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Journal Cover   Archives of Bone and Joint Surgery
  [2 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  [12 journals]
  • Evaluation of distal femoral rotational alignment with spiral CT scan
           before total knee ...

    • Abstract: Background: Evaluation of the landmarks for rotation of distal femur is usually a challenge for orthopedic surgeons. Although posterior femoral condyle axis is more available landmark for the surgeons, other landmarks especially surgical transepicondylar axis may be more valid. Preoperative CT scan can help to evaluate these landmarks more accurately. The purpose of our study was to ascertain the relationships among the axes guiding distal femur rotational alignment in preoperative CT scan of Iranian patients’ candidate for total knee arthroplasty surgery and the effects of age, gender and knee alignment on these relationships.Methods: One hundred eight cases being admitted to two university hospitals for total knee arthroplasty surgery, included in this study .The rotation of distal femur was evaluated using the single axial CT image through the femoral epicondyles. Four lines were drawn digitally in this view: anatomical & surgical transepicondylar axes, posterior condylar axis and Whiteside anteroposterior line. Also, alignment of the extremity is evaluated in the standing alignment view. Then we measured the angles among these lines and evaluated the relationship between them.Results: Mean angle between anatomical transepicondylar axis and posterior condylar axis and between surgical transepicondylar axis and posterior condylar axis were 5.9° ±1.6 and 1.6°± 1.7° respectively. Mean angle between Whiteside’s anteroposterior line and the line perpendicular to posterior condylar axis was 3.7°± 2.1°. There were significant differences between the two genders in these relationships. No significant correlation between patients’ age and angles of distal femur was detected. Anatomical Surgical transepicondylar axis was in 4.3 ° externally rotation related to surgical transepicondylar axis.Conclusion: Preoperative CT scan can help to determine rotational landmarks of distal femur more accurately. If one of the reference axes couldn’t be determined, we can use other reference axes because of good correlation between these landmarks.
      PubDate: Sat, 28 Nov 2015 20:30:00 +010
  • Neglected Alkaptonuric patient presenting with Steppage gait

    • Abstract: Even though intervertebral disc degeneration could be found in the natural course of alkaptonuria, detection of the disease by black disc color change in a patient without any other presentation of alkaptonuria is an exceptionally rare condition.To report a very rare case of alkaptonuria presented with low back pain and steppage gait.We report a 51-year-old male with a complaint of chronic low-back pain and steppage gait who was operated for prolapsed lumbar disc herniation. Intraoperatively his lumbar disk was discovered to be black. The alkaptonuria diagnosis was considered after histopathological examination of the black disc material. Elevated urinary concentration of homogentisic acid confirmed the diagnosis.To our knowledge, this presentation has not been reported previously in literature.
      PubDate: Sat, 28 Nov 2015 20:30:00 +010

    • Abstract: Abscess formation following intramuscular (IM) injections are rare and they are most commonly seen in immunocompromised individuals. In this case series we present a cohort of three patients presented to us in a critically ill condition with IM injection abscess. Vancomycin resistant Staphylococcus aureus (VRSA) was isolated from all three patients. These patients posed a major challenge to the health care setup and the treating physician because of the severity of illness, virulence and resistance of the organism, rarity of the situation, immune state of the patient, and lack of supporting evidence guiding management and overwhelming utilization of health resources. To the best of our knowledge, there is no report available in the English literature on VRSA associated with intramuscular injections abscess.
      PubDate: Sat, 28 Nov 2015 20:30:00 +010
  • A Survey on Transfusion Status in Orthopedic Surgery at a Trauma Center

    • Abstract: Abstract:Introduction and Objective: Increased costs and mortality associated with inappropriate blood transfusion have led to investigations about blood request and blood transfusion techniques. We investigated Transfusion status in patients with orthopedic surgery in Poursina hospital (Rasht, Iran) to optimizing the blood usage and determine if the correct schedule transfusion program for each orthopedic surgery could improve the blood transfusion management.Materials and Method: In this descriptive-prospective study, all orthopedic surgeries in Poursina hospital, Rasht, between April to June in 2013 were included. All patients’ information was recorded, including demographic, type of surgery, patient’s hemoglobin level, cross-match test, duration of surgery, and blood loss and transfused. Based on One-Way Anova test and Independent Samples Test analysis, Cross-match to transfusion ratio, Transfusion Possibility , transfusion Index and Maximal Surgical Blood Order Schedule were calculated to determine blood transfusion status.Results: Among 872 elective orthopedic surgery candidates, 318 of them were cross-matched and among those 114 patients had blood transfusion. In this study Cross-Match to Transfusion ratio, Transfusion Possibility, Transfusion Index and Maximal Surgical Blood Order Schedule were 6.4, 36.47% , 0.6 and 0.9 respectively.Conclusion: We found that blood ordering was moderately higher than standard so it is highly recommended to focus on the knowledge of evidence based on transfusion and standard guidlines for transfusion to blood avoid over -ordering.
      PubDate: Sat, 21 Nov 2015 20:30:00 +010
  • Supracondylar Osteotomy in Valgus Knee: Angle Blade Plate versus Locking
           Compression Plate

    • Abstract: Background: There are few studies comparing the biomechanical properties of angle blade pated (ABP) and locking compression plates (LCP) in supracondylar osteotomy (SCO). In current randomized study, we prospectively compared the clinical and radiological outcomes of SCO using these two plates.Methods: Forty patients with valgus knee mal alignment were randomly assigned to two equal groups: ABP group and LCP group. All of the patients underwent medial closing wedge SCO and were followed for 1 year. Before and after the operation, the valgus angle and mechanical lateral distal femoral angle (mLDFA) were compared between groups. Also, the rate of complications was compared.Results: After the operation, the mean valgus angle and mLDFA improved significantly in two groups (p<0.001). Although, the preoperative amount of valgus angle and mLDFA were the same but at the last visit, the valgus angle (5.4±2.1 versus 3.1±1.8; p= 0.032) and mLDFA (87.6±2 versus 89.7±3.2; p= 0.041) were significantly lower and higher in ABP group, respectively. Nonunion occurred in 4 patients (20%) in LCP group (p=0.35). Conclusion: Based on the greater amount of valgus angle and mLDFA correction in ABP group and considerable rate of nonunion in LCP group, the authors recommend using ABP for fixation of medial closing wedge SCO for patients with valgus mal alignment. However, more long-term studies are required.
      PubDate: Sat, 21 Nov 2015 20:30:00 +010
  • The Radiological Prevalence of Incidental Kienböck Disease

    • Abstract: Objective: To determine the prevalence of incidental Kienböck disease. Methods: A retrospective analysis of 150,912 radiological reports or images obtained over a five year period was performed of 76,174 patients who underwent a radiograph or computed tomography scan which included the wrist, in Edinburgh and Lothian, UK. Results: There were 5 cases of incidental Kienböck disease and 13 cases of symptomatic Kienböck disease. There were no significant differences in age, sex, ethnicity, comorbidities, smoking status, excess alcohol use or Lichtman stage between the incidental and symptomatic Kienböck groups.Conclusions: The radiological prevalence of incidental Kienböck disease was 0.0066% or 7 in 100,000 patients.
      PubDate: Fri, 20 Nov 2015 20:30:00 +010
  • Influence of Sexuality in Functional Recovery after SPINAL CORD INJURY in

    • Abstract: Purpose: Spinal cord injury is a major clinical condition and researches are performing to find treatment options for it. There are also some degrees of spontaneous recovery after SCI. Gender is said to be a contributing factor in recovery after SCI, but this is controversial. This study was done to compare the effects of sexuality on spontaneous recovery after spinal cord injury in Wistar Rats.Methods: Spinal cord lesions were made by compressing the cord at T9 level and making a spinal cord contusion. Daily care of each rat accomplished in daily manner. The LSS scoring system was used to measure the locomotion of these rats and to compare the recovery rate between male and female rats.Results: The results suggest that there was no significant difference between to genders in recovery.Conclusion: To be female is not a good prognostic factor for recovery after SCI. this primary study could be repeated in the other animals and in larger studies.
      PubDate: Fri, 20 Nov 2015 20:30:00 +010
  • Unicompartmental knee osteoarthritis (UKOA): Unicompartmental knee
           arthroplasty (UKA) or high ...

