bluuebunny/crossref_metadata_2025_split huggingface dataset:
15-Year Follow-up Results of the Hydroxyapatite Ceramic—Coated Femoral Stem
Authors: Slack R , Tindall A , Shetty AA , James KD , Rand C 
Published: October 2016

Purpose. To evaluate the clinical and radiological outcomes following implantation of the Furlong hydroxyapatite ceramic–coated femoral stem in total hip arthroplasty. Methods. A longitudinal cohort of 116 consecutive patients (134 hips) was followed up prospectively. The follow-up period was at least 13 years (range, 13–15 years). Clinical and radiological assessments were made using the Merle d'Aubigne and Postel score and Engh score for fixation and stability, respectively. Osteointegration was assessed radiographically by examining the bone implant interface using the method described by Gruen. Results. 22 patients died during the study period and 6 were lost to follow-up. The respective mean Merle d'Aubigne and Postel scores for pain, range of movement, and ability to walk were 2.2, 2.8, and 2.4 preoperatively and 5.8, 4.8, and 5.4 postoperatively. Engh described satisfactory bony ongrowth as 10 points or more; the mean Engh score for fixation and stability was 24.7 (fixation=10, stability=14.7). One femoral stem was revised for a periprosthetic fracture caused by a fall, but none was revised for loosening. This gave a 99% survival at 13 years (95% confidence interval 94–100). Conclusion. The long-term results of this hydroxyapatite ceramic–coated femoral prosthesis are very satisfactory.
Effect of Drain Pressure in Total Knee Arthroplasty
Authors: Cheung KW , Chiu KH 
Published: October 2016

Purpose. To study the effect of drain suction pressure on drainage volume, decrease in haemoglobin level, blood transfusion, and wound complications following total knee arthroplasty. Methods. Primary total knee arthroplasty for degenerative osteoarthritis was performed in 60 (49 female and 11 male) patients. Patients were randomised for high-pressure (600 mm Hg) or low-pressure (350 mm Hg) postoperative suction drainage. Drain output was recorded daily and the drain removed after 48 hours. Postoperative haemoglobin level was measured on the evening of the operation day and on postoperative day 2. Results. The high-pressure group had a significantly higher drainage volume and decrease in haemogloblin level than the low-pressure group. However, there was no significant difference between groups in the transfusion rate, number of units of blood transfused, wound discharge, or Knee Society knee and function scores. No wound infection was detected in any patient. Conclusion. Low-pressure suction drainage results in less blood loss without a significant increase in wound complications.
Retrograde Nailing for Distal Third Femoral Shaft Fractures: A Prospective Study
Authors: Acharya KN , Rao MR 
Published: October 2016

Purpose. To evaluate the postoperative knee function and results of unreamed retrograde nailing for distal third femoral shaft fractures. Methods. Between January 2002 and 2003 inclusive, a consecutive series of 27 patients (with 28 fractures) who underwent retrograde nailing were prospectively evaluated. Outcome measures were union time, initiation of weight bearing, deformity and shortening, functional length of the nail, knee function assessed using a modified Knee Society Knee Score. Correlations between union time and other variables were also studied. Results. In these patients 26 (93%) of the 28 fractures achieved union, of which 5 underwent dynamisation; the mean union time for the other 21 fractures was 4.4 months. Angular malalignment was present in 4 patients and shortening in 4 others. There was negligible correlation between union time and variables of nail-canal diameter mismatch, functional length of nail, fracture geometry, or initiation of partial weight bearing ambulation. Knee flexion of more than 100 degrees was achieved in 26 patients. 19 patients had anterior knee pain and 10 had instability. By the end of one year, excellent or good scores for pain and function were recorded in 77% and 73% respectively, of the 26 patients. Conclusion. In view of such favourable union rates but significant deterioration in overall knee joint function, at best retrograde nailing is a reliable alternative in the management of selected complicated fractures of the distal femoral shaft.
Locking Compression Plate in the Treatment of Forearm Fractures: A Prospective Study
Authors: Leung F , Chow SP 
Published: October 2016

