged hospital stay. Preoperative nutritional assessment may be useful in predicting patients at high surgical risk.
Blood Cultures for Evaluation of Early Postoperative Fever after Femoral Neck Fracture Surgery
Authors: Sivakumar Brahman , Vijaysegaran Praveen , Ottley Michael , Crawford Ross , Coulter Christopher 
Published: October 2016

Purpose. To evaluate the utility of blood cultures in the assessment of early postoperative fever in hip fracture patients with no other indicators of sepsis. Methods. 101 blood cultures were drawn on postoperative days 0 to 5 to investigate 84 febrile episodes in 31 women and 30 men (mean age, 80 years) whose body temperature measured via the tympanic route was ≥38°C. Culture results of these 61 patients were divided into culture-positive and culture-negative groups for comparison. Results. Of the 101 blood cultures, only 2 were positive: one was obtained 5 days after dynamic hip screw fixation, and the other 4 days after hemiarthroplasty. Both blood cultures grew coagulase-negative staphylococcal species, which were deemed to be skin contaminants not requiring change of patient management. 44 of these patients were treated with oral or intravenous antibiotics for a period of time. Conclusion. The risk of bacteraemia in patients with postoperative fever but no other symptoms of infection is low. Routine procurement of blood cultures in such patients is ineffective and of limited utility.
Mobile-Bearing, Congruent Patellofemoral Prosthesis: Short-Term Results
Authors: Yadav Basavaraj , Shaw David , Radcliffe Graham , Dachepalli Sunil , Kluge Wolfram 
Published: October 2016

Purpose. To report the short-term outcome of the low contact stress (LCS) patellofemoral prosthesis in 51 knees. Methods. 12 men and 37 women aged 23 to 79 (mean, 53.4) years underwent 51 consecutive LCS patellofemoral replacements. All patients had symptomatic isolated arthritis in the patellofemoral joint with well-preserved tibiofemoral compartments. All knees were evaluated pre- and post-operatively. The new Oxford scoring system was used. Anteroposterior, lateral, and skyline weight-bearing radiographs were reviewed. Results. The mean follow-up period was 4.2 years; no patient was lost to follow-up. The mean new Oxford Knee score was 13.9 preoperatively and improved by 13.7 at 3 months (p<0.001) and by further 7.1 at 12 months (p<0.001). Any change after 12 months was not significant (p=0.73). 18 of the knees developed patellar maltracking and resulted in subluxation and lateral tilt of the patella with severe polyethylene wear. 10 (20%) of the knees were revised; 8 with patellar maltracking were revised to total knee arthroplasty (n=3) or patellofemoral arthroplasty with a different implant (n=5), whereas 2 with disease progression were revised to total knee arthroplasty. The estimated survival rate of the prosthesis was 73% at 4.5 years and 48% at 5.5 years. Conclusion. The revision rate for the LCS patellofemoral prosthesis was high (20%).
Short-Term Outcome of Transforaminal Lumbar Interbody Fusion for Lytic and Degenerative Spondylolisthesis
Authors: Ali Yousuf , Najmus-Sakeb  , Rahman Muhibbur , Mhamud Salauddin 
Published: October 2016

Purpose. To compare early outcome of transforaminal lumbar interbody fusion (TLIF) for lytic versus degenerative spondylolisthesis. Methods. 14 women and 8 men aged 20 to 60 (mean, 36) years underwent TLIF for lytic (n=15) or degenerative (n=7) spondylolisthesis. Of the 15 patients with lytic spondylolisthesis, 9 involved L4/ L5 and 6 L5/S1. Of the 7 patients with degenerative spondylolisthesis, 3 involved L4/L5, 2 L5/S1, one L2/L3, and one L3/L4. The spondylolistheses were classified as grade II (n=15), grade III (n=4), and retrolisthesis (n=3). 11 patients with lytic and 2 with degenerative spondylolisthesis had sensory deficits (n=12), motor deficits (n=9), and diminished reflexes (n=7). Visual analogue score (VAS) for pain and the Oswestry Disability Index (ODI) of each patient were assessed at months 3, 6, and 12, and 6 monthly thereafter. Fusion status was assessed by radiologists. Comprehensive outcome of each patient was graded as excellent, good, fair, or poor. Results. The mean VAS score for low back pain improved significantly from 7.4 preoperatively to 2.1 at year 1 (p<0.001), as did the mean VAS score for leg pain from 6.7 to 1.4 (p<0.001) and the mean ODI from 67.8% to 11.8% (p<0.001). No patient had any residual neurological deficit, and all achieved radiological fusion. The comprehensive outcome was excellent in 16 patients, good in 5, and fair in one. 16 patients returned to their previous level of activity. Conclusion. TLIF is a safe and effective surgical procedure for the treatment of lytic and degenerative spondylolisthesis.
Predictors of Posterior Cruciate Ligament Degeneration in Osteoarthritic Knees
Authors: Aggarwal Aditya K , Goel Akshay , Radotra Bishan D 
Published: October 2016

