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<title>Organizations RSS : Gourt</title>
<link>http://www.gourt.com/Health/Medicine/Surgery/Orthopedics/Organizations.html</link>
<description></description>
<dc:language>en-us</dc:language>
<dc:rights>Copyright 2007, Gourt.com</dc:rights>
<dc:date>2012-02-09T03:26+35:00
</dc:date>
<dc:publisher>rtruog@gourt.com</dc:publisher>
<dc:creator>rtruog@gourt.com</dc:creator>
<dc:subject>Organizations RSS : Gourt</dc:subject>
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  <rdf:li rdf:resource="http://www.josr-online.com/content/7/1/3" />
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  <rdf:li rdf:resource="http://www.josr-online.com/content/6/1/64" />
  <rdf:li rdf:resource="http://www.josr-online.com/content/6/1/63" />
  <rdf:li rdf:resource="http://www.josr-online.com/content/6/1/62" />
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<item rdf:about="http://www.josr-online.com/content/7/1/5">
<title>Comparison of cement pressurisation in flanged and unflanged acetabular cups</title>
<link>http://www.josr-online.com/content/7/1/5</link>
<description><![CDATA[Background:
This biomechanical study examined difference in cement pressures generated by flanged and unflanged acetabular cups in hip arthroplasty.MethodUsing a model acetabulum, cement was inserted and pressurised followed by cup insertion and pressurisation. Pressures were recorded using transducers in the acetabulum. We compared Charnley Ogee (flanged), Exeter contemporary (flanged) and Exeter low profile (unflanged) cups using Simplex and CMW1 cements in turn.
Results:
Using Simplex, Charnley Ogee cup generated highest initial peak pressure and overall mean pressure. Exeter unflanged cup generated higher initial and mean pressures compared to Exeter flanged cup. With CMW, there was no significant difference between the pressures generated by the cups.
Conclusions:
Our experiment suggests that flanged cups do not consistently generate significantly higher cement pressures compared to unflanged cups.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/7/1/4">
<title>Mid-term functional outcome after the internal fixation of distal radius fractures</title>
<link>http://www.josr-online.com/content/7/1/4</link>
<description><![CDATA[Background:
Distal radius fracture is a common injury with a variety of operative and non-operative management options.  There remains debate as to the optimal treatment for a given patient and fracture.  Despite the popularity of volar locking plate fixation, there are few  large cohort or long term follow up studies to justify this modality.  Our aim was to report the functional outcome of a large number of patients at a significant follow up time after fixation of their distal radius with a volar locking plate.
Methods:
180 patients with 183 fractures and a mean age of 62.4 years were followed up retrospectively at a mean of 30 months (Standard deviation=10.4).  Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand and modified MAYO wrist scores.  Statistical analysis was performed to identify possible variables affecting outcome and radiographs were assessed to determine time to fracture union.
Results:
The median DASH score was 2.3 and median MAYO score was 90 for the whole group.  Overall, 133 patients (74%) had a good or excellent DASH and MAYO score.  Statistical analysis showed that no specific variable including gender, age, fracture type, post-operative immobilisation or surgeon grade significantly affected outcome.  Complications occurred in 27 patients (15%) and in 11 patients were major (6%).
Conclusion:
This single centre large population series demonstrates good to excellent results in the majority of patients after volar locking plate fixation of the distal radius, with complication rates comparable to other non-operative and operative treatment modalities.  On this basis we recommend this mode of fixation for distal radius fractures requiting operative intervention.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/7/1/3">
<title>Open wedge high tibial osteotomy: cause of patellar descent</title>
<link>http://www.josr-online.com/content/7/1/3</link>
<description><![CDATA[: This was a retrospective review of the nine open wedge high tibial osteotomy (HTO) done in a regional hospital in Hong Kong from 2006 to 2008. The mechanical hip-knee-ankle angle improved from average 169.5 degrees(164-175) to average 183.9 degrees (179-187). Patellar descent was noted in all patients postoperatively, with Blackburne-Peel (BP) index significantly changing from 0.78 (0.64-0.93) to 0.59 (0.38-0.78) (p<0.05). This change was strongly correlated with the size of anterior bone graft (r= -0.766; p= 0.016). The patellar tendon length as measured by Insall-Salvati index was not changed (pre-operative: 1.02 (0.88-1.25), final: 1.09 (0.8-1.22) (p=0.683)), inferring that scarring contracture of patellar tendon was not related to patellar descent.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/7/1/2">
<title>Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview</title>
<link>http://www.josr-online.com/content/7/1/2</link>
<description><![CDATA[Background:
The clavicle hook plate achieves like most other operative techniques, a high percentage of union and a low percentage of complications however concerns about long term complications still exist, particularly the involvement of the acromioclavicular joint.
