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  [13 journals]
  • Use of "Hardware" Battery drill in Orthopedic Surgery

    • Abstract: Among the power drills ( Electrical/ Pneumatic/Battery ) used in Orthopedic surgery, battery drill has got several advantages. Surgeons in low resource settings could not routinely use Orthopedic battery drills (OBD) due to the prohibitive cost of good drills or poor quality of other drills. "Hardware" or Engineering battery drill (HBD) is a viable alternative to OBD. HBD is easy to procure, rugged in nature, easy to maintain, durable, easily serviceable and 70 to 75 times cheaper than the standard high end OBD. We consider HBD as one of the cost effective equipment in Orthopedic operation theatres.
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • Closed internal degloving of the the flank

    • Abstract: Originally described in 1853 by Dr. Morel-Lavellee, closed internal degloving injuries represent an important, although uncommon, source of morbidity in trauma patients. The term Morel-Lavellee lesion is the term used to describe the classic lesion initially described overlying the greater trochanter. Similar closed degloving injuries can occur anywhere on the trunk and extremities. These injuries are typically the result of a shearing or crushing force that traumatically separates the skin and subcutaneous tissue from the underlying fat. This results in disruption of perforating blood vessels and lymphatics, leading to hematoma/seroma formation. We describe two cases in which industrial crush injuries resulted in lumbar transverse process fracture. Both patient developed closed degloving injuries of the flank. To the author's knowledge, this is the first case series describing the occurrence of closed internal degloving injuries of the flank with transverse process fractures. We advise that a high level of suspicion for these lesions to occur with transverse spinal fractures should be maintained, as they may arise several years post initial injury.
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • Reverse total shoulder arthroplasty for the treatment of synovial
           chondromatosis: a case report ...

    • Abstract: Synovial chondromatosis affecting the glenohumeral joint is rare. Treatment primarily consists of arthroscopic loose body removal and synovectomy. Shoulder arthroplasty has been mentioned in the literature as a treatment option for patients with coexisting arthritis, although the results have been underreported. The case of an 84-year-old man with long standing synovial chondromatosis of the shoulder resulting in severe degenerative disease is presented. The patient was treated with a reverse total shoulder arthroplasty, loose body removal, and a complete synovectomy. Three and six month follow up results have shown a decrease in the visual analogue scale for pain, improved range of motion, and no radiographic evidence of disease recurrence. Reverse total shoulder arthroplasty is a viable treatment option for synovial chondromatosis in patients with coexisting glenohumeral arthritis demonstrating good short term outcomes.
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • Long-term results of osteoarticular allograft reconstruction in children
           with distal femoral ...

    • Abstract: There is no consensus regarding the best method of reconstruction in pediatric population following the wide resection of malignant bone tumors. More exploration of the complications of osteoarticular reconstruction leads to less existing controversy of this type of reconstruction, which is the main point of this article.Methods: We retrospectively reviewed the long-term results of osteoarticular allograft reconstruction of primary distal femoral bone sarcomas in 22 children with the mean age of 10.68 years old. We evaluated complications and outcome. Musculoskeletal Tumor Society (MSTS) scoring system was used for the functional evaluation of the allografts.Result: With an average follow-up time of 81 months, outcome of 16 patients, who have allograft in places at final follow up was evaluated. As expected, Limb length discrepancy (LLD) was observed in all patients (mean LLD= 2.73cm), which was significantly correlated to allograft survival time (p<0.001). Degenerative joint disease (DJD) was also seen in all of our patients and its grade was also significantly correlated to allograft survival time (p<0.001). The mean MSTS-score was 74% at the latest follow-up, ranging from 60% to 90%. 5 and 10 year survival rate of allografts were 93.3 and 62.2, respectively. Conclusion: Osteoarticular allograft reconstruction could result in several complications including DJD. In spite of its considerable biologic advantage over endoprosthesis, we must admit that at the moment, this reconstruction is a long-lasting but still a temporary solution before performing megaprosthesis. This allows patients to preserve their remaining physis for growth of their limb and to become old enough for an adult megaprosthesis, in those who outlive their disease.
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • Patient Complaints at a Tertiary Referral Hospital Emphasize Opportunities
           for Improving ...

    • Abstract: Patient concerns represent opportunities for improvement in orthopaedic care. This study's objective is to identify the nature and prevalence of unsolicited patient complaints regarding orthopaedic care at a tertiary referral hospital. The primary null hypothesis that there are no demographic factors associated with complaint types was tested. Secondarily we determined if the overall complaint number and types differed by year.Methods: Complaints to the hospital ombudsperson by orthopaedic patients between January 1997 and June 2013 were reviewed. All 1118 complaints were categorized: access and availability, humaneness and disrespect, communication, expectations of care and treatment, distrust, billing and research.Results: Patients between 40 and 60 years of age filed the most complaints in all categories except distrust (more common in patients over age 80) and research. Women were slightly more likely to address access and availability, humaneness, disrespect, and billing compared to men. The overall number of complaints peaked in 1999. The most common issue was access and availability followed by communication, and humaneness/disrespect.Conclusions: Half of concerns voiced by patients addressed interpersonal issues. The largest category was related to access and availability. Quality improvement efforts can address technology to improve access and availability as well as empathy and communication strategies.
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • The prevalence of unanticipated hamate hook abnormalities in computed
           tomography scans: a ...