Purpose. To evaluate the tibial articular cartilage and histology of the posterior cruciate ligament (PCL) in osteoarthritic knees so as to determine predictors of PCL degeneration. Methods. 23 advanced osteoarthritic knees (mean patient age, 61 years) treated with total knee arthroplasty (TKA) were prospectively studied. The Knee Society Score was assessed. Osteoarthritic changes on radiographs were graded as mild, moderate, or severe. Tibial articular cartilage erosion was assessed. The appearance of both cruciate ligaments was classified as normal, abnormal (thinner and sclerotic), or ruptured. Both ligaments were examined histologically for degenerative changes. Each degenerative change of the PCL was graded by 2 histopathologists twice separately. Higher scores indicated more severe degeneration. Results. Of the 23 knees, the gross appearance of the anterior cruciate ligaments (ACLs) was normal in 6, abnormal in 11, and ruptured in 6. Histologically, the PCLs were normal in 4, minimally degenerated in 2, mildly in 8, moderately in 5, and severely in 4. The predominant degenerative change was the presence of loose fibrous tissue. ACL appearance correlated positively with PCL degeneration ( r=0.883, p=0.001). The mean Knee Society Score was 24 (range, 0–43), and the mean function score was 30 (range, 5–55). PCL degeneration correlated positively with the Knee Society Score ( r=0.565, p=0.02) but not with the function score ( r=0.061, p=0.447). Anteroposterior instability correlated positively with PCL degeneration ( r=0.691, p=0.01). Erosion in the lateral tibiofemoral compartment and ACL insufficiency were indicators of PCL degeneration (despite a normal appearance). Inter-observer reliability and intra-observer reproducibility were 0.82 and 0.87, respectively. Conclusion. The Knee Society Score, anteroposterior instability, ACL appearance, and erosion in the lateral tibiofemoral compartment are predictors of PCL degeneration and can help decide on the optimal type of TKA implant (PCL-retaining vs. PCL-sacrificing design).
Coronal Shear Fracture of the Humeral Trochlea
Authors: Sen Ramesh Kumar , Tripathy Sujit Kumar , Goyal Tarun , Aggarwal Sameer 
Published: October 2016

Purpose. To review records of 5 patients with anterior coronal trochlear fractures. Methods. Four men and one woman aged 25 to 46 (mean, 34) years underwent cancellous screw (n=3) or Kirschner wire (n=2) fixation for anterior coronal fractures of the humeral trochlea after falling on a flexed elbow. Patients were operated on through a medial approach. Three patients who had a large osteochondral fragment underwent fixation using 4-mm AO partially threaded cancellous screws. Two patients who had a small un-amenable osteochondral fragment (with articular cartilage damage) underwent fixation using Kirschner wires. Patients were evaluated using the Mayo Elbow Performance Index (MEPI) based on pain, arc of motion, stability, and functional disability. Results. The mean time from injury to surgery was 7 (range, 5–10) days. The mean follow-up period was 2.7 years. No patient had any wound-related problems, postoperative neurovascular compromise, or avascular necrosis. Radiographic union was noted after a mean of 14 weeks. Outcome was excellent in 4 patients and good in one. The mean arc of flexion-extension was 101° and the mean arc of supination-pronation was 130°. The mean MEPI was 92. The MEPI was relatively low in the 2 patients with a small osteochondral fragment who underwent Kirschner wire fixation. One patient with articular cartilage damage developed mild degenerative changes and had to change his occupation. The remaining 4 patients were pain-free and had returned to their occupations within 4 months. Conclusion. Open reduction and screw fixation restores articular congruency and enables early mobilisation. Small coronal shear fractures of the trochlea not amenable to screw fixation should be fixed with Kirschner wires.