bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midterm Results of Cemented Press Fit Condylar Sigma Total Knee Arthroplasty System
Authors: Asif S , Choon DSK 
Published: October 2016

Purpose. To evaluate the midterm results of 50 patients who underwent total knee replacement using Press Fit Condylar (PFC) Sigma system. Methods. We retrospectively reviewed 87 consecutive cases (50 patients with 37 bilateral cases) of PFC Sigma total knee replacement performed between January 1998 and December 1999. Patients were evaluated clinically and radiographically by an independent observer. The American Knee Society Score, Oxford Knee Score, and Knee Society radiographic assessment were used to rate knee function and to determine the satisfaction level of each patient. Results. The mean age of the patients at the time of operation was 65 years (range, 41–85 years). The mean follow-up period was 5.4 years (range, 4.5–6.4 years). 44 patients (79 knees) were available for follow-up, 3 patients (3 knees) were lost to follow-up, and 3 patients (5 knees) died of unrelated causes. At the final follow-up, the mean Oxford Knee Score was 22. Using the American Knee Society Score, 88% of the knees were rated excellent, 4% good, 2% fair, and 6% poor. Five knees required revision surgery, the indications being infection in 4 knees and aseptic loosening in one knee. The survival rate of the implants was 94% at 6 years. Conclusion. The PFC Sigma total knee arthroplasty system has demonstrated good midterm results at our institution.
Closed Reduction and External Fixation for Displaced Proximal Humeral Fractures
Authors: Monga Puneet , Verma Rajeev , Sharma Vinod K 
Published: October 2016

Purpose. To assess results of closed reduction and external fixation for displaced proximal humeral fractures. Methods. 18 men and 2 women aged 18 to 60 (mean, 38) years underwent closed reduction and external fixation using a standard AO fixator for displaced fractures of the proximal humerus. Injury mechanisms were road traffic accident (n=15) and fall from a height (n=5). 15 were 2-part fractures of the surgical neck, 4 were 3-part fractures of the greater tuberosity and surgical neck, and one was a 4-part fracture. One patient also had a grade-1 open fracture. The quality of reduction and shoulder function were assessed. Results. The mean duration of external fixation was 38 (range, 29–46) days. The mean time to radiological union was 11 (range, 9–13) weeks. The mean follow-up period was 11 (range, 6–18) months. Reduction was good (position equivalent to minimal displacement) in 12 patients and fair (good bony contact between the fragments) in 8 patients. Seven patients had pin site infection; all responded to local dressings and oral antibiotics. No patient had avascular necrosis of the humeral head. The mean Neer score was 85 (range, 42–98) out of 100. Shoulder function was excellent in 10 patients, satisfactory in 6, unsatisfactory in 2, and a failure in 2. Conclusion. External fixation preserves the vascularity of the fracture fragments, enables early mobilisation, and achieves safe healing and good function. It is effective for management of displaced proximal humeral fractures.
Radiographic Assessment of Congenital C2–3 Synostosis
Authors: Moon Myung-Sang , Kim Sung-Soo , Lee Bong-Jin , Moon Jeong-Lim , Lin Jin-Fu , Moon Young-Wan 
Published: October 2016

Purpose. To evaluate the morphologies of congenital C2–3 synostosis in 25 patients. Methods. Radiographs of 11 males and 14 females aged 5 to 74 years with congenital C2–3 synostosis were reviewed. All cases were found incidentally on radiographs when presenting with neck/shoulder discomfort/pain. Results. 13 of the patients had spondylosis in 21 segments: C1–2 (n=1) and C3–4 (n=1), C4–5 (n=7), C5–6 (n=9), and C6–7 (n=3). Of whom 12 had normal sagittal alignment and one had kyphotic synostosis (who developed compensatory hyperlordosis of the caudal mobile segments and subsequent spondylosis at C3–4 and C5 retrolisthesis). The remaining 12 patients had no spondylosis and had normal sagittal alignment, but had other associated pathologies including disc herniation at C3–4, C1 ring hypoplasia, and calcification of the nuchal ligament. Conclusion. Normally aligned congenital synostosis of C2–3 is rarely associated with a junctional problem, whereas a kyphotic synostosis is associated with a caudal junctional problem. Spondylosis developing after age 40 years is not associated with C2–3 synostosis.
Effects of Tranexamic Acid on Blood Loss during Total Hip Arthroplasty
Authors: Singh Jagwant , Ballal Moez S , Mitchell P , Denn PG 
Published: October 2016

