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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  [11 journals]
  • Current Rates of Publication for Podium and Poster Presentations at the
           American Society for ...

    • Abstract: Background:  Research projects are presented at the Annual Meetings of the American Society for Surgery of the Hand (ASSH). It is unknown how many achieve publication in peer-reviewed journals. We sought to determine current rates of publication of podium and poster presentations.  Methods:  All ASSH podium and poster presentations from 2000 to 2005 were reviewed, and an Internet-based search using PubMed and Google was conducted to determine whether the presented studies had been published. Times to publication and journal names were recorded. Data were analyzed with descriptive statistics. Fisher’s exact  test was conducted to compare current trends with previous trends.  Results:  Of 1127 podium and poster presentations reviewed, 46% were published in peer-reviewed journals. Forty-seven percent of published presentations (242 presentations) were in Journal of Hand Surgery , and 11% (59presentations) were in Journal of Bone and Joint Surgery . Forty-five percent of presentations were published within 2 years and 66% within 3 years. The publication rate for podium presentations was significantly higher than that previously reported for Journal of Hand Surgery, at 54% compared with 44% (P =0.004).   Conclusions:  Currently, fewer than half of the studies presented at Annual Meetings of the ASSH achieve publication in peer-reviewed journals. Presentations are most likely to be published within 3 years, and almost half are published in Journal of Hand Surgery .  
      PubDate: Fri, 05 Sep 2014 19:30:00 +010
  • Anterior Ankle Arthrodesis with Molded Plate: Technique and Outcomes

    • Abstract: Background:   There is still controversy regarding the best technique for ankle arthrodesis to acheive stable rigid fixation along with reconstructing a functional plantigrade foot. Moreover, existing techniques have complictions related to stability, soft tissue covering, fusion rate, and exposure. Methods:   With the anterior approach exactly on the tibialis anterior sheath, the joint was exposed and previous hardware, if any, was removed and with the safe direct approach, the ankle, hindfoot, and indirectly the subtalar joints were accessed. Then fresh cancellous bone was obtained and complete denudation was preformed. Lastly, a narrow  4.5 millimeter plate was carefully placed on what was determined to be the best final position.In this prospective study, 12 patients with severe ankle pain and arthritis enrolled from February 2010 to January 2012. Eight of them had  posttraumatic arthritis and deformity with hardware, two had rheumatoid arthritis, one had poliomyelitis with severe deformity of the foot and knee, and another had chronic ulcerative synovitis of the ankle joint. The patients were assessed clinically and radiographically for an average of two years (range: 13 months to 4 years) for functional  recovery, range of motion, stability of the ankle, and imaging evidence of union.     Results:   Ankle deformities and pain in all 12 cases were corrected. With a short healing time and rapid recovery period, after six weeks all of the patients could walk independently. Also, scores of the Manchester–Oxford Foot  Questionnaire (MOXFQ) improved significantly from 69 preoperatively to 33 postoperatively).     Conclusions:   Anterior ankle arthrodesis with molded plating can be an easy and safe way to manage deformities and it has excellent fusion rate and sufficient rigid fixation.    
      PubDate: Fri, 05 Sep 2014 19:30:00 +010
  • Osteoid osteoma in the neck of the Scapula: A misleading case : A Case

    • Abstract: Osteoid osteoma is a benign bone tumor that when located on the base of the coracoids process of the scapula is very rare and diagnosis and treatment is often delayed because of its rarity. Almost any bone can be involved, but half of cases involve the femur or tibia. The radiologic features of osteoid osteoma are well known, but these tumors may present with unusual features and be easily misdiagnosed. In thisreport, we present a case of osteoid osteoma of the neck of the left scapula that took almost 27 months to be diagnosed accurately.
      PubDate: Fri, 05 Sep 2014 19:30:00 +010
  • Intraarticular Ganglion Cyst of the Long Head of Biceps Tendon Originating
           from the ...

    • Abstract: Ganglion cysts commonly occur around the shoulder, mostly in the spinoglenoid and suprascapular notches. We report a very rare case of intra articular Ganglion cyst of the long head of the biceps tendon that originated from the bicipital groove as a rare cause of shoulder pain.
      PubDate: Fri, 05 Sep 2014 19:30:00 +010
  • Medial Unicompartmental Osteoarthritis (MUO) of the Knee: Unicompartmental
           Knee Replacement ...