    • Abstract: Background: It is possible that some hamate hook fractures are not diagnosed or treated, thereby affecting the study of their natural history. Study of the prevalence of incidental hamate hook fractures, nonunions, and other abnormalities on computed tomography (CT) ordered for another reason could document a subset of undiagnosed and untreated hamate hook fractures which might change our understanding about the natural history.Methods: Reports of 2489 hand, wrist, and forearm CT scans for hamate hook abnormalities were searched. We excluded 19 patients with anticipated hamate fractures and 1 patient that had a hamate hook excision. Twenty-eight patients had an unanticipated hamate hook abnormality.Results: There was a significant difference in the prevalence of incidental hamate hook abnormalities by sex (P = 0.014) but not by age (P = 0.096). Among the 28 unexpected hamate hook abnormalities, there were 16 fractures of the base (12 acute, 1 nonunion, and 3 of uncertain age), 5 acute oblique fractures, and 7 tip abnormalities/ossicles. The patient with an incidental nonunion had a CT scan for wrist pain and was diagnosed with gout. All fractures involved a direct blow to the hand (distal radius or scaphoid fracture, or crush injury). The 7 patients with a hamate tip abnormality had a CT scan for a distal radius or metacarpal fracture, crush injury or wrist pain. Five acute fractures were treated operatively with excision and the other 23 fractures were treated nonoperatively.Conclusions: Hamate fractures can be diagnosed incidental to other hand and wrist problems on CT.
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • Challenges in Evaluating Sleep Disturbances in Patients with Hand and
           Upper Extremity Disease

    • Abstract: Dear Editor,It was with great interest that we read the recent study by Peters et al regarding sleep disturbances in patients with disease of the upper extremity (1). In this article, the authors aimed to correlate sleep disturbance and other psychosocial factors with upper extremity disability using a series of Patient-Reported OutcomesMeasurement Information System (PROMIS) questionnaires.
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • Relationship between bone mineral density and serum vitamin D with low
           energy hip and distal ...

    • Abstract: Objectives:To determine serum vitamin D and bone mineral density status in female and male low-energy hip and distal radius fracture patients compared to matched controls.Methods: Between January 2013 and January 2014 we recruited all patients aged 55 years or older with a low-energy hip and distal radius fracture. The control group consisted of age-matched subjects. Bone mineral density was measured with dual energy X-ray absorptiometry and serum sample was obtained to check vitamin D,calcium, phosphorus, alkaline phosphatase, and protein. Results:Our final study subjects which evaluated, were 78 in hip and distal radius fracture group and 80 in control group. The overall mean serum level of vitamin D3 was significantly different among the three groups (p=0.035). Similar results were revealed with hip and spine t-score between the groups (p˂0.001).Conclusion: There is not only a direct relation between serum vitamin D and risk of low energy hip and distal radius fractures, but also a significant relation between low bone density in hip and spine area with low serum calcium.
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • Does Tranexamic Acid Reduce Bleeding During Femoral Fracture

    • Abstract: Introduction: Proximal femoral fracture repair is associated with a high risk of perioperative bleeding which leads to postoperative anemia. Tranexamic acid is an efficient inhibitor for plasminogen. Hence, the current study evaluated the effect of tranexamic acid on the level of bleeding and the need for transfusion in patients under femur fixation. Patients and Methods: The current controlled randomized clinical trial enrolled 38 patients with intramedullary nailing for proximal femoral fracture and divided them into two groups. The intervention group received 15 mg/kg tranexamic acid via intravenous infusion, before the surgery; while no medicine was given to the placebo group. General anesthesia was performed all subjects. Blood hemoglobin of the subjects was measured four hours before and after the surgery, and after transferring the patients to the ward;Packed Red Blood Cell (PRBC) was administered based on allowable blood loss (ABL) calculation; hemoglobin loss and level of bleeding and transfusion need was compared between the groups. The employed statistical tests were as follows: independent T-test, repeated measurement, Mann-Whitney U test, Chi –square test and statistical analysis was conducted by SPSS ver.16. P Results: The mean of hemoglobin loss after the surgery, compared to the same before the surgery, in the intervention group (I) receiving tranexamic acid and the placebo group (P) were 1.75 ± 0.84 and 2.04 ± 1.97 mg/dL, respectively. Hemoglobin loss in the placebo group was higher than tranexamic acid (P= 0.570). Also, the rate of receiving P. cell in the intervention group (5.6%) was lower than that of the placebo group (30%)(P= 0.06).Conclusion: Preoperative treatment with tranexamic acid in the patients under femur fixation lowers the level of hemoglobin loss and reduces the rate of transfusion during the surgery.
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • The Zeitgeist of Challenging the Evidence. ...

    • Abstract: Purpose: The economic burden of the treatment of periprosthetic joint infection (PJI) is high and the treatment of PJI has a high degree of international controversy.Several papers have declared the International Consensus Meeting on Periprosthetic Joint Infection (ICMPJI) to be the “flawless pledge of international academics” to overcome the challenges of musculoskeletal infections. The purpose of this paper is to highlight for the first time some essential insights into the key dilemmas that are associated with this international consensus process.Method: The proceedings of the ICMPJI was reviewed, and the critical consensus agreements that were reached were communicated via e-mail to 38 leading orthopaedic surgeons, microbiologists and statisticians around the world. Of these, 30 responded, 8 did not, and 10 of respondents were not aware of the ICMPJI. This paper was developed based on their expertise, our clinical experiences, and current literature. Summary of Findings:A thorough review of the ICMPJI proceedings identified a clear need to resolve some of the dilemmas that we highlight in this paper. The Delphi procedure has been described as a survey technique that enables a group dynamic-based practice. Although there have been several published reports on this procedure, its scientific merit is still being debated. Several challenges and questions have been raised regarding the application of the Delphi technique, but there is no doubt that it is a vital approach for achieving consensus on subjects where none currently exists. Conclusion:Performing prospective clinical studies in this area is currently the best and only option to overcome this challenge. In the long term, this approach will not only incorporate the standard of clinical evidence but also adopt regional mores for treating infection, which include patient values, cultural differences and local financial resources.
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • Acetabular Fractures in the Senior Population – Epidemiology,
           Mortality and Treatments

