ISRN Orthopedics The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Dynamic Hip Screw for the Treatment of Femoral Neck Fractures: A Prospective Study with 96 Patients Thu, 24 Apr 2014 00:00:00 +0000 Objectives. To study the correlation between avascular necrosis and the demographics, time elapsed from fracture to surgery, quality of reduction, Garden classification, and the position of the screw following use of the dynamic hip screw (DHS) in the treatment of subcapital neck fractures. Methods. A prospective study of 96 patients with subcapital neck fractures was carried out in a faculty hospital. Patients underwent surgery with closed reduction and internal fixation with DHS. Results. There were 58% male and 42% female patients, with a mean age of 53 years (+/−14). In terms of Garden classification, 60% were Garden IV, 26% were Garden III, and 14% were Garden II. Nonunion was observed in three cases (3%) and was treated with valgus intertrochanteric osteotomy, in all cases leading to successful healing. Avascular necrosis was observed in 16% of patients. The positioning of the screw into the femoral head showed a significant correlation with necrosis. Conclusions. The incidence of necrosis in patients under the age of 50 years is twice as high as that in older patients. Displacement is a predictive factor regarding osteonecrosis and is associated with a high and anterior position of the screw in the femoral head. Level II of evidence. Study Type: therapeutic study. Carlos Roberto Schwartsmann, Lucas Senger Jacobus, Leandro de Freitas Spinelli, Leonardo Carbonera Boschin, Ramiro Zilles Gonçalves, Anthony Kerbes Yépez, Rodrigo Py Gonçalves Barreto, and Marcelo Faria Silva Copyright © 2014 Carlos Roberto Schwartsmann et al. All rights reserved. A Staged Surgical Treatment Outcome of Type 3 Open Tibial Fractures Tue, 15 Apr 2014 11:29:32 +0000 Aim. In these case series which are about type 3 open tibial fractures formed with three different high energy trauma etiologies in different parts of tibia. We aimed to assess our three-stage treatment approach and discuss final results of our elective surgery management with three different fixation methods. Patients and Methods. We assessed 19 patients with type 3 open tibial fractures between 2009 and 2012. Our treatment protocol consisted of three stages. Early intervention in operating room, which including vascular repairs or soft tissue closure, was done if necessary. Definitive surgery was performed using internal or external fixation in the first 15 days. Patients were followed up for at least one year. Last conditions of all our cases were evaluated according to modified Johner and Wruhs criteria. Results. Nine cases were type 3A, seven cases were type 3B, and three cases were type 3C in terms of fracture typing. All patients were followed up for at least one year and mean follow up time was 15 months. In terms of functional and clinical outcome, six cases were evaluated as excellent, eight cases as good, two cases as fair, and three cases as poor. Discussion. Staged treatment option in type 3 open tibial fractures seems to be a good method in reducing complication and achieving the best result. We think that definitive staged treatment protocol including internal fixation with plating or intramedullary nailing (IMN) of the fractures is a reliable method, especially to avoid complications as a result of external fixator and to provide patient rapport. Ahmet Aslan, Emin Uysal, and Ahmet Özmeriç Copyright © 2014 Ahmet Aslan et al. All rights reserved. Treatment Options for Brachial Plexus Injuries Mon, 14 Apr 2014 00:00:00 +0000 The incidence of brachial plexus injuries is rapidly growing due to the increasing number of high-speed motor-vehicle accidents. These are devastating injuries leading to significant functional impairment of the patients. The purpose of this review paper is to present the available options for conservative and operative treatment and discuss the correct timing of intervention. Reported outcomes of current management and future prospects are also analysed. Vasileios I. Sakellariou, Nikolaos K. Badilas, Nikolaos A. Stavropoulos, George Mazis, Helias K. Kotoulas, Stamatios Kyriakopoulos, Ioannis Tagkalegkas, and Ioannis P. Sofianos Copyright © 2014 Vasileios I. Sakellariou et al. All rights reserved. Normal Range of Thoracic Kyphosis in Male School Children Sun, 06 Apr 2014 09:38:47 +0000 Background. Although there are frequent studies about normal range of thoracic kyphosis, there is still a controversy about the exact values of this curve. In nine reported studies on 10 to 20 years of age boys, the value ranged from 25.1° to 53.3°. Objective for the Study. The aim of the present research was investigation of normal ranges of thoracic kyphosis in school children in Kermanshah, western Iran. Methods. 