    • Abstract: The aim of this review article is to analyze the clinical effectiveness of total knee replacement (TKR) compared to unicompartmental knee replacement (UKR) in patients with medial unicompartmental osteoarthritis (MUO) in terms of survival rates, revision rates and postoperative complications. The search engine was MedLine. The keywords used were: medial knee osteoarthritis. Three thousand and ninety-six articles were found on 28 April 2014. Of those, only twenty-eight were selected and reviewed because they were strictly focused on the topic of this article. Com pared with those who have TKR, patients who undergo UKR have higher revision rates and lower survival rates at 5, 10 and 15 years. The reported overall risk of postoperative complications for patients undergoing TKR is 11%, compared with 4.3% for patients ndergoing UKR. In conclusion, UKR have higher revision rates and lower survival rates than TKR. There is, however, an increased risk of postoperative complications after TKR.
      PubDate: Fri, 05 Sep 2014 19:30:00 +010
  • Hemodynamic and Arterial Blood Gas Parameters during Cemented Hip
           Hemiarthroplasty in Elderly ...

    • Abstract: Background:  Patients undergoing cemented hip hemiarthroplasty may develop bone cement implantation syndrome (BCIS) which is a leading cause of intraoperative complications. The purpose of this study was to  valuate cardiovascular changes during cemented hip hemiarthroplasty in elderly patients.  Methods:  Cemented hip hemiarthroplasty was performed on 72 patients with femoral neck fracture. All patients were catheterized with a radial artery catheter to assess mean arterial pressure (MAP) and arterial blood gas (ABG) in these time points: just before cementation, just after cementation (0th), 5 min (5th) and 10 min (10th ) after cementation, and at the end of surgery (END). Also, systolic and diastolic blood pressure (SBP & DBP), heart rate and any arrhythmia or cardiac arrest was evaluated.   Results:  Seventy-two patients (33 females, 39 males; mean age: 66.8±7 years) were evaluated. All parameters changed during cementation with a significant drop in MAP, SBP, and DBP immediately after cementation and pH and base excess decreased significantly (P<0.001) with no changes in O2 saturation. Mean heart rate rose until the 5th and then decreased dramatically with no bradycardia presentation. During cementation, 12 patients showed arrhythmia, but no cardiac-arrest was observed.   Conclusions:  Under strict observation of a anesthesiology care team, hemiarthroplasty can be a safe method for femoral neck fracture in elderly osteoporotic patients without severe cardiopulmonary compromise.  
      PubDate: Fri, 05 Sep 2014 19:30:00 +010
  • Progression of Carpal Tunnel Syndrome According to Electrodiagnostic
           Testing in Nonoperatively ...

    • Abstract: Background:  This study tested the null hypothesis that nonoperatively treated patients would not show disease progression of carpal tunnel syndrome (CTS) over time according to median nerve distal motor latency (DML) on two electrodiagnostic tests.  Methods:  This retrospective study analyzed sixty-two adult nonoperatively treated patients who were diagnosed with CTS confirmed by a minimum of two electrodiagnostic tests at our institution between December 2006 and October 2012. A Wilcoxon signed-rank test was conducted to test the difference between electrodiagnostic measurements between the first and last test. Results:  The mean time between the first and last electrodiagnostic test was 26±12 months (range, 12 to 55 months). The only electrodiagnostic measurement that increased significantly was the difference between median and ulnar DML on the same side (r=0.19, P =0.038). The time between the electrodiagnostic tests was significantly longer for patients with at least 10% worsening of the DML at the second test compared to cases of which the DML did not worsen or improve a minimum of 10% (P=0.015).  Conclusions:  There is evidence that—on average—idiopathic median neuropathy at the carpal tunnel slowly progresses over time, and this can be measured with electrodiagnostics, but studies with a much longer interval between electrodiagnostic tests may be needed to determine if it always progresses.
      PubDate: Fri, 05 Sep 2014 19:30:00 +010
  • Predictors of Missed Research Appointments in a Randomized
           Placebo-Controlled Trial

