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Journal Cover Archives of Bone and Joint Surgery
  [7 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2345-4644 - ISSN (Online) 2345-461X
   Published by Mashhad University of Medical Sciences Homepage  [14 journals]
  • Orthopedic History in Iran: Ancient, Contemporary and Modern Times

    • Abstract: Ancient IranSigns of pierced skulls and healed broken bones have been found in the archaeological site of “Shahr-e Sūkhté” (the Burnt City), a large Bronze Age urban habitation located in Sistan and Baluchistan Province at the southeastern part of Iran, going back to over 4000 years ago. The treatment of patients in ancient Iran was mostly carried out by the spiritualist clergymen1.Abu Bakr Mohammad Zakaria Razi, Razes, (854– 925) has described joint sprains, fractures, and bone anomalies in his “The Kitab al-Hawi Fi Tebb”. He was the first to use plaster casts for fracture immobilization. Later, Avicenna (980-1037) used tractions and splints for fracture management. He also used plaster casts, mummies and bitumen to support and protect fractures1.Rashid al-Din Fazlullah Hamedani (1247–1318), the powerful vizier of Ghazan, established and endowed "Rab-e-Rashidi", the clinical teaching complex in Tabriz, where orthopedic training as well as the management of fractures was also carried out. However, the establishment was looted and destroyed after the execution of Rashid al-Din Fazlullah. Thereafter, medicine was long declined in Iran, and there was no other place in the name of hospital where patients could be treated2.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Osteoporosis and the Management of Spinal Degenerative Disease

    • 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: Thu, 31 Aug 2017 19:30:00 +010
       
  • Restoration of the Mechanical Axis in Total Knee Artrhoplasty Using
           Patient-Matched Technology ...

    • Abstract: Background: The aim of this study is to evaluate the accuracy of bone cuts and the resultant alignment, using theMyKnee patient specific cutting blocks.Methods: We retrospectively reviewed 132 patients undergoing primary TKR for osteoarthritis by one single surgeon.The operative time, the preoperative Hip-Knee-Ankle (HKA) axis based on the CT-scan, the postoperative HKA axisbased on long axis standing x-rays, the planned and the actual size of the femoral and the tibial components, and thenumber of the recuts which has been made intraoperative were measured.Results: The average preoperative HKA axis was 177.50 (range 163.50 to 1940), whereas the average postoperativeHKA axis was 179.40 (range 177.10 to 182.70). No outliers were reported in the study (0%). Intraoperatively, 4 femoralcomponents (3.03%), and 7 tibial components (5.30%) applied to the patients were different than the planned size.There was no need of recuts in any of our cases intraoperatively.Conclusion: The MyKnee system evaluated in this study was shown to be remarkable reliable in the coronal planealignment, and the prediction of the component size. However, further studies are needed to determine whether thereare any clinically important improvements in outcomes or patient satisfaction when using patient-specific cutting blocksfor TKA.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • What Are The Results of Minimally Invasive Plate Osteosynthesis for
           Femoral and Tibial ...

    • Abstract: Purpose: Comminuted fractures happen frequently due to traumas and accidents. Recently fixa-tion without opening the fracture site known as Minimally Invasive Plate Osteosynthesis (MIPO) has become prevalent. As this method has not been discussed as often in orthopedic textbooks and its accurate results on comminuted fractures has not been clear, we performed this study to assess the results and complications of this treatment for tibial and femoral comminuted frac-tures.Methods: In this cross-sectional study 60 patients with femoral and tibial comminuted fractures were treated with MIPO method. 11 patients excluded due to lack of adequate follow-ups. Data including union time, infection in the fractured site, hip and knee range of motion and any malu-nion or deformities like limb length discrepancy collected after the surgery form every patient in every session.Results: 32 femoral fractures and 17 tibial fractures were evaluated. In 48 patients, union was completed but in one patient with femoral fractures, there was nonunion. Mean union time was 18.57±2.42 weeks. Femur fractures healed faster than tibia (17.76±2.36 and 19±2.37 weeks, re-spectively). None of our patients suffered from infections or fistula. The range of motion in hip and knee remained intact in approximately all of our patients. Malunion happened in ‘three’ pa-tients, 10-degree internal rotation in ‘one’ patient and ‘one’ centimeter limb shortening in ‘two’ patients. Conclusion: according to the result of this study and comparing it with other studies, it can be drawn that MIPO is a simple and effective method of fixation for comminuted fractures of long bones. It has a high rate of union with minimal complications. Infection is rare, and malunion or any deformity is incredibly infrequent. MIPO appears to be a promising and safe treatment alter-native for comminuted fractures with advantages and also disadvantages.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Long-term Results of Osteoarticular Allograft Reconstruction in Children
           with Distal Femoral ...

