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Journal Cover   Archives of Bone and Joint Surgery
  [2 followers]  Follow
  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  [11 journals]
  • Overlapped Pubic Symphysis; a case report and review of the literature

    • Abstract: Overlapped pubic symphysis is a rare but serious pelvic injury. This study presents a case of overlapped dislocation of the pubic symphysis. He was managed by closed reduction under general anesthesia. The patient had urethral transaction. At the latest follow up, seven months post injury; he was able to walk well without any pelvic pain. However, his urologic problems were continued. We also reviewed the literature and analyzed the data of the previous reports as well as the current case collectively. The two terms of “locked pubic symphysis” and “overlapped pubic symphysis” have been used synonymously in the literature. Overlapped pubic symphysis is commonly associated with fracture of the sacrum and urethral injury in the male patients. After closed or open reduction, if pelvic instability persists, it needs anterior and may posterior internal fixation to achieve a stable pelvis.
      PubDate: Tue, 12 May 2015 19:30:00 +010
  • Hardware removal due to infection after open reduction and internal
           fixation: trends and predictors

    • Abstract: INTRODUCTION: Little is known about trends and predictors of hardware related infection following open reduction and internal fixation (ORIF) of extremity fractures, one of the major causes of failure following ORIF. The present study was designed and conducted to determine trends and predictors of infection-related hardware removal following ORIF of extremities using a nationally representative database. MATERIALS AND METHODS: We used Nationwide Inpatient Sample data from 2002 to 2011 to identify cases of ORIF following upper and lower extremity fractures, as well as cases that underwent infection-related hardware removal following ORIF. Multivariate analysis was performed to identify independent predictors of infection-related hardware removal, controlling for patient demographics and comorbidities, hospital characteristics, site of fracture, and year. RESULTS: For all ORIF procedures, the highest rate of hardware removal related to infection was observed in tarsal fractures (5.56%), followed by tibial (3.65%) and carpal (3.37%) fractures. Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Tarsal fractures (odds ratio (OR)=1.06, 95% confidence interval (CI): 1.04-1.09, p <0.001), tibial fractures (OR=1.04, 95% CI: 1.03-1.06, p<0.001) and those patients with diabetes mellitus (OR=2.64, 95% CI: 2.46-2.84, p<0.001), liver disease (OR=2.04, 95% CI: 1.84- 2.26, p <0.001), and rheumatoid arthritis (OR=2.06, 95% CI: 1.88-2.25 p<0.001) were the main predictors of infection-related removals; females were less likely to undergo removal due to infection (OR= 0.61, 95% CI: 0.59-0.63 p<0.001). CONCLUSION: Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Diabetes, liver disease, and rheumatoid arthritis were important predictors of infection-related hardware removal. The study identified some risk factors for hardware related infection following ORIF, such as diabetes, liver disease, and rheumatoid arthritis, that should be studied further in an attempt to implement strategies to reduce rate of infection following ORIF
      PubDate: Sun, 10 May 2015 19:30:00 +010
  • Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid
           Fix : A Retrospective ...

    • Abstract: BACKGROUND:No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstructionHYPOTHESIS:There is similar functional outcome after rigid fix compared to other methods of fixation which has been publishedSTUDY DESIGN:Retrospective observational study METHODS:A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months.RESULTSIn our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively.Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26 .Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test p<0.001CONCLUSIONArthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation
      PubDate: Sun, 10 May 2015 19:30:00 +010
  • Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A
           Case Study

    • Abstract: Tendon transfers in hand patients are a commonly performed procedure after extensor tendon rupture. However, the standard side to side technique is not applicable in every patient. We present a case of a musician with unique demands to demonstrate the option to customize surgical technique and therapy regimen to the unique needs of each patient.An extensor indicis proprius to extensor digitorum communis transfer was performed in a 73 year old musician. A controlled active motion therapy protocol was followed. The patients musical practice regimen was incorporated into the therapy. The patient was able to independently extend her ring and small fingers in order to play her instrument and resumed play within one month postoperatively. A patient’s functional goals including avocations need to be considered when selecting the appropriate surgical and therapeutic approach.
      PubDate: Fri, 08 May 2015 19:30:00 +010
  • Compartment Syndrome of the Calf Due to Nicolau Syndrome

    • Abstract: Abstract: We report a case of Nicolau syndrome in a 15 months old girl following of an intramuscular injection of penicillin 6.3.3 in her left buttock. This case is unique because she developed compartment syndrome in her left calf far from her injection site. Her toe’s tips gangrened in the course of her ailment.Amputation of the greater toe was performed through the interphalangeal joint. Amputation of the second through fifth toes was performed through the proximal interphalangeal joints. Follow up electromyography and nerve conduction study showed ischemic changes of the calf muscles and a permanent deep peroneal nerve damage. We hypothesized that the compartment syndrome might be produced by a probable intra-arterial injection that had produced embolic obstruction of the small and medium sized arteries in her leg or a probable perineural or periarteial injection had produced secondary sympathetic stimulation, extensive vasospasm, compromised microcirculation and the development of compartment syndrome.
      PubDate: Wed, 06 May 2015 19:30:00 +010
  • Outcome of ACL reconstruction and concomitant articular injury treatment
           Tahami M, Derakhshan M. ...

