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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  [15 journals]
  • The Most Appropriate Reconstruction Method Following Giant Cells Tumor
           Curettage: A ...

    • Abstract: Giant cell tumor (GCT) is a primary and benign tumor of bone, albeit locally aggressive in some cases, such as in the epi-metaphyseal region of long bones, predominantly the distal end of femur and proximal end of tibia (1). There are a variety of treatments for a bone affected by GCT, ranging from chemotherapy, radiotherapy, embolization, and cryosurgery, to surgery with the use of chemical or thermal adjuvant (2). Even with advances in new chemotropic drugs, surgery is still the most effective treatment for this kind of tumor (3). The surgery often involves defect reconstruction following tumor removal (4). The aims of treatment are removing the tumor and reconstructing the bone defect in order to decrease the risk of recurrence, and restore limb function, respectively. To achieve these goals, reconstruction is usually accompanied with PMMA bone cement infilling (4). The high heat generated during PMMA polymerization in the body can kill the remaining cancer cells, and hence the chance of recurrence decreases (5). In addition, filling the cavity with bone cement provides immediate stability, enabling patients to return to their daily activities soon (6). The major drawbacks of the technique of curettage and cementation is the high fracture risk, due to the early loading of the bone, and the insufficient fixation of the cement in the cavity (7). Hence, several methods have been developed to fix the bone cement in order to prevent the postoperative fracture. Pattijn et.al packed the cement with a titanium membrane which was attached to the periosteum with small screws (7). The membrane can make early normal functioning of patients possible, since it partially restore the strength and stiffness of the bone. Cement augmentation with internal fixation is another method to decrease the risk of postoperative fractures (6, 8, 9).
      PubDate: Wed, 28 Feb 2018 20:30:00 +010
       
  • Current Concepts in Scaffolding for Bone Tissue Engineering

    • Abstract: Bone disorders are of significant worry due to their increased prevalence in the median age. Scaffold-based bonetissue engineering holds great promise for the future of osseous defects therapies. Porous composite materials andfunctional coatings for metallic implants have been introduced in next generation of orthopedic medicine for tissueengineering. While osteoconductive materials such as hydroxyapatite and tricalcium phosphate ceramics as wellas some biodegradable polymers are suggested, much interest has recently focused on the use of osteoinductivematerials like demineralized bone matrix or bone derivatives. However, physiochemical modifications in terms ofporosity, mechanical strength, cell adhesion, biocompatibility, cell proliferation, mineralization and osteogenicdifferentiation are required. This paper reviews studies on bone tissue engineering from the biomaterial point of viewin scaffolding.
      PubDate: Wed, 28 Feb 2018 20:30:00 +010
       
  • Total Knee Replacement Sizing: Shoe Size Is a Better Predictor for Implant
           Size than Body Height

    • Abstract: Background: Various sizes of implants need to be available during surgery. The purpose of this paper is to comparebody height and shoe size with implant sizes in patients who underwent total knee replacement surgery to see whichbiomarker is a better predictor for preoperative planning to determine implant size.Methods: A total of 100 knees, belonging to 50 females and 50 males, were observed. Participants’ body height andshoe size were collected and correlated to implant sizes of a current, frequently used, standard total knee replacement(TKR) implant. The femoral anteroposterior and mediolateral width and the tibial anteroposterior and mediolateral widthwere correlated with height and shoe size.Results: The correlation between shoe size and the four knee implant dimensions, femoral AP, ML, and tibial AP andML were higher than the correlations between height and the same four dimensions.Conclusion: The results indicated that shoe size is a better predictor of component dimensions than is body height.
      PubDate: Wed, 28 Feb 2018 20:30:00 +010
       
  • The Stabilising Effect of the Anterior Oblique Ligament to Prevent
           Directional Subluxation at ...

    • Abstract: Background: The trapeziometacarpal joint (TMCJ) is inherently unstable, relying on ligament restraint to preventsubluxation. Subluxation of the thumb in a dorsoradial direction is often observed in clinical practice, either after acuteligament injury or more commonly with osteoarthritis (OA). This subluxation follows loss of function of trapeziometacarpalligaments that stabilise this joint, resisting the deforming force of abductor pollicis longus (APL). The exact ligamentsthat stabilise and prevent the thumb from the pull of APL causing dorsoradial subluxation remain unknown, although theanterior oblique ligament (AOL) has been implicated. The aim of this study was to measure the direction of subluxationresisted by the AOL.Methods: In this study we used cadaveric limbs and custom made biomechanical testing to measure the influence AOLhas in stabilising the thumb against subluxation in three planes: radial, dorsal and dorsoradial. Three fresh frozen handswere dissected to expose the TMCJ, leaving all ligaments, capsule and APL attachment in place. The force requiredto create a displacement of 5mm between the first metacarpal and the trapezium in these three planes was measuredbefore and after AOL division.Results: The average force to displace in the dorsoradial plane prior to division was 6.68N, and a statistically significantreduction to 1.15N (P<0.001) was found after division of the AOL. A statistically significant increase in force (P<0.001)from 2.89N to 4.04N was seen in the radial plane, while no change was seen dorsally (P=0.98), with average forces of2.74N and 2.62N found pre and post division.Conclusion: There is clinical significance in reporting quantifiable data in this field, as subluxation of the thumb is oftenseen with OA. The results of our study provide support for surgical reconstruction of the AOL as the primary surgicalstabilizer against dorsoradial subluxation of the thumb.
      PubDate: Wed, 28 Feb 2018 20:30:00 +010
       
  • Combination of bone marrow derived cells transplantation and high tibial
           osteotomy in early ...

    • Abstract: Purpose: high tibial osteotomy (HTO) is a recommended treatment for medial compartment knee osteoarthritis. Newer cartilage regenerative procedures may add benefits to the result of HTO. In this prospective study we investigate safety and also results of HTO associated with bone marrow derived cells (BMDC) transplantation in relatively young and middle aged active individuals with early osteoarthritis of the knee and our hypothesis is combination of these procedures is safe and leads to better outcome. Methods: 24 patients (with mean age of 47.9 years) with varus knee and symptomatic medial compartment osteoarthritis were treated with medial opening-wedge high tibial osteotomy in conjunction with transplantation of bone marrow derived cells into the chondral lesions. Clinical outcome was assessed by IKDC score, KOOS score, VAS and Tegner scores and radiographic study was performed preoperatively and at follow-ups. Results: there were no major complications during operation and postoperative follow-ups.all the clinical scores significantly were improved for the IKDC score (from 32.7 +/-15 to 64+/- 21), KOOS score (from30 +/- 11 to 68 +/- 19), VAS (from7.5 to 3), and Tegner score (from 1.2 to 2.1). Conclusions: HTO in conjunction with BMDC transplantation is a safe and feasible treatment for early medial compartment osteoarthritis in varus knees and associated with good results in short term follow up.
      PubDate: Wed, 28 Feb 2018 20:30:00 +010
       
  • Reliability and Validity of the Swiss Spinal Stenosis Questionnaire for
           Iranian Patients with ...

    • Abstract: Background: The purpose of this study was validation of the Persian translation of the Swiss Spinal StenosisQuestionnaire in order to be used by Iranian researchers.Methods: A total of 104 patients with spinal stenosis diagnosis, who were candidates for operative treatment wereentered into the study. The patients completed the translated questionnaire in the 1st and the 7th days of admissionand 6 months after surgery. Visual analogue scale was used to determine the severity of the pain in the1st day andthe 6th month. Discriminant validity, convergent validity, test-retest reliability, internal consistency, ability to detectchanges and sensitivity to clinical changes were assessed for the statistical purposes.Results: Cronbach’s α was more than 0.9 for all the items. ICC was about 0.9 for all the items. For symptoms, physical andtotal items, Cronbach’s α was 0.942, 0.957, 0.926 and Intraclass correlation were 0.891, 0.918, 0.862, respectively. Pairedt-test was significantly different between the 1st day and the 6th month questionnaire. There was a positive correlation eitherbetween the first VAS and the 1st day questionnaire (1st day Q) (r=0.892, P=0.000) or between the 6th month VAS and 6thmonth Q (r=0.940, P=0.000). The Pearson’s correlation between the difference of the total scores of the 1st day and the6th month and satisfaction score after surgery showed negative correlation (r= -0.746, P=0.000). The effect size was 2.55.Conclusion: The Iranian version of the Swiss Spinal Stenosis has excellent internal consistency, excellent reliability,good ability to alter with changes, especially parallel with clinical improvement, excellent ability to detect changes, andwell either convergent or discriminant validity.
      PubDate: Wed, 28 Feb 2018 20:30:00 +010
       
  • Comparison of Clinical Results between Patellar Resurfacing and
           Non-resurfacing in Total Knee ...

