Volume 19-4, Winter 2010

A multicenter study was conducted to determine the durability and performance of a medially pivoting knee prosthesis in total knee arthroplasty (TKA). Between February 1999 and June 2001, 276 patients underwent 298 primary TKAs at five centers. There were 189 patients (204 knees) available for clinical evaluation after surgery, with an average follow-up of 5.4 years (range, 5.0–7.6 years). The mean age at follow-up was 69 years (range, 39–87 years). The posterior cruciate ligament was resected in 65% of the procedures. Knee Society scores (KSS) and radiographs were assessed for patients who returned for follow-up evaluation. Patients unwilling or unable to return were asked their status via telephone. There were a total of five revisions, and 5-year survivorship using Kaplan–Meier analysis was 97.2%. All radiographs exhibited well-fixed implants with no signs of gross migration or pending failure. Preoperative mean KSS and flexion were 33 and 107°, respectively, improving at latest follow-up to 90 and 121°, respectively. The medial-pivot prosthesis resulted in excellent survivorship with good functional results atmedium-term follow-up. (Journal of Surgical Orthopaedic Advances 19(4):191–195, 2010) Key words: implant, medial-pivot prosthesis, survivorship, total knee arthroplasty

The purpose of this study was to compare open to percutaneous tendo achilles lengthening (TAL) as treatment for equinus deformity (ED) in children with cerebral palsy (CP). Eighteen ambulatory spastic CP children (28 feet) with isolated primary fixed ED were randomized to these two methods and prospectively followed up 7 to 18 months postoperatively (mean 11 months). The study found that the percutaneous TAL gave shorter operative time, shorter hospitalization period, better active dorsal and plantarflexion abilities, better parent satisfaction, and lower complication rate. It was concluded that percutaneous TAL seemed to be superior to the open TAL regarding the studied parameters. (Journal of Surgical Orthopaedic Advances 19(4):196–199, 2010) Key words: cerebral palsy; open tendo-achilles lengthening; outcome; percutaneous tendo-achilles lengthening; spastic equines deformity

Anthropometric data and stature profiling are needed for the accurate sizing of prosthetic systems in total knee arthroplasty (TKA). The purpose of this study was to collect and analyze anthropometric knee data using a virtual surgical method. Computed tomography images (107) from patients (66) of three races were converted to virtual models and oriented with an anatomical coordinate system. The models were used to obtain anterior–posterior, medial–lateral, and condylar spacing measurements. Mean values for all measurements were larger for males than females in the overall population and within each race, and differences between races were observed. Comparisons of males to females from different races showed overlapping mean measurements for males of one race and females of another. These overlaps indicate that certain measurements relevant to TKA system sizing are not strictly related to sex. (Journal of Surgical Orthopaedic Advances 19(4):200–208, 2010) Key words: anthropometric data, computed tomography, distal femur size, implant, stature profiling, TKA, virtual surgery

The management of scaphoid nonunion in heavy manual workers is challenging. Symptoms appear earlier and manual labor-related stress at the operated nonunion site may worsen the postoperative outcome. This study involved 16 heavy manual workers with scaphoid nonunion (11 cases involving the dominant hand) treated by internal fixation and autologous bone grafting. The nonunion was in 12 patients in the waist, in 3 patients in the proximal, and in 1 patient in the distal pole of the scaphoid. Clinical and radiographic evaluation of union was done according to the criteria of Bynum et al. and Fernandez and Eggli. Pain, wrist motion, and grip strength were evaluated and compared to the contralateral side. At a mean follow-up of 24 months (range, 10 months to 6 years), the mean range of motion and the grip strength compared to the contralateral hand were 95% and 91%, respectively. Overall hand function was excellent in 13 patients, good in 2 patients, and fair in 1 patient. All except one patient were pain free and returned to their work without or with minimal complaints at an average of 3.4 months (range, 2–6 months), postoperatively. In 15 patients, scaphoid nonunions healed at a mean time of 64 days. One patient had a reoperation, and union was observed at 90 days after the second operation. In all patients, the radiolunate angle was restored to normal. One patient developed complex regional pain syndrome that resolved completely after 2 months with adequate intensive physical therapy. Clinical symptoms of scaphoid nonunions are moresevere and appear earlier in heavy manual workers; in this group of patients, surgical treatment is necessary. The double-threaded screw provides adequate stabilization for union. Autologous cancellous bone graft, because of its plasticity and malleability to exactly fill the scaphoid defect, is recommended. (Journal of Surgical Orthopaedic Advances 19(4):209–213, 2010) Key words: cancellous bone graft, double-threaded cannulated screws, heavy manual labor, scaphoid nonunion