    • Abstract: Background: Articular cartilage injuries are a common clinical problem at the time of ACL reconstruction with an incidence of 16-46%.Good results of ACL reconstruction combined with chondral lesions treatment have been published in some studies.Material and Method: After statistical analysis 30 patients were selected and divided in 2 groups. First group consisted of 15 patients who have isolated ACL tear without any other concomitant injuries and the second group consisted of 15 patients with ACL tear and concomitant high grade (grade 3 or 4 of outerbridge classification) contained articular cartilage injuries during arthroscopy. Group 1 underwent ACL reconstruction and group 2 underwent ACL reconstruction combined with chondroplasty via drilling and micro fracture technique. For each patient Lysholm knee score questionnaire was filled before operation, 6 months and1 year later after surgery.Results: The mean of Lysholm knee score in both group improved as follows: 9.6 point after 6month and 16.06 point after 1year in group 1 and 23.26 point after 6 month and 30.66 after 1 year in group 2 that was statistically significant (p value <0.05).Conclusion: Improvement in Lysholm knee score in both groups showed that ACL reconstruction concomitant with high grade chondral injury chondroplasty with microfracture and drilling technique have good results and is accompanying with satisfaction in patients and improves their quality of life.Key words: Anterior Cruciate Ligament,Chondral injury,Lysholm knee score
      PubDate: Mon, 04 May 2015 19:30:00 +010
  • Effectiveness of the gastrocsoleous flap for coverage of soft tissue
           defects in leg with ...

    • Abstract: Abstract Introduction: The standard methods for reconstruction of soft tissue defects in the leg include gastrocnemius flap for proximal third defects, soleus flap for middle third and free flap in the distal third. However, there are problems with the use of free flap, like increased operative time, damage of major vessels and the need for experienced microsurgeon. Materials and Methods: This prospective study was undertaken on 23 patients (20 male and 3 female) with the mean age 32.13 years (14 to 65). This group consisted of all of the patients referred to Dr Bahonar Hospital, Kerman with soft tissue defects between April 2011 and April 20012 and would give informed consent for participation in the study and treatment of the defect with muscle flaps. 8 patients with proximal third defects were treated with were treated with gastrocnemius flap, 4 with middle third defects with soleus flap and 3 with reverse soleus flap and 8 with distal third defects with reverse soleus flap. The patients were followed up for at least 1 year. Finally the results were analyzed by SPSS 16. Results: In patients with soft tissue defect in proximal and middle third of leg repair was successful in all. In 5 patients with soft tissue defect in distal third of leg repair was complete but in 3 of them flap failure was seen. Overall success rate for reverse soleous flap was 72.7%. Conclusion: The success rate of the flap for the upper and lower thirds was similar to other studies and seems that this is the standard method. In the distal third defects the reverse soleous flap failed in 3 cases and it seems that preoperative investigations such as angiography must be performed before embarking on such a procedure.
      PubDate: Mon, 04 May 2015 19:30:00 +010
  • Risk of Spermatic Cord Injury During Anterior Pelvic Ring and Acetabular
           Surgery: An Anatomical ...

    • Abstract: Introduction: Anterior pelvic ring surgery includes a variety of plating techniques and insertion of retrograde superior pubic ramus screws. Anterior acetabular surgery also includes fixation through an ilioinguinal or Stoppa approach. These exposures risk injury to the spermatic cord and accompanying genital branch of the genitofemoral nerve. The primary aim of this study was to identify the distance between the midline and the spermatic cords in adult male cadaveric specimens. The secondary aim was to determine spermatic cord diameters and measure the distance between the spermatic cord and implant during instrumentation of a retrograde superior pubic ramus medullary screw. Materials and Methods: Extended Pfannenstiel and Stoppa approaches were performed on 18 embalmed male cadavers bilaterally. Spermatic cord characteristics were recorded and a number of measurements were performed to determine the distance of implants and the midline from the spermatic cord. Results: The average distance between the midline and spermatic cords was 34.2 mm. The average distance between the spermatic cord and implant was 18.2 mm. Eleven of the thirty-six dissections had abnormalities including cord lipomas and inguinal hernias. The average cord diameter was 18.6 mm. The average cord diameter in those with abnormalities was 24.9 mm and 16 mm in those without abnormalities, this difference was statistically significant. Discussion: Due to the proximity of the spermatic cord, the surgeon should either formally expose the cord or limit lateral dissection from the midline during Pfannenstiel and Stoppa exposures. Similarly, the surgeon should use soft-tissue sleeves and oscillating drills to avoid injury to the contralateral spermatic cord during the insertion of retrograde superior pubic ramus medullary screws.
      PubDate: Sun, 03 May 2015 19:30:00 +010
  • Clinical Results of Meniscal Repair Using Submeniscal Horizontal Sutures

