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Journal Cover Archives of Bone and Joint Surgery
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 2345-4644 - ISSN (Online) 2345-461X
   Published by Mashhad University of Medical Sciences Homepage  [14 journals]
  • Infrapatellar branch of saphenous nerve injury in ACL Reconstruction with
           hamstring tendon ...

    • Abstract: Background: Infrapatellar branch of saphenous nerve (IPBSN) injury is common after arthroscopic ACL reconstruction with hamstring tendon autograft, as reported up to 88%. Hypothesis/Purpose: Due to close relationship of IBSN with pesanserine tendons insertion harvesting gracillis and semitendinous tendons, skin incision may cause a damage to IPBSN. IPBSN course at anterior aspect of knee is oblique, so we hypothesized that a parallel skin incision with nerve passage may decrease nerve injury. Study Design: Randomized Controlled Clinical Trial; Level of evidence: 1 Methods: In this clinical trial we compare vertical incision with oblique incision in 79 patients. In 2 weeks, 8 weeks and 6 months after surgery we measured sensory loss area and patient complain of numbness. Results: In oblique group both sensory loss area and patient complain of numbness had been significantly decreased p<0001. Conclusion: We recommend oblique skin incision instead of traditional vertical incision harvesting hamstring tendons in arthroscopic ACL reconstruction with hamstring tendon autograft.
      PubDate: Fri, 01 Dec 2017 20:30:00 +010
  • First Metatarsophalangeal Joint Arthrodesis: A Retrospective Comparison of
           Crossed-screws, ...

    • Abstract: Background:Locking plate fixation is increasingly used for first metatarsophalangeal joint (MTP-I) arthrodesis. Still there is few comparable clinical data regarding this procedure. Methods:We retrospectively evaluated 60 patients who received an arthrodesis of the MTP-I between January 2008 and June 2010. With 20 patients each we performed a locking plate fixation with lag screw, arthrodesis with crossed-screwsor with a nonlocking plate with lag screw. Results: There were four non-unions in crossed-screws patients and one nonunion in non-locked plate group. All the patients in locking plate group achieved union. 90% of the patients were completely or mildly satisfied in locking plate group, whereas this rate was 80% for patients in both crossed screws and non-locking plate groups. Conclusions: Use of dorsal plating for arthrodesis of MTP1 joint either locking or non-locking were associated with high union rate and acceptable and comparable functional outcome. Although nonunion rate was high using two crossed screws but functional outcome was not significantly different compare to dorsal plating.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Evaluation of Level of Evidence in the Archive of Bone and Joint Surgery

    • Abstract: Introduction: In the field of orthopedic surgery, highly impact journals like Journal of Bone and Surgery (JBJS-Am) and Clinical orthopedics and Related Research (CORR) publishing the LOE for their manuscript. JBJS-Am started to publish the level of evidence (LOE) for all manuscript since 2013. Results:310 articles were reviewed. Country of origin for these, were twelve different countries including Iran. International articles consistently increased from 23 % of all published articles in 2013 to 47% in 2016. Overall one- third of articles came from USA and Europe in this period and at the last year, this proportion exceeds 41 %. Discussion: Publishing LOE and the study type helps the reader to imagine the estimated quality of the research presented before starting to read . The aim of this study was to determine the level of contribution of international researchers and also detect any possible progress in LOE of publications over the past four years in ABJS.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Association between ESRα Gene Pvu II T>C, XbaI A>G and BtgI
           G>A Polymorphisms and ...

