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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  [12 journals]
  • Axillary artery injury associated with proximal humerus fracture: a report
           of 6 cases

    • Abstract: Proximal humerus fractures are common, but associated injury of the axillary artery is uncommon. The majority of published blunt traumatic axillary artery injuries are associated with anterior glenohumeral dislocation; a few are associated with isolated proximal humerus fractures or fracture-dislocation. Experience within our institution demonstrates that axillary artery injury is often unrecognized on initial presentation owing to palpable peripheral pulses and the absence of ischemia and places the hand at risk of necrosis and amputation if there is prolonged ischemia and the forearm at risk of compartment syndrome after revascularization. Accurate physical examination in combination with a low threshold for Doppler examination or angiography can establish the diagnosis of axillary artery injury. We present 6 cases of axillary artery injury associated with proximal humerus fractures in order to highlight the potential for this vascular injury in the setting of a proximal humerus fracture.
      PubDate: Fri, 15 Jan 2016 20:30:00 +010
       
  • Evaluation of clinical results and complications of structural allograft
           reconstruction after ...

    • Abstract: Introduction In cases of Limbs preservation and reconstruction, after massive benign and malignant bone tumors resection, massive bone allograft is an option . The purpose of this study is to analyze the outcome of these procedures in at Emam Reza Hospital-Mashhad University of Medical Sciences Method: In this study we are going to present 113 cases but 11 cases were excluded (traumatic defect or patients that passed away in less than 2 years of follow up) , a questioner form , physical exam and if indicated x.ray information were collected and the Patients were divided into three groups of chemotherapy ( 46), chemotherapy plus radiation therapy( 23), and no-adjuvant-therapy recipients ( 33 Results: 54 cases were male, the mean age was 24.5+/- 5.39 and indications for operation were; 33 cases of aggressive benign tumors or low grade malignant bone tumors ( large bone defects ) and 69 cases of high grade malignant bone tumors . First group recieved no adjuvant therapy, but second devided to cases who recieved chemotherapy or whom recieved chemotherapy plus radiotherapy. The localization of tumors were as following , 8 cases in pelvic bone , 12 proximal femur, 18 femoral shaft, 36 distal femur, 12 proximal tibia and 16 cases were located in humeral bone. In 12 cases of proximal femoral defects we reconstacted theme by allograft composite prosthesis, 18 diaphyseal defects with intercalary allograft and 36 of distal femoral defects were reconstructed by using osteoarticullar allograft. The Rate of deep infection was 7/8 % (8 patients)
      PubDate: Tue, 12 Jan 2016 20:30:00 +010
       
  • Assessment of decisional conflict about the treatment of trigger finger,
           comparing patients and ...

    • Abstract: Background: As an early step in the development of a decision aid for idiopathic trigger finger (TF) we were interested in the level of decisional conflict experienced by patients and hand surgeons. This study tested the null hypothesis that there is no difference in decisional conflict between patients with one or more idiopathic trigger fingers and hand surgeons. Secondary analyses address the differences between patients and surgeons regarding the influence of the DCS-subcategories on the level of decisional conflict, as well as the influence of patient and physician demographics, the level of self-efficacy, and satisfaction with care on decisional conflict. Methods: One hundred and five hand surgeon-members of the Science of Variation Group (SOVG) and 84 patients with idiopathic TF completed the survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). Results: On average, patients had decisional conflict comparable to physicians, but by specific category patients felt less informed and supported than physicians. The only factors associated with greater decisional conflict was the relationship between the patient and doctor. Conclusions: There is a low, but measurable level of decisional conflict among patients and surgeons regarding idiopathic trigger finger. Studies testing the ability of decision aids to reduce decisional conflict and improve patient empowerment and satisfaction with care are merited.
      PubDate: Tue, 12 Jan 2016 20:30:00 +010
       
  • Aneurysmal Bone Cyst: An Analysis of 38 Cases and Report of Four Unusual
           Surface Ones

    • Abstract: Aneurysmal bone cyst (ABC) is a benign expansile bone tumor, most commonly involving the medulla of long bones. ABC rarely arises within the cortex or in the subperiosteal region, radiographically mimicking other conditions, in particular surface osteosarcoma that is low-grade in nature and may go secondary ABC changes, and telangiectatic osteosarcoma. Both of these are sometimes mistaken microscopically for primary ABC. We review the characteristics of ABC cases in our center and report four unusual surface ABCs arising in the subperiosteal or cortical region of long bones, identified among 38 histologically proven ABCs during a four-year period in our center. The surface ABCs occurred at an older age with a predilection for diaphysis of femur, tibia, and humerus.
      PubDate: Sun, 10 Jan 2016 20:30:00 +010
       
  • Ossified Dorsal Wrist Ganglion Cyst - A Case Report

    • Abstract: Ganglion cysts are the most common wrist tumors, and 60 -70% originate dorsally from the scapholunate interval. Ossification of these lesions is exceedingly rare, with only one such lesion located in the finger reported in the literature. We present a case of an ossified dorsal wrist ganglion in a 68 year old woman.
      PubDate: Wed, 06 Jan 2016 20:30:00 +010
       
  • Subchondral Insufficiency Fracture of the Femoral Head treated with Core
           Decompression and Bone ...

    • Abstract: Subchondral insufficiency fracture of the femoral head (SIFFH) is characterized by acute onset hip pain without overt trauma. It appears as a low intensity band with bone marrow edema on T1-weighted MRI. The most common course of treatment is protected weight bearing for a period of several weeks. Total hip arthroplasty (THA) has been commonly used if the patient does not respond to the initial protected weight bearing treatment. We present a case of a 48-year-old male with SIFFH who was treated with core hip decompression and bone void filler as a hip-preserving alternative to THA. The patient has an excellent clinical and radiographic result at final follow up. Core hip decompression with bone void filler is a less invasive alternative to THA, and may be a preferred initial treatment strategy for SIFFH in the young and active patient who has failed conservative measures.
      PubDate: Wed, 06 Jan 2016 20:30:00 +010
       
  • Temporal and spatial expression of TGF-b1 in the early phase of patellar
           tendon healing after ...