    • Abstract: Background: There is no difference in the functional outcomes 6 months after total knee arthroplasty (TKA) for kneeosteoarthritis between patellar resurfacing and non-resurfacing. Thus, we have performed this study to compare theshort-term clinical outcomes of TKA performed with and without the patella resurfacing.Methods: A total of 50 patients with osteoarthritis of the knee (OAK) were randomized to receive patellar resurfacing(n=24; resurfaced group) or to retain their native patella (n=26; non-resurfaced group) based on envelope selectionand provided informed consent. Disease specific outcomes including Knee Society Score (KSS), Knee SocietyFunction Score (KSKS-F), Kujala Anterior Knee Pain Scale (AKPS), Western Ontario and McMaster UniversitiesArthritis Index (WOMAC), Short Form 36 (SF-36), and functional patella-related activities were measured within sixmonths of follow-up.Results: There was no significant difference between the resurfaced and non-resurfaced groups in pre and postoperativeimprovement of range of motion (ROM) (P=0.421), KSS (P=0.782, P=0.553), KSKS-F (P=0.241, P=0.293),AKPS (P=0.128, P=0.443), WOMAC (P=0.700, P=0.282), and pain scores (P=0.120, P=0.508). There was nodifference in ROM between resurfaced and non-resurfaced group pre (15.24° and 15.45°) and post-operative (18.48°and 18.74). No side effects related to patella was observed in any of the groups. Revision was required in none ofthe participants.Conclusion: The results showed no significant difference between patellar resurfacing and non-resurfacing in TKA forall outcome measures in a short term.
      PubDate: Wed, 28 Feb 2018 20:30:00 +010
       
  • Clinical outcome of anatomical transportal arthroscopic anterior cruciate
           ligament ...

    • Abstract: A B S T R A C T Good clinical outcome and return to sport and daily functions after anterior cruciate ligament (ACL) reconstruction is goal standard in this surgery. but to date, there are different challenging issues between orthopedic surgeons regarding graft selection and surgical techniques. Material and Methods: We retrospectively reviewed the patients who underwent anatomical arthroscopic one bundle ACL reconstruction with quadruple hamstring tendon autograft from 2010 to 2016 in our clinic. Eighty-two eligible patients (82 knees) who had met our inclusion criteria were examined in terms of knee stability by clinical examinations and KT 2000 arthrometer and - also were evaluated regarding variables related to their health and knee status with a mean 48months follow-up. Results: Seventy-seven patients (93.9%) were male and the other 5 cases (6.1%) were female. The mean age was 33 ± 8.06 years old at the time of surgery and mean BMI amount was 26.81 ± 3.72. 78 patients (95%) returned to pre-injury sport activity level after ACL reconstruction .63 patients (76.8%) had negative anterior drawer and 67patients (81.8%) negative lachman tests . 10 patients (13%) were found to have positive pivot shift tests. 72 patients (87%) had negative tests in active and 70(85.4%) had less than 3 mm side to side difference in manual testing by KT2000. Final KOOS score was70.87 ± 19.76. Mean Lysholm score was 90 ± 4.77. Mean International Knee Documentation Committee (IKDC) score of this study was 85 ± 14.11.Mean kujala score was 79 ± 3.07. Conclusions: The use of quadrupled hamstring tendon autograft besides the most important part of the treatment which is the surgical technique would yield to excellent results in ACL reconstruction both subjectively and objectively. In addition, patient selection and surgeon’s experience should be considered in determining the treatment plan for the patients.
      PubDate: Wed, 28 Feb 2018 20:30:00 +010
       
  • Epineural Sleeve Reconstruction Technique for Median Nerve Complete
           Transection

    • Abstract: In microsurgical nerve repair, the epineural sleeve technique can be used to bridge short nerve defects and to coverthe coaptation site with the epineurium of the nerve stump. The epineurium serves as a mechanical aid to reducegap size, and increase repair strength, effectively assisting nerve regeneration.This article presents a 32-year-old patient who experienced complete transection of the median nerve at thedistal forearm, which was treated with the epineural sleeve graft reconstruction technique. Nerve regenerationwas followed-up for 18 months and evaluated with the Rosén and Lundborg scoring system. The final outcomewas excellent; at the last follow-up, the patient experienced complete sensory and motor function of the mediannerve.
      PubDate: Wed, 28 Feb 2018 20:30:00 +010
       
  • Healing of Complete Tear of the Anterior Talofibular Ligament and Early
           Ankle Stabilization ...

    • Abstract: Lateral Ankle sprain (LAS) is a common sports injury associated with recurrent ankle sprain, chronic ankle instability(CAI) and post-traumatic ankle osteoarthritis (PTOA). Platelet Rich Plasma (PRP) has been increasingly used fortherapeutic applications in sports-related injuries, and is thought to stimulate tissue healing. We reported a case ofLAS with complete tear of anterior talofibular ligament, which showed complete healing of ligament and early anklestabilization after PRP. The healing is supported by dynamic ultrasound images and magnetic resonance imaging.We therefore proposed that PRP may serve as an alternative non-surgical treatment option in LAS in future research,with the potential to prevent the development of CAS and PTAO.
      PubDate: Wed, 28 Feb 2018 20:30:00 +010
       
  • Acute Combined Median and Radial Nerve Palsies after Distal Humeral Shaft
           Fracture

    • Abstract: We report a case of a 29-year-old man who presented with a distal humeral shaft fracture sustained by blunt trauma. Physicalexamination and nerve conduction study were consistent with injury to the median and radial nerves proximal to theelbow. The patient underwent open reduction and internal fixation of the humeral shaft fracture with neurolysis of the medianand radial nerves. Repeat electromyography at 6 months postoperatively showed recruitment of motor units in all musclessampled, in keeping with clinical improvement. At 16 months follow-up, the patient was full strength in all muscle groups,was back to all activities with no restrictions, and was discharged from follow-up. Our case describes clinical improvementafter surgical intervention in a patient with combined median and radial nerve palsies following distal humeral shaft fracture.
      PubDate: Wed, 28 Feb 2018 20:30:00 +010
       
  • Intrapelvic Protrusion of a Broken Guide Wire Fragment during Fixation of
           a Femoral Neck Fracture

    • Abstract: Breakage of DHS guide wire during surgery and its migration into the pelvis through the hip joint is a rare complication and its removal can be very challenging for the surgeon. We share our experience of a similar case wherein we used an ‘iliofemoral’ approach to successfully remove the broken transfixing guidewire from the hip joint. Although iliofemoral approach is similar to the lateral window of conventional ilioinguinal approach, yet it is less invasive, has lesser complications, requires less expertise and is easily reproducible by an average orthopaedic trauma surgeon. We recommend that surgical approaches for removal of these broken or migrated wires should be individualized depending upon the exact location of the wire tip in the hip joint or pelvis and need for exposure.
      PubDate: Wed, 28 Feb 2018 20:30:00 +010
       
  • Long- Stem Total Knee Arthroplasty for Proximal Tibial Stress Fractures in
           the Elderly Patients

    • Abstract: Purpose: Because of the poor bone stock, it is not infrequent that elderly patients may present with stress fracture of the proximal tibia. The optimal management of patients with severe gonarthrosis of the knee and concurrent tibial stress fracture is not known. In this study we report the outcome of primary total knee arthroplasty (TKA) using stemmed components in this group of patients. Methods: Between 2009 and 2014, 16 elderly patients with proximal tibial stress fractures and concurrent gonarthrosis were treated with TKA using long stemmed components at our institution. Diagnosis of stress fractures was based on changes seen on radiographs. Standing alignment view was obtained for all patients preoperatively. Union of the fracture site was investigated using plain anteroposterior (AP) and lateral leg x-rays. Results: All patients experienced significant relieve of symptoms. The Knee Society score and Knee Society functional score averaged 86±4 and 85±6, respectively. The mean arc of motion of the knee was 118 ±2 degrees at the latest follow-up. All stress fractures resolved at a mean of 8.3±1.1 weeks. Medial proximal tibial angle increased from 74.7±5.7 preoperatively to 90.3±1.1 degrees (p<0.001) postoperatively. Tegner activity scale increased from 2.1±1.3 to 3.4±0.9 (p<0.001). Conclusion: Based on this case series, it appears that patients with stress fracture of proximal tibia and concurrent gonarthrosis may be treated with primary TKA using stemmed components that may bypass the stress fracture and allow healing of the fracture.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • How much bone cement is utilized for component fixation in primary
           cemented total knee ...

