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Journal Cover   Archives of Bone and Joint Surgery
  [4 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  [11 journals]
  • Knee fusion or above-the-knee amputation after failed two-stage
           reimplantation total knee ...

    • Abstract: Background: Prosthetic joint infection (PJI) is a serious complication of total knee arthroplasty (TKA). Control of infection after a failed two-stage TKA is not always possible, and the resolution of infection may require an above-knee amputation (AKA) or a knee fusion (KF).Purpose: The purpose of this review is to determine which treatment method (AKA or KF) yields better function and ambulatory status for patients after a failed two-stage reimplantation.Methods: A PubMed search related to the resolution of infection by means of an above-knee amputation (AKA) or a knee fusion was performed until 10 January 2015. The key words were: infected TKA and above-the-knee amputation. Five hundred and sixty-six papers were found, of which ten were reviewed because they were focused on the topic of the article. Results: KF should be strongly considered as the treatment of choice for patients who have persistent infected TKA after a failed two-stage revision arthroplasty. Patients can walk at least inside the house, and activity of daily living independence is achieved by the patients with successful KF, although walking aids, including a shoe lift, are required. An intramedullary nail leads to better functional results than an external fixator. The functional outcome after AKA performed after TKA is poor. A substantial percentage of the patients never fit with a prosthesis, and those who are seldom obtain functional independence. Only 50% of patients are able to walk after AKA. Conclusions: Patients receiving KF for treating recurrent PJI after TKA have better function and ambulatory status compared to patients receiving AKA. KF must be recommended as the treatment of choice for patients who have persistent infected TKA after a failed two-stage reimplantation procedure
      PubDate: Wed, 15 Apr 2015 19:30:00 +010
  • Pedicle Subtraction Osteotomy in a 5-Year-Old Child with Congenital

    • Abstract: Vertebral anomalies may also distort the normal regional or global spinal alignment and necessitate some therapeutic interventions. Hemiepiphysiodesis is a traditional procedure usually described for these young patients but in more severe cases some type of osteotomy seems to be necessary. In this technical note, we describe a 5-year-old boy with failed previous hemiepiphysiodesis surgery, who was successfully treated with one level pedicle subtraction osteotomy. This procedure not only corrects the kyphotic deformity at the time of the procedure (not relying on future spinal growth), but also avoids more hazardous anterior approach. سرکار خانم عرفانی، با سلام ، برای موارد technical noteبر اساس استیل مجله، باید تعداد کلمات در چکیده زیر 150 باشد ولی در تعریف این قسمت اگر کمتر از 150 کلمه باشد امکان عبور از این قسمت وجود ندارد. لطفأ این مساله را در سیستم اصلاح کنید. من مجبور شدن در این قسمت بنویسم تا امکان ادامه ساب میت مقاله من وجود داشته باشد.
      PubDate: Tue, 14 Apr 2015 19:30:00 +010
  • Outcome of Distal Both Bone Leg Fractures Fixed by Intramedulary Nail for
           Fibula & MIPPO in ...

    • Abstract: Background:  Fractures of the distal third of the tibia are mostly associated with a fibular fracture that often requires fixation. The preferred treatment of distal tibial fracture is the minimally invasive percutaneous plate osteosynthesis  (MIPPO) procedure. However, there are no clear cut guidelines on fixation of the fibular fracture and currently most orthopedic surgeons use a plate osteosynthesis for the fibula as well. A common complication associated with dual plating is an increased chance of soft tissue necrosis, infection, and in some cases resulting in an exposed implant. We conducted a prospective study to analyze the results of fractures of the distal in both leg bones managed by the MIPPO procedure for tibial fractures and a rush nail for fibular fractures.  Methods:  The study was conducted in a tertiary care hospital from November 2012 to May 2014, a total of 30 fractures in 30 patients (18 males, 12 females) with a mean age of 42.4 years (26-60 years) were treated in our institution in the aforesaid time period with MIPPO for tibia and rush nail for fibular fractures. All the cases were operated on by a single surgeon in emergency within 24 hours. The patients with skin blistering and compound fractures were excluded from this study. Rehabilitative measures were proceeded as per patient’s pain profile, isometric and isotonic exercises were started on the first post-operative day, with full weight bearing at 10-12 weeks after assessing clinical and radiological union. Regular follow up of patients was done, radiographs were taken at the immediate post-operative period and at 3, 6, 12 and 24 weeks.  Results:  All the patients were available for regular follow up. Radiological and clinical union proceeded normally in all the patients, no patients had signs of any deep infection, delayed union or nonunion, three patients had a superficial infection of the tibial incision that healed with a change in antibiotic.  Conclusions:  The use of dual plating for fixation of the lower tibia and fibula fractures is often associated with soft tissue complications, exposed implant, and increased risk of infection. We conclude that in fractures of the distal tibia and fibula it is better to use a rush nail for the fibula with a concurrent MIPPO for the tibia for the reasons cited above. Moreover, with the use of rush nail the cost of implant is also reduced, which is a very important factor in developing  countries.  
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Arthroscopic Meniscal Repair: “Modified Outside-In Technique”