    • Abstract: Background: There is no consensus regarding the best method of reconstruction in pediatric population following thewide resection of malignant bone tumors. More exploration of the complications of osteoarticular reconstruction leads toless existing controversy of this type of reconstruction, which is the main point of this article.Methods: Long-term outcomes and complications of osteoarticular allograft reconstruction of primary distal femoral bonesarcomas in 22 children with mean age of 10.7 years old were reviewed in this study. Musculoskeletal Tumor Society(MSTS) scoring system was used for functional evaluation of the allografts.Results: With an average follow-up time of 81 months, the outcomes of 16 patients with allografts at the final follow upwere evaluated. As expected, Limb length discrepancy (LLD) was observed in all patients (mean LLD= 2.73cm), whichwas significantly correlated to allograft survival time (P<0.001). Degenerative joint disease (DJD) was also seen in allpatients and its grade was also significantly correlated to allograft survival time (P<0.001). The mean MSTS-score was74% at the latest follow-up, ranging from 60% to 90%. Five and 10 year survival rate of allografts were found to be 93.3%and 62.2%, respectively.Conclusion: Osteoarticular allograft reconstruction could result in several complications including DJD. Despite itsconsiderable biologic advantage over endoprosthesis, osteoarticular allograft reconstruction is a long-lasting but still atemporary solution before performing megaprosthesis. This allows patients to preserve their remaining physis for limbgrowth and become old enough for an adult megaprosthesis.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Acute Primary Total Knee Arthroplasty for Proximal Tibial Fractures in
           Elderly

    • Abstract: Background: Proximal tibial fractures in elderly patients with osteoporosis or knee osteoarthritis (OA) are challengingcases. In the current study, we present our experience with uncommon acute primary total knee arthroplasty (PTKA)in this patient population.Methods: PTKAs were performed following proximal tibial fractures in 30 consecutive patients over 60 years of agewith osteoporosis or knee OA between 2005 and 2009. Three constrained condylar knees (CCK) and no hinged kneeprosthesis were used. Patients were followed up for 4.5±1.1 years.Results: Patients were discharged after 4.6±1.2 days. The postoperative Tegner activity scale (3.5±1.3) was improvedsignificantly compared to the preoperative scale (2.5±1.2) (P<0.001). The knee flexion range was significantly greaterin the operated side (106±13 degrees) compared to the uninjured knee (120±8 degrees) (P<0.001). The two sectionsof knee society knee score (knee and function section) averaged 90.7±6.5 and 69.6±8.8, respectively. All patientsreturned to their previous activities. Based on the visual analogue scale, the patients’ satisfaction and pain at final visitwere scored 8.1±1 and 1.5±1.2, respectively. No infection, thromboembolic events and loosening were observed.Conclusion: PTKA following a proximal tibial fracture in elderly patients with osteoporosis or knee degeneration can beconsidered as a safe alternative for open reduction and internal fixation. PTKA resulted in immediate weight-bearing,improved functional status and patients’ satisfaction. However, functional outcomes were dependent on the generalcondition of 24 the patient. Also, constrained knee prostheses were not necessary for a vast majority of the patients.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Interobserver Variability of Radiographic Assessment using a Mobile
           Messaging Application as a ...