Purpose. To assess the effects of tranexamic acid (TA) in patients undergoing total hip arthroplasty (THA) for osteoarthritis. Methods. 42 patients underwent primary THA for osteoarthritis by a single surgeon. 10 men and 11 women who did not receive TA were controls, whereas 9 men and 12 women who received TA constituted the treatment group. Both groups were matched for age, gender, body mass index, and American Society of Anesthesiologists grading. The type of prosthesis used (cemented or uncemented) was based on the surgeon's preference and patient age, activity level and demands. No hybrid prosthesis was used. 10 minutes prior to incision, a single dose of intravenous TA (10 mg per kg body weight) was given to patients in the treatment group. Comparison was made between both groups with regard to intra-operative blood loss, postoperative reduction in haemoglobin and haematocrit levels, blood transfusion, incidence of deep vein thrombosis, and the length of hospital stay. Results. The mean intra-operative blood loss (489±281 vs. 339±184 ml, p=0.048) and the decrease in haemoglobin level (38±12 vs. 29±10 g/l, p=0.014) were significantly higher in the control than the treatment group. Two patients among the controls received a transfusion, compared to none in the TA group (p=0.49, Fisher's exact test). The 2 patients who needed blood transfusion had blood losses of 600 and 690 ml, compared to a mean of 489 ml in the whole group. No patient in either group developed deep vein thrombosis or pulmonary embolism up to 3 months. Conclusion. A single dose of intravenous TA (10 mg per kg body weight) given 10 minutes prior to THA is a cost-effective and safe means of minimising blood loss and reduction in haemoglobin concentrations as well as the need for allogenic blood transfusion, without increasing the risk of thromboembolic events.
Correlation between a Bone Resorption Marker and Structural Geometry of the Proximal Femur in Osteoporotic Women Treated with Raloxifene
Authors: Takada Junichi , Iba Kousuke , Yoshizaki Takashi , Yamashita Toshihiko 
Published: October 2016

Purpose. To assess correlations between a bone resorption marker and the structural geometry of the proximal femur in raloxifene-treated postmenopausal women with osteoporosis. Methods. 45 postmenopausal, osteoporotic women aged 57 to 79 (mean, 67) years underwent raloxifene treatment (60 mg/day) for 12 months. Serum type-I collagen crosslinked N-telopeptide (sNTX) as the bone resorption marker was measured at baseline and 6 months, whereas hip structure analysis (HSA) parameters of the femur (neck, intertrochanter, and shaft) were measured at baseline and 12 months using dual energy X-ray absorptiometry. The HSA parameters included areal bone mineral density (BMD), inner diameter, mean cortical thickness, cross-sectional area, section modulus, and buckling ratio. Correlations between sNTX and HSA parameters were analysed using Pearson's R. Results. At baseline, sNTX correlated inversely with BMD, cross-sectional area, mean cortical thickness, and section modulus, and positively with buckling ratio in the intertrochanter and shaft (but not the neck). These correlations were significant both crude and adjusted for age. After 12 months of raloxifene treatment, HSA parameters improved significantly for the intertrochanter and shaft only. Of the 3 femoral sites, only the change in sNTX at month 6 correlated positively with changes in the inner diameter at the intertrochanter at month 12 ( r=0.303, p=0.045 adjusted for age). Changes in sNTX did not correlate with changes in any other parameters. Conclusion. The surrogate markers for hip fracture including sNTX, BMD, and HSA parameters correlated significantly with each other. Improvement (decrease) of sNTX indicated reduction in bone resorption.
Outcome after Knee Arthrodesis for Failed Septic Total Knee Replacement Using a Monolateral External Fixator
Authors: Corona Pablo S , Hernandez Alejandro , Reverte-Vinaixa M Mercedes , Amat Carles , Flores Xavier 
Published: October 2016