    • Abstract: PURPOSE: The aim of this review article is to analyze the results of high tibial osteotomy (HTO) compared to unicompartmental knee arthroplasty (UKA) in patients with unicompartmental knee osteoarthritis (UKOA). METHODS: The search engine was PubMed. The keywords used 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 were strictly focused on the topic of this article. RESULTS: In a meta-analysis the ratio for an excellent outcome was higher in UKA than HTO and the risks of revision and complications were lower in UKA than HTO. A prospective comparative study showed that UKA offers better long-term success (77% for UKA and 60% for HTO at 7-10 years). A review of the literature showed no evidence of superior results of one treatment over the other. A multicenter study stated that UKOA without constitutional deformity should be treated with UKA while in cases with constitutional deformity HTO should be indicated. A case control study stated that UKA offers a viable alternative to HTO if proper patient selection is done. CONCLUSION: The literature is still controversial regarding the best surgical treatment for UKOA (HTO or UKA). However, UKA utilization is increasing while HTO utilization is decreasing, and a meta-analysis has shown better outcomes in UKA than HTO and less risk of revision and complications in UKA than in HTO. A systematic review has found that with the correct patient selection, both HTO and UKA show effective and reliable results. Prospective randomized studies are needed for the future to answer the question of this article.
      PubDate: Fri, 20 Nov 2015 20:30:00 +010
  • Position of the Patella among Emirati Adult Knees. ...

    • Abstract: Background: Abnormal patellar height is associated with anterior knee pain and several conditions that affect the patellofemoral joint. The aim of this study was to 1) report the incidence of patella alta and patella baja and 2) investigate whether the normal limits of the Insall-Salvati ratio is applicable in adult Middle-Easterners. Methods: A radiographic review of the lateral radiographs of 736 Middle-Eastern knees were performed. Patellar tendon length (TL) and the patellar length (TP) was digitally measured and the ratios of these measures was used to calculate the Insall-Salvati ratio.Results: The overall mean TL/PL ratio was 1.20± 0.17. The Insall-Salvati ratio was higher (p=0.0013) in males (1.22± 0.12) than in females (1.18± 0.17). According to our measurement, the recommended levels for defining abnormal patellar position should be 0.86 for patella baja and 1.54 for patella alta.Conclusion: The use of TL/PL ratio demonstrated a higher incidence of patella alta and a higher mean TL/PL ratio compared to other techniques. The normal ranges for the TL/PL differs from western populations and may be attributed to lifestyle differences.
      PubDate: Sun, 01 Nov 2015 20:30:00 +010
  • Assessing practitioners’ and patients’ needs regarding shared
           decision-making and decision aids.

    • Abstract: Background: As part of the process of developing a decision aid for carpal tunnel syndrome (CTS) according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict.Methods: One-hundred-twenty-three observers of the Science of Variation Group (SOVG) and 84 patients with carpal tunnel syndrome completed a 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 significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons.Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one’s goals in spite of pain), and higher PDRQ (relationship between patient and doctor). Surgeons from Europe have—on average--significantly more decision conflict than surgeons in the United States of America. Conclusions:Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict.
      PubDate: Sun, 01 Nov 2015 20:30:00 +010
  • Which Route of Tranexamic Acid Administration is more effective to Reduce
           Blood Loss following ...

    • Abstract: Background: The most appropriate route of TXA administration is controversial. In current study, we compared the efficacy of intravenous (IV) and topical intra-articular TXA in reducing blood loss and transfusion rate in patients underwent primary total knee arthroplasty (TKA).Materials and methods: There were 120 patients scheduled to undergo primary TKA. Patients randomly allocated to three equal groups: IV TXA (500 mg), topical TXA (3 gr in 100 mL normal saline) and control. In topical group, half of the volume was used to irrigate the joint and other half was injected intra-articularly. The volume of blood loss, hemoglobin (Hb) level at 24 postoperative hours and rate of transfusion was compared between groups.Results: The blood loss and Hb level were significantly greater and lower in control group, respectively (p<0.05). Also, the rate of transfusion was significantly greater in control group (p<0.05). However, IV and topical groups did not differ significantly in terms of measured variables. There was no patient with thromboembolic event in our study.Conclusion: TXA is a useful antifibrinolytic drug to reduce the postoperative blood loss, Hb drop and rate of blood transfusion in patients undergoing TKA. The route of TXA administration did not affect the efficacy and safety.
      PubDate: Mon, 26 Oct 2015 20:30:00 +010
  • Discrete Pathophysiology is Uncommon in Patients with Nonspecific Arm Pain

    • Abstract: Background: Nonspecific symptoms are common in all areas of medicine. Patients and caregivers can be frustrated when an illness cannot be reduced to a discrete pathophysiological process that corresponds with the symptoms. We therefore asked the following questions: (1) Which demographic factors and psychological comorbidities are associated with change from an initial diagnosis of nonspecific arm pain to eventual identification of discrete pathophysiology that corresponds with symptoms' (2) What is the percentage of patients eventually diagnosed with discrete pathophysiology, what are those pathologies, and do they account for the symptoms'Patients and Methods: We evaluated 634 patients with an isolated diagnosis of nonspecific upper extremity pain to see if discrete pathophysiology was diagnosed on subsequent visits to the same hand surgeon, a different hand surgeon, or any physician within our health system for the same pain.Results: There were too few patients with discrete pathophysiology at follow-up to address the primary study question. Definite discrete pathophysiology that corresponded with the symptoms was identified in subsequent evaluations by the index surgeon in one patient (0.16% of all patients) and cured with surgery (nodular fasciitis). Subsequent doctors identified possible discrete pathophysiology in one patient and speculative pathophysiology in four patients and the index surgeon identified possible discrete pathophysiology in four patients, but the five discrete diagnoses accounted for only a fraction of the symptoms.Conclusion: Nonspecific diagnoses are not harmful. Prospective randomized research is merited to determine if nonspecific, descriptive diagnoses are better for patients than specific diagnoses that imply pathophysiology in the absence of discrete verifiable pathophysiology.
      PubDate: Sat, 24 Oct 2015 20:30:00 +010