    • Abstract: Background: To examine whether interobserver reliability, decision-making, and confidence in decision-making in thetreatment of distal radius fractures changes if radiographs are viewed on a messenger application on a mobile phonecompared to a standard DICOM viewer.Methods: Radiographs of distal radius fractures were presented to surgeons on either a smart phone using a mobilemessenger application or a laptop using a DICOM viewer application. Twenty observers participated: 10 (50%) wererandomly assigned to the DICOM viewer group and 10 (50%) to the mobile messenger group. Each observer was askedto evaluate the cases and (1) classify the fracture type according to the AO classification, (2) recommend operative orconservative treatment and (3) rate their confidence about this decision.Results: There was no significant difference in interobserver reliability for AO classification and recommendation forsurgery for distal radius fractures in both groups. The percentage of recommendation for surgery was significantlyhigher in the messenger application group compared to the DICOM viewer group (89% versus 78%, P=0.019) and theconfidence for treatment decision was significantly higher in the mobile messenger group compared to the DICOM viewergroup (8.9 versus 7.9, P=0.026).Conclusion: Messenger applications on mobile phones could facilitate remote decision-making for patients with distalradius fractures, but should be used with caution.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Blood Glucose Levels in Diabetic Patients Following Corticosteroid
           Injections into the ...

    • Abstract: Background: Corticosteroid injections are used to treat a variety of orthopedic conditions with the goal of decreasingpain and inflammation. Administration of systemic or local corticosteroids risks temporarily increasing blood glucoselevels, especially diabetic patients. The purpose of this study is to quantify the effects of corticosteroid injections onblood glucose levels in diabetic patients with shoulder pathology.Methods: Diabetic patients who regularly monitored their blood glucose levels and were indicated for a subacromialcorticosteroid injection were included in this prospective investigation. The typical normal morning fasting glucoseand most recent hemoglobin A1c level was recorded for each patient. After injection, patients were contacted daily toconfirm their fasting morning glucose level for 10 days post-injection.Results: Seventeen consecutive patients were enrolled. Patients with hemoglobin A1c of <7% had an average risein blood glucose of 38 mg/dL compared to 98 mg/dL in the poorly controlled group after injection (P<0.001). Wellcontrolledpatients’ glucose levels returned to near baseline levels around post-injection day 8, while poorly controlledpatients levels remained elevated. Similarly, insulin-dependent diabetic patients had an average increase in fastingglucose level of 99 mg/dL versus 50 mg/dL in non-insulin-dependent diabetic patients (P<0.001).Conclusion: After corticosteroid injection, patients with well-controlled diabetes experience smaller elevations andfaster return to baseline glucose levels than patients with poor control. Insulin dependent diabetics experienced similarfindings as patients with poor control. Future studies are needed to evaluate dosing to optimize the risks of bloodglucose elevation while maintaining therapeutic benefit.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Single Cut Distal Femoral Varus Osteotomy (SCFO): A Preliminary Study

    • Abstract: Background: Genu valgum usually originates from a deformity of distal femur that is often corrected by distal femoralvarus osteotomy. The osteotomy includes both components of angulationcorrection and translation because the siteof osteotomy is not commonly at the apex of deformity. Improvement of patellar tracking not only depends on valguscorrection, but also it may be partially due to centralization of the trochlear groove under the femoral anatomical axis(FAA).We asked whether we could accurately correct the deformities based on our preoperative goals for the correction ofthe mechanical axis and centralization of the trochlear groove under the FAA by using a single bone cut.This study describes a new lateral single cut distal femoral osteotomy (SCFO) that enables concurrent correction ofangulation and translation.Methods: This study was done on 12 young adult patients with femoral juxta-articular genu valgum deformityusing SCFO. The average age at operation was 21 years (range: 16-25). SCFO is a type of closing-openingdistal femoral osteotomy that corrects the valgus deformity of the distal femur while the translation of the distalfragment is done using one oblique cut. It centralizes the trochlear groove under the FAA. We compared the preand postoperative radiographic and clinical variables including mechanical tibiofemoral angle, knee range of motion(ROM), International knee documentation committee (IKDC) score and the time to union. Mean follow-up of thepatients was 24 months.Results: The average mechanical tibiofemoral angle improved from 16 degrees (10-23) to 1 degrees (-2 to +2). IKDCsubjective score slightly improved from preoperative (65) to 2-year follow-up (71). Centralization of the trochlea wasachieved in all patients.Conclusion: SCFO can be a reasonable alternative for correction of the distal femur genu valgum deformity. It cancentralize the patellar groove under the FAA with satisfactory clinical outcomes.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Clinical Results of Platelet-Rich Plasma for Partial Thickness Rotator
           Cuff Tears: A Case Series