582 male students aged 13 to 18 years old using cluster random sampling were recruited from schools in Kermanshah city, 97 students for each age. Thoracic curves were measured using the flexicurve method. Results. Mean thoracic kyphosis for whole population was 35.49° SD 7.83 and plus or minus two standard deviations ranged from 19.83° to 51.15°. It increased gradually from 13 to 16 and then there was a little decrease to 18 years. Mean values for each age (13–16) were 13 (34.41 SD 7.47°), 14 (34.86 SD 8.29°), 15 (35.79 SD 7.93°), 16 (36.49 SD 7.85°), 17 (35.84 SD 8.33°), and 18 (35.55 SD 7.07°). Conclusions. Our results are in agreement with previous reports and can be used as normal values for local and regional purposes. MohammadBagher Shamsi, Korosh Veisi, Loghman Karimi, Javad Sarrafzadeh, and Farid Najafi Copyright © 2014 MohammadBagher Shamsi et al. All rights reserved. Comparison of Functional Outcomes of Tibial Plateau Fractures Treated with Nonlocking and Locking Plate Fixations: A Nonrandomized Clinical Trial Sun, 16 Mar 2014 13:35:05 +0000 Fixation of tibial plateau fractures with plate has been widely used. This prospective study was planned to compare locking plate fixation of tibial plateau fracture with nonlocking methods in terms of their functional outcomes. The subjects of the study were selected from consecutive patients suffering from tibial plateau fractures referred to Kashani Hospital in Isfahan, Iran, between 2012 and 2013 and were candidate for surgery. The final included patients were assigned to two groups, those who were treated with locking plate () and those who were treated with nonlocking plates (). The mean duration of follow-up was 13.4 months (ranging between 10 and 17 months). The mean of knee scores was significantly higher in locking plate group than in nonlocking plate group at the follow-up time ( versus , ). Also, the mean VAS pain severity score was significantly lower in locking plate group compared with nonlocking plate group ( versus , ). This study confirmed superiority of the locking plate method over nonlocking plate method with regard to knee score as well as VAS pain score. Mohammad Ali Tahririan, Seyyed Hamid Mousavitadi, and Mohsen Derakhshan Copyright © 2014 Mohammad Ali Tahririan et al. All rights reserved. Plate on Plate Osteosynthesis for the Treatment of Nonhealed Periplate Fractures Tue, 11 Mar 2014 13:12:35 +0000 Purpose. The purpose of this paper is to present our technique for the treatment of periplate fractures. Methods. From 2009 to 2012 we treated three patients. In all cases the existing plate was left and the new one placed over the existing. Locking screws were placed through both plates. The other screws in the new plate were used as best suited the fracture. Results. In all cases less than 6 months had passed between fractures. None of the original fractures had healed. Mean followup was 2 years. All fractures proceeded to union within 7 months. No complications were recorded. All the patients returned to their normal activities and were satisfied with the results of their treatment. Conclusion. Our plate on plate technique is effective for the treatment of periplate fractures. A solid fusion can be achieved at the new fracture site without disturbing the previous fixation. Georgios Arealis, Vassilios S. Nikolaou, Andrew Lacon, Neil Ashwood, and Mark Hamlet Copyright © 2014 Georgios Arealis et al. All rights reserved. Distal Radial Fractures in the Superelderly: Does Malunion Affect Functional Outcome? Tue, 04 Mar 2014 09:47:12 +0000 Purpose. The management of unstable distal radial fractures in the superelderly (≥80 years old) remains controversial. The aim of this study was to compare the functional outcome of super-elderly patients with and without malunion after a distal radial fracture. Methods. We identified 51 superelderly patients living independently with displaced fractures from a prospective database of 4024 patients with distal radial fractures. Activities of daily living, presence of wrist pain, whether the wrist had returned to its normal level function, grip strength and ROM were recorded. The dorsal angulation was measured radiographically. Results. There were 17 (33.3%) patients defined to have a malunion. The outcomes of the independent patients with and without malunion were compared at a mean follow-up of 15 months. No difference was observed in activities of daily living , wrist pain , whether the wrist had returned to its normal level function , grip strength , or ROM . An increasing degree of dorsal angulation correlated with diminished ROM (), but did not correlate with activities of daily living (). Conclusions. Malunion of the distal radius does not influence the functional outcome of independent superelderly patients. N. D. Clement, A. D. Duckworth, C. M. Court-Brown, and M. M. McQueen Copyright © 2014 N. D. Clement et al. All rights reserved. The Role of Fascia Iliaca Blocks in Hip Fractures: A Prospective Case-Control Study and Feasibility Assessment of a Junior-Doctor-Delivered Service Tue, 04 Mar 2014 07:37:14 +0000 Hip fractures are common and the incidence is expected to increase. Systemic analgesics, often prescribed to relieve pain after hip fractures, have huge side effects and can delay surgery. We analyse the role and efficacy of alternative forms of analgesia like fascia-iliac blocks (FIB) and assess the feasibility of a service delivered by junior doctors. 