    • Abstract: Purpose: No scientific evidence exists regarding the amount of bone cement used and discarded in primary cemented Total knee arthroplasty (TKA). The aim of this study was to identify the exact amount of bone cement utilized for component fixation in primary TKA. Methods: In a prospective study carried out at five centers, 133 primary cemented TKAs were performed. One pack of 40g Palacos bone cement ( PBC 40) was hand mixed and digitally applied during the surgery. After fixation of the TKA components, the remaining bone cement was methodically collected and weighed on a digital weighing scale. The actual quantity of cement utilized for component fixation was calculated. Results: On an average, 22.1 g of bone cement was utilized per joint, which accounted to 39 % of 57g , the solidified dry weight of PBC 40. Among 133 knees, the cement usage was 20 % to 50% in 109 knees, more than 50% in 20 knees and less than 20% in 4 knees. Knees which received larger sized femoral implant required more cement compared to medium and small sizes. Knees which had pulse lavage had more cement utilization compared to knees which had simple syringe lavage before implantation. Conclusion: Large quantity of bone cement was handled than actual requirements in primary TKA when a standard 40g pack was used with the digital application technique, resulting in sizeable discard of bone cement. Customizing cement pack according to the implant size can potentially avoid this cement wastage. Future research is required to study the utility and economic impact of smaller packs ( 20 g or 30 g) of bone cement in primary TKA.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Simultaneous Quadruple Joint Replacement (QJR) in disabling Juvenile
           Rheumatoid Arthritis – a ...

    • Abstract: We wish to present a case of 47-year-old patient with Juvenile Rheumatoid Arthritis and ankylosis of both hips and both knees treated by bilateral hip and knee arthroplasty in a single anaesthesia i.e. Quadruple joint replacement in single sitting. He was back on his feet from his bed-ridden state within the fortnight following surgery. He has been followed up for four years and has been performing his activities of daily living independently. We discuss the preoperative planning, surgical details and post-operative rehabilitation and unique challenges pertaining to this case.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Short-Term Results of The DePuy Global Unite Platform Shoulder System: A
           Two-Year Outcome Study

    • Abstract: Introduction The Global Unite Shoulder System is the next generation of implant from the Depuy Global Shoulder line. The primary feature of the Global Unite is adaptability through the interchangeable modular bodies, modular suture collars, and stems. Short-term functional and radiographic outcomes of the Global Unite Platform Shoulder System were assessed as well as complication and revision rates. Methods 95 subjects were enrolled prospectively between 2013 and 2015 that underwent anatomic or reverse shoulder arthroplasty utilizing the DePuy Global Unite Anatomic Platform Shoulder System. Functional outcome data (ASES and SANE) as well as radiographic data was collected on these patients pre-operatively, and at 6 months, 1 year and 2 years post-operatively. Results The cohort consisted of 97 shoulders in 95 patients of which 54 (56.8%) are males and 41 (43.2%) are female. There were 55/97 (56.7%) were primary anatomic total shoulder arthroplasties, 37/97 (38.1%) primary reverse shoulder arthroplasties, and 3/97 (3.1%) revision procedures to a reverse shoulder arthroplasty. Outcome scores demonstrated an increase in ASES score from a mean of 33.00 to 79.56 and SANE score of 21.30 to 84.08. Conclusion The Depuy Global Unite shoulder system demonstrated very good short-term results in this two-year outcome study. Functional outcome scores are similar to current literature for anatomic and reverse primary cases. Radiographic measures at two years are promising with only 2 cases of grade 1 scapular notching and one case of grade 2 scapular notching. Overall the Depuy Global Unite is a versatile shoulder system with very good early outcomes
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • The Midterm Results of the Delta Xtend Reverse Shoulder System: A
           Five-Year Outcome Study

    • Abstract: Object: The purpose of this study was to examine the mid-term functional outcomes, radiographic results, and revision rates of patients treated with the Delta Xtend Reverse Shoulder System for both primary and revision arthroplasty indications. Methods: A retrospective review was conducted of records for all individuals who underwent a reverse shoulder arthroplasty using the Delta Xtend Reverse Shoulder Prosthesis at a single institution. Radiographic analysis as well as pain and functional measures using the ASES, Quick DASH, SST, SF-12, Penn, SANE, EQ-5D and VAS, and VR-12 scores. Patients were evaluated for five-year outcomes. Results: Fifty patients were available for 5-year outcomes. Thirty-three cases were primary arthroplasty cases and 17 were revision arthroplasty cases. Postoperative radiographs at five years out from surgery were available for 46 patients. The mean AGT overall was 32.6mm: 31.7mm the primary cases and 34.8mm for revision cases. Sirveaux scapular notching was: 65.2% (30/46) at Grade 0, 23.9% (11/46) at Grade 1, and 10.9% (5/46) at Grade 2. Overall, 32/46 of stems were in neutral position, 10/46 were in valgus position, and 4/46 were in varus position. There was no significant correlation between stem position and scapular notching. The mean outcome scores for all patients at five years were good to excellent. Two revision patients demonstrated loosening of the humeral stem on radiographs. Nine patients demonstrated calcification of the long head of the triceps tendon. Conclusions: In conclusion, the Delta Xtend Reverse Shoulder System has shown to be a reliable arthroplasty system for patients with CTA or failed prior arthroplasty. Patients are generally quite functional at five years out from their reverse shoulder arthroplasty using this implant. Radiographic measures used to interpret the status of the implant demonstrate that AGT is well maintained and scapular notching is minimal for the majority of cases.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • An anteriorly presenting ‘wrap around’ popliteal cyst

    • Abstract: The article describes a case in which a popliteal cyst was identified presenting as a mass on the anterior aspect of the right tibia. This occurred as a result of polyethylene wear debris from a previous total knee arthroplasty. Although alternative diagnoses for an anterior tibial mass are more likely, a popliteal cyst must be considered, particularly if the patient has a history of total knee arthroplasty.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • High serum alpha-2-macroglobulin level in patients with osteonecrosis of
           the femoral head

    • Abstract: Background Diagnosis of osteonecrosis of the femoral head (ONFH), a disabling and devastating condition, is complicated by the lack of reliable serum biomarkers. This study aimed to investigate whether the serum level of alpha-2-macroglobulin (A2M) can be used for ANFH diagnosis. Methods Blood samples from 36 ONFH patients were obtained. Serum protein capillary electrophoresis was performed on the sera of the patients. The serum levels of A2M were also subjected to be measured by A2M human enzyme-linked immunosorbent assay. Results Serum protein capillary electrophoresis of ONFH patients revealed that the level of alpha-2 subunit, composed of alpha-2-macroglobulin, ceruloplasmin and 2-2 haptoglobin phenotype, was increased significantly as compared to healthy subjects (p value: 0.0001). Moreover, alpha-2-macroglobulin ELISA assay proved that the A2M has been significantly raised (p value: 0.037). Conclusion Taken together, these findings suggest that avascular necrotic femur head presumably directly or indirectly elevates A2M into the bloodstream. Thus, measuring the serum level of A2M might be used as a reliable diagnostic tool in clinical practice.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Denosumab in Patients with Giant Cell Tumor and Its Recurrence: A
           Systematic Review

    • Abstract: Recent studies regarding drug treatment with Denosumab suggest that this drug reduces the size of tumor, and therefore make surgery easier with lower morbidity. However, some studies have reported several complications associated with this drug. So, we decided to do systematic review .This study reviews the literature to determine the effectiveness and safety of Denosumab in reducing activity bone destructions in giant cell tumor and skeletal- related events in patients with giant cell tumor of bone and its recurrence. We explored studies in PubMed, Cochrane Collaboration Library. For this purpose, articles of various levels were retrieved until October 22, 2016. Two reviewers assessed articles independently based on predefined criteria to extract the relevant data. Primary outcomes associated with skeletal-related event (SRE), overall survival, and secondary outcomes such as pain, quality of life and adverse events were evaluated and analyzed. The total population of this meta-analysis consisted of 686 patients. Of this population, only 55% had primary giant cell tumor of bone and the remaining 45% had giant cell tumor recurrence, with 2% experiencing secondary recurrence. The results showed the effectiveness of Denosumab in reducing the tumor size due to inhibiting the Osteoclastogenesis. Denosumab does not have any effect on reducing tumor recurrence, but in cases where complete tumor surgery is not possible and tumor residuals may remain, Denosumab can be helpful. Also, the clinician should consider that risk benefit of Denosumab.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Clinical Outcomes after Microdiscectomy for Recurrent Lumbar Disk
           Herniation