Purpose. To evaluate the use of locking compression plates (LCPs) in diaphyseal forearm fractures. Methods. 9 women and 23 men (mean age, 35; range, 12–70 years) with 45 forearm fractures were treated by open reduction and internal fixation with 3.5-mm stainless steel LCPs. All patients were followed up monthly until union; the mean duration being 20 months. Radiographic assessment was performed at 3, 6, 12, and 18 months. Clinical assessments regarding pain and function were undertaken at the final follow-up. Results. Two patients had delayed union but none had nonunion. There was no deep infection and only one superficial infection. Two refractures occurred after implant removal, both were of simple transverse type and at the sites of the original fractures. 33% of the fractures were reduced anatomically. 56% of the fractures healed with no or minimal callus formation and 44% with moderate callus formation. In total, 13% of the anatomically reduced fractures had moderate or abundant callus formation. 22 patients opted for removal of the implants (29 LCPs), after a mean of 16 (range, 9–21) months. Conclusion. The LCP is an effective bridging device used for treating comminuted fractures, but for treating simple fractures its superiority over conventional plating is yet to be proven.
Morphological Adaptation of the Bone Graft and Fused Bodies after Non-Instrumented Anterior Interbody Fusion of the Lower Cervical Spine
Authors: Moon MS , Moon YW , Kim SS , Moon JL 
Published: October 2016

Purpose. To assess the remodelling process of the bone graft and fused bodies after non-instrumented anterior interbody fusion with autogenous iliac graft in patients with spondylosis, infections, fractures, or disorders of the cervical spine. Methods. 68 patients aged 18 to 58 years who underwent non-plated anterior lower cervical interbody fusion with an iliac graft were retrospectively studied. Diagnoses of the patients were degenerative disc diseases (n=32), disc herniation (n=15), fractures (n=13), and tuberculosis (n=8). The Robinson and Smith technique was used to treat degenerative disc diseases and protruded disc, and the Bailey and Badgley procedure for fractures or tuberculosis of the cervical spine. 34, 25, and 9 patients underwent one-, 2-, and 3-segment fusions, respectively. 18 of the 25 patients underwent two-segment fusion with a single large bone block, and 7 with 2 separate bone blocks for each segment. Four of the 9 patients underwent three-segment fusion with a single large bone block, and 5 used separate grafts for each segment independently. Plain and stress radiography was primarily used to assess the fusion. Computed tomography and magnetic resonance imaging were also used in some patients. Some anterior graft extrusion (amounting to less than 10% of corresponding anteroposterior body width) was used to observe the remodelling during graft-take and thereafter. Postoperative cervical traction for 2 to 4 weeks, then cervical collar immobilisation for 4 to 12 weeks were strictly followed according to the numbers of fused segments. A halo vest was applied in 4 patients with fracture undergoing 3-segment fusion as they could not tolerate the prolonged bed rest or rigid cervical brace. Results. The mean time for the graft to fuse was 8.6 (range, 7–14) weeks in patients who underwent each segment fusion with independent free grafts, and 10 and 14 weeks in those who underwent 2- and 3-segment single large graft fusion, respectively. The final loss of disc height and joint angle were negligible, regardless of the extent of fusion. Bony absorption of the anteriorly protruded part of the graft began at postoperative week 10 (range, 6–28), which coincided with the time of graft-take and initiation of remodelling. Conclusion. The earliest sign of bony absorption of the anteriorly protruded part of the graft indicated the initiation of the graft-take and the graft remodelling. The inwaisting sign of the surgically fused block of vertebral bodies was a morphological adaptation. Despite the altered biomechanics of the spine in the fused area, the inwaisting sign indicated maintenance of normal function at the parafusion motion segments.
Reproducibility of the Gartland Classification for Supracondylar Humeral Fractures in Children
Authors: Heal J , Bould M , Livingstone J , Blewitt N , Blom AW 
Published: October 2016

Purpose. To evaluate the intra- and inter-observer reproducibility of the Gartland radiographic classification for supracondylar humeral fractures in children. Methods. Anteroposterior and lateral radiographs of 50 supracondylar humeral fractures in children were graded on 2 separate occasions by 4 orthopaedic surgeons according to the Wilkins modification of the Gartland classification. Data were analysed by calculating the Kappa values for intra- and inter-observer agreement to indicate the reproducibility of the classification. Results. There was moderate inter-observer agreement, except for poor agreement over type I fractures. Type II fractures only showed fair to moderate agreement. Type III fractures and the flexion group showed good to very good agreement. Intra-observer agreement was good to very good. Conclusion. Surgeons should treat paediatric supracondylar humeral fractures based on an assessment of the degree of displacement rather than by employing the Gartland classification.
Promotion of Medial Collateral Ligament Healing Using a High-Voltage Electrical Field
Authors: Ito MM , Murase K , Tanaka S , Matsushita T 
Published: October 2016