    • Abstract: Background The aim of this study is to find out the spatial and temporal expression of TGF-b1 during the tendon healing, after application of Platelet Rich Plasma (PRP).Materials and methods A patellar tendon defect model in rabbits was used for this purpose. 48 skeletally mature New Zealand White rabbits, weighing 3.5 kg, were used for this study. Equal numbers of animals from both groups were sacrificed at 4 different time points (1st, 2nd, 3rd, and 4th week). A full thickness patellar tendon substance in the right limb of each animal was excised from its central portion during the operation. PRP with a gel form was applied and filled the tendon defect in PRP group. No PRP was applied in the tendon defect of controls. Histological sections with hematoxylin-eosin and immunohistochemical sections with an anti-TGF-b1 primary antibody were made for the evaluation of the results.Results A differentiation of the healing process was observed in the PRP group in comparison with the control group. TGF-b1 expression was detected in various cell populations (inflammatory cells, endothelial cells, macrophages, and tenocytes). Both cytoplasmic and nuclear expressions were present. The larger amounts of immunoexpression were localized in epitenon and in the repair site. PRP group showed stronger and more extensive staining at 1st and 2nd week (p<0.0001), whereas control group showed more extensive staining at the 3rd and 4th week (p<0.0001).Conclusions Our study demonstrates that locally application of PRP result in an alteration of TGF-b1 expression during the healing of a patellar tendon defect.
      PubDate: Mon, 04 Jan 2016 20:30:00 +010
       
  • Treatment of displaced Sacroiliac fracture using the lateral window for
           short plate buttress ...

    • Abstract: Fractures through the sacroiliac joint are very challenging to treat, technically difficult to reduce through closed methods on account of the multiaxial displacement of fractures fragments, frequently occur in very unwell patients, and have poor outcomes if malreduction is present. We describe a technique utilising the lateral window and a short buttress plate to reduce and stabilize the fragments prior to percutaneous fixation with sacroiliac screws.
      PubDate: Sun, 03 Jan 2016 20:30:00 +010
       
  • Platelet-Rich Plasma for Frozen Shoulder: A Case Report

    • Abstract:   Frozen shoulder is a glenohumeral joint disorder that perturbs movement because of adhesion and the existence of fibrosis in the shoulder capsule. Platelet-rich plasma can produce collagen and growth factors, which increases stem cells and consequently enhances the healing. To date, there is no evidence regarding the effectiveness of platelet-rich plasma in frozen shoulder. A 45-year-old man with shoulder adhesive capsulitis volunteered for this treatment. He underwent two consecutive platelet-rich plasma injections at the seventh and eighth month after initiation of symptoms. We measured pain, function, and ROM by the visual analogue scale (VAS), and scores from the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and goniometer; respectively. After the first injection, the patient reported 60% improvement regarding diurnal shoulder pain, and no night pains. Also, two-fold improvement for ROM and more than 70% improvement for function were reported. This study suggests the use of platelet-rich plasma in frozen shoulder to be tested in randomized trials.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • An Isolated Mass in the Palm, Starting Manifestation of Sarcoidosis

    • Abstract:   Sarcoidosis is a systemic disease that is characterized with noncaseating granulomatous nodules which present in multiple organs specially lungs (90%) . Incidence of masses due to Sarcoidosis in upper extremity is low and most cases present in association with involvement of pulmonary hilary lymph nodes. In this article we present a rare case of Sarcoidosis which presented as a single soft tissue mass in hand without osseous or pulmonary hillary lymph node involvement. Incidence of involvement of musculoskeletal system is 1-5 % , mostly it occurs in small bones in hands and feet. In most cases involvement of soft tissue in extremities is accompanied with bone lesions. Those cases of soft tissue involvement are generally coincide with pulmonary lymph nodules. To the authors knowledge this is the first case of Sarcoidosis that presents without spreading in bones or pulmonary hilar lymph nodes.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • Compartment Syndrome of the Calf Due to Nicolau Syndrome

    • 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. 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 size 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: Thu, 31 Dec 2015 20:30:00 +010
       
  • Intramuscular Lipoma of the Thenar: A Rare Case

    • Abstract:   Lipomas are the most common benign mesenchymal tumors. They are located either subcutaneously or under the investing fascia in intramuscular or intermuscular regions. The reported frequency of intramuscular lipomas among all benign adipocytic tumors is 1.0%–5.0% and for intermuscular lipomas is 0.3%–1.9%. The frequency of these lesions is the same in all age groups, but in adults deep seated-lipomas are most commonly discovered between the ages of 30 and 60. The most common sites of involvement of intramuscular lipomas are the large muscles of the extremities, especially those of the thigh, shoulder, and upper arm. Intramuscular lipomas of the hand are extremely rare and only few cases have been reported in the literature. In cases with hand location, they may present with functional deficit or neurovascular compromise due to the effect of the mass. We report an unusual case of a large intramuscular lipoma of the thenar that was treated with surgical excision due to the impairment of hand function.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • A Survey of Blood Request Versus Blood Utilization at a University
           Hospital in Iran

    • Abstract:   Background: Reservation of blood leads to blood wastage if the blood is not transfused. Therefore, in some centers only blood type and screen are evaluated. In this study, the efficacy of a blood crossmatch-to-transfusion ratio was measured and then compared with the standard levels. Methods: This prospective study was conducted during one year in a university hospital. During this period, 398 patients for whom blood had been requested were studied. In these patients, at the first surgical type, the laboratory tests (hematocrit, hemoglobin, platelet count, and prothrombin time) and the number of preoperative crossmatched and intraoperative transfused blood units were recorded. Then the crossmatch-to-transfusion ratio, transfusion probability, transfusion index, and correlation between related factors, and the transfusion ratio were evaluated. Results: In this cross-sectional study, blood was requested for 398 patients. According to available blood unit deficiency, from 961 blood unit requisitions, only 456 units were crossmatched and 123 units were transfused. The crossmatch-to-transfusion ratio, transfusion probability, and transfusion index were 3.71 (7.81 if all requisitions were crossmatched), 16.83%, and 0.31, respectively. The most unfavorable indexes were observed in patients who had ear, nose, and throat surgeries (0 transfused from 19 crossmatched blood units) and obstetric and gynecologic surgery (crossmatch-to-transfusion ratio was 18.6). The best indexes were related to thoracic surgery and neurosurgery (crossmatch-to-transfusion ratio was 1.53 and 1.54, respectively). There were no significant correlations between hemoglobin, hematocrit, platelet count, and prothrombin time with the number of transfused blood units (P = 0.2, 0.14, 0.26, and 0.06, respectively). Conclusion: The data for the crossmatch-to-transfusion ratio, transfusion probability, and transfusion index were suboptimal at this center, especially for ear, nose, and throat and obstetric and gynecologic surgeries. Further multidimensional studies and determination of a new model for blood requests and to decrease blood wastage are needed.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • Which Route of Tranexamic Acid Administration is More Effective to Reduce
           Blood Loss Following ...