104 consecutive hip fracture patients were prospectively recruited and equally divided into cases (patients receiving FIB) and controls (patients receiving systemic analgesia). Outcome measures included time of initial analgesia, total preoperative dose of analgesia, pain scores from admission to 24 hours preoperatively, and complications. The pain scores were significantly lower () in patients receiving FIB at 2 and 8 hours preoperatively. The timing of initial analgesia was also quicker in patients with FIB (25 compared to 40 minutes). FIB patients required fewer doses of systemic analgesia. The block was successful in 67% of patients. There were no complications. The implementation of EWTD, HAN, and shift-system and the reduction in the number of medical staff have increased the burden on emergency departments. This study demonstrates that FIB performed by junior doctors are not only safe and effective analgesia but also provide an opportunity for junior doctors to improve current clinical practice. L. Hanna, A. Gulati, and A. Graham Copyright © 2014 L. Hanna et al. All rights reserved. Distal Tibial Metaphyseal Fractures: Does Blocking Screw Extend the Indication of Intramedullary Nailing? Mon, 17 Feb 2014 09:14:15 +0000 Aim. To evaluate the clinical use of blocking screws as a supplement to stability in distal tibial metaphyseal fractures treated with statically locked intramedullary nail. Main Outcome Measurement. Alignment and reduction preoperatively, postoperatively, and at healing were the main outcome measured with an emphasis on maintenance of initial reduction on followup. Patients and Methods. This was a prospective study of 20 consecutive cases of distal tibial metaphyseal fractures treated with statically locked intramedullary nailing with supplementary blocking screw between August 2006 and September 2007 with a maximum followup of 3 years. Medullary canal diameter was measured at the levels of fracture and isthmus. Results. The mean diameter of tibia at the level of isthmus was 11.9 mm and at the fracture site was 22.9 mm. Mean length of distal fracture segment was 4.6 cm. Mean varus/valgus alignment was 10.3 degrees preoperatively and 1.7 degrees immediatly postoperatively and was maintained till union. Using Karlstrom-Olerud score the outcome was excellent to good in 90%. Conclusion. We conclude that the use of blocking screw as a supplement will aid in achieving and maintaining the reduction of distal tibial metaphyseal fractures when treated with intramedullary nailing thereby extending the indication of intramedullary nailing. Mugundhan Moongilpatti Sengodan, Singaravadivelu Vaidyanathan, Sankaralingam Karunanandaganapathy, Sukumaran Subbiah Subramanian, and Samuel Gnanam Rajamani Copyright © 2014 Mugundhan Moongilpatti Sengodan et al. All rights reserved. Brachial Plexus Injuries in Adults: Evaluation and Diagnostic Approach Sun, 09 Feb 2014 07:22:20 +0000 The increased incidence of motor vehicle accidents during the past century has been associated with a significant increase in brachial plexus injuries. New imaging studies are currently available for the evaluation of brachial plexus injuries. Myelography, CT myelography, and magnetic resonance imaging (MRI) are indicated in the evaluation of brachial plexus. Moreover, a series of specialized electrodiagnostic and nerve conduction studies in association with the clinical findings during the neurologic examination can provide information regarding the location of the lesion, the severity of trauma, and expected clinical outcome. Improvements in diagnostic approaches and microsurgical techniques have dramatically changed the prognosis and functional outcome of these types of injuries. Vasileios I. Sakellariou, Nikolaos K. Badilas, George A. Mazis, Nikolaos A. Stavropoulos, Helias K. Kotoulas, Stamatios Kyriakopoulos, Ioannis Tagkalegkas, and Ioannis P. Sofianos Copyright © 2014 Vasileios I. Sakellariou et al. All rights reserved. Infraspinatus/Teres Minor Transfer Biceps In Situ Tenodesis Procedure: Initial Results of a Technique for Massive Cuff Tears Wed, 30 Oct 2013 11:17:10 +0000 Massive rotator cuff tears may not be primarily repairable with salvage options not necessarily providing acceptable results. Extrinsic tendon transfer is a significant undertaking with prolonged rehabilitation and variable outcome. A novel technique for the reconstruction of massive tears, not amenable to primary repair, by performing a transfer of the intrinsic posterior rotator cuff onto an intact, tenodesed long head of biceps tendon acting as a scaffold for the intrinsic transfer is described. The clinical results at short to medium term in 17 initial patients are presented. Encouraging results from this study suggest that this is a viable option for the management of massive rotator cuff tears with an intact posterior cuff with results equal or superior to other reconstructive techniques. Matt D. A. Fletcher Copyright © 2013 Matt D. A. Fletcher. All rights reserved. Microorganisms and Their Sensitivity Pattern in Septic Arthritis of North Indian Children: A Prospective Study from Tertiary Care Level Hospital Tue, 22 Oct 2013 17:57:42 +0000 Background. Septic arthritis is a true orthopaedic emergency. Important factors determining outcome are rapid diagnosis and timely intervention. Changing trends in microbiological spectrum and emerging drug resistance poses big challenge. Present study evaluates bacterial strains and their sensitivity pattern in septic arthritis of North Indian children. Methods. Fifty children with septic arthritis of any joint were evaluated. Joint was aspirated and 2 cc of aspirated fluid was sent for gram stain and culture. Blood cultures were also sent for bacteriological evaluation. Results. Fifty percent cases had definite radiological evidence of septic arthritis whereas ultrasound revealed fluid in 98% cases. Aspirated fluid showed isolates in 72% cases. The most common organism was Staphylococcus aureus (62%) followed by Streptococcus pneumoniae and Gr. B Streptococcus. Blood culture