    • Abstract: Background:  Despite the introduction of different techniques for meniscal repair, no single procedure is superior in all situations. The new method for meniscal repair named “ modified outside-in technique ” aims to achieve higher primary fixation strength by an alternative suture technique as well as avoid disadvantages of outside-in, inside-out, and all-inside suture procedures. Additionally, the mid-term results of surgically treated patients with  eniscal injuries by our new technique were evaluated. Methods:  The current prospective study included 66 patients who underwent meniscal repair by the modified outside-in technique. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form was completed pre- and post-operatively. At final follow-up, Lysholm score was completed and patients were questioned about their return to previous sport activities. Clinical success was defined as lack of swelling and joint line tenderness, absence of locking, negative McMurray test and no need for meniscectomy. Patients’ satisfaction was evaluated using the visual analogue scale (VAS). Patients were followed for 26±1.7 months.  Results:  Clinical success was achieved in 61 patients (92.4%) and 5 candidates required meniscectomy (7.6%). IKDC Subjective Knee Evaluation Form score increased significantly from 54.2±12.7 preoperatively to 90.8±15.6  postoperatively (P<0.001). Lysholm score was excellent and good in 49 (80.3%) patients and fair in 12 (19.7%). Patients’ satisfaction averaged at 8.35±1 (6-10). Neurovascular injury, synovitis and other knot-related complications were not reported. Conclusions:  The modified outside-in technique has satisfactory functional and clinical outcomes. We believe that this procedure is associated with better clinical and biomechanical results; however, complementary studies should be performed to draw a firm conclusion in this regard.    
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Radial Head Prosthesis Removal:a Retrospective Case Series of 14 Patients

    • Abstract: Background:  The purpose of this study was to report the preoperative complaints and postoperative outcome of patients after removal of the radial head prosthesis.   Methods:  This is a retrospective review of 14 adult patients (6 females and 8 males) from 2007 to 2011, who underwent radial head prosthesis removal by three surgeons. The average time between implantation and removal was 23 months (range from 2 weeks to 12 years, median 12 months).  Results:  The leading reported complaints before removal were restricted mobility of the elbow (active range of motion of less than 100 degrees) in 6, pain in 3, and pain together with restricted mobility in 4 patients. The objective  findings before removal were restricted mobility of the elbow in 10 (71%), capitellar cartilage wear, loose implants, and heterotopic ossification each in 8 (57%), subluxation of the radio-capitellar joint or malpositioning of the stem in 5 (36%), and chronic infection in 2 (14%) patients. All patients with pain had wear of the capitellar cartilage on radiographs. The ulnar nerve was decompressed in four patients at the time of removal. Four patients underwent a subsequent operation for postoperative ulnar nerve symptoms 5 to 21 months after removal. Four patients were still complaining about persistent pain at the last follow-up visit. Except two patients, the total range of motion improved with a mean of 34 degrees (range 5 to 70) after a mean follow-up of 11 months. Conclusions:  Removal of radial head prosthesis improved function and lessened pain in our case series. The reoperation rate was yet nearly 30% due to ulnar neuritis. Selective ulnar nerve decompression at the time of removal must be evaluated, especially in patients with expected large gain in range of motion after removal.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Elbow Stiffness Secondary to Elbow Joint Osteoid Osteoma, a Diagnostic

    • Abstract: We present a 23-year-old man with distal humerus osteoid osteoma referring to our hospital with pain and progressive stiffness. The patient has been suffering from the disease for two years without a certain diagnosis. The radiographies of elbow did not reveal the pathology but further CT scan and MRI studies demonstrated the tumor. The en block resection of the tumor resolved the pain immediately but range of motion remained restricted.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Is there any Correlation Between Patient Height and Patellar Tendon

