bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midshaft Clavicular Non-Unions Treated with the Herbert Cannulated Bone Screw
Authors: Proubasta IR , Itarte JP , Lamas CG , Cáceres E 
Published: October 2016

Purpose. To assess an alternative technique for the treatment of midshaft non-unions of the clavicle. Methods. Five patients with symptomatic non-unions of the clavicle were treated with open reduction and intramedullary fixation by using a Herbert cannulated bone screw. Autogenous bone grafting was applied in one case and decortication in the other 4 cases. Results. Review of the clinical and radiological documentation at a mean time of 13 months (range, 9–26 months) postoperatively shows that union was achieved in all 5 cases. There were no complications related to the operation, and no patient needed removal of the implant for protrusion, loosening, or any other cause. Conclusion. Midshaft non-unions of the clavicle can be treated successfully using the Herbert cannulated bone screw, which avoids the need for a second operation to remove the implant after bone union.
Profile of Bilateral Anterior Cruciate Ligament Injuries: A Retrospective Follow-up Study
Authors: Motohashi M 
Published: October 2016

Purpose. To assess the mechanism of injury of anterior cruciate ligaments, surgical results, and radiographic findings among patients with bilateral knee injuries, and to compare these features with those of patients sustaining unilateral injuries. Methods. From 1977 to 1988, among 458 patients with injury of anterior cruciate ligament operated in our hospital, 11 were of bilateral injury, in whom 10 could be followed up. A laxity score was calculated to evaluate laxity of 7 joints. A notch width index was measured to show the narrowing of femoral notch. Results. The mean follow-up duration was 3 years 3 months. All 10 patients with bilateral injury of anterior cruciate ligaments were female, and 90% had non-contact injuries. The mean (standard deviation) laxity score was significantly higher in the bilateral injury group than in the unilateral injury group (3.3 [1.4] versus 2.2 [1.4] points; p<0.05). The mean notch width index was significantly lower in the bilateral injury group than in the healthy group (0.278 [0.025] versus 0.294 [0.031]; p<0.05). The mean age at the time of the first injuries was significantly lower among the bilateral injury group than among the unilateral injury group (16.6 [2.1] years versus 19.8 [6.1]; p<0.05). The level of return to full sporting activities was low in the bilateral group. Conclusion. These results suggest that several factors are involved in the occurrence of the anterior cruciate injuries. Besides being younger at the time of the first injury, patients in bilateral injury group had higher mean laxity score and lower mean notch width index than unilateral injury group. Most of the injuries in bilateral group were of non-contact type.
Prognosis of Proximal Femoral Fracture in Patients Aged 90 Years and Older
Authors: Hagino T , Maekawa S , Sato E , Bando K , Hamada Y 
Published: October 2016

Purpose. To examine the walking ability and survival outcome of patients aged 90 years and older who sustained proximal femoral fractures, and to compare the findings with those of younger patients reported in previous studies. Methods. Between January 1997 and June 2004 inclusive, 56 patients (11 men and 45 women) aged 90 years and older (range, 90–103 years; mean, 93 years) with hip fracture were reviewed. Their walking ability and survival outcome at discharge was investigated. Comparison was made between patients aged 60 to 89 years and those aged 90 years and older with respect to sex, fracture type, and other characteristics. Results. Of 56 patients, 26 injured the right side and 30 the left side. Before injury, 33 (59%) were living at home and 23 (41%) were institutionalised in long-term care facilities or other hospitals. Fracture occurred at the femoral neck in 14 patients and at the trochanter in 42. Ten patients were treated conservatively because of severe dementia, comorbidity, or refusal of surgery by the patients or their families, whereas 46 underwent surgery. Of the 45 who were previously ambulatory, 22 regained walking ability on discharge from hospital. None of the 10 patients treated conservatively were ambulatory on discharge. During hospitalisation, 4 became bedridden and 5 died (mainly due to pneumonia); among these 9 patients, 5 were deemed physically unfit for surgery. Conclusion. Surgery is the treatment of choice for patients aged 90 years and older with proximal femoral fracture. However, they have a lower rate of regaining pre-injury walking ability and a higher in-hospital death rate than younger patients.
The Usefulness of Computed Tomography following Open Reduction and Internal Fixation of Acetabular Fractures
Authors: O'Shea K , Quinlan JF , Waheed K , Brady OH 
Published: October 2016

