各位同道：下面是英国版 Journal of Bone and Joint Surgery 2007 年 3 月第 3 期的文章
标题和摘要，请大家看后建议选择那些文章翻译出来以后会对中国的骨科医生更有价
值。
1. A. J. Langdown, R. J. Pickard, C. M. Hobbs, H. J. Clarke, D. J. N. Dalton, and M. L.
Grover. Incomplete seating of the liner with the Trident acetabular system: A CAUSE FOR
CONCERN? J Bone Joint Surg Br 89-B: 291-295.
2. E. H. van Haaren, I. C. Heyligers, F. G. M. Alexander, and P. I. J. M. Wuisman. High
rate of failure of impaction grafting in large acetabular defects. J Bone Joint Surg Br 89-B:
296-300.
3. H. Ziaee, J. Daniel, A. K. Datta, S. Blunt, and D. J. W. McMinn. Transplacental
transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty: A
CONTROLLED STUDY. J Bone Joint Surg Br 89-B: 301-305.
4. D. O. Molloy, H. A. P. Archbold, L. Ogonda, J. McConway, R. K. Wilson, and D. E.
Beverland. Comparison of topical fibrin spray and tranexamic acid on blood loss after total
knee replacement: A PROSPECTIVE, RANDOMISED CONTROLLED TRIAL. J Bone
Joint Surg Br 89-B: 306-309.
5. C. E. Ackroyd, J. H. Newman, R. Evans, J. D. J. Eldridge, and C. C. Joslin. The Avon
patellofemoral arthroplasty: FIVE-YEAR SURVIVORSHIP AND FUNCTIONAL RESULTS.
J Bone Joint Surg Br 89-B: 310-315.
6. E. O. Pearse, B. F. Caldwell, R. J. Lockwood, and J. Hollard. Early mobilisation after
conventional knee replacement may reduce the risk of postoperative venous
thromboembolism. J Bone Joint Surg Br 89-B: 316-322.
7. M. Citak, D. Kendoff, M. Kfuri, Jr, A. Pearle, C. Krettek, and T. Hüfner. Accuracy
analysis of Iso-C3D versus fluoroscopy-based navigated retrograde drilling of
osteochondral lesions: A PILOT STUDY. J Bone Joint Surg Br 89-B: 323-326.
8. A. E. Price, P. DiTaranto, I. Yaylali, M. A. Tidwell, and J. A. I. Grossman. Botulinum
toxin type A as an adjunct to the surgical treatment of the medial rotation deformity of the
shoulder in birth injuries of the brachial plexus. J Bone Joint Surg Br 89-B: 327-329.
9. M. Cesar, Y. Roussanne, F. Bonnel, and F. Canovas. GSB III total elbow replacement
in rheumatoid arthritis. J Bone Joint Surg Br 89-B: 330-334.
10. J.-D. Albert, J. Meadeb, P. Guggenbuhl, F. Marin, T. Benkalfate, H. Thomazeau, and
G. Chalès. High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the
rotator cuff: A RANDOMISED TRIAL. J Bone Joint Surg Br 89-B: 335-341.
11. R Vaidya, R. Weir, A. Sethi, S. Meisterling, W. Hakeos, and C. D. Wybo. Interbody
fusion with allograft and rhBMP-2 leads to consistent fusion but early subsidence. J Bone
Joint Surg Br 89-B: 342-345.
12. S. Danaviah, S. Govender, M. L. Gordon, and S. Cassol. Atypical mycobacterial
spondylitis in HIV-negative patients identified by genotyping. J Bone Joint Surg Br 89-B:
346-348.
13. S.-K. Goh, K. Y. Yang, J. S. B. Koh, M. K. Wong, S. Y. Chua, D. T. C. Chua, and T. S.
Howe. Subtrochanteric insufficiency fractures in patients on alendronate therapy: A
CAUTION. J Bone Joint Surg Br 89-B: 349-353.
14. G. G. Konrad, K. Kundel, P. C. Kreuz, M. Oberst, and N. P. Sudkamp. Monteggia
fractures in adults: LONG-TERM RESULTS AND PROGNOSTIC FACTORS. J Bone
Joint Surg Br 89-B: 354-360.
15. F. Vult von Steyern, I. Kristiansson, K. Jonsson, P. Mannfolk, D. Heinegård, and A.
Rydholm. Giant-cell tumour of the knee: THE CONDITION OF THE CARTILAGE AFTER
TREATMENT BY CURETTAGE AND CEMENTING. J Bone Joint Surg Br 89-B: 361-365.
16. A. H. Krieg, A. W. Davidson, and P. D. Stalley. Intercalary femoral reconstruction with
extracorporeal irradiated autogenous bone graft in limb-salvage surgery. J Bone Joint
Surg Br 89-B: 366-371.
17. E. Morsi. Acetabuloplasty for neglected dislocation of the hip in older children. J Bone
Joint Surg Br 89-B: 372-374.
18. P. Kasten, F. Geiger, F. Zeifang, S. Weiss, and M. Thomsen. Compliance with
continuous passive movement is low after surgical treatment of idiopathic club foot in
infants: A PROSPECTIVE, DOUBLE-BLINDED CLINICAL STUDY. J Bone Joint Surg Br
89-B: 375-377.
19. A. F. Lourenço, and J. A. Morcuende. Correction of neglected idiopathic club foot by
the Ponseti method. J Bone Joint Surg Br 89-B: 378-381.
20. D. M. A. Knight, R. Birch, and J. Pringle. Benign solitary schwannomas: A REVIEW
OF 234 CASES. J Bone Joint Surg Br 89-B: 382-387.
21. S. V. Kanakaraddi, G. Nagaraj, and T. M. Ravinath. Adamantinoma of the tibia with
late skeletal metastasis: AN UNUSUAL PRESENTATION. J Bone Joint Surg Br 89-B:
388-389.
22. A. Manzotti, N. Confalonieri, and C. Pullen. Intertrochanteric fracture of an
arthrodesed hip. J Bone Joint Surg Br 89-B: 390-392.
23. T. W. Briant-Evans, M. R. Norton, and E. D. Fern. Fractures of Corin ‘Taper-Fit’ CDH
stems used in ‘cement-in-cement’ revision total hip replacement. J Bone Joint Surg Br
89-B: 393-395.
24. I.-Y. Ok, and S.-J. Kim. Remodelling of the distal radius after epiphysiolysis and
lengthening. J Bone Joint Surg Br 89-B: 396-397.
25. Y. In, S.-J. Kim, and Y.-J. Kwon. Patellar tendon lengthening for patella infera using
the Ilizarov technique. J Bone Joint Surg Br 89-B: 398-400.
26. T. Alcantara-Martos, A. D. Delgado-Martinez, M. V. Vega, M. T. Carrascal, and L.
Munuera-Martinez. Effect of vitamin C on fracture healing in elderly Osteogenic Disorder
Shionogi rats. J Bone Joint Surg Br 89-B: 402-407.
27. H.-M. Ma, Y.-C. Lu, T.-G. Kwok, F.-Y. Ho, C.-Y. Huang, and C.-H. Huang. The effect
of the design of the femoral component on the conformity of the patellofemoral joint in total
knee replacement. J Bone Joint Surg Br 89-B: 408-412.
28. R. P. van Riet, F. van Glabbeek, W. de Weerdt, J. Oemar, and H. Bortier. Validation
of the lesser sigmoid notch of the ulna as a reference point for accurate placement of a
prosthesis for the head of the radius: A CADAVER STUDY. J Bone Joint Surg Br 89-B:
413-416.