Purpose. To evaluate the pain level and patient satisfaction as well as the fusion and infection eradication rates after knee arthrodesis using a monolateral external fixator for failed septic total knee replacement (TKR). Methods. Records of 10 male and 11 female consecutive patients aged 70 to 88 (mean, 81) years who underwent knee arthrodesis using a monolateral external fixator for failed septic TKR were retrospectively reviewed. Each patient had undergone a mean of 3.4 (range, 1–15) procedures. The infection eradication rate, fusion rate, time to achieve fusion, pain level, patient satisfaction, and health-related quality of life were evaluated. Results. Infection was eradicated in 18 (86%) of the 21 patients, whereas fusion was achieved in 17 (81%) of the 21 patients after a mean of 10.3 (range, 4–16) months. Those who did and did not achieve fusion differed significantly in terms of the mean pain score (2.3 vs. 6.4, p=0.031). Compared with age-matched Spanish general population, patients aged >75 years fared significantly worse in terms of the mean physical summary component score (40.7 vs. 34.9, p=0.001). Among those who achieved fusion, 82% were very or somewhat satisfied; none was very dissatisfied. Among those who did not achieve fusion, 75% were very or somewhat dissatisfied. Conclusion. Knee arthrodesis using a monolateral external fixator for failed septic TKR achieved high fusion and infection eradication rates, despite the extended time needed. When fusion is achieved, patients had good pain relief and satisfaction.
Injection of Autologous Blood versus Corticosteroid for Lateral Epicondylitis: A Randomised Controlled Study
Authors: Arik Hasan Onur , Kose Ozkan , Guler Ferhat , Deniz Gokmen , Egerci Omer Faruk , Ucar Mehmet 
Published: October 2016

Purpose. To compare the efficacy of autologous blood injection versus corticosteroid injection for lateral epicondylitis. Methods. 21 men and 59 women (mean age, 45.2 years) presenting with lateral epicondylitis were randomised to receive either autologous blood injection (2 ml of autologous venous blood mixed with 1 ml of 2% prilocaine hydrochloride) or corticosteroid injection (1 ml of 40 mg methylprednisolone acetate mixed with 1 ml of 2% prilocaine hydrochloride) given by a single physician. Patients were assessed before (day 0) and after (days 15, 30, and 90) treatment for elbow pain (using a visual analogue scale [VAS]), function (using the patient-rated tennis elbow evaluation [PRTEE] questionnaire), and grip strength (using a hydraulic hand dynamometer). Patients were followed up at 6 months by telephone to assess elbow pain using the VAS. Results. No complications (infection, skin atrophy, neurovascular damage, or tendon rupture) were noted. 10 patients reported increased pain for up to 2 days after autologous blood injection. In both groups, the VAS score for elbow pain, PRTEE score, and grip strength improved significantly after treatment (p=0.0001), but the pattern of improvement differed. Compared with autologous blood injection, corticosteroid injection improved all 3 scores at a faster rate over the first 15 days (p=0.0001), and then started to decline slightly until day 90. After autologous blood injection, all 3 scores improved steadily and were eventually better (p=0.0001). If a 37% decrease in PRTEE is defined as complete recovery, 38 (95%) of patients with autologous blood injection and 25 (62.5%) of patients with corticosteroid injection achieved complete recovery (p=0.0001). Conclusion. Autologous blood injection was more effective over the follow-up period than corticosteroid injection in improving pain, function, and grip strength. It is recommended as a first-line injection treatment because it is simple, cheap, and effective.
Transolecranon and Lateral Kirschner Wire Fixation for Displaced Supracondylar Humeral Fracture in Children
Authors: Sharma Anmol , Kahal Karamdeep , Sharma Shardaindu 
Published: October 2016

Purpose. To evaluate the outcome after closed reduction and pinning using a Kirschner wire inserted laterally and another inserted vertically through the olecranon for displaced supracondylar humeral fractures. Methods. 39 boys and 11 girls aged 2 to 12 (mean, 7.27) years underwent closed reduction and pinning using a Kirschner wire inserted laterally and another inserted vertically through the olecranon for posteromedially (n=28), posterolaterally (n=7), or posteriorly (n=15) displaced extension-type supracondylar humeral fractures (Gartland types II and III). Results. Compared with the uninjured elbows, the injured elbows had a mean loss of flexion of 4.52° (p<0.001), a mean loss of extension of 1.7° (p=0.008), and mean change in carrying angle of 3.47° (p<0.001). According to the Flynn grading system, outcome was excellent in 35 patients, good in 9, fair in 2, and poor in 4. Outcome did not differ significantly between patients aged 2 to 4, 5 to 8, and 9 to 12 years or between those operated on within 24 hours of injury and those operated on 2 to 5 days after injury. One patient developed superficial pin tract infection, and 2 patients developed cubitus varus deformity. No patient sustained iatrogenic nerve injury. Conclusion. Transolecranon vertical and lateral Kirschner wire fixation is a viable option for displaced supracondylar humeral fractures in children, especially when there is massive swelling.
Use of Erythrocyte Sedimentation Rate and C-Reactive Protein to Predict Osteomyelitis Recurrence
Authors: Lin Ziwei , Vasudevan Anupama , Tambyah Paul Anantharajah 
Published: October 2016