Purpose. To investigate the role of a supplemental imaging modality in postoperative assessment of acetabular fractures following open reduction and internal fixation. Methods. Postoperative axial computed tomographic (CT) scans were compared with plain radiographs of 20 patients with regard to their sensitivity for detecting articular fracture reduction in terms of gap displacement and step deformity or offset. Three observers independently reviewed the plain radiographs and CT scans at 2 separate time points and categorised the outcome as either anatomical or non-anatomical. The inter-observer reliability and intra-observer reproducibility of these measurements was expressed as a kappa statistic. The radiological result was correlated with the clinical outcome measures using the Merle D'Aubigne scale, the Harris Hip Score, and the SF-36 score. Results. Plain radiography was less effective in the detection of postoperative articular displacement (mean, 75.1% sensitive). The inter-observer and intra-observer agreement between reviewers was good to excellent in detecting reduction quality between the 2 modalities. Patient management was not altered by the findings of the CT scans. Conclusions. Although postoperative CT scanning of acetabular fractures in selective cases may be useful, issues such as higher cost, less effective allocation of resources, and excessive radiation doses do not support its routine use.
Omnifit Acetabular Component: A Solution to Preventing and Treating Dislocation
Authors: Jones SA , John A , Mahesen M , Blom AW , Wharton R , Bannister GC 
Published: October 2016

Purpose. To assess short- to medium-term outcome of the Omnifit constrained acetabular component in preventing dislocation in at-risk patients after total hip arthroplasty (THA). Methods. 81 patients (mean age, 77 years) underwent either primary or revision THA with an Omnifit constrained acetabular component and were followed up clinically and radiologically for a mean period of 24 months. Results. There was one dislocation and one revision for avulsion of the acetabulum. The remaining prostheses remained well fixed. Conclusions. In the short- to medium-term, the Omnifit constrained acetabular component is effective in preventing primary and recurrent dislocation in at-risk patients. Long-term follow-up is needed to assess whether good fixation is maintained. The Omnifit acetabular cup is recommended for elderly patients with limited life expectancy and functional demands.
Right Hip Adduction Deficit and Adolescent Idiopathic Scoliosis
Authors: Cheung KMC , Cheng ACS , Cheung WY , Chooi YS , Wong YW , Luk KDK 
Published: October 2016

Purpose. To determine whether right hip adduction deficit is associated with adolescent idiopathic scoliosis. Methods. 102 adolescents (mean age, 14 years) with idiopathic scoliosis were prospectively studied. Their spinal curve pattern (according to Lenke's classification), curve severity (by Cobb's angle), and hip adduction ranges of both sides were recorded. Additional factors that may affect hip adduction range including the preferred leg during standing, the presence of hip flexor tightness, and the side of the dominant leg were also assessed. Results. The mean Cobb's angle was 27°. The difference in hip adduction range between the right and left hips was 5° (p<0.05). Of 102 patients, 64 had an adduction range deficit of the right hip, 4 of the left hip, and 34 had no difference. Patients with >10° of right hip adduction deficit were associated with a higher proportion of left leg dominance than those with ≤10° of right hip adduction deficit (18% vs 4%). Conclusion. Left leg dominance may play a role in right hip adduction deficit and scoliosis.
Modified Rush Pin Technique for Two- or Three-Part Proximal Humeral Fractures
Authors: Mallick A , Hearth M , Singh S , Pandey R 
Published: October 2016