    • Abstract: Objectives: Revision discectomy is the principal procedure for recurrent lumbar disk herniation (RLDH). The clinical outcomes after this procedure are as good as or slightly poorer than those produced by primary discectomy. In this study, the clinical outcomes of patients treated with microsurgical discectomy for RLDH were analyzed. Methods: We examined 179 patients undergoing lumbar microdiscectomy surgery for RLDH. The visual analogue scale (VAS), Prolo scoring system, and Oswestry Disability Index (ODI) were used for evaluating the improvement of symptoms and functional outcomes. Results: Among 179 patients, 101 (56%) obtained good and excellent Prolo scores (group 1), while 78 (44%) obtained fair or poor results (group 2). There was no significant difference between the groups regarding age, gender, body mass index, diabetes mellitus, smoking, interval between primary and revision surgeries, and surgical outcomes. However, significant improvements were achieved in VAS scores for back and radicular pain, as well as ODI scores. Based on the findings, only ODI scores showed a significant inter-group difference in the 12-month follow-up. Conclusion: Limited microsurgical discectomy could be considered as the main surgical method in patients with RLDH without overt instabilities.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Significance of perioperative tests to diagnose the infection in revision
           total shoulder ...

    • Abstract: Purpose: The purpose of this study was to evaluate the value of perioperative tests for the diagnosis of infection in revision shoulder arthroplasty. Methods: A retrospective analysis was performed on 537 shoulder arthroplasties(429 patients) that underwent revision shoulder arthroplasty at our institution. Periprosthetic tissue cultures were positive in 169/537 surgeries. Results: White-blood cell count (WBC) was elevated in 3.8% revision arthroplasties. Erythrocyte sedimentation rate (ESR) was elevated in 23.1% revision arthroplasties. The C-reactive protein (CRP) was elevated in 20.8% revision arthroplasties. Bone scans (technetium,indium) were performed on 9.9% patients and it was positive for osteomyelitis in just one revision arthroplasty. Intra-operative pathology was read as consistent with acute inflammation in 11.9% revision arthroplasties. The positive and negative predictive values for intra-operative pathology were 56.7% and 71.6% respectively. Conclusions: All of the perioperative tests had a high specificity and negative predictive value, but low sensitivity and positive predictive value.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Does adding Lidocaine to intrathecal Bupivacaine improve hemodynamic
           parameters during hip ...

    • Abstract: Background: In this study to reduce the hemodynamics complications of intrathecal Bupivacaine, investigators reduced the dose of Bupivacaine and added Lidocaine and Epinephrine to assess their effects on hemodynamic complications such as hypotension and bradycardia. Materials and methods: This study was a double-blind clinical trial that was conducted on 292 patients. For spinal anesthesia, Patients were allocated to two Groups of B (10 mg of hyperbaric 0.5% Bupivacaine) and BL (5 mg hyperbaric Bupivacaine 0.5% plus 50 mg Lidocaine 5%). Sensory and motor block and hemodynamic changes were consecutively measured before spinal anesthesia (T0), immediately after spinal injection (T1), every 5 minutes for half an hour (T2- T7), at 45th minutes (T8) and 60th minutes (T9). Results: Comparing demographic characteristics including age, sex, BMI, ASA Class, baseline blood pressure and heart rate in groups showed no statistical significant difference. The onsets of sensory and motor blocks in group BL were faster than Group B. Also, the durations of sensory and motor blocks in group B were longer than group BL and significant difference between groups was noted (P = 0.0001). Systolic blood pressure in all periods showed that group BL had lower blood pressure (P <0.05). In examining the heart rate in both groups, although the heart rate at all times in the group BL was lower than Group B, but this difference was only significant during T2-T3. Group BL had more episodes of hypotension, bradycardia, nausea and vomiting . Conclusion: In the present study it was shown that using 50 mg of Lidocaine in combination with 5 mg of Bupivacaine, compared with 10 mg Bupivacaine alone for spinal anesthesia for hip fracture was more associated with hypotension and bradycardia. As a result, using Bupivacaine with Lidocaine at this dose in these patients is not recommended for induction of anesthesia.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Results of open Bankart surgery for the treatment of recurrent anterior
           shoulder dislocation ...

    • Abstract: Background: Open Bankart surgery is a main treatment procedure in the patients with recurrent anterior shoulder dislocation , especially in cases with glenoid bone defect . The goal of this study is to determine results after open Bankart surgery in cases of recurrent anterior shoulder dislocation with glenoid bone defect and concomitant Hill-Sachs lesion. Methods:Between 2006 and 2010, 89 patients with recurrent anterior shoulder dislocation with glenoid bone defects (10-30%) and Hill-Sachs lesions undergoing open Bankart surgery were reviewed. mean Follow-up after the surgery was 7 years (5.5-9.5 years).The recurrence rate was determined and the degree of shoulder pain and daily activity level were determined subjectively based on VAS (Visual Analogue Scale) and ADL (Activity Daily Living).Shoulder ROM in abduction and external rotation compared with contralateral side and finally, ASES (American Shoulder and Elbow Score) and CMS (Constant-Murley score) were calculated . Results: Over 7 years of follow-up, a total of 15 patients (16.8%) undergoing surgery had instability (3 patients (3.3%) had dislocation and 12 patients had (13.4%) Subluxation). There were larger glenoid bone defect (p value =0.0001) and Hill-Sachs lesion(p value=0.019) in these patient versus patient without postsurgical instability. Mean loss of forward flexion compared with the normal contralateral side was 4º and Mean loss of external rotation between both sides was 5º.In the final visit, average VAS was 0.4 (out of 10). ADL was 28.97 (range,25-30) and ASES=96.1(range 78.3-100) . The mean value of CMS was 93.9( range 82-100). Conclusion: Open Bankart surgery with anteroinferior capsular shift for recurrent anterior shoulder dislocation with up to 30% glenoid bone defect and Hill-Sachs lesion provided desirable results in terms of shoulder function and recurrence rate . It is a successful and practical option in these patients and can be considered as an alternative to other procedures.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Arthroscopic partial meniscectomy for painful degenerative meniscal tears
           in the presence of ...

    • Abstract: Background: The role of arthroscopic partial meniscectomy (APM) for painful degenerative meniscal tears (PDMT) is currently controversial. Purpose: To define the rate of early (1 to 5 years) conversion to total knee replacement (TKR) and their predictors after APM for PDMT in patients with knee osteoarthritis and more than 50 years of age. Methods: Retrospective cohort study of patients more than 50 years of age with the diagnosis of PDMT, treated by means of APM. Patients were classified in two groups: Patients that required an early (between 1 and 5 years after APM) TKR (TKR group) after its failure and patients that did not require a TKR (non-TKR group). Patient demographics, general characteristics, Kellgren & Lawrence (KL) classification, Outerbridge classification, and other characteristics were analyzed. Postoperative variables were also analyzed: pain, use of walking aids and use of intra-articular injections (hyaluronic acid or corticosteroids) at 3, 6, and 12 months of follow-up. Results: A total of 356 patients (356 APMs) were included. Forty-nine patients (13.7%) required an early (1.8 years on average) TKR and 307 did not. The main predictor of early TKR was the grade of the KL classification. After APM, the presence of pain and the need of walking aids also were predictors of an early TKR. Conclusions: In patients older than 50 years with PDMT, APM should be cautiously indicated in case of KL grade of 1 or more. Postoperative pain and prolonged need of walking aids were also predictors of an early (mean 1.8 years) TKR.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Comparison of clinical and radiological outcome of Salter innominate
           osteotomy for ...

    • Abstract: Introduction: Developmental dysplasia of the hip (DDH) is one of the most important and challenging conditions in the field of pediatric orthopedics; if not diagnosed and treated in time, it would lead to remarkable morbidity. . Methods of treatment based on the patient's age can vary. The aim of this study is to compare the outcomes of salter osteotomy surgery in two groups of patients under and over the age of three. Material and method: In this retrospective study, medical records of patients over the past 10 years whom had innominate salter osteotomy due to non-pathological DDH. Mean follow up of all patients is 70.28 months (min = 25, max =118). Results: Overall 70 patients were finally selected, in whom 85 hips had undergone surgery. Radiological satisfaction based on modified Severin score system rate was 86% calculated in lower three years old group, while in the second group it was 85%. In clinical assessment in 82 percent of the patients in lower three years group and 82.9 percent of patients in the higher than 3 years old group were satisfactory. There was no statistically significant difference between the two groups based on Modified MacKay criteria. Conclusion: Results in both groups of patients under and over 3 years old were found satisfactory. patient satisfaction difference rate, based on clinical and radiological outcomes, was not statistically significant between two groups. It should also note that complications such as redislocation and deep infection would cause poor clinical and radiological outcomes.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • The influence of proximal femur geometry in identifying femoral neck
           fractures and ...