Methods:
To evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 65 months (5.4 years) of 28 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate.
Results:
Short term functional results in all patients were good to excellent. All but one patient had a united fracture (96%). Nine patients (32%) developed impingement symptoms and in 7 patients (25%) subacromial osteolysis was found. These findings resolved after plate removal. Twenty-four patients were re-evaluated at a mean follow-up period of 5.4 years. The Constant-Murley score was 97 and the DASH score was 3.5. Four patients (14%) developed acromioclavicular joint arthrosis of which one was symptomatic. Three patients (11%) had extra articular ossifications of which one was symptomatic. There was no relation between the impingement symptoms, subacromial osteolysis and development of acromioclavicular joint arthrosis or extra articular ossifications.
Conclusions:
The clavicle hook plate is a good primary treatment option for the acute displaced lateral clavicle fracture with few complications. At mid term the results are excellent and no long term complications can be addressed to the use of the plate.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/7/1/1">
<title>Risk factor analysis for early femoral failure in metal-on-metal hip resurfacing arthroplasty: the effect of bone density and body mass index</title>
<link>http://www.josr-online.com/content/7/1/1</link>
<description><![CDATA[Background:
The importance of appropriately selecting patients based on factors such as bone mineral density, body mass index, age, gender, and femoral component size has been demonstrated in many studies as an aid in decreasing the rate of revisions and improving the outcomes for patients after hip resurfacing arthroplasty (HRA); however, there are few published studies quantitatively specifying the potential risk factors  that affect early femoral component failures.  Therefore, the purpose of this study was to investigate the specific causes of early femoral component failures in hip resurfacing separately and more carefully in order to develop strategies to prevent these failures, rather than excluding groups of patients from this surgical procedure.
Methods:
This retrospective study included 373 metal-on-metal HRAs performed by a single surgeon using the vascular sparing posterior minimally invasive surgical approach. The average length of follow-up was 30+/-6 months.   In order to understand the causes of early femoral failure rate, a multivariable logistic regression model was generated in order to analyze the effects of bone mineral density (T-score), gender, diagnosis, body mass index, femoral implant fixation type, age, and femoral component size.
Results:
The average post-operative Harris hip score was 92+/-11 points and the average post-operative UCLA score was 7+/-2 points.  There were three revisions due to femoral neck fracture and two for femoral component loosening.  These occurred in two female and three male patients. In the multi-variable regression model, only T-score and body mass index showed significant effects on the failure rate of femoral components.  Patients with a lower T-score and a higher body mass index had a significantly increased risk of early femoral component failure.
Conclusions:
We recommend that dual energy x-ray absorptiometry scan T-score tests should be routinely performed on all hip resurfacing patients pre-operatively.  If a patient has a low T-score (=29 kg/m2).]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/6/1/65">
<title>A comparison of Leg Length and Femoral Offset discrepancies in Hip Resurfacing, Large Head Metal-on-Metal and Conventional Total Hip Replacement: a case series</title>
<link>http://www.josr-online.com/content/6/1/65</link>
<description><![CDATA[Background:
A discrepancy in leg length and femoral offset restoration is the leading cause of patient dissatisfaction in hip replacement surgery and has profound implications on patient quality of life. The aim of this study is to compare biomechanical hip reconstruction in hip resurfacing, large-diameter femoral head hip arthroplasty and conventional total hip replacement.MethodSixty patient's post-operative radiographs were reviewed; 20 patients had a hip resurfacing (HR), 20 patients had a Large Head Metal-on-metal (LHM) hip replacement and 20 patients had a conventional small head Total Hip Replacement (THR). The leg length and femoral offset of the operated and unoperated hips were measured and compared.