    • Abstract: Background: Many studies have reported the association of estrogen receptor α gene (ESRα) ESRα PvuII T>C, XbaI A>G and BtgI G>A polymorphisms with Knee osteoarthritis (KOA) risk, but the results remained controversial. In order to drive a more precise estimation, the present systematic review and meta-analysis was performed to investigate the association between ESRα polymorphisms and KOA susceptibility. Methods: Eligible articles were identified by search of databases including PubMed, ISI Web of Knowledge and Google scholar up to March 2017. Data were extracted by two independent authors and pooled odds ratio (OR) with 95% confidence interval (CI) was calculated. Results: A total of 22 case-control studies in eleven publications with 6,575 KOA cases and 7,459 controls were included in the meta-analysis. By pooling all the studies, either ESRα PvuII T>C and XbaI A>G polymorphisms was not associated with KOA risk in the overall population. However, ESRα BtgI G>A was significantly associated with KOA risk under all five genetic models. In the subgroup analysis by ethnicity, a significant association was observed between ESRα PvuII T>C polymorphism and KOA risk in Asians under heterozygote model. In addition, significant association was found between ESRα XbaI A>G polymorphism and KOA in Caucasians under allelic, homozygote, dominant and recessive models. Conclusion: The present meta-analysis suggests that ESRα BtgI G>A rather than ESRα PvuII T>C and XbaI A>G polymorphisms is associated with an increased KOA risk in overall population. Moreover, we have found that ESRα PvuII T>C and XbaI A>G polymorphisms associated with KOA susceptibility by ethnicity backgrounds.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Osteoporosis and the Management of Spinal Degenerative Disease (II)

    • Abstract: Osteoporosis has become a major medical problem as the aged population of the world rapidly grows. Osteoporosispredisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concernbefore performing spine surgery, especially with bone fusions and instrumentation. Osteoporosis has often beenconsidered a contraindication for spinal surgery, while in some instances patients have undergone limited and inadequateprocedures in order to avoid concomitant instrumentation. As the population ages and the expectations of older patientsincrease, the demand for surgical treatment in older patients with osteoporosis and spinal degenerative diseasesbecomes progressively more important. Nowadays, advances in surgical and anesthetic technology make it possible tooperate successfully on elderly patients who no longer accept disabling physical conditions. This article discusses thebiomechanics of the osteoporotic spine, the diagnosis and management of osteoporotic patients with spinal conditions,as well as the novel treatments, recommendations, surgical indications, strategies and instrumentation in patients withosteoporosis who need spine operations.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Evaluation of Radiocapitellar Arthritis in Patients with a Second
           Radiograph at Least 2 Years ...

    • Abstract: Background: To study if patients that have a second radiograph 2 or more years after nonoperative treatment of anisolated radial head fracture have radiocapitellar osteoarthritis (RC OA).Methods: We used the database of 3 academic hospitals in one health system from 1988 to 2013 to find patientswith isolated radial head fractures (no associated ligament injury or fracture) that had a second elbow radiographafter more than 2 years from the initial injury. Of 887 patients with isolated radial head fractures, 54 (6%) hadan accessible second radiograph for reasons of a second injury (57%), pain (30%), or follow-up visit (13%). Twoorthopedic surgeons independently classified the radial head fractures on the initial radiographs using the Brobergand Morrey modified Mason classification, and assessed the development of RC OA on the final radiograph using abinary system (yes/no).Results: Four out of 54 (7.5%) patients had RC OA, one with isolated RC arthrosis that seemed related to capitellarcartilage injury, and 3 that presented with pain and had global OA (likely primary osteoarthritis).Conclusion: With the caveat that some percentage of patients may have left our health system during the studyperiod, about 1 in 887 patients (0.1%) returns with isolated radiocapitellar arthritis after an isolated radial head fracture,and this may relate to capitellar injury rather than attrition. Patients with isolated radial head fractures can considerpost-traumatic radiocapitellar arthritis a negligible risk.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Economic Analysis of Bisphosphonate Use after Distal Radius Fracture for
           Prevention of Hip Fracture