29. T. M. Bielecki, T. S. Gazdzik, J. Arendt, T. Szczepanski, W. Król, and T.
Wielkoszynski. Antibacterial effect of autologous platelet gel enriched with growth factors
and other active substances: AN IN VITRO STUDY. J Bone Joint Surg Br 89-B: 417-420.
-------------------------------------------------------------------------------Abstract 1 of 29
Incomplete seating of the liner with the Trident acetabular system
A CAUSE FOR CONCERN?
A. J. Langdown, BSc, FRCS (T & Orth), Consultant Orthopaedic Surgeon1; R. J. Pickard,
FRCS, Orthopaedic Specialist Registrar1; C. M. Hobbs, FRCS(Tr & Orth), Consultant
Orthopaedic Surgeon1; H. J. Clarke, FRCS, Consultant Orthopaedic Surgeon1; D. J. N.
Dalton, FRCS(Tr & Orth), Consultant Orthopaedic Surgeon1; and M. L. Grover, FRCS,
Consultant Orthopaedic Surgeon1
1 Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Southwick Hill Road,
Cosham, Portsmouth PO6 3LY, UK.
Correspondence should be sent to Mr A. J. Langdown; e-mail:
andrew.langdown@porthosp.nhs.uk
We reviewed the initial post-operative radiographs of the Trident acetabulum and
identified a problem with seating of the metal-backed ceramic liner. We identified 117 hips
in 113 patients who had undergone primary total hip replacement using the Trident shell
with a metal-backed alumina liner. Of these, 19 (16.4%) were noted to have incomplete
seating of the liner, as judged by plain anteroposterior and lateral radiographs. One case
of complete liner dissociation necessitating early revision was not included in the
prevalence figures. One mis-seated liner was revised in the early post-operative period
and two that were initially incompletely seated were found on follow-up radiographs to
have become correctly seated. There may be technical issues with regard to the
implanting of this prosthesis of which surgeons should be aware. However, there is the
distinct possibility that the Trident shell deforms upon implantation, thereby preventing
complete seating of the liner.
-------------------------------------------------------------------------------Abstract 2 of 29
High rate of failure of impaction grafting in large acetabular defects
E. H. van Haaren, MD, Resident in Orthopaedic Surgery1; I. C. Heyligers, MD, PhD,
Orthopaedic Surgeon2; F. G. M. Alexander, MD, Research Assistant1; and P. I. J. M.
Wuisman, MD, PhD, Professor in Orthopaedic Surgery1
1 Department of Orthopaedic Surgery, VU University Medical Center, P. O. Box 7057,
1007 MB, Amsterdam, The Netherlands.
2 Department of Orthopaedic Surgery, Atrium Medical Center, Henri, Dunanstraat 5, 6419
PC, Heerlen, The Netherlands.
Correspondence should be sent to Professor P. I. J. M. Wuisman; e-mail:
orthop@vumc.nl
We reviewed the results of 71 revisions of the acetabular component in total hip
replacement, using impaction of bone allograft. The mean follow-up was 7.2 years (1.6 to
9.7). All patients were assessed according to the American Academy of Orthopedic
Surgeons (AAOS) classification of bone loss, the amount of bone graft required, thickness
of the graft layer, signs of graft incorporation and use of augmentation.
A total of 20 acetabular components required re-revision for aseptic loosening, giving an
overall survival of 72% (95% CI, 54.4 to 80.5). Of these failures, 14 (70%) had an AAOS
type III or IV bone defect. In the failed group, poor radiological and histological graft
incorporation was seen.
These results suggest that impaction allografting in acetabular revision with severe bone
defects may have poorer results than have previously been reported.
-------------------------------------------------------------------------------Abstract 3 of 29
Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip
arthroplasty
A CONTROLLED STUDY
H. Ziaee, BSc(Hons), Biomedical Scientist1; J. Daniel, FRCS, Director of Research, Staff
Orthopaedic Surgeon1; A. K. Datta, MD, MRCOG, Specialist Registrar2; S. Blunt, MD,
FRCOG, Consultant Obstetrician2; and D. J. W. McMinn, FRCS, Consultant Orthopaedic
Surgeon1
1 The McMinn Centre, 25, Highfield Road, Birmingham, B15 3DP, UK.
2 Gynaecologist Birmingham Women’s Health Care NHS Trust, Metchley Park Road,
Birmingham B15 2TG, UK.
Correspondence should be sent to Mr J. Daniel; e-mail:
josephdaniel@mcminncentre.co.uk
Metal-on-metal bearings are being increasingly used in young patients. The potential
adverse effects of systemic metal ion elevation are the subject of ongoing investigation.
The purpose of this study was to investigate whether cobalt and chromium ions cross the
placenta of pregnant women with a metal-on-metal hip resurfacing and reach the
developing fetus. Whole blood levels were estimated using high-resolution
inductively-coupled plasma mass spectrometry.
Our findings showed that cobalt and chromium are able to cross the placenta in the study
patients with metal-on-metal hip resurfacings and in control subjects without any metal
implants. In the study group the mean concentrations of cobalt and chromium in the
maternal blood were 1.39 µg/l (0.55 to 2.55) and 1.28 µg/l (0.52 to 2.39), respectively. The
mean umbilical cord blood concentrations of cobalt and chromium were comparatively
lower, at 0.839 µg/l (0.42 to 1.75) and 0.378 µg/l (0.14 to 1.03), respectively, and this
difference was significant with respect to chromium (p < 0.05).
In the control group, the mean concentrations of cobalt and chromium in the maternal
blood were 0.341 µg/l (0.18 to 0.54) and 0.199 µg/l (0.12 to 0.33), and in the umbilical cord
blood they were 0.336 µg/l (0.17 to 0.5) and 0.194 µg/l (0.11 to 0.56), respectively. The
differences between the maternal and umbilical cord blood levels in the controls were
marginal, and not statistically significant (p > 0.05). The mean cord blood level of cobalt in
the study patients was significantly greater than that in the control group (p < 0.01).
Although the mean umbilical cord blood chromium level was nearly twice as high in the
study patients (0.378 µg/l) as in the controls (0.1934 µg/l), this difference was not
statistically significant. (p > 0.05)
The transplacental transfer rate was in excess of 95% in the controls for both metals, but
only 29% for chromium and 60% for cobalt in study patients, suggesting that the placenta
exerts a modulatory effect on the rate of metal ion transfer.
-------------------------------------------------------------------------------Abstract 4 of 29
Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee
replacement
A PROSPECTIVE, RANDOMISED CONTROLLED TRIAL
D. O. Molloy, MRCSI, MPhil, Orthopaedic Registrar1; H. A. P. Archbold, MRCS,
Orthopaedic Registrar1; L. Ogonda, MRCS, MPhil, Orthopaedic Registrar1; J. McConway,
MRCS, Arthroplasty Research Fellow1; R. K. Wilson, FRCS, MPhil, Orthopaedic
Registrar1; and D. E. Beverland, MD, FRCS, Consultant Orthopaedic Surgeon1
1 Orthopaedic Outcomes Department, Musgrave Park Hospital, Stockmans Lane, Belfast,
BT9 7JB, Northern Ireland.
Correspondence should be sent to Mr D. O. Molloy; e-mail:
dennis.molloy@greenpark.n-i.nhs.uk
We performed a randomised, controlled trial involving 150 patients with a pre-operative
level of haemoglobin of 13.0 g/dl or less, to compare the effect of either topical fibrin spray
or intravenous tranexamic acid on blood loss after total knee replacement.
A total of 50 patients in the topical fibrin spray group had 10 ml of the reconstituted
product applied intra-operatively to the operation site. The 50 patients in the tranexamic
acid group received 500 mg of tranexamic acid intravenously five minutes before deflation
of the tourniquet and a repeat dose three hours later, and a control group of 50 patients
received no pharmacological intervention.