Purpose. To assess the biomechanical and histological effects of a high-voltage electrical field on ligament healing. Methods. 54 male Wistar rats were used. The medial collateral ligaments (MCLs) of 6 rats were measured for normal biomechanical failure load and stiffness. MCLs of the remaining 48 rats were transected and randomly assigned; half were subjected to a high-voltage electrical field for 8 hours a day (experimental group), and the other half were kept under normal conditions (control group). Eight rats from each group were killed 2, 4, and 6 weeks after the transection and their MCLs were tested biomechanically and histologically. Results. Failure load and stiffness of the MCLs in the experimental group were significantly higher than those in the control group 2 weeks after transection, but not thereafter. At week 2, the granulation tissue completely occupied the space between the cut ends of the MCL in the experimental group, whereas some gaps remained in the control group. Conclusion. A high-voltage electrical field appear to accelerate ligament healing in the initial 2 weeks. Earlier initial healing may allow earlier start of the rehabilitation.
Tensile Strength of Modified 4-Strand Cruciate Technique for Transversely or Obliquely Lacerated Tendons
Authors: Yuen MH , Ip WY 
Published: October 2016

Purposes. To assess the tensile strength of the modified 4-strand cruciate technique for obliquely lacerated tendons, and to compare the findings with the strength of transversely lacerated tendons repaired at various grasping depths. Methods. 60 porcine front foot tendons were evenly divided into 4 groups. In groups 1 to 3, tendons were transversely lacerated and repaired with grasping points at both ends away from the laceration by 5 mm, 10 mm, and 15 mm respectively. In group 4, tendons were obliquely lacerated and repaired with a grasping point 5 mm away from the laceration on one end and 15 mm on the other. All tendons were repaired with a modified 4-strand core suture and continuous epitendinous suture, and then tested to failure in a tensile machine. Results. The tensile strength in group 1 was significantly lower than that in the other 3 groups (p<0.005). The tensile strength in group 4 was not significantly different from groups 2 and 3. Conclusion. The tensile strength of modified 4-strand cruciate repair configuration is not weakened in obliquely lacerated tendons; the grasping point at one end of the tendon being 15 mm away from laceration provides sufficient strength to compensate for the relatively weak 5-mm end. So long as one grasping point is away from the laceration site by 10 mm, the ultimate tensile strength of the transversely lacerated tendons appears acceptable. The modified 4-strand cruciate repair is safe to use for repairing obliquely lacerated tendons.
Paediatric Trauma Epidemiology in an Urban Scenario in India
Authors: Tandon T , Shaik M , Modi N 
Published: October 2016

Purposes. To identify the epidemiology of paediatric trauma in an urban scenario of India and compare results with studies from developed countries, and to formulate preventive measures to decrease such traumas. Methods. Between January 2004 and 2005 inclusive, 500 paediatric, orthopaedic trauma patients presenting to our hospital were prospectively studied. Information was recorded in a prescribed proforma. Results. The children's ages ranged from 0 to 16 years; 274 were males. Most fractures occurred in children aged 7 to 12 years and decreased in older children. The ratio of fractures in left versus right upper extremity was 2:1. In children aged 0 to 6 years, the most common injured site was the elbow, whereas in children aged 7 to 16 years it was the distal radius. In descending order, most injuries were sustained at home (47%), in school (21%), due to sports (17%), and due to vehicular accidents (13%). Conclusion. An effective accident prevention programme in developing countries requires changes in lifestyle and environment, and overcoming obstacles such as ignorance, illiteracy, and inadequate resources.
The Efficacy of Methotrexate-Impregnated Hydroxyapatite Composites on Human Mammary Carcinoma Cells
Authors: Vechasilp J , Tangtrakulwanich B , Oungbho K , Yuenyongsawad S 
Published: October 2016