    • Abstract: Purpose: The purpose of this study was to find the effect of proximal femur geometry in identifying the femoral neck fracture and intertrochanteric fracture in senile patients by using a new measurement method. Methods: A total of 298 patients with acute hip fractures were included in this study and was divided into two groups: femoral neck fracture group (n=155) and intertrochanteric fracture group (n=143). The total hip bone mineral density and morphological parameters such as femoral neck width (FNW), femoral neck length (FNL), femoral head height (FHH), femoral head diameter (FHD), neck-shaft angle (NSA) and offset were measured and compared. Multiple logistic regression analysis was conducted among these parameters. The receiver operating curve (ROC) analysis was performed to evaluate the predictability of each index. Results: Patients with intertrochanteric fractures were significantly older than patients with femoral neck fractures. Longer FNL (88.94 versus 86.45), larger FHD (45.55 versus 44.30), shorter offset (29.18 versus 30.32) and larger NSA (131.49 versus 128.32) were found in femoral neck fracture group (P<0.05). In multiple logistic regression analysis, age, FNL and NSA were independent factors in identifying fracture types (OR=1.056, 1.089 and 1.262, respectively, P<0.001). The ROC analysis showed that NSA was a good discriminator with an area under the curve value of 0.721. Conclusions: This study showed that morphological discrepancy existed between the two types of hip fractures. A larger NSA was considered as the best predictor for the occurrence of femoral neck fractures.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • The outcomes of pilon fracture treatment: Primary open reduction and
           internal fixation versus ...

    • Abstract: Object: Pilon fracture is one of the challenging injuries in orthopedic surgery. Associated soft tissue injury is important factor in choosing treatment options. Two major method of treatment are one stage open reduction internal fixation (ORIF) and two stage ORIF (primary external fixation and secondary ORIF). The latter is most accepted in literature. In current study, we compared the results of these two methods. Methods: In current study, 41 patients were assigned to two groups: one stage primary ORIF (21 patients) group and two stage group included external fixation and secondary ORIF (20 patients). The rate of infection (superficial or deep infection, osteomyelitis), malunion, nonunion, duration of hospital stay, neurovascular injury, pain intensity, consent and AOFAS score were compared between two groups. Results: There was no significant difference between two groups in measured variables except hospital stay which was significantly longer in two stage group. Conclusions: Based on our findings, we recommend using one stage ORIF if the patient is planned to be operated on during the first 24 hours after the injury.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • THE “JULY EFFECT” ON SHOULDER ARTHROPLASTY: ARE COMPLICATION RATES
           HIGHER AT THE BEGINNING ...

    • Abstract: INTRODUCTION: The ”July effect” is a colloquialism asserting an increased rate of errors at the start of the academic year in teaching hospitals. This retrospective population-based study evaluated for the presence of the July effect in performing shoulder arthroplasty. METHODS: Using the Nationwide Inpatient Sample for 2002 through 2011, a total of 178,590 patients undergoing shoulder arthroplasty at academic medical centers were identified and separated into 2 groups: 1) patients admitted during July and 2) patients admitted between August and June. Multivariable logistic regression was used to identify associations with inpatient mortality and adverse events, blood transfusion, prolonged length of stay (>75th percentile) and non-routine discharge. RESULTS: After adjusting for patient, procedure, and hospital characteristics in multivariable modeling, admission in July was not associated with increased risk for inpatient mortality (OR 1.6) aggregate morbidity, blood transfusion, prolonged length of stay, and non-routine discharge. DISCUSSION: This nationwide database analysis shows that shoulder arthroplasty at academic medical centers is not associated with increased perioperative morbidity and resource utilization during the month of July.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Titanium elastic nails versus Spica cast in pediatric femoral shaft
           fractures: A Systematic ...

    • Abstract: BACKGROUND There is a general consensus on the management of femoral fractures in children younger than two years and adolescents older than sixteen years. The best treatment for patients younger than sixteen years of age is still debatable. Titanium Elastic Nails (TENS), is widely used with some evidence, nonetheless, we performed a systematic meta-analysis to synthesize evidence from published studies about the efficacy of TENS compared to Spica cast for the management of femoral shaft fracture in children aged between 2 to 16 years old. METHODS A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central was conducted using relevant keywords. Records were screened for eligible studies and data were extracted and synthesized using Review Manager version 5.3 for Windows. Our search retrieved 573 unique articles. Following the abstract and full text screening, 12 studies with a total of 1012 patients were eligible for the final analysis RESULTS In terms of union (in weeks), our analysis showed a statistically significant difference favoring the TENS group. Moreover, the overall standardized mean difference in sagittal and coronal angulations favored TENS fixation in management of femoral fractures younger than 16 years. There was a statistically significant shorter length of hospital stay in the TENS group. The overall risk ratio of malalignment favored the TENS as well as walking independently. Based on our analysis, TENS treatment is superior to traction and hip spica for femoral-shaft fractures in children younger than 16 years old. CONCLUSION Based on our analysis we recommend the use of TENS fixation in management of pediatric femoral fractures in patients younger than 16 years.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Effect of Zoledronic Acid and Vitamin E on Surgical–Induced Femoral Head
           Osteonecrosis in Rabbit

    • Abstract: Objectives: Femoral head osteonecrosis is a progressive disease with disabling outcomes in hip joint if not treated. This study was designed to compare the effects of zoledronic acid plus vitamin E versus zoledronic acid alone in femoral head osteonecrosis induced by surgical method in rabbits. Methods: 26 Japanese white adult male normal rabbits at 28-32 weeks old were underwent surgical femoral dislocation to devastate the femoral neck vessels; the femoral neck vessels were ligated. Next, the first 10 rabbits received Zoledronic acid alone; the second group (10 rabbits) received the zoledronic acid plus oral vitamin E and the third group was considered as control group. The treatment process was persisted for 12 weeks and the radiographic and postmortem pathological assessments were performed. The Ficat classification, Epiphyseal Quotient, new bone formation, and residual necrotic bone were assessed. The results were analyzed by statistical chi-square, paired t-tests, independent t-test, Fisher’s test and p-value < 0.05 was considered significant. Results: There were significant statistical difference between the combination therapy group with control for Ficat at 12th weeks (p-value=0.048). Also, both treated groups with control had significant statistical difference for RNB (p-value=0.015). There were no statistically significant differences between three groups for Ficat at 6th week, EQ at 6th and 12th week and NBF (p-value ≥ 0.05) in comparing the three groups. Conclusion: Although zoledronic acid therapy along with vitamin E could improve some radiologic and pathological indices related to femoral head osteonecrosis, vitamin E showed relative impact. Keywords: Zoledronic acid, Vitamin E, Femoral head osteonecrosis
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Myotopography in Tibial Lengthening

    • Abstract: Limb lengthening by Ilizarov lengthens not just the long bone, but also the soft tissues too. Damage of the muscles during corticotomy and their stretching during distraction play a crucial role in occurrence of complications and final limb function. We present here a systematic codified nomenclature system of each muscle summarising all the influence that corticotomy and distraction have the particular muscle and demonstrate the same in the setting of tibial lengthening. This scheme helps the surgeon easily recollect what all muscles are involved in what all ways in each level of corticotomy thus enabling him to watch out for complications thereof and monitor and accordingly modify the limb lengthening process.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Ilizarov Stump Lenthening can Aggravate Phantom Limb Pain – a Case
           Report

    • Abstract: Ilizarov is an accepted technique for lengthening short amputation stumps to improve prosthetic function and rehabilitation. The relation of stump lengthening and phantom limb pain (PLP) has not been reported in literature. We present here a case report of a transfemoral amputee who had a flare up of PLP following stump lengthening. He responded well to a combination of pharmacological therapy and soft tissue manipulative techniques and desired length was achieved. This report alerts the possibility of aggravation of PLP following stump lengthening and discusses its management.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Multimodal Pain Management Protocol versus Patient Controlled Narcotic
           Analgesia for ...

