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Journal Cover Archives of Bone and Joint Surgery
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 2345-4644 - ISSN (Online) 2345-461X
   Published by Mashhad University of Medical Sciences Homepage  [14 journals]
  • Epidemiology of joint dislocations and ligamentous/tendinous injuries
           among 2,700 patients: ...

    • Abstract: Purpose: The epidemiology of traumatic dislocations and ligamentous/tendinous injuries is poorly understood. In this study, we aimed to evaluate the prevalence and distribution of various dislocations and ligamentous/tendinous injuries in a tertiary orthopedic hospital in Iran. Methods: In a 5-year prospective study, musculoskeletal injuries of an academic tertiary health care center in Tehran were recorded. Demographic details of patients with diagnosis of pure dislocations and ligamentous/tendinous injuries were extracted. Type and site of injuries were classified according to specific age/gender groups. Result: Of 18,890 admitted patients, 628 (3.3%) were diagnosed with dislocations and 2,081 (11%) were diagnosed with ligamentous/tendinous injuries. The total Male/Female ratio was 4.2:1 in patients with dislocations and 1.7:1 in patients with ligamentous/tendinous injuries. The most prevalent site of dislocation was shoulder (50.6%), followed by fingers (10.1%), toes (7.6%), hip (7.3%), and elbow (6.5%). Ankle was the most common site of ligamentous/tendinous injury (53.5%), followed by midfoot (12.3%), knee (8.3%), hand (7%), and shoulder (5%). The mean age of the patients was 35.0 (SD = 18.2) in dislocations and 31.3 (SD = 15.1) in ligamentous/tendinous injuries. There was no seasonal variation. Conclusion: Shoulder dislocation and ankle ligamentous injury are the most frequent injuries. Dislocations and ligamentous/tendinous injuries are more common in younger population. Dislocations and ligamentous/tendinous injuries have different distribution patterns in specific age and sex groups. Epidemiologic studies can help to develop and evaluate injury prevention strategies, resource allocation, and training priorities.
      PubDate: Sun, 28 May 2017 19:30:00 +010
  • Comparison of Clinical Outcomes Between Different Femoral Tunnel Positions
           after Anterior ...

    • Abstract: Purpose: This study investigated whether a change in the femoral tunnel position in both axial and coronal planes can significantly alter the postoperative functional and clinical outcomes of the patients. Method: This comparative, retrospective, single-center study was performed on 44 patients who had underwent single-bundle Anterior Cruciate Ligament Reconstruction (ACLR). To evaluate the tunnel position in coronal and axial planes, radiographic assessments were done. Based on radiographic data, the patients were classified into 4 groups. The time interval between surgery and last visit averaged 23.6 ± 2.2 months (18-30 mos.). Lysholm knee score, and Cincinnati score were completed for all of the patients. Furthermore, the Lachman, anterior drawer and pivot-shift tests were performed. Results: Of the 44 patients included in the study, 9 patients (20.4%) were classified as the low-anterior group, 17(38.6%) were classified as the low-posterior group and 18(40.9%) were classified as the high-posterior group. None of the patients were included in high-anterior group. A greater mean Lysholm score (96±3) in low-posterior group was the only significant difference between the three groups. Conclusion: Findings of the current study demonstrated that low-posterior placement of the femoral tunnel in the intrercondylar notch, based on both anteroposterior (AP) and tunnel-view x-rays, is associated with better clinical outcomes in short-term than the routine tunnel placements.
      PubDate: Wed, 24 May 2017 19:30:00 +010
  • First metatarsophalangeal joint arthrodesis: a retrospective comparison of
           crossed-screws, ...

    • Abstract: Background:Locking plate fixation is increasingly used for first metatarsophalangeal joint (MTP-I) arthrodesis. Still there is few comparable clinical data regarding this procedure. Methods:We retrospectively evaluated 60 patients who received an arthrodesis of the MTP-I between January 2008 and June 2010. With 20 patients each we performed a locking plate fixation with lag screw, arthrodesis with crossed-screwsor with a nonlocking plate with lag screw. Results: There were four non-unions in crossed-screws patients and one nonunion in non-locked plate group. All the patients in locking plate group achieved union. 90% of the patients were completely or mildly satisfied in locking plate group, whereas this rate was 80% for patients in both crossed screws and non-locking plate groups. Conclusions: Use of dorsal plating for arthrodesis of MTP1 joint either locking or non-locking were associated with high union rate and acceptable and comparable functional outcome. Although nonunion rate was high using two crossed screws but functional outcome was not significantly different compare to dorsal plating. Level of evidence:Ш, retrospective comparative study
      PubDate: Mon, 22 May 2017 19:30:00 +010
  • Total Knee Arthroplasty in Patients with Retention of Prior Hardware
           Material: What is the Outcome'

    • Abstract: Background: There is an information gap in literature regarding postoperative outcome of total knee arthroplasty (TKA) in patients with hardware in-situ from the previous knee surgery. The present study aims to evaluate impact of retained hardware on short-term outcome of TKA patients. Methods: Perioperative radiographs of patients who had undergone TKA between 2007 and 2012 were reviewed and patients in whom partial or complete retention of hardware was evident after TKA were included. These patients were matched in 1 to 2 ratio based on age (+/- 2 years), gender, surgeon and year of surgery to a group of patients that underwent primary TKA without hardware in the affected knee. The average follow up of these patients was 43.45 (range 12-155.2) months. Complication rates were compared between the two groups using statistical tests that took into account the matched data structure. Results: We included a total of 55 cases and 110 controls. The incidence of complications was higher, although not all statistically significant, in the case group. Only mechanical complications were significantly different in the cases group (5.5% versus 0%, p=0.01). Time to event analysis using the mixed-effects Cox model didn’t show a statistically significant difference between two groups for various outcomes. Conclusions: Presence of retained hardware around the knee may predispose the patient to a higher rate of complications particularly mechanical complications of the implant after TKA. Further studies are required to investigate impact of retained hardware around the knee in patients undergoing TKA.
      PubDate: Fri, 12 May 2017 19:30:00 +010
  • Important Lessons Learned From Nearly a Half-Century of Orthopedic

    • Abstract: “Those who cannot remember the past are condemned to repeat it” [1]. The famous quote from Hispanic American philosopher George Santayana reminds us of the critical importance of constantly reflecting on the most important lessons garnered from both our own personal experiences and those of our peers. In 49 years of academic orthopedic practice, I have frequently reflected on the most important lessons I have learned, and to which, in addition to hard work and perhaps simple luck, I attribute much of my success
      PubDate: Wed, 10 May 2017 19:30:00 +010
  • Preoperative Sterilization Preparation of the Shoulder: A Comparative
           Study Evaluating Gauze ...