Purpose. To investigate the efficacy of local biodegradable composites of hydroxyapatite, plaster of Paris, and a binder of either alginate or chitosan impregnated with methotrexate on human mammary carcinoma cells. Methods. An in vitro analysis of drug dissolution and a cytotoxicity test on human mammary carcinoma cells were performed over one month. Physicochemical properties of each composite were investigated using scanning electron microscopy, X-ray diffractometry, and Fourier transform infrared spectroscopy. Results. Both composites with a binder of either alginate or chitosan could release methotrexate for over one month. The amount of methotrexate released depended on the amount of methotrexate loaded. The composite using alginate as a binder released a significantly greater amount of methotrexate than that using chitosan as a binder (p<0.05). The elution of both composites showed favourable cytotoxicity when the concentration was greater than 5 μg/ml. Conclusion. Methotrexate-impregnated hydroxyapatite composites appear to be effective local skeletal methotrexate delivery systems against human mammary carcinoma cells in an in vitro model.
Immediate Interlocking Nailing versus External Fixation Followed by Delayed Interlocking Nailing for Gustilo Type IIIB Open Tibial Fractures
Authors: Park HJ , Uchino M , Nakamura K , Ueno M , Kojima Y , Itoman M , Yokoyama K , Suzuki T , Nemoto M 
Published: October 2016

Purpose. To compare immediate interlocking nailing with external fixation followed by delayed interlocking nailing, for Gustilo type IIIB open tibial fractures. Methods. 23 patients with Gustilo IIIB open tibial fractures were treated with either immediate unreamed interlocking nailing (n=9) or external fixation followed by delayed unreamed interlocking nailing (n=14). Patient age, sex ratio, fracture site, fracture type, and severity were similar in both groups. The time to union, deep infection rate, and nonunion rate in the 2 groups were compared. Results. In the immediate and delayed nailing groups, respective mean times to union were 21 (standard deviation [SD], 14) months and 14 (SD, 8) months; nonunion rates were 44% (4/9) and 36% (5/14), and deep infection rates were 22% (2/9) and 7% (1/14). All corresponding differences were not statistically significant. Conclusion. Prospective, randomised, multicentre studies are needed to assess whether there are significant differences between the 2 treatment methods.
Knee Flexion after Total Knee Arthroplasty
Authors: Li PH , Wong YC , Wai YL 
Published: October 2016

Purpose. To identify factors related to knee flexion after total knee arthroplasty in a Chinese population. Methods. Records of 242 total knee arthroplasties were retrospectively reviewed. The parameters evaluated were age, gender, diagnosis, preoperative knee flexion and extension, preoperative flexion arc, tibiofemoral angle, Knee Society knee score and functional score, and implant design. Results. Advanced age, female gender, and good preoperative flexion and flexion arc were related to better postoperative flexion. Postoperative flexion tended to migrate to the middle range despite different ranges of preoperative flexion. Preoperative tibiofemoral malalignment had no significant effect on postoperative flexion. Conclusion. Contemporary designs of posterior stabilised prostheses with right and left femoral components were superior to older designs.
Staged Bilateral Hip or Knee Arthroplasties
Authors: Hashmi FR , Barlas K , Mann CF , Howell FR 
Published: October 2016

Purpose. To compare the operating time, amount of blood transfused, length of hospital stay, and early complications (within 6 months) between 2-week staged bilateral arthroplasties and matched randomised controls undergoing unilateral arthroplasties. Methods. From October 1992 to October 2000, 90 patients who underwent bilateral hip or knee arthroplasties with a 2-week interval were compared with matched randomised controls undergoing unilateral arthroplasties. A single surgeon performed all procedures. Results. After the match-up process, 30 pairs of patients were included in the analysis. There were no significant differences in the operating times, amount of blood transfused, and early complication rates. The mean difference in length of hospital stay was significant ( t= −3.552, df=29, p<0.001). Conclusion. Compared to staged procedures with an interval months apart, staged sequential arthroplasty with a 7- to 10-day interval during one hospital admission is more efficient, as it facilitates earlier rehabilitation without higher complication rates, and entails shorter hospital stays.
Posterior 360-Degree Stabilisation of the Upper Thoracic Spine: A Technical Note
Authors: Timbihurira G , Nakajima H , Kobayashi S , Sato R , Yayama T , Uchida K , Horiuchi Y , Baba H 
Published: October 2016