    • Abstract: Background The purpose of this study was to determine whether implementing a protocol (TLC), that utilizes a multimodal pain control approach, improves pain control and decreases narcotic utilization. Materials and Methods: Patients undergoing primary total or reverse shoulder arthroplasty using interscalene brachial plexus blockade were retrospectively studied. Patients were either provided a patient-controlled analgesic pump postoperatively (“traditional” approach) or preoperative and postoperative multimodal, non-narcotic analgesic medications and breakthrough narcotics. Morphine equivalent units (MEU) consumed and Visual Analog Scale (VAS) scores for pain (0, 8, 16, and 24 hours) were analyzed. Results: There were 108 patients in each group. In the first 24 postoperative hours, narcotic consumption was 38.5 +/- 81.1 MEU in the “Traditional group” and 59.3 +/- 59.1 MEU in the TLC group (p < 0.001). VAS pain was significantly higher in the “Traditional group” at 16 hours (4.1 +/- 2.9 vs 3.2 +/- 2.7, p = 0.020) and 24 hours (4.8 +/- 2.7 vs 3.7 +/- 2.6, p = 0.004). Discussion: While the TLC protocol led to an improved pain experience, both groups experienced rebound pain. Further modification of the current protocol may be necessary to reduce overall narcotic utilization.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Economic Analysis of the Cost of Implants Used for Treatment of Distal
           Radius Fractures

    • Abstract: Background: There are a number of different implant choices for surgical treatment of distal radius fractures, often determined by surgeon preference or availability. Although no one volar plate demonstrates superior outcomes, there are significant cost differences absorbed by hospitals and surgical centers. This purpose of this study is to characterize the economic implications of implant selection in the surgical management of distal radius fractures. Methods: A retrospective review of billing records at a mid-size community surgicenter was conducted for CPT codes 25607, 25608, and 25609 between 1/1/2014 and 6/1/2014, and associated implant costs and facility reimbursements were collected. A unique stochastic simulation model was developed from derived probabilities, reimbursements, and costs, and analyzed by Monte Carlo simulation. Results: Reimbursement to the facility for distal radius ORIF cases ranged from $1,102.20 to $7,393.86, with an average of $3,824.56. Per case operating costs to the facility ranged from $1,250 to $7,270, with an average of $2,817.42. In the US, variations in implant cost 25% above or below the mean translates to annual operating profits realized by facilities ranging from a loss of $57,047,720 to profits of $55,189,729. On average, per case operating costs for distal radius fractures need to be less than $2956 for facilities to realize a per case profit. Conclusion: Value based purchasing is by necessity becoming integrated into clinical decision making by orthopaedic surgeons. Variations of 25% around the mean per case operating cost can vary facility operating margins by $112,237,450 annually. Arming the orthopaedic surgeon with the realities of the cost of implant selection in the operative management of distal radius fractures will lead to better value based decision making, substantial cost savings to the US hospital system, and ultimately payers and patients.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Early Regain of Function and Proprioceptive Improvement Following Knee
           Arthroplasty

    • Abstract: Background- Techniques that allow early muscle activation, such as closed kinetic chain (CKC) and open kinetic chain (OKC) exercises may play a beneficial role in the early rehabilitation of the reconstructed knee. However, current rehabilitation regimens have not been shown to reverse post-operative quadriceps activation failure and weakness. Objective- To investigate if patients who used a continuous active motion (CAM) device that follows closed kinetic chain principles have better early post-operative functional improvements than patients who used a continuous passive motion (CPM) device that follows the principles of open kinetic chain principles. Design- A prospective randomized controlled trial with non-blinded study staff. Setting- A tertiary care clinic at a teaching hospital. Participants- A total of 110 patients signed the consent form and 83 patients participated in the study. Methods- Patients were randomly assigned to use either the CPM device for 4 hours daily for 3 weeks (control group) or a CAM device for 3 sessions of 20 minutes for 3 weeks (intervention group) starting 24 hours after knee replacement surgery Main Outcome Measurements- The primary outcome measure was to identify the superiority, inferiority or equivalence of one device at week 4 post knee arthroplasty. Results- At 4 weeks all outcome measurements were comparable between the two groups with the exception of the sit-to-stand test: in the treatment group the time was significantly shorter compared to the control group (p= .016). Balance was significantly better in both control (p= .001) and treatment group (p= .032). Conclusions-Most clinical centers would like to expedite functional recovery of knee arthroplasty patients without increasing the risk of falls. Balance and kinesthesia improved with both devices. This could be beneficial for fast recovery programs such as to increase the number of patients being discharged home earlier and safely with early independence of daily living activities.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Impact of Bone Mineral Density Measured by Quantitative Ultrasound of the
           Heel and Vitamin D ...

    • Abstract: Introduction A better understanding of how bone mineral density and vitamin D levels are associated with femoral neck and intertrochanteric hip fractures may help inform healthcare providers. We asked: 1) In patients age ≥ 55 years, is there a difference in quantitative ultrasound of the heel (QUS) t-score between patients with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors 2) In patients age ≥ 55 years, is there a difference in vitamin D level between those with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors' 3) Is there an association between vitamin D level and QUS t-score' Methods In this retrospective cohort study, 1,030 patients were identified using CPT codes for fixation of hip fractures between December 2010 and September 2013. Patients ≥ 55 years of age who underwent operative management for a hip fracture following a fall from standing height were included. Three orthopaedic surgeons categorized fracture type using patient radiographs. Upon hospital admission, QUS t-scores and vitamin D levels were determined. Descriptive statistics, bivariate analyses and multivariable regression were performed. Results Accounting for potential confounders, patients with lower QUS t-scores were more likely to have intertrochanteric femur fractures than femoral neck fractures. In a bivariate analysis, there was no association between vitamin D level and either fracture type. Given the p-value, a multivariable analysis was not completed. There was no association between vitamin D level and bone mineral density. Conclusions Patients with lower bone density that suffer a hip fracture are more likely to suffer a fracture in the intertrochanteric region than the femoral neck, but vitamin D levels are unrelated. Awareness of this association emphasizes the importance of bone mineral density screening to assist with intertrochanteric hip fracture prevention.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • A challenge on orthopedic sciences: The Influence of Spinal Disease and
           Deformities on Total ...

    • Abstract: Purpose: Adult degenerative disorders of the hip and spine are common. The recent studies inconsistently have discussed about the influence of spinal disorders on total hip arthroplasty (THA).In this review we discussed clearly about these relationships and their effects on the most appropriate position of the acetabular component. Methods: We searched on databases and evaluated the articles about spinopelvic parameters in patients with spinal disorders who need total hip arthroplasty. Results: A review in literature, at a glance, showed a prevalence of 21.2 % to 60.4% of LBP in patients, who are candidates for primary total hip arthroplasty (THA).The coexistence of degenerative disease of hip and spine or other diseases can significantly alter spinopelvic alignment. Accordingly, pain management or any other treatment in these patients requires knowing about biomechanics of the hip and spinal parameters and consideration of the relative contribution of each region. In this review article we discussed about these relationships and finally their effects on the most appropriate position of the acetabular component. Conclusion: We concluded that Counseling sessions among patients, orthopedic surgeons and spine surgeons can result the best outcome for these individuals.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Ethical issues in Technological disaster: A Systematic review of
           literature

    • Abstract: Ethical issues in Technological disaster: A systematic review of literature Introduction: Industrialization could bring risk of Technological Disaster (TD) such as happened in Chernobyl, Bhopal and Fukushima crisis. little has been discussed about its related ethical issues. In this study, we aimed to investigate ethical issues have been stated for technological disasters. Material and Methods: A systematic search was conducted on the main international literature databases including Pubmed, Embase, Scopus and ISI (Jan 1, 2000 to March 30, 2014). From 64 articles were eligible for investigation of ethical issues in Natural disaster, 6 was related to Technological Disaster. The articles were in English language. Result: Our result show that there are six articles discussing ethical issues during Technological disaster. All of them are related to nuclear crisis in Fukushima resulting from Japan tsunami 2011. These articles discussed mainly three ethical issues in providing medical care to victims of Technological Disasters as follow: 1- Duty of care 2- Mandatory evacuation and Resource Allocation. Conclusion: Victim health is the main factor for making decision and implementation of any programs during response to disasters. Mandatory Evacuation for reasons other than providing health to people (such as: maintain public order) and if bring health risk to people will be unjustified. Duty of health workers for providing care is based on General beneficence meanwhile it is necessary to provide facilities to protect them from dangers that treat them in the field. For act ethically, Health workers must have adequate preparedness for response to T-D meanwhile it is necessary to provide guidelines for individuals that participation in relief operation. It is necessary to discuss more about Technological Disaster Ethics especially in industrial countries and where there is especial industrial with potential of huge crises.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • A new multimodal orthosis for non-invasive musculoskeletal pain management

    • Abstract: Chronic musculoskeletal pain is highly prevalent and costly disorder, which dramatically degrades the patient life quality, so it becomes one of the global healthcare concern. Several methods have been proposed for management of this problem including, but not limited to different type of braces and physical agent modalities. In this paper, we present a new generation orthosis, hope to be effective in management of chronic musculoskeletal pain. This orthosis, as a complementary treatment, will help patients to self-control their pain during the home-based rehabilitation process.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Functional outcome and incidence of osteoarthritis in operated tibial
           plateau fractures.