    • Abstract:   Background: The most appropriate route of tranexamic acid administration is controversial. In the current study, we compared the efficacy of intravenous (IV) and topical intra-articular tranexamic acid in reducing blood loss and transfusion rate in patients who underwent primary total knee arthroplasty. Methods: One hundred twenty 120 patients were scheduled to undergo primary total knee arthroplasty. Patients were randomly allocated to three equal groups: IV tranexamic acid (500 mg), topical tranexamic acid (3 g in 100 mL normal saline) and the control. In the topical group, half of the volume was used to irrigate the joint and the other half was injected intra-articularly. The volume of blood loss, hemoglobin (Hb) level at 24 hours postoperative, and rate of transfusion was compared between groups. Results: The blood loss and Hb level were significantly greater and lower in the control group, respectively (P<0.05). Also, the rate of transfusion was significantly greater in the control group (P<0.05). However, IV and topical groups did not differ significantly in terms of measured variables. No patient experienced a thromboembolic event in our study. Conclusion: Tranexamic acid is a useful antifibrinolytic drug to reduce postoperative blood loss, Hb drop, and rate of blood transfusion in patients undergoing total knee arthroplasty. The route of tranexamic acid administration did not affect the efficacy and safety.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • A Survey on Transfusion Status in Orthopedic Surgery at a Trauma Center

    • Abstract:   Background: Increased costs and mortality associated with inappropriate blood transfusions have led to investigations about blood request and blood transfusion techniques. We investigated the transfusion status in patients who underwent orthopedic surgery in Poursina Hospital (Rasht, Iran) to optimizing blood usage and determine if a scheduled transfusion program for every orthopedic surgery could improve blood transfusion management. Method: In this descriptive-prospective study, all orthopedic surgeries in Poursina Hospital, Rasht, between April to June 2013 were reviewed. All patient information was recorded, including: demographics, type of surgery, hemoglobin level, cross-match test, duration of surgery, and blood loss, and transfusion. Based on the one-way ANOVA and independent samples test analysis, cross-match to transfusion ratio and transfusion possibility, the transfusion index, and maximal surgical blood order schedule were calculated to determine blood transfusion status. Results: Among 872 selected orthopedic surgery candidates, 318 of them were cross-matched and among those, 114 patients received a blood transfusion. In this study, the cross-match to transfusion ratio was 6.4, transfusion possibility 36.47%, transfusion index 0.6, and maximal surgical blood order schedule 0.9. Conclusion: We found that blood ordering was moderately higher than the standard; so it is highly recommended to focus on the knowledge of evidence based on transfusion and standard guidelines for blood transfusion to avoid over-ordering.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • Influence of Sexuality in Functional Recovery after Spinal Cord Injury in
           rats

    • Abstract:   Background: Spinal cord injury (SCI) is a major clinical condition and research is commonly done to find suitable treatment options. However, there are some degrees of spontaneous recovery after SCI and gender is said to be a contributing factor in recovery, but this is controversial. This study was done to compare the effects of sexual dimorphism on spontaneous recovery after spinal cord injury in Wistar Rats. Methods: Spinal cord lesions were made by compressing the cord at T9 level and making a spinal cord contusion. Routine care of each rat was done daily. The LSS scoring system was used to measure the locomotion of these rats and to compare the recovery rate between male and female rats. Results: The results suggested that there was no significant difference between the two sex in recovery. Conclusions: To be female does not seem to be a prognostic factor for recovery after SCI. However, this preliminary study should be repeated in other animals and in larger cohorts.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • How Much are Emergency Medicine Specialists’ Decisions Reliable in
           the Diagnosis and ...

    • Abstract:   Background: Considering the importance of an early diagnosis and proper decision-making in regards to the treatment of pediatric distal radius and elbow fractures, this study examines emergency medicine specialists’ accuracy in the diagnosis and treatment of these patients. Methods: From 2012 and 2013, children less than 14 years old who were referred to an academic hospital emergency department with elbow or distal radius fractures were enrolled. Initially, patients were examined by an emergency medicine specialist and then they were referred to an orthopedic surgeon. Type of fracture and the proposed treatment of two specialists were compared. Results: In total, there were 108 patients (54 patients in each group) with a mean age of 8.1+3.3 years. Identical diagnosis in 48 cases (88.9%) of distal radius and 36 cases (66.7%) of elbow trauma were observed. We found a difference between diagnosis of the two specialists in diagnosing lateral condyle of the humerus fracture in the elbow group and growth plate fracture in the distal radius fracture group, but the differences were not significant. Among 108 patients, 70 patients (64.8%) received identical treatment. Conclusion: Although the emergency medicine specialists responded similarly to the orthopedic specialists in the diagnosis of pediatric distal radius and elbow fractures, diagnosis of more complicated fractures such as lateral condylar humoral fractures, distal radius growth plate and for choosing the proper treatment option, merits further education.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • Prognostic Value of Impaired Preoperative Ankle Reflex in Surgical Outcome
           of Lumbar Disc Herniation

    • Abstract:   Background: Several prognostic factors exist influencing the outcome of surgical discectomy in the patients with lumbar disc herniation (LDH). The aim of this study is to evaluate the relationship between severity of preoperative impaired ankle reflex and outcomes of lumbar discectomy in the patients with L5-S1 LDH. Methods: We retrospectively evaluated 181 patients (108 male and 73 female) who underwent simple discectomy in our orthopedic department from April 2009 to April 2013 and followed them up for more than one year. The mean age of the patients was 35.3±8.9 years old. Severity of reflex impairment was graded from 0 to 4+ and radicular pain and disability were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) questionnaires, respectively. Subjective satisfaction was also evaluated at the last follow-up visit. Chi-square and Kruskal-Wallis tests were used to compare qualitative variables. Results: Reflex impairment existed in 44.8% preoperatively that improved to 10% at the last follow-up visit. Statistical analyses could not find a significant relationship between the severity of impaired ankle reflex and sex or age (P=0.538 and P=0.709, respectively). There was a remarkable relationship between severity of reflex impairment and preoperative radicular pain or disability (P=0.012 and P=0.002, respectively). Kruskal-Wallis test showed that a more severity in ankle reflex impairment was associated with not only less improvement in postoperative pain and disability but also less satisfaction rate (P<0.001 in all three). Conclusions: In the patients with L5-S1 LDH, more severe ankle reflex impairment is associated with less improvement in postoperative pain, disability, and subjective satisfaction.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • Double-button Fixation System for Management of Acute Acromioclavicular
           Joint Dislocation

    • Abstract:   Background: Surgical treatments for acromioclavicular (AC) joint dislocation present with some complications. The present study was designed to evaluate the double-button fixation system in the management of acute acromioclavicular joint dislocation. Methods: This cross sectional study, done between February 2011 to June 2014, consisted of 28 patients who underwent surgical management by the double-button fixation system for acute AC joint dislocation. Age, sex, injury mechanism, dominant hand, side with injury, length of follow up, time before surgery, shoulder and hand (DASH), constant and visual analogue scale (VAS) scores, and all complications of the cases during the follow up were recorded. Results: The mean age of patients was 33.23±6.7 years. Twenty four patients (85.71%) were male and four (14.28%) were female. The significant differences were observed between pre-operation VAS, constant shoulder scores and post-operation measurements (P=0.001, P=0.0001, P=0.0001, respectively). There were not any significant differences between right and left coracoclavicular (P=0.238), but two cases of heterotrophic ossifications were recorded. The mean follow-up time was 16.17±4.38 months. Conclusion: According to the results, the double-button fixation system for management of acute acromioclavicular joint dislocation has suitable results and minimal damage to the soft tissues surrounding the coracoclavicular ligaments.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • Treatment Outcome of Intramedullary Fixation with a Locked Rigid Nail in
           Humeral Shaft Fractures