    • Abstract: Background:   The primary aim of this study was to determine predictors of missed research appointments in a prospective randomized placebo injection-controlled trial with evaluations 1 to 3 and 5 to 8 months after enrollment.     Methods:   This study represents a secondary use of data from 104 patients that were enrolled in a prospective randomized controlled trial of dexamethasone versus lidocaine (placebo) injection for various diagnoses. Patients   were enrolled between June 2003 and February 2008. Sixty-three patients (61%) had lateral epicondylosis, 17 patients (16%) had trapeziometacarpal arthrosis, and 24 patients (23%) had de Quervain syndrome. Each patient completed a set of questionnaires at time of enrollment. Bivariable and multivariable analyses were used to determine factors associated with missed research appointments.    Results:   Fourteen patients (13%) did not return for the first follow-up and 33 patients (32%) did not return for the second follow-up. The best multivariable logistic regression model for missing the first research visit explained 35% of the variability and included younger age, belief that health can be controlled, and no college education. The best model for missing the second research visit explained 17% of the variability and included greater pain intensity, less personal responsibility for health, and diagnosis (trapeziometacarpal arthrosis and de Quervain syndrome). Conclusions:   Younger patients with no college education, who believe their health can be controlled, are more likely to miss a research appointment when enrolled in a randomized placebo injection-controlled trial.    
      PubDate: Fri, 05 Sep 2014 19:30:00 +010
  • Evolution in diagnosis and treatment of Legg-Calve-Perthes disease

    • Abstract: Legg-Calvé-Perthes disease (LCPD) is an idiopathic osteonecrosis of the femoral head with variable complications and resultant deformity of the femoral head and osteoarthritis. Suggested risk factors are acetabular retroversion, obesity, latitude, hyperactivity, and coagulopathy. The most commonly applied classification is based on radiolucency in the lateral pillar of the femoral head, which is strongly correlated with the outcome. In the fragmentation stage of the disease involvement can be classified into three groups. After skeletal maturity, the outcome can be classified using the Stulberg classification based on the sphericity and congruence of the femoral head in relation to the acetabulum. The early goal of treatment is to prevent head deformation by weight transmitted forces during remodeling and ossification stages containment is the widely accepted principle of treatment. Although the Petrie cast still has a role in the short-term treatment of LCPD before and during the reossification stage, available data does not support additional benefits from braces during the course of LCPD.
      PubDate: Sat, 31 May 2014 19:30:00 +010
  • Orthopedic Lesions in Tethered Cord Syndrome: The Importance of Early
           Diagnosis and Treatment ...

    • Abstract: Background:   Many of the patients with tethered cord syndrome (TCS) are admitted because of neurological symptoms, while some are admitted because of their orthopedic, urologic, anorectal, and dermatologic manifestations.Consequently, this study aimed to evaluate the importance of early diagnosis and treatment of tethered cord syndrome on patient outcome. Methods: Fourty-three patients who underwent surgery because of tethered cord syndrome from 2006 to 2010 were studied. Many of these cases were referred by orthopedic surgeons. All of the findings were recorded and follow up was done twice (1 and 3 years after surgery). Results: Thirty-seven patients were less than 7 years old and 6 were between 17 to 33 years old. According to clinical and neurological exams, satisfactory results were achieved in both groups. Those with early surgical intervention, especially in their early follow up assessment, had the best results. Seventeen cases were referred by an orthopedic surgeon because of manifestations such as leg weakness and numbness, leg pain and spasticity, pes cavus, claw toes, and leg or foot length discrepancy. Cerebrospinal fluid leakage occurred in 3 cases after surgery and 1 showed pseudomeningocele formation. Conclusions: After one year of follow up, initially the results of the treatment were better in early operated cases, but in later follow up assessment (after 3 years) the results were almost the same in both of the groups.    
      PubDate: Sat, 31 May 2014 19:30:00 +010
  • Comparison of Three Skin Closure Methods in Knee Mid-Anterior Incisions