    • Abstract: Introduction: Surgical site infection (SSI) remains a concern in shoulder surgery, especially during arthroplasty. While many studies have explored the characteristics and efficacy of different sterilizing solutions, no study has evaluated the method of application. The purpose of this study was to compare two popular pre-surgical preparatory applications (two 4 x 4 cm gauze sponges and applicator stick) in their ability to cover the skin of the shoulder. Methods: Two orthopedic surgeons simulated the standard pre-surgical skin preparation on 22 shoulders of volunteer subjects. Each surgeon alternated between an applicator stick and two sterile 4x4 cm gauze sponges. Skin preparation was performed with a commercially available solution that can be illuminated under UV-A light. Advanced image-analysis software was utilized to determine un-prepped areas. A two-tailed paired t-test was performed to compare percentage of un-prepped skin. Results: The applicator stick method resulted in a significantly higher percentage of un-prepped skin (27.25%, Range 10-49.3) than the gauze sponge method (15.37%, Range 5-32.8, p=0.002). Based on image evaluation, most un-prepped areas were present around the axilla [Figure 1]. Conclusion: Based on our findings, the use of simple gauze sponges for pre-surgical preparatory application of sterilization solution may result in a lower percent of un-prepped skin than commercially available applicator stick. Orthopaedic surgeons and operating room staff should be careful during the pre-surgical sterile preparation of the shoulder, especially the region around the axilla, in order to reduce the potential risk of surgical site infection.
      PubDate: Wed, 10 May 2017 19:30:00 +010
  • Early versus Late Reverse Shoulder Arthroplasty for Proximal Humerus
           Fractures: Does it Matter'

    • Abstract: Background: This study compared the outcomes between patients with proximal humerus fractures (PHF) who underwent acute reverse total shoulder arthroplasty (RSA) to those who underwent an alternative initial treatment before requiring (secondary) RSA. Methods: Patients who underwent RSA after suffering a PHF were identified. Two year clinical follow-up was required for inclusion. Patients were divided into an acute group (RSA Results: Forty-seven patients met inclusion criteria with 15 in the acute RSA group and 32 in the secondary RSA group. The acute RSA group demonstrated better external rotation (28˚) than the secondary RSA group (18˚, p=0.0495). The acute RSA group showed a trend towards better Single Assessment Numeric Evaluation (SANE) scores. Tuberosity healing rate was higher in the acute RSA group. Conclusion: While acute and secondary RSA can yield successful outcomes, acute RSA results in a higher tuberosity healing rate and improved external rotation.
      PubDate: Wed, 10 May 2017 19:30:00 +010
  • Is it “Fractured” or “Broken”' A patient survey study to
           assess injury comprehension ...

    • Abstract: Introduction: Patients who sustain orthopaedic trauma in the form of fractures commonly ask treating providers whether the bone is “fractured” or “broken”. While orthopaedic surgeons consider these terms synonymous, patients appear to comprehend the terms as having different meanings. Given the commonality of this frequently posed question, it may be important for providers to assess patients’ level of understanding in order to provide optimal care. The purpose of this study is to evaluate patients’ comprehension and understanding regarding the use of the terms fractured and broken. Methods: A survey was administered as a patient-quality measure to patients, family members and/or other non-patients presenting to an orthopaedic outpatient clinic at an academic teaching hospital. Results: 200 responders met inclusion criteria. Only 45% of responders understood the terms fractured and broken to be synonymous. Age, gender, nor ethnicity correlated with understanding of terminology. Responders described a “fractured” bone using synonyms of less severe characteristics for 55.7% of their answers and chose more severe characteristics 44.3% of the time, whereas responders chose synonyms to describe a "broken” bone with more severe characteristics as an answer in 62.1% of cases and chose less severe characteristics 37.9% of the time. The difference for each group was statistically significant (P-Value = 0.0458 and P-Value = < .00001, respectively).There was no correlation between level of education nor having a personal orthopaedic history of a previous fracture with understanding the terms fracture and broken as synonymous. Having an occupation in the medical field significantly improved understanding of terminology. Conclusion: The majority of people, regardless of the age, gender, race, education or history of previous fracture, may not understand that fractured and broken are synonymous terms. Providers need to be cognizant of the terminology they use when describing a patient's injury in order to optimize patient understanding and care.
      PubDate: Wed, 10 May 2017 19:30:00 +010

    • Abstract: Osteoporosis has become a major medical problem as the aged population of the world rapidly grows. Osteoporosis predisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concern before performing spine surgery, especially with bone fusions and instrumentation. Osteoporosis has often been considered a contraindication for spinal surgery, while in some instances patients have undergone limited and inadequate procedures in order to avoid concomitant instrumentation. As the population ages and the expectations of older patients increase, the demand for surgical treatment in older patients with osteoporosis and spinal degenerative diseases becomes progressively more important. Nowadays, advances in surgical and anesthetic technology make it possible to operate successfully on elderly patients who no longer accept disabling physical conditions. This article discusses the biomechanics of the osteoporotic spine, the diagnosis and management of osteoporotic patients with spinal conditions, as well as the novel treatments, recommendations, surgical indications, strategies and instrumentation in patients with osteoporosis who need spine operations.
      PubDate: Wed, 10 May 2017 19:30:00 +010
  • A single femoral component for all total hip replacements performed by a
           trust' Does this ...

    • Abstract: Background: Hospitals may be under pressure to implement cost saving strategies regarding prosthesis choice. This may involve the use of components which are not the first preference of individual surgeons, or those they have little experience with. We aim to examine the effect of standardizing the type of femoral stem used in a single trust, and determine whether this is safe practice, particularly in those who have never used this particular stem before. Methods: We report results at 2 years of 151 primary total hip arthroplasties performed using a single femoral stem. Data was split into 2 groups: those in which the operating surgeon was previously using this femoral stem, and those who were not. Radiographic outcomes measured were leg length discrepancy, cement mantle grade, and femoral stem alignment. We also report on clinical outcomes, complications, and construct survivability. Results: No significant differences in clinical outcomes were observed. Cement quality was generally worse in those with no prior use of this stem. Leg length inequality was greater in those previously using the stem (+1.57mm vs 3.83mm), however this did not correlate to clinical outcomes. Alignment was similar between the groups (p = 0.464) Conclusion: Our findings suggest that although clinical outcomes are similar at 2 years, radiological differences can be observed even at this early stage in follow up. Choice of components for arthroplasty should remain surgeon led until long term follow up studies can prove otherwise.
      PubDate: Wed, 10 May 2017 19:30:00 +010
  • Adductor Canal Block for Knee Surgeries: An Emerging Analgesic Technique

    • Abstract: In recent years, adductor canal block (ACB) has been introduced as an alternative for femoral nerve block with a great advantage of preserving or minimally reducing quadriceps strength. The technique is relatively easy and is performed under ultrasound guidance. Despite growing evidence regarding efficacy and safety of ACB following knee surgery, use of ACB is still limited to high volume orthopedic centers where trained anesthesiologists in regional anesthesia are available. In this editorial, we aim to briefly review current evidence about ACB.
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • The Prevalence of Unanticipated Hamate Hook Abnormalities in Computed
           Tomography Scans: A ...