could grow the organism in 34% cases only. The bacterial strain showed significant resistance to common antibiotic cocktail in routine practice. Resistance to cloxacillin and ceftriaxone was 62% and 14% respectively. No organisms were resistant to vancomycin and linezolid. Conclusion. S. aureus is still the most common organism in septic arthritis. Though a significant resistance to common antibiotic cocktail is noticed, the strain is susceptible to higher antibiotics. We recommend using these antibiotics as an empirical therapy till culture and sensitivity report is available. Sanjay Yadav, Mandeep Singh Dhillon, Sameer Aggrawal, and Sujit Kumar Tripathy Copyright © 2013 Sanjay Yadav et al. All rights reserved. Static and Dynamic Differences in Fixation Stability between a Spacer Plate and a Small Stature Plate Fixator Used for High Tibial Osteotomies: A Biomechanical Bone Composite Study Mon, 23 Sep 2013 08:37:17 +0000 Background. The objective of the present study was to compare mechanical strength and stability of the newly designed spacer plate with the gold standard plate for the treatment of medial knee joint osteoarthritis. Materials and Methods. Ten fourth-generation tibial bone composites underwent a medial open-wedge high tibial osteotomy (HTO) according to standard techniques, using five TomoFix plates and five Contour Lock plates. Static compression load to failure and load-controlled cyclical fatigue failure tests were performed. Forces and horizontal displacements were measured; plastic deformations and dynamic stiffness were determined. Results and Discussion. In all samples, rotation of the tibial head and fracture of the opposite cortex were observed. Behaviors of the specimens under static loading were comparable between groups. Cyclic testing revealed lateral significant higher stiffness until failure for the Contour Lock compared to the TomoFix plate. No visible implant failure was observed in any group. Conclusion. Considering the static analysis, both plates offered sufficient stability under physiologic loads of up to 3000 N. The Contour Lock plate-fixated specimens showed a higher stability during the cyclic testing, supposedly due to the wider distance between the fixation screws. Stefan Maas, Arnaud Diffo Kaze, Klaus Dueck, and Dietrich Pape Copyright © 2013 Stefan Maas et al. All rights reserved. Total Hip Arthroplasty with Bulk Femoral Head Autograft for Acetabular Reconstruction in Developmental Dysplasia of the Hip Wed, 18 Sep 2013 10:16:27 +0000 Developmental hip dysplasia (DDH) presents considerable technical challenges to the primary arthroplasty surgeon. Autogenous bulk grafting using the femoral head has been utilised to achieve anatomic cup placement and superolateral bone coverage in these patients, but reported outcomes on this technique have been mixed with the lack of graft integration and subsequent collapse, an early cause of failures. We describe a novel technique combining the use of bulk autograft with an iliac osteotomy, which provides primary stability and direct cancellous-cancellous bone contact, optimising the environment for early osseointegration. Twenty-one hips in 21 patients with DDH underwent this technique and were followed for a mean of 8.1 years. The preoperative radiographic classification was Crowe type I in 12 hips (57%), type II in 4 hips, and type III in 5 hips, and the mean Sharp angle was 49.6° (range 42°–60°). All grafts united by year. At time of followup, there was no radiographic evidence of graft collapse or loosening. There were no reoperations. Our study has shown that this technique variation combining an iliac osteotomy with bulk autograft in cases of developmental hip dysplasia provides early stability and reliable graft incorporation, together with satisfactory clinical and radiological outcomes in the medium term. Longer term study is necessary to confirm the clinical success of this procedure. Fernando Claros Pizarro, Simon W. Young, Jorge H. Blacutt, Rolando Mojica, and Juan C. Cruz Copyright © 2013 Fernando Claros Pizarro et al. All rights reserved. Comparison between Conventional and Minimally Invasive Dynamic Hip Screws for Fixation of Intertrochanteric Fractures of the Femur Mon, 26 Aug 2013 09:53:50 +0000 Background. Intertrochanteric fractures of the proximal femur are one of the most common fractures encountered, and dynamic hip screw with a side plate is the standard treatment. We compared a minimally invasive surgical technique with the conventional surgical technique used in the fixation of intertrochanteric fractures with the dynamic hip screw (DHS) device. Methods. Thirty patients with such fractures were treated with the conventional open technique and 30 with a new minimally invasive technique. Patients in both groups were followed up for 1 year. Results. There was less blood loss, minimal soft tissue destruction, shorter hospital stay, and early mobilization with the minimally invasive technique. Conclusion. The present study finds minimally invasive technique superior to conventional (open) DHS. A. Mahmood, M. Kalra, and M. K. Patralekh Copyright © 2013 A. Mahmood et al. All rights reserved. Comparative Outcomes Assessment: Hip Hemiarthroplasty as an Alternative to THA in Patients with Surgically Pristine Acetabulum—Is There Still a Role? Mon, 12 Aug 2013 10:55:13 +0000 This is a retrospective review of 243 hip arthroplasties treated with either hemiarthroplasty (61 