There was a significant reduction in the total calculated blood loss for those in the topical
fibrin spray group (p = 0.016) and tranexamic acid group (p = 0.041) compared with the
control group, with mean losses of 1190 ml (708 to 2067), 1225 ml (580 to 2027), and
1415 ml (801 to 2319), respectively. The reduction in blood loss in the topical fibrin spray
group was not significantly different from that achieved in the tranexamic acid group (p =
0.72).
-------------------------------------------------------------------------------Abstract 5 of 29
The Avon patellofemoral arthroplasty
FIVE-YEAR SURVIVORSHIP AND FUNCTIONAL RESULTS
C. E. Ackroyd, MA, FRCS, Consultant Orthopaedic Surgeon1; J. H. Newman, MA, FRCS,
Consultant Orthopaedic Surgeon1; R. Evans, RGN, Research Nurse1; J. D. J. Eldridge,
BSc, FRCS(Orth), Consultant Orthopaedic Surgeon1; and C. C. Joslin, MBChB,
FRCS(Orth), Specialist Registrar1
1 Bristol Knee Group, Winford Unit, Avon Orthopaedic Centre, Southmead Hospital,
Westbury-on-Trym, Bristol BS10 5NB, UK.
Correspondence should be sent to Mr C. E. Ackroyd at 2 Clifton Park, Clifton, Bristol BS8
3BS, UK; e-mail: Kathiereynolds@2CP.co.uk
We report the mid-term results of a new patellofemoral arthroplasty for established
isolated patellofemoral arthritis. We have reviewed the experience of 109 consecutive
patellofemoral resurfacing arthroplasties in 85 patients who were followed up for at least
five years.
The five-year survival rate, with revision as the endpoint, was 95.8% (95% confidence
interval 91.8% to 99.8%). There were no cases of loosening of the prosthesis. At five
years the median Bristol pain score improved from 15 of 40 points (interquartile range 5 to
20) pre-operatively, to 35 (interquartile range 20 to 40), the median Melbourne score from
10 of 30 points (interquartile range 6 to 15) to 25 (interquartile range 20 to 29), and the
median Oxford score from 18 of 48 points (interquartile range 13 to 24) to 39 (interquartile
range 24 to 45). Successful results, judged on a Bristol pain score of at least 20 at five
years, occurred in 80% (66) of knees. The main complication was radiological progression
of arthritis, which occurred in 25 patients (28%) and emphasises the importance of the
careful selection of patients. These results give increased confidence in the use of
patellofemoral arthroplasty.
-------------------------------------------------------------------------------Abstract 6 of 29
Early mobilisation after conventional knee replacement may reduce the risk of
postoperative venous thromboembolism
E. O. Pearse, MA, FRCS(Orth), Specialist Registrar in Orthopaedics, Clinical Knee
Fellow1; B. F. Caldwell, FRACS(Orth), Orthopaedic Surgeon1; R. J. Lockwood, BHlth
Sc(Nursing), RN Surgical Nursing Unit Manager2; and J. Hollard, BMed(Hons), FANZCA,
Consultant Anaesthetist3
1 North Sydney Orthopaedic & Sports Medicine Centre, 286, Pacific Highway, Crows Nest
2068, New South Wales, Australia.
2 Toronto Private Hospital, Cary Street, Toronto 2283, New South Wales, Australia.
3 Newcastle Anaesthesia & Perioperative Service, P. O. Box 17, Lambton 2299, New
South Wales, Australia.
Correspondence should be sent to Mr E. O. Pearse; e-mail: YemiPearse@aol.com
We carried out an audit on the result of achieving early walking in total knee replacement
after instituting a new rehabilitation protocol, and assessed its influence on the
development of deep-vein thrombosis as determined by Doppler ultrasound scanning on
the fifth post-operative day. Early mobilisation was defined as beginning to walk less than
24 hours after knee replacement.
Between April 1997 and July 2002, 98 patients underwent a total of 125 total knee
replacements. They began walking on the second post-operative day unless there was a
medical contraindication. They formed a retrospective control group. A protocol which
allowed patients to start walking at less than 24 hours after surgery was instituted in
August 2002. Between August 2002 and November 2004, 97 patients underwent a total of
122 total knee replacements. They formed the early mobilisation group, in which data
were prospectively gathered. The two groups were of similar age, gender and had similar
medical comorbidities. The surgical technique and tourniquet times were similar and the
same instrumentation was used in nearly all cases. All the patients received
low-molecular-weight heparin thromboprophylaxis and wore compression stockings
post-operatively.
In the early mobilisation group 90 patients (92.8%) began walking successfully within 24
hours of their operation. The incidence of deep-vein thrombosis fell from 27.6% in the
control group to 1.0% in the early mobilisation group (chi-squared test, p < 0.001). There
was a difference in the incidence of risk factors for deep-vein thrombosis between the two
groups. However, multiple logistic regression analysis showed that the institution of an
early mobilisation protocol resulted in a 30-fold reduction in the risk of post-operative
deep-vein thrombosis when we adjusted for other risk factors.
-------------------------------------------------------------------------------Abstract 7 of 29
Accuracy analysis of Iso-C3D versus fluoroscopy-based navigated retrograde drilling of
osteochondral lesions
A PILOT STUDY
M. Citak, MD, Orthopaedic Surgeon1; D. Kendoff, MD, Orthopaedic Surgeon1; M. Kfuri, Jr,
MD, Assistant Professor2; A. Pearle, MD, Orthopaedic Surgeon3; C. Krettek, FRACS, MD,
Professor1; and T. Hüfner, MD, Professor Trauma Department1
1 Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625, Hannover, Germany.
2 Department of Biomechanics, Medicine and Rehabilitation of Locomotor System,
Ribeirão Preto Medical School, São Paulo University, Avenue, Bandeirantes 3900-11O.
andar, 14049-900, Ribeirão Preto, São Paulo, Brazil.
3 Orthopaedic Department, Hospital for Special Surgery, 535 East 70th Street, New York,
10021, New York, USA.
Correspondence should be sent to Dr M. Citak; e-mail: citak.musa@mh-hannover.de
The aim of this pilot study was to evaluate the accuracy of two different methods of
navigated retrograde drilling of talar lesions. Artificial osteochondral talar lesions were
created in 14 cadaver lower limbs. Two methods of navigated drilling were evaluated by
one examiner. Navigated Iso-C3D was used in seven cadavers and 2D fluoroscopy-based
navigation in the remaining seven. Of 14 talar lesions, 12 were successfully targeted by
navigated drilling. In both cases of inaccurate targeting the 2D fluoroscopy-based
navigation was used, missing lesions by 3 mm and 5 mm, respectively. The mean
radiation time was increased using Iso-C3D navigation (23 s; 22 to 24) compared with 2D
fluoroscopy-based navigation (14 s, 11 to 17).
-------------------------------------------------------------------------------Abstract 8 of 29
Botulinum toxin type A as an adjunct to the surgical treatment of the medial rotation
deformity of the shoulder in birth injuries of the brachial plexus
A. E. Price, MD, Orthopaedic Surgeon1; P. DiTaranto, MD, Research Associate2; I.
Yaylali, MD, PhD, Neurophysiologist2; M. A. Tidwell, MD, Orthopaedic Surgeon2; and J. A.
I. Grossman, MD, FACS, Hand Peripheral Nerve Surgeon2
1 Hospital for Joint Diseases, Brachial Plexus Program, 301 East 17th Street, New York,
New York 10003, USA.
