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Journal Cover Archives of Bone and Joint Surgery
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 2345-4644 - ISSN (Online) 2345-461X
   Published by Mashhad University of Medical Sciences Homepage  [13 journals]
  • Preliminary Results of a Consecutive Series of Large & Massive Rotator
           Cuff Tears Treated ...

    • Abstract:  Background: Recurrence rate of rotator cuff tears is still high despite the improvements of surgical techniques, materials used and a better knowledge of the healing process of the rotator cuff tendons. Large to massive rotator cuff tears are particularly associated with a high failure rate, especially in elderly. Augmentation of rotator cuff repairs with extracellular matrix or synthetic patches has gained popularity in recent years with the aim of reducing failure.The aim of this study was to investigate the outcome of rotator cuff repairs augmented with denatured extracellular matrix in a series of patients who underwent arthroscopic rotator cuff repair for large to massive tears.Methods: Ten consecutive patients, undergoing arthroscopic rotator cuff repair with extracellular matrix augment for large and massive tears, were prospectively enrolled into this single surgeon study. All repairs were performed arthroscopically with a double row technique augmented with extracellular matrix. Oxford Shoulder Score, Constant Score and pain visual analogue scale (VAS) were used to monitor the shoulder function and outcome pre-operatively and at three, six and 12-month follow-up. Minimum follow up was tree months. Mean follow up was 7 months.Results: Mean Constant score improved from 53 (SD=4) pre-operatively to 75 (SD=11) at final follow up. Mean Oxford score also increased from 30 (SD=8) pre-operatively to 47 (SD=10) at the final follow up. The visual analogue scale (VAS) improved from seven out of 10 (SD=2) preoperatively to 0.6 (SD=0.8) at final follow up. Additionally, there was significant improvement at three months mark in Constant score. Conclusion: Arthroscopic repair and augmentation of large and massive rotator cuff tears with extracellular matrix patch has good early outcome.
      PubDate: Sat, 31 Dec 2016 20:30:00 +010
  • How do Orthopedic Surgeons Address Psychological Aspects of Illness?

    • Abstract:   Background: Orthopaedic surgeons have a pivotal role in transitioning the care of orthopedic patients from a biomedical to a biopsychosocial model. In an effort to foster this transition, we designed a study aimed to determine surgeons’ attitudes and practice of noticing, screening, discussing psychological illness with patients, as well as making referrals to address psychosocial issues in patients in need. Additionally, we asked surgeons to rank order potential barriers to and reasons for referrals to psychosocial treatment.   Methods: Orthopaedic surgeons members of the Science and Variation Group and Ankle Platform (N =350) completed demographics, and a 4-part survey assessing the degree to which surgeons notice, assess, screen and refer for psychological treatments, as well ranked ordered barriers to engaging in these processes. Results: As a group surgeons were neutral to referral for psychological treatment and formal screening of psychological factors, and somewhat likely to notice and discuss psychological factors. Surgeons were more likely to refer for psychological treatment if they engaged in research, or if they reside in South America as opposed to North America. The highest ranked barriers to screening, noticing, discussing and referring for psychological treatment were lack of time, stigma and feeling uncomfortable. Conclusion: Overall surgeons are likely to notice and discuss psychological factors, but less likely to formally screen or refer for psychological treatment. Transition to biopsychosocial models should focus on problem solving these barriers by teaching surgeons communication skills to increase comfort with discussing psychoemotional factors associated with orthopedic problems. The use of empathic communication can be very helpful in normalizing the difficulty of coping with an orthopedic condition, and may facilitate referral.
      PubDate: Sat, 31 Dec 2016 20:30:00 +010
  • Qualitative Evaluation of Digital Hand X-rays is Not a Reliable Method to
           Assess Bone Mineral ...

    • Abstract: Object: The gold standard for evaluating bone mineral density is dual energy x-ray absorptiometry (DEXA).  Prior studies have shown poor reliability using analog wrist X-rays in diagnosing osteoporosis. Our goal was to investigate if there was improved diagnostic value to visual assessment of digital hand X-rays in osteoporosis screening. We hypothesized that similar to analog counterparts, digital hand X-rays have poor correlation and reliability in determining bone mineral density (BMD) relative to DEXA.Methods: We prospectively evaluated female patients older than 65 years who presented to our hand clinic with digital hand and wrist X-rays as part of their evaluation over six months. Patients who had a fracture and were without DEXA scans within the past two years were excluded. Five fellowship-trained hand surgeons, blinded to DEXA T-scores, evaluated the x-rays over two assessments separated by four weeks and classified them as osteoporotic, osteopenic, or normal BMD.  Accuracy relative to DEXA T-score, interobserver and intraobserver rates were calculated.Results: Thirty four patients met the inclusion criteria and a total of 340 x-rays reviews were performed.  The assessments were correct in 169 cases (49%) as compared to the DEXA T-scores. A mean weighted kappa coefficient of agreement between observers was 0.29 (range 0.02-0.41) reflecting a fair agreement. The first and second assessment for all five physicians was 0.46 (range 0.19-0.78) reflecting a moderate agreement.  Grouping osteoporosis and osteopenia together compared to normal, the accuracy, interobserver and intraobserver rates increased to 63%, 0.42 and 0.54 respectively.Conclusion: Abnormally low BMD is a common occurrence in patients treated for upper extremity disorders. There is poor accuracy relative to DEXA scan and only fair agreement in diagnosing osteoporosis using visual assessments of digital x-rays. 
      PubDate: Sat, 31 Dec 2016 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: Sat, 31 Dec 2016 20:30:00 +010
  • Osteochondritis Dissecans of the Humeral Head: A Case Report and Review of
           the Literature