    • Abstract:  Background:It is possible that some hamate hook fractures are not diagnosed or treated, thereby affecting the study of their natural history. Study of the prevalence of incidental hamate hook fractures, nonunions, and other abnormalities on computed tomography (CT) ordered for another reason could document a subset of undiagnosed and untreated hamate hook fractures which might change our understanding about the natural history.Methods: Reports of 2489 hand, wrist, and forearm CT scans for hamate hook abnormalities were searched. We excluded 19 patients with anticipated hamate fractures and 1 patient that had a hamate hook excision. Twenty-eight patients had an unanticipated hamate hook abnormality.Results: There was a significant difference in the prevalence of incidental hamate hook abnormalities by sex but not by age. Among the 28 unexpected hamate hook abnormalities, there were 16 fractures of the base (12 acute, 1 nonunion, and 3 of uncertain age), 5 acute oblique fractures, and 7 tip abnormalities/ossicles. The patient with an incidental nonunion had a CT scan for wrist pain and was diagnosed with gout.All fractures involved a direct blow to the hand (distal radius or scaphoid fracture, or crush injury). The 7 patients with a hamate tip abnormality had a CT scan for a distal radius or metacarpal fracture, crush injury or wrist pain. Five acute fractures were treated operatively with excision and the other 23 fractures were treated nonoperatively.Conclusion: Hamate fractures can be diagnosed incidental to other hand and wrist problems on CT.  
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • An Assessment of Online Reviews of Hand Surgeons

    • Abstract:  Background: The purpose of this study is to evaluate the number of reviews and scores for active members of the American Society for Surgery of the Hand (ASSH) in popular physician rating websites ( and A total of 433 ASSH active members were searched in two popular rating websites for a total of 866 web searches. Demographic data, overall and subcategory scores, number of reviews, and wait times were scored from each member’s webpage.Results: The average number of reviews per surgeon on and were 13.8 (range 1-108) and 9.4 (range 0-148), respectively. The average overall score for physicians was 8.1 out of 10 points. For both websites, the vast majority (80-90%) of active members of the ASSH had 20 or less reviews. Multivariate data analysis revealed no statistical differences in overall score by region (P=0.24) or gender (P=0.38). Increasing physician age negatively correlated with overall score (P=0.01). Wait time was not associated with a negative score (P=0.38).Conclusion: Active members of the ASSH received generally positive reviews. The average number of reviews for active members of the ASSH was exceedingly small, bringing into question the legitimacy and validity of these scores. This is especially important when taking into consideration the increasing popularity of these websites, and the reliance of patients on them to obtain physician information. The clinical implication of this study is that physicians have a vested interest in the legitimacy of the data provided by these websites and other physician rating outlets.
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • A Comparison of Patients Absorption Doses with Bone Deformity Due to the
           EOS Imaging and ...

    • Abstract:  Background: This study has aimed to measure the patient dose in entire spine radiography by EOS system in comparison with the digital radiography. Methods: EOS stereo-radiography was used for frontal and lateral view spine imaging in 41 patients in a prospective analytical study. A calibrated dose area product (DAP) meter was used for calibration of the DAP in EOS system. The accuracy and precision of the system was confirmed according to the acceptance testing. The same procedure was used for 18 patients referred for lumbar spine digital radiology (overall 36 images). Results: Although radiation fields in the EOS were almost twice of that in digital radiology, and the average peak tube voltage (kVp), current supply to the tube (mA), and the average size and age of the patients referred for EOS imaging were greater than digital radiology, however, the average DAP in EOS was 1/5 of that in digital radiology system. Also, the average dose in the EOS was about 1/20 of that in digital radiology. Conclusion: The patient dose in EOS imaging system was lower in comparison with digital radiology (1/20).
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • Evaluation of Changes in the Tibiotalar joint after High Tibial Osteotomy

    • Abstract: Background: There are limited studies regarding the effects of high tibial osteotomy (HTO) on other areas of lower extremity. In current study, we investigated the changes of tibiotalar joint following HTO. Methods: A total of 39 patients with genu varum requiring HTO were enrolled in this before and after study. The genu varus, joint diversion (JDA), lateral distal tibial (LDTA) and lateral distal tibial-ground surface (LDT-GSA) angles were measured before the operation and compared with 6 months after the surgery. Results: Twenty threeout of39 patients (59%) were females. The genu varus angle decreased significantly (130±1.70versus 0.60±10). No significant changes were seen in JDA (P=0.45) and LDTA (P=0.071). LDT-GSA changed significantly (P=0.011) from 8.10±10 in varus to -0.30±0.50 in valgus. Conclusion: Although HTO did not change the JDA and LDTA, however, significant change in LDT-GSAindicates that HTO can significantly decrease the shearing forces exerted on the ankle joint.
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • Responsiveness of Static and Dynamic Postural Balance Measures in Patients
           with Anterior ...

    • Abstract: Background:The main goal of physiotherapy for patients with anterior cruciate ligament reconstruction (ACL-R) is to improve postural control and retain knee function. Therefore, clinicians need to use evaluative tools that assess postural changes during physiotherapy. To maximize the clinical utility of the results of these tools, the extracted measures should have appropriate psychometric properties of reliability, validity and responsiveness. No study has yet addressed responsiveness of postural measures in these patients. This study was designed to investigate the responsiveness and determine the minimal clinically important changes (MCIC) of static and dynamic postural measures in patients with (ACL-R) following physiotherapy. Methods: Static and dynamic postural measures were evaluated at first occasion and again after four weeks physiotherapy. The static measures consisted of center of pressure (COP) parameters while dynamic measures included the stability indices. Correlation analysis and ROC curve were applied for assessing the responsiveness. Results:The meanand SD velocity of COP had acceptable responsiveness in both conditions of standing on injured leg with open-eyes and on uninjured leg with closed-eyes, both with nocognitive task. For dynamic measures, stability indices in double-leg standing with closed-eyes with cognitive task condition attained acceptable responsiveness. MCICs for mean and SD velocity in anteroposterior and mediolateral directions were 0.28cm/s, 0.008cm/s, 0.02cm/s, respectively in standing on injured leg with open-eyes; and 0.14cm/s, 0.07cm/s, 0.06cm/s, respectively in uninjured leg with closed-eyes condition. Also, MCICs for anteroposterior, mediolateral and total stability indices were 0.51◦, 0.37◦, 0.34◦, respectively in DCT condition. Conclusion:Our findings provide evidence for selection of appropriate static and dynamic postural measures for assessment of changes in these patients. MCICs for these measures were determined, which provide practical information for clinicians to make decision on clinical significance of changes in patients’ status.
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • Ponseti Casting Method in Idiopathic Congenital Clubfoot and Its
           Correlation with Radiographic ...