2 Miami Children’s Hospital, Brachial Plexus Program, 3100 SW 62nd Avenue, Miami,
Florida 33155, USA.
Correspondence should be sent to Dr J. A. I. Grossman at 8940 N. Kendall Drive, Miami,
Florida 33176, USA; e-mail: info@handandnervespecialist.com
We retrospectively reviewed 26 patients who underwent reconstruction of the shoulder for
a medial rotation contracture after birth injury of the brachial plexus. Of these, 13 patients
with a mean age of 5.8 years (2.8 to 12.9) received an injection of botulinum toxin type A
into the pectoralis major as a surgical adjunct. They were matched with 13 patients with a
mean age of 4.0 years (1.9 to 7.2) who underwent an identical operation before the
introduction of botulinum toxin therapy to our unit.
Pre-operatively, there was no significant difference (p = 0.093) in the modified Gilbert
shoulder scores for the two groups. Post-operatively, the patients who received the
botulinum toxin had significantly better Gilbert shoulder scores (p = 0.012) at a mean
follow-up of three years (1.5 to 9.8).
It appears that botulinum toxin type A produces benefits which are sustained beyond the
period for which the toxin is recognised to be active. We suggest that by temporarily
weakening some of the power of medial rotation, afferent signals to the brain are reduced
and cortical recruitment for the injured nerves is improved.
--------------------------------------------------------------------------------
Abstract 9 of 29
GSB III total elbow replacement in rheumatoid arthritis
M. Cesar, MD, Resident1; Y. Roussanne, MD, Orthopaedic Surgeon1; F. Bonnel, MD,
Orthopaedic Surgeon, Professor, Head of Department1; and F. Canovas, MD, PhD,
Professor of Anatomy and Orthopaedic Surgery1
1 Department of Orthopaedic and Traumatology Surgery Lapeyronie University Hospital,
371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cédex 5, France.
Correspondence should be sent to Dr M. Cesar; e-mail: matthieucesar@yahoo.fr
Between 1993 and 2002, 58 GSB III total elbow replacements were implanted in 45
patients with rheumatoid arthritis by the same surgeon. At the most recent follow-up, five
patients had died (five elbows) and six (nine elbows) had been lost to follow-up, leaving 44
total elbow replacements in 34 patients available for clinical and radiological review at a
mean follow-up of 74 months (25 to 143). There were 26 women and eight men with a
mean age at operation of 55.7 years (24 to 77).
At the latest follow-up, 31 excellent (70%), six good (14%), three fair (7%) and four poor
(9%) results were noted according to the Mayo elbow performance score. Five humeral
(11%) and one ulnar (2%) component were loose according to radiological criteria (type III
or type IV). Of the 44 prostheses, two (5%) had been revised, one for type-IV humeral
loosening after follow-up for ten years and one for fracture of the ulnar component. Seven
elbows had post-operative dysfunction of the ulnar nerve, which was transient in five and
permanent in two.
Despite an increased incidence of loosening with time, the GSB III prosthesis has given
favourable mid-term results in patients with rheumatoid arthritis.
-------------------------------------------------------------------------------Abstract 10 of 29
High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff
A RANDOMISED TRIAL
J.-D. Albert, MD, Rheumatologist1; J. Meadeb, MD, Rheumatologist1; P. Guggenbuhl,
MD, Rheumatologist1; F. Marin, MD, Radiologist2; T. Benkalfate, MD, Orthopaedic
Surgeon3; H. Thomazeau, MD, Professor of Orthopaedic Surgery4; and G. Chalès, MD,
Professor of Rheumatology1
1 Department of Rheumatology
2 Department of Radiology
3 Department of Orthopaedic Surgery, Clinique Mutualiste La Sagesse, 4 place Saint
Guenolè, 35043 Rennes Cedex, France.
4 Department of Orthopaedic Surgery, Hôpital-Sud, Rennes University Hospital, 16
Boulevard de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France.
Correspondence should be sent to Dr J.-D. Albert; e-mail:
jean-david.albert@chu-rennes.fr
In a prospective randomised trial of calcifying tendinitis of the rotator cuff, we compared
the efficacy of dual treatment sessions delivering 2500 extracorporeal shock waves at
either high- or low-energy, via an electromagnetic generator under fluoroscopic guidance.
Patients were eligible for the study if they had more than a three-month history of
calcifying tendinitis of the rotator cuff, with calcification measuring 10 mm or more in
maximum dimension. The primary outcome measure was the change in the Constant and
Murley Score.
A total of 80 patients were enrolled (40 in each group), and were re-evaluated at a mean
of 110 (41 to 255) days after treatment when the increase in Constant and Murley score
was significantly greater (t-test, p = 0.026) in the high-energy treatment group than in the
low-energy group. The improvement from the baseline level was significant in the
high-energy group, with a mean gain of 12.5 (–20.7 to 47.5) points (p < 0.0001). The
improvement was not significant in the low-energy group. Total or subtotal resorption of
the calcification occurred in six patients (15%) in the high-energy group and in two
patients (5%) in the low-energy group.
High-energy shock-wave therapy significantly improves symptoms in refractory calcifying
tendinitis of the shoulder after three months of follow-up, but the calcific deposit remains
unchanged in size in the majority of patients.
-------------------------------------------------------------------------------Abstract 11 of 29
Interbody fusion with allograft and rhBMP-2 leads to consistent fusion but early
subsidence
R Vaidya, MD, FRCS(C), Chief Orthopaedic Surgeon1; R. Weir, MD, Resident,
Orthopaedic Surgeon2; A. Sethi, MD, Orthopaedic Surgeon1; S. Meisterling, MD,
Resident Orthopaedic Surgeon2; W. Hakeos, MD, Resident Orthopaedic Surgeon2; and
C. D. Wybo, MS, Senior Research Engineer2
1 Department of Orthopaedic Surgery, Detroit Receiving Hospital and University Health
Center, 4201 St. Antoire Boulevard. 6A, Detroit, Michigan 48201, USA.
2 Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W Grand Boulevard,
Detroit, Michigan 48202, USA.
Correspondence should be sent to Dr R. Vaidya; e-mail: ravaidya@hotmail.com
We carried out a prospective study to determine whether the addition of a recombinant
human bone morphogenetic protein (rhBMP-2) to a machined allograft spacer would
improve the rate of intervertebral body fusion in the spine. We studied 77 patients who
were to undergo an interbody fusion with allograft and instrumentation. The first 36
patients received allograft with adjuvant rhBMP-2 (allograft/rhBMP-2 group), and the next
41, allograft and demineralised bone matrix (allograft/demineralised bone matrix group).
Each patient was assessed clinically and radiologically both pre-operatively and at each
follow-up visit using standard methods. Follow-up continued for two years.
Every patient in the allograft/rhBMP-2 group had fused by six months. However, early
graft lucency and significant (> 10%) subsidence were seen radiologically in 27 of 55
levels in this group. The mean graft height subsidence was 27% (13% to 42%) for anterior
lumbar interbody fusion, 24% (13% to 40%) for transforaminal lumbar interbody fusion,
and 53% (40% to 58%) for anterior cervical discectomy and fusion. Those who had
undergone fusion using allograft and demineralised bone matrix lost only a mean of 4.6%
(0% to 15%) of their graft height.
Although a high rate of fusion (100%) was achieved with rhBMP-2, significant subsidence
occurred in more than half of the levels (23 of 37) in the lumbar spine and 33% (6 of 18) in
the cervical spine. A 98% fusion rate (62 of 63 levels) was achieved without rhBMP-2 and
without the associated graft subsidence. Consequently, we no longer use rhBMP-2 with
allograft in our practice if the allograft has to provide significant structural support.