    • Abstract:   Background: The aim of this study was to determine the treatment outcome of humeral shaft fractures with a locked rigid intramedullary nail in patients indicated for surgical treatment. Methods: In this descriptive-cross sectional study, all patients were followed up for one, six, and 18 months post operatively. The Short Form Questionnaire (SF-36) and Constant Shoulder Score were applied. Results: Of 78 included patients (mean age: 35), one patient had a soft tissue infection, one had secondary radial nerve palsy, eight had non-union, one had elbow limited range of motion in extension, and three patients had decreased shoulder range of motion. The Constant Shoulder Score and Short Form Questionnaire Score (SF-36) increased in all patients, although aged women showed lower improvement. Conclusion: Intramedullary nail fixation in the humeral shaft fracture may be associated with high rates of non-union.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • Supracondylar Osteotomy in Valgus Knee: Angle Blade Plate Versus Locking
           Compression Plate

    • Abstract:   Background: There are few studies comparing the biomechanical properties of angled blade plate and locking compression plates in supracondylar osteotomy. In the current randomized study, we prospectively compared the clinical and radiological outcomes of supracondylar osteotomy using these two plates. Methods: Forty patients with valgus knee malalignment were randomly assigned to two equal numbered groups: angled blade plate and locking compression plates. All of the patients underwent medial closing wedge supracondylar osteotomy and were followed for one year. Before and after the operation the valgus angle and mechanical lateral distal femoral angle were compared between groups. Also, the rate of complications were compared. Results: After the operation, the mean valgus angle and mechanical lateral distal femoral angle improved significantly in the two groups (P<0.001). Although, the preoperative amount of the valgus angle and mechanical lateral distal femoral angle were the same, at the last visit the valgus angle (5.4±2.1 versus 3.1±1.8; P=0.032) and mechanical lateral distal femoral angle (87.6±2 versus 89.7±3.2; P=0.041) were significantly lower and higher in the angled blade plate group, respectively. Nonunion occurred in four patients (20%) in the locking compression plates group (P=0.35). Conclusion: Based on having a larger valgus angle and mechanical lateral distal femoral angle correction in the angled blade plate group and considerable rate of nonunion in the locking compression plate group, the authors recommend using the angled blade plate for fixation of medial closing wedge supracondylar osteotomy for patients with valgus malalignment. However, more long-term studies are required.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • Sleep Disturbance and Upper-Extremity Disability

    • Abstract:   Background: Although upper-extremity disability correlates with psychosocial aspects of illness the association with sleep disturbance in upper extremity disability is less certain. To evaluate whether sleep disturbance is associated with upper-extremity disability among patients with upper extremity illness, accounting for sociodemographic, condition-related, and psychosocial factors. Methods: A cohort of 111 new or follow-up patients presenting to an urban academic hospital-based hand surgeon completed a sociodemographic survey and measures of sleep disturbance (PROMIS Sleep Disturbance), disability (PROMIS Upper-Extremity Physical Function), ineffective coping strategies (PROMIS Pain Interference), and depression (PROMIS Depression). Bivariate and multivariable linear regression modeling were performed. Results: Sleep disturbance correlated with disability (r=-0.38; P<0.001) in bivariate analysis. Symptoms of depression (r=-0.44; P<0.001) and ineffective coping strategies (PROMIS Pain Interference: r=-0.71; P<0.001) also correlated with upper-extremity specific disability in bivariate analysis. Pain Interference was the only factor associated with disability in multivariable analysis. Conclusions: Sleep disturbance is not as strongly or directly associated with symptom intensity and magnitude of disability as ineffective coping strategies. Interventions to reduce pain interference (e.g. cognitive behavioral therapy) hold great potential to decrease musculoskeletal symptom intensity and magnitude of disability, and perhaps even sleep disturbance.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • Type II Intertrochanteric Fractures: Proximal Femoral Nailing (PFN) Versus
           Dynamic Hip Screw(DHS)

    • Abstract:   osteoporotic bones, usually due to low-energy trauma like simple falls. Dynamic Hip Screw (DHS) is still considered the gold standard for treating intertrochanteric fractures by many. Not many studies compare the DHS with Proximal femoral nail (PFN), in Type II intertrochanteric fractures (Boyd and Griffin classification). This study was done to compare the functional and radiological outcome of PFN with DHS in treatment of Type II intertrochanteric fractures. Methods: From October 2012 to March 2015, a prospective comparative study was done where 30 alternative cases of type II intertrochanteric fractures of hip were operated using PFN or DHS. Intraoperative complications were noted. Functional outcome was assessed using Harris Hip Score and radiological findings were compared at 3, 6, and 12 months postoperatively. Results: The average age of the patients was 60 years. In our series we found that patients with DHS had increased intraoperative blood loss (159ml), longer duration of surgery (105min), and required longer time for mobilization while patients who underwent PFN had lower intraoperative blood loss (73ml), shorter duration of surgery (91min), and allowed early mobilization. The average limb shortening in DHS group was 9.33 mm as compared with PFN group which was only 4.72 mm. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early post-op period. At the end of 12th month, there was not much difference in the functional outcome between the two groups. Conclusion: PFN was better than DHS in type II inter-trochanteric fractures in terms of decreased blood loss, reduced duration of surgery, early weight bearing and mobilization, reduced hospital stay, decreased risk of infection and decreased complications.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • The World Learns Together

    • PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • Giant Cell Tumor of Bone - an Overview

    • Abstract:   Giant Cell tumors (GCT) are benign tumors with potential for aggressive behavior and capacity to metastasize. Although rarely lethal, benign bone tumors may be associated with a substantial disturbance of the local bony architecture that can be particularly troublesome in peri-articular locations. Its histogenesis remains unclear. It is characterized by a proliferation of mononuclear stromal cells and the presence of many multi- nucleated giant cells with homogenous distribution. There is no widely held consensus regarding the ideal treatment method selection. There are advocates of varying surgical techniques ranging from intra-lesional curettage to wide resection. As most giant cell tumors are benign and are located near a joint in young adults, several authors favor an intralesional approach that preserves anatomy of bone in lieu of resection. Although GCT is classified as a benign lesion, few patients develop progressive lung metastases with poor outcomes. Treatment is mainly surgical. Options of chemotherapy and radiotherapy are reserved for selected cases. Recent advances in the understanding of pathogenesis are essential to develop new treatments for this locally destructive primary bone tumor.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • Operating Room Time Savings with the Use of Splint Packs: A Randomized
           Controlled Trial