A magnetic emergency release system was developed for use in halo traction systems. Commercially available rare earth mounting magnets, with selected weight-carrying capacities, along with ferromagnetic receptacles, were used in line between halos and overhead pulleys to both carry the prescribed traction force and provide an emergency release in the event of excessive applied force due to a transportation accident and/or sudden application of full body weight when using overhead walkers equipped with traction systems. The magnet–receptacle pairs were calibrated with an in-line digital scale. Load rate dependencies were noted, indicating that prescribed magnet–receptacle pairs should be chosen to carry at least 110% body weight. This weight capacity is reduced to approximately 88% of body weight during higher loading rates, such as transportation accidents and accidental falls. (Journal of Surgical Orthopaedic Advances 19(4):214–217, 2010) Key words: halo, magnet, release, traction

Ulnar impaction syndrome is a common cause of ulnar-sided wrist pain that is thought to be a result of abutment between the ulna and the ulnar carpus. A systematic review of the literature was conducted to determine the effectiveness of different treatment options in managing ulnar impaction syndrome. PubMed, the Cochrane database, and secondary references were reviewed to identify all Englishlanguage articles with reported results on the treatment of ulnar impaction syndrome. A total of 16 articles met the criteria for review. Three procedures were identified as the most commonly used in treating this syndrome: ulnar shortening osteotomy, the wafer procedure, and the arthroscopic waferprocedure. Mean time to union and percentage nonunion for the osteotomy group was 10.3 weeks and 1.7%, respectively. The overall complication rate for patients in the ulnar shortening osteotomy group, the wafer procedure group, and the arthroscopic wafer group was 30%, 8.8%, and 21%, respectively.The authors were unable to determine a single best treatment option based on the available studies, mainly due to the variability in the reporting of subjective outcome measures. Ulnar shortening osteotomy was associated with a higher complication rate than other procedures. (Journal of Surgical Orthopaedic Advances 19(4):218–222, 2010) Key words: ulnar impaction, ulnocarpal impaction

The purpose of this study was to evaluate the 8-year effect of a hip fracture service on time to surgery; duration of surgery; length of stay in acute care, intensive care, and rehabilitation unit; and incidence of postoperative complications and in-hospital mortality. The study group consisted of 50 female patients 65 years of age or older who were treated for hip fractures in 1999 and 50 case-, age-, and American Society of Anesthesiologists score-matched female patients treated in 2006. Group differences were compared via the Student paired t test and
2 analysis (statistical significance, p
.05). The 2006 group had a significantly shorter mean surgical time than did the 1999 group, but time to surgery did not change. The 2006 group showed improvements (but not statistically significant ones) in length of stay in acute care, intensive care, and rehabilitation unit, and in the incidence of complications and in-hospital mortality. (Journal of Surgical Orthopaedic Advances 19(4):223–228, 2010) Key words: Charlson Comorbidity Index, hip fracture, medical complication, multidisciplinary team, orthogeriatric care

The axillary arch is a variant muscle found in approximately 7% of individuals. Most reports describe its incidental finding in cadaveric limbs. Several reports describe its potential clinical relevance, typically axillary neurovascular compression due to an axillary arch detected at surgical exploration. This report presents a case in which preoperative identification of this muscle led to a limited surgical approach using computed tomography (CT) guided, percutaneously placed, localizing wires. A 32-year-old man presented with intermittent, vague left arm pain and forearm and hand paresthesias that were aggravated with overhead activity. Routine neurologic examination, electrophysiologic testing, as well as CT and magnetic resonance imaging of the shoulder were interpreted as normal. Focused diagnostic ultrasonography of the axillary region did not reveal a definite abnormality. However, retrospective review of the CT with arms overhead during the ultrasound appointment confirmed the presence of an axillary arch compressing the neurovascular bundle. Percutaneous CT guided needle localization wires were placed preoperatively to mark the axillary arch, limit the operative exposure, and simplify the resection. Postoperatively, the patient had complete resolution of his arm symptoms and returned to his premorbid activity as a telephone lineman within 6 weeks. At 3-month follow-up, CT with arms overhead confirmed decompression of the neurovascular bundle. (Journal of Surgical Orthopaedic Advances 19(4):229–233, 2010) Key words: Langer’s axillary arch, latissimus dorsi, neurovascular compression, thoracic outlet syndrome, variant muscle, wire guidance

Subchondral insufficiency fractures of the femoral head have been described in elderly, osteoporotic patients and most commonly occur at the superolateral aspect of the femoral head. This case report describes an insufficiency fracture that involves the posterior inferior aspect of the femoral head in a thin, elderly woman. (Journal of Surgical Orthopaedic Advances 19(4):234–235, 2010) Key words: femoral head impaction fracture, subchondral insufficiency fracture