    • Abstract: Object: Acetabular fractures are challenging injuries to manage successfully in the senior population. Unfortunately, treating surgeons have a paucity of information to guide the treatment in this patient population. The purpose of this study was to determine: (1) demographic and epidemiologic data, (2) mortality rates for nonoperative compared to operative management at different time points, (3) common fracture configurations, and (4) fracture fixation strategies in senior patients treated with acetabular fractures.Methods: Retrospective review of prospectively gathered data at a Level I trauma center over a five year period. 1123 acetabular fractures were identified, 156 of which were in patients over the age of 65 (average age 78). Results: Falls and motor vehicle accidents accounted for the two most common mechanisms of injury. Eighty-two percent of the patients had significant medical comorbidities. Fifty-one patients (33%) died within one year, and 75% of those died within 90 days of their acetabular fracture. Of the 51 who died during the study period, 84% had non-operative treatment. For those patients treated with traction alone, there was a 79% one-year mortality and 50% mortality rate at 90 days. Within the entire cohort, 70% had either an associated both-column (ABC) or anterior column/posterior hemitransverse (AC/PHT) fracture pattern. Fifty-seven patients (36.5%) underwent open reduction and internal fixation using standard reduction techniques and surgical implants via two main surgical exposures: the ilioinguinal (69%) and Kocher-Langenbeck (29%). Conclusion: Geriatric patients with acetabular fractures are uncommon accounting for only 14% of all acetabular fractures. Patients who undergo surgery trend towards lower mortality rates. ABC and AC/PHT fracture patterns are the two most common fracture patterns. Routine fixation constructs and implants can be used to manage these challenging fractures. Most patients are unable to return to their homes and instead require skilled nursing facility during their convalescence.
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • Preliminary results of a consecutive series of large & massive rotator
           cuff tears treated ...

    • Abstract: AbstractObject: Recurrence rate of rotator cuff tears is still high despite the improvements of surgical techniques, materials used and a better knowledge of the healing process of the rotator cuff tendons. Large to massive rotator cuff tears are particularly associated with a high failure rate, especially if assessed in elderly.Augmentation technique of rotator cuff repairs with extracellular matrix or synthetic patches has gained popularity in recent years with the aim of reducing failure. However, further studies regarding its safety, reliability and surgical technique are required. The aim of this study was to investigate the outcome of rotator cuff repairs augmented with denatured extracellular matrix in a series of patients who underwent arthroscopic rotator cuff repair for large to massive tears.Methods: Ten consecutive patients, undergoing arthroscopic rotator cuff repair with extracellular matrix augment for large and massive tears, were prospectively enrolled into this single surgeon study. All repairs were performed arthroscopically with a double row technique augmented with extracellular matrix. Oxford Shoulder Score, Constant Score and pain visual analogue scale (VAS) were used to monitor the shoulder function and outcome pre-operatively and at three, six and 12-month follow-up. Minimum follow up was tree months. Mean follow up was 7 months. Results: Mean Constant score improved from 53 (SD=4.2) pre-operatively to 75 (SD=11) at final follow up. Mean Oxford score also increased from 30 (SD=7.9) pre-operatively to 47 (SD=9,6) at the final follow up. The visual analogue scale (VAS) improved from seven out of 10 (SD=2) preoperatively to 0.6 (SD=0.8) at final follow up. Additionally, there was significant improvement at three months mark in Constant score.Conclusion: Arthroscopic repair and augmentation of large and massive rotator cuff tears with extracellular matrix patch has good early outcome. Keywords: Augment, Patch, Rotator Cuff Tear, Rotator Cuff Repair, Owl Technique
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • How do Orthopaedic Surgeons Address Psychological Aspects of Illness?

    • Abstract: Orthopaedic surgeons have a pivotal role in transitioning the care of orthopedic patients from a biomedical to a biopsychosocial model. In an effort to foster this transition, we designed a study aimed to determine surgeons’ attitudes and practice of noticing, screening, discussing psychological illness with patients, as well as making referrals to address psychosocial issues in patients in need. Additionally, we asked surgeons to rank order potential barriers to and reasons for referrals to psychosocial treatment. Orthopaedic surgeons members of the Science and Variation Group and Ankle Platform (N =350) completed demographics, and a 4-part survey assessing the degree to which surgeons notice, assess, screen and refer for psychological treatments, as well ranked ordered barriers to engaging in these processes. As a group surgeons were neutral to referral for psychological treatment and formal screening of psychological factors, and somewhat likely to notice and discuss psychological factors. Surgeons were more likely to refer for psychological treatment if they engaged in research, or if they reside in South America as opposed to North America. The highest ranked barriers to screening, noticing, discussing and referring for psychological treatment were lack of time, stigma and feeling uncomfortable. Overall surgeons are likely to notice and discuss psychological factors, but less likely to formally screen or refer for psychological treatment. Transition to biopsychosocial models should focus on problem solving these barriers by teaching surgeons communication skills to increase comfort with discussing psychoemotional factors associated with orthopedic problems. The use of empathic communication can be very helpful in normalizing the difficulty of coping with an orthopedic condition, and may facilitate referral.
      PubDate: Fri, 02 Dec 2016 20:30:00 +010
  • Nail Psoriasis Was Triggered by the Reconstruction of Syndactyly

    • Abstract: Koebner phenomenon can be seen in a number of inflammatory skin diseases. Psoriasis is one of the common skin diseases associated with Koebner phenomenon. nail psoriasis can be developed independently from the inflammatory arthritis and skin the current report we presented A 30-year old lady underwent reconstruction of the third web of her right hand because of congenital syndactyly. Four months after the surgery she developed nail dystrophy, onycholysis and onychorrhexis of the middle, ring and little fingernails. The clinical and histopathology findings were compatible with the diagnosis of isolated nail psoriasis.
      PubDate: Wed, 16 Nov 2016 20:30:00 +010
  • Osteochondritis dissecans of the humeral head: a case report and review of
           the literature

    • Abstract: Osteochondritis dissecans (OCD) is a common pathology in the knee, ankle and elbow but is rarely found in glenohumeral joint. In current study, we report an asymptomatic case of humeral head OCD which was detected incidentally following a trauma. X-rays showed an oval central lytic lesion measuring about 1 cm on the superior aspect of the humeral head. However, the patient was pain- free and ranges of shoulder motions were normal.
      PubDate: Wed, 16 Nov 2016 20:30:00 +010
  • Qualitative Evaluation of Digital Hand X-rays is Not a Reliable Method to
           Assess Bone Mineral ...