    • Abstract: Partial thickness rotator cuff tears (PTRCTs) are a common pathology among shoulder disorders in people over 50 years.Treatment of PTRCTs remains controversial. Most studies on the treatment of PTRCTs have explained surgical techniquesor outcomes; few studies have centralized on the conservative and new management of PTRCTs, like treatmentwith Platelet-rich plasma (PRP). These case series study have been conducted on Platelet-rich plasma (PRP) injection,as a concentrated source of autologous platelets in blood plasma, contains several different growth factors and othercytokines that can stimulate healing of soft tissue.PRP injection showed positive effect on improving PTRCTs complains. This method improved pain, function, DASH scoreand shoulder joint range motion in. Because of PRP products are safe and easy to prepare and apply, and also accordingto improving patient’s condition, this method can be used to treat PTRCTs.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Unusual Complete Isolated Scaphoid Dislocation, Report of a Case

    • Abstract: Isolated scaphoid dislocations are extremely rare injuries and are commonly associated with significant ligamentousdisruptions. A dorsiflexion-supination force upon the hand is considered as the most common mechanism of injury.Different treatment options have been proposed for the management of this uncommon entity, ranging from conservativetreatment with closed reduction and casting to a wide range of open or percutaneous surgical techniques. In thisarticle, we reported ona case of this rare injury managed with open reduction and pinning along with ligamentousreconstruction.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Open Anterior Hip Dislocation in A Child: A Rare Mechanism of Injury

    • Abstract: Traumatic anterior dislocation of the hip is an extremely rare condition in children and open dislocation is even rarer. Thisisusually caused by high-energy trauma. In the current study, we present a case of an eight-year-old child suffering froman open anterior–inferior dislocation of the right hip concomitant with pelvic ring disruption and an ipsilateral open distalfemoral fracture (Salter-Harris type 4, Gustilo type IIIA) caused by a traffic accident. The patient underwent successfulemergent open reduction due to the buttonholed femoral head after appropriate irrigation and debridement. Successfulrecovery was achieved and the patient was discharged after two weeks. After nine months of follow-up, the X-ray imagesshowed slight changes related to the osteonecrosis of the femoral head. Long-term follow-up over a period of six yearsshowed sufficient range of motion. The patient’s gait was normal and he was satisfied with the outcome. In addition, slightnon-progressive osteonecrotic changes were obvious in the right hip.
      PubDate: Thu, 31 Aug 2017 19:30:00 +010
       
  • Brucella Arthritis Following Total Knee Arthroplasty in a Patient with
           Hemophilia: A Case Report

    • Abstract: Total knee arthroplasty (TKA) is a rewarding procedure in patients with hemophilia and end stage knee hemophilicarthropathy. However, this procedure might be associated with complications such as infection. There periprostheticjoint infection in patients with hemophilia is very well known, though we are not aware of any previous report on Brucellainfection in this group of patients. Here, we reported a 28-year old man with Brucella infection of total knee replacementwho initially underwent a conservative treatment followed bya two-stage revision. We believe that this report will alertphysicians who work in endemic area for brucellosis to consider this in differential diagnosis and do the right interventionat the right time.
      PubDate: Thu, 31 Aug 2017 19:30:00 +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
       
  • Evaluation of normal ranges of wrist radiologic indexes in Mashhad
           population

    • 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: Fri, 04 Aug 2017 19:30:00 +010
       
  • Effects of human adipose-derived stem cells and platelet-rich plasma on
           healing response of ...