    • Abstract: Background: The aim of this study was to evaluate the idiopathic congenital clubfoot deformity treated by Ponseti method to determine the different factors such as radiological investigations that may have relations with the risk of failure and recurrence in mid-term follow-up of the patients. Methods: Since 2006 to 2011, 226 feet from 149 patients with idiopathic congenital clubfoot were treated with weekly castings by Ponseti method. Anteroposterior and lateral foot radiographies were performed at the final follow-up visit and the data from clinical and radiological outcomes were analysed. Results: In our patients, 191(84.9%) feet required percutaneous tenotomy. The successful correction rate was 92% indication no need for further surgical correction. No significant correlation was found between the remained deformity rate and the severity of the deformity and compliance of using the brace (P=0.108 and 0.207 respectively). The remained deformity rate had an inverse association with the beginning age of treatment (P=0.049). No significant correlation was found between the percutaneous tetonomy and passive dorsiflexion range (P=0.356). Conclusion: According to our results treatment with the Ponseti method resulted in poor or no correlation. The diagnosis of clubfoot is a clinical judgment; therefore, the outcome of the treatment must only be clinically evaluated. Although the Ponseti method can retrieve the normal shape of the foot, it fails to treat the bone deformities and eventually leads to remained radiologic deformity. Further studiesare suggested to define a different modification that can address the abnormal angles between the foot and ankle bones to minimize the risk of recurrence.
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • Comparison of Double and Single Leg Weight-Bearing Radiography in
           Determining Knee Alignment

    • Abstract:  Background: Knee malalignment is an important modifiable cause of osteoarthritis (OA). Surgical therapeutic procedures depend on proper knee alignment assessment. The purpose of this study was to compare knee alignment parameters between double and single leg weight-bearing radiographs and to evaluate the reproducibility of inter- and intra-observer measurements. Methods: One hundred eight patients (59 male and 49 female) with knee deformity visited at Kerman Knee Clinic were selected. Full limb anteroposterior (AP) Radiographs were taken for each participant in double and single leg weight-bearing positions. Hip-Knee-Ankle Angle (HKAA), Medial-Proximal-Tibial Angle (MPTA), Lateral-Distal-Femoral Angle (LDFA) and Joint-Line-Convergence Angle (JLCA) measured. Images stored on PC were examined by three observers to assess inter and intra observer reproducibility. Data analysis was done by SPSS software. Results: The mean age of patients was 48.4 (±6.84) years, mean BMI was 26.55 (±1.94) Kg/m2. The mean HKAA and JLCA were significantly different between double and single leg weight-bearing radiographs. Intraclass correlation coefficient (ICC) test showed high (0.99) inter-reproducibility between three observers in all cases, except one (ICC=0.92). Intra-observer reproducibility indicated a strong correlation between the observer’s measurements at different times (ICC > 0.99). Conclusion: HKAA and JLCA were affected by the patient’s position. Observer and time interval had no effect on either of HKAA, MPTA, LDFA, and JLCA. Also the measurement of knee alignment parameters was not dependent on observer’s experience. In conclusion single leg weight-bearing radiography is more representative of knee alignment and is inter and intra-observer reproducible.
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • The Effect of Dynamic Hyperextension Brace on Osteoporosis and
           Hyperkyphosis Reduction in ...

    • Abstract: Background: Osteoporosis and hyperkyphosis could impose a considerable financial and therapeutic burden on the affected society. Thus, new strategies to prevent or manage such complications are of significant importance. Here we evaluate the effect of ‘Dynamic Hyperextension Brace’ (DHB) on bone density, and hyperkyphosis correction. Methods:Sixty postmenopausal women were randomly assigned to the case and control groups and followed for one year. DHB was applied in the case group according to the pre-designed protocol and the patients’ clinical and paraclinical parameters, including bone mineral density (BMD), kyphosis angle, osteoporotic fracture, and serum alkaline phosphatase (ALP) were evaluated in two groups. Results:Despite no significant difference in basic BMD and kyphosis between the case and control groups, BMD and kyphosis were significantly improved in the DHB treated group, at the end of the study (P=0.003 and P=0.001, respectively). Serum ALP level was significantly higher in cases compared to the controls (P=0.48). The vertebral fracture rate was also lower in the case group compared to the controls. Conclusion:The efficacy of bracing in osteoporosis and kyphosis management should be more emphasized. However, more detailed and controlled studies with more patients and a longer follow-up period is needed to adequately evaluate the long-term results of braces, including DHB.
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • Epidemiological Profile of Extremity Fractures and Dislocations in Road
           Traffic Accidents in ...

    • Abstract: Background: Apart from the mortality, road traffic injuries are associated with significant morbidities. This study has aimed to examine the pattern of traffic accident-related extremity fractures/dislocations and their related disabilities. Methods: A retrospective hospital-based study was conducted to assess the characteristics of limb fractures/dislocations among road traffic accident victims registered in Trauma Research Center registry of Kashan University of Medical Sciences, Kashan, Iran, during 2012-2013. Age and sex distribution, cause of injury, and site of fractures/dislocations were recorded. Years lived with disability (YLD) was calculated as a scale to measure the disability. One-way ANOVA and chi-square tests were used for data analysis. Results: From a total of 962 subjects, 812 (84.4%) were males (the male/female sex ratio: 5.4:1). The mean age of victims was 32.7±17.9. Leg (37%) and forearm (19%) fractures were the most frequent fractures. Shoulder dislocations were among the most affected joints accounting for 36.6% of the cases. The total calculated YLD was 135.6 (34.4 for temporal and 101.2 for lifelong disabilities, and totally 117.3 and 18.3 for males and females, respectively). The highest YLD was for motorcyclists (104) and while the most YLD was for 15-29 years (68.2). Conclusion: Young men motorcyclist accidents are a major problem in Kashan region. Generally, they have been accounted for the highest YLD due to fractures/dislocations, especially in lower extremity. Although the calculated YLD will be decreased with increasing age, the elder people also had the high rate of traffic-related limb injuries.
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • Nail Psoriasis Triggered by the Reconstruction of Syndactyly

    • Abstract:  Koebner phenomenon is observed in a number of inflammatory skin diseases. Psoriasis is one of the most common skin diseases associated with Koebner phenomenon. Nail psoriasis may be developed independently from inflammatory arthritis and skin psoriasis. This study reports on the reconstruction of third web of a 30-year-old woman, which performed on her right, due to congenital syndactyly. Four months postoperatively, she developed nail dystrophy, onycholysis and onychorrhexis of the middle, ring and little fingernails. The clinical and histopathology findings were compatible with diagnosis of isolated nail psoriasis.
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • Chronic Recurrent Multifocal Osteomyelitis in a 9-year-old Boy

