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Journal Cover Archives of Bone and Joint Surgery
  [7 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2345-4644 - ISSN (Online) 2345-461X
   Published by Mashhad University of Medical Sciences Homepage  [14 journals]
  • Unusual complete isolated scaphoid dislocation. Report of a case .

    • Abstract: Isolated scaphoid dislocations are extremely rare injuries and are commonly associated with significant ligamentous disruptions. A dorsiflexion-supination force upon the hand consists the commonest mechanism of injury. Different treatment options have been proposed for the management of this uncommon entity. Reduction is difficult to achieve by closed means and usually open reduction is necessary. Techniques that have been proposed for the anatomical realignment of the carpal scaphoid into its fossa include closed reduction and percutaneous pinning, open reduction and pinning, with or without additional ligament reconstruction. The integrity of the ligaments that stabilize the scaphoid should be assessed. It has been described that the first ligaments that fail are the scapholunete and radioscaohocapitate followed by the radiolunate and finally the scaphotrapezial ligament.These disruptions must be addressed during surgery to prevent further complications.We present a case of an unusual complete isolated carpal scaphoid dislocation managed with open reduction and pinning along with ligamentous reconstruction.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • Open Anterior Hip Dislocation: A rare mechanism of injury

    • Abstract: Traumatic anterior dislocation of the hip is an extremely rare condition in children and open one is even rarer. This usually caused by high energy trauma. In following study, we present a case of an eight-year old child suffering an open anterior-inferior dislocation of right hip concomitant with pelvic ring disruption and ipsilateral open distal femoral fracture (Salter-Harris type 4, Gustilo type IIIA) due to a traffic accident. The patient underwent successful emergent open reduction due to the button-holed femoral head after appropriate irrigation and debridement. Successful recovery was achieved and the patient was discharged after 2 weeks. At 9 months follow-up, X-ray images showed slight changes related to osteonecrosis of the femoral head. Long-term follow-up over a course of 6 years showed sufficient range of motion. The gait was normal and the patient was satisfied with the outcomes. Also, slight non-progressive osteonecrotic changes was obvious in the right hip.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • Epidemiological profile of extremity fractures and dislocations in road
           traffic accidents in ...

    • Abstract: Introduction: Apart from the worst outcome, mortality, road traffic injuries are associated with significant morbidity too. This study aimed to examine the pattern of traffic accident-related extremity fractures/dislocations and their related disability.Materials and Methods: A retrospective, hospital-based study was conducted to assess the characteristics of limb fractures/dislocations among road traffic accident victims registered in Trauma Research Center registry of Kashan University of Medical Sciences, Kashan, Iran, during 2012-2013. Age and sex distribution, cause of injury, and site of fractures/dislocations were recorded. Years lived with disability (YLD) was calculated as a scale to measure disability. Data were analyzed using one-way ANOVA and chi-square tests. Results: From a total of 962 subjects, 812 (84.4%) were males (the male/female sex ratio: 5.4:1). The mean age of victims was 32.7±17.9. Fracture of the leg was the most frequent fracture (37%), followed by forearm (19%). Among dislocations, the most affected joint was shoulder accounting for 36.6% of the cases. The total calculated YLD was 135.6 (34.4 for temporal and 101.2 for lifelong disabilities, totally, 117.3 and 18.3 for males and females respectively). From the different transport modes, the highest YLD was for motorcyclists (104) and regarding the age groups the most YLD was for 15-29 years (68.2). Conclusions: Young men motorcyclists are a major problem in Kashan region. Generally, they were accounted for the highest YLD due to fractures/dislocations, especially in lower extremity. Although with increasing age the calculated YLD will be decreased, the elder people also had the high rate of traffic-related limb injuries.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • Restoration of the mechanical axis in Total Knee Artrhoplasty using
           patient-matched technology ...

    • Abstract: Background: The aim of this study is to evaluate the accuracy of bone cuts and the resultant alignment, using the MyKnee patient specific cutting blocks.Methods: We retrospectively reviewed 132 patients undergoing primary TKR for osteoarthritis by one single surgeon. The operative time, the preoperative Hip-Knee-Ankle (HKA) axis based on the CT-scan, the postoperative HKA axis based on long axis standing x-rays, the planned and the actual size of the femoral and the tibial components, and the number of the recuts which has been made intraoperative were measured.Results: The average preoperative HKA axis was 177.50 (range 163.50 to 1940), whereas the average postoperative HKA axis was 179.40 (range 177.10 to 182.70). No outliers were reported in the study (0%). Intraoperatively, 4 femoral components (3.03%), and 7 tibial components (5.30%) applied to the patients were different than the planned size. There was no need of recuts in any of our cases intraoperatively.Conclusions: The MyKnee system evaluated in this study was shown to be remarkable reliable in the coronal plane alignment, and the prediction of the component size. However, further studies are needed to determine whether there are any clinically important improvements in outcomes or patient satisfaction when using patient-specific cutting blocks for TKA.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • What Are The Results of Minimally Invasive Plate Osteosynthesis for
           Femoral and Tibial ...