    • Abstract: Object: The gold standard for evaluating bone mineral density is dual energy x-ray absorptiometry (DEXA). Prior studies have shown poor reliability using analog wrist X-rays in diagnosing osteoporosis. Our goal was to investigate if there was improved diagnostic value to visual assessment of digital hand X-rays in osteoporosis screening. We hypothesized that similar to analog counterparts, digital hand X-rays have poor correlation and reliability in determining bone mineral density (BMD) relative to DEXA. Methods: We prospectively evaluated female patients older than 65 years who presented to our hand clinic with digital hand and wrist X-rays as part of their evaluation over six months. Patients who had a fracture and were without DEXA scans within the past two years were excluded. Five fellowship-trained hand surgeons, blinded to DEXA T-scores, evaluated the x-rays over two assessments separated by four weeks and classified them as osteoporotic, osteopenic, or normal BMD. Accuracy relative to DEXA T-score, interobserver and intraobserver rates were calculated.Results: Thirty four patients met the inclusion criteria and a total of 340 x-rays reviews were performed. The assessments were correct in 169 cases (49%) as compared to the DEXA T-scores. A mean weighted kappa coefficient of agreement between observers was 0.29 (range 0.02-0.41) reflecting a fair agreement. The first and second assessment for all five physicians was 0.46 (range 0.19-0.78) reflecting a moderate agreement. Grouping osteoporosis and osteopenia together compared to normal, the accuracy, interobserver and intraobserver rates increased to 63%, 0.42 and 0.54 respectively.Conclusion: Abnormally low BMD is a common occurrence in patients treated for upper extremity disorders. There is poor accuracy relative to DEXA scan and only fair agreement in diagnosing osteoporosis using visual assessments of digital x-rays. Clinical Relevance: Given the poor reliability, visual assessment of digital hand X-rays is not a reliable screening tool for osteoporosis.
      PubDate: Wed, 16 Nov 2016 20:30:00 +010
  • Total Knee Arthroplasty in severe Unstable Knee: Case-report and
           Literature Review

    • Abstract: Rarely, an arthritic knee undergoing TKA may also show multiplanar or global laxity where there is significant medial, lateral and posterior ligamentous insufficiency along with significant bone loss. severe or global knee instability may be secondary to a neuromuscular disorder (such as post- poliomyelitis, spinal neuropathy) or due to post- traumatic global ligamentous insufficiency. The estimated prevalence for the concurrence of CMT with MG suggests, that it is an extremely rare event.We presented a 54-year-old female patient with charcot marie-tooth(CMT) and myasthenia gravis(MG) complaining of progressive pain, swelling, and crepitation of the knee joints that was undergo of total knee arthroplasty(TKA)with rotating hinge prothesis .she has a acute myasthenia crisis soon after operation with prolonge intubation and intensive care unit admission. Radiographies and physical examination revealed bilateral severe unstable arthritic knee joints and left knee posterior dislocation. Short-term postoperative follow-up of our patient revealed improved knee function and resolution of all symptoms in operated side.
      PubDate: Sun, 13 Nov 2016 20:30:00 +010
  • Analgesia following arthroscopy – a comparison of intra-articular
           bupivacaine and/or ...

    • Abstract: Introduction: Arthroscopic surgery is one of the most common orthopedic surgeries. Different drugs are used by intra-articular administration to induce analgesia after knee arthroscopic surgery. The aim of this study was to evaluate analgesic effects of Bupivacaine (marcaine), Bupivacaine plus midazolam and Bupivacaine plus fentanyl in reducing pain after knee arthroscopic surgery Method: Frothy five patients who were candidate for knee arthroscopy were divided into three groups. Group A received Bupivacaine 50 mg, group B Bupivacaine 50 mg + midazolam 50 µg/kg, and group C Bupivacaine 50 mg + fentanyl 3 µg/kg. The analgesic solutions were diluted with normal saline up to 20 ml. the analgesic effects were evaluated by VAS during first 24 hrs after surgery. With the VAS > 4, extra analgesic (pethidine) was administrated for patient. Results: The amount of induced analgesia and need for extra analgesic were different between groups but it was not statistically significant (p<0.109). The amount of used analgesic (pethidine) in first 24 hours after operation in group A was 275 mg, while it was150 mg for group B and 75 mg for group C. In group A 46.67% of patients required further analgesic while this was 26.67% and 13.34% for groups B and C respectively. Conclusion: Intra-articular administration of studied drugs in all three groups reduced post-operation pain. The amount of induced analgesia was highest in group C, and group B drugs induced better analgesia compared with group C. However we did not find significant difference between groups which could be because of lack of placebo group or small sample size.
      PubDate: Sun, 13 Nov 2016 20:30:00 +010
  • The Effect of Patellofemoral Pain Syndrome on Gait Parameters: A
           Literature Review

    • Abstract:  Background: Patellofemoral pain syndrome (PFPS) is one of the most frequent causes of anterior knee pain in adolescents and adults. This disorder can have a big effect on patients’ ability and quality of life and gait.  Methods:This review included all articles published during 1990 to 2016. An extensive literature search was performed in databases of Science Direct, Google Scholar, PubMed and ISI Web of Knowledge using OR, AND, NOT between the selected keywords. Finally, 16 articles were selected from final evaluation. Results:In PFPS subjects, there was lower gait velocity, decreased cadence, and reduced knee extensor moment in the loading response and terminal stance, delayed peak rear foot eversion during gait and greater hip adduction compared to healthy subjects, while for hip rotation, there was controversy in studies. Conclusion:Changes in the walking patterns of PFPS subjects may be associated with the strategy used for the reduction of patellofemoral joint reaction force and pain.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Unicompartmental Knee Osteoarthritis (UKOA): Unicompartmental Knee
           Arthroplasty (UKA) or High ...