    • Abstract:  Background: A potential specific problem of patellar tendon graft in ACL reconstruction is the possibility of graft-tunnel mismatch which could be more problematic with anatomic ACL reconstruction where the femoral tunnel is placed low on the lateral wall of the lateral femoral condyle. The occasional occurrence of this mismatch raises the question that whether a correlation exists between patient height and patellar tendon length. The purpose of the present study was to measure patellar tendon length as an anthropometric finding and to evaluate whether a correlation exists between patient height and patellar tendon length.  Methods: Intra-operative measurement of patellar tendon length was carried out in 267 consecutive patients during bone-patellar tendon-bone (BTB) graft ACL reconstruction. Patient age, gender, height were recorded. The patellar tendon measurements were done independently by two surgeons and the possible inter-observer errors were checked. The data were analyzed using the Pearson correlation. Results: The mean length of the patellar tendon was 46.4 ± 4.8 mm (Mean ± SD) with a range of 32–61 mm. The mean patient height was 177 ± 7 cm (Mean ± SD) with a range of 159–197 cm. A weak positive correlations were found between patient height and patellar tendon length (Pearson r = 0.24, P< 0.001). The linear regression equation for patellar tendon length (y, in millimeters) as a function of patient height (x, in centimeters) can be expressed as y=16.54 + 0.17x. Conclusions: Our study showed a weak correlation between patellar tendon length and patient height. This finding is in contrast to the usual measurements in human anthropometry in which taller individuals have normally longer tendons and ligaments. The graft-tunnel mismatch may be the result of this variation.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Evaluation of Patient Outcome and Satisfaction after Surgical Treatment of
           Adolescent ...

    • Abstract: Background:  Adolescent idiopathic scoliosis (AIS) may lead to physical and mental problems. It also can adversely affect patient satisfaction and the quality of life. In this study, we assessed the outcomes and satisfaction rate after surgical treatment of AIS using scoliosis research society-30 questionnaire (SRS-30).   Methods:  We enrolled 135 patients with AIS undergoing corrective surgery. Patients were followed for at least 2 years. We compared pre- and post-operative x-rays in terms of Cobb’s angles and coronal balance. At the last visit, patients completed the SRS-30 questionnaire. We then assessed the correlation between radiographic measures, SRS-30 total score, and patient satisfaction.  Results: Cobb’s angle and coronal balance improved significantly after surgery (P <0.001). The scores of functional activity, pain, self-image/cosmesis, mental health, and satisfaction were 27±4.3, 26±2.5, 33±5.2, 23±3.5, and 13±1.8,  respectively. The total SRS-30 score was 127±13. Radiographic measures showed significant positive correlation with satisfaction and SRS-30 total scores ( P<0.05). There was also a positive correlation between. satisfaction and selfimage/cosmesis domain scores ( P<0.05).  Conclusions:  The greater radiographic angles were corrected the higher SRS-30 total score and patient satisfaction were. It is intuitive that the appearance and cosmesis is of most important factor associated with patient satisfaction.    
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • An Unusual Case of a Large Hematorrachis Associated with Multi-Level
           Osteoporotic Vertebral ...

    • Abstract: Spinal epidural haemorrhage may present as back pain associated with radicular symptoms and can be a catastrophic clinical scenario with progression to paraplegia or even sudden death. Being a rare entity, it needs a high index ofclinical suspicion to diagnose it. Fractures have been documented as a cause of hematorrachis but such hematomas only extend to one or two vertebral segments. Large epidural hematomas are usually associated with conditions like bleeding diathesis, arterio-venous malformations, plasma cell myeloma, and non-Hodgkin’s lymphoma. Surgical management with immediate evacuation of the hematoma is the usual line of management in patients with neurological deficits. Though rare, monitored and careful conservative management can lead to recovery of neurological symptoms and resolution of the hematoma. We report a case of a very large post traumatic epidural hematorrchis extending to 11 vertebral segments from D3 to L1 vertebral bodies, who had a gradual spontaneous recovery.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Two-Stage Nerve Graft in Severe Scar: A Time-Course Study in a Rat Model