    • Abstract: Background: Management of first shoulder dislocation following reduction remains controversial. The two main options are immobilisation and arthroscopic stabilisation. The aim of this article is to highlight some of the issues that influence decision making when discussing management options with these patients, including natural history of the first time dislocation, outcomes of surgery and non-operative management particularly on the risk of future osteoarthritis (OA), the effects of delaying surgery and the optimal method of immobilisation.MATERIAL & METHODS: Extensive literature review was performed looking for previous publication addressing 4 points. i) Natural history of primary shoulder dislocation ii) Effect of surgical intervention on natural history iii) Risk of long term osteoarthritis with and without surgical intervention iv) Immobilisation techniques post reduction.RESULTS: Individuals younger than 25 years old are likely to re-dislocate with non-operative management. Surgery reduces risk of recurrent instability. Patients with recurrent instability appear to be at a higher risk of OA. Those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop OA than those with recurrent instability. Delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. Recent studies have failed to match the preliminary outcomes associated with external rotation braces.CONCLUSION: Defining the best timing and type of treatment remains a challenge and should be tailored to each individual’s age, occupation and degree of physical activity.
      PubDate: Sun, 11 Oct 2015 20:30:00 +010
  • Malnutrition in Joint Arthroplasty: Prospective Study Indicates Risk of
           Unplanned ICU Admission

    • Abstract: ObjectMalnutrition has been linked to poor outcomes after elective joint arthroplasty, but the risk of unplanned postoperative intensive care unit (ICU) admission in malnourished arthroplasty patients is unknown. Methods1098 patients were followed as part of a prospective risk stratification program at a tertiary, high-volume arthroplasty center. Chronic malnutrition was defined as preoperative albumin The overall incidence of malnutrition was 16.9% (primary and revision arthroplasty patients). Average BMI was highest for patients in albumin category 3.0-3.5 (BMI 35.7). Preoperative albumin ConclusionsPatients with poor nutritional status must be counseled on the risks of adverse medical complications.
      PubDate: Thu, 08 Oct 2015 20:30:00 +010
  • The effect of the silicone ring tourniquet and standard pneumatic
           tourniquet on the motor nerve ...

    • Abstract: Background: The pneumatic tourniquet (PT) is routinely used in upper and lower limb operations by most orthopaedic surgeons. The silicone ring tourniquet (SRT) was introduced in clinical practice the last decade. Clinical as well comparative studies in volunteers concerning its safety and efficacy have been published. The aim of this study was to investigate the postoperative effect of the silicone ring tourniquet (SRT), primarily on the motor nerve conduction, and secondarily on the pain and grip strength, in comparison to the effect of the pneumatic tourniquet (PT) in healthy volunteers. Methods: Both tourniquets were applied in the forearm of the dominant arm in 20 healthy volunteers and were kept on for 10 minutes. Pain was measured using the visual analogue scale and grip strength was measured with a hand dynamometer. We evaluated the following parameters of median nerve conduction: motor conduction velocity (MCV), latency (LAT) and amplitude (AMP). Results: Pain score at the time of tourniquet application was higher in SRT group but the alteration in pain scores in PT group was higher, with statistical significance (p<0.05). The grip strength was reduced by the application of both tourniquets; however there was a significantly higher reduction in the SRT group (p<0.05). The conduction impairment of the median nerve was worse in the PT group than in the SRT one, according to the changes in MCV (p<0.05). Conclusion: Median nerve conduction was affected more after PT application as compared to the SRT. Nevertheless, the reduction of grip strength was higher after the SRT application.
      PubDate: Thu, 08 Oct 2015 20:30:00 +010
  • Double-button fixation system for management of acute acromioclavicular
           joint dislocation

    • Abstract: Purpose: Surgical treatments for acromioclavicular (AC) joint dislocation this this type of dislocation is with some complications. The present study was designed to evaluate the double-button fixation system in management of cute acromioclavicular joint dislocation. Methods: In a cross sectional, between February 2011 to June 2014, performed 28 patients underwent surgical management for acute AC joint dislocation with double-button fixation system enrolled into the study. Age, sex, injury mechanism, dominant hand, side of injury, length of follow up, time before surgery, Shoulder and hand (DASH), constant and visual analogue scale (VAS) scores and all complications of cases during the follow up were recorded. Results: The mean age of patients was 33.23±6.7 year. Twenty four patients (85.71%) were male and four (14.28%) were female. The significant differences were observed between pre-operation VAS, constant shoulder scores and post-operation measurements (P=0.001, P=0.0001, P=0.0001, respectively). There wasn’t significant differences between right and left CC (P=0.238). Two cases with heterotrophic ossifications were recorded. The mean time of follow-up was 16.17±4.38 months.Conclusion: According to the results, double-button fixation system for management of acute acromioclavicular joint dislocation has suitable results and minimal damage to the soft tissues surrounding the CC ligaments.
      PubDate: Thu, 08 Oct 2015 20:30:00 +010
  • Pelvic Incidence in Patients with Hip Osteoarthritis

    • Abstract: BACKGROUND: Hip osteoarthritis (OA) is a major cause of pain and disability that results in considerable social and medical costs. Mechanics such as posture, alignment and orientation of the hips and the spinal column and the relationship between these factors have been implicated in the development of both hip and spine pathologies. This study aims to test the hypothesis if pelvic incidence varies in patients with and without osteoarthritis. We assessed the relationship between spinopelvic alignment as measured by pelvic incidence (PI) and the presence of hip OA.METHODS: We collected supine pelvis CT scans of 1,012 consecutive patients not known to have hip OA. Our first group consisted of 95 patients with moderate to severe hip OA as per radiology reports. The second group included 87 patients with no evidence of hip OA. Power analysis revealed the need for 77 patients per group to find a mean difference in PI of 5⁰ or less between both groups. Two trained physicians independently measured the PI to account for inter-observer reliability.RESULTS: Patients with moderate to severe hip OA had a mean PI of 56.5⁰±12.8⁰. The mean PI for patients without hip OA was 57.2⁰±7.5⁰. An independent samples t-test revealed no significant difference between the PI values of the two groups. Spearman’s correlation coefficient of 0.754 demonstrated a high inter-observer reliability. CONCLUSIONS: There was no difference in PI angle of hip OA patients and “healthy” patients. Our measurements of patients without OA were almost identical to the reported normal PI values in the literature. It appears that hip OA is not associated with PI angle, refuting the hypothesis made in previous studies, stating that elevated PI contributes to the future development of hip arthritis. CT scan seems to be a reliable and accurate way of assessing pelvic incidence.
      PubDate: Thu, 08 Oct 2015 20:30:00 +010
  • Type II intertrochanteric fractures: Proximal femoral nailing (PFN) versus
           Dynamic hip screw(DHS).

    • Abstract: INTRODUCTIONIntertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low-energy trauma like simple falls. Dynamic Hip Screw (DHS) is still considered the gold standard for treating intertrochanteric fractures by many. Not many studies compare the DHS with Proximal femoral nail (PFN), in Type II intertrochanteric fractures (Boyd and Griffin classification) . This study was done to compare the functional and radiological outcome of PFN with DHS in treatment of Type II intertrochanteric fractures.METHODS AND MATERIALSFrom October 2012 to March 2015, a prospective comparative study was done where 30 alternative cases of type II intertrochanteric fractures of hip were operated using PFN or DHS. Intraoperative complications were noted. Functional outcome was assessed using Harris Hip Score and radiological findings were compared at 3months, 6months and 12 months post operatively.RESULTS The average age of the patient was 60.3 years. In our series we found that patients with DHS had increased intraoperative blood loss (159.33ml), longer duration of surgery (105.33min) and required longer time for mobilization. While in patients who underwent PFN, we found to have lower intraoperative blood loss (72.67ml), shorter duration of surgery (90.67min) and allowed early mobilization. The average limb shortening in DHS group was 9.33mm as compared with PFN group which was only 4.72 mm. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early post-op period. At the end of 12th month, there was not much difference in the functional outcome between the two groups. CONCLUSION PFN is better than DHS in type II intertrochanteric fractures femur in terms of decreased blood loss, reduced duration of surgery, early weight bearing and mobilization, reduced hospital stay, decreased risk of infection and decreased complications.
      PubDate: Thu, 08 Oct 2015 20:30:00 +010
  • Corrective osteotomy for intra-articular distal humerus malunion.