    • Abstract:  Background: The most expensive variable in the operating room (OR) is time. Lean Process Management is being used in the medical field to improve efficiency in the OR. Streamlining individual processes within the OR is crucial to a comprehensive time saving and cost-cutting health care strategy. At our institution, one hour of OR time costs approximately $500, exclusive of supply and personnel costs. Commercially prepared splint packs (SP) contain all components necessary for plaster-of-Paris short-leg splint application and have the potential to decrease splint application time and overall costs by making it a more lean process. We conducted a randomized controlled trial comparing OR time savings between SP use and bulk supply (BS) splint application. Methods: Fifty consecutive adult operative patients on whom post-operative short-leg splint immobilization was indicated were randomized to either a control group using BS or an experimental group using SP. One orthopaedic surgeon (EMB) prepared and applied all of the splints in a standardized fashion. Retrieval time, preparation time, splint application time, and total splinting time for both groups were measured and statistically analyzed. Results: The retrieval time, preparation time and total splinting time were significantly less (p<0.001) in the SP group compared with the BS group. There was no significant difference in application time between the SP group and BS group. Conclusion: The use of SP made the process of splinting more lean. This has resulted in an average of 2 minutes 52 seconds saved in total splinting time compared to BS, making it an effective cost-cutting and time saving technique. For high volume ORs, use of splint packs may contribute to substantial time and cost savings without impacting patient safety.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • The Effect of the Silicone Ring Tourniquet and Standard Pneumatic
           Tourniquet on the Motor Nerve ...

    • Abstract:   Background: The pneumatic tourniquet (PT) is routinely used in upper and lower limb operations by most orthopaedic surgeons. The silicone ring tourniquet (SRT) was introduced in clinical practice the last decade. Clinical as well comparative studies in volunteers concerning its safety and efficacy have been published. The aim of this study was to investigate the postoperative effect of the silicone ring tourniquet (SRT), primarily on the motor nerve conduction, and secondarily on the pain and grip strength, in comparison to the effect of the pneumatic tourniquet (PT) in healthy volunteers. Methods: Both tourniquets were applied in the forearm of the dominant arm in 20 healthy volunteers and were kept on for 10 minutes. Pain was measured using the visual analogue scale and grip strength was measured with a hand dynamometer. We evaluated the following parameters of median nerve conduction: motor conduction velocity (MCV), latency (LAT) and amplitude (AMP). Results: Pain score at the time of tourniquet application was higher in SRT group but the alteration in pain scores in PT group was higher, with statistical significance (P<0.05). The grip strength was reduced by the application of both tourniquets; however there was a significantly higher reduction in the SRT group (P<0.05). The conduction impairment of the median nerve was worse in the PT group than in the SRT one, according to the changes in MCV (P<0.05). Conclusion: Median nerve conduction was affected more after PT application as compared to the SRT. Nevertheless, the reduction of grip strength was higher after the SRT application.
      PubDate: Thu, 31 Dec 2015 20:30:00 +010
       
  • A Comparison of Pillar Pain and Hand Function after Z-plasty
           Reconstruction of the Transverse ...

    • Abstract: Bachgraound: Carpal tunnel syndrome (CTS) is the most common focal mono-neuropathy. We designed a study to compare the effects of traditional open carpal tunnel release with median neurolysis and Z-plasty reconstruction of the transverse carpal ligament on post-operative pillar pain and hand function in patients with idiopathic CTS.Methods: Over a 3 years period, 52 patients with idiopathic CTS entered the study. The patients were randomly assigned into two groups to go under simple TCL release or division of the TCL with Z-lengthening reconstruction. After the procedure, the patients were followed to assess the post-operative pillar pain and hand function during a 12-week period.Results: Forty five patients completed the study. Two patients of the simple open surgery group and 5 patients of the Z-plasty reconstruction group did not complete the follow up course. The scores of pillar pain at the first day after surgery were not statistically different between the two groups (p= 0.213). But the score of pillar pain was significantly lower in the Z-plasty reconstruction group at 1st week, 3rd week and 6th weeks after surgery (p< 0.001). However, at the 12th week, no patient complained of pillar pain in both groups.Considering hand function, no patient had normal hand grip after the first week, but after 3 weeks, significantly higher proportion of patients in the Z-plasty reconstruction group had reached near normal hand grip (76.1% vs. 29.1%; p= 003). However, at 6th and 12th weeks, the differences were not statistically different between the two groups.Conclusion: We observed significant reduction in pillar pain, shorter duration of pillar pain and shorter period of time to reach normal hand grip by Z-plasty reconstruction of the TCL. We suggest further studies with larger number of patients and also we suggest comparing this approach with ECTR in the future.
      PubDate: Sat, 26 Dec 2015 20:30:00 +010
       
  • MRI-Arthroscopic correlation in rotator cuff tendon pathologies; A
           comparison between various ...

    • Abstract: Introduction :Magnetic resonance imaging (MRI) has long been considered a perfect imaging study for evaluation of shoulder pathologies despite occasional discrepancies between MR reports and arthroscopic findings. In this study we aim to evaluate impact of imaging center as an indicator of image quality on accuracy of MRI reports in diagnosis of rotator cuff tendon pathologies.Material and Methods: We reviewed MR reports of 64 patients who underwent arthroscopy in university center hospital. MRIs were done in various centers including both university-affiliated and out-centers. All studies were reported by two radiologists in consensus unaware of the arthroscopic results or previous reports. An inter-observer agreement analysis using the kappa statistics was performed to determine consistency among imaging and surgical reports.Results: Kappa values for out-centers were as follows: 0.785 for biceps, 0.469 for suscapularis, 0.846 for supraspinatus and 0.785 for infraspinatus tendons. In university centers values were 0.799 for biceps, 0.802 for suscapularis, 0.789 for supraspinatus and 0.770 for infraspinatus tendons.Conclusion: Image reporting in university centers with proficient sequences increased accuracy of diagnosis in 3/4 of evaluated features and showed subtle decreased inter-observer agreement in 1/4 of features. Uniformity of the scanners and protocols as well as evaluation on a workstation rather than hard copies cumulatively resulted in a meaningful increase in the accuracy of the same radiologists in diagnosis of rotator cuff tendon tear.
      PubDate: Sat, 26 Dec 2015 20:30:00 +010
       