    • Abstract:  Osteochondritis dissecans (OCD) is a common joint disorder in knee, ankle and elbow, however it can be rarely found in glenohumeral joint. In this study, we report an asymptomatic case of humeral head OCD, which was detected incidentally following a trauma. X-rays showed an area of lucency around an oval bony fragment measuring about 1 cm on the superior aspect of the humeral head. However, the patient was pain-free and the shoulder range of motion was normal.
      PubDate: Sat, 31 Dec 2016 20:30:00 +010
  • Loosening of Total Knee Arthroplasty after Brucellosis Infection: A Case

    • Abstract:   In this report we describe a 78-year-old man whose total knee arthroplasty showed the symptoms of infection with brucella with radiographic signs of loosening 5 years after the index surgery. The patient was treated successfully after a 2-stage revision arthroplasty surgery along with using rifampicin and doxycycline for 8 weeks.
      PubDate: Sat, 31 Dec 2016 20:30:00 +010
  • Axillary Artery Injury Associated with Proximal Humerus Fracture: A Report
           of 6 Cases

    • Abstract:  Proximal humerus fractures are common, but associated injury of the axillary artery is uncommon. The majority of published blunt traumatic axillary artery injuries are associated with anterior glenohumeral dislocation; a few are associated with isolated proximal humerus fractures or fracture-dislocation. Experience within our institution demonstrates that axillary artery injury is often unrecognized on initial presentation owing to palpable peripheral pulses and the absence of ischemia and places the hand at risk of necrosis and amputation if there is prolonged ischemia and the forearm at risk of compartment syndrome after revascularization. Accurate physical examination in combination with a low threshold for Doppler examination or angiography can establish the diagnosis of axillary artery injury. We present 6 cases of axillary artery injury associated with proximal humerus fractures in order to highlight the potential for this vascular injury in the setting of a proximal humerus fracture.
      PubDate: Sat, 31 Dec 2016 20:30:00 +010
  • Total Knee Arthroplasty in Severe Unstable Knee: Case-Report and
           Literature Review

    • Abstract:   Multiplanar or global laxity in arthritic knee is rare , most of this patients have neuromuscular disorder (post poliomyelitis , spinal dystrophy) or history of knee trauma. Ligament insufficiency and severe bone loss is significant in this patient. The estimated prevalence for the concurrence of charcot marie-tooth (CMT) with myasthenia gravis (MG) suggests an extremely rare event. We have presented a 54-year-old female patient with CMT and MG complaining of progressive pain, swelling, and crepitation of the knee joints who had been undergone total knee arthroplasty (TKA) with rotating hinge prosthesis. She had an acute myasthenia crisis soon after operation with prolonged intubation and intensive care unit admission. Radiographies and physical examination revealed bilateral severe unstable arthritic knee joints and left knee posterior dislocation. Short-term postoperative follow-up revealed improved knee function and resolution of all symptoms in the operated side.
      PubDate: Sat, 31 Dec 2016 20:30:00 +010
  • Comparison of Pediatric and General Orthopedic Surgeons’ Approaches
           in Management of ...