    • Abstract: Background:Parts of the implants placed over the meniscus during meniscal repair can wear down the cartilage in the contact zones and cause chronic synovitis. Placing horizontal sutures under the meniscus may overcome this potential hazard. The purpose of this prospective study was to evaluate the midterm results of arthroscopic meniscal repair using submeniscally placed out-in horizontal sutures. Methods: One hundred and three meniscal repairs with submeniscal horizontal out-in technique in 103 patients were performed between 2009 and 2012. Our indications for meniscal repair were all longitudinal tear in red-red and red-white zone with acceptable tissue quality. Clinical evaluation included the Tegner and Lysholm knee scores and clinical success was defined as absence of joint-line tenderness, locking, swelling, and a negative McMurray test.Results: The average follow-up was 19 months (range, 14 to 40 months). The time interval from injury to meniscal repair ranged from 2 days to 390 days (median, 96 days). At the end of follow-up, the clinical success rate was 86.5%. Fourteen of 103 repaired menisci (13.5%) were considered failures according to Barrett’s criteria. The mean Lysholm score significantly improved from 39.6 preoperatively to 84.5 postoperatively (P ˂ .001). Eighty five patients (82.5%) had an excellent or good result according to Lysholm knee score. Tegner activity score improved significantly (P ˂.01) from an average of 3.4 (range, 2-6) preoperatively to 5.9 (range, 5-8) postoperatively. Statistical analysis showed that age, simultaneous anterior cruciate ligament reconstruction, chronicity of injury did not affect the clinical outcome.Conclusion: Our results showed that acceptable midterm results are expected from submeniscal horizontal out-in repair technique. This technique is cheap, safe and has the advantage of avoiding chondral abrasion caused by solid implants and suture materials placed over the meniscus.
      PubDate: Sun, 03 May 2015 19:30:00 +010
  • Avascular Necrosis of the Femoral Head: Are Any Genes Involved'

    • Abstract: Avascular necrosis of the femoral head (ANFH) is a pathologic process that results from interruption of blood supply to the femur bone which resulting in death of bone cells and collapse of the femoral head. Nontraumatic ANFH continues to represent a significant challenge to orthopedic surgeons. While the exact mechanisms remain elusive, many new insights have emerged from research in the last decade that have given us a clearer picture of the pathogenesis of nontraumatic ANFH. Progression to the end stage of ANFH appears to be related to five main mechanisms: conditions that promote hypercoagulable states, angiogenesis suppressions, hyperadipogenesis, heritable states and switching the bone remodelling into bone resorption. Researchers have examined the pathogenic mechanisms of ANFH but none of them has been firmly confirmed, although some appear more plausible than others. All of these factors can switch bone remodelling into bone resorption which can lead to ANFH progression and end up to femoral head collapse.
      PubDate: Sun, 03 May 2015 19:30:00 +010
  • Short-Term Clinical Outcomes of Radial Shortening Osteotomy and Capitates
           Shortening Osteotomy ...

    • Abstract: Background: There is no consensus on the best surgical treatment in Kienböck disease. We evaluated the short-term outcomes of radial shortening osteotomy and capitate shortening osteotomy in Kienböck disease patients. Materials and Methods: In a retrospective study of 21 patients with stage IIIA of Kienböck disease, 12 patients with average follow up of 3.2 ± 0.6 had radial shortening osteotomy (group I) and 9 patients with average follow up of 3.1 ± 0.7 years had capitate shortening osteotomy (group II). The two groups were similar in age, sex, operated side, initial Lichtman stage and follow-up duration. At the last follow-up the patients were evaluated for pain, wrist range of motion, grip strength, wrist functional status and change in Lichtman stage. The overall results were evaluated by Cooney wrist function score and DASH score. Results: All the patients in the 2 groups had improvement of their wrist pains. According to the Cooney wrist function score; there were 1 excellent, 9 good and 2 fair scores in group I and 1 excellent, 6 good and 2 fair scores in group II. Comparisons between the means of pain VAS scores, wrist range of movement, grip strength, DASH score and Cooney wrist function score in the two groups were not significant. The changes of Lichtman stage in the two groups were not significant. Conclusion: Both groups had reasonable short-term outcomes. We were unable to recognize a substantial clinical difference between the two surgical treatments in short-term outcome.
      PubDate: Sun, 03 May 2015 19:30:00 +010
  • Factors Associated with Operative Treatment of De Quervain Tendinopathy

    • Abstract: Purpose: Geographic and doctor-to-doctor variations in care are a focus of quality and safety efforts in medicine. This study addresses factors associated with variation in the rate of operative treatment of de Quervain tendinopathy.Methods: We used a database including all patient encounters at 2 large medical centers, to study the experience of 10 hand surgeons and 1 physiatrist working in a hand surgery office in the treatment of 2,513 patients with de Quervain tendinopathy over a 12-year period. Survival analysis using the Kaplan-Meier method was used to compare surgery rates and time to surgery. Cox multivariable regression analysis was applied to identify factors associated with operative treatment.Results: One hundred ninety nine (7.9%) patients had surgery. The odds of operative treatment were 1.7 times greater after corticosteroid injection and varied more than 10-fold among providers. There was substantial variation in the overall rate of surgery by provider. Corticosteroid injection delayed surgery slightly, but was associated with a higher rate of surgery.Conclusion: Providers have substantial influence on treatment of de Quervain tendinopathy. The use of decision aids and other methods that help involve the patient in decision-making merit investigation as interventions to help reduce doctor-to-doctor variation.
      PubDate: Tue, 28 Apr 2015 19:30:00 +010