-------------------------------------------------------------------------------Abstract 12 of 29
Atypical mycobacterial spondylitis in HIV-negative patients identified by genotyping
S. Danaviah, MMedSc, PhD Student1; S. Govender, FRCS, MD, Professor and Head of
Department2; M. L. Gordon, PhD, Lecturer3; and S. Cassol, PhD, Professor4
1 Africa Centre for Health and Population Studies.
2 Department of Orthopaedic Surgery
3 Department of Virology, Nelson R. Mandela School of Medicine, University of
KwaZulu-Natal, 719 Umbilo Road, Durban, 4013, South Africa.
4 HIV-1 Immunopathology and Therapuetics Research Program, Department of
Immunology, Institute of Pathology, University of Pretoria, 5, Baphela Road Pretoria, 0001,
South Africa.
Correspondence should be sent to Professor S. Govender; e-mail: katia@ukzn.ac.za
Non-tuberculous mycobacterial infections pose a significant diagnostic and therapeutic
challenge. We report two cases of such infection of the spine in HIV-negative patients who
presented with deformity and neurological deficit. The histopathological features in both
specimens were diagnostic of tuberculosis. The isolates were identified as Mycobacterium
intracellulare and M. fortuitum by genotyping (MicroSeq 16S rDNA Full Gene assay) and
as M. tuberculosis and a mycobacterium other than tuberculosis, respectively, by culture.
There is a growing need for molecular diagnostic tools that can differentiate accurately
between M. tuberculosis and atypical mycobacteria, especially in regions of the
developing world which are experiencing an increase in non-tuberculous mycobacterial
infections.
-------------------------------------------------------------------------------Abstract 13 of 29
Subtrochanteric insufficiency fractures in patients on alendronate therapy
A CAUTION
S.-K. Goh, MA, MRCS, Registrar1; K. Y. Yang, FRCS(Orth), Consultant Orthopaedic
Surgeon1; J. S. B. Koh, FRCS(Orth), Consultant Orthopaedic Surgeon1; M. K. Wong,
FRCS(Orth), Senior Consultant Orthopaedic Surgeon1; S. Y. Chua, MRCS, Registrar2; D.
T. C. Chua, FRCS(Orth), Senior Consultant Orthopaedic Surgeon2; and T. S. Howe,
FRCS(Orth), Senior Consultant Orthopaedic Surgeon and Director of Trauma1
1 Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road,
Singapore, 169608, Republic of Singapore.
2 Department of Orthopaedic Surgery, Changi General Hospital, 2, Simei Street 3,
Singapore, 529889, Republic of Singapore.
Correspondence should be sent to Dr S. K. Goh; e-mail: seokiat.goh@cantab.net
We carried out a retrospective review over ten months of patients who had presented with
a low-energy subtrochanteric fracture. We identified 13 women of whom nine were on
long-term alendronate therapy and four were not. The patients treated with alendronate
were younger, with a mean age of 66.9 years (55 to 82) vs 80.3 years (64 to 92) and were
more socially active. The fractures sustained by the patients in the alendronate group
were mainly at the femoral metaphyseal-diaphyseal junction and many had occurred after
minimal trauma. Five of these patients had prodromal pain in the affected hip in the
months preceding the fall, and three demonstrated a stress reaction in the cortex in the
contralateral femur.
Our study suggests that prolonged suppression of bone remodelling with alendronate may
be associated with a new form of insufficiency fracture of the femur. We believe that this
finding is important and indicates the need for caution in the long-term use of alendronate
in the treatment of osteoporosis.
-------------------------------------------------------------------------------Abstract 14 of 29
Monteggia fractures in adults
LONG-TERM RESULTS AND PROGNOSTIC FACTORS
G. G. Konrad, MD, Orthopaedic Surgeon1; K. Kundel, MD, Orthopaedic Surgeon2; P. C.
Kreuz, MD, Orthopaedic Surgeon1; M. Oberst, MD, Orthopaedic Surgeon1; and N. P.
Sudkamp, MD, Orthopaedic Surgeon, Professor1
1 Department of Orthopaedic and Trauma Surgery, Albert-Ludwigs-University, Hugstetter
Strasse 55, 79106, Freiburg, Germany.
2 Orthopaedic and Trauma Surgery, Klinikum Aichach, Krankenhausstrasse 11, 86551,
Aichach, Germany.
Correspondence should be sent to Dr G. G. Konrad; e-mail: gerhard.konrad@aol.com
The objective of this retrospective study was to correlate the Bado and Jupiter
classifications with long-term results after operative treatment of Monteggia fractures in
adults and to determine prognostic factors for functional outcome. Of 63 adult patients
who sustained a Monteggia fracture in a ten-year period, 47 were available for follow-up
after a mean time of 8.4 years (5 to 14). According to the Broberg and Morrey elbow scale,
22 patients (47%) had excellent, 12 (26%) good, nine (19%) fair and four (8%) poor
results at the last follow-up. A total of 12 patients (26%) needed a second operation within
12 months of the initial operation. The mean Broberg and Morrey score was 87.2 (45 to
100) and the mean DASH score was 17.4 (0 to 70). There was a significant correlation
between the two scores (p = 0.01). The following factors were found to be correlated with
a poor clinical outcome: Bado type II fracture, Jupiter type IIa fracture, fracture of the
radial head, coronoid fracture, and complications requiring further surgery.
Bado type II Monteggia fractures, and within this group, Jupiter type IIa fractures, are
frequently associated with fractures of the radial head and the coronoid process, and
should be considered as negative prognostic factors for functional long-term outcome.
Patients with these types of fracture should be informed about the potential risk of
functional deficits and the possible need for further surgery.
-------------------------------------------------------------------------------Abstract 15 of 29
Giant-cell tumour of the knee
THE CONDITION OF THE CARTILAGE AFTER TREATMENT BY CURETTAGE AND
CEMENTING
F. Vult von Steyern, MD, PhD, Orthopaedic Surgeon1; I. Kristiansson, MD, Radiologist2;
K. Jonsson, MD, PhD, Radiologist, Professor of Radiology2; P. Mannfolk, MSc, PhD
Student3; D. Heinegård, MD, PhD, Professor4; and A. Rydholm, MD, PhD, Professor of
Orthopaedic Oncology1
1 Department of Orthopaedics
2 Department of Diagnostic Radiology, Centre for Medical Imaging and Physiology
3 Department of Radiation Physics, Lund University Hospital, SE-221 85, Lund, Sweden.
4 Department of Experimental Medical Sciences, BMC, plan C12, SE-221 84 Lund,
Sweden.
Correspondence should be sent to Dr F. Vult von Steyern; e-mail:
Fredrik.VultvonSteyern@skane.se
We reviewed nine patients at a mean period of 11 years (6 to 16) after curettage and
cementing of a giant-cell tumour around the knee to determine if there were any long-term
adverse effects on the cartilage. Plain radiography, MRI, delayed gadolinium-enhanced
MRI of the cartilage and measurement of the serum level of cartilage oligomeric matrix
protein were carried out. The functional outcome was evaluated using the Lysholm knee
score.
Each patient was physically active and had returned to their previous occupation. Most
participated in recreational sports or exercise.
The mean Lysholm knee score was 92 (83 to 100). Only one patient was found to have
cartilage damage adjacent to the cement. This patient had a history of intra-articular
fracture and local recurrence, leading to degenerative changes.
Interpretation of the data obtained from delayed gadolinium-enhanced MRI of the cartilage
was difficult, with variation in the T1 values which did not correlate with the clinical or
radiological findings. We did not find it helpful in the early diagnosis of degeneration of
cartilage. We also found no obvious correlation between the serum cartilage oligomeric
matrix protein level and the radiological and MR findings, function, time after surgery and
the age of the patient.