    • Abstract:   Chronic recurrent multifocal osteomyelitis (CRMO) is a rare aseptic, auto-inflammatory bone disorder. CRMO presents with bone pain with or without fever. The diagnosis of CRMO is a diagnosis of exclusion and should be included in the differential diagnosis of chronic inflammatory bone lesions in children. Cultures of the bone are typically sterile, antibiotic therapy does not result in clinical improvement whereas anti-inflammatory drugs improve the condition. Furthermore, biopsy should be considered in chronic and relapsing bone pain and swelling unresponsive to treatment. Herein, we present a nine-year-old boy complaining of recurrent pain in his upper and lower extremities. On examination he had mild fever and cervical lymphadenopathy. He also had experienced bone pain and weight loss in the recent month. Based on biopsy and bone scan he was finally diagnosed with CRMO. Naproxen and Pamidronate was prescribed and he was getting better and returned to normal life and activity without need to corticosteroids.
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • Anatomic Spring Ligament and Posterior Tibial Tendon Reconstruction: New
           Concept of Double ...

    • Abstract:   A new technique in spring ligament reconstruction using medial half of posterior tibial tendon is demonstrated as a means of supporting the arch. In addition a new concept of double bundle PTT reconstruction based on anatomical attachments of original PTT is presented with the goal of obtaining the full function of PTT.
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • DDH Epidemiology Revisited , Do We Need New Strategies'

    • Abstract: DDH Epidemiology Revisited , Do We Need New Strategies' Introduction: Developmental Dysplasia of the Hip (DDH), is well known to pediatric orthopedists but its etiology still remains unknown. Although a vast majority of research are dedicated to this, but the results are confusing and inadequate. Material and method: 1073 neonates’ hips were examined by sonography and the results were classified according to Graf’s classification. Pathologic hips were cross checked by known risk factors for DDH. Result: There is a significant correlation between DDH occurrence and breech presentation, torticollis, positive family history, metatarsus adductus and oligohydramnious. Conclusion:Incidence of DDH is significantly high in this group of neonates. This make us reevaluate our current approach to this condition .We need to improve our screening protocols with the help of trained pediatricians, sonographists and other health professions. Keywords: congenital hip dysplasia, medical sonography, incidence study.
      PubDate: Mon, 24 Apr 2017 19:30:00 +010
  • Blood Glucose Levels in Diabetic Patients Following Corticosteroid
           Injections into the ...

    • Abstract: Introduction Corticosteroid injections are used to treat a variety of orthopedic conditions with the goal of decreasing pain and inflammation. Administration of systemic or local corticosteroids risks temporarily increasing blood glucose levels, especially diabetic patients. The purpose of this study is to quantify the effects of corticosteroid injections on blood glucose levels in diabetic patients with shoulder pathology. Methods Diabetic patients who regularly monitored their blood glucose levels and were indicated for a subacromial corticosteroid injection were included in this prospective investigation. The typical normal morning fasting glucose and most recent hemoglobin A1c level was recorded for each patient. After injection, patients were contacted daily to confirm their fasting morning glucose level for 10 days post-injection. Results Seventeen consecutive patients were enrolled. Patients with hemoglobin A1c of < 7% had an average rise in blood glucose of 38 mg/dL compared to 98 mg/dL in the poorly controlled group after injection (p < 0.001). Well-controlled patients’ glucose levels returned to near baseline levels around post-injection day 8, while poorly controlled patients levels remained elevated. Similarly, insulin-dependent diabetic patients had an average increase in fasting glucose level of 99 mg/dL versus 50 mg/dL in non-insulin-dependent diabetic patients (p<0.001). Conclusions After corticosteroid injection, patients with well-controlled diabetes experience smaller elevations and faster return to baseline glucose levels than patients with poor control. Insulin dependent diabetics experienced similar findings as patients with poor control. Future studies are needed to evaluate dosing to optimize the risks of blood glucose elevation while maintaining therapeutic benefit.
      PubDate: Sat, 15 Apr 2017 19:30:00 +010
  • Dupuytren’s Disease: Predicting Factors and Associated Conditions.

    • Abstract: Object: Conflicting studies link several conditions and risk factors to Dupuytren’s disease (DD). A questionnaire-based case-control study was set to investigate associated conditions and clinical features of DD in a sample of Italian patients. The main purpose was the identification of predicting factors for: DD development; involvement of multiple rays; involvement of both hands; development of radial DD; development of recurrences and extensions. Material and Methods: A self-administered questionnaire was used to investigate medical and drug histories, working and life habits, DD clinical features, familial history, recurrences and extensions. Binary logistic regression, Mann Whitney U-test and Fisher’s exact test were used for the statistical analysis. Results: A role in DD development was found for male sex, cigarette smoking, diabetes and heavy manual work. The development of aggressive DD has been linked to age, male sex, high alcohol intake, dyslipidemias and positive familial history. Conclusions: Further studies might explain the dual relationship between ischemic heart disease and DD. According to our results, the questionnaire used for this study revealed to be an easy-handling instrument to analyze the conditions associated to DD. Nevertheless, its use in further and larger studies is needed to confirm our results as well as the role of the questionnaire itself as investigation tool for clinical studies.
      PubDate: Sat, 15 Apr 2017 19:30:00 +010
  • Economic Analysis of Bisphosphonate Use after Distal Radius Fracture for
           Prevention of Hip Fracture

    • Abstract: INTRODUCTION Osteoporosis is a common condition among the elderly population, and is associated with an increased risk of fracture. One of the most common fragility fractures involve the distal radius, and are associated with risk of subsequent fragility fracture. Early treatment with bisphosphonates has been suggested to decrease the population hip fracture burden. However, there have been no prior economic evaluations of the routine treatment of distal radius fracture patients with bisphosphonates, or the implications on hip fracture rate reduction. METHODS Age specific distal radius fracture incidence, age specific hip fracture rates after distal radius fracture with and without risendronate treatment, cost of risendronate treatment, risk of atypical femur fracture with bisphosphonate treatment, and cost of hip fracture treatment were obtained from the literature. A unique stochastic Markov chain decision tree model was constructed from derived estimates. The results were evaluated with comparative statistics, and a one-way threshold analysis performed to identify the break-even cost of bisphosphonate treatment. RESULTS Routine treatment of the current population of all women over the age of 65 suffering a distal radius fracture with bisphosphonates would avoid 94,888 lifetime hip fractures at the cost of 19,464 atypical femur fractures and $19,502,834,240, or on average $2,186,617,527 annually, which translates to costs of $205,534 per hip fracture avoided. The breakeven price point of annual bisphosphonate therapy after distal radius fracture for prevention of hip fractures would be approximately $70 for therapy annually. CONCLUSION Routine treatment of all women over 65 suffering distal radius fracture with bisphosphonates would result in a significant reduction in the overall hip fracture burden, however at a substantial cost of over a $2 billion dollars annually. To optimize efficiency of treatment either patients may be selectively treated, or the cost of annual bisphosphonate treatment should be reduced to cost-effective margins.
      PubDate: Sat, 15 Apr 2017 19:30:00 +010
  • Giant cell tumor of the sacrum: Series of 19 patients and review of the