    • Abstract: Dear Editor, We have greatly enjoyed reading the case report entitled “‘Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature in the issue of Arch Bone Jt Surg. 2015;3(2) with great interest. We would like to commend the authors for their detailed and valuable work. Although various case reports have described postoperative distal femur fracture at a range of time intervals (1,2) intraoperative intra-articular distal femur fracture is a unique entity. However, we believe that some important additional observations seem necessary to be contributed through this study. In this article, the authors stated that, to the best of their knowledge, there is no other case report in the literature introducing a femoral condyle fracture during arthroscopic ACL reconstruction or revision reconstruction. Nevertheless, we would like to call the attention of the readers to the fact that that the literature contains one additional case report re‌porting on intraoperative distal femoral coronal plane (Hoffa) fracture during primary ACL reconstruction (2). Werner BC and Miller MD presented of case report of an intraoperative distal femoral coronal plane (Hoffa) fracture that occurred during independent femoral tunnel drilling and dilation in a primary ACL reconstruction. As in the their case, this type of fracture can occur with appropriately placed femoral tunnels, but the risk can increase with larger graft diameters in patients with smaller lateral femoral condyles The patient was treated with open reduction and internal fixation, without compromise of graft stability and with good recovery of function. We believe that tailoring graft size to the size of the patient is important to prevent similar adverse events.
      PubDate: Tue, 28 Apr 2015 19:30:00 +010
  • Ultrasound-guided percutaneous medial pinning of pediatric supracondylar
           humeral fractures to ...

    • Abstract: Introduction: Medial pinning is one of the most controversial aspects of the surgical treatment of supracondylar humeral fractures (SHF) owing to the risk of ulnar nerve injuryAim: To evaluate the safety and usefulness of medial pinning for supracondylar humeral fractures using ultrasound imaging for ulnar nerve visualization. Patients and Methods: Fifteen children, with a mean age of 60 months, with displaced supracondylar humeral fractures were treated with a crossed-pinning configuration after fracture reduction. Intraoperative ultrasound was used to guide medial pin insertion to avoid ulnar nerve injury.Results: Cubital tunnel anatomy was easily identified in all children. All children showed a subluxating ulnar nerve which required elbow extension to about 90º before medial pin insertion. None suffered ulnar nerve dysfunction after using the referred technique. Conclusions: Although technically demanding, ultrasound may be a valuable adjuvant to avoid ulnar nerve injury while performing a medial pinning in pediatric supracondylar humeral fractures.
      PubDate: Tue, 28 Apr 2015 19:30:00 +010
  • Reliability, Readability and Quality of Online Information about
           Femoracetabular Impingement

    • Abstract: The Internet has become the most widely-used source for patients seeking information more about their health and many sites geared towards this audience have gained widespread use in recent years. Additionally, many healthcare institutions publish their own patient-education web sites with information regarding common conditions. Little is known about how these resources impact patient health, though, as they have the potential both to inform and to misinform patients regarding their prognosis and possible treatments. In this study we investigated the reliability, readability and quality of information about femoracetabular impingement, a condition which commonly affects young patients. The terms “hip impingement” and “femoracetabular impingement” were searched in Google® in November 2013 and the first 30 results were analyzed. The LIDA scale was used to assess website accessibility, usability and reliability. The DISCERN scale was used to assess reliability and quality of information. The FRE score was used to assess readability. The patient-oriented sites performed significantly worse in LIDA reliability, and DISCERN reliability. However, the FRE score was significantly higher in patient-oriented sites.According to our results, the websites intended to attract patients searching for information regarding femoroacetabular impingement are providing a highly accessible, readable information source, but do not appear to apply a comparable amount of rigor to scientific literature or healthcare practitioner websites in regard to matters such as citing sources for information, supplying methodology and including a publication date. This indicates that while these resources are easily accessed by patients, there is potential for them to be a source of misinformation.
      PubDate: Tue, 28 Apr 2015 19:30:00 +010
  • Knee fusion or above-the-knee amputation after failed two-stage
           reimplantation total knee ...

    • Abstract: Background: Prosthetic joint infection (PJI) is a serious complication of total knee arthroplasty (TKA). Control of infection after a failed two-stage TKA is not always possible, and the resolution of infection may require an above-knee amputation (AKA) or a knee fusion (KF).Purpose: The purpose of this review is to determine which treatment method (AKA or KF) yields better function and ambulatory status for patients after a failed two-stage reimplantation.Methods: A PubMed search related to the resolution of infection by means of an above-knee amputation (AKA) or a knee fusion was performed until 10 January 2015. The key words were: infected TKA and above-the-knee amputation. Five hundred and sixty-six papers were found, of which ten were reviewed because they were focused on the topic of the article. Results: KF should be strongly considered as the treatment of choice for patients who have persistent infected TKA after a failed two-stage revision arthroplasty. Patients can walk at least inside the house, and activity of daily living independence is achieved by the patients with successful KF, although walking aids, including a shoe lift, are required. An intramedullary nail leads to better functional results than an external fixator. The functional outcome after AKA performed after TKA is poor. A substantial percentage of the patients never fit with a prosthesis, and those who are seldom obtain functional independence. Only 50% of patients are able to walk after AKA. Conclusions: Patients receiving KF for treating recurrent PJI after TKA have better function and ambulatory status compared to patients receiving AKA. KF must be recommended as the treatment of choice for patients who have persistent infected TKA after a failed two-stage reimplantation procedure
      PubDate: Wed, 15 Apr 2015 19:30:00 +010
  • Pedicle Subtraction Osteotomy in a 5-Year-Old Child with Congenital