Results:
Hip resurfacing accurately restored hip biomechanics with no statistical difference in leg length (P=0.07) or femoral offset (P=0.95) between the operated and non-operative hips. Overall HR was superior for reducing femoral offset discrepancies where it had the smallest bilateral difference (-0.2 %, P= 0.9). The traditional total hip replacement was least effective at restoring the hip anatomy.
Conclusion:
The use of a larger-diameter femoral head in hip resurfacing does not fully account for the superior biomechanical restoration, as LHM did not restore femoral offset as accurately.  We conclude that restoration of normal hip biomechanics is best achieved with hip resurfacing.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/6/1/64">
<title>Flexible intramedullary nailing in paediatric femoral fractures. A report of 73 cases</title>
<link>http://www.josr-online.com/content/6/1/64</link>
<description><![CDATA[Background:
Flexible intramedullary nailing has emerged as an accepted procedure for paediatric femoral fractures. Present indications include all patients with femoral shaft fractures and open physis. Despite its excellent reported results, orthopaedic surgeons remain divided in opinion regarding its usefulness and the best material used for nails. We thus undertook a retrospective study of paediatric femoral fractures treated with titanium or stainless steel flexible nails at our institute with a minimum of 5 years follow up.Material and Methods: We included 73 femoral shaft fractures in 69 patients treated with retrograde flexible intramedullary nailing with a minimum follow up of 5 years. Final limb length discrepancy and any angular or rotational deformities were determined.
Results:
Mean age at final follow up was 15.5 years (10-21 years). Mean follow up was 7.16 years (5.0-8.6 years). Titanium and stainless steel nails were used in 43 and 30 cases respectively. There were 51 midshaft, 17 proximal, and 5 distal fractures.All fractures united at an average of 11 weeks but asymptomatic malalignment and LLD were seen in 19% and 58% fractures respectively. LLD ranged from -3 cm to 1.5 cm. Other complications included superficial infection(2), proximal migration of nail(3), irritation at nail insertion site(5) and penetration of femoral neck with nail tip(1). There were 59 excellent, 10 satisfactory and 4 poor results.
Conclusion:
Flexible intramedullary nailing is reliable and safe for treating paediatric femoral shaft fractures. It is relatively free of serious complications despite asymptomatic malalignment and LLD in significant percentage of fractures.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/6/1/63">
<title>Representation to the Accident and Emergency department within 1-year of a fractured neck of femur</title>
<link>http://www.josr-online.com/content/6/1/63</link>
<description><![CDATA[Background:
The fractured neck of femur (NOF) is a leading cause of morbidity and mortality. The mortality attendant upon such fractures is 10% at 1 month and 30% at one year with a cost to the NHS of £1.4 billion annually. This retrospective study sought to examine rates and prevailing trends in representation to A&E in the year following a NOF fracture in an attempt to identify the leading causes behind the morbidity and mortality associated with this fracture.
Methods:
1108 patients who suffered a fractured NOF between 1 January 2002 and 31 December 2007 were identified from a University Hospital A&E database. This database was then used to identify those patients who represented within 1-year following the initial fracture. The presenting complaint, provisional diagnosis and the outcome of this presentation were identified at this time.
Results:
234 patients (21%) returned to A&E on 368 occasions in the year following a hip fracture. 77% (284/368) of these presentations necessitated admission. Falls, infection and fracture were the leading causes of representation. Falls accounted for 20% (57/284) of admissions; 20.7% of patients were admitted because of a fracture, while 56.6% of admissions were for medical ailments of which infection was the chief precipitant (28% (45/161)).DiscussionThe causes for representation are varied and multifactorial. The results of this study suggest that some of those events or ailments necessitating readmission may be obviated and potentially reduced by interventions that can be instituted during the primary admission and continued following discharge.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/6/1/62">
<title>A Rat Model of Early Stage Osteonecrosis Induced by Glucocorticoids</title>
<link>http://www.josr-online.com/content/6/1/62</link>
<description><![CDATA[Background:
Glucocorticoid (GC)-induced osteonecrosis (ON) is an important complication of medical therapy. The exact pathomechanisms of ON has not been clearly elucidated. There is a need for a reproducible animal model that better approximates the clinical scenario.