    • Abstract: excessive scarring; paralleling the process in tendon reconstruction of the hand. Inspired by the advantages of the two-stage technique in tendon grafting and with encouraging preliminary results, we aimed to investigate the two-stage nerve grafting technique as an alternative method of secondary nerve repair. Methods:  Thirty female rats (~200 g) were randomly distributed into two groups (n=15). A 15 mm gap was created in the sciatic nerve of all the animals and an excessive extraneural scar was induced using the “mincing” method. In this method, a thin strip of muscle was removed, minced in a petri dish and returned to the peripheral nerve. In the two stage nerve graft group, a silicone tube was interposed in the first stage. After 4 weeks, in the second stage, the silicone tube was removed and a median nerve autograft was interposed through the newly formed vascularized sheath. In the conventional graft group, two nerve ends were protected with silicone caps in the first stage. After 4 weeks the caps were removed and the median graft was interposed. Behavioral assessments were performed at week 15 after surgery with the withdrawal reflex latency (WRL) and extensor postural thrust (EPT) and at the 3, 6 and 15-week time points with the TOA (toe out angle). Masson Trichrome staining method was used for histological assessments at week 15. Results: According to the EPT and WRL, the two-stage nerve graft showed significant improvement (P=0.020 and P =0.017 respectively). The TOA showed no significant difference between the two groups. The total vascular index was significantly higher in the two-stage nerve graft group (P<0.001). Conclusions:  Two-stage nerve graft using a silicone tube enhances vascularity of the graft and improves functional recovery.    
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Childhood Facial Osteosracoma: a Case Report

    • Abstract: Osteosarcoma (OS) is the eighth common cancer of childhood and its incidence is 4 cases in one million in children younger than 14. Facial OS incidence is estimated between 8 and 10% of OS cases. The main etiology of OS is unknown, but various predisposing factors are proposed such as radiation, radiotherapy, some benign bone diseases like Paget’s disease or fibrous dysplasia. There is a 5-year survival rate of 68% and it decreases with the increase of age. Positive history of radiotherapy is the main predisposing factor for childhood OS. There is some evidence about the X-ray induced mutation in genomic DNA that leads to osteosarcoma. In the present paper we present a 19-month old girl with a mass located in the inferior margin of the left cheek and orbit. Our case is unique with regard to her young age and sex. Moreover, the tumor was located in an uncommon site and her disease was progressive and resistant.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • A Pitfall in Fixation of Distal Humeral Fractures with Pre-Contoured
           Locking Compression Plate

    • Abstract: Anatomically precontoured locking plates are intended to facilitate the fixation of articular fractures and particularly those associated with osteoporosis. Fractures of the distal humerus are relatively uncommon injuries where operative intervention can be exceptionally challenging. The distal humeral trochlea provides a very narrow anatomical window through which to pass a fixed-angle locking screw, which must also avoid the olecranon, coronoid, and radial fossae. We describe 3 patients (ages 27, 49, and 73 years) with a bicolumnar fracture of the distal humerus where very short distal locking screws were used. Intra-articular screw placement was avoided but loss of fixation occurred in two patients and a third was treated with a prolonged period of immobilization. We postulate that fixed-angle screw trajectories may make it difficult for the surgeon to place screws of adequate length in this anatomically confined region, and may lead to insufficient distal fixation. Surgical tactics should include placement of as many screws as possible into the distal fragment, as long as possible, and that each screw pass through a plate without necessarily locking in.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament
           Reconstruction: Case ...

    • Abstract:  Background: A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture.    Case presentation: A 35-year old male soccer player with a history of ACL tear from the previous year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages: first fixation of the fracture and then ACL re-revision after fracture healing was complete. Conclusions: Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Sternocostoclavicular Joint Swelling; Diagnosis of a Neglected Entity

    • Abstract: Background:  Sternocostoclavicular joint (SCCJ) swelling is an underdiagnosed, albeit important entity in clinical practice. The present study was conducted in order to identify the incidence and common causes of this entity.  Methods:  Patients presenting to the Orthopaedic Clinic with a swelling of the sternocostoclavicular joint, during the study period of two years were included, and detailed history was obtained from the patient. Baseline investigations (total and differential leukocyte count, ESR, CRP, X-ray and CT) wereperformed. Magnetic resonance imaging,FNAC or joint aspiration was performed whenever clinically or radiologically indicated.  Results:   A total of 21 patients were enrolled into the study for a duration of 2 years. Patients mainly presented with both pain and swelling of the SCCJ with predominant right sided involvement. Osteoarthritis was the most frequent diagnosis followed by infections, primary bone/cartilage tumor, and metastasis.  Conclusions:  Although most of the patients with SCCJ swelling have a benign etiology, it is not wise to dismiss thisswelling as degenerative changes. Serious conditions like septic arthritis or neoplasia, may masquerade with similar presentations such as osteoarthritis. It would be therefore imperative to rule out all of these potentially life threatening conditions using thorough clinic-radiological workups.    
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • A Survey of Severity and Distribution of Musculoskeletal Pain in Multiple
           Sclerosis Patients; a ...