    • Abstract: Vertebral anomalies may also distort the normal regional or global spinal alignment and necessitate some therapeutic interventions. Hemiepiphysiodesis is a traditional procedure usually described for these young patients but in more severe cases some type of osteotomy seems to be necessary. In this technical note, we describe a 5-year-old boy with failed previous hemiepiphysiodesis surgery, who was successfully treated with one level pedicle subtraction osteotomy. This procedure not only corrects the kyphotic deformity at the time of the procedure (not relying on future spinal growth), but also avoids more hazardous anterior approach. سرکار خانم عرفانی، با سلام ، برای موارد technical noteبر اساس استیل مجله، باید تعداد کلمات در چکیده زیر 150 باشد ولی در تعریف این قسمت اگر کمتر از 150 کلمه باشد امکان عبور از این قسمت وجود ندارد. لطفأ این مساله را در سیستم اصلاح کنید. من مجبور شدن در این قسمت بنویسم تا امکان ادامه ساب میت مقاله من وجود داشته باشد.
      PubDate: Tue, 14 Apr 2015 19:30:00 +010
  • “Ceramic” databases improve the retrospective studies in
           orthopedic surgery

    • Abstract: Technology has affected all aspects of our lives, but it seems that it does not penetrate to clinical research centers as much as other fields.   For example, technology could be used to promote the quality of “Retrospective” studies as much as it become near to the “Prospective” studies. Orthopedics research centers, especially “Hand and upper extremity services” are a good place to start. When we want to set a retrospective study, there is always a lack of accurate objective and subjective data. Perhaps, this is the major reason we tend to utilize prospective studies instead(1-3). Nowadays, with the help of technology, we can overcome this problem.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Outcome of Distal Both Bone Leg Fractures Fixed by Intramedulary Nail for
           Fibula & MIPPO in ...

    • Abstract: Background:  Fractures of the distal third of the tibia are mostly associated with a fibular fracture that often requires fixation. The preferred treatment of distal tibial fracture is the minimally invasive percutaneous plate osteosynthesis  (MIPPO) procedure. However, there are no clear cut guidelines on fixation of the fibular fracture and currently most orthopedic surgeons use a plate osteosynthesis for the fibula as well. A common complication associated with dual plating is an increased chance of soft tissue necrosis, infection, and in some cases resulting in an exposed implant. We conducted a prospective study to analyze the results of fractures of the distal in both leg bones managed by the MIPPO procedure for tibial fractures and a rush nail for fibular fractures.  Methods:  The study was conducted in a tertiary care hospital from November 2012 to May 2014, a total of 30 fractures in 30 patients (18 males, 12 females) with a mean age of 42.4 years (26-60 years) were treated in our institution in the aforesaid time period with MIPPO for tibia and rush nail for fibular fractures. All the cases were operated on by a single surgeon in emergency within 24 hours. The patients with skin blistering and compound fractures were excluded from this study. Rehabilitative measures were proceeded as per patient’s pain profile, isometric and isotonic exercises were started on the first post-operative day, with full weight bearing at 10-12 weeks after assessing clinical and radiological union. Regular follow up of patients was done, radiographs were taken at the immediate post-operative period and at 3, 6, 12 and 24 weeks.  Results:  All the patients were available for regular follow up. Radiological and clinical union proceeded normally in all the patients, no patients had signs of any deep infection, delayed union or nonunion, three patients had a superficial infection of the tibial incision that healed with a change in antibiotic.  Conclusions:  The use of dual plating for fixation of the lower tibia and fibula fractures is often associated with soft tissue complications, exposed implant, and increased risk of infection. We conclude that in fractures of the distal tibia and fibula it is better to use a rush nail for the fibula with a concurrent MIPPO for the tibia for the reasons cited above. Moreover, with the use of rush nail the cost of implant is also reduced, which is a very important factor in developing  countries.  
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Arthroscopic Meniscal Repair: “Modified Outside-In Technique”

    • Abstract: Background:  Despite the introduction of different techniques for meniscal repair, no single procedure is superior in all situations. The new method for meniscal repair named “ modified outside-in technique ” aims to achieve higher primary fixation strength by an alternative suture technique as well as avoid disadvantages of outside-in, inside-out, and all-inside suture procedures. Additionally, the mid-term results of surgically treated patients with  eniscal injuries by our new technique were evaluated. Methods:  The current prospective study included 66 patients who underwent meniscal repair by the modified outside-in technique. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form was completed pre- and post-operatively. At final follow-up, Lysholm score was completed and patients were questioned about their return to previous sport activities. Clinical success was defined as lack of swelling and joint line tenderness, absence of locking, negative McMurray test and no need for meniscectomy. Patients’ satisfaction was evaluated using the visual analogue scale (VAS). Patients were followed for 26±1.7 months.  Results:  Clinical success was achieved in 61 patients (92.4%) and 5 candidates required meniscectomy (7.6%). IKDC Subjective Knee Evaluation Form score increased significantly from 54.2±12.7 preoperatively to 90.8±15.6  postoperatively (P<0.001). Lysholm score was excellent and good in 49 (80.3%) patients and fair in 12 (19.7%). Patients’ satisfaction averaged at 8.35±1 (6-10). Neurovascular injury, synovitis and other knot-related complications were not reported. Conclusions:  The modified outside-in technique has satisfactory functional and clinical outcomes. We believe that this procedure is associated with better clinical and biomechanical results; however, complementary studies should be performed to draw a firm conclusion in this regard.    
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Radial Head Prosthesis Removal:a Retrospective Case Series of 14 Patients