    • Abstract: : Introduction: There are still some debates regarding the best treatment of Giant Cell Tumor (GCT) of the sacrum. Since GCT of this location is rare, therapeutic strategies are mainly based on the treatment of GCT in other anatomic locations. The objective of this study was to evaluate the oncologic and clinical results of surgical management of sacral GCT with and without local adjuvant therapy. Methods: Medical records of 19 patients diagnosed with GCT of the sacrum, were retrospectively reviewed. Sixteen patients were treated by intralesional curettage and three patients with marginal resection. Musculoskeletal tumor society (MSTS) score was used for the evaluation of functional outcome. Results: Prolonged pain was the most common complication after treatment. Mean Pre and post-operative pain based on visual analogue scale (VAS)was 6.1 ± 1.99 and 3.05 ± 1.64, respectively. Postoperative neurologic deficit appeared in six patients. In addition, infection occurred in five patients. One case of spinopelvic instability was also observed after surgery. At average follow up of 158.5 ± 95.9 months (range 25 to 316 months), recurrence was seen in eight (42.7%) out of seventeen patients treated by intralesional curettage. The size of the tumor significantly correlated with the tumor recurrence (r=0.654, p=0.001). Mean MSTS score was 74.7 ± 16.78. Those patients, in whom sacral nerve roots remained intact before and after surgery, had better functional outcome. Conclusion: Preservation of sacral nerve roots is associated with better functional outcome and less pain. Although an acceptable surgical outcome was observed in our cohort, the problem of local recurrence still warrants further investigations for better local control of the tumor.
      PubDate: Sat, 15 Apr 2017 19:30:00 +010
  • Joint distraction in advanced osteoarthritis of the ankle

    • Abstract: Background: Ankle joint distraction (AJD) avoids the potential complications associated with ankle arthrodesis or total ankle replacement (TAR) in patients with severe ankle osteoarthritis. Ankle joint distraction could a viable alternative to ankle arthrodesis or TAR. Methods: A review has been performed on the role of AJD in advanced osteoarthritis of the ankle. The search engine was MedLine. The keywords used were: joint distraction ankle. Three hundred and eleven articles were found. Of those, only 14 were selected and reviewed because they were strictly focused on the topic and the question of this article. Results: The types of studies reported so far have a low level of evidence (levels III and IV). The overall number of patients treated so far by means of ankle joint distraction is 249. The reported mean follow-up is very variable, from 1 year to 12 years. The percentage of good results ranged between 73% and 91%. The rate of failure (eventual ankle arthrodesis or total ankle replacement) ranged between 6.2% and 44%. A minimum of 5.8 mm of distraction gap must be achieved. Ankle function following AJD declines over time. Adding ankle motion to distraction will result in an early and sustained beneficial effect on outcome. Conclusions: Between 73% and 91% of patients with severe osteoarthritis of the ankle obtained a clinical benefit from AJD. A minimum of 5.8 mm of distraction gap must be achieved. Adding ankle motion to distraction will produce an early and sustained beneficial effect on outcome. Ankle function following AJD declines over time.
      PubDate: Sat, 15 Apr 2017 19:30:00 +010
  • Brucella Arthritis Following Total Knee Arthroplasty in a Patient with
           Hemophilia: a Case Report

    • Abstract: Total knee arthroplasty is a rewarding procedure in patients with hemophilia and end stage knee hemophilic arthropathy. However, this procedure may be associated with complications such as infection. There periprosthetic joint infection in patients with hemophilia is very well known, though we are not aware of any previous report on Brucella infection in this group of patients. We report a 28 years old man with Brucella infection of total knee replacement who underwent conservative treatment at the beginning and finally by two stage revision. We believe that this report will alert physicians who work in endemic area for brucellosis to consider this in differential diagnosis and do the right intervention at the right time.
      PubDate: Sat, 08 Apr 2017 19:30:00 +010
  • Anatomical repair of Stener-like lesion of Medial collateral ligament; A
           Case Series and ...

    • Abstract: Medial collateral ligament tears usually will be treated through non-surgical methods, But, in some cases such as those with tears at the distal insertion where the reduction could be blocked by the pes anserine tendons (Stener-like lesion), surgery will be indicated. Here, we present a surgical technique in such cases. In this retrospective case series, we describe six patients diagnosed with Stener-like lesion based on clinical evaluation and imaging results. In the one-year follow-up visit, there was no complain of pain or joint instability and full range of motion and negative valgus stress test were reported in all cases. The results showed this surgical technique is a useful and safe treatment approach in such cases.
      PubDate: Sat, 08 Apr 2017 19:30:00 +010
  • Measurement of posterior tibial slope using magnetic resonance imaging

    • Abstract: Background: Posterior tibial slope (PTS) is an important factor in the knee joint biomechanics and one of the bone features, which leads to knee joint stability. Posterior tibial slope affects flexion gap, knee joint stability and posterior femoral rollback that are related to wide range of knee motion. During high tibial osteotomy and total knee arthroplasty (TKA) surgery, proper retaining the mechanical and anatomical axis is important. The aim of this study was to evaluate the value of posterior tibial slope in medial and lateral compartments of tibial plateau and to assess the relationship among the slope with age, gender and other variables of tibial plateau surface. Materials and methods: This descriptive study was conducted on 132 healthy knees (80 males and 52 females) with a mean age of 38.26±11.45 (20-60 years) at a medical center in Mashhad, Iran. All patients required to MRI admitted for knee pain with uncertain clinical history and physical examination that were reported healthy at knee examination were enrolled in the study. Results: The mean posterior tibial slope was 7.78±2.48 degrees in the medial compartment and 6.85±2.24 degrees in lateral compartment. No significant correlation was found between age and gender with posterior tibial slope (P≥0.05), but there was significant relationship among PTS with mediolateral width, plateau area and medial plateau. Conclusions: Comparison of different studies revealed that the PTS value in our study is different from other communities, which genetic and racial factors can be involved in these differences. The results of our study are useful to PTS reconstruction in surgeries.
      PubDate: Sat, 08 Apr 2017 19:30:00 +010
  • Unusual complete isolated scaphoid dislocation. Report of a case .