    • Abstract:  Background: The aim of this review article is to analyze the results of high tibial osteotomy compared to unicompartmental knee arthroplasty in patients with unicompartmental knee osteoarthritis.  Methods:The search engine used was PubMed. The keywords 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 strictly focused on the topic. Results:In a meta-analysis the ratio for an excellent outcome was higher in unicompartmental knee arthroplasty than high tibial osteotomy and the risks of revision and complications were lower in the former. A prospective comparative study showed that unicompartmental knee arthroplasty offers better long-term success (77% for unicompartmental knee arthroplasty and 60% for high tibial osteotomy at 7-10 years). However, a review of the literature showed no evidence of superior results of one treatment over the other. A multicenter study stated that unicompartmental knee osteoarthritis without constitutional deformity should be treated with unicompartmental knee arthroplasty while in cases with constitutional deformity high tibial osteotomy should be indicated. A case control study stated that unicompartmental knee arthroplasty offers a viable alternative to high tibial osteotomy if proper patient selection is done. Conclusion:The literature is still controversial regarding the best surgical treatment for unicompartmental knee osteoarthritis (high tibial osteotomy or unicompartmental knee arthroplasty). However, unicompartmental knee arthroplasty utilization is increasing, while high tibial osteotomy utilization is decreasing, and a meta-analysis has shown better outcomes and less risk of revision and complications in the former. A systematic review has found that with correct patient selection, both procedures show effective and reliable results. However, prospective randomized studies are needed in order to answer the question of this article.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Complicated Congenital Dislocation of the Knee: A Case Report

    • Abstract:  Congenital dislocation of the knee (CDK) is a rare disorder. We report the case of a 7-year-old girl with bilateral knee stiffness, marked anterior bowing of both legs, and inability to walk without aid.Radiologic investigation revealed bilateral knee joint dislocation accompanied by severe anterior bowing of both tibia proximally and posterior bowing of both femur distally, demonstrating a complicated congenital knee dislocation. Two-staged open reduction with proximal tibial osteotomy was performed to align the reduced knee joints. The patient was completely independent in her daily activities after surgical correction. 
      PubDate: Fri, 30 Sep 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: Fri, 30 Sep 2016 20:30:00 +010
  • Arthroscopic Bridge Technique for PCL Avulsion: Surgical Technique and Key

    • Abstract: This study redescribes an arthroscopic bridge technique for repair of avulsion of the posterior cruciate ligament. The procedure is performed step-to-step. In this technique we created two bone tunnels in the anterior aspect of the tibia and inferior medial of the tibia tuberosity and then create suture fixation of the fragment using the suture bridge. The arthroscopic bridge technique was used in 3 patients. All were satisfied and returned to activities. This technique is a safe and effective method of repair of PCL avulsion that allows active mobilization with minimal risk of complication
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Spinopelvic Fixation of Sacroiliac Joint Fractures and
           Fracture-Dislocations: A Clinical 8 ...

    • Abstract:   Background: Pelvic ring injuries and sacroiliac dislocations have significant impacts on patient’s quality of life. Several techniques have been described for posterior pelvic fixation. The current study has been designed to evaluate the spinopelvic method of fixation for sacroiliac fractures and fracture-dislocations.   Methods: Between January 2006 and December 2014, 14 patients with sacroiliac joint fractures, dislocation and fracture-dislocation were treated by Spinopelvic fixation at Shahid Sadoughi Training Hospital, Yazd, Iran. Patients were seen in follow up, on average, out to 32 months after surgery. Computed tomographic (CT) scans of patients with sacral fractures were reviewed to determine the presence of injuries. A functional assessment of the patients was performed using Majeed’s score. Patient demographics, reduction quality, loss of fixation, outcomes and complications, return to activity, and screw hardware characteristics are described Results: The injury was unilateral in 11 (78.5%) patients and bilateral in 3 (21.5%). Associated injuries were present in all patients, including fractures, dislocation and abdominal injuries. Lower limb length discrepancy was less than 10 mm in all patients except two. Displacement, as a measure of quality of reduction was less than 5 mm in 13 patients. The mean Majeed score was 78/100. Wound infection and hardware failure were observed in 3 (21.4%) and 1 (7.1%) cases, respectively. In this study most patients (85%) return to work postoperatively. Conclusion: According to the findings, spinopelvic fixation is a safe and effective technique for treatment of sacroiliac injuries. This method can obtain early partial to full weight bearing and possibly reduce the complications.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Psychometric Properties of the Persian Version of the Simple Shoulder Test
           (SST) Questionnaire

    • Abstract:  Background: To validate the Persian version of the simple shoulder test in patients with shoulder joint problems.  Methods:Following Beaton`s guideline, translation and back translation was conducted. We reached to a consensus on the Persian version of SST. To test the face validity in a pilot study, the Persian SST was administered to 20 individuals with shoulder joint conditions. We enrolled 148 consecutive patients with shoulder problem to fill the Persian SST, shoulder specific measure including Oxford shoulder score (OSS) and two general measures including DASH and SF-36. To measure the test-retest reliability, 42 patients were randomly asked to fill the Persian-SST for the second time after one week. Cronbach’s alpha coefficient was used to demonstrate internal consistency over the 12 items of Persian-SST. Results:ICC for the total questionnaire was 0.61 showing good and acceptable test-retest reliability. ICC for individual items ranged from 0.32 to 0.79. The total Cronbach’s alpha was 0.84 showing good internal consistency over the 12 items of the Persian-SST. Validity testing showed strong correlation between SST and OSS and DASH. The correlation with OSS was positive while with DASH scores was negative. The correlation was also good to strong with all physical and most mental subscales of the SF-36. Correlation coefficient was higher with DASH and OSS in compare to SF-36. Conclusion:Persian version of SST found to be valid and reliable instrument for shoulder joint pain and function assessment in Iranian population.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Assessment of Coronal Radiographic Parameters of the Spine in the
           Treatment of Adolescent ...