    • Abstract: Purpose: An intra-articular distal humerus malunion can be disabling. To improve function, pain reduction and/or prevention further secondary osteoarthritis an intra-articular corrective osteotomy can be considered. Herein we present the indications, practical guidelines for pre- operative planning and surgical technique. Subsequently, we documented the surgical outcome with long-term results of osteotomy for distal humerus malunion. Methods: We included six consecutive patients operated for intra-articular distal humerus malunion. Mean follow-up was 88 months. At last follow up elbow function was assessed according to standardized questionnaires and classification systems.Results: All six patients healed their osteotomies. Three patients had a postoperative complication which were treated succesfully. Range of motion improved significantly and all patients were satisfied with the outcome. Their elbow performance scores were good to excellent in all. Correlation analyses showed that age and level of osteoarthritis are very strong predictors for the long-term elbow function and quality of life. Conclusion: An intra-articular corrective osteotomy for a malunited distal humerus fracture is worthwhile procedure. Based on our results it should particularly be considered in young patients with minimal osteoarthritis and moderate to severe functional disability and/or pain.
      PubDate: Wed, 07 Oct 2015 20:30:00 +010
  • Prognostic Effect of Impaired Ankle Reflex in Surgical Outcomes of Lumbar
           Disc Herniation

    • Abstract: Background. Several prognostic factors exist influencing the outcome of surgical discectomy in the patients with lumbar disc herniation (LDH). The aim of this study is to evaluate the relationship between severity of preoperative impaired ankle reflex and outcomes of lumbar discectomy in the patients with L5-S1 LDH.Methods: We retrospectively evaluated 181 patients (108 male and 73 female) who underwent simple discectomy in our orthopedic department from April 2009 to April 2013 and followed them up for more than one year. The mean age of the patients was 35.3±8.9 years old. Severity of reflex impairment was graded from 0 to 4+ and radicular pain and disability were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) questionnaires, respectively. Subjective satisfaction was also evaluated at the last follow-up visit. Chi-square and Kruskal-Wallis tests were used to compare qualitative variables. Results: Reflex impairment existed in 44.8% preoperatively that improved to 10% at the last follow-up visit. Statistical analyses could not find a significant relationship between the severity of impaired ankle reflex and sex or age (p=0.538 and p=0.709, respectively). There was a remarkable relationship between severity of reflex impairment and preoperative radicular pain or disability (p=0.012 and p=0.002, respectively). Kruskal-Wallis test showed that a more severity in ankle reflex impairment was associated with not only less improvement in postoperative pain and disability but also less satisfaction rate (pConclusions: In the patients with L5-S1 LDH, more severe ankle reflex impairment is associated with less improvement in postoperative pain, disability, and subjective satisfaction.
      PubDate: Wed, 07 Oct 2015 20:30:00 +010
  • Intrapelvic protrusion of a broken guide wire fragment during fixation of
           a femoral neck fracture

    • Abstract: During fixation of a femoral neck fracture in a 23-year-old male patient with cannulated screws, a broken guide wire fragment inadvertently advanced through the hip joint and protruded into the pelvis. A second surgical approach was needed to remove the broken fragment from the pelvis. Awareness of such a potentially devastating complication will make surgeons more cautious during implementation of orthopedic instruments and increases patient’s safety during surgery.
      PubDate: Wed, 07 Oct 2015 20:30:00 +010
  • Sleep Disturbance and Upper-Extremity Disability

    • Abstract: Background: Although upper-extremity disability correlates with psychosocial aspects of illness the association with sleep disturbance in upper extremity disability is less certain. To evaluate whether sleep disturbance is associated with upper-extremity disability among patients with upper extremity illness, accounting for sociodemographic, condition-related, and psychosocial factors. Methods: A cohort of 111 new or follow-up patients presenting to an urban academic hospital-based hand surgeon completed a sociodemographic survey and measures of sleep disturbance (PROMIS Sleep Disturbance), disability (PROMIS Upper-Extremity Physical Function), ineffective coping strategies (PROMIS Pain Interference), and depression (PROMIS Depression). Bivariate and multivariable linear regression modeling were performed. Results: Sleep disturbance correlated with disability (r=-0.38; p<0.001) in bivariate analysis. Symptoms of depression (r=-0.44; p<0.001) and ineffective coping strategies (PROMIS Pain Interference: r=-0.71; p<0.001) also correlated with upper-extremity specific disability in bivariate analysis. Pain Interference was the only factor associated with disability in multivariable analysis.Conclusions: Sleep disturbance is not as strongly or directly associated with symptom intensity and magnitude of disability as ineffective coping strategies. Interventions to reduce pain interference (e.g. cognitive behavioral therapy) hold great potential to decrease musculoskeletal symptom intensity and magnitude of disability, and perhaps even sleep disturbance.
      PubDate: Wed, 07 Oct 2015 20:30:00 +010
  • First Carpometacarpal Joint Dislocation and Review of Literatures

    • Abstract:   Dislocation of the first carpometacarpal (CMC) is a rare occurrence. Treatment of this dislocation varies from closed reduction and casting to ligament repair. Neglected dislocation or incomplete reduction of the 1st CMC cause chronic instability and painful arthritis, muscle imbalance and decreased grip force. In our study 6 patients is evaluated that were visited in less than 24 hours from their injury. All were primarily reduced and except one patient later injured ligament were repaired. All patient after 6 months had normal range of motion without pain and they had not any complaint. Stability at the 1st CMC joint is dependent on static and dynamic forces. However, dislocation of the 1st CMC occur rare, but important function of the thumb specially in gripping and grasping makes it a significant problem. Injured ligament should repair for increased stability of 1st CMC joint, because neglected dislocation or incomplete reduction cause chronic instability and painful arthritis.
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Bacille Calmette-Guérin osteomyelitis