Purpose. To determine the association between both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and osteomyelitis recurrence. Methods. Records of 81 males and 27 females aged 10 to 87 (median, 54) years who underwent antibiotic/surgical treatment for primary (n=68) or recurrent (n=40) osteomyelitis that was related (n=26) or unrelated (n=82) to a prosthesis were reviewed. Of the 40 cases of osteomyelitis recurrence followed up for a median of 23.4 (range, 0.6–74.0) months, 7 and 33 were related and unrelated to a prosthesis, respectively. The cutoff points of lowest ESR and CRP for osteomyelitis recurrence were calculated. Risk factors for osteomyelitis recurrence were determined. Results. Osteomyelitis recurrence was associated with diabetes mellitus, ischaemic heart disease, non-healing wound, infection in the lower limb, and infection with methicillin-resistant Staphylococcus aureus. The cutoff points of CRP ≥5 mg/l and ESR ≥20 mm/h were used for osteomyelitis recurrence. Risk factors for osteomyelitis recurrence were ESR ≥20 mm/h, infection with methicillin-resistant S aureus, and infection in the lower limb. Conclusion. ESR was more sensitive, specific, and independently associated with osteomyelitis recurrence and should be used to guide the duration of antibiotic treatment.
Correlation Between the Talar Tilt Angle and Hindfoot Varus in Medial Ankle OA
Authors: Kim Kyung-mu , Yim Hyun Seok , Hong Sung-Ha , Sung Ki Sun 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Radiographically medial ankle osteoarthritis shows different features according to talar tilt which is known to an important determining factor in low tibial osteotomy surgery. However, little is known about the reason of this presentation. We hypothesized that the talar tilt angle and degree of hind foot varus might be correlated. Methods: We reviewed radiographs of 184 patients diagnosed with medial ankle osteoarthritis between May 2006 and February 2015. A total of 126 ankles in 97 patients diagnosed as Takakura stage 1–3b medial ankle osteoarthritis, were reviewed. We measured tibio-talar angle, talar tilt angle, tibial-anterior surface angle, and hindfoot alignment angle We divided the ankles into 4 groups according to tibio-talar angle by 10 degrees, and each group was further divided into 2 subgroups based on median talar tilt angle. We analyzed the correlation between talar tilt and hindfoot alignment angle in each group. We analyzed the differences in the hind foot alignment between the subgroups. Ankle radiographs of selected patients were measured by two observers to determine the interobserver reliability. One of the observers evaluated all radiographs twice to determine the intraobserver reliability. Results: The tibiotalar angle was strongly correlated with the talar tilt angle (r=−0.845), while there was no correlation between tibio-talar angle and hindfoot alignment angle(r=-0.595). Among the groups, tibio-talar angle of 70-80 showed a significantly different hindfoot alignment between the 2 subgroups (p=0.0187). In the rest groups, there was no significant difference between tibio-talar and hindfoot alignment angle. The interobserver and intraobserver reliability for all radiographic measurements was good to excellent Conclusion: We could find out a definite correlation between talar tilt and hindfoot alignment angle in certain degree of varus ankle OA, and no correlation between tibio-talar angle and hindfoot alignment, which might have a clincal relevance in determining the method of osteotomy surgery.
Distribution of Neuropeptides in the Synovium of Charcot Neuroarthropathy
Authors: Schon Lew C. , Mitchell Reed , Zahoor Talal A. , Zhang Zijun 
Published: October 2016