    • Abstract:   Background: Pain, a common phenomenon in multiple sclerosis (MS) patients, is associated with many symptoms and problems.  To investigation severity and distribution of musculoskeletal pain in MS patients. Methods: In this cross-sectional study, 115 members of the Mazandaran MS Association with confirmed MS were randomly selected to participate in the study. The patients were asked to fill out Numerical Rating Score and Nodric questionnaires, respectively. The data was analyzed by SPSS ver. 16 software. Results: The mean age of the participants was 30.43±5.86 years and 88 cases (76.5%) were female. The mean disease duration was 26.34±24.32 months and 87.8% of the cases were experiencing pain at the time of study. The mean pain severity was 3.75±2.25 and worst pain experienced was 5.73±2.12. The most common pain sites were: the knees (55.7%), wrist (43.5%), and neck (41.7%). Women experience higher prevalence of shoulder, upper back, and ankle pain (P
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Prevention of Periprosthetic Joint Infection

    • Abstract: Prosthetic joint infection (PJI) is a calamitous complication with high morbidity and substantial cost. The reported incidence is low but it is probably underestimated due to the difficulty in diagnosis. PJI has challenged the orthopaedic community for several years and despite all the advances in this field, it is still a real concern with immense impact on patients, and the healthcare system. Eradication of infection can be very difficult. Therefore, prevention remains the ultimate goal. The medical community has executed many practices with the intention to prevent infection and treat it effectively when it encounters. Numerous factors can predispose patients to PJI. Identifying the host risk factors, patients’ health modification, proper wound care, and optimizing operative room environment remain some of the core fundamental steps that can help minimizing the overall incidence of infection. In this review we have summarized the effective prevention strategies along with the recommendations of a recent International Consensus Meeting on Surgical Site and Periprosthetic Joint Infection.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • Adult Degenerative Scoliosis with Spinal Stenosis Treated with Stand-Alone
           Cage via an Extreme ...

    • Abstract: We report the case of a 73-year-old female with severe degenerative scoliosis and back and leg pain that wassuccessfully treated with stand- alone cages via an extreme lateral transpsoas approach. This patient had declinedopen surgery and instrumentation due to her advanced age concerns about potential side effects.
      PubDate: Tue, 31 Mar 2015 19:30:00 +010
  • A Review Article: Diagnosis and Treatment of Radial Tunnel Syndrome

    • Abstract: Radial tunnel syndrome is a disease which we should consider it in elbow and forearm pains. It is diagnosed with lateral elbow and dorsal forearm pain may radiate to the wrist and dorsum of fingers. The disease is more prevalent in women with the age of 30 to 50 years old. It occurs by intermittent compression on the radial nerve from the radial head to the inferior border of the supinator muscle, without obvious extensor muscle weakness. Compression could happen in five different sites but the arcade of Frose is the most common area that radial nerve is compressed. To diagnosis radial tunnel syndrome, clinical examination is more important than paraclinic tests such as electrodiagnsic test and imaging studies. The exact site of the pain which can more specified by rule of nine test and weakness of the third finger and wrist extension are valuable physical exams to diagnosis. MRI studies my show u muscle edema or atrophy along the distribution of the posterior interosseous nerve. Although non-surgical treatments such as rest, NSAIDs, injections and physiotherapy do not believe to have permanent relief, but it is justify undergoing them before surgery. Surgery could diminish pain and symptoms in 67 to 93 percents of patients completely.
      PubDate: Mon, 16 Mar 2015 20:30:00 +010
  • Hip Arthroplasty and its revision in a child: case report and literature

    • Abstract: Abstract:Juvenile idiopathic arthritis is the leading cause of hip replacement in young children. However , arthroplasty in this population is challenging with several concerns about bone quality, prosthesis and patient survival ,young age for revision surgery and difficulties in potential several revisions. In this study we introduced one of the youngest revision hip arthroplasties in a 12 year old child ,the index operation was hybrid replacement,cemented for stem. Two years later revision was done with sever femoral deficiency(paprosky type 3B).this second procedure was challenging but with short-term promising we reviewed literature for arthroplasty and recent findings and concepts in this young population. According to literature survival of prosthesis is longer with cemented acetabular component and pressfit stem, however, There are evidences that show poor outcome of joint replacement after first revision. it seems that Nowadays we have turned full circle to the point that joint preservation procedures should be settled in young patients ,eventhough complete pain relief cannot be achieve with this means .
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
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