    • Abstract:   Background: Tuberculosis is an essential problem for healthcare systems especially in developing countries . All newborns are given Bacillus Calmette-Guérin (BCG) vaccine in Iran which is prepared from live bovine tuberculosis bacillus, and is given to protect against tuberculosis. Osteomyelitis secondary to BCG vaccination is rare and usually involves epiphysis of long tubular bones. Methods: 4 patients, 3 males and a female entered this study and were between 11 to 24 months old. The involved bones were first metatarsi, talus, humerus and tibia bone. The main radiologic finding was lytic lesion with cortical destruction and periosteal reaction. Results: 3 patients underwent core needle biopsy and the one with the proximal tibia involvement, underwent open surgery. Pathology report suggested granulomatous osteomyelitis and typical caseous necrosis compatible with tuberculosis. Surgical treatment for these patients was curettage and debridement of the bone lesion and involved tissues around. The patients got standard anti TB pharmacotherapy, were completely cured and no short term complication was seen in a one year follow up. Conclusion: BCG osteomyelitis and cold abscess, should be kept in mind when assessing a child presenting chronic symptoms like pain, limping or local swelling of extremities. The long interval time between BCG vaccination and outbreak of the culture-negative abscess is a major point which emphasizes on pathologic evaluation. Imageguided tissue biopsy and PCR studies confirm diagnosis. Early use of a surgical curettage and debridement along with chemotherapy soon afterwards, enabled these children to enjoy a satisfactory clinical outcome.
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Unusual Presentation of Synovial Sarcoma as Meniscal Cyst: A Case Report

    • Abstract:   Periarticular cyst and cystic soft tissue lesion around the knee are common. Synovial sarcoma is a rare and malignant soft tissue tumor accounting for approximately 5% of soft tissue sarcoma. A case is presented where a lesion adjacent to the joint line of the knee was diagnosed clinically and on imaging as a meniscal cyst. MRI signal was homogenous and no concomitant meniscal tears were seen. The tissue diagnosis was monophasic synovial sarcoma.
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Assessment of Correlation Between MRI and Arthroscopic Pathologic Findings
           in the Shoulder Joint

    • Abstract:   Background: The objective of this study was to determine the diagnostic value of magnetic resonance imaging for shoulder joint pathologies and then compare the results with arthroscopy, the standard for joint diagnosis. Methods: In this cross-sectional study, 80 patients with shoulder joint disorders, who underwent final arthroscopy, were studied. Based on patients’ medical history and physical examinations, shoulder MRI was requested if paraclinical investigations were. If non-surgical therapies failed, arthroscopy of the affected shoulder was done and the same structures were inspected. Subsequently, sensitivity, specificity, and positive and negative predictive values (PPV) and (NPV) of MRI were determined by arthroscopy comparisons. Results: The highest sensitivity, specificity, PPV and NPV were found in MRI pathology reports that included: Hill-Sach lesion (0.910), infraspinatus tendon (0.985), supraspinatus tendon (0.930), and biceps tendon (0.954), respectively. Rotator interval (0.250), biceps labrum complex (0.805), subscapularis tendon (0.538) and anterior labrum lesions (0.604) had the lowest sensitivity, specificity, PPV and NPV, respectively. Conclusion: The results showed that MRI can be a useful tool in ruling out possible abnormalities in the shoulder and to give clues to the most probable diagnosis. Although knowing some practical skills in order to successfully perform the procedure and experience of the radiologist with suitable feedback by surgeon is necessary.
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Comparison of Intravenous Morphine with Sublingual Buprenorphine in
           Management of Postoperative ...

    • Abstract:   Background: Postoperative pain is a common side effect following surgery that can significantly reduce surgical quality and patient’s satisfaction. Treatment options are morphine and buprenorphine. We aimed to compare the efficacy of a single dose of intravenous morphine with sublingual buprenorphine in postoperative pain control following closed reduction surgery. Methods: This triple blind clinical trial was conducted on 90 patients referred for closed reduction orthopedic surgery. They were older than 18 years and in classes I and II of the American Society of Anesthesiologists (ASA) with an operation time of 30-90 minutes. Patients were divided into two groups of buprenorphine (4.5μg/kg sublingually) and morphine (0.2mg/kg intravenously). Baseline characteristics, vital signs, pain score, level of sedation and pharmacological side effects were recorded in the recovery room (at 0 and 30 minutes), and in the ward (at 3, 6 and 12 hours). SPSS version 19 software was used for data analysis and the significance level was set at P Results: Ninety patients were studied, 60 males and 30 females with a mean age of 37.7±16.2 years. There was no significant difference between the two groups in terms of baseline characteristics.Pain score in the morphine group was significantly higher than the buprenorphine group with an average score of 2.5 (P<0.001). Postoperative mean heart rate in the buprenorphine group was four beats lower than the morphine group (P<0.001). Also, in the buprenorphine 48.6% and in the morphine group 86.7% of cases were conscious in recovery (P=0.001) with a higher rate of pruritus in the latter group (P=0.001). Conclusion: Sublingual buprenorphine administration before anesthesia induction in closed reduction surgery can lead to better postoperative pain control in comparison to intravenous morphine. Due to simple usage and longer postoperative sedation, sublingual buprenorphine is recommended as a suitable drug in closed reduction surgery.
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Inguinal Abnormalities in Male Patients with Acetabular Fractures Treated
           Using an Ilioinguinal ...

    • Abstract: Purpose: Surgeons performing an ilioinguinal exposure for acetabular fracture surgery need to be aware of aberrant findings such as inguinal hernias and spermatic cord lesions. The purpose of this study is to report these occurrences in a clinical series of adult males undergoing acetabular fracture fixation and a series of adult male cadavers. The secondary aim is to characterize these abnormalities to aid surgeons in detecting these abnormalities preoperatively and coordinating a surgical plan with a general surgeon.Methods: Clinical study- Retrospective review of treated acetabular fractures through an ilioinguinal approach. Incidence of inguinal canal and spermatic cord abnormalities requiring general surgery consultation were identified. Corresponding CT scans were reviewed and radiographic characteristics of the spermatic cord abnormalities and/or hernias were noted.Cadaveric study- 18 male cadavers dissected bilaterally using an ilioinguinal exposure. The inguinal canal and the contents of the spermatic cord were identified and characterized.Results: Clinical Study- 5.7% (5/87) of patients had spermatic cord lesion and/or inguinal hernia requiring general surgical intervention. Preoperative pelvic CT scan review identified abnormalities noted intraoperatively in four of the five patients. Cord lipomas visualized as enlargements of the spermatic cord with homogeneous density. Hernias visualized as enlarged spermatic cords with heterogeneous density. Cadaver Study- 31% (11/36) of cadavers studied had spermatic cord and/or inguinal canal abnormalities. Average cord diameter in those with abnormalities was 24.9 mm (15-28) compared to 16 mm (11-22) in normal cords, which was statistically significant.Conclusion: The clinical and cadaveric findings emphasize the importance of understanding inguinal abnormalities and the value of detecting them preoperatively. The preoperative pelvic CT scans were highly sensitive in detecting inguinal abnormalities.
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Risk of Spermatic Cord Injury During Anterior Pelvic Ring and Acetabular
           Surgery: An Anatomical ...

    • Abstract:   Background: Anterior pelvic ring surgery includes a variety of plating techniques and insertion of retrograde superior pubic ramus screws. Anterior acetabular surgery also includes fixation through an ilioinguinal or Stoppa approach. These exposures risk injury to the spermatic cord and accompanying genital branch of the genitofemoral nerve. The primary aim of this study was to identify the distance between the midline and the spermatic cords in adult male cadaveric specimens. The secondary aim was to determine spermatic cord diameters and measure the distance between the spermatic cord and implant during instrumentation of a retrograde superior pubic ramus medullary screw. Methods: Extended Pfannenstiel and Stoppa approaches were performed on 18 embalmed male cadavers bilaterally. Spermatic cord characteristics were recorded and a number of measurements were performed to determine the distance of implants and the midline from the spermatic cord. Results: The average distance between the midline and spermatic cords was 34.2 mm. The average distance between the spermatic cord and implant was 18.2 mm. Eleven of the thirty-six dissections had abnormalities including cord lipomas and inguinal hernias. The average cord diameter was 18.6 mm. The average cord diameter in those with abnormalities was 24.9 mm and 16 mm in those without abnormalities, this difference was statistically significant. Discussion: Due to the proximity of the spermatic cord, the surgeon should either formally expose the cord or limit lateral dissection from the midline during Pfannenstiel and Stoppa exposures. Similarly, the surgeon should use soft-tissue sleeves and oscillating drills to avoid injury to the contralateral spermatic cord during the insertion of retrograde superior pubic ramus medullary screws.
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid
           Fix: A Retrospective ...