  • A slightly dorsally tilted lunate on MRI can be considered normal

    • Abstract: Background: Abnormal angulation of the lunate can be an indication of intercarpal pathology. On magnetic resonance images (MRIs) the lunate often looks dorsally angulated, even in healthy wrists. The tilt on individual slices can also be different and might be misinterpreted as pathological, contributing to inaccurate diagnoses and unnecessary surgery. The primary aim of this study was to determine the average radiolunate angle on sagittal wrist MRI images as well as the radiolunate angle in the most radial, central and most ulnar part of the lunate; also the interobserver reliability was determined. Methods: 140 MRIs from adult, non-pregnant patients presenting to the outpatient hand and upper extremity service between 2010 and 2013 with wrist pain were used for this retrospective study. One author measured the radiolunate and capitolunate angle (i.e., tangential and axial method) in all MRIs. Additionally, two authors measured the same angles independently in 46 MRIs to analyze interobserver reliability.Results: The average radiolunate angle was 8.7 degrees dorsal. There were no significant differences in the radiolunate angles between the different parts of the lunate. A very good interrater agreement was measured considering the radiolunate angle and capitolunate angle (tangential and axial method).Conclusions: Our study showed that the lunate appears slightly dorsally angulated on an MRI of a healthy wrist. Regarding the radiolunate angle, 10 to 15 degrees of dorsal tilt can be considered normal. This study provides reference information of normal anatomy for carpal axial alignment that may facilitate diagnoses of wrist pathology.
      PubDate: Mon, 07 Dec 2015 20:30:00 +010
       
  • Evaluation of distal femoral rotational alignment with spiral CT scan
           before total knee ...

    • Abstract: Background: Evaluation of the landmarks for rotation of distal femur is usually a challenge for orthopedic surgeons. Although posterior femoral condyle axis is more available landmark for the surgeons, other landmarks especially surgical transepicondylar axis may be more valid. Preoperative CT scan can help to evaluate these landmarks more accurately. The purpose of our study was to ascertain the relationships among the axes guiding distal femur rotational alignment in preoperative CT scan of Iranian patients’ candidate for total knee arthroplasty surgery and the effects of age, gender and knee alignment on these relationships.Methods: One hundred eight cases being admitted to two university hospitals for total knee arthroplasty surgery, included in this study .The rotation of distal femur was evaluated using the single axial CT image through the femoral epicondyles. Four lines were drawn digitally in this view: anatomical & surgical transepicondylar axes, posterior condylar axis and Whiteside anteroposterior line. Also, alignment of the extremity is evaluated in the standing alignment view. Then we measured the angles among these lines and evaluated the relationship between them.Results: Mean angle between anatomical transepicondylar axis and posterior condylar axis and between surgical transepicondylar axis and posterior condylar axis were 5.9° ±1.6 and 1.6°± 1.7° respectively. Mean angle between Whiteside’s anteroposterior line and the line perpendicular to posterior condylar axis was 3.7°± 2.1°. There were significant differences between the two genders in these relationships. No significant correlation between patients’ age and angles of distal femur was detected. Anatomical Surgical transepicondylar axis was in 4.3 ° externally rotation related to surgical transepicondylar axis.Conclusion: Preoperative CT scan can help to determine rotational landmarks of distal femur more accurately. If one of the reference axes couldn’t be determined, we can use other reference axes because of good correlation between these landmarks.
      PubDate: Sat, 28 Nov 2015 20:30:00 +010
       
  • Neglected Alkaptonuric patient presenting with Steppage gait

    • Abstract: Even though intervertebral disc degeneration could be found in the natural course of alkaptonuria, detection of the disease by black disc color change in a patient without any other presentation of alkaptonuria is an exceptionally rare condition.To report a very rare case of alkaptonuria presented with low back pain and steppage gait.We report a 51-year-old male with a complaint of chronic low-back pain and steppage gait who was operated for prolapsed lumbar disc herniation. Intraoperatively his lumbar disk was discovered to be black. The alkaptonuria diagnosis was considered after histopathological examination of the black disc material. Elevated urinary concentration of homogentisic acid confirmed the diagnosis.To our knowledge, this presentation has not been reported previously in literature.
      PubDate: Sat, 28 Nov 2015 20:30:00 +010
       
  • INTRAMUSCULAR INJECTION ABSCESS DUE TO VRSA: A NEW HEALTH CARE CHALLENGE

    • Abstract: Abscess formation following intramuscular (IM) injections are rare and they are most commonly seen in immunocompromised individuals. In this case series we present a cohort of three patients presented to us in a critically ill condition with IM injection abscess. Vancomycin resistant Staphylococcus aureus (VRSA) was isolated from all three patients. These patients posed a major challenge to the health care setup and the treating physician because of the severity of illness, virulence and resistance of the organism, rarity of the situation, immune state of the patient, and lack of supporting evidence guiding management and overwhelming utilization of health resources. To the best of our knowledge, there is no report available in the English literature on VRSA associated with intramuscular injections abscess.
      PubDate: Sat, 28 Nov 2015 20:30:00 +010
       
  • The Radiological Prevalence of Incidental Kienböck Disease

    • Abstract: Objective: To determine the prevalence of incidental Kienböck disease. Methods: A retrospective analysis of 150,912 radiological reports or images obtained over a five year period was performed of 76,174 patients who underwent a radiograph or computed tomography scan which included the wrist, in Edinburgh and Lothian, UK. Results: There were 5 cases of incidental Kienböck disease and 13 cases of symptomatic Kienböck disease. There were no significant differences in age, sex, ethnicity, comorbidities, smoking status, excess alcohol use or Lichtman stage between the incidental and symptomatic Kienböck groups.Conclusions: The radiological prevalence of incidental Kienböck disease was 0.0066% or 7 in 100,000 patients.
      PubDate: Fri, 20 Nov 2015 20:30:00 +010
       
  • Unicompartmental knee osteoarthritis (UKOA): Unicompartmental knee
           arthroplasty (UKA) or high ...

    • Abstract: PURPOSE: The aim of this review article is to analyze the results of high tibial osteotomy (HTO) compared to unicompartmental knee arthroplasty (UKA) in patients with unicompartmental knee osteoarthritis (UKOA). METHODS: The search engine was PubMed. The keywords used were: `high tibial osteotomy versus unicompartmental knee arthroplasty´. Twenty-one articles were found on 28 February 2015, but only eighteen were selected and reviewed because they were strictly focused on the topic of this article. RESULTS: In a meta-analysis the ratio for an excellent outcome was higher in UKA than HTO and the risks of revision and complications were lower in UKA than HTO. A prospective comparative study showed that UKA offers better long-term success (77% for UKA and 60% for HTO at 7-10 years). A review of the literature showed no evidence of superior results of one treatment over the other. A multicenter study stated that UKOA without constitutional deformity should be treated with UKA while in cases with constitutional deformity HTO should be indicated. A case control study stated that UKA offers a viable alternative to HTO if proper patient selection is done. CONCLUSION: The literature is still controversial regarding the best surgical treatment for UKOA (HTO or UKA). However, UKA utilization is increasing while HTO utilization is decreasing, and a meta-analysis has shown better outcomes in UKA than HTO and less risk of revision and complications in UKA than in HTO. A systematic review has found that with the correct patient selection, both HTO and UKA show effective and reliable results. Prospective randomized studies are needed for the future to answer the question of this article.
      PubDate: Fri, 20 Nov 2015 20:30:00 +010
       
  • Position of the Patella among Emirati Adult Knees. ...