    • Abstract: Background: Few clinical trials have studied the functional and cosmetic outcomes using different closure techniques for surgical incisions. Since wound and rupture closure methods may influence the healing process and cosmetic outcome, the present study aims at comparing three different suture techniques. Methods: In a clinical trial, sixty patients with an anterior cruciate ligament rupture were studied. At the end of the operation and after subcutaneous tissue closure, the skin incision was divided into three equal parts. Each part was randomly sutured using one of three techniques: simple, vertical mattress, or semisubcuticular suture techniques. After six months follow-up, we take a picture of the healed wound in each individual. The cosmetic outcome was rated and evaluated by three Orthopedic Surgeons according to the visual analogue scale (zero to 10). During the study, wounds were followed up for inflammation, infection, or discharges. Results: There were no significant differences between cosmetic results of different suturing methods. The mean and standard deviation of VAS scores for three different observer were 5.62±1.39, 5.62±1.13, 5.65±1.29 in the simple suture; 6.05±1.33, 6.13±1.01, 5.93±1.02 in the vertical mattress technique and 5.72±1.82, 5.81±097 and 5.77±0.99 in the semisubcutaneous method. Overall agreements between observers were weak to moderate. Slight superiority of the semisubcuticular sutures were not statistically significant. Conclusions: The methods used for suturing an anterior midline incision of the knee does not seem to affect the finalcosmetic outcome. The concept of different surgeons from a favorable cosmetic result could totally differ.
      PubDate: Sat, 31 May 2014 19:30:00 +010
  • Comparison of Outcome of Femoral Shaft Fracture Fixation with
           Intramedullary Nail in Elderly ...

    • Abstract: Background:   Although intramedullary nailing (IMN) is an established and accepted operative treatment for femoral shaft fracture in patients younger than 60, there is a lack of data on the results of this treatment on those over 60. The purpose of this study was to determine if the outcome of IMN for femoral shaft fracture in elderly patients is also acceptable. Particular challenges in this group of patients included osteopenia and other associated multiple medical problems frequently observed. Methods: The outcome of 84 patients who had IMN for femoral shaft fracture was reviewed and the results were compared between two groups of patients (younger than 60 and over 60 year old patients). Complications and mortality was analyzed for each group, and then compared between the two groups by testing the null hypothesis that the outcome of treatment in the two groups are similar (P>0.05). Results: The mean duration of follow up was 57.3 months (range: 10-94 months). Incidence of malunion, nonunion, infection, DVT, and dependence on walker/crutch in the groups were similar and differences were not significant (P>0.05). However, incidence of mortality (P<0.05), knee pain, loss of motion, and dependence on cane were significantly higher in elderly patients (P<0.05). Conclusions: There is no significant difference between the outcomes of femoral shaft fracture treatment with IMN fixation in younger patients when compared with elderly patients. However, elderly patients with IMN have more symptoms when compared with younger patients.    
      PubDate: Sat, 31 May 2014 19:30:00 +010
  • Prevalence of Malignant Soft Tissue Tumors inExtremities: An
           Epidemiological Study in Syria

    • Abstract: Background:   Although the majority of soft tissue masses are benign, it is important to consider malignancy in differential diagnoses. Because most soft tissue sarcomas present as a painless mass, clinicians must watch for signs suggestive of malignancy, including large size, rapid growth, and site deep into the deep fascia.The purpose of this study was to determine the relative prevalence according to sex and age, site of tumor, skeletal distribution, and treatment (surgery, chemotherapy and radiotherapy) before and after surgery, and ascertain the relative frequency of these tumors in specific anatomic sites and age groups based on pathological studies. Methods: A total of 308 patients, with a musculoskeletal tumor were evaluated retrospectively. All of the patients enrolled into this study were referred to the Beirouni Hospital of Damascus University with a proven diagnosis of alignant soft tissue tumors from the beginning of January 2008 until the end of 2010. The prevalence of the malignant soft tissue tumors in these patients was analyzed. For purposes of analysis, all lesions were placed in 1 of 9 categories: hand and wrist, forearm, humorous (arm), proximal limb girdle (axilla and shoulder), foot and ankle, thigh, hip and buttocks region, trunk, and other lesions. Age and sex also were recorded. Results: Malignant tumors consisted of seven diagnostic categories: malignant fibrous histiocytoma (23%), liposarcoma (22%), rhabdomyosarcoma (9%), leiomyosarcoma (8%), malignant schwannoma (5%), dermatofibrosarcoma protuberans (5%), synovial sarcoma (10%), fibrosarcoma (13%), extraskeletal chondrosarcoma (1%), and extraskeletal Ewing sarcoma (4%). Conclusions: Despite the multitude of pathologic possibilities, most malignant soft-tissue tumors are classified into a small number of diagnoses. These may be further defined when the site of the lesion and the age of the patient are considered. Knowledge of tumor prevalence will assist radiologists in establishing a suitably ordered differential diagnosis when a soft-tissue tumor has a nonspecific radiologic appearance.    
      PubDate: Sat, 31 May 2014 19:30:00 +010
  • Snow Catastrophe Conditions: What is its Impact on Orthopedic