    • Abstract:   Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively.Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26 .Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Outcome of ACL Reconstruction and Concomitant Articular Injury Treatment

    • Abstract:   Background: Articular cartilage injuries are a common clinical problem at the time of ACL reconstruction with an incidence rate of 16-46%. Good results of ACL reconstruction combined with the treatment of chondral lesions have been published in some studies. Method: After statistical analysis 30 patients were selected and divided in 2 groups. TheFfirst group consisted of 15 patients wite isolated ACL tear without any other concomitant injuries and the second group consisted of 15 patients with ACL tear and concomitant high grade (grade 3 or 4 of outerbridge classification) contained articular cartilage injuries during arthroscopy. Group 1 underwent ACL reconstruction and group 2 underwent ACL reconstruction combined with chondroplasty via the drilling and microfracture technique. For each patient the Lysholm knee score questionnaire was completed before surgery, 6 months and 1 year after surgery. Results: The mean Lysholm knee score in both groups improves: 9.6 points after 6 months and 16.06 points after 1 year in group 1 and 23.26 points after 6 months and 30.66 after 1 year in group 2, whict was statistically significant (Pvalue<0.05). Conclusion: Improvement in the Lysholm knee score in both groups showed that ACL reconstruction concomitant with high grade chondral injury chondroplasty with microfracture and drilling techniques have good results with patient satisfaction and improves their quality of life.
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Introduction of a New Suture Method in Repair of Peripheral Nerves Injured
           with a Sharp Mechanism

    • Abstract:   Background: The standard method for repair of an injured peripheal nerve is epineural repair with separate sutures. Herein we describe a method in which the nerve is sutured with continous sutures. In fact this method has not been utilized for nerve repair previously and our purpose was to compare it to the standard method. If it proved to be successful it would replace the standard method in certain circumstances. Methods: The proposal of the clinical trial was given a reference number form the ethics comitee. 25 dogs in which the scaitic nerve was cut by a sharp blade under genaeral anesthesia were divided randomly into three groups: control (5 dogs), repair of sciatic nerve with simple sutures (10) and repair with continous sutures (10). In the control group the nerve was not repaired at all. After 6 weeks the dogs were killed and the nerve was studied by light and electronic microscopes. The amount of consumed suture material, time of repair, myelin thickness and axon diiameter were examined. Ultrastructural studies were performed to assess degeneration and regeneration findings. Results: Time of repair and the amount of consumed suture material were significantly lower in the continous group (P<0.001). No difference was found with regard to light microscopy findings and regeneration was confirmed by electron microscopy in the continous group. Conclusion: The method described in the present study, provided a result similar to the standard method. Though undobtfully it has some limitations, can replace the standard method in many circumstances.
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Normal Age-Related Alterations on Distal Radius Radiography

    • Abstract:   Background: The present study was designed to ascertain serial changes on distal radius radiographic parameters attributable to aging. Methods: In this prospective study, the sample consisted of 120 healthy individuals who were divided into four age groups each containing 15 males and 15 females. In the two below-20-year-old groups, only ulnar variance could be investigated. Wrist radiography was taken and then parameters of the distal radius were measured and compared based on age and sex. Results: Average UV was -2.48 mm and -1.6 mm in the 2-9 and 10-19-year-old age groups, respectively. Also, in the two above-20-year-old groups, the average radial inclination (RI), palmar tilt (PT), radial length (RL), and UV was 23.7º, 12.4º, 10.5 and +1.1 mm, respectively. Considering ulnar variance, no significant difference was found between the 2-9- and 10-19-year-old groups, as well as among the two above-20-year-old groups. However, a significant difference was observed between the below 20 and above 20 groups. The study results showed no significant differences between males and females in any of the study groups. Discussion: There is significant ulnar variance change toward less negative ulnar variance with aging until maturity.
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Correlation of Reconstructed Scaphoid Morphology with Clinical Outcomes

    • Abstract:   Background: Scaphoid malunion alters the carpal kinematics and impairs clinical outcome because of pain, weakness, restricted range of motion and predisposing the wrist joint to early osteoarthritis. The aim of this study was to evaluate the influence of the scaphoid morphological angles on clinical outcomes in patients with reconstructed scaphoid by non-vascularized bone graft. Methods: Seventeen male patients with the mean age of 31.7±3.7 years and mean non-union time of 31.5±14.7 months were enrolled in this retrospective study. Average follow up was 48.8±9.4 months. At the last follow-up, the patients were evaluated clinically for pain, wrist range of motion, grip strength, and wrist functional status. They were also evaluated radiologically by wrist radiographs and computerized tomography (CT). The overall clinical outcomes were evaluated by the Cooney wrist function score. The morphology of the reconstructed scaphoids was evaluated by the lateral intrascaphoid angle, antroposterior intrascaphoid angle, dorsal cortical angle, measuring the length (mm), and height-to-length ratio on CT scan. The radiological measurements were compared against the overall clinical outcomes. Results: There were 7 excellent, 7 good, 3 fair clinical results. The mean Cooney wrist function score was 83±4. The mean lateral intrascaphoid angle was 34.8±1.4 degrees, mean antroposterior intrascaphoid angle was 33.4±2.2 degrees, mean dorsal cortical angle was 158.3±4.8 degrees, mean scaphoid length was 22.1± 0.7 mm, and mean scaphoid height-to-length ratio was 0.74±0.04. There were no significant statistical correlations between the lateral intrascaphoid angles, antroposterior intrascaphoid angles, dorsal cortical angles, scaphoid lengths and scaphoid height-to-length ratios and Cooney wrist scores in the patients. Conclusion: In the current study, all the patients had some degree of scaphoid malunion; however, the radiological measurements of the reconstructed scaphoids did not correlate with the clinical outcomes.
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Self-archiving of Our Own Articles: Romeo and Juliet Notes

    • PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Failure of Anterior Cruciate Ligament Reconstruction

    • Abstract:   The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL) surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient.
      PubDate: Tue, 29 Sep 2015 20:30:00 +010
  • Knee Fusion or Above-The-Knee Amputation after Failed Two-Stage
           Reimplantation Total Knee ...

    • Abstract:   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). 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. 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. 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. 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: Tue, 29 Sep 2015 20:30:00 +010
  • A chick embryo in-vitro model of knee morphogenesis.