Purpose. To report the outcomes of modified Rush pin fixation for proximal humeral fractures. Methods. 42 men and 20 women aged 19 to 94 (mean, 64) years with 2- or 3-part proximal humeral fractures underwent reduction and fixation using the modified Rush pin technique. 11 patients died from reasons unrelated to the surgery. Results. Of 40 (out of 51) patients completing a subjective functional assessment using an Oxford Shoulder Questionnaire, 28 (70%) had 2-part and 10 (25%) had 3-part displaced fractures, and the remaining 2 (5%) had fracture-dislocations (one being 2-part and one 3-part). 25 (63%) patients were very satisfied (including one with a 3-part fracture after 6 months of rehabilitation), 7 (17%) were moderately satisfied, and 8 (20%) were not satisfied. There were 8 complications, including pin cut-out from the proximal fragment (n=2), proximal pin migration (n=2), distal pin migration (n=1), cortical perforation during surgery (n=1), mild ulnar nerve symptoms (n=1). No patients had non-union, myositis ossificans, avascular necrosis of the humeral head, or axillary nerve injury. Conclusion. The modified Rush pin fixation minimises tissue dissection; the implants are cheap and readily available; and the technical expertise is easily learnt. This technique is a suitable alternative of fixing proximal humeral fractures, especially in the elderly.
Locked Intramedullary Nailing versus Dynamic Compression Plating for Humeral Shaft Fractures
Authors: Putti Amit B , Uppin Rajendra B , Putti Babu B 
Published: October 2016

Purpose. To compare functional outcomes, union and complication rates in patients treated with locked intramedullary nailing or dynamic compression plating for humeral shaft fractures. Methods. 32 men and 2 women with humeral shaft fractures were randomised to undergo locked antegrade intramedullary nailing (IMN, n=16) or dynamic compression plating (DCP, n=18). Patients with pathological fractures, grade-III open fractures, neurovascular injury, or fractures for more than 2 weeks were excluded. Fractures were classified according to the AO classification system (one in A1, 6 in A2, 12 in A3, 6 in B1, and 9 in B2). 28 were injured in road traffic accidents. The functional outcome (according to the American Shoulder and Elbow Surgeons [ASES] score) and rates of union and complication of the 2 groups were compared. Results. All patients were followed up for a minimum of 24 months. In the respective IMN and DCP groups, the mean ASES scores were 45.2 and 45.1 (p=0.69), the complication rates were 50% and 17% (p=0.038), and the non-union rates were 0% and 6% (p=0.15). In the IMN group, 2 sustained iatrogenic fractures during nail insertion; 2 had transient radial nerve palsies; one underwent nail removal for shoulder impingement; and 3 had adhesive capsulitis. In the DCP group, one underwent re-operation for implant failure; one had a superficial infection; and one developed adhesive capsulitis. Conclusion. The complication rate was higher in the IMN group, whereas functional outcomes were good with both modalities.
Correlation of Low Back Pain to a High-Intensity Zone of the Lumbar Disc in Indian Patients
Authors: Pande Ketan C , Khurjekar Ketan , Kanikdaley Vilas 
Published: October 2016

Purpose. To assess the correlation between low back pain and a high-intensity zone (HIZ) of the lumbar disc in Indian patients. Methods. 200 patients with low back and/or leg pain underwent magnetic resonance imaging of the lumbosacral spine. The location and severity of pain and disability were assessed using the pain drawing, visual analogue scale, and Oswestry Disability Index, respectively. The inter-observer reliability was assessed using the kappa statistic. Results. The prevalence of an HIZ was 13% and 17% according to observers A and B, respectively. The inter-observer reliability was fair (κ=0.64, p<0.005). The presence of an HIZ did not correlate with low back pain according to the pain drawing, visual analogue scale, and Oswestry Disability Index. According to the pain drawing data, the sensitivity, specificity, and positive predictive values of an HIZ to low back pain were 11%, 82%, and 62%, respectively. Conclusion. The presence of an HIZ is not diagnostic of a disrupted and painful disc, and should be interpreted together with other prevailing symptoms and clinical findings.
Perioperative Management for Orthopaedic Patients with Sickle Cell Anaemia
Authors: Marulanda German A , Minniti Caterina P , Ulrich Slif D , Seyler Thorsten M , Mont Michael A 
Published: October 2016