    • Abstract: INTRODUCTION Osteoporosis is a common condition among the elderly population, and is associated with an increased risk of fracture. One of the most common fragility fractures involve the distal radius, and are associated with risk of subsequent fragility fracture. Early treatment with bisphosphonates has been suggested to decrease the population hip fracture burden. However, there have been no prior economic evaluations of the routine treatment of distal radius fracture patients with bisphosphonates, or the implications on hip fracture rate reduction. METHODS Age specific distal radius fracture incidence, age specific hip fracture rates after distal radius fracture with and without risendronate treatment, cost of risendronate treatment, risk of atypical femur fracture with bisphosphonate treatment, and cost of hip fracture treatment were obtained from the literature. A unique stochastic Markov chain decision tree model was constructed from derived estimates. The results were evaluated with comparative statistics, and a one-way threshold analysis performed to identify the break-even cost of bisphosphonate treatment. RESULTS Routine treatment of the current population of all women over the age of 65 suffering a distal radius fracture with bisphosphonates would avoid 94,888 lifetime hip fractures at the cost of 19,464 atypical femur fractures and $19,502,834,240, or on average $2,186,617,527 annually, which translates to costs of $205,534 per hip fracture avoided. The breakeven price point of annual bisphosphonate therapy after distal radius fracture for prevention of hip fractures would be approximately $70 for therapy annually. CONCLUSION Routine treatment of all women over 65 suffering distal radius fracture with bisphosphonates would result in a significant reduction in the overall hip fracture burden, however at a substantial cost of over a $2 billion dollars annually. To optimize efficiency of treatment either patients may be selectively treated, or the cost of annual bisphosphonate treatment should be reduced to cost-effective margins.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Dupuytren’s Disease: Predicting Factors and Associated Conditions.

    • Abstract: Object: Conflicting studies link several conditions and risk factors to Dupuytren’s disease (DD). A questionnaire-based case-control study was set to investigate associated conditions and clinical features of DD in a sample of Italian patients. The main purpose was the identification of predicting factors for: DD development; involvement of multiple rays; involvement of both hands; development of radial DD; development of recurrences and extensions. Material and Methods: A self-administered questionnaire was used to investigate medical and drug histories, working and life habits, DD clinical features, familial history, recurrences and extensions. Binary logistic regression, Mann Whitney U-test and Fisher’s exact test were used for the statistical analysis. Results: A role in DD development was found for male sex, cigarette smoking, diabetes and heavy manual work. The development of aggressive DD has been linked to age, male sex, high alcohol intake, dyslipidemias and positive familial history. Conclusions: Further studies might explain the dual relationship between ischemic heart disease and DD. According to our results, the questionnaire used for this study revealed to be an easy-handling instrument to analyze the conditions associated to DD. Nevertheless, its use in further and larger studies is needed to confirm our results as well as the role of the questionnaire itself as investigation tool for clinical studies.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Functional Results of Unstable (Type 2) Distal Clavicle Fractures Treated
           with Superior ...

    • Abstract: Background: The treatment of distal clavicle fracture is always a challenge, as it is mostly unstable and has higherrate of delayed union, malunion, non-union and associated acromioclavicular arthritis. So the management of thesefractures remains controversial. The purpose of this study is to evaluate the functional results of Type 2 distal endclavicle fractures treated with superior anterior locking plate.Methods: From June 2011 to August 2015 a retrospective study of12 male patients (mean age of 41.3 years) 11 withunilateral and 1 with bilateral distal clavicle fractures treated with superior anterior locking plate was done. They wereevaluated at regular intervals with mean follow up of 14 months(12-18 months).Those with minimum one year followup were included in our study. All were evaluated for the functioning of the shoulder joint by both Oxford shoulder scoreand Quick DASH scores, rate of bone union, complications and earliest time for return to work.Results: All fractures union seen within 6-8 weeks (mean time: 7.1 weeks).All had good shoulder range of motion. Theaverage oxford shoulder and Quick DASH score were 46.2 and 6.5.There were no major complications in our studyviz. non-union, plate failure, secondary fracture. But one patient had superficial wound infection. All patients returned towork within 3 months of postoperative period.Conclusion: Displaced distal clavicle fractures treated with superior anterior locking plates achieved excellent resultsin terms of bony union with rarely any complications and demonstrate promising results with this novel technique.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • First Use of a Brief 60-second Mindfulness Exercise in an Orthopedic
           Surgical Practice; Results ...