surgeries-Group 1) or total hip arthroplasty (182 surgeries-Group 2). The mid- to long-term results of relatively similar, predominately young patient cohorts were assessed annually via radiographs and the Harris Hip Scores for pain and clinical function. Groin pain persisted in 16.4% of Group 1 and 5.5% of Group 2 (). Thigh pain persisted in 11.5% of Group 1 and 2.2% of Group 2 (). Complications in Group 1 were 4/61 including 2 revisions with an overall survival rate of 96.7% versus Group 2 complication rate of 29/182 with 15 revisions and an overall survival rate of 91.8%. There were no cases of acetabular protrusio in Group 1, but 2 cases (1%) in Group 2 had cup loosening or osteolysis. Two cases were revised in Group 1 (3.2%). Both were undersized femoral stems. The fifteen revisions (8.2%) in Group 2 included loose stem (1), instability (8), infections (3), cup loosening (2), and accelerated polyethylene wear (1). Hemiarthroplasty has a higher incidence of thigh and groin pain but fewer complications compared with total hip arthroplasty. Thomas B. Pace, Brad Prather, Brian Burnikel, Brayton Shirley, Stephanie Tanner, and Rebecca Snider Copyright © 2013 Thomas B. Pace et al. All rights reserved. Intraoperative Platelet Rich Plasma Usage in Total Knee Arthroplasty: Does It Help? Wed, 24 Jul 2013 11:12:48 +0000 Autologous platelet rich plasma preparations, commonly referred to as platelet gel, have been reported to have benefits when used in total knee replacement of less blood loss and better motion, with few reported complications. This retrospective review of 268 consecutive primary total knee arthroplasty cases compares postsurgical range of motion at 2, 8, and 12 weeks, knee manipulation rates, change in hemoglobin, and complications between one group receiving a platelet gel preparation (135 cases), and an equivalent group receiving no platelet gel preparation (133 control cases). No difference was found between groups in manipulation rates, knee range of motion, or changes in hemoglobin (). The use of platelet gel in this study did not have a significant effect on hemoglobin at 72 hours postoperatively, knee range of motion, or manipulation rates up to 3 months post-op in this patient cohort. Thomas B. Pace, Jonathan L. Foret, M. Jason Palmer, Stephanie L. Tanner, and Rebecca G. Snider Copyright © 2013 Thomas B. Pace et al. All rights reserved. Evaluation of Stability of Rotating Hinge Knee Prostheses: A Biomechanical Study Thu, 18 Jul 2013 08:30:05 +0000 Purpose. Rotating hinge knee prostheses should provide a stable situation following reconstruction. We performed a biomechanical analysis to establish the association between design of the central rotational stem (peg) and implant’s stability, in a theoretical setting. Methods. Six different rotating hinge designs were tested, and three observers performed two different measurements with a custom made biomechanical apparatus and laterally directed pressure. The aim was to assign the degree of tilting of the peg within the vertical post-in channel by extending the distraction as well as the maximum amount of distraction before the peg’s dislocation. An intraclass-correlation coefficient (ICC) was calculated to determine the observer’s reliability. Results. Implant designs with cylindrical pegs of different lengths were superior to implant designs with conical or other shaped pegs concerning stability and maximum amount of distraction before dislocation, showing steep rising distraction-angular displacement curves. The ICC at 15 mm and 25 mm of distraction revealed high interobserver reliability (). Conclusion. The biomechanical analysis showed that rotating hinge prostheses with long and cylindrical pegs have the highest stability at any given amount of distraction. Designs with shorter and markedly tapered pegs may become unstable under conditions of mild joint distraction which has to be proven in future in vivo investigations. Joerg Friesenbichler, Andreas Leithner, Mathias Glehr, Patrick Sadoghi, Werner Maurer-Ertl, Alexander Avian, and Reinhard Windhager Copyright © 2013 Joerg Friesenbichler et al. All rights reserved. Robot-Assisted Navigation versus Computer-Assisted Navigation in Primary Total Knee Arthroplasty: Efficiency and Accuracy Mon, 24 Jun 2013 13:29:52 +0000 Background. Since the introduction of robot-assisted navigation in primary total knee arthroplasty (TKA), there has been little research conducted examining the efficiency and accuracy of the system compared to computer-assisted navigation systems. Objective. To compare the efficiency and accuracy of Praxim robot-assisted navigation (RAN) and Stryker computer-assisted navigation (CAN) in primary TKA. Methods. This was a retrospective study consisting of 52 patients who underwent primary TKA utilizing RAN and 29 patients utilizing CAN. The primary outcome measure was navigation time. Secondary outcome measures included intraoperative final mechanical axis alignment, intraoperative robot-assisted bone cut accuracy, tourniquet time, and hospitalization length. Results. RAN navigation times were, on average, 9.0 minutes shorter compared to CAN after adjustment. The average absolute intraoperative malalignment was less in the RAN procedures compared to the CAN procedures after adjustment. Patients in the RAN group tended to be discharged 0.6 days earlier compared to patients in the CAN group after adjustment. Conclusions. Among patients undergoing TKA, there was decreased navigation time, decreased final malalignment, and decreased hospitalization length associated with the use of RAN when compared to CAN independent of age, BMI, and pre-replacement alignment. Tanner C. Clark and Frank H. Schmidt Copyright © 2013 Tanner C. Clark and Frank H. Schmidt. All rights reserved. Aequalis Humeral Head Resurfacing in Glenohumeral Arthritis at a Minimum Followup of 2 Years Tue, 11 Jun 2013 13:14:33 +0000 Aim. To evaluate results of Aequalis humeral head resurfacing in patients with end-stage glenohumeral arthritis at a minimum followup of two years. Patients and Methods. Twenty-one consecutive patients underwent humeral head resurfacing hemiarthroplasty between 2007 and 2009. Three patients did not fulfill the inclusion criteria. 