In summary, we found no evidence that the long-term presence of cement close to the
knee joint was associated with the development of degenerative osteoarthritis.
-------------------------------------------------------------------------------Abstract 16 of 29
Intercalary femoral reconstruction with extracorporeal irradiated autogenous bone graft in
limb-salvage surgery
A. H. Krieg, MD, Orthopaedic Surgeon1; A. W. Davidson, FRCS(Trauma & Orth),
Consultant Orthopaedic Surgeon2; and P. D. Stalley, FRCS, Orthopaedic Surgeon, Head
of Department3
1 Orthopaedic Department, University Children’s Hospital (UKBB), P. O. Box,
Römergasse 8, 4005 Basel, Switzerland.
2 Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
3 Orthopaedic Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown,
New South Wales 2050, Australia.
Correspondence should be sent to Dr A. H. Krieg; e-mail: andreas.krieg@ukbb.ch
Between 1996 and 2003, 16 patients (nine female, seven male) were treated for a primary
bone sarcoma of the femur by wide local excision of the tumour, extracorporeal irradiation
and re-implantation. An additional vascularised fibular graft was used in 13 patients (81%).
All patients were free from disease when reviewed at a minimum of two years
postoperatively (mean 49.7 months (24 to 96).
There were no cases of infection. Primary union was achieved after a median of nine
months (interquartile range 7 to 11). Five host-donor junctions (16%) united only after a
second procedure. Primary union recurred faster at metaphyseal junctions (94% (15) at a
median of 7.5 months (interquartile range 4 to 12)) than at diaphyseal junctions (75% (12)
at a median of 11.1 months (interquartile range 5 to 18)).
Post-operatively, the median Musculoskeletal Tumour Society score was 85%
(interquartile range 75 to 96) and the median Toronto Extremity Salvage score 94%
(interquartile range 82 to 99). The Mankin score gave a good or excellent result in 14
patients (88%).
The range of movement of the knee was significantly worse when the extracorporeally
irradiated autografts were fixed by plates rather than by nails (p = 0.035).
A total of 16 (62%) of the junctions of the vascularised fibular grafts underwent
hypertrophy, indicating union and loading.
Extracorporeal irradiation autografting with supplementary vascularised fibular grafting is
a promising biological alternative for intercalary reconstruction after wide resection of
malignant bone tumours of the femur.
-------------------------------------------------------------------------------Abstract 17 of 29
Acetabuloplasty for neglected dislocation of the hip in older children
E. Morsi, MD, Professor1
1 Orthopaedic Department Menoufyia University, 25 Elmohtsb Street, Mohrm Bak,
Alexandria, Egypt.
Correspondence should be sent to Professor E. Morsi; e-mail:
Elsayed_morsi@hotmail.com
This paper describes the technique and results of an acetabuloplasty in which the false
acetabulum is turned down to augment the dysplastic true acetabulum at its most
defective part. This operation was performed in 17 hips (16 children), with congenital
dislocation and false acetabula. The mean age at operation was 5.1 years (4 to 8). The
patients were followed clinically and radiologically for a mean of 6.3 years (5 to 10). A total
of 16 hips had excellent results and there was one fair result due to avascular necrosis.
The centre-edge angles and the obliquity of the acetabular roof improved in all cases,
from a mean of –15.9° (–19° to 3°) and 42.6° (33° to 46°) to a mean of 29.5° (20° to 34°)
and 11.9° (9° to 19°), respectively. The technique is not complex and is stable without
internal fixation. It provides a near-normal acetabulum that requires minimal remodelling,
and allows early mobilisation.
-------------------------------------------------------------------------------Abstract 18 of 29
Compliance with continuous passive movement is low after surgical treatment of
idiopathic club foot in infants
A PROSPECTIVE, DOUBLE-BLINDED CLINICAL STUDY
P. Kasten, MD, PhD, Orthopaedic Surgeon1; F. Geiger, MD, Orthopaedic Surgeon1; F.
Zeifang, MD, Orthopaedic Surgeon1; S. Weiss, MD, Orthopaedic Surgeon1; and M.
Thomsen, MD, PhD, Orthopaedic Surgeon and Professor1
1 Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher
Landstrasse 200a, 69118 Heidelberg, Germany.
Correspondence should be sent to Professor M. Thomsen; e-mail:
marc.thomsen@ok.uni-heidelberg.de
Treatment by continuous passive movement at home is an alternative to immobilisation in
a cast after surgery for club foot. Compliance with the recommended treatment, of at least
four hours daily, is unknown. The duration of treatment was measured in 24 of 27
consecutive children with a mean age of 24 months (5 to 75) following posteromedial
release for idiopathic club foot. Only 21% (5) of the children used the continuous passive
movement machine as recommended. The mean duration of treatment at home each day
was 126 minutes (11 to 496). The mean range of movement for plantar flexion improved
from 15.2° (10.0° to 20.6°) to 18.7° (10.0° to 33.0°) and for dorsiflexion from 12.3° (7.4° to
19.4°) to 18.9° (10.0° to 24.1°) (both, p = 0.0001) when the first third of therapy was
compared with the last third.
A low level of patient compliance must be considered when the outcome after treatment at
home is interpreted.
-------------------------------------------------------------------------------Abstract 19 of 29
Correction of neglected idiopathic club foot by the Ponseti method
A. F. Lourenço, MD, Assistant in Pediatric Orthopaedics1; and J. A. Morcuende, MD, PhD,
Assistant Professor2
1 Department of Orthopaedics and Traumatology Federal University of São Paulo, Rua
Napoleão de Barros, 715-04024-002 São Paulo, Brazil.
2 Department of Orthopaedics and Rehabilitation University of Iowa, 200 Hawkins Drive,
Iowa City, Iowa 52242, USA.
Correspondence should be sent to Dr A. F. Lourenço at R. Itajobi, 49 Pacaembu, São
Paulo, São Paulo 01246-010, Brazil; e-mail: alex.dot@uol.com.br
The Ponseti method of treating club foot has been shown to be effective in children up to
two years of age. However, it is not known whether it is successful in older children. We
retrospectively reviewed 17 children (24 feet) with congenital idiopathic club foot who
presented after walking age and had undergone no previous treatment. All were treated
by the method described by Ponseti, with minor modifications. The mean age at
presentation was 3.9 years (1.2 to 9.0) and the mean follow-up was for 3.1 years (2.1 to
5.6). The mean time of immobilisation in a cast was 3.9 months (1.5 to 6.0).
A painless plantigrade foot was obtained in 16 feet without the need for extensive
soft-tissue release and/or bony procedures. Four patients (7 feet) had recurrent equinus
which required a second tenotomy. Failure was observed in five patients (8 feet) who
required a posterior release for full correction of the equinus deformity.
We conclude that the Ponseti method is a safe, effective and low-cost treatment for
neglected idiopathic club foot presenting after walking age.
-------------------------------------------------------------------------------Abstract 20 of 29
Benign solitary schwannomas
A REVIEW OF 234 CASES
D. M. A. Knight, MBBS, MRCS, BSc(Hons), Specialist Registrar in Trauma and
Orthopaedics1; R. Birch, MChir FRCS, Orthopaedic Surgeon PNI Unit1; and J. Pringle,
MBChB, FRCS, Honorary Consultant Histopathologist1
1 Department of Pathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore,
Middlesex HA7 4LP, UK.