    • Abstract: Background: Mindfulness based interventions may be useful for patients with musculoskeletal conditions in orthopedicsurgical practices as adjuncts to medical procedures or alternatives to pain medications. However, typical mindfulnessprograms are lengthy and impractical in busy surgical practices. We tested the feasibility, acceptability and preliminaryeffect of a brief, 60-second mindfulness video in reducing pain and negative emotions in patients presenting to anorthopedics surgical practice.Methods: This was an open pilot study. Twenty participants completed the Numerical Rating Scale to assess painintensity, the State Anxiety subscale of the State Trait Anxiety Scale to assess state anxiety, and emotional thermometersto assess distress, anxiety, anger and depression immediately prior to and following the mindfulness video exercise.At the end of the exercise patients also answered three questions assessing satisfaction with the mindfulness video.Results: Feasibility of the mindfulness video was high (100%). Usefulness, satisfaction and usability were alsohigh. Participants showed improvements in state anxiety, pain intensity, distress, anxiety, depression and anger afterwatching the video. These changes were both statistically significant and clinically meaningful, when such informationwas available.Conclusion: People with musculoskeletal pain seeking orthopedic care seem receptive and interested in briefmindfulness exercises that enhance comfort and calm.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Effects of Human Adipose-derived Stem Cells and Platelet-rich Plasma on
           Healing Response of ...

    • Abstract: Background: Due to the known disadvantages of autologous bone grafting, tissue engineering approaches havebecome an attractive method for ridge augmentation in dentistry. To the best of our knowledge, this is the first studyconducted to evaluate the potential therapeutic capacity of PRP-assisted hADSCs seeded on HA/TCP granules onregenerative healing response of canine alveolar surgical bone defects. This could offer a great advantage to alternativeapproaches of bone tissue healing-induced therapies at clinically chair-side procedures.Methods: Cylindrical through-and-through defects were drilled in the mandibular plate of 5 mongrel dogs and filledrandomly as following: I- autologous crushed mandibular bone, II- no filling material, III- HA/TCP granules in combinationwith PRP, and IV- PRP-enriched hADSCs seeded on HA/TCP granules. After the completion of an 8-week period ofhealing, radiographic, histological and histomorphometrical analysis of osteocyte number, newly-formed vessels andmarrow spaces were used for evaluation and comparison of the mentioned groups. Furthermore, the buccal side ofmandibular alveolar bone of every individual animal was drilled as normal control samples (n=5).Results: Our results revealed that hADSCs subcultured on HA/TCP granules in combination with PRP significantlypromoted bone tissue regeneration as compared with those defects treated only with PRP and HA/TCP granules (P<0.05).Conclusion: In conclusion, our results indicated that application of PRP-assisted hADSCs could induce bone tissueregeneration in canine alveolar bone defects and thus, present a helpful alternative in bone tissue regeneration.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Comparison of Clinical Outcomes between Different Femoral Tunnel Positions
           after Anterior ...

    • Abstract: Background: It has been shown that the proper placement of ACL graft during the ACL reconstruction surgerysignificantly improves the clinical outcomes. This study investigated whether a change in the femoral tunnel position inboth axial and coronal planes can significantly alter the postoperative functional and clinical outcomes of the patients.Methods: This comparative, retrospective, single-center study was performed on 44 patients undergone single-bundleanterior cruciate ligament reconstruction (ACLR). Radiographic assessments were done to evaluate the tunnel positionin coronal and axial planes. Patients were classified into 4 groups based on radiographic data. The time intervalbetween surgery and last visit averaged 23.6 ± 2.2 months (18-30 mos.). Lysholm knee score and Cincinnati scorewere completed for all of the patients. Furthermore, the Lachman, anterior drawer and pivot-shift tests were performed.Results: Of the 44 patients included in the study, 9 patients (20.4%) were classified as the low-anterior group,17(38.6%) were classified as the low-posterior group and 18(40.9%) were classified as the high-posterior group. Noneof the patients were included in high-anterior group. A greater mean Lysholm score (96±3) in low-posterior group wasthe only significant difference between the three groups (P<0.001).Conclusion: Findings of the current study demonstrated that low-posterior placement of the ACL graft through theintercondylar notch, based on both antero-posterior (AP) and tunnel-view x-rays, is associated with better clinicaloutcomes in short-term compared to the routine tunnel placements.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Epidemiology of Joint Dislocations and Ligamentous/ Tendinous Injuries
           among 2,700 Patients: ...