    • Abstract: Background: Abnormal patellar height is associated with anterior knee pain and several conditions that affect the patellofemoral joint. The aim of this study was to 1) report the incidence of patella alta and patella baja and 2) investigate whether the normal limits of the Insall-Salvati ratio is applicable in adult Middle-Easterners. Methods: A radiographic review of the lateral radiographs of 736 Middle-Eastern knees were performed. Patellar tendon length (TL) and the patellar length (TP) was digitally measured and the ratios of these measures was used to calculate the Insall-Salvati ratio.Results: The overall mean TL/PL ratio was 1.20± 0.17. The Insall-Salvati ratio was higher (p=0.0013) in males (1.22± 0.12) than in females (1.18± 0.17). According to our measurement, the recommended levels for defining abnormal patellar position should be 0.86 for patella baja and 1.54 for patella alta.Conclusion: The use of TL/PL ratio demonstrated a higher incidence of patella alta and a higher mean TL/PL ratio compared to other techniques. The normal ranges for the TL/PL differs from western populations and may be attributed to lifestyle differences.
      PubDate: Sun, 01 Nov 2015 20:30:00 +010
       
  • Assessing practitioners’ and patients’ needs regarding shared
           decision-making and decision aids.

    • Abstract: Background: As part of the process of developing a decision aid for carpal tunnel syndrome (CTS) according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict.Methods: One-hundred-twenty-three observers of the Science of Variation Group (SOVG) and 84 patients with carpal tunnel syndrome completed a survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). Results: On average, patients had significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons.Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one’s goals in spite of pain), and higher PDRQ (relationship between patient and doctor). Surgeons from Europe have—on average--significantly more decision conflict than surgeons in the United States of America. Conclusions:Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict.
      PubDate: Sun, 01 Nov 2015 20:30:00 +010
       
  • Discrete Pathophysiology is Uncommon in Patients with Nonspecific Arm Pain

    • Abstract: Background: Nonspecific symptoms are common in all areas of medicine. Patients and caregivers can be frustrated when an illness cannot be reduced to a discrete pathophysiological process that corresponds with the symptoms. We therefore asked the following questions: (1) Which demographic factors and psychological comorbidities are associated with change from an initial diagnosis of nonspecific arm pain to eventual identification of discrete pathophysiology that corresponds with symptoms' (2) What is the percentage of patients eventually diagnosed with discrete pathophysiology, what are those pathologies, and do they account for the symptoms'Patients and Methods: We evaluated 634 patients with an isolated diagnosis of nonspecific upper extremity pain to see if discrete pathophysiology was diagnosed on subsequent visits to the same hand surgeon, a different hand surgeon, or any physician within our health system for the same pain.Results: There were too few patients with discrete pathophysiology at follow-up to address the primary study question. Definite discrete pathophysiology that corresponded with the symptoms was identified in subsequent evaluations by the index surgeon in one patient (0.16% of all patients) and cured with surgery (nodular fasciitis). Subsequent doctors identified possible discrete pathophysiology in one patient and speculative pathophysiology in four patients and the index surgeon identified possible discrete pathophysiology in four patients, but the five discrete diagnoses accounted for only a fraction of the symptoms.Conclusion: Nonspecific diagnoses are not harmful. Prospective randomized research is merited to determine if nonspecific, descriptive diagnoses are better for patients than specific diagnoses that imply pathophysiology in the absence of discrete verifiable pathophysiology.
      PubDate: Sat, 24 Oct 2015 20:30:00 +010
       
  • TRAUMATIC FIRST TIME SHOULDER DISLOCATION: SURGERY VS. NON-OPERATIVE.

    • Abstract: Background: Management of first shoulder dislocation following reduction remains controversial. The two main options are immobilisation and arthroscopic stabilisation. The aim of this article is to highlight some of the issues that influence decision making when discussing management options with these patients, including natural history of the first time dislocation, outcomes of surgery and non-operative management particularly on the risk of future osteoarthritis (OA), the effects of delaying surgery and the optimal method of immobilisation.MATERIAL & METHODS: Extensive literature review was performed looking for previous publication addressing 4 points. i) Natural history of primary shoulder dislocation ii) Effect of surgical intervention on natural history iii) Risk of long term osteoarthritis with and without surgical intervention iv) Immobilisation techniques post reduction.RESULTS: Individuals younger than 25 years old are likely to re-dislocate with non-operative management. Surgery reduces risk of recurrent instability. Patients with recurrent instability appear to be at a higher risk of OA. Those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop OA than those with recurrent instability. Delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. Recent studies have failed to match the preliminary outcomes associated with external rotation braces.CONCLUSION: Defining the best timing and type of treatment remains a challenge and should be tailored to each individual’s age, occupation and degree of physical activity.
      PubDate: Sun, 11 Oct 2015 20:30:00 +010
       
  • Malnutrition in Joint Arthroplasty: Prospective Study Indicates Risk of
           Unplanned ICU Admission

    • Abstract: ObjectMalnutrition has been linked to poor outcomes after elective joint arthroplasty, but the risk of unplanned postoperative intensive care unit (ICU) admission in malnourished arthroplasty patients is unknown. Methods1098 patients were followed as part of a prospective risk stratification program at a tertiary, high-volume arthroplasty center. Chronic malnutrition was defined as preoperative albumin The overall incidence of malnutrition was 16.9% (primary and revision arthroplasty patients). Average BMI was highest for patients in albumin category 3.0-3.5 (BMI 35.7). Preoperative albumin ConclusionsPatients with poor nutritional status must be counseled on the risks of adverse medical complications.
      PubDate: Thu, 08 Oct 2015 20:30:00 +010
       
  • Pelvic Incidence in Patients with Hip Osteoarthritis

    • Abstract: BACKGROUND: Hip osteoarthritis (OA) is a major cause of pain and disability that results in considerable social and medical costs. Mechanics such as posture, alignment and orientation of the hips and the spinal column and the relationship between these factors have been implicated in the development of both hip and spine pathologies. This study aims to test the hypothesis if pelvic incidence varies in patients with and without osteoarthritis. We assessed the relationship between spinopelvic alignment as measured by pelvic incidence (PI) and the presence of hip OA.METHODS: We collected supine pelvis CT scans of 1,012 consecutive patients not known to have hip OA. Our first group consisted of 95 patients with moderate to severe hip OA as per radiology reports. The second group included 87 patients with no evidence of hip OA. Power analysis revealed the need for 77 patients per group to find a mean difference in PI of 5⁰ or less between both groups. Two trained physicians independently measured the PI to account for inter-observer reliability.RESULTS: Patients with moderate to severe hip OA had a mean PI of 56.5⁰±12.8⁰. The mean PI for patients without hip OA was 57.2⁰±7.5⁰. An independent samples t-test revealed no significant difference between the PI values of the two groups. Spearman’s correlation coefficient of 0.754 demonstrated a high inter-observer reliability. CONCLUSIONS: There was no difference in PI angle of hip OA patients and “healthy” patients. Our measurements of patients without OA were almost identical to the reported normal PI values in the literature. It appears that hip OA is not associated with PI angle, refuting the hypothesis made in previous studies, stating that elevated PI contributes to the future development of hip arthritis. CT scan seems to be a reliable and accurate way of assessing pelvic incidence.
      PubDate: Thu, 08 Oct 2015 20:30:00 +010
       
  • Corrective osteotomy for intra-articular distal humerus malunion.