    • Abstract: Background:  The purpose of this study was to report the preoperative complaints and postoperative outcome of patients after removal of the radial head prosthesis.   Methods:  This is a retrospective review of 14 adult patients (6 females and 8 males) from 2007 to 2011, who underwent radial head prosthesis removal by three surgeons. The average time between implantation and removal was 23 months (range from 2 weeks to 12 years, median 12 months).  Results:  The leading reported complaints before removal were restricted mobility of the elbow (active range of motion of less than 100 degrees) in 6, pain in 3, and pain together with restricted mobility in 4 patients. The objective  findings before removal were restricted mobility of the elbow in 10 (71%), capitellar cartilage wear, loose implants, and heterotopic ossification each in 8 (57%), subluxation of the radio-capitellar joint or malpositioning of the stem in 5 (36%), and chronic infection in 2 (14%) patients. All patients with pain had wear of the capitellar cartilage on radiographs. The ulnar nerve was decompressed in four patients at the time of removal. Four patients underwent a subsequent operation for postoperative ulnar nerve symptoms 5 to 21 months after removal. Four patients were still complaining about persistent pain at the last follow-up visit. Except two patients, the total range of motion improved with a mean of 34 degrees (range 5 to 70) after a mean follow-up of 11 months. Conclusions:  Removal of radial head prosthesis improved function and lessened pain in our case series. The reoperation rate was yet nearly 30% due to ulnar neuritis. Selective ulnar nerve decompression at the time of removal must be evaluated, especially in patients with expected large gain in range of motion after removal.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Elbow Stiffness Secondary to Elbow Joint Osteoid Osteoma, a Diagnostic

    • Abstract: We present a 23-year-old man with distal humerus osteoid osteoma referring to our hospital with pain and progressive stiffness. The patient has been suffering from the disease for two years without a certain diagnosis. The radiographies of elbow did not reveal the pathology but further CT scan and MRI studies demonstrated the tumor. The en block resection of the tumor resolved the pain immediately but range of motion remained restricted.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Is there any Correlation Between Patient Height and Patellar Tendon

    • Abstract:  Background: A potential specific problem of patellar tendon graft in ACL reconstruction is the possibility of graft-tunnel mismatch which could be more problematic with anatomic ACL reconstruction where the femoral tunnel is placed low on the lateral wall of the lateral femoral condyle. The occasional occurrence of this mismatch raises the question that whether a correlation exists between patient height and patellar tendon length. The purpose of the present study was to measure patellar tendon length as an anthropometric finding and to evaluate whether a correlation exists between patient height and patellar tendon length.  Methods: Intra-operative measurement of patellar tendon length was carried out in 267 consecutive patients during bone-patellar tendon-bone (BTB) graft ACL reconstruction. Patient age, gender, height were recorded. The patellar tendon measurements were done independently by two surgeons and the possible inter-observer errors were checked. The data were analyzed using the Pearson correlation. Results: The mean length of the patellar tendon was 46.4 ± 4.8 mm (Mean ± SD) with a range of 32–61 mm. The mean patient height was 177 ± 7 cm (Mean ± SD) with a range of 159–197 cm. A weak positive correlations were found between patient height and patellar tendon length (Pearson r = 0.24, P< 0.001). The linear regression equation for patellar tendon length (y, in millimeters) as a function of patient height (x, in centimeters) can be expressed as y=16.54 + 0.17x. Conclusions: Our study showed a weak correlation between patellar tendon length and patient height. This finding is in contrast to the usual measurements in human anthropometry in which taller individuals have normally longer tendons and ligaments. The graft-tunnel mismatch may be the result of this variation.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Evaluation of Patient Outcome and Satisfaction after Surgical Treatment of
           Adolescent ...

    • Abstract: Background:  Adolescent idiopathic scoliosis (AIS) may lead to physical and mental problems. It also can adversely affect patient satisfaction and the quality of life. In this study, we assessed the outcomes and satisfaction rate after surgical treatment of AIS using scoliosis research society-30 questionnaire (SRS-30).   Methods:  We enrolled 135 patients with AIS undergoing corrective surgery. Patients were followed for at least 2 years. We compared pre- and post-operative x-rays in terms of Cobb’s angles and coronal balance. At the last visit, patients completed the SRS-30 questionnaire. We then assessed the correlation between radiographic measures, SRS-30 total score, and patient satisfaction.  Results: Cobb’s angle and coronal balance improved significantly after surgery (P <0.001). The scores of functional activity, pain, self-image/cosmesis, mental health, and satisfaction were 27±4.3, 26±2.5, 33±5.2, 23±3.5, and 13±1.8,  respectively. The total SRS-30 score was 127±13. Radiographic measures showed significant positive correlation with satisfaction and SRS-30 total scores ( P<0.05). There was also a positive correlation between. satisfaction and selfimage/cosmesis domain scores ( P<0.05).  Conclusions:  The greater radiographic angles were corrected the higher SRS-30 total score and patient satisfaction were. It is intuitive that the appearance and cosmesis is of most important factor associated with patient satisfaction.    
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • An Unusual Case of a Large Hematorrachis Associated with Multi-Level
           Osteoporotic Vertebral ...