Correspondence should be sent to Miss D. M. A. Knight; e-mail: dmaknight@rcsed.ac.uk
We reviewed 234 benign solitary schwannomas treated between 1984 and 2004. The
mean age of the patients was 45.2 years (11 to 82). There were 170 tumours (73%) in the
upper limb, of which 94 (40%) arose from the brachial plexus or other nerves within the
posterior triangle of the neck. Six (2.6%) were located within muscle or bone. Four
patients (1.7%) presented with tetraparesis due to an intraspinal extension.
There were 198 primary referrals (19 of whom had a needle biopsy in the referring unit)
and in these patients the tumour was excised. After having surgery or an open biopsy at
another hospital, a further 36 patients were seen because of increased neurological deficit,
pain or incomplete excision. In these, a nerve repair was performed in 18 and treatment
for pain or paralysis was offered to another 14.
A tender mass was found in 194 (98%) of the primary referrals. A Tinel-like sign was
recorded in 155 (81%). Persistent spontaneous pain occurred in 60 (31%) of the 194 with
tender mass, impairment of cutaneous sensibility in 39 (20%), and muscle weakness in 24
(12%).
After apparently adequate excision, two tumours recurred. No case of malignant
transformation was seen.
-------------------------------------------------------------------------------Abstract 21 of 29
Adamantinoma of the tibia with late skeletal metastasis
AN UNUSUAL PRESENTATION
S. V. Kanakaraddi, MBBS(MS), Post-Graduate Student1; G. Nagaraj, MS, Professor,
Head of Department1; and T. M. Ravinath, MS, Professor1
1 Department of Orthopaedics J. J. M. Medical College, Bapuji Hospital,
Davangere-577004, Karnataka, India.
Correspondence should be sent to Mr S. V. Kanakaraddi; e-mail:
blazedoc1421@yahoo.co.in
Adamantinoma is a rare tumour of long bones that occurs most commonly in the tibia. Its
pathogenesis is unknown. It is locally aggressive and recurrences are common after
resection. Metastases have been reported in 10% to 20% of cases, most commonly in the
lungs and rarely in the lymph nodes. We report a patient who developed a skeletal
metastasis four years after resection of the primary tumour. There was no evidence of
recurrence at the primary site or of secondary deposits in the lungs.
-------------------------------------------------------------------------------Abstract 22 of 29
Intertrochanteric fracture of an arthrodesed hip
A. Manzotti, MD, Orthopaedic Surgeon1; N. Confalonieri, MD, Orthopaedic Surgeon1;
and C. Pullen, FRACS, Orthopaedic Surgeon2
1 1st Orthopaedic Department, C.T.O Hospital, via Bignami 1, Milan, 20172 Italy.
2 Orthopaedic Department, Royal Melbourne Hospital, Gratton Street, Parkville, Victoria,
3050 Australia.
Correspondence should be sent to Dr A. Manzotti at Via Giovanni XXIII n.24, Bettola
d’Adda, 20060 Milan, Italy; e-mail: alf.manzotti@libero.it
We report the case of a 74-year-old woman who sustained an intertrochanteric fracture of
the femoral neck in a previously arthrodesed hip. The hip arthrodesis had been performed
53 years earlier to treat septic arthritis. The fracture was treated successfully using a
double-plating technique with 4.5 mm titanium reconstruction plates.
-------------------------------------------------------------------------------Abstract 23 of 29
Fractures of Corin ‘Taper-Fit’ CDH stems used in ‘cement-in-cement’ revision total hip
replacement
T. W. Briant-Evans, MRCS, Specialist Registrar in Orthopaedics1; M. R. Norton,
FRCS(Orth), Orthopaedic Consultant1; and E. D. Fern, FRCS(Orth), Orthopaedic
Consultant1
1 Department of Orthopaedics, Royal Cornwall Hospitals NHS Trust, Treliske, Truro TR2
4HU, UK.
Correspondence should be sent to Mr T. W. Briant-Evans; e-mail:
tbriantevans@hotmail.com
We describe two cases of fracture of Corin Taper-Fit stems used for cement-in-cement
revision of congenital dysplasia of the hip. Both prostheses were implanted in patients in
their 50s, with high offsets (+7.5 mm and +3.5 mm), one with a large diameter (48 mm)
head and one with a constrained acetabular component. Fracture of the stems took place
at nine months and three years post-operatively following low-demand activity. Both
fractures occurred at the most medial of the two stem introducer holes in the neck of the
prosthesis, a design feature that is unique to the Taper-Fit stem. We would urge caution in
the use of these particular stems for cement-in-cement revisions.
-------------------------------------------------------------------------------Abstract 24 of 29
Remodelling of the distal radius after epiphysiolysis and lengthening
I.-Y. Ok, MD, PhD, Professor1; and S.-J. Kim, MD, PhD, Assistant Professor2
1 Department of Orthopaedic Surgery, KangNam St. Mary’s Hospital, The Catholic
University of Korea School of Medicine, 505 Banpo-dong, Seocho-gu, Seoul, 137-040,
Republic of Korea.
2 Department of Orthopaedic Surgery Uijongbu St. Mary’s Hospital, The Catholic
University of Korea School of Medicine, 65-1 Kumho-dong, Uijongbu-si, Kyunggi-do,
480-717, Republic of Korea.
Correspondence should be sent to Dr S.-J. Kim; e-mail: peter@catholic.ac.kr
Arrest of growth of the distal radius is rare but will produce deformity of the wrist. We
corrected angular deformity and shortening of the distal radius by epiphysiolysis and
gradual lengthening without a corrective osteotomy.
-------------------------------------------------------------------------------Abstract 25 of 29
Patellar tendon lengthening for patella infera using the Ilizarov technique
Y. In, MD, PhD, Assistant Professor1; S.-J. Kim, MD, PhD, Assistant Professor1; and Y.-J.
Kwon, MD, Instructor1
1 Department of Orthopaedic Surgery, Uijongbu St. Mary’s Hospital, The Catholic
University of Korea School of Medicine, 65-1 Kumoh-dong, Uijeonbu-si, Gyeonggi-do,
480-717, Republic of Korea.
Correspondence should be sent to Dr S.-J. Kim; e-mail: peter@catholic.ac.kr
Patella infera can cause knee pain and lead to patellofemoral osteoarthritis. Treatment is
usually unsatisfactory. We describe a case of severe patella infera after operative
treatment for fracture of the patella. We used Ilizarov external fixation and gradual
lengthening of the patellar tendon. The patellar height was restored and the patient’s
symptoms were much improved.
-------------------------------------------------------------------------------Abstract 26 of 29
Effect of vitamin C on fracture healing in elderly Osteogenic Disorder Shionogi rats
T. Alcantara-Martos, MD, PhD, Orthopaedic Surgeon1; A. D. Delgado-Martinez, MD, PhD,
FEBOT Orthopaedic Surgeon, Professor2; M. V. Vega, MD, PhD, Orthopaedic Surgeon
Assistant2; M. T. Carrascal, PhD, Industrial Engineer, Professor3; and L.
Munuera-Martinez, MD, PhD, Orthopaedic Surgeon, Professor4
1 Hospital "San Agustin", Avda de San Cristobal S/N, 23700 Linares, Jaén, Spain.
2 Department of Surgery Ed. B-3, Universidad de Jaén, Campus Lagunillas S/N, 23071
Jaén, Spain.