    • Abstract: Background:   Iran places sixth amongst high risk natural disaster countries and Guilan province of Iran shoulders a large amount of socio-economic burden due to snow catastrophes. The more knowledge of circumstances we have, the more efficient our future encounters will be. Methods: In this retrospective study, of all of the patients admitted to Poursina Hospital due to snow and ice related trauma in the first two weeks of February 2014, 306 cases were found eligible for entry into the present study. Results: Of the 306 eligible patients (383 injuries), there were 175 men (57.2%) and 131 women (42.8%). Most patients suffered from orthopedic injuries (81%) and the most common fractures were distal radius fractures in the upper extremities and hip fractures in the lower extremities. Slipping was the most common and motor vehicle accidents had the rarest injury mechanisms. It was shown that the frequency of injuries were higher on icy days (67.6%) than snowy days (32.4%). Conclusions: Snow crises may lead to increased risk of slipping and falling situations, especially on icy days. The peak of injury rates is a few days after snowfall with the most common injury being distal radius fracture. Providing essential instructions and supporting resource allocation to better handle such catastrophes may improve outcomes.
      PubDate: Sat, 31 May 2014 19:30:00 +010
  • Posterior Vertebral Injury; Is This a Burst Fracture or a
           Flexion-Distraction Injury'

    • Abstract: In thoracolumbar spinal fractures with posterior column injury for applying proper management, it is important to distinguish a flexion-distraction injury (FDI) from a three column burst fracture (BF) as in clinical examination, both may have a similar significant tenderness on direct spinal palpation. Careful attention to the comprehensive clinical examination and detailed imaging features are essential in making an accurate diagnosis and thus appropriate treatment.    
      PubDate: Sat, 31 May 2014 19:30:00 +010
  • Trend of Elevator-Related Accidents in Tehran

    • Abstract: Background:   Elevator-related accidents are uncommon, but can cause significant injury. However, little data exist on these types of accidents. To compile and analyze accident data involving elevators in an effort to eliminate or at least significantly reduce such accidents. Methods: In this retrospective study we investigated 1,819 cases of elevator-related accidents during a four-year period (1999-2003) in Tehran. The data were obtained from the Tehran Safety Services & Fire Fighting Organization (TSFO) that is officially and solely responsible to conduct rescue missions of civilians in Tehran. Results: The number of elevator accidents has increased steadily during the four year study period. During these four years here was a positive upward trend for serious injuries and mortality resulting from elevator accidents. Technical problems were the main cause with 74.5%, followed by power loss and overcapacity riding with 11.5% and 7.9%respectively. Sixty-three individuals sustained serious injury and 15 people died as a result of elevator accidents. The number of accidents was significantly higher in summer (x2=18.32, P=0.032) and a considerable proportion of incidences (54%, 947 cases out of 1819) occurred between 5 and 12 pm. Conclusions: Establishment of an organization to inspect the settings, maintenance, and repair of elevators is necessary
      PubDate: Sat, 31 May 2014 19:30:00 +010
  • Contribution of Surgery in Solitary Plasmacytoma of Spine; A Case Report

    • Abstract: Solitary plasmacytoma of bone is a rare malignant tumor mostly involving the axial skeleton. The tumor occurs in middle- aged or elderly people (mean age: 55 years) and has a high risk of progression to multiple myeloma. Radiotherapy is the preferred treatment for this disease. We report a case of recurrent solitary plasmacytoma of the fourth lumbar vertebra in a 35-year-old male. The patient suffered from intractable pain due to a pathologic fracture and instability. We performed two-stage posterior and anterior surgical procedures on him. Our method was useful for immediate pain relief and early return to activity, spinal decompression and biomechanical stabilization of the involved vertebra. Afterward, the patient underwent radiotherapy as the adjuvant therapy. The patient is asymptomatic without any recurrenceafter a one-year follow up. We recommend surgery as an appropriate option for patients with intractable pain as a result of pathologic fracture, vertebral instability, neurological compromise, failure of radiotherapy or a combination of these disorders.
      PubDate: Sat, 31 May 2014 19:30:00 +010
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