    • Abstract: Purpose: An intra-articular distal humerus malunion can be disabling. To improve function, pain reduction and/or prevention further secondary osteoarthritis an intra-articular corrective osteotomy can be considered. Herein we present the indications, practical guidelines for pre- operative planning and surgical technique. Subsequently, we documented the surgical outcome with long-term results of osteotomy for distal humerus malunion. Methods: We included six consecutive patients operated for intra-articular distal humerus malunion. Mean follow-up was 88 months. At last follow up elbow function was assessed according to standardized questionnaires and classification systems.Results: All six patients healed their osteotomies. Three patients had a postoperative complication which were treated succesfully. Range of motion improved significantly and all patients were satisfied with the outcome. Their elbow performance scores were good to excellent in all. Correlation analyses showed that age and level of osteoarthritis are very strong predictors for the long-term elbow function and quality of life. Conclusion: An intra-articular corrective osteotomy for a malunited distal humerus fracture is worthwhile procedure. Based on our results it should particularly be considered in young patients with minimal osteoarthritis and moderate to severe functional disability and/or pain.
      PubDate: Wed, 07 Oct 2015 20:30:00 +010
       
  • Intrapelvic protrusion of a broken guide wire fragment during fixation of
           a femoral neck fracture

    • Abstract: During fixation of a femoral neck fracture in a 23-year-old male patient with cannulated screws, a broken guide wire fragment inadvertently advanced through the hip joint and protruded into the pelvis. A second surgical approach was needed to remove the broken fragment from the pelvis. Awareness of such a potentially devastating complication will make surgeons more cautious during implementation of orthopedic instruments and increases patient’s safety during surgery.
      PubDate: Wed, 07 Oct 2015 20:30:00 +010
       
  • A chick embryo in-vitro model of knee morphogenesis.

    • Abstract: Purpose: In this feasibility study, a mechanically loaded in-vitro tissue culture model of joint morphogenesis using the isolated lower extremity of the 8 day old chick embryo was developed to assess the effects of mechanical loading on joint morphogenesis.Methods: The developed in-vitro system allows controlled flexion and extension of the chick embryonic knee with a range of motion of 20 degrees from a resting position of 90-100 degrees of flexion. Joint morphogenesis at 2, 3, 4 and 7 days of culture was assessed by histology and micro MRI in 4 specimen types: undisturbed in-ovo control embryos, in-ovo paralyzed embryos, in-vitro unloaded limb cultures, and in-vitro loaded limb cultures. Relative glycosaminoglycan (GAG) concentration across the joint was assessed with an MRI technique referred to as dGEMRIC (delayed gadolinium enhanced MRI of cartilage) where T1 is proportional to glycosaminoglycan concentration. Results: Average T1 over the entire tissue image for the normal control (IC) knee was 480 msec; for the 4 day loaded specimen average T1 was 354 msec; and for the 7 day loaded specimens T1 was 393 msec. The 4 day unloaded specimen had an average T1 of 279 msec while the 7 day unloaded specimen had an average T1 of 224 msec. The higher T1 values in loaded than unloaded specimens suggest that more glycosaminoglycan is produced in the loaded culture than in the unloaded preparation. Conclusion: Isolated limb tissue cultures under flexion-extension load can be viable and exhibit more progression of joint differentiation and glycosaminoglycan production than similarly cultured but unloaded specimens. However, when compared with controls consisting of intact undisturbed embryos in-ovo , the isolated loaded limbs in culture do not demonstrate equivalent amounts of absolute growth or joint differentiation
      PubDate: Sun, 20 Sep 2015 19:30:00 +010
       
  • Fanconi anemia concurrent with an unusual thumb polydactyly

    • Abstract: Abstract: This case report presents a case of Fanconi’s Anemia with an unusual thumb poly dactyly in a 2-year old boy. The extra thumb had no nail, nail bed and distal phalanx. The extra thumb had no active motion.The duplication of the thumb occurred at the carpo metacarpal joint but its morphology did not match with any classification described for thumb poly dactyly. Although his thumb poly dactyly was apparent at birth, Fanconi’s anemia was not suspected until during a routine pre operative laboratory test (CBC) for the elective surgery of his thumb. An early diagnosis of FA is important and the hand surgeons may be the first to have the opportunity to suspect and diagnose the underlying life threatening disorder. This case report presented an opportunity to diagnosis a fatal disorder by a routine pre operative laboratory test. To the best of my knowledge, the phenotype of the thumb poly dactyly of the current case has not yet reported.
      PubDate: Sun, 16 Aug 2015 19:30:00 +010
       
  • Extensive Osteochondroma of talus presenting as tarsal tunnel syndrome:
           Report of a case and ...

    • Abstract: Osteochondroma or exostosis is the most common benign bone tumor, and occurring frequently in the proximal humerus, tibia, and distal femur. It rarely affects talus. Osteochondroma of talus is a very rare etiology of tarsal tunnel syndrome (TTS). We report a rare case of extensive osteochondroma of the talus in a 60 year old female presenting with multiple swellings around the ankle and symptoms suggestive of tarsal tunnel syndrome. En-block excision of the multiple masses was done. Histopathological examination confirmed the diagnosis of osteochondroma with no features suggestive of malignancy. Although most of the osteochondromas are being treated conservatively, those presenting with multiple swellings, restriction of movements and compressive neuropathies should be treated with surgical excision. Excision is a successful method of treatment for symptomatic osteochondromas with low recurrence.
      PubDate: Sun, 16 Aug 2015 19:30:00 +010
       
  • Extra-articular diffuse giant cell tumor of the tendon sheath: A report of
           2 cases.

    • Abstract: Two rare cases of extra-articular diffuse variant giant cell tumor of the tendon sheath are presented, at the elbow of a 68-year-old female and the foot of a 56-year-old male. Both patients presented with a palpable masses and marginal excision was performed; histological sections confirmed the diagnosis of extra-articular giant cell tumor. No adjuvant therapy was administered. At the last follow-up, minimum 24 months after excision both patients were disease-free.
      PubDate: Fri, 31 Jul 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
       
 
 
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