Purpose. To compare outcomes of 2 types of perioperative optimisation for patients with sickle cell anaemia (SCA) undergoing various orthopaedic surgeries. Methods. 12 female and 11 male patients aged 13 to 40 (mean, 18) years with SCA underwent 31 separate orthopaedic procedures for osteonecrosis of the femoral head. They were referred to a haematologist for 2 types of perioperative optimisation, based on the choice of the attending paediatrician. In the aggressive management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to 9 to 11 g/dl and to lower the haemoglobin S level to <30%. Fresh frozen plasma was given when their Factor VII level was <30%. In the conservative management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to a minimum of 10 g/dl. Fresh frozen plasma or packed red blood cells were given intra-operatively only when excessive bleeding occurred. The length of hospital stay, the number of perioperative complications, the number of transfusions, and episodes of alloimmunisation and/or vaso-occlusive crises in the two groups were compared. Results. No patient in the aggressive management group received supplemental oxygen or had an estimated intra-operative blood loss of >400 ml. Three patients in the conservative management group received multiple intra- and post-operative transfusions and supplemental oxygen. Conclusion. Both aggressive and conservative protocols may be safely used in SCA patients. The more aggressive protocol resulted in lower rates for postoperative complications, transfusions, and resorting to supplemental oxygen.
Differential Distraction for Relapsed Clubfoot Deformity in Children
Authors: Devadoss A , Devadoss Sathish , Kapoor Amit 
Published: October 2016

Purpose. To evaluate the long-term outcome of clubfoot correction following differential distraction using the Joshi external stabilisation system (JESS). Methods. 13 male and 9 female patients aged 1.5 to 5 years with 28 idiopathic clubfeet underwent differential distraction using JESS for relapsed deformity after posteromedial soft-tissue release. They were available for review after a mean of 12 years. Deformities of the feet were rigid and graded as Dimeglio type III or more. Pain, function, and satisfaction were evaluated using a questionnaire. Alignments of the forefoot and hindfoot, subtalar motion, ankle range of movement, muscle power, foot size, calf circumference, and limb length discrepancy were also evaluated. Each foot was rated using the Ponseti scale. Results. In 16 patients with unilateral clubfoot, the abnormal side differed significantly from the normal side in terms of foot size, calf circumference, ankle motion, and Ponseti score. Most affected feet were smaller. The mean Ponseti score for the 28 clubfeet was 80. 20 of the feet had good-to-excellent and 5 had fair scores, whereas 3 had poor scores (because of recurrence of deformity). Most patients were able to perform activities of daily living without any problem. The function of the ankle and subtalar joints was limited. Only 3 feet achieved ankle dorsiflexion of >10°, 15 were beyond neutral to 10°, 7 were neutral, and 3 were less than neutral. Most patients developed pin site infection, but none necessitated premature removal of the assembly or any surgical intervention. Conclusion. Differential distraction using JESS enabled long-term maintenance of correction and good function, despite hindfoot stiffness.
Effect of Medial Soft-Tissue Releases during Posterior-Stabilised Total Knee Arthroplasty
Authors: Chen Weijia , Nagamine Ryuji , Kondo Keiichi , Todo Mitsugu 
Published: October 2016

Purpose. To assess the effect of each step of medial soft-tissue releases on the joint gap angle during posterior-stabilised total knee arthroplasty (TKA). Methods. 82 women and 9 men (mean age, 72 years) with medial osteoarthritic knees underwent 100 posterior-stabilised TKAs, in which release of superficial fibres of the medial collateral ligament (MCL) were required using the gap control technique. The order of releases was the superficial MCL, the pes anserinus, and then the semi-membranosus. The superficial MCL was released selectively. The effect of each step of medial soft-tissue releases in full extension and in 90° flexion was compared. Results. After all medial soft-tissue releases, the mean joint gap angles decreased from 8.7° to 3.8° varus in flexion and from 4.4° to 1.4° varus in extension. The total effect of medial soft-tissue releases was significantly larger in flexion than in extension (4.9°±3.2° vs. 3.0°±2.0°, p<0.0001), except for the release of posterior fibres of the superficial MCL. The effect of release of the semi-membranosus in flexion was largest. Conclusion. The release effect was significantly greater in flexion than in extension during posterior-stabilised TKA; the joint gap technique may be more reliable in medial osteoarthritic knees with moderate and severe varus instability.
Consent Process for Elective Total Hip and Knee Arthroplasty
Authors: Beresford-Cleary Nicolas , Halliday Jane , Biant Leela , Breusch Steffen 
Published: October 2016