    • Abstract: Purpose: In this feasibility study, a mechanically loaded in-vitro tissue culture model of joint morphogenesis using the isolated lower extremity of the 8 day old chick embryo was developed to assess the effects of mechanical loading on joint morphogenesis.Methods: The developed in-vitro system allows controlled flexion and extension of the chick embryonic knee with a range of motion of 20 degrees from a resting position of 90-100 degrees of flexion. Joint morphogenesis at 2, 3, 4 and 7 days of culture was assessed by histology and micro MRI in 4 specimen types: undisturbed in-ovo control embryos, in-ovo paralyzed embryos, in-vitro unloaded limb cultures, and in-vitro loaded limb cultures. Relative glycosaminoglycan (GAG) concentration across the joint was assessed with an MRI technique referred to as dGEMRIC (delayed gadolinium enhanced MRI of cartilage) where T1 is proportional to glycosaminoglycan concentration. Results: Average T1 over the entire tissue image for the normal control (IC) knee was 480 msec; for the 4 day loaded specimen average T1 was 354 msec; and for the 7 day loaded specimens T1 was 393 msec. The 4 day unloaded specimen had an average T1 of 279 msec while the 7 day unloaded specimen had an average T1 of 224 msec. The higher T1 values in loaded than unloaded specimens suggest that more glycosaminoglycan is produced in the loaded culture than in the unloaded preparation. Conclusion: Isolated limb tissue cultures under flexion-extension load can be viable and exhibit more progression of joint differentiation and glycosaminoglycan production than similarly cultured but unloaded specimens. However, when compared with controls consisting of intact undisturbed embryos in-ovo , the isolated loaded limbs in culture do not demonstrate equivalent amounts of absolute growth or joint differentiation
      PubDate: Sun, 20 Sep 2015 19:30:00 +010
  • An Isolated Mass in the Palm, Starting Manifestation of Sarcoidosis

    • Abstract: Sarcoidosis is a systemic disease that is characterized with noncaseating granulomatous nodules which present in multiple organs specially lungs (90%) . Incidence of masses due to Sarcoidosis in upper extremity is low and most cases present in association with involvement of pulmonary hilary lymph nodes. In this article we present a rare case of Sarcoidosis which presented as a single soft tissue mass in hand without osseous or pulmonary hillary lymph node involvement. Incidence of involvement of musculoskeletal system is 1-5 % , mostly it occurs in small bones in hands and feet. In most cases involvement of soft tissue in extremities is accompanied with bone lesions. Those cases of soft tissue involvement are generally coincide with pulmonary lymph nodules. To the authors knowledge this is the first case of Sarcoidosis that presents without spreading in bones or pulmonary hilar lymph nodes.
      PubDate: Fri, 04 Sep 2015 19:30:00 +010
  • Fanconi anemia concurrent with an unusual thumb polydactyly

    • Abstract: Abstract: This case report presents a case of Fanconi’s Anemia with an unusual thumb poly dactyly in a 2-year old boy. The extra thumb had no nail, nail bed and distal phalanx. The extra thumb had no active motion.The duplication of the thumb occurred at the carpo metacarpal joint but its morphology did not match with any classification described for thumb poly dactyly. Although his thumb poly dactyly was apparent at birth, Fanconi’s anemia was not suspected until during a routine pre operative laboratory test (CBC) for the elective surgery of his thumb. An early diagnosis of FA is important and the hand surgeons may be the first to have the opportunity to suspect and diagnose the underlying life threatening disorder. This case report presented an opportunity to diagnosis a fatal disorder by a routine pre operative laboratory test. To the best of my knowledge, the phenotype of the thumb poly dactyly of the current case has not yet reported.
      PubDate: Sun, 16 Aug 2015 19:30:00 +010
  • A survey of blood request versus blood utilization at a university
           hospital in Iran

    • Abstract: Background Reservation of blood leads to the blood wastage if not transfused; therefore in some centers, only type and screen are evaluated. In this study, efficacy of blood cross-match to transfusion ratio was measured and then compared with the standard levels.Materials and MethodsThis prospective study was conducted during one year in a university hospital. During this period, 398 patients for who had requested blood were studied. In these patients, at first surgical type, the probability related laboratory tests (hematocrit, hemoglobin, platelet count, and PT) and then number of preoperative cross-matched and intraperative transfused blood units are recorded. Then crossmatch to transfusion ratio, transfusion probability, transfusion index and correlation between related factors and transfusion ratio were evaluated.ResultsIn this cross-sectional study, blood was requested for 398 patients. According to available blood unit deficiency, from 961 blood units' requisition, only 456 units were cross-matched, and 123 units were transfused. Crossmatch to transfusion ratio, transfusion probability, and transfusion index were 3.71 (7.81 if all requisitions were cross-matched), 16.83%, and 0.31, respectively. Based on the surgery groups, the most unfavorable indexes were observed in ear, nose, and throat surgeries (0 transfused from 19 cross-matched blood units) and also obstetrics and gynecology (C/T ratio was 18.6); the best indexes were related to thoracic and neurosurgeries (C/T ratio were 1.53 and 1.54, respectively). There were not significant correlations between hemoglobin, hematocrit, platelet count and PT with transfused blood units (P-value = 0.2, 0.14, 0.26 and 0.06 respectively).Conclusion Cross-match to transfusion ratio, transfusion probability and index were not appropriate at this center especially in ENT and obstetric surgeries. We need to further multidimensional studies and determination of a new model for blood request and less blood wastage.
      PubDate: Sun, 16 Aug 2015 19:30:00 +010
  • Extensive Osteochondroma of talus presenting as tarsal tunnel syndrome:
           Report of a case and ...

    • Abstract: Osteochondroma or exostosis is the most common benign bone tumor, and occurring frequently in the proximal humerus, tibia, and distal femur. It rarely affects talus. Osteochondroma of talus is a very rare etiology of tarsal tunnel syndrome (TTS). We report a rare case of extensive osteochondroma of the talus in a 60 year old female presenting with multiple swellings around the ankle and symptoms suggestive of tarsal tunnel syndrome. En-block excision of the multiple masses was done. Histopathological examination confirmed the diagnosis of osteochondroma with no features suggestive of malignancy. Although most of the osteochondromas are being treated conservatively, those presenting with multiple swellings, restriction of movements and compressive neuropathies should be treated with surgical excision. Excision is a successful method of treatment for symptomatic osteochondromas with low recurrence.
      PubDate: Sun, 16 Aug 2015 19:30:00 +010
  • Giant Cell Tumor Of Bone - An Narrative Review Of Literature

    • Abstract: Giant Cell tumors (GCT) are benign tumors with potential for aggressive behavior and capacity to metastasize. Although rarely lethal, benign bone tumors may be associated with a substantial disturbance of the local bony architecture that can be particularly troublesome in peri-articular locations. Its histogenesis remains unclear. It is characterized by a proliferation of mononuclear stromal cells and the presence of many multi- nucleated giant cells with homogenous distribution. There is no widely held consensus regarding the ideal treatment method selection. There are advocates of varying surgical techniques ranging from intra-lesional curettage to wide resection. As most giant cell tumors are benign and are located near a joint in young adults, several authors favor an intralesional approach that preserves anatomy of bone in lieu of resection. Although GCT is classified as a benign lesion, few patients develop progressive lung metastases with poor outcomes. Treatment is mainly surgical. Options of chemotherapy and radiotherapy are reserved for selected cases. Recent advances in the understanding of pathogenesis are essential to develop new treatments for this locally destructive primary bone tumor.
      PubDate: Fri, 14 Aug 2015 19:30:00 +010
  • Intamuscular lipoma of the thenar: a rare case

    • Abstract: Lipomas are the commonest benign mesenchymal tumors. They are located either subcutaneously or under the investing fascia in intramuscular or intermuscular regions. The reported frequency of intramuscular lipomas among all benign adipocytic tumors is 1%–5.0% and that of intermuscular lipomas is 0.3%–1.9%.The frequency of these lesions is the same in all age groups, but in adults deep seated-lipomas are most commonly discovered between the ages of 30 and 60. The most common sites of involvement of intramuscular lipomas are the large muscles of the extremities, especially those of the thigh, shoulder, and upper arm. Intramuscular lipomas of the hand are extremely rare and only few cases have been reported till now in the literature. In cases with hand location, they may present with functional deficit or neurovascular compromise due to mass effect. We report an unusual case of a large intramuscular lipoma of the thenar that was treated with surgical excision due to the impairment of hand function.
      PubDate: Wed, 05 Aug 2015 19:30:00 +010
  • Extra-articular diffuse giant cell tumor of the tendon sheath: A report of
           2 cases.