    • Abstract: Background: In the challenging tibial condyle fractures despite anatomical joint reconstruction, development of osteoarthritis may still occur secondary to the initial articular cartilage and meniscal injury. The aim of the study was to know incidence of osteoarthritis in our operated cases of tibial plateau fracture and to evaluate functional outcome. Methods and Material: Our operated 60 patients of tibial plateau fractures between 2006 to 2013 were evaluated retrospectively. Pre-operative radiographs were classified using Schatzker classification. Patients were followed up clinically and radiologically and were assessed for functional outcome and development of osteoarthritis. Results: The average duration of follow up was 76.32 months ranging from 42 to 130 months. The average age was 41.28(20-73) years. According to Schatzker classification type VI accounted for 32.5% and type V for 20 %. Average VAS Score was 1.35 ranging from 0 to 4. According to American knee society scoring system, 47patients had excellent and 8 patients had good knee scores, while 52 patients had excellent , 4 patients had good and 1 patient had poor functional scores. According to Ahlback classification 25 patients had grade I, while 9 patients had grade II, 7 patients had grade III and 3 patients had grade IV osteoarthritis of knee. Conclusions: Incidence of osteoarthritis goes higher with Schatzker's grading. Despite presence of radiological arthritis patients can have good clinical function if the articular reduction and limb alignment are maintained. Treatment goals should include a congruent articular reduction, adequate knee stability, anatomical limb alignment and avoidance of complications.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Total Hip Replacement revision in a single brand small cementless stem –
           our experience after ...

    • Abstract: Background Cementless total hip replacement is the common THR performed in England, Wales, Northern Ireland and the Isle of Man. The Corail stem is the most popular cementless implant and has a ODEP 10A rating. Review of its performance in the registry identified an increase rate of revision amongst the smaller stem sizes. However, clarity was not provided on the explanation for this finding. We reviewed our own experience of smaller stems with a view to understanding the reasons for revision. Methods We reviewed a single centre, single surgeon experience of the smaller Corail stem sizes for a ten-year period from 2003 to 2013. All data was collected from a prospectively maintained database. Details of clinical and radiological follow up were collected for all patients who had Corail stem size 8 and 9 implanted. Revision for any cause was taken as our endpoint. Results 542 patients underwent total hip arthroplasty using the Corail stem during the study period. 53 small size Corail stems were implanted. The average age was 59 (range 17-88 years) and the average follow up was 41.4 months (range 1-118 months). 6 patients underwent revision during the study period, but only 4 stems required revision. The reasons for revision were aseptic loosening, fracture and metal-on metal complications. Only two stems required revision for stem related factors (3.8%) Conclusions There was no evidence of an increased rate of revision in the small Corail stems in our cohort.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • The effect of Spinal and General Anesthesia on Serum Lipid Peroxides and
           Total Antioxidant ...

    • Abstract: Background: Anesthesia is performed in two major methods including regional and general. Aim: The aim of this study was to compare the effect of anesthesia method (spinal and general) on oxidative stress in diabetic patients underwent diabetic amputation surgery. Design and Setting: randomized control trial Method: In this randomized control trial, 40 patients with diabetic foot who were candidate for foot amputation surgery at our academic hospital, in 2013 were selected and divided into two groups based on anesthesia method. Lipid peroxide level and serum total antioxidant capacity (TAC) were measured before anesthesia induction and one hour after surgery. As the normal range, the findings obtained from 23 healthy volunteers were utilized. Results: mean age was 54.9±11.21 and 52.4±11.23 years in the spinal anesthesia (SA) and the general anesthesia (GA) group, respectively (p=0.49). Serum TAC in GA group increased from 1.03±0.04 mM to 2.98±0.7 mM, in SA group the increase of serum TAC from 1.22±0.11 mM to 3.42±0.5 mM was observed; that indicated the increases of serum TAC in both groups was not significantly different (p =0.21). Serum Malondialdehyde (MDA) in GA and SA groups did not show a significant difference before surgery (31.14±3.9 mM vs 29.06±2.49 mM in GA and SA groups, respectively) (p =0.31), it was significantly different after surgery (23.14±2.6 mM and 19.24±2.7 mM in GA and SA groups, respectively) (p =0.03). Conclusion: lower limb amputation can help to control oxidative stress in diabetic patients; and considering serum MDA as a marker of oxidative stress, SA seems to be more effective to control this problem.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • The outcome of proximal humeral locking plates in the management of three
           and four part ...

    • Abstract: Background: Locking plate fixation provides satisfactory outcome following proximal humerus fractures. None of the previous studies selectively evaluate the outcome in young patients. This study evaluates outcome of locking plate system in the treatment of acute three- and four-part fractures in young patients. Materials &Methods: In this prospective study we included all patients who were less than 60 years, involved in high velocity trauma, had proximal humerus comminuted three part and four part fractures and were operated using locking plate at our centre, between August 2011 to August 2015. All the patients were followed up regularly. Assessment was done clinically using Constant and Murley scoring system and radiologically using signs of healing in the form of callus formation and cortical continuity. Result:Twenty-five eligible patients were operated during the study period. All patients were involved in motor vehicle collision. Average age of our patients was 41.2. The average duration of follow-up was 18.2 months(8 months to 27 months). 24 out of 25 fractures united clinically and radiologically at three months’ follow-up. Average Constant and Murley score at final follow-up was 78.52. The results were excellent to good in 15 patients, fair in five patients and poor in five patients. Overall complication rate was 24%. Majority of them (20%) were restriction of movements of shoulders. None of our patients needed reoperation. Conclusion: Locking plate system, in three part and four part proximal humerus fractures in young patients, provides secure and stable fracture fixation for early mobilization. Early results with locking plate system were promising in younger patients. In these patients, locking plate system has definite role to preserve the humeral head and there by maintain the functional activity level.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • A low cost Suture-Button Construct for Acute Ankle Syndesmotic Injuries; A
           prospective clinical ...

    • Abstract: ABSTRACT PURPOSE: The importance of the syndesmosis in ankle stability is well recognized. Numerous means of fixation have been described for syndesmotic injuries including the suture button technique. Significant cost limits the use the commercially available options. We, therefore, designed a cheap and readily available alternative construct. We aim to assess the results of using a novel suture-button construct in treatment of syndesmotic ankle injuries. METHODS Fifty-two patients (34 males and 18 females) fulfilled our inclusion/exclusion criteria. Five patients were lost to follow-up. The remaining 47 patients were successfully followed up for a minimum of 24 months. The pre and post-surgery American Orthopedic Foot and Ankle Society scores (AOFAS) together with reported complications and post-operative radiological analysis were assessed. In this innovative construct, we utilized polyester braided surgical sutures jointly with double mini two- holed plates, a No.2 polygalactin 910 suture, a 4 mm drill bit, together with a 15 cm long suture needle with slotted end. This technique was supported with the use of the image intensifier. RESULTS The AOFAS score improved significantly from a mean of 32.4 to 94.2 (p˂ 0.004). Radiologically, the medial clear space (MCS), tibio-fibular clear space (TFCS) (p = 0.05) and tibio-fibular overlap (TFO) measurements showed a significant improvement postoperatively (p= 0.02). Patients reported good satisfaction rates with a 96% success rate (95% CI: 94.0% to 99.3%). CONCLUSIONS We have observed that this low cost suture button construct is a simple, safe and cost effective treatment option for acute syndesmotic injuries. Level of Evidence: IV
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • THE ROLE OF BIPLANAR DISTAL LOCKING IN INTRAMEDULLARY NAILING OF TIBIAL
           SHAFT FRACTURES