    • Abstract: Background: The epidemiology of traumatic dislocations and ligamentous/tendinous injuries is poorly understood.In this study, we aimed to evaluate the prevalence and distribution of various dislocations and ligamentous/tendinousinjuries in a tertiary orthopedic hospital in Iran.Methods: Musculoskeletal injuries in an academic tertiary health care center in Tehran February 2005 to October2010 were recorded. The demographic details of patients with pure dislocations and ligamentous/tendinousinjuries were extracted and the type and site of injuries were classified according to their specific age/gendergroups.Results: Among 18,890 admitted patients, 628 (3.3%) were diagnosed with dislocations and 2.081 (11%) withligamentous/tendinous injuries. The total male/female ratio was 4.2:1 in patients with dislocations and 1.7:1 in patientswith ligamentous/tendinous injuries. Shoulder was the most prevalent site of dislocation (50.6%), followed by fingers(10.1%), toes (7.6%), hip (7.3%), and elbow (6.5%). Ankle was the most common site of ligamentous/tendinous injury(53.5%), followed by midfoot (12.3%), knee (8.3%), hand (7%), and shoulder (5%). The mean ages of the patients indislocations and ligamentous/tendinous injuries were 35.0±18.2 and 31.315.1±, respectively. There was no seasonalvariation.Conclusion: Shoulder dislocation and ankle ligamentous injury are the most frequent injuries especially in youngerpopulation and have different distribution patterns in specific age and sex groups. Epidemiologic studies can helpdevelop and evaluate the injury prevention strategies, resource allocation, and training priorities.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Measurement of Posterior Tibial Slope Using Magnetic Resonance Imaging

    • Abstract: Background: Posterior tibial slope (PTS) is an important factor in the knee joint biomechanics and one of the bone features, which leads to knee joint stability. Posterior tibial slope affects flexion gap, knee joint stability and posterior femoral rollback that are related to wide range of knee motion. During high tibial osteotomy and total knee arthroplasty (TKA) surgery, proper retaining the mechanical and anatomical axis is important. The aim of this study was to evaluate the value of posterior tibial slope in medial and lateral compartments of tibial plateau and to assess the relationship among the slope with age, gender and other variables of tibial plateau surface. Materials and methods: This descriptive study was conducted on 132 healthy knees (80 males and 52 females) with a mean age of 38.26±11.45 (20-60 years) at a medical center in Mashhad, Iran. All patients required to MRI admitted for knee pain with uncertain clinical history and physical examination that were reported healthy at knee examination were enrolled in the study. Results: The mean posterior tibial slope was 7.78±2.48 degrees in the medial compartment and 6.85±2.24 degrees in lateral compartment. No significant correlation was found between age and gender with posterior tibial slope (P≥0.05), but there was significant relationship among PTS with mediolateral width, plateau area and medial plateau. Conclusions: Comparison of different studies revealed that the PTS value in our study is different from other communities, which genetic and racial factors can be involved in these differences. The results of our study are useful to PTS reconstruction in surgeries.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • DDH Epidemiology Revisited: Do We Need New Strategies'

    • Abstract: DDH Epidemiology Revisited , Do We Need New Strategies' Introduction: Developmental Dysplasia of the Hip (DDH), is well known to pediatric orthopedists but its etiology still remains unknown. Although a vast majority of research are dedicated to this, but the results are confusing and inadequate. Material and method: 1073 neonates’ hips were examined by sonography and the results were classified according to Graf’s classification. Pathologic hips were cross checked by known risk factors for DDH. Result: There is a significant correlation between DDH occurrence and breech presentation, torticollis, positive family history, metatarsus adductus and oligohydramnious. Conclusion:Incidence of DDH is significantly high in this group of neonates. This make us reevaluate our current approach to this condition .We need to improve our screening protocols with the help of trained pediatricians, sonographists and other health professions. Keywords: congenital hip dysplasia, medical sonography, incidence study.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Giant Cell Tumor of the Sacrum: Series of 19 Patients and Review of the