    • Abstract: Spinal epidural haemorrhage may present as back pain associated with radicular symptoms and can be a catastrophic clinical scenario with progression to paraplegia or even sudden death. Being a rare entity, it needs a high index ofclinical suspicion to diagnose it. Fractures have been documented as a cause of hematorrachis but such hematomas only extend to one or two vertebral segments. Large epidural hematomas are usually associated with conditions like bleeding diathesis, arterio-venous malformations, plasma cell myeloma, and non-Hodgkin’s lymphoma. Surgical management with immediate evacuation of the hematoma is the usual line of management in patients with neurological deficits. Though rare, monitored and careful conservative management can lead to recovery of neurological symptoms and resolution of the hematoma. We report a case of a very large post traumatic epidural hematorrchis extending to 11 vertebral segments from D3 to L1 vertebral bodies, who had a gradual spontaneous recovery.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Two-Stage Nerve Graft in Severe Scar: A Time-Course Study in a Rat Model

    • Abstract: excessive scarring; paralleling the process in tendon reconstruction of the hand. Inspired by the advantages of the two-stage technique in tendon grafting and with encouraging preliminary results, we aimed to investigate the two-stage nerve grafting technique as an alternative method of secondary nerve repair. Methods:  Thirty female rats (~200 g) were randomly distributed into two groups (n=15). A 15 mm gap was created in the sciatic nerve of all the animals and an excessive extraneural scar was induced using the “mincing” method. In this method, a thin strip of muscle was removed, minced in a petri dish and returned to the peripheral nerve. In the two stage nerve graft group, a silicone tube was interposed in the first stage. After 4 weeks, in the second stage, the silicone tube was removed and a median nerve autograft was interposed through the newly formed vascularized sheath. In the conventional graft group, two nerve ends were protected with silicone caps in the first stage. After 4 weeks the caps were removed and the median graft was interposed. Behavioral assessments were performed at week 15 after surgery with the withdrawal reflex latency (WRL) and extensor postural thrust (EPT) and at the 3, 6 and 15-week time points with the TOA (toe out angle). Masson Trichrome staining method was used for histological assessments at week 15. Results: According to the EPT and WRL, the two-stage nerve graft showed significant improvement (P=0.020 and P =0.017 respectively). The TOA showed no significant difference between the two groups. The total vascular index was significantly higher in the two-stage nerve graft group (P<0.001). Conclusions:  Two-stage nerve graft using a silicone tube enhances vascularity of the graft and improves functional recovery.    
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Childhood Facial Osteosracoma: a Case Report

    • Abstract: Osteosarcoma (OS) is the eighth common cancer of childhood and its incidence is 4 cases in one million in children younger than 14. Facial OS incidence is estimated between 8 and 10% of OS cases. The main etiology of OS is unknown, but various predisposing factors are proposed such as radiation, radiotherapy, some benign bone diseases like Paget’s disease or fibrous dysplasia. There is a 5-year survival rate of 68% and it decreases with the increase of age. Positive history of radiotherapy is the main predisposing factor for childhood OS. There is some evidence about the X-ray induced mutation in genomic DNA that leads to osteosarcoma. In the present paper we present a 19-month old girl with a mass located in the inferior margin of the left cheek and orbit. Our case is unique with regard to her young age and sex. Moreover, the tumor was located in an uncommon site and her disease was progressive and resistant.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • A Pitfall in Fixation of Distal Humeral Fractures with Pre-Contoured
           Locking Compression Plate

    • Abstract: Anatomically precontoured locking plates are intended to facilitate the fixation of articular fractures and particularly those associated with osteoporosis. Fractures of the distal humerus are relatively uncommon injuries where operative intervention can be exceptionally challenging. The distal humeral trochlea provides a very narrow anatomical window through which to pass a fixed-angle locking screw, which must also avoid the olecranon, coronoid, and radial fossae. We describe 3 patients (ages 27, 49, and 73 years) with a bicolumnar fracture of the distal humerus where very short distal locking screws were used. Intra-articular screw placement was avoided but loss of fixation occurred in two patients and a third was treated with a prolonged period of immobilization. We postulate that fixed-angle screw trajectories may make it difficult for the surgeon to place screws of adequate length in this anatomically confined region, and may lead to insufficient distal fixation. Surgical tactics should include placement of as many screws as possible into the distal fragment, as long as possible, and that each screw pass through a plate without necessarily locking in.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament
           Reconstruction: Case ...