    • Abstract: Purpose: Comminuted fractures happen frequently due to traumas and accidents. Recently fixa-tion without opening the fracture site known as Minimally Invasive Plate Osteosynthesis (MIPO) has become prevalent. As this method has not been discussed as often in orthopedic textbooks and its accurate results on comminuted fractures has not been clear, we performed this study to assess the results and complications of this treatment for tibial and femoral comminuted frac-tures.Methods: In this cross-sectional study 60 patients with femoral and tibial comminuted fractures were treated with MIPO method. 11 patients excluded due to lack of adequate follow-ups. Data including union time, infection in the fractured site, hip and knee range of motion and any malu-nion or deformities like limb length discrepancy collected after the surgery form every patient in every session.Results: 32 femoral fractures and 17 tibial fractures were evaluated. In 48 patients, union was completed but in one patient with femoral fractures, there was nonunion. Mean union time was 18.57±2.42 weeks. Femur fractures healed faster than tibia (17.76±2.36 and 19±2.37 weeks, re-spectively). None of our patients suffered from infections or fistula. The range of motion in hip and knee remained intact in approximately all of our patients. Malunion happened in ‘three’ pa-tients, 10-degree internal rotation in ‘one’ patient and ‘one’ centimeter limb shortening in ‘two’ patients. Conclusion: according to the result of this study and comparing it with other studies, it can be drawn that MIPO is a simple and effective method of fixation for comminuted fractures of long bones. It has a high rate of union with minimal complications. Infection is rare, and malunion or any deformity is incredibly infrequent. MIPO appears to be a promising and safe treatment alter-native for comminuted fractures with advantages and also disadvantages.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • evaluation of Changes in the Tibiotalar joint after High Tibial Osteotomy

    • Abstract: Background: There are limited studies regarding the effects of high tibial osteotomy (HTO) on other areas of lower extremity. In current study, we investigated the changes of tibiotalar joint following HTO.Methods: In this before and after study, 39 patients with genu varum requiring HTO were contributed. Before the operation and 6 months after the surgery, the genu varus angle, joint diversion angle (JDA), lateral distal tibial angle (LDTA) and lateral distal tibial-ground surface angle (LDT-GSA) were measured and compared.Results: totally 39 patients were investigated. Twenty three patients were females. The genu varus angle was decreased significantly (13±1.7 degrees versus 0.6±1 degrees). LDTA and JDA weren’t significant. LDT-GSA was changed significantly from 8.1±1 in varus to -0.3±0.5 in valgus.Conclusion: Although HTO did not changed the JDA and LDTA, but with significant change in LDT-GSA, it seems that HTO can significantly decrease the shearing forces exerted on ankle joint.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • The effect of sagittal femoral bowing on the femoral component position in
           total knee arthroplasty

    • Abstract: Purpose: In current study, we investigated that how sagittal femoral bowing can affect the sagittal alignment of the femoral component in total knee arthroplasy. Materials: There were 25 patients underwent TKA. long leg radiogaraphy in lateral view was performed. The sagittal femoral bowing (SFB) and component alignment in relation to the sagittal mechanical axis and distal anterior cortical line (DACL) were measured. Finally, the correlation of component alignment and SFB was examined. Results: Mean SFB was 7±2.7 degrees. The component was in flexion position in relation to mechanical axis and DACL as 8.4±2.9 degrees and 1.7±0.9 degrees, respectively. The flexion alignment of the component was significantly correlated with SFB. Conclusion: Mechanical alignment of the limb in both coronal and sagittal axes should be preserved in TKA. SFB can significantly increased the flexion alignment of the femoral component.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • Is spinal anesthesia with low dose lidocaine better than sevoflorane
           anesthesia in patients ...

    • Abstract: AbstractPurpose: to evaluate general anesthesia with sevoflurane vs spinal anesthesia with low dose lidocaine 5% on hemodynamics changes in patients undergoing hip fracture surgery. Methods and materials: in this randomized double blind trial 100 patients (50 patients in each group) older than 60 years under hip surgery were randomized in general anesthesia with sevoflurane and spinal anesthesia with lidocaine 5%.Then hemodynamic changes including mean arterial pressure (MAP) and heart rate, blood loss, pain severity, nausea and vomiting and opioids consumption were compared in two groups. Results: during surgery difference between two groups regarding changes in mean arterial pressure was not significant (p=0.103),but the changes in heart rate was significant different (p=0.004).Mean arterial pressure changes during recovery between two groups were significantly different. But there was no significant difference in heart rate changes. Bleeding in the sevoflurane group was significantly more than spinal group (513.ml vs 365 ml, P=0.001) .Moreover, AS Score, opioid consumption, and the nausea and vomiting in spinal anesthesia group was significantly lower than the sevoflurane group (p=0.0001).Conclusion: we confirmed that general anesthesia with sevoflurane and spinal anesthesia with low dose lidocaine 5% have comparable effects on hemodynamics changes in patients undergoing hip fracture surgery. However postoperative pain score, vomiting and morphine consumption in patients with spinal anesthesia was lower than general anesthesia.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • Adductor canal block for knee surgeries: An emerging analgesic technique