    • Abstract: : Introduction: There are still some debates regarding the best treatment of Giant Cell Tumor (GCT) of the sacrum. Since GCT of this location is rare, therapeutic strategies are mainly based on the treatment of GCT in other anatomic locations. The objective of this study was to evaluate the oncologic and clinical results of surgical management of sacral GCT with and without local adjuvant therapy. Methods: Medical records of 19 patients diagnosed with GCT of the sacrum, were retrospectively reviewed. Sixteen patients were treated by intralesional curettage and three patients with marginal resection. Musculoskeletal tumor society (MSTS) score was used for the evaluation of functional outcome. Results: Prolonged pain was the most common complication after treatment. Mean Pre and post-operative pain based on visual analogue scale (VAS)was 6.1 ± 1.99 and 3.05 ± 1.64, respectively. Postoperative neurologic deficit appeared in six patients. In addition, infection occurred in five patients. One case of spinopelvic instability was also observed after surgery. At average follow up of 158.5 ± 95.9 months (range 25 to 316 months), recurrence was seen in eight (42.7%) out of seventeen patients treated by intralesional curettage. The size of the tumor significantly correlated with the tumor recurrence (r=0.654, p=0.001). Mean MSTS score was 74.7 ± 16.78. Those patients, in whom sacral nerve roots remained intact before and after surgery, had better functional outcome. Conclusion: Preservation of sacral nerve roots is associated with better functional outcome and less pain. Although an acceptable surgical outcome was observed in our cohort, the problem of local recurrence still warrants further investigations for better local control of the tumor.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Evaluation of Normal Ranges of Wrist Radiologic Indexes in Mashhad

    • Abstract: Background: The current study aims to measure the normal wrist indexes in our area, compares it with other present databases and discovers the factors may influence radiographic normal indexes. Methods: 100 healthy participants enrolled in this prospective and cross-sectional study. After performing PA or lateral radiographs, all radiological wrist indexes including first and third metacarpal length, wrist height, ulnar variance, radial tilt, radial inclination, radiolunate angle, capitolunate angle, scapholunate angle, capitate and scaphoid length, lunate and wrist width and Lunate diameter were measured. Results: Regarding gender, statically significant differences was measured in first and third metacarpal length, wrist height, radial tilt, radiolunate angle, capitate and scaphoid length, lunate, and wrist width, lunate length, and Lunate diameter. The significant linear correlation was measured between ulnar variance, scapholunate angle, wrist width and length with age. Conclusion: Our study is useful to obtain radiographic normal values of hand and wrist regarding morphological differences among Iranian.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Massive Emphysema and Pneumothorax Following Shoulder Arthroscopy under
           General Anaesthesia: A ...

    • Abstract: The patient was a 61-year-old female with massive rotator cuff tear who had no history of smoking, COPD, asthma, or other pulmonary diseases. Four hours following shoulder arthroscopy, the patient developed progressive dyspnea, which was diagnosed as pneumothorax with subcutaneous emphysema extending to the neck and face. Chest tube was inserted promptly. The patient was discharged with a good condition after 7 days. Follow up of the patient for the next 3 months was uneventful.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Does a previous high tibial osteotomy (HTO) influence the long-term
           function or survival of a ...