    • Abstract:  Background: To determine the most important preoperative factors that affect postoperative coronal parameters of scoliotic curves.  Methods:All Adolescent Idiopathic Scoliosis (AIS) patients included in the study were classified according to Lenke and King Classification. The fusion levels were selected according to the rigidity of the existing curves (correction less than 50%), tilt of T1 and shoulders, sagittal angle of the curves and with considering stable and neutral end vertebra. The radiographic coronal parameters: shoulders tilt angle, iliolumbar angle and coronal balance were measured in all patients before, after, and in the last follow- up visit. Results:One hundred twenty patients after mean of 25 months follow-up (18-40 months) were included in the study. Before operation, abnormal coronal balance (more than 2 cm shift) was noticed in 46 patents (38%) and in the last visit, was noted in 22 patients (18%). Multivariate regression analysis revealed a significant predictive value of the preoperative coronal balance on the last visit coronal balance (P value=0.01). Conclusion:Preoperative coronal balance is very important to make a balanced spine after surgery. Other parameters like Lenke classification or main thoracic overcorrection did not affect postoperative coronal decompensation.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Assessment of Diagnostic Value of Single View Dynamic Technique in
           Diagnosis of Developmental ...

    • Abstract:    Background: Developmental dysplasia of hip (DDH) is a common childhood disorder, and ultrasonography examination is routinely used for screening purposes. In this study, we aimed to evaluate a modified combined static and dynamic  ultrasound technique for the detection of DDH and to compare with the results of static and dynamic ultrasound techniques.    Methods:In this cross-sectional study, during 2013- 2015, 300 high-risk infants were evaluated by ultrasound for DDH. Both hips were examined with three techniques: static, dynamic and single view static and dynamic technique. Statistical analysis was performed using SPSS version 11.5. Results:Patients aged 9 days to 83 weeks. 75% of the patients were 1 to 3 months old. Among 600 hip joints, about 5% were immature in static sonography and almost all of them were unstable in dynamic techniques. 0.3% of morphologically normal hips were unstable in dynamic sonography and 9% of unstable hips had normal morphology. The mean β angle differences in coronal view before and after stress maneuver was 14.43±5.47° in unstable hips. Single view static and dynamic technique revealed that all cases with acetabular dysplasia, instability and dislocation, except two dislocations, were detected by dynamic transverse view. For two cases, Ortolani maneuver showed femoral head reversibility in dislocated hips. Using single view static and dynamic technique was indicative and applicable for detection of more than 99% of cases. Conclusion:Single view static and dynamic technique not only is a fast and easy technique, but also it is of high diagnostic value in assessment of DDH.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Surgical Treatment of Tennis Elbow; Minimal Incision Technique

    • Abstract:  Background: When non-operative treatment of tennis elbow fails; a surgical procedure can be performed to improve the associated symptoms. Different surgical techniques for treatment of lateral epicondylitis are prescribed. The purpose of this study was to evaluate the clinical outcomes of surgical treatment for tennis elbow based on small incision techniques.  Methods:This technique was performed on 24 consecutive patients between June 2011 and July 2013. Outcomes were assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE), Nirschl’s staging system and visual analog scale (VAS) for pain and satisfaction criteria. Results:There were 15 female and 9 male patients in the study. The mean duration of symptoms before surgery was 3.7 years. The average duration of follow-up was 34.8 months. The post-operative outcome was good to excellent in most patients. The mean VAS score improved from 7.2 to 3.5 points. The total PRTEE improved from 68.7 to 15.8 points. Conclusion:This procedure provides a low complication rate which is associated with a high rate of patient satisfaction. Therefore, we suggest this option after failed conservative management of tennis elbow.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Predictors of Upper-Extremity Physical Function in Older Adults

    • Abstract:  Background: Little is known about the influence of habitual participation in physical exercise and diet on upper-extremity physical function in older adults. To assess the relationship of general physical exercise and diet to upper-extremity physical function and pain intensity in older adults.  Methods:A cohort of 111 patients 50 or older completed a sociodemographic survey, the Rapid Assessment of Physical Activity (RAPA), an 11-point ordinal pain intensity scale, a Mediterranean diet questionnaire, and three Patient- Reported Outcomes Measurement Information System (PROMIS) based questionnaires: Pain Interference to measure inability to engage in activities due to pain, Upper-Extremity Physical Function, and Depression. Multivariable linear regression modeling was used to characterize the association of physical activity, diet, depression, and pain interference to pain intensity and upper-extremity function. Results:Higher general physical activity was associated with higher PROMIS Upper-Extremity Physical Function and lower pain intensity in bivariate analyses. Adherence to the Mediterranean diet did not correlate with PROMIS Upper-Extremity Physical Function or pain intensity in bivariate analysis. In multivariable analyses factors associated with higher PROMIS Upper-Extremity Physical Function were male sex, non-traumatic diagnosis and PROMIS Pain Interference, with the latter accounting for most of the observed variability (37%). Factors associated with greater pain intensity in multivariable analyses included fewer years of education and higher PROMIS Pain Interference. Conclusions:General physical activity and diet do not seem to be as strongly or directly associated with upper-extremity physical function as pain interference.
      PubDate: Fri, 30 Sep 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: Fri, 30 Sep 2016 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: Fri, 30 Sep 2016 20:30:00 +010
  • Inter-observer agreement between 2-dimensional CT versus 3-dimensional
           I-Space model in the ...