    • Abstract: Two rare cases of extra-articular diffuse variant giant cell tumor of the tendon sheath are presented, at the elbow of a 68-year-old female and the foot of a 56-year-old male. Both patients presented with a palpable masses and marginal excision was performed; histological sections confirmed the diagnosis of extra-articular giant cell tumor. No adjuvant therapy was administered. At the last follow-up, minimum 24 months after excision both patients were disease-free.
      PubDate: Fri, 31 Jul 2015 19:30:00 +010
  • How much are emergency medicine specialists' decisions reliable in the
           diagnosis and treatment ...

    • Abstract: AbstractBackground: Considering the need and importance of an early diagnosis and proper decisions regarding treatment of pediatric distal radius and elbow fractures, this study examines emergency medicine specialists' accuracy in the diagnosis and treatment of these patients.Methods: In the years 2012 and 2013, children less than 14 years old who were referred to academic hospital emergency with elbow or distal radius fractures were included. Initially, patients were examined by an emergency medicine specialist and then they were referred to an orthopedic surgeon. Type of fracture and the proposed treatment of two specialists were compared.Results: In total there were 108 patients (54 patients in each group) with mean age of 8.1+3.3 years. Identical diagnosis among 48 cases (88.9%) and 36 cases (66.7%) were observed in distal radius and elbow trauma, respectively. We found a difference between diagnosis of two specialists in diagnosis of lateral condyle of humerus fracture in elbow group and growth plate fracture in distal radius fracture group, but those were not significant. Among 108 patients, 70 patients (64.8%) received identical treatment (p=0.0001). Conclusions: Although emergency medicine specialists act similarly to those orthopedic specialists in diagnosing pediatric distal radius and elbow fractures, in diagnosing more complicated fractures such as lateral condylar humoral fractures, distal radius growth plate and also picking proper treatment for the patient, they still need further education.
      PubDate: Sat, 11 Jul 2015 19:30:00 +010
  • Treatment outcome of intramedullary fixation with a locked rigid nail in
           humeral shaft fractures

    • Abstract: Treatment outcome of intramedullary fixation with a locked rigid nail in humeral shaft fracturesAbstractBackground: The aim of this study was to determine the treatment outcome of humeral shaft fractures with a locked rigid intramedullary nail in patients indicated for surgical treatment.Methods: In this descriptive-cross sectional study, all patients were followed up in one, six and 18 month post operatively. Short form questionnaire (SF-36) and Constant score were applied. Results: Of 78 included patients (mean age: 35), there were one patient with soft tissue infection, one with secondary radial nerve palsy, eight with nonunion, one with elbow limited range of motion in extension and three patients with decreased shoulder range of motion. Both Constant score and short form questionnaire score (SF-36) increased in all patients, however aged women showed lower improvement.Conclusion: Intramedullary nail fixation in humeral shaft fracture may be associated with high rates of non-union. Keywords: Orthopedic procedures, Humeral shaft fractures, Nailing, Treatment outcome
      PubDate: Mon, 06 Jul 2015 19:30:00 +010
  • Operating Room Time Savings with the Use of Splint Packs: A Randomized
           Controlled Trial

    • Abstract: Background: The most expensive variable in the operating room (OR) is time. Lean Process Management is being used in the medical field to improve efficiency in the OR. Streamlining individual processes within the OR is crucial to a comprehensive time saving and cost-cutting health care strategy. At our institution, one hour of OR time costs approximately $500, exclusive of supply and personnel costs. Commercially prepared splint packs (SP) contain all components necessary for plaster-of-Paris short-leg splint application and have the potential to decrease splint application time and overall costs by making it a more lean process. We conducted a randomized controlled trial comparing OR time savings between SP use and bulk supply (BS) splint application. Materials and Methods: Fifty consecutive adult operative patients on whom post-operative short-leg splint immobilization was indicated were randomized to either a control group using BS or an experimental group using SP. One orthopaedic surgeon (EMB) prepared and applied all of the splints in a standardized fashion. Retrieval time, preparation time, splint application time, and total splinting time for both groups were measured and statistically analyzed.Results: The retrieval time, preparation time and total splinting time were significantly less (p<0.001) in the SP group compared with the BS group. There was no significant difference in application time between the SP group and BS group. Conclusion: The use of SP made the process of splinting more lean. This has resulted in an average of 2 minutes 52 seconds saved in total splinting time compared to BS, making it an effective cost-cutting and time saving technique. For high volume ORs, use of splint packs may contribute to substantial time and cost savings without impacting patient safety.
      PubDate: Fri, 22 May 2015 19:30:00 +010
  • Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A
           Case Study

    • Abstract: Tendon transfers in hand patients are a commonly performed procedure after extensor tendon rupture. However, the standard side to side technique is not applicable in every patient. We present a case of a musician with unique demands to demonstrate the option to customize surgical technique and therapy regimen to the unique needs of each patient.An extensor indicis proprius to extensor digitorum communis transfer was performed in a 73 year old musician. A controlled active motion therapy protocol was followed. The patients musical practice regimen was incorporated into the therapy. The patient was able to independently extend her ring and small fingers in order to play her instrument and resumed play within one month postoperatively. A patient’s functional goals including avocations need to be considered when selecting the appropriate surgical and therapeutic approach.
      PubDate: Fri, 08 May 2015 19:30:00 +010
  • Compartment Syndrome of the Calf Due to Nicolau Syndrome

    • Abstract: Abstract: We report a case of Nicolau syndrome in a 15 months old girl following of an intramuscular injection of penicillin 6.3.3 in her left buttock. This case is unique because she developed compartment syndrome in her left calf far from her injection site. Her toe’s tips gangrened in the course of her ailment.Amputation of the greater toe was performed through the interphalangeal joint. Amputation of the second through fifth toes was performed through the proximal interphalangeal joints. Follow up electromyography and nerve conduction study showed ischemic changes of the calf muscles and a permanent deep peroneal nerve damage. We hypothesized that the compartment syndrome might be produced by a probable intra-arterial injection that had produced embolic obstruction of the small and medium sized arteries in her leg or a probable perineural or periarteial injection had produced secondary sympathetic stimulation, extensive vasospasm, compromised microcirculation and the development of compartment syndrome.
      PubDate: Wed, 06 May 2015 19:30:00 +010
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