    • Abstract:  Developmental dysplasia of the hip (DDH) and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS) (n=20) and pediatric orthopedic surgeons (POS) (n=20), were asked to answer an 8-item questionnaire on DDH and flexible flatfoot. The questions were provided with two- or multiple choices and a single choice was accepted for each one. Chi-square and Fisher’s exact tests was performed to compare the responses. For a neonate with limited hip abduction, hip ultrasonography was the agreed-upon approach in both groups (100% POS vs 71% GOS), and for its interpretation 79% of POS relied on their own whereas 73% of GOS relied on radiologist’s report (P=0.002). In failure of a 3-week application of the Pavlik harness, ending it and closed reduction (57% POS vs. 41% GOS) followed by surgery quality assessment with CT scan (64% POS vs. 47% GOS) and without the necessity for avascular necrosis evaluation (79% POS vs. 73% GOS) were the choice measures. In case of closed reduction failure, open reduction via medial approach was the favorite next step in both groups (62% POS and 80% GOS). For the patient with flexible flat foot, reassurance was the choice plan of 79% of pediatric orthopedists. Our findings demonstrated significant disagreements among the orthopedic surgeons. This proposes insufficiency of high-level evidence.
      PubDate: Sat, 31 Dec 2016 20:30:00 +010
  • Minimally Invasive Surgical Approach to Distal Fibula Fractures: A
           Technique Tip

    • Abstract:  Wound complications following ankle fracture surgery are a major concern. Through the use of minimally invasive surgical techniques some of these complications can be mitigated. Recent investigations have reported on percutaneous fixation of distal fibula fractures demonstrating similar radiographic and functional outcomes to traditional open approaches. The purpose of this manuscript is to describe in detail the minimally invasive surgical approach for distal fibula fractures.
      PubDate: Sat, 31 Dec 2016 20:30:00 +010
  • The Zeitgeist of Challenging the Evidence. ...

    • Abstract:  Background: The economic burden of the treatment of periprosthetic joint infection (PJI) is high and the treatment of PJI has a high degree of international controversy. Several papers have declared the International Consensus Meeting on Periprosthetic Joint Infection (ICMPJI) to be the "flawless pledge of international academics" to overcome the challenges of musculoskeletal infections. The purpose of this paper is to highlight for the first time some essential insights into the key dilemmas that are associated with this international consensus process. Methods: The proceedings of the ICMPJI was reviewed, and the critical consensus agreements that were reached were communicated via e-mail to 48 leading orthopaedic surgeons, microbiologists and statisticians around the world. Of these, 30 responded, 8 did not, and 10 of respondents were not aware of the ICMPJI. Results: A thorough review of the ICMPJI proceedings identified a clear need to resolve some of the dilemmas that we highlight in this paper. The Delphi procedure has been described as a survey technique that enables a group dynamic-based practice. Although there have been several published reports on this procedure, its scientific merit is still being debated. Several challenges and questions have been raised regarding the application of the Delphi technique, but there is no doubt that it is a vital approach for achieving consensus on subjects where none currently exists. Conclusion: Performing prospective clinical studies in this area is currently the best and only option to overcome this challenge. In the long term, this approach will not only incorporate the standard of clinical evidence but also adopt regional mores for treating infection, which include patient values, cultural differences and local financial resources.
      PubDate: Sat, 31 Dec 2016 20:30:00 +010
  • Relationship between Bone Mineral Density and Serum Vitamin D with Low
           Energy Hip and Distal ...

    • Abstract:  Background: The main purpose of this study was to determine the relationship between serum vitamin D and the status of bone mineral density in patients with low-energy hip and distal radius fracture. Methods: This retrospective case-control study was performed between January 2013 and January 2014. Participants aged 55 years or older were divided to case group including 85 patients with low-energy hip fracture and 83 patients with low-energy distal radius fractures, and 82 subjects as a matched control group. Bone mineral density was measured with dual energy X-ray absorptiometry and serum sample was obtained to check vitamin D, calcium, phosphorus, alkaline phosphatase, and protein. Results: Study subjects for final evaluation consisted of 78 in hip and distal radius fracture groups and 80 in control group. There were no significant differences in the mean serum levels of calcium, phosphorus and alkaline phosphatase between the three groups. The overall mean serum level of vitamin D3 was significantly different among the three groups. Similar results were observed with hip and spine t-score between the groups. Conclusion: There is not only a direct relation between serum vitamin D and the risk of low energy hip and distal radius fractures, but also a significant relation between low bone density in hip and spine area with low serum calcium was observed.
      PubDate: Sat, 31 Dec 2016 20:30:00 +010
  • Analgesia Following Arthroscopy – a Comparison of Intraarticular
           Bupivacaine and/or Midazolam ...