    • Abstract: Object: Due to the known disadvantages of autologous bone grafting, tissue engineering approaches have become an attractive method for ridge augmentation in dentistry. To the best of our knowledge, this is the first study conducted to evaluate the potential therapeutic capacity of PRP-assisted hADSCs seeded on HA/TCP granules on regenerative healing response of canine alveolar surgical bone defects. This could offer a great advantage to alternative approaches 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 filled randomly as following: I- autologous crushed mandibular bone, II- no filling material, III- HA/TCP granules in combination with PRP, and IV- PRP-enriched hADSCs seeded on HA/TCP granules. After the completion of an 8-week period of healing, radiographic, histological and histomorphometrical analysis of osteocyte number, newly-formed vessels and marrow spaces were used for evaluation and comparison of the mentioned groups. Furthermore, the buccal side of mandibular 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 significantly promoted 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 tissue regeneration in canine alveolar bone defects and thus, present a helpful alternative in bone tissue regeneration.
      PubDate: Fri, 04 Aug 2017 19:30:00 +010
       
  • Epineural sleeve reconstruction technique for median nerve complete
           transection

    • Abstract: In microsurgical nerve repair, the epineural sleeve technique can be used to bridge short nerve defects and to 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
           Fracture

    • 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
       
  • 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 orthopedic surgical practices as adjuncts to medical procedures or alternatives to pain medications. However, typical mindfulness programs are lengthy and impractical in busy surgical practices. We tested the feasibility, acceptability and preliminary effect of a brief, 60-second mindfulness video in reducing pain and negative emotions in patients presenting to an orthopedics surgical practice. Methods: This was an open pilot study. Twenty participants completed the Numerical Rating Scale to assess pain intensity, the State Anxiety subscale of the State Trait Anxiety Scale to assess state anxiety, and emotional thermometers to 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 also high. Participants showed improvements in state anxiety, pain intensity, distress, anxiety, depression and anger after watching the video. These changes were both statistically significant and clinically meaningful, when such information was available. Conclusion: People with musculoskeletal pain seeking orthopedic care seem receptive and interested in brief mindfulness exercises that enhance comfort and calm.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • Epidemiology of joint dislocations and ligamentous/tendinous injuries
           among 2,700 patients: ...

    • Abstract: Purpose: 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/tendinous injuries in a tertiary orthopedic hospital in Iran. Methods: In a 5-year prospective study, musculoskeletal injuries of an academic tertiary health care center in Tehran were recorded. Demographic details of patients with diagnosis of pure dislocations and ligamentous/tendinous injuries were extracted. Type and site of injuries were classified according to specific age/gender groups. Result: Of 18,890 admitted patients, 628 (3.3%) were diagnosed with dislocations and 2,081 (11%) were diagnosed with ligamentous/tendinous injuries. The total Male/Female ratio was 4.2:1 in patients with dislocations and 1.7:1 in patients with ligamentous/tendinous injuries. The most prevalent site of dislocation was shoulder (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 age of the patients was 35.0 (SD = 18.2) in dislocations and 31.3 (SD = 15.1) in ligamentous/tendinous injuries. There was no seasonal variation. Conclusion: Shoulder dislocation and ankle ligamentous injury are the most frequent injuries. Dislocations and ligamentous/tendinous injuries are more common in younger population. Dislocations and ligamentous/tendinous injuries have different distribution patterns in specific age and sex groups. Epidemiologic studies can help to develop and evaluate injury prevention strategies, resource allocation, and training priorities.
      PubDate: Sun, 28 May 2017 19:30:00 +010
       
  • Comparison of Clinical Outcomes Between Different Femoral Tunnel Positions
           after Anterior ...