Category: Basic Sciences/Biologics Introduction/Purpose: The pathology of Charcot neuroarthropathy (CNA) presents inflammation, and bone and cartilage destruction. It is still unclear how the neuropathic signals lead to joint inflammation and destruction. Neuropeptides are secreted by neurons and involve in the regulation of inflammation. Synovium is richly innervated and known to play a critical role in the pathology of inflammatory arthritis. This study is designed to investigate the distribution of several neuropeptides, such as vasoactive intestinal peptide (VIP), substance P (SP) and calcitonin gene-related peptide (CGRP), in CNA synovium, in comparison with non-CNA synovium, with immunohistochemistry. Methods: Synovial samples were collected from CNA patients (n=3) and patients with osteoarthritis and intraarticular fracture (non-CNA; n=3), during foot and ankle surgery (approved by IRB). The tissue samples were fixed with 4% paraformaldehyde, embedded in O.T.C media and sectioned with a cryostat. From each patient, 6-9 sections were randomly selected for immunohistochemistry. After blocking the tissue sections with normal serum, primary antibody of SP, VIP and CGRP was separately applied and incubated at 4ºC overnight. The biotinylated secondary antibody and ABC kit (Victor Laboratories) were applied subsequently. DAB (3,3’-diaminobenzidine) was used for colorimetric detection (brown) of immunohistochemical reactions. The cell nuclei were stained with hematoxylin. The staining was viewed under a microscope and images were taken with a digital camera. Results: In the non-CNA synovium, SP was stained around neuro-vascular bundles and intensely stained on the surface of the synovium, i.e. the intimal layer. In the CNA synovium, SP staining was increased and more diffuse into the subintimal layer of the synovium (Fig 1). In non-CNA synovium, VIP was detected along the surface area of the synovium but not limited in the intimal layer. In CNA synovium, VIP was a similar staining pattern with a reduced staining intensity. The CGRP staining was primarily limited in the intimal layer in the non-CNA synovium. In CNA synovium, CGRP was stained in the intimal layer with an increased intensity. Conclusion: SP, VIP and CGRP are well-studied neuropeptides and have broad biological and pathological functions. All of them were detected in the intimal layer, where fibroblast-like synoviocytes are located. Fibroblast-like synoviocytes are fundamental elements of joint inflammation and are capable of degradation of bone and cartilage directly and indirectly. The changed patterns of SP, VIP and CGRP distributions in CNA synovium revealed by immunohistochemistry indicate a possible pathological pathway in CNA development: the unbalanced neuropathic signals direct fibroblast-like synoviocytes to an inflammatory state, which trigger the cascade of bone and cartilage destruction in CNA.
Incidence and Risk Factors of Venous Thromboembolism After Foot and Ankle Surgery
Authors: Ahmad Jamal , Lynch Mary-Katherine , Maltenfort Mitchell 
Published: October 2016

Category: Basic Sciences/Biologics Introduction/Purpose: The purpose of this study is to evaluate the incidence and risk factors of symptomatic postoperative venous thromboembolism (VTE) in a single surgeon’s (JA) practice at a tertiary care center after orthopaedic foot/ankle surgery. We hypothesize that the incidence of postoperative VTE is not significant, but certain patients may be at higher risk for VTE than others. Methods: This is a retrospective review of patients that received orthopaedic foot/ankle surgery between September 2006 and September 2015 by a single surgeon (JA). Inclusion criteria involved surgical patients that were without coagulopathy, previous VTE, and/or using anti-coagulation medications including aspirin. Patients with coagulopathy, prior VTE, and/or taking anti- coagulation medication were excluded from this study. Patients’ charts were reviewed for their age, weight, and medical co- morbidities. The diagnosis and procedure(s) that each patient received was recorded. Postoperatively, all patients were immobilized (i.e., surgical shoe, splint, or external fixator) and rendered partial or nonweightbearing for a minimum of 4 weeks after surgery. Every patient’s postsurgical course was examined for the occurrence of a symptomatic postoperative VTE. This event was defined as a superficial vein thrombosis (SVT), deep vein thrombosis (DVT), or pulmonary embolus (PE) within 90 days from surgery. Results: Of 2746 patients that received foot/ankle surgery, 22 (0.80%) developed a post-operative VTE. The mean age of these patients was 47.3 years. 12 patients were male and the remaining 10 were female. 16 patients were obese and the remaining 6 were non-obese. Surgeries performed were ankle fracture repair in 8 (0.29%), hindfoot arthrodesis in 3 (0.11%), Achilles tendon repair in 2 (0.07%), ankle ligament reconstruction in 2, hammer-toe correction in 2, calcaneal fracture repair in 1 (0.04%), metatarsal fracture repair in 1, ankle cartilage repair in 1, peroneal tendon repair in 1, and below-knee amputation in 1. Obesity was predictive of post-operative VTE to a significant (P=0.04) degree. Age, sex, medical co-morbidities, and type of surgery were not significantly prognostic for a post-surgical VTE. Conclusion: This study demonstrates that the incidence of VTE after orthopaedic foot and/or ankle surgery is low. However, this research shows that obese patients are at significantly higher risk for VTE after such surgeries. This is highly important when educating patients as to their chances of developing a VTE from foot/ankle surgery and preventing its occurrence in those at risk.
Minimal residual disease is an independent predictor for 10-year survival in CLL
Authors: Kwok Marwan , Rawstron Andy C. , Varghese Abraham , Evans Paul A. S. , O’Connor Sheila J. M. , Doughty Chi , Newton Darren J. , Moreton Paul , Hillmen Peter 
Published: October 2016

Key Points
MRD negativity is a predictor for long-term progression-free and overall survival independent of the type and line of therapy. MRD negativity confers the greatest prognostic benefit when achieved in the frontline setting.