    • Abstract:  Background: The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space) in diagnosing acute occult scaphoid fractures.  Methods:A convenient cohort of 24 patients with a CT-scan from prior studies, without a scaphoid fracture on radiograph, yet high clinical suspicion of a fracture, were included in this study. CT-scans were evaluated in the I-Space by 7 observers of which 3 observers assessed the scans in the I-Space twice. The observers in this study assessed in the I-Space whether the patient had a scaphoid fracture. The kappa value was calculated for inter- and intra-observer agreement. Results:The Kappa value varied from 0.11 to 0.33 for the first assessment. For the three observers who assessed the CT-scans twice; observer 1 improved from a kappa of 0.33 to 0.50 (95% CI 0.26-0.74, P=0.01), observer 2 from 0.17 to 0.78 (95% CI 0.36-1.0, P<0.001), and observer 3 from 0.11 to 0.24 (95% CI 0.0-0.77, P=0.24). Conclusion:Following our findings the I-Space has a fast learning curve and has a potential place in the diagnostic modalities for suspected scaphoid fractures.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Does Computed Tomography Change our Observation and Management of Fracture

    • Abstract:  Background: The purpose of this study was to determine whether Multi-Detector Computed Tomography (MDCT) in addition to plain radiographs influences radiologists’ and orthopedic surgeons’ diagnosis and treatment plans for delayed unions and non-unions.  Methods:A retrospective database of 32 non-unions was reviewed by 20 observers. On a scale of 1 to 5, observers rated on X-Ray and a subsequent Multi Detector Helical Computer Tomography (MDCT) scan was performed to determine the following categories: "healed", "bridging callus present", "persistent fracture line" or "surgery advised". Interobserver reliability in each category was calculated using the Interclass Correlation Coefficient (ICC). The influence of the MDCT scan on the raters’ observations was determined in each case by subtracting the two scores of both time points. Results:All four categories show fair interobserver reliability when using plain radiographs. MDCT showed no improvement, the reliability was poor for the categories "bridging callus present" and "persistent fracture line", and fair for "healed" and "surgery advised". In none of the cases, MDCT led to a change of management from nonoperative to operative treatment or vice versa. For 18 out of 32 cases, the treatment plans did not alter. In seven cases MDCT led to operative treatment while on X-ray the treatment plan was undecided. Conclusion:In this study, the interobserver reliability of MDCT scan is not greater than conventional radiographs for determining non-union. However, a MDCT scan did lead to a more invasive approach in equivocal cases. Therefore a MDCT is only recommended for making treatment strategies in those cases.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Long-term Results, Functional Outcomes and Complications after Open
           Reduction and Internal ...

    • Abstract:  Background: Humerus fractures include 5% to 8% of total fractures. Non-union and delayed union of GT (GT) fractures is uncommon; however they present a challenge to the orthopedic surgeons. Significant controversy surrounds optimal treatment of neglected fractures. The purpose of this article was to perform a comparative study to evaluate the outcomes of open reduction and internal fixation (ORIF) of neglected GT fractures.  Methods:We retrospectively evaluated the results of surgical intervention in 12 patients with displaced nonunion of GT fractures who were referred to our center. Before and minimally 25 months after surgery ROM, muscle forces, Constant Shoulder Score (Constant-Murley score) (CSS), Visual Analogue Scale (VAS), Activities of Daily Living (ADL) Score and American Shoulder and Elbow Surgeons (ASES) Score were all recorded. Additionally, the results were compared with undamaged shoulder. Results:Between March 2006 and January 2013, 12 patients underwent surgical intervention and followed for 36.2 months in average. All fractures healed. Anatomic reduction achieved only in 6 cases with no report of avascular necrosis or infection. All ROMs and muscle forces increased significantly (Mean Forward Flexion: 49.16 to 153.3, Mean Internal Rotation: 3 to 9, Mean External Rotation: -5 to 27.5) (P value<0.0001). All functional scores including CSS, VAS, ADL and ASES score improved significantly (Mean VAS: 6.5 to 1.3, Mean CSS: 29.83 to 86, Mean ADL: 6.6 to 27.1, Mean ASES: 28.6 to 88.9) (P value<0.0001). Conclusion:ORIF for neglected and displaced GT fractures has satisfactory functional outcomes, despite of non-anatomical reduction of the fracture.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Potential Role of Local Estrogen in Enhancement of Fracture Healing:
           Preclinical Study in Rabbits

    • Abstract:       Background: Effects of estrogen on bone metabolism and its protective role on prevention of osteoporosis are well   documented. However, the efficacy of estrogen treatment on bone healing is not well investigated. The drug can be delivered both systemically or locally to the bone with differences in concentrations and side effects. The aim of this study was to investigate the effect of local and systemic administration of estrogen on the fracture healing process.       Methods: Standardized tibial fractures with 4 millimeter gaps were created in twenty four adult male Dutch rabbits. Fractures were fixed using intramedullary wires and long leg casts. Rabbits were randomly divided into three groups. Group A was treated with twice a week administration of long acting systemic estrogen; group B was treated with a similar regimen given locally at the fracture gap; and group C received sham normal saline injections (control). Fracture healing was assessed at six weeks post fracture by gross examination, radiographic and histomorphometric analysis. Results: Group B had significantly higher gross stability, radiographic union and gap reduction than the two other groups. Histomorphometric analysis showed higher cartilaginous proportion of periosteal callus area in the control group. Conclusions: Our results showed that estrogen may enhance fracture healing of long bone in rabbits. Furthermore, local estrogen treatment might have better effect than systemic treatment.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Proximity of Vital Structures to the Clavicle: Comparison of Fractured and
           Non-fractured Side

    • Abstract:   Background: Previous anatomic and radiological studies have described the relationship of the clavicle to major neurovascular structures in healthy subjects. We were curious about this relationship in patients with a clavicle fracture and if it is different from non-fractured clavicles.   Methods: We retrospectively identified all patients with a clavicle fracture between July 2001 and October 2013 in two level 1 trauma centers. Patients aged 18 years or greater with an acute unilateral clavicle fracture and a chest CT scan in the supine position displaying both clavicles and the complete fracture were included. Seventy patients were available for study. The distance was measured from the fracture site and from the closest clavicular cortex to the closest major artery, major vein, and inner surface of the thoracic cavity. CT data was evaluated in OsiriX DICOM viewer software with the use of three-dimensional Multiplanar Reconstruction. Results: Compared to the fractured side, the clavicle was significantly closer to the artery and vein on the non-fractured side (PP=0.0025 respectively). There was a significant difference in the median distance of the fracture site to the artery, vein, and inner surface of thoracic cavity between the different types of fractures (P<0.001). A post-hoc comparison showed significant differences in all distances between fracture types, except for the distance of proximal third compared to middle third fractures to the closest artery (P=0.41). There was no significant difference in distance when the arm is up overhead compared to down by the side of the body in computed tomography (CT) scans. Conclusions: A fracture of the clavicle changes the relationship of the clavicle to major vital structures. The minimum distance of the clavicle to the closest artery and vein is significantly less on the non-fractured side, compared to the fractured side.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Predicting the Hamstring Tendon Diameter Using Anthropometric Parameters