    • Abstract: Isolated scaphoid dislocations are extremely rare injuries and are commonly associated with significant ligamentous disruptions. A dorsiflexion-supination force upon the hand consists the commonest mechanism of injury. Different treatment options have been proposed for the management of this uncommon entity. Reduction is difficult to achieve by closed means and usually open reduction is necessary. Techniques that have been proposed for the anatomical realignment of the carpal scaphoid into its fossa include closed reduction and percutaneous pinning, open reduction and pinning, with or without additional ligament reconstruction. The integrity of the ligaments that stabilize the scaphoid should be assessed. It has been described that the first ligaments that fail are the scapholunete and radioscaohocapitate followed by the radiolunate and finally the scaphotrapezial ligament.These disruptions must be addressed during surgery to prevent further complications.We present a case of an unusual complete isolated carpal scaphoid dislocation managed with open reduction and pinning along with ligamentous reconstruction.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
  • Open Anterior Hip Dislocation: A rare mechanism of injury

    • Abstract: Traumatic anterior dislocation of the hip is an extremely rare condition in children and open one is even rarer. This usually caused by high energy trauma. In following study, we present a case of an eight-year old child suffering an open anterior-inferior dislocation of right hip concomitant with pelvic ring disruption and ipsilateral open distal femoral fracture (Salter-Harris type 4, Gustilo type IIIA) due to a traffic accident. The patient underwent successful emergent open reduction due to the button-holed femoral head after appropriate irrigation and debridement. Successful recovery was achieved and the patient was discharged after 2 weeks. At 9 months follow-up, X-ray images showed slight changes related to osteonecrosis of the femoral head. Long-term follow-up over a course of 6 years showed sufficient range of motion. The gait was normal and the patient was satisfied with the outcomes. Also, slight non-progressive osteonecrotic changes was obvious in the right hip.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
  • Restoration of the mechanical axis in Total Knee Artrhoplasty using
           patient-matched technology ...

    • Abstract: Background: The aim of this study is to evaluate the accuracy of bone cuts and the resultant alignment, using the MyKnee patient specific cutting blocks.Methods: We retrospectively reviewed 132 patients undergoing primary TKR for osteoarthritis by one single surgeon. The operative time, the preoperative Hip-Knee-Ankle (HKA) axis based on the CT-scan, the postoperative HKA axis based on long axis standing x-rays, the planned and the actual size of the femoral and the tibial components, and the number of the recuts which has been made intraoperative were measured.Results: The average preoperative HKA axis was 177.50 (range 163.50 to 1940), whereas the average postoperative HKA axis was 179.40 (range 177.10 to 182.70). No outliers were reported in the study (0%). Intraoperatively, 4 femoral components (3.03%), and 7 tibial components (5.30%) applied to the patients were different than the planned size. There was no need of recuts in any of our cases intraoperatively.Conclusions: The MyKnee system evaluated in this study was shown to be remarkable reliable in the coronal plane alignment, and the prediction of the component size. However, further studies are needed to determine whether there are any clinically important improvements in outcomes or patient satisfaction when using patient-specific cutting blocks for TKA.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
  • What Are The Results of Minimally Invasive Plate Osteosynthesis for
           Femoral and Tibial ...

    • Abstract: Purpose: Comminuted fractures happen frequently due to traumas and accidents. Recently fixa-tion without opening the fracture site known as Minimally Invasive Plate Osteosynthesis (MIPO) has become prevalent. As this method has not been discussed as often in orthopedic textbooks and its accurate results on comminuted fractures has not been clear, we performed this study to assess the results and complications of this treatment for tibial and femoral comminuted frac-tures.Methods: In this cross-sectional study 60 patients with femoral and tibial comminuted fractures were treated with MIPO method. 11 patients excluded due to lack of adequate follow-ups. Data including union time, infection in the fractured site, hip and knee range of motion and any malu-nion or deformities like limb length discrepancy collected after the surgery form every patient in every session.Results: 32 femoral fractures and 17 tibial fractures were evaluated. In 48 patients, union was completed but in one patient with femoral fractures, there was nonunion. Mean union time was 18.57±2.42 weeks. Femur fractures healed faster than tibia (17.76±2.36 and 19±2.37 weeks, re-spectively). None of our patients suffered from infections or fistula. The range of motion in hip and knee remained intact in approximately all of our patients. Malunion happened in ‘three’ pa-tients, 10-degree internal rotation in ‘one’ patient and ‘one’ centimeter limb shortening in ‘two’ patients. Conclusion: according to the result of this study and comparing it with other studies, it can be drawn that MIPO is a simple and effective method of fixation for comminuted fractures of long bones. It has a high rate of union with minimal complications. Infection is rare, and malunion or any deformity is incredibly infrequent. MIPO appears to be a promising and safe treatment alter-native for comminuted fractures with advantages and also disadvantages.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
  • The effect of sagittal femoral bowing on the femoral component position in
           total knee arthroplasty

    • Abstract: Purpose: In current study, we investigated that how sagittal femoral bowing can affect the sagittal alignment of the femoral component in total knee arthroplasy. Materials: There were 25 patients underwent TKA. long leg radiogaraphy in lateral view was performed. The sagittal femoral bowing (SFB) and component alignment in relation to the sagittal mechanical axis and distal anterior cortical line (DACL) were measured. Finally, the correlation of component alignment and SFB was examined. Results: Mean SFB was 7±2.7 degrees. The component was in flexion position in relation to mechanical axis and DACL as 8.4±2.9 degrees and 1.7±0.9 degrees, respectively. The flexion alignment of the component was significantly correlated with SFB. Conclusion: Mechanical alignment of the limb in both coronal and sagittal axes should be preserved in TKA. SFB can significantly increased the flexion alignment of the femoral component.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
  • Is spinal anesthesia with low dose lidocaine better than sevoflorane
           anesthesia in patients ...

    • Abstract: Purpose: to evaluate general anesthesia with sevoflurane vs spinal anesthesia with low dose lidocaine 5% on hemodynamics changes in patients undergoing hip fracture surgery. Methods and materials: in this randomized double blind trial 100 patients (50 patients in each group) older than 60 years under hip surgery were randomized in general anesthesia with sevoflurane and spinal anesthesia with lidocaine 5%.Then hemodynamic changes including mean arterial pressure (MAP) and heart rate, blood loss, pain severity, nausea and vomiting and opioids consumption were compared in two groups. Results: during surgery difference between two groups regarding changes in mean arterial pressure was not significant (p=0.103),but the changes in heart rate was significant different (p=0.004).Mean arterial pressure changes during recovery between two groups were significantly different. But there was no significant difference in heart rate changes. Bleeding in the sevoflurane group was significantly more than spinal group ( vs 365 ml, P=0.001) .Moreover, AS Score, opioid consumption, and the nausea and vomiting in spinal anesthesia group was significantly lower than the sevoflurane group (p=0.0001).Conclusion: we confirmed that general anesthesia with sevoflurane and spinal anesthesia with low dose lidocaine 5% have comparable effects on hemodynamics changes in patients undergoing hip fracture surgery. However postoperative pain score, vomiting and morphine consumption in patients with spinal anesthesia was lower than general anesthesia.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
           WITH SUPERIOR ...