Purpose. To assess the consent process for elective primary total hip replacement (THR) and total knee replacement (TKR) in our hospital. Methods. Consent processes of 47 THR and 53 TKR patients performed by 11 surgeons were reviewed. Complications that were documented were recorded, as was the grade of surgeon (consultant or specialist trainee) performing consent, and the location at which this took place. Comparisons were made between rates of documented, clinically significant complications discussed during consent, and those listed in the British Orthopaedic Association (BOA), in the literature, and other joint registries. Results. The consent processes of 37, 57, and 6 patients were conducted by consultants, specialist trainees, and both, respectively. 13% and 21% of THR patients had ‘revision’ and ‘heterotropic ossification’, respectively, documented as complications, neither of which were listed on the BOA consent form. Similarly 4% and 11% of TKR patients had ‘revision’ and ‘dissatisfaction’, respectively, documented as complications, neither of which were listed on the BOA consent form. In 23% of THR and 32% of TKR patients, none of the BOA-listed complications was documented. In 13% of THR and 15% of TKR patients, no complications were documented. In 13% of THR and 17% of TKR patients, only non-specific descriptions of complications (e.g. morbidity, mortality and medical complications) were used in their consent forms. Conclusion. Documentation of complications for THR and TKR patients was often incomplete and variable. The use of structured, procedure-specific consent forms is recommended.
Predictors of Neck Pain after Motor Vehicle Collisions: A Prospective Survey
Authors: Harris Ian A , Young Jane M , Jalaludin Bin B , Solomon Michael J 
Published: October 2016

Purpose. To identify possible predictors (psychosocial) of neck pain in patients with acute injuries following motor vehicle trauma. Methods. 221 male and 85 female patients aged 18 to 85 (mean, 38) years who had acute fractures of the humerus, radius, ulna, pelvis, femur, patella, tibia, talus or calcaneus following motor vehicle trauma were prospectively recruited. No patient sustained a cervical spine injury. Patients sustaining minor trauma were excluded. As putative predictors of neck pain, data relating to demographics, injury, socio-economic status, and compensation were collected at the time of presentation and at month 6. Neck pain was measured by adapting the bodily pain questions from the SF-36 general health survey. Simple unadjusted and multiple regression analyses were conducted. Results. 232 (76%) of the 306 patients completed the 6-month questionnaire. In multiple regression analysis, neck pain at 6 months was significantly associated with female gender, having a primary level of education only, and use of a lawyer. Conclusion. Adversarial legal and compensation involvement may attribute to the development and continuation of neck pain after motor vehicle trauma.
Hyaluronic Acid Instillation following Arthroscopic Anterior Cruciate Ligament Reconstruction: A Double-Blinded, Randomised Controlled Study
Authors: Chau Jackie YM , Chan WL , Woo SB , Cheng SC , Wong TM , Wong TK , Yen CH , Wong K , Wong WC 
Published: October 2016

Purpose. To assess the effect of hyaluronic acid instillation after arthroscopic anterior cruciate ligament (ACL) reconstruction for improving pain, range of movement, and function of the knee. Methods. 28 men and 4 women underwent arthroscopic ACL reconstruction for isolated ACL rupture (partial or complete) and instability after recreational sports injury 2 to 120 months earlier. They were randomised to undergo arthroscopic ACL reconstruction followed by intra-articular viscoseal instillation (13 men and 3 women) or arthroscopic ACL reconstruction alone (15 men and 1 woman). The knee injury osteoarthritis outcome score (for pain, symptoms, activities of daily living, sport and recreation function, and quality of life), range of movement, knee circumference, and analgesic use were assessed on days −1, 1, and 2, and weeks 2, 6 and 12. Results. Patient demographics were similar at baseline. At postoperative days 1 and 2, all subscales of the knee injury osteoarthritis outcome score (except for quality of life) were significantly higher in the viscoseal group. At weeks 2, 6, and 12, improvement in both groups equalised. Knee swelling (change in knee circumference) was significantly less in the viscoseal group at days 1 and 2 (p=0.009 and p=0.038, respectively, Mann-Whitney U test). Only one patient in the viscoseal group had a limited range of movement. No patient developed any adverse reaction. Conclusion. Intra-articular viscoseal instillation improved pain control and swelling 2 days after arthroscopic ACL reconstruction.