    • Abstract:  Background: Despite the importance of hamstring tendon autograft, one major disadvantage in applying this technique in the surgical reconstruction of anterior cruciate ligament is individual variability in the tendon diameter. Hence, the purpose of the present study was to use anthropometric parameters such as gender, height and body mass index to predict 4-strand (quadruple) hamstring tendons (gracilis and 2-strand semitendinosus tendons).  Methods:This is a cross-sectional study conducted on all consecutive patients who underwent arthroscopic ACL reconstruction between 2013 and 2015. The anthropometric variables (age, gender, height, and body mass index) were recorded. The quadruple hamstring tendon (gracilis and semitendinosus) autografts were measured using sizing cylinders. The relationship between these parameters was statistically determined using the Pearson Spearman test and linear regression test. Results:The mean age of the 178 patients eligible for the study was 29.58±9.93 (118 males and 60 females). The mean hamstring tendon diameter was 7.8±0.7 mm, the mean for males was 7.9±0.6 and for females 7.89± mm (P=0.0001). There were significant correlations between the mean hamstring tendon diameter with BMI (Pearson correlation=0.375, R2=0.380, and P=0.0001), height (Pearson correlation=0.441, R2=0.121, and P=0.0001), and weight (Pearson correlation=0.528, R2= -0.104 and P=0.0001). However,patient’s age and genderwerenot found to be a predictor of the size of the hamstring tendon diameter. Conclusion:Based on findings from this study weight, height, body mass index,and the length of the tendon may be predictors of the hamstring tendon diameter for anterior cruciate ligamentreconstruction. These findings could be used in preoperative planning of patients undergoing ACL reconstruction surgery to estimate the size of the graft and select of the appropriate type of graft.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Restoring Nature Through Individualized Anatomic Anterior Cruciate
           Ligament Reconstruction Surgery

    • Abstract: Anterior cruciate ligament (ACL) reconstruction surgery has significantly evolved in recent years. This has led to development of new technologies that facilitate the diagnosis of ACL injury and the application of state of the art methods for treatment. In particular, individualized anatomical ACL reconstruction aims to restore native ACL function. Treatment is tailored to each patient based on each individual’s characteristics. Individualized treatment approach continues after reconstruction surgery and during rehabilitation period and return to sporting activities.
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Anatomical Individualized ACL Reconstruction

    • Abstract:  The anterior cruciate ligament (ACL) is composed of two bundles, which work together to provide both antero-posterior and rotatory stability of the knee. Understanding the anatomy and function of the ACL plays a key role in management of patients with ACL injury. Anatomic ACL reconstruction aims to restore the function of the native ACL. Femoral and tibial tunnels should be placed in their anatomical location accounting for both the native ACL insertion site and bony landmarks. One main component of anatomical individualized ACL reconstruction is customizing the treatment according to each patient’s individual characteristics, considering preoperative and intraoperative evaluation of the native ACL and knee bony anatomy. Anatomical individualized reconstruction surgery should also aim to restore the size of the native ACL insertion as well. Using this concept, while single bundle ACL reconstruction can restore the function of the ACL in some patients, double bundle reconstruction is indicated in others to achieve optimal outcome.  
      PubDate: Fri, 30 Sep 2016 20:30:00 +010
  • Recurrent dislocation of proximal interphalangeal joint of the finger: A
           rare issue in hand surgery

    • Abstract: Recurrent dislocation is not common in small joints. This report presents a new case of chronic recurrent dislocation of proximal interphalangeal joint of the finger in which soft tissue injuries have a role in the dislocation. The patient was a 23 years old man who had referred to our center because of recurrent dislocation of proximal interphalangeal joint of his right ring finger during sports activities. This case was unique since no flexor digitorum superficialis or flexor digitorum profundus tendons were used for reconstruction of volar plate avulsion in the treatment.
      PubDate: Fri, 08 Jul 2016 19:30:00 +010
  • Relation between cervical injuries and helmet use, collision type and
           speed in motorcycle ...

    • Abstract: Objective: Spinal injuries are among the most important injuries in motorcyclists accounting for 1 to 5% of all injuries in this group with the frequency rising as high as 11% in severe and fatal cases .The most commonly involved areas are thoracic and cervical spines. Injuries to these areas can lead to significant morbidities with life-long complications. In this study, we aim to evaluate the relation of some risk factors including speed of motorcycle at the crash, the type and the mechanism of collision and using helmet with the rate and severity of cervical injury in motorcyclists. Patients and Methods: We retrospectively analyzed the medical files of patients with the cervical spinal injury due to motorcycle crash, diagnosed according to ICD10, who were admitted to Shahid Kamyab Trauma Center in Mashhad, Iran from January 2011 to January 2012. Medical files involved in motorcycle crashes were selected and patients who met the inclusion criteria were enrolled to the study. Characteristics of each motorcycle collision for each patient were determined by a traffic specialist from Traffic Police Department. Finally, the medical records were evaluated by a neurosurgery resident to identify the type of the neck injury and determine the Injury Scale Score to assess the severity of the injury. Data was analyzed using SPSS software version 18. Results: A total of 176 patients (mean age: 31.4, 97% male) met the inclusion criteria. Most of the accidents had occurred in rural and suburb roads outside the cities. Of the studied patients, 25 (14.2%) were found to have cervical spine fractures, 27 (15.3%) had neck strain or sprain and 153 (58.5%) had simply neck pain with no sever injuries. Neck fracture was significantly more common among the motorcyclists who had helmet when compared with nonhelmeted ....
      PubDate: Fri, 15 Apr 2016 19:30:00 +010
  • 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
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