    • Abstract:  Background: A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture.    Case presentation: A 35-year old male soccer player with a history of ACL tear from the previous year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages: first fixation of the fracture and then ACL re-revision after fracture healing was complete. Conclusions: Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Sternocostoclavicular Joint Swelling; Diagnosis of a Neglected Entity

    • Abstract: Background:  Sternocostoclavicular joint (SCCJ) swelling is an underdiagnosed, albeit important entity in clinical practice. The present study was conducted in order to identify the incidence and common causes of this entity.  Methods:  Patients presenting to the Orthopaedic Clinic with a swelling of the sternocostoclavicular joint, during the study period of two years were included, and detailed history was obtained from the patient. Baseline investigations (total and differential leukocyte count, ESR, CRP, X-ray and CT) wereperformed. Magnetic resonance imaging,FNAC or joint aspiration was performed whenever clinically or radiologically indicated.  Results:   A total of 21 patients were enrolled into the study for a duration of 2 years. Patients mainly presented with both pain and swelling of the SCCJ with predominant right sided involvement. Osteoarthritis was the most frequent diagnosis followed by infections, primary bone/cartilage tumor, and metastasis.  Conclusions:  Although most of the patients with SCCJ swelling have a benign etiology, it is not wise to dismiss thisswelling as degenerative changes. Serious conditions like septic arthritis or neoplasia, may masquerade with similar presentations such as osteoarthritis. It would be therefore imperative to rule out all of these potentially life threatening conditions using thorough clinic-radiological workups.    
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • A Survey of Severity and Distribution of Musculoskeletal Pain in Multiple
           Sclerosis Patients; a ...

    • Abstract:   Background: Pain, a common phenomenon in multiple sclerosis (MS) patients, is associated with many symptoms and problems.  To investigation severity and distribution of musculoskeletal pain in MS patients. Methods: In this cross-sectional study, 115 members of the Mazandaran MS Association with confirmed MS were randomly selected to participate in the study. The patients were asked to fill out Numerical Rating Score and Nodric questionnaires, respectively. The data was analyzed by SPSS ver. 16 software. Results: The mean age of the participants was 30.43±5.86 years and 88 cases (76.5%) were female. The mean disease duration was 26.34±24.32 months and 87.8% of the cases were experiencing pain at the time of study. The mean pain severity was 3.75±2.25 and worst pain experienced was 5.73±2.12. The most common pain sites were: the knees (55.7%), wrist (43.5%), and neck (41.7%). Women experience higher prevalence of shoulder, upper back, and ankle pain (P
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Prevention of Periprosthetic Joint Infection

    • Abstract: Prosthetic joint infection (PJI) is a calamitous complication with high morbidity and substantial cost. The reported incidence is low but it is probably underestimated due to the difficulty in diagnosis. PJI has challenged the orthopaedic community for several years and despite all the advances in this field, it is still a real concern with immense impact on patients, and the healthcare system. Eradication of infection can be very difficult. Therefore, prevention remains the ultimate goal. The medical community has executed many practices with the intention to prevent infection and treat it effectively when it encounters. Numerous factors can predispose patients to PJI. Identifying the host risk factors, patients’ health modification, proper wound care, and optimizing operative room environment remain some of the core fundamental steps that can help minimizing the overall incidence of infection. In this review we have summarized the effective prevention strategies along with the recommendations of a recent International Consensus Meeting on Surgical Site and Periprosthetic Joint Infection.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Adult Degenerative Scoliosis with Spinal Stenosis Treated with Stand-Alone
           Cage via an Extreme ...

    • Abstract: We report the case of a 73-year-old female with severe degenerative scoliosis and back and leg pain that wassuccessfully treated with stand- alone cages via an extreme lateral transpsoas approach. This patient had declinedopen surgery and instrumentation due to her advanced age concerns about potential side effects.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • A Review Article: Diagnosis and Treatment of Radial Tunnel Syndrome

    • Abstract: Radial tunnel syndrome is a disease which we should consider it in elbow and forearm pains. It is diagnosed with lateral elbow and dorsal forearm pain may radiate to the wrist and dorsum of fingers. The disease is more prevalent in women with the age of 30 to 50 years old. It occurs by intermittent compression on the radial nerve from the radial head to the inferior border of the supinator muscle, without obvious extensor muscle weakness. Compression could happen in five different sites but the arcade of Frose is the most common area that radial nerve is compressed. To diagnosis radial tunnel syndrome, clinical examination is more important than paraclinic tests such as electrodiagnsic test and imaging studies. The exact site of the pain which can more specified by rule of nine test and weakness of the third finger and wrist extension are valuable physical exams to diagnosis. MRI studies my show u muscle edema or atrophy along the distribution of the posterior interosseous nerve. Although non-surgical treatments such as rest, NSAIDs, injections and physiotherapy do not believe to have permanent relief, but it is justify undergoing them before surgery. Surgery could diminish pain and symptoms in 67 to 93 percents of patients completely.
      PubDate: Mon, 16 Mar 2015 20:30:00 +010
  • Hip Arthroplasty and its revision in a child: case report and literature

    • Abstract: Abstract:Juvenile idiopathic arthritis is the leading cause of hip replacement in young children. However , arthroplasty in this population is challenging with several concerns about bone quality, prosthesis and patient survival ,young age for revision surgery and difficulties in potential several revisions. In this study we introduced one of the youngest revision hip arthroplasties in a 12 year old child ,the index operation was hybrid replacement,cemented for stem. Two years later revision was done with sever femoral deficiency(paprosky type 3B).this second procedure was challenging but with short-term promising we reviewed literature for arthroplasty and recent findings and concepts in this young population. According to literature survival of prosthesis is longer with cemented acetabular component and pressfit stem, however, There are evidences that show poor outcome of joint replacement after first revision. it seems that Nowadays we have turned full circle to the point that joint preservation procedures should be settled in young patients ,eventhough complete pain relief cannot be achieve with this means .
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
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