18 patients with mean age of 75.1 years (range 58–91 years) and a mean duration of preoperative symptoms of 33.6 months (range 6–120 months) were analyzed. Patients’ self-reported Oxford shoulder score (OSS) was collected prospectively and was used as an assessment tool to measure final outcome. Results. The mean initial OSS was 15 (range 3–29). The score improved by an average of 19.5 points at a mean followup of 36.3 months (range 24–54 months) to reach a mean final OSS of 34.5 (range 6–47). The improvement of OSS was highly significant with a two-tailed value less than 0.0001. The overall patient satisfaction was 94%. Conclusion. This study demonstrates Aequalis shoulder resurfacing hemiarthroplasty as a reliable procedure, away from its originating center, for improvement of shoulder function as shown by the patients’ self-reported outcome score (OSS) in end-stage glenohumeral arthritis at a minimum followup of 2 years. Roshan Raghavan, Amitabh J. Dwyer, and Andrew F. W. Chambler Copyright © 2013 Roshan Raghavan et al. All rights reserved. The Retroacetabular Angle Determines the Safe Angle for Screw Placement in Posterior Acetabular Fracture Fixation Tue, 28 May 2013 09:10:13 +0000 Introduction. A method for the determination of safe angles for screws placed in the posterior acetabular wall based on preoperative computed tomography (CT) is described. It defines a retroacetabular angle and determines its variation in the population. Methods. The retroacetabular angle is the angle between the retroacetabular surface and the tangent to the posterior acetabular articular surface. Screws placed through the marginal posterior wall at an angle equal to the retroacetabular angle are extraarticular. Medial screws can be placed at larger angles whose difference from the retroacetabular angle is defined as the allowance angles. CT scans of all patients with acetabular fractures treated in our institute between September 2002 to July 2007 were used to measure the retroacetabular angle and tangent. Results. Two hundred thirty one patients were included. The average (range) age was 42 (15–74) years. The average (range) retroacetabular angle was 39 (30–47) degrees. The average (range) retroacetabular tangent was 36 (30–45) mm. Conclusions. Placing the screws at an average (range) angle of 39 (33–47) degrees of anterior inclination with the retroacetabular surface makes them extraarticular. Angles for medial screws are larger. Safe angles can be calculated preoperatively with a computer program. Ayman M. A. Tadros, Thomas R. Oxland, and Peter O’Brien Copyright © 2013 Ayman M. A. Tadros et al. All rights reserved. Treatment of Ganglion Cysts Tue, 28 May 2013 08:54:36 +0000 Ganglion cysts are soft tissue swellings occurring most commonly in the hand or wrist. Apart from swelling, most cysts are asymptomatic. Other symptoms include pain, weakness, or paraesthesia. The two main concerns patients have are the cosmetic appearance of the cysts and the fear of future malignant growth. It has been shown that 58% of cysts will resolve spontaneously over time. Treatment can be either conservative or through surgical excision. This review concluded that nonsurgical treatment is largely ineffective in treating ganglion cysts. However, it advised to patients who do not surgical treatment but would like symptomatic relief. Compared to surgery, which has a lower recurrence rate but have a higher complication rate with longer recovery period. It has been shown that surgical interventions do not provide better symptomatic relief compared to conservative treatment. If symptomatic relief is the patient’s primary concern, a conservative approach is preferred, whilst surgical intervention will decrease the likelihood of recurrence. Matthew Suen, B. Fung, and C. P. Lung Copyright © 2013 Matthew Suen et al. All rights reserved. Dorsally Comminuted Fractures of the Distal End of the Radius: Osteosynthesis with Volar Fixed Angle Locking Plates Wed, 08 May 2013 15:51:04 +0000 Background. Dorsally comminuted distal radius fractures are unstable fractures and represent a treatment challenge. The objective of this study was to evaluate the functional and radiological outcome of dorsally comminuted fractures of the distal radius fixed with a volar locking plate. Patients and Methods. Thirty-three consecutive patients with dorsally comminuted fractures of the distal end of the radius were treated by open reduction and internal fixation with AO 2.4 mm ()/3.5 mm () volar locking distal radius plate (Synthes, Switzerland, marketed by Synthes India Pvt. Ltd.). There were 7 type A3, 8 type C2, and 18 type C3 fractures. The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Subjective