    • Abstract: ABSTRACTBACKGROUND :Treatment of Distal clavicle fractures are always a challenge,as they are mostly unstable and have high rate of delayed union, malunion ,non-union and associated acromioclavicular arthritis. Management of these fractures remains controversial. The purpose of study is to evaluate the functional results of Type 2 distal end clavicle fractures treated with superior anterior locking plate.MATERIALS AND METHODS: From june 2011 to august 2015 a retrospective study of 12 male patients ( mean age of 41.3),11 with unilateral and 1 with bilateral distal clavicle fractures treated with superior anterior locking plate. They were evaluated at regular intervals with mean follow up of 14 months(12-18months).Those with minimum one year follow up were included in our study. All were evaluated for shoulder function by both Oxford shoulder score and QuickDASH scores ,rate of bone union, complications and earliest time to return to workRESULTS: All fractures united with mean time for union was 7.1 weeks(6-8 weeks).All had good shoulder range of motion. the average oxford shoulder and quickDASH score were 46.2 and 6.5. There were no major complications in our study such as non-union ,plate failure, secondary fracture but 1 had superficial wound infection .All returned to work within 3 months of postop period.CONCLUSION: Displaced distal clavicle fractures treated with superior anterior locking plates achieved excellent results in terms of bony union with rarely any complications and demonstrates promising results with this novel technique
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
  • Acute Primary Total Knee Arthroplasty for proximal Tibial Fractures in

    • Abstract: Purpose: Proximal tibial fractures in elderly patients with osteoporosis or kneeosteoarthritis (OA) are challenging. In current study, we present our experiencewith uncommon acute primary total knee arthroplasty (PTKA) in this patientpopulation.Methods: Between 2005 and 2009, we performed PTKAs following a proximaltibial fracture for 30 consecutive patients aged over 60 years with osteoporosis orknee OA. Three condylar constrained knees (CCK) and no hinged knee prosthesiswere used. Patients were followed for 4.5±1.1 years.Results: Patients discharged after 4.6±1.2 days. The postoperative Tegner activityscale improved significantly compared to preoperative scale (3.5±1.3 versus2.5±1.2; p<0.001). The range of knee flexion was significantly greater in operatedside compared to uninjured knee (106±13 degrees Vs 120±8 degrees; p<0.001).The knee and function scores of the knee society knee score averaged 90.7±6.5and 69.6±8.8, respectively. All of the patients returned to their previous activities.Based on visual analogue scale, the patients' satisfaction and pain at final visitdetermined 8.1±1 and 1.5±1.2, respectively. There was no patient with infection,thromboembolic events and loosening.Conclusions: PTKA following a proximal tibial fracture in elderly patients withosteoporosis or knee degeneration can be considered as a safe alternative foropen reduction and internal fixation. PTKA resulted in immediate weight-bearing,improved functional status and patients' satisfaction. However, functionaloutcomes were dependent on the general condition of 24 the patient. Also,constrained knee prosthesis were not necessary for a vast majority of thepatients.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010

    • Abstract: Introduction: Femoral shaft fractures are an incapacitating peadiatric injury accounting for 1.6% of all paediatric bony injuries. Management of these fractures is largely directed by age, fracture pattern, associated injuries, built of the child and socioeconomic status of the family. We retrospectively evaluated the use of elastic stable intramedullary nail (ESIN) in surgical management of femoral shaft fractures in children and its complications.Materials and Methods: 52 children were treated with titanium elastic nails (TEN) from June 2009 to June 2014 at our institution.At the end of the study there were 48 children. Fractures were classified according to Winquest and Hansen’s as Grade I(n=32),Grade II(n=10),Grade III(n=6 ) and compound fractures by Gustilo and Anderson’s classification, Grade I (n=5), Grade II (n=3 ). There were 36 mid-shaft fractures, 7 proximal third shaft fractures, 5 distal third shaft fractures. The final results were clinically evaluated by using Flynn’s criteria and radiologically by Anthony et al’s criteria.Results: The mean duration of follow-up was 20 months(range 12 – 40 months). All fractures healed radiologically with grade III callus formation at 9 – 12 weeks (mean 9.7 weeks) . The results were analysed using Flynn’s criteria and were excellent in 40 children (83%) and satisfactory in 8 children (17%). The soft tissue discomfort near the knee produced by nail ends was the most common problem in our study (25%). Other complications include limb shortening (n=5), varus malunion (n=4), pin site infection (n=4) and nail migration (n=2). There was no delayed union,non-union or refractures. Conclusion: TEN is minimally invasive, safe, relatively easy to use and an effective treatment for fracture shaft of femur in properly selected children.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
  • Translation and validation of the Persian version of the Patient Rated
           Wrist Evaluation

    • Abstract: Purpose: the aim of this study was to validate and convert the original version of the PRWE into PersianMethods: One hundred and fourthly one adult patients with upper extremity conditions participated in this ethical board approved study from August 2015 to May 2016. After translating the original version of the PRWE into Persian, all patients filled out the PRWE in addition to the VAS (Visual analogue scale) and DASH questionnaires. For evaluating reliability, after seven days the researchers called back some of the patients who did not receive treatment and asked them to complete the PRWE retest (104 patients).Results: Cronbach’s alpha was calculated as high as 0.934, implying very reliable internal consistency. After each item deletion, the Cronbach’s alpha was still constant (range: 0.926 to 0.936). Intraclass correlation coefficient was 0.952 and this showed excellent test-retest reliability. The correlation coefficient between the PRWE and DASH scores was strong. Multivariable analysis showed an association between the PRWE and years educated.Conclusion: Our study has shown that the Persian version of the PRWE is valid and reliable for patients with upper extreme disabilities.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010

    • Abstract: Osteoporosis has become a major medical problem as the aged population of the world rapidly grows. Osteoporosis predisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concern before performing spine surgery, especially with bone fusions and instrumentation. Osteoporosis has often been considered a contraindication for spinal surgery, while in some instances patients have undergone limited and inadequate procedures in order to avoid concomitant instrumentation. As the population ages and the expectations of older patients increase, the demand for surgical treatment in older patients with osteoporosis and spinal degenerative diseases becomes progressively more important. Nowadays, advances in surgical and anesthetic technology make it possible to operate successfully on elderly patients who no longer accept disabling physical conditions. This article discusses the biomechanics of the osteoporotic spine, the diagnosis and management of osteoporotic patients with spinal conditions, as well as the novel treatments, recommendations, surgical indications, strategies and instrumentation in patients with osteoporosis who need spine operations.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
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