3 ETS Ingenieros Industriales, UNED, Apdo Correos 60149, 28080, Madrid, Spain.
4 Department of Surgery Universidad Autónoma de Madrid, C/Arzobispo Morcillo S/N,
28046 Madrid, Spain.
Correspondence should be sent to Dr T. Alcantara-Martos at San Sebastián, 75 23640 Torredelcampo, Jaén, Spain; e-mail: toalma@telefonica.net
We studied the effect of vitamin C on fracture healing in the elderly. A total of 80 elderly
Osteogenic Disorder Shionogi rats were divided into four groups with different rates of
vitamin C intake. A closed bilateral fracture was made in the middle third of the femur of
each rat. Five weeks after fracture the femora were analysed by mechanical and
histological testing. The groups with the lower vitamin C intake demonstrated a lower
mechanical resistance of the healing callus and a lower histological grade. The vitamin C
levels in blood during healing correlated with the torque resistance of the callus formed (r
= 0.525). Therefore, the supplementary vitamin C improved the mechanical resistance of
the fracture callus in elderly rats. If these results are similar in humans, vitamin C
supplementation should be recommended during fracture healing in the elderly.
-------------------------------------------------------------------------------Abstract 27 of 29
The effect of the design of the femoral component on the conformity of the patellofemoral
joint in total knee replacement
H.-M. Ma, MD, Orthopaedic Surgeon1; Y.-C. Lu, MD, Orthopaedic Surgeon1; T.-G. Kwok,
MD, FRCS, Orthopaedic Surgeon1; F.-Y. Ho, MS, Researcher2; C.-Y. Huang, MS,
Researcher2; and C.-H. Huang, MD, Professor and Superintendent1
1 Department of Orthopaedic Surgery
2 Biomechanics Laboratory Mackay Memorial Hospital, 92 Sec.Z, Chung-Shan N. Road,
Taipei, Taiwan, Republic of China.
Correspondence should be sent to Professor C.-H. Huang; e-mail:
fyho@ms1.mmh.org.tw
One of the most controversial issues in total knee replacement is whether or not to
resurface the patella. In order to determine the effects of different designs of femoral
component on the conformity of the patellofemoral joint, five different knee prostheses
were investigated. These were Low Contact Stress, the Miller-Galante II, the NexGen, the
Porous-Coated Anatomic, and the Total Condylar prostheses. Three-dimensional models
of the prostheses and a native patella were developed and assessed by computer. The
conformity of the curvature of the five different prosthetic femoral components to their
corresponding patellar implants and to the native patella at different angles of flexion was
assessed by measuring the angles of intersection of tangential lines.
The Total Condylar prosthesis had the lowest conformity with the native patella (mean
8.58°; 0.14° to 29.9°) and with its own patellar component (mean 11.36°; 0.55° to 39.19°).
In the other four prostheses, the conformity was better (mean 2.25°; 0.02° to 10.52°) when
articulated with the corresponding patellar component. The Porous-Coated Anatomic
femoral component showed better conformity (mean 6.51°; 0.07° to 9.89°) than the
Miller-Galante II prosthesis (mean 11.20°; 5.80° to 16.72°) when tested with the native
patella. Although the Nexgen prosthesis had less conformity with the native patella at a
low angle of flexion, this improved at mid (mean 3.57°; 1.40° to 4.56°) or high angles of
flexion (mean 4.54°; 0.91° to 9.39°), respectively. The Low Contact Stress femoral
component had the best conformity with the native patella (mean 2.39°; 0.04° to 4.56°).
There was no significant difference (p > 0.208) between the conformity when tested with
the native patella or its own patellar component at any angle of flexion.
The geometry of the anterior flange of a femoral component affects the conformity of the
patellofemoral joint when articulating with the native patella. A more anatomical design of
femoral component is preferable if the surgeon decides not to resurface the patella at the
time of operation.
-------------------------------------------------------------------------------Abstract 28 of 29
Validation of the lesser sigmoid notch of the ulna as a reference point for accurate
placement of a prosthesis for the head of the radius
A CADAVER STUDY
R. P. van Riet, MD, PhD, Specialist Registrar1; F. van Glabbeek, MD, PhD, Orthopaedic
Surgeon1; W. de Weerdt, MD, Specialist Registrar1; J. Oemar, MD, Specialist Registrar2;
and H. Bortier, MD, PhD, Tenured Professor3
1 University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
2 Atrium Medical Centre, Henri Dunantstraat 5, Postbus 4446, 6401 CX Heerlen, The
Netherlands.
3 University of Antwerp, Groenenborgerlaan 171, 2020 Antwerpen, Belgium.
Correspondence should be sent to Dr R.P. van Riet; e-mail: rogervanriet@hotmail.com
We undertook a study on eight arms from fresh cadavers to define the clinical usefulness
of the lesser sigmoid notch as a landmark when reconstructing the length of the neck of
the radius in replacement of the head with a prosthesis. The head was resected and its
height measured, along with several control measurements. This was compared with in
situ measurements from the stump of the neck to the proximal edge of the lesser sigmoid
notch of the ulna. All the measurements were performed three times by three observers
acting independently.
The results were highly reproducible with intra- and interclass correlations of > 0.99. The
mean difference between the measurement on the excised head and the distance from
the stump of the neck and the lesser sigmoid notch was –0.02 mm (–1.24 to +0.97). This
difference was not statistically significant (p = 0.78).
The proximal edge of the lesser sigmoid notch provides a reliable landmark for positioning
a replacement of the radial head and may have clinical application.
-------------------------------------------------------------------------------Abstract 29 of 29
Antibacterial effect of autologous platelet gel enriched with growth factors and other active
substances
AN IN VITRO STUDY
T. M. Bielecki, MD, PhD, Orthopaedic Surgeon1; T. S. Gazdzik, MD, PhD, Professor1; J.
Arendt, MD, PhD, Professor2; T. Szczepanski, MD, PhD, Pediatrician3; W. Król, MD, PhD,
Professor4; and T. Wielkoszynski, MD, PhD, Senior Researcher5
1 Department and Clinic of Orthopaedics, Medical University of Silesia, Pl. Medyków 1,
41-200, Sosnowiec, Poland.
2 Department and Clinic of General and Gastroenterological Surgery, Medical University
of Silesia, Ul. Zeromskiego 13, 41-300, Bytom, Poland.
3 Department of Pediatric Hematology and Oncology, Medical University of Silesia, Ul. 3
Maja 13-15, 41-800, Katowice, Poland.
4 Department of Microbiology and Immunology
5 Department of Biochemistry, Medical University of Silesia, Ul. Jordana 19, 41-800,
Katowice, Poland.
Correspondence should be sent to Dr T. M. Bielecki; e-mail: tomekbiel@o2.pl
Platelet-rich plasma is a new inductive therapy which is being increasingly used for the
treatment of the complications of bone healing, such as infection and nonunion. The
activator for platelet-rich plasma is a mixture of thrombin and calcium chloride which
produces a platelet-rich gel.
We analysed the antibacterial effect of platelet-rich gel in vitro by using the platelet-rich
plasma samples of 20 volunteers. In vitro laboratory susceptibility to platelet-rich gel was
determined by the Kirby-Bauer disc-diffusion method. Baseline antimicrobial activity was
assessed by measuring the zones of inhibition on agar plates coated with selected
bacterial strains.
Zones of inhibition produced by platelet-rich gel ranged between 6 mm and 24 mm (mean
9.83 mm) in diameter. Platelet-rich gel inhibited the growth of Staphylococcus aureus and
was also active against Escherichia coli. There was no activity against Klebsiella
pneumoniae, Enterococcus faecalis, and Pseudomonas aeruginosa. Moreover,
platelet-rich gel seemed to induce the in vitro growth of Ps. aeruginosa, suggesting that it
may cause an exacerbation of infections with this organism. We believe that a
combination of the inductive and antimicrobial properties of platelet-rich gel can improve
the treatment of infected delayed healing and nonunion.