assessment was done as per Disabilities Arm, Shoulder, and Hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist; the radiological determinants were radial angle, radial length, volar angle, and ulnar variance. The final assessment was done as per Demerit point system of Saito. Results. There were 23 males and 10 females with an average age of 44.12 ± 18.63 years (18–61 years). Clinicoradiological consolidation of the fracture was observed in all cases at a mean of 9.6 weeks (range 7–12 weeks). The average final extension was 58.15° ± 7.83°, flexion was 54.62° ± 11.23°, supination was 84.23° ± 6.02°, and pronation was 80.92° ± 5.54°. Demerit point system of Saito yielded excellent results in 79% (), good in 18% (), and fair in 3% () patients. Three patients had loss of reduction but none of the patients had tendon irritation or ruptures, implant failure, or nonunion at the end of an one-year followup. Conclusion. Volar locking plate fixation for dorsally comminuted distal radius fractures results in good to excellent functional outcomes despite a high incidence of loss of reduction and fracture collapse. Paritosh Gogna, Harpal Singh Selhi, Rohit Singla, Ashish Devgan, Narender Kumar Magu, Pankaj Mahindra, and Mohammad Yamin Copyright © 2013 Paritosh Gogna et al. All rights reserved. Humeral Shaft Fractures Secondary to Hand Grenade Throwing Sun, 21 Apr 2013 15:31:42 +0000 A series of five cases were presented in which similar fractures of the shaft of the humerus occurred during the hand grenade throwing activity during the military education. All the fractures were in the 1/3 distal humeral shaft, and butterfly fragments were accompanying in two soldiers. All the fractures healed without any clinical complications with conservative treatment. The mechanism of the fracture is discussed with reference to the recent literature. Bahattin Kerem Aydin, Ramazan Akmese, and Mustafa Agar Copyright © 2013 Bahattin Kerem Aydin et al. All rights reserved. Vitamin D Status and Spine Surgery Outcomes Thu, 11 Apr 2013 11:41:21 +0000 There is a high prevalence of hypovitaminosis D in patients with back pain regardless of whether or not they require surgical intervention. Furthermore, the risk of hypovitaminosis D is not limited to individuals with traditional clinical risk factors. Vitamin D plays an essential role in bone formation, maintenance, and remodeling, as well as muscle function. Published data indicate that hypovitaminosis D could adversely affect bone formation and muscle function in multiple ways. The literature contains numerous reports of myopathy and/or musculoskeletal pain associated with hypovitaminosis D. In terms of spinal fusion outcomes, a patient may have a significant decrease in pain and the presence of de novo bone on an X-ray, yet their functional ability may remain severely limited. Hypovitaminosis D may be a contributing factor to the persistent postoperative pain experienced by these patients. Indeed, hypovitaminosis D is not asymptomatic, and symptoms can manifest themselves independent of the musculoskeletal pathological changes associated with conditions like osteomalacia. It appears that vitamin D status is routinely overlooked, and there is a need to raise awareness about its importance among all healthcare practitioners who treat spine patients. William J. Rodriguez and Jason Gromelski Copyright © 2013 William J. Rodriguez and Jason Gromelski. All rights reserved. The Correlation of Serum Metal Ions with Functional Outcome Scores at Three-to-Six Years following Large Head Metal-on-Metal Hip Arthroplasty Wed, 27 Mar 2013 18:33:19 +0000 Based on success of hip resurfacing, large head Metal on Metal (MoM) hip arthroplasty has gained significant popularity in recent years. There are growing concerns about metal ions related soft tissue abnormalities. The aim of this study was to define a correlation of metal ions with various functional outcome scores following large head MoM hip arthroplasty. Consecutive cohort of 70 patients (76 hips) with large head MoM hip arthroplasty using SL-Plus femoral stem and Cormet acetabular component were prospectively followed up. An independent observer assessed the patients which included serology for metal ion levels and collection of Oxford Hip, Harris hip, WOMAC, SF-36 & modified UCLA scores. Median serum cobalt and chromium levels were 3.10 g/L (0.35–62.92) and 4.21 g/L (0.73–69.27) with total of median 7.30 g/L (2.38–132.19). The median Oxford, Harris, WOMAC, SF-36 and modified UCLA scores were 36 (6–48), 87 (21–100), 36 (24–110), 104 (10–125), and 3 (1–9), respectively. Seventeen patients had elevated serum cobalt and chromium levels ≥7 g/L. There was no significant correlation between serum metal ion levels with any of these outcome scores. We recommend extreme caution during follow up of these patients with large head MoM arthroplasty. Sheethal Prasad Patange Subbarao, Ibrahim A. Malek, Khitish Mohanty, Phillip Thomas, and Alun John Copyright © 2013 Sheethal Prasad Patange Subbarao et al. All rights reserved. Early Total Care versus Damage Control: Current Concepts in the Orthopedic Care of Polytrauma Patients Thu, 21 Mar 2013 13:46:21 +0000 The management of the polytraumatized orthopedic patient remains a challenging issue. In recent years many efforts have been made to develop rescue techniques and to promote guidelines for the management of these patients. Currently