Purpose. To describe a technique involving posterior 360-degree stabilisation of the upper thoracic spine: spinal cord decompression, posterior vertebral body replacement, and then posterior instrumentation and intercostal posterolateral vertebral stabilisation. Methods. Three men and 4 women aged 41 to 77 (mean, 58) years underwent posterior 360-degree stabilisation of the upper thoracic spine. Their indications for surgery were bone metastasis (n=5), burst fracture (n=1), and osteoporotic collapse with cord compression (n=1). Their clinical and radiological findings and treatment outcomes were retrospectively reviewed. Results. Pain status of all patients improved after surgery: 4 had severe and 3 had mild pain preoperatively; in 3 pain became minimal and 4 had none postoperatively. All patients except one had Frankel/American Spinal Injury Association scores of E after surgery indicating complete recovery of sensory and motor function. There were no complications related to surgery or instrumentation construct. At the time of review, one patient had died of old age 8.6 years after surgery and another from local recurrence and lung metastasis 5.7 years after surgery. All other patients were living. Conclusion. One-stage posterior 360-degree stabilisation and vertebral body replacement is a useful technique for upper thoracic spine surgery.
Proximal Femoral Nail for Treatment of Trochanteric Femoral Fractures
Authors: Morihara T , Arai Y , Tokugawa S , Fujita S , Chatani K , Kubo T 
Published: October 2016

Purpose. To report outcomes of 87 consecutive patients treated with a proximal femoral nail (PFN) for trochanteric femoral fractures. Methods. 17 men and 70 women aged 58 to 95 (mean, 85) years with trochanteric femoral fractures underwent PFN fixation using an intramedullary nail, a lag screw, and a hip pin. Fractures were classified according to the AO system; the most common fracture type was A2 (n=45), followed by A1 (n=36) and A3 (n=6). The position of the lag screw within the femoral head was measured. The lateral slide of the lag screw after fracture consolidation was measured by comparing the immediate postoperative and final anteroposterior radiographs. Results. 90% of lag screws were placed in an optimal position. The length of lateral slide of the lag screw in stable A1 fractures was significantly less than that in unstable A2 fractures; it was over 10 mm in 7 of 45 patients with A2 fractures. Cut-out of lag screw did not occur, suggesting that free sliding of the lag screw facilitates direct impaction between fragments. Conclusion. A PFN is useful for the treatment of trochanteric femoral fractures.
Intramedullary Nailing for Pathological Femoral Fractures
Authors: Sharma H , Bhagat S , McCaul J , MacDonald D , Rana B , Naik M 
Published: October 2016

Purpose. To evaluate whether the operating time correlates with the survival and outcome in patients who underwent intramedullary nailing for metastatic femoral fractures. Methods. Records of 10 men and 11 women aged 43 to 86 (mean, 66) years who underwent intramedullary nailing (4 bilaterally) for metastatic femoral fractures between 1999 and 2003 were reviewed. The patients were followed up for at least 2 years or until their death. The main outcome measure was the correlation between operating time and survival. Operating time was categorised into 5 groups from 60 to 210 minutes, with 30-minute increments. Results. Operating time does not correlate with survival and outcome. The mean survival period was 9.4 months. Pain relief was achieved in 90% of the patients. There was no implant failure, but one loss of reduction. Conclusion. Intramedullary nailing appears safe and effective for treatment of metastatic bone disease, and confers good functional results, pain relief, and mobility.
Modified Brostrom-Evans-Gould Technique for Recurrent Lateral Ankle Ligament Instability
Authors: Ng ZD , De S Das 
Published: October 2016

Purpose. To review the outcome of the modified Brostrom-Evans-Gould technique in patients with chronic lateral ankle ligament instability. Methods. Between August 2003 and June 2005, 20 men aged 19 to 35 (mean, 23) years with chronic lateral instability affecting 21 ankles, underwent the modified Brostrom-Evans-Gould technique by a single surgeon. The mean follow-up period was 12 (range, 6–20) months. Patients were assessed preoperatively and postoperatively using the Kaikkonen Ankle Scoring Scale. Results. Preoperatively, all patients had poor scores (<50). Postoperatively, 17 (81%) of the ankles attained excellent scores (85–100) and 4 (19%) attained good scores (70–84). Conclusion. The modified Brostrom-Evans-Gould technique appears effective for chronic lateral ankle ligament instability, particularly in the Asian population with a higher prevalence of generalised joint hyperlaxity.