    • Abstract: Purpose: This study investigated whether a change in the femoral tunnel position in both axial and coronal planes can significantly alter the postoperative functional and clinical outcomes of the patients. Method: This comparative, retrospective, single-center study was performed on 44 patients who had underwent single-bundle Anterior Cruciate Ligament Reconstruction (ACLR). To evaluate the tunnel position in coronal and axial planes, radiographic assessments were done. Based on radiographic data, the patients were classified into 4 groups. The time interval between surgery and last visit averaged 23.6 ± 2.2 months (18-30 mos.). Lysholm knee score, and Cincinnati score were 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. None of the patients were included in high-anterior group. A greater mean Lysholm score (96±3) in low-posterior group was the only significant difference between the three groups. Conclusion: Findings of the current study demonstrated that low-posterior placement of the femoral tunnel in the intrercondylar notch, based on both anteroposterior (AP) and tunnel-view x-rays, is associated with better clinical outcomes in short-term than the routine tunnel placements.
      PubDate: Wed, 24 May 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
       
  • 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. Osteoporosis predisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concern before performing spine surgery, especially with bone fusions and instrumentation. Osteoporosis has often been considered a contraindication for spinal surgery, while in some instances patients have undergone limited and inadequate procedures in order to avoid concomitant instrumentation. As the population ages and the expectations of older patients increase, the demand for surgical treatment in older patients with osteoporosis and spinal degenerative diseases becomes progressively more important. Nowadays, advances in surgical and anesthetic technology make it possible to operate successfully on elderly patients who no longer accept disabling physical conditions. This article discusses the biomechanics 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 with osteoporosis who need spine operations.
      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
       
  • DDH Epidemiology Revisited , Do We Need New Strategies'

    • Abstract: DDH Epidemiology Revisited , Do We Need New Strategies' Abstract 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: Mon, 24 Apr 2017 19:30:00 +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: Sat, 15 Apr 2017 19:30:00 +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: Sat, 15 Apr 2017 19:30:00 +010
       
  • Giant cell tumor of the sacrum: Series of 19 patients and review of the
           literature.

    • Abstract: 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: Sat, 15 Apr 2017 19:30:00 +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: Sat, 08 Apr 2017 19:30:00 +010
       
  • FUNCTIONAL RESULTS OF UNSTABLE( TYPE 2) DISTAL CLAVICLE FRACTURES TREATED
           WITH SUPERIOR ...

    • Abstract: ABSTRACTBACKGROUND :Treatment of Distal clavicle fractures are always a challenge,as they are mostly unstable and have high rate of delayed union, malunion ,non-union and associated acromioclavicular arthritis. Management of these fractures remains controversial. The purpose of study is to evaluate the functional results of Type 2 distal end clavicle fractures treated with superior anterior locking plate.MATERIALS AND METHODS: From june 2011 to august 2015 a retrospective study of 12 male patients ( mean age of 41.3),11 with unilateral and 1 with bilateral distal clavicle fractures treated with superior anterior locking plate. They were evaluated at regular intervals with mean follow up of 14 months(12-18months).Those with minimum one year follow up were included in our study. All were evaluated for shoulder function by both Oxford shoulder score and QuickDASH scores ,rate of bone union, complications and earliest time to return to workRESULTS: All fractures united with mean time for union was 7.1 weeks(6-8 weeks).All had good shoulder range of motion. the average oxford shoulder and quickDASH score were 46.2 and 6.5. There were no major complications in our study such as non-union ,plate failure, secondary fracture but 1 had superficial wound infection .All returned to work within 3 months of postop period.CONCLUSION: Displaced distal clavicle fractures treated with superior anterior locking plates achieved excellent results in terms of bony union with rarely any complications and demonstrates promising results with this novel technique
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • ELASTIC STABLE INTRAMEDULLARY NAILING OF FEMORAL SHAFT FRACTURE –
           EXPERIENCE IN 48 CHILDREN

    • 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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