    • Abstract: Background: High tibial osteotomy (HTO) is a well established technique for the treatment of medial osteoarthritis of the knee with varus malalignment. The outcome of total knee arthroplasty (TKA) after HTO remains uncertain. Question/Purpose: The aim of this paper is to revise the literature with the aim of answering the following question: Does a previous (HTO) influence the long-term function or survival of a TKA'. Methods: The search engine was MedLine. The keywords used were: total knee arthroplasty after high tibial osteotomy. One hundred and ten articles were found. Of those, only 19 were selected and reviewed because they were strictly focused on the topic and the question of this article. Results: The reports published so far have a low grade of evidence (levels III and IV). Most of them are prospective case series (level IV). One is a systematic review of level III studies reported in 2009. Two recent studies based in a great number of cases (registers) showed similar survival in the 2 groups: around 92% at 10 years, and 88% at 15 years. Conclusions: The review of the literature suggests that a previous HTO does not influence the function or survival of a TKA in the long-term.
      PubDate: Tue, 31 Oct 2017 20:30:00 +010
  • Total Knee Replacement Sizing: Shoe Size is a Better Predictor for Implant
           Size than Body Height

    • Abstract: Background and Purpose- Various sizes of implants need to be available during surgery. The purpose of this paper is to compare body height and shoe size with implant sizes in patients who underwent total knee replacement surgery to see which biomarker is a better predictor for implant size. Methods- A total of 100 knees, 50 female and 50 male knees were matched with body height and shoe size. The femoral anteroposterior and mediolateral width and the tibial anteroposterior and mediolateral width were correlated. Results- The correlation between shoe size and the four knee implant dimensions, femoral AP, ML, and tibial AP and ML were higher than the correlations between height and the same four dimensions. Conclusion- The results indicated that shoe size is a better predictor of component dimensions than body height is.
      PubDate: Fri, 04 Aug 2017 19:30:00 +010
  • Intrapelvic Protrusion of a Broken Guide Wire Fragment during Fixation of
           a Femoral Neck Fracture

    • Abstract: Breakage of DHS guide wire during surgery and its migration into the pelvis through the hip joint is a rare complication and its removal can be very challenging for the surgeon. We share our experience of a similar case wherein we used an ‘iliofemoral’ approach to successfully remove the broken transfixing guidewire from the hip joint. Although iliofemoral approach is similar to the lateral window of conventional ilioinguinal approach, yet it is less invasive, has lesser complications, requires less expertise and is easily reproducible by an average orthopaedic trauma surgeon. We recommend that surgical approaches for removal of these broken or migrated wires should be individualized depending upon the exact location of the wire tip in the hip joint or pelvis and need for exposure.
      PubDate: Fri, 04 Aug 2017 19:30:00 +010
  • Epineural sleeve reconstruction technique for median nerve complete

    • Abstract: In microsurgical nerve repair, the epineural sleeve technique can be used to bridge short nerve defects and to cover the coaptation site with the epineurium of the nerve stump. The epineurium serves as a mechanical aid to reduce gap size, and increase repair strength, effectively assisting nerve regeneration. This article presents a 32-year-old patient who experienced complete transection of the median nerve at the distal forearm, which was treated with the epineural sleeve graft reconstruction technique. Nerve regeneration was followed-up for 18 months and evaluated with the Rosén and Lundborg scoring system. The final outcome was excellent; at the last follow-up, the patient experienced complete sensory and motor function of the median nerve.
      PubDate: Fri, 28 Jul 2017 19:30:00 +010
  • Acute Combined Median and Radial Nerve Palsies after Distal Humeral Shaft

    • Abstract: We report a case of a 29-year-old man who presented with a distal humeral shaft fracture sustained by blunt trauma. Physical examination and nerve conduction study were consistent with injury to the median and radial nerves proximal to the elbow. The patient underwent open reduction and internal fixation of the humeral shaft fracture with neurolysis of the median and radial nerves. Repeat electromyography at 6 months postoperatively showed recruitment of motor units in all muscles sampled, in keeping with clinical improvement. At 16 months follow-up, the patient was full strength in all muscle groups, was back to all activities with no restrictions, and was discharged from follow-up. Our case describes clinical improvement after surgical intervention in a patient with combined median and radial nerve palsies following distal humeral shaft fracture.
      PubDate: Fri, 21 Jul 2017 19:30:00 +010
  • Total Knee Arthroplasty in Patients with Retention of Prior Hardware
           Material: What is the Outcome'

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

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

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

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