    • Abstract:   Background: Arthroscopic intervention is very common for conducting orthopedic surgeries. After a knee arthroscopic surgery, different drugs are used through intra-articular administration to induce analgesia. The aim of this study was to evaluate analgesic effects of Bupivacaine (marcaine), Bupivacaine plus midazolam, and Bupivacaine plus fentanyl in reducing pain after knee arthroscopic surgery. Methods: Frothy five patients who were candidate for knee arthroscopy were divided into three groups. Group A, B and C received Bupivacaine (50 mg), Bupivacaine (50 mg) plus midazolam (50 μg/kg), and Bupivacaine (50 mg) plus fentanyl (3 μg/kg), respectively. The analgesic solutions were diluted with normal saline up to 20 ml. The analgesic effects were evaluated by VAS during first 24 hrs after surgery. With the VAS > 4, extra analgesic (pethidine) was administrated for patient. Results:The amount of induced analgesia and need for extra analgesic was different between groups; however, it was not statistically significant (p<0.109). The amount of administered analgesic (pethidine) in first 24 hours post-operatively was 275 mg for group A, while it was 150 mg for group B and 75 mg for group C. In group A, 46.67% of patients required further analgesic while this was 26.67% and 13.34% for groups B and C respectively (p<0.109). Conclusion: Intra-articular administration of studied drugs in all three groups reduced post-operation pain. The amount of induced analgesia was the highest for group C, while group B drugs induced better analgesia compared to group C.
      PubDate: Sat, 31 Dec 2016 20:30:00 +010
  • Crash in Publication Ethics in 2016 in a Glance: Avoid Paper Retraction

    • Abstract:  On November 1st  2016, Springer Nature announced that Springer and BioMed Central are retracting 58 articles published by Iran-based authors across seven journals. The decision was made after thorough investigation following receiving allegations of plagiarism, peer review, and authorship manipulation in an effort to mislead the review system (1, 2). Not all papers were involved with all of the above issues, but each showed the evidence of at least one of these issues. At this time, we are not able to comment on the involvement of each individual author, but this has already added a black sheath to his or her records....
      PubDate: Sat, 31 Dec 2016 20:30:00 +010
  • Interobserver Variability of Radiographic Assessment of Distal Radius
           Fractures using a Mobile ...

    • Abstract: Study designInterobserver variability studyObjectiveTo examine whether interobserver reliability, decision-making, and confidence in decision-making in the treatment of distal radius fractures changes if radiographs are viewed on a messenger application on a mobile phone compared to a standard DICOM viewer.Methods Radiographs of distal radius fractures were presented to surgeons on either a smart phone using a mobile messenger application or a laptop using a DICOM viewer application. Twenty observers participated: 10 (50%) were randomly assigned to the DICOM viewer group and 10 (50%) to the mobile messenger group. Each observer was asked to evaluate the cases and (1) classify the fracture type according to the AO classification, (2) recommend operative or conservative treatment and (3) rate their confidence about this decision.ResultsThere was no significant difference in interobserver reliability for AO classification and recommendation for surgery for distal radius fractures in both groups. The percentage of recommendation for surgery was significantly higher in the messenger application group compared to the DICOM viewer group (89% versus 78%, P=0.019) and the confidence for treatment decision was significantly higher in the mobile messenger group compared to the DICOM viewer group (8.9 versus 7.9, P=0.026).Conclusions:Messenger applications on mobile phones could facilitate remote decision-making for patients with distal radius fractures, but should be used with caution.
      PubDate: Sun, 04 Dec 2016 20:30:00 +010
  • Questionable Word Choice in Scientific Writing in Orthopedic Surgery

    • Abstract: Background: Given the strong influence of thoughts, emotions, and behaviors on musculoskeletal symptoms and limitations it’s important that both scientific and lay writing use the most positive, hopeful, and adaptive words and concepts consistent with best evidence. The use of words that might reinforce misconceptions about preference-sensitive conditions (particularly those associated with age) could increase symptoms and limitations and might also distract patients from the treatment preferences they would select when informed and at ease. Methods: We reviewed 100 consecutive papers published in 2014 and 2015 in 6 orthopedic surgery scientific journals. We counted the number and proportion of journal articles with questionable use of one or more of the following words: tear, aggressive, required, and fail. For each word, we counted the rate of misuse per journal and the number of specific terms misused per article per journal. Results: Eighty percent of all orthopedic scientific articles reviewed had questionable use of at least one term. Tear was most questionably used with respect to rotator cuff pathology. The words fail and require were the most common questionably used terms overall. Conclusion: The use of questionable words and concepts is common in scientific writing in orthopedic surgery. It’s worth considering whether traditional ways or referring to musculoskeletal illness merit rephrasing.
      PubDate: Sun, 04 Dec 2016 20:30:00 +010
  • Use of "Hardware" Battery drill in Orthopedic Surgery

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

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

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

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

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

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

    • Abstract: Dear Editor,It was with great interest that we read the recent study by Peters et al regarding sleep disturbances in patients with disease of the upper extremity (1). In this article, the authors aimed to correlate sleep disturbance and other psychosocial factors with upper extremity disability using a series of Patient-Reported OutcomesMeasurement Information System (PROMIS) questionnaires.
      PubDate: Sat, 03 Dec 2016 20:30:00 +010
  • Does Tranexamic Acid Reduce Bleeding During Femoral Fracture

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

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

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

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