    • Abstract: Objective: To compare the union times of the uncomplicated tibial shaft fractures, which were distally locked by two coronal and one sagittal screws and by only two coronal screws. Methods: 45 patients with tibial shaft treated with intramedullary nailing included in this study. 23 of 45 fractures were treated with uniplanar two distal interlocking (Group 1) and 22 fractures were treated with biplanar three distal interlocking (Group 2). Patients with closed fractures treated by closed nailing and having a full set of radiographs on PACS system was included. Fracture unions were evaluated by two authors. Results: Union time was significantly shorter in biplanar distal interlocking group (Group 2) compared to uniplanar distal interlocking group (Group 1) (p=0.02). Mean union time in groups 1 and 2 were 14.63 ±4.5 and 10.77 ±3.0 weeks, respectively .When only distal third tibial shaft fractures were evaluated, Group 2 [11.2 ±3.1 weeks (n:17)] had significantly lower union time compared to Group 1 [15.07 ±4.8 weeks (n:14)] (p=0.01). Inter-observer reliability for fracture union times was high with rho= 0.89 with SE of 0.51 (p<0.001). Conclusion: Biplanar distal interlocking procedure had a significantly shorter union time. Biplanar distal interlocking procedure allows a faster fracture union probably because of a more stable fixation construct.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Preoperative aspiration culture (PAC) for the diagnosis of infection in a
           prosthetic knee joint

    • Abstract: Background: Periprosthetic infection is the most serious joint replacement complication, occurring in 0.8-1.9% of total knee arthroplasties (TKA). Purpose: This review aims to define the role of preoperative aspiration culture (PAC) for diagnosis of TKA infection. Methods: A PubMed (MEDLINE) search related to TKA infection and PAC was analyzed. The main criteria for selection were that the articles were focused in the aforementioned question. Results: Twenty articles were found, but only fourteen were selected and reviewed because they were deeply focused on the topic. PAC has shown an average sensitivity of 67.6% (range, 28% to 100%) and an average specificity of 98.4% (range, 96% to 100%). Conclusions: PAC has moderate to high sensitivity and very high specificity for diagnosing TKA infection.
      PubDate: Tue, 06 Feb 2018 20:30:00 +010
       
  • Early results of Oxford mobile bearing Medial Unicompartmental Knee
           Replacement (UKR) with the ...

    • Abstract: Object: Oxford medial unicompartmental knee replacement (UKR) is indicated in patients with anteromedial osteoarthritis (AMOA) of the knee. Microplasty (MP) instrumentation was introduced in 2012 as an improvement over phase 3 instrumentation. Advantages of this instrumentation include conservative tibial cut, decreased tibial re-cut rate and improved component alignment. We report the results of UKR with the new instrumentation in a consecutive series with a minimum follow-up of 2 years. Materials and Methods: A prospective study of 115 cemented medial Oxford UKRs implanted in 89 patients was done. Post-operative alignment of the tibial and femoral components was analysed. Patient reported outcome measures were recorded using Oxford Knee Score (OKS) and the American Knee Society Score (KSS). Tegner Activity Scale (TAS) was used to record the activity level. Results: 115 consecutive medial Oxford UKRs were studied. All patients were followed up annually in this prospective ethically approved study. The mean follow-up was 36 months and the minimum follow-up was 25 months. No patient died and none were lost to follow-up. At the final follow-up, the average OKS of the cohort was 39.5 (SD: 5.7). 91.2 % of the patients had good or excellent OKS with only 3.5 % reporting poor OKS. The overall limb alignment was 4.80 varus (0 – 140 varus). Tibia was recut in 5.2 % of cases. Median bearing size was 3 (range: 3 to 6). There was one case of bearing dislocation and one case of aseptic tibial loosening. Conclusion: This is the first study to report results of MP instrumentation at a minimum follow-up of 2 years. Our study indicates that the new instrumentation results in reliable and accurate implantation of femoral and tibial components in majority of the cases, with a decrease in number of alignment outliers, and also a reduced rate of bearing dislocation.
      PubDate: Mon, 05 Feb 2018 20:30:00 +010
       
  • Protocols for Management of Underserved Patients Undergoing Arthroplasty:
           A National Survey of ...

    • Abstract: Introduction: Although it has been shown that perioperative protocols enhance arthroplasty care and safety, it is not known how prevalent their use is in safety net hospitals, which operate with a mandate to treat the poor and underserved. Understanding the elements currently included in standard perioperative arthroplasty protocols at various institutions may help guide future interventions and policy aimed at improving underserved patients’ outcomes. Methods: In this cross-sectional study, safety net hospitals were asked to complete a survey over the phone, via email or in person regarding existence and elements of perioperative management protocols for total hip arthroplasty (THA) and total knee arthroplasty (TKA). Implementation barriers were also addressed. Specifically, survey questions sought to determine the total yearly number of arthroplasty procedures performed at each institution and better understand, among other elements, the following: presence of preoperative pain management protocols, inpatient care pathways, use of social workers and involvement of physical therapy services. Descriptive statistics were calculated and reported. Results: Over 90% of safety net hospitals performing arthroplasty utilized regional anesthetic techniques, inpatient clinical care pathways and inpatient physical therapy. However, 16.7%, 20.0%, 23.3% and 73% lacked social services, anesthesia preoperative clinics, inpatient pain management protocols and preoperative sobriety pathways, respectively. Conclusions: Barriers to receiving arthroplasty care included lack of qualified surgical personnel and concerns about surgical risk in vulnerable patient populations. These findings suggest that further effort is warranted to expand and improve arthroplasty care for the underserved to ensure safety and high quality outcomes.
      PubDate: Mon, 05 Feb 2018 20:30:00 +010
       
  • Identification of Risk Factors for Abnormal Postoperative Chemistry Labs
           after Primary Shoulder ...

    • Abstract: Purpose Purpose The purpose of this study was to determine patient-specific risk factors and clinical intervention rates for abnormal postoperative Chem-7 panels in shoulder arthroplasty patients. Methods Retrospectively, all primary anatomic total (aTSA) and reverse shoulder (RTSA) arthroplasties (between 2007-2013) performed at a single institution were identified. All patients underwent routine preoperative and postoperative day one (POD1) chemistry panels. Each clinically significant component of the Chem-7 panel was independently evaluated using a multivariate analysis to identify risk factors for abnormal results. Associated clinical intervention rates were also calculated. Results Data from 1,012 patients (248 RTSA; 764 aTSA) was analyzed. 5.4% of patients had at least one preoperative abnormal chemistry result. On multivariate analysis, patients with abnormal preoperative Chem-7 labs and a history of renal disease had significantly increased risk for abnormal POD1 labs (p <0.001). Although 25.6% (259/1,012) of patients had at least one abnormal POD1 lab result, the total postoperative clinical intervention rate was 15.1% (39/259). Conclusion Renal disease and a preoperative abnormal chemistry result are important risk factors for abnormal postoperative Chem-7. Optimizing renal status and correcting abnormal blood chemistry results preoperatively may reduce the incidence of abnormal postoperative chemistry results.
      PubDate: Mon, 05 Feb 2018 20:30:00 +010
       
  • Evaluation of clinical outcomes of spinal osteotomies in patients with
           sagittal imbalance

    • Abstract: Objects: Sagittal imbalance is known as the main radiographic driver of disability in adult spinal deformity (ASD). In this study, the association of radiological parameters and clinical outcome was evaluated after corrective surgery of sagittal imbalance, to explore the predictive ability of each radiologic parameter. Methods: A number of 23 patients, who underwent corrective osteotomy for the restoration of sagittal balance, were included in this study. Pre and postoperative radiological parameters including pelvic tilt (PT), sagittal vertical axis (SVA) and pelvic incidence minus lumbar lordosis (PI-LL) were assessed for each patient. Clinical outcomes were evaluated using oswestry disability Index (ODI). Results: Pre and Postoperative ODI change was significantly correlated with PI-LL and SVA change (r=536, p=0.008 and r=416, p=0.04, respectively), but not with PT change (r=247, p=0.25). The outcome was better in pedicle subtraction osteotomy (PSO) compared to Smith-Petersen Osteotomy (SPO). Conclusion: Surgical correction of sagittal imbalance could limit the amount of disability caused by this misalignment. According to our results, while all the spinopelvic parameters could be used in the prediction of outcome of the corrective surgery of sagittal imbalance, PI-LL was the most informative parameter and more attention should be devoted to this parameter.
      PubDate: Mon, 05 Feb 2018 20:30:00 +010
       
 
 
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