Methods:
To determine the genetic susceptibility of rats to develop GC-induced femoral head ON, we evaluated 5 different inbred strains of rats (Spontaneous Hypertensive Rat, Wistar Kyoto, Wistar Furth, SASCO Fisher and Lewis). Prednisone pellets (dosage of 1.82-2.56 mg/kg/day) were implanted subcutaneously for 90 days. After 90 days, the femurs were resected and examined histologically and radiographically. Pathological and histological examination was performed. Hematoxylin and eosin (H & E) staining was used to delineate the femoral head osteonecrosis lesions as well as abnormalities of articular cartilage and growth plate.
Results:
The greatest differences in H & E staining were seen in the Wistar Kyoto and Wistar Furth groups.  In these groups 4 out of 5 and 3 out of 5, respectively, steroid-induced rats revealed growth plate disruption with acellular areas. The TUNEL apoptosis staining assay for apoptosis revealed that 4 out of 5 of Wistar Kyoto rats, 5 out of 5 of Wistar Furth, 2 out of 4 of surviving Lewis and 2 out of 2 of the surviving spontaneous hypertensive rats had apoptotic osteocytes in trabeculae, whereas none of the Fisher rats showed apoptotic osteocytes.
Conclusions:
We postulate that Wistar Kyoto, Wistar Furth and spontaneous hypertensive rats may be strains of rats more susceptible to develop ON of the femoral head while Fisher rats were the most resistant.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/6/1/61">
<title>The influence of a weight-bearing platform on the mechanical behavior of two Ilizarov ring fixators: tensioned wires vs. half-pins</title>
<link>http://www.josr-online.com/content/6/1/61</link>
<description><![CDATA[Background:
A weight-bearing platform applied at the distal end of an Ilizarov external frame allows patients with hindfoot transfixations, foot deformities or plantar skin lesions to bear weight. This leads to an indirect loading of the fracture or osteotomy site. However, the effect on the fracture/osteotomy site's motion or compressive loads is unknown. The aim of this study was to analyze the mechanical effects of a weight-bearing platform on the traditional all-wire, four-ring frame in comparison to a two-ring frame consisting of half-pins.
Methods:
Two frame configurations, with either anatomically positioned wires or half-pins, were analyzed with and without a weight-bearing platform applied underneath the distal ring. Composite tibiae with a mid-diaphyseal osteotomy of 3.5 mm were used in all the experiments. An axial load was applied with the use of a universal test machine (UTS®). Interfragmentary movements, the relative movements of bone fragments and movements between rings were recorded using displacement transducers. Compressive loads at the osteotomy site were recorded with loading cells.
Results:
Indirect loading with a weight-bearing platform altered the force transmission through the osteotomy. Indirect loading of the tibiae decreased the extent of the axial micro-motion by 50% under the applied weight load when compared to direct weight loading (p < 0.05). The half pin frame was 25% stiffer than the wire frame under both direct and indirect loading of the tibiae (p < 0.05). Compressive loads under indirect loading were reduced by 67% in the wire frame and by 57% in the half-pin frames compared to direct loading of the bones (p < 0.05). While axial loading in the wire frames resulted in plain axial movements at the site of the osteotomy, it was coupled with translational movements and angular displacements in the half pin mountings. This effect was more apparent in the case of indirect loading.
Conclusions:
A weight-bearing platform has substantial influence on the biomechanical performance of an Ilizarov external fixator. Half-pins induce greater stiffness to the Ilizarov external fixator and allow the usage of only one ring per bone segment, but shear stresses at the osteotomy under axial loading should be considered. The results allow an estimation of the size and direction of interfragmentary movements based on the extent of weight bearing.]]></description>
</item>

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