controversies persist between two orthopedic approaches: the Early Total Care and the Damage Control Orthopedics. An overview of the current literature on the orthopedic management of polytrauma patient is provided. Subsequently, femoral shaft fractures, representing extremely common lesions, and pelvic ring injuries, that are associated with a high mortality rate, are analyzed in detail. Ratto Nicola Copyright © 2013 Ratto Nicola. All rights reserved. Treatment of AO Type C Fractures of the Distal Part of the Humerus through the Bryan-Morrey Triceps-Sparing Approach Wed, 20 Mar 2013 09:06:30 +0000 Several alternative approaches have been described to avoid the complications related to the olecranon osteotomy used to treat distal articular humerus fractures. The published experience with the triceps-sparing approach is scant. In this prospective study, a total of 12 patients with an articular humeral fracture were treated using this approach. At a mean followup of 1,7 years, the average range of motion was 112.8° (range from 85° to 135°); the elbow flexion averaged 125.5° (range from 112° to 135°) and the deficit of elbow extension 14.6° (range from 0° to 30°). All the elbows were stable. The Mayo Elbow Performance Score (MEPS) averaged 93.3 (range from 80 to 100). In the present series no failure of the triceps reattachment to the olecranon was found, and all the patients recalled returning to their previous daily life activities without impairment with a satisfactory MEPS. As a conclusion, the triceps-sparing approach can be considered for treating distal articular humerus fractures. We consider that three clinical settings can be more favorable to use this approach: those cases in which a total elbow prosthesis might be needed, cases of ipsilateral diaphyseal fracture, or presence of previous hardware in the olecranon. J. A. Fernández-Valencia, E. Muñoz-Mahamud, J. R. Ballesteros, and S. Prat Copyright © 2013 J. A. Fernández-Valencia et al. All rights reserved. TEFTOM: A Promising General Trauma Expectation/Outcome Measure—Results of a Validation Study on Pan-American Ankle and Distal Tibia Trauma Patients Thu, 28 Feb 2013 18:01:12 +0000 Background. In orthopedics, there is no instrument specifically designed to assess patients’ expectations of their final surgery outcome in general trauma populations. We developed the Trauma Expectation Factor Trauma Outcome Measure (TEFTOM) to investigate the fulfilment of patients’ expectations one year after surgery as a measure of general trauma surgical outcomes. The aim of this paper was to assess the psychometric characteristics of this new general trauma outcome measure. Methods. The questionnaire was tested in 201 ankle and distal tibia fracture patients scheduled for surgery. Patients were followed up for twelve months. The TEFTOM questionnaire was evaluated for its criterion validity, internal consistency, reproducibility, and responsiveness. Results. TOM showed good criterion validity against the American Academy of Orthopaedic Surgeons Foot and Ankle Scale (Pearson’s correlation coefficient = 0.69–0.77). Internal consistency was acceptable for TEF (Cronbach’s alpha = 0.65–0.76) and excellent for TOM (Cronbach’s alpha = 0.76–0.85). Reproducibility was moderate to very good (intraclass coefficient correlation (ICC) ) for TEF and very good (ICC ) for TOM. TOM also proved to be responsive to changes in patients’ condition over time (Wald test; ). Conclusions. TEFTOM is a promising tool for measuring general trauma outcomes in terms of patients’ expectation fulfilment that proved to be valid, internally consistent, reproducible, and responsive to change. Michael Suk, Monica Daigl, Richard E. Buckley, Cleber A. J. Paccola, Dean G. Lorich, David L. Helfet, and Beate Hanson Copyright © 2013 Michael Suk et al. All rights reserved. Comparing the In Vitro Stiffness of Straight-DCP, Wave-DCP, and LCP Bone Plates for Femoral Osteosynthesis Tue, 26 Feb 2013 08:27:18 +0000 The objective of this study was to compare the Locking Compression Plate (LCP) with the more cost-effective straight-dynamic compression plate (DCP) and wave-DCPs by testing in vitro the effects of plate stiffness on different types of diaphyseal femur fractures (A, B, and C, according to AO classification). The bending structural stiffness of each plate was obtained from four-point bending tests according to ASTM F382-99(2008). The plate systems were tested by applying compression/bending in different osteosynthesis simulation models using wooden rods to simulate the fractured bone fragments. Kruskal-Wallis test showed no significant difference in the bending structural stiffness between the three plate models. Rank-transformed two-way ANOVA showed significant influence of plate type, fracture type, and interaction plate versus fracture on the stiffness of the montages. The straight-DCP produced the most stable model for types B and C fractures, which makes its use advantageous for complex nonosteoporotic fractures that require minimizing focal mobility, whereas no difference was found for type A fracture. Our results indicated that DCPs, in straight or wave form, can provide adequate biomechanical properties for fixing diaphyseal femoral fractures in cases where more modern osteosynthesis systems are cost restrictive. José Ricardo Lenzi Mariolani and William Dias Belangero Copyright © 2013 José Ricardo Lenzi Mariolani and William Dias Belangero. All rights reserved.