    • Abstract: In recent years, adductor canal block (ACB) has been introduced as an alternative for femoral nerve block with a great advantage of preserving or minimally reducing quadriceps strength. The technique is relatively easy and is performed under ultrasound guidance. Despite growing evidence regarding efficacy and safety of ACB following knee surgery, use of ACB is still limited to high volume orthopedic centers where trained anesthesiologists in regional anesthesia are available. In this editorial, we aim to briefly review current evidence about ACB.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • FUNCTIONAL RESULTS OF UNSTABLE( TYPE 2) DISTAL CLAVICLE FRACTURES TREATED
           WITH SUPERIOR ...

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

    • Abstract: Purpose: Proximal tibial fractures in elderly patients with osteoporosis or kneeosteoarthritis (OA) are challenging. In current study, we present our experiencewith uncommon acute primary total knee arthroplasty (PTKA) in this patientpopulation.Methods: Between 2005 and 2009, we performed PTKAs following a proximaltibial fracture for 30 consecutive patients aged over 60 years with osteoporosis orknee OA. Three condylar constrained knees (CCK) and no hinged knee prosthesiswere used. Patients were followed for 4.5±1.1 years.Results: Patients discharged after 4.6±1.2 days. The postoperative Tegner activityscale improved significantly compared to preoperative scale (3.5±1.3 versus2.5±1.2; p<0.001). The range of knee flexion was significantly greater in operatedside compared to uninjured knee (106±13 degrees Vs 120±8 degrees; p<0.001).The knee and function scores of the knee society knee score averaged 90.7±6.5and 69.6±8.8, respectively. All of the patients returned to their previous activities.Based on visual analogue scale, the patients' satisfaction and pain at final visitdetermined 8.1±1 and 1.5±1.2, respectively. There was no patient with infection,thromboembolic events and loosening.Conclusions: PTKA following a proximal tibial fracture in elderly patients withosteoporosis or knee degeneration can be considered as a safe alternative foropen reduction and internal fixation. PTKA resulted in immediate weight-bearing,improved functional status and patients' satisfaction. However, functionaloutcomes were dependent on the general condition of 24 the patient. Also,constrained knee prosthesis were not necessary for a vast majority of thepatients.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • An assessment of online reviews of hand surgeons

    • Abstract: Goals: The purpose of this study is to evaluate the number of reviews and scores for active members of the American Society for Surgery of the Hand (ASSH) in popular physician rating websites (Healthgrades.com and Vitals.com). Methods: A total of 433 ASSH active members were searched in two popular rating websites for a total of 866 web searches. Demographic data, overall and subcategory scores, number of reviews, and wait times were scored from each member’s webpage. Results: The average number of reviews per surgeon on Healthgrades.com was 13.8 (range 1-108), while the average number of reviews on Vitals.com was 9.4 (range 0-148). The average overall score for physicians was 8.1 of 10 points. For both websites, the vast majority (80-90%) of active members of the ASSH in our study had twenty or less reviews. Analysis of the data using multivariate analysis revealed no statistical differences in overall score by region or gender. Increasing physician age negatively correlated with overall score. Wait time was not associated with a negative score. Discussion: Active members of the ASSH received generally positive reviews. The average number of reviews for active members of the ASSH was exceedingly small, bringing into question the legitimacy and validity of these scores. This is especially important when taking into consideration the increasing popularity of these websites, and the reliance of patients on them to obtain physician information. The clinical implication of this study is that physicians have a vested interest in the legitimacy of the data provided by these websites and other physician rating outlets.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • ELASTIC STABLE INTRAMEDULLARY NAILING OF FEMORAL SHAFT FRACTURE –
           EXPERIENCE IN 48 CHILDREN

    • Abstract: Introduction: Femoral shaft fractures are an incapacitating peadiatric injury accounting for 1.6% of all paediatric bony injuries. Management of these fractures is largely directed by age, fracture pattern, associated injuries, built of the child and socioeconomic status of the family. We retrospectively evaluated the use of elastic stable intramedullary nail (ESIN) in surgical management of femoral shaft fractures in children and its complications.Materials and Methods: 52 children were treated with titanium elastic nails (TEN) from June 2009 to June 2014 at our institution.At the end of the study there were 48 children. Fractures were classified according to Winquest and Hansen’s as Grade I(n=32),Grade II(n=10),Grade III(n=6 ) and compound fractures by Gustilo and Anderson’s classification, Grade I (n=5), Grade II (n=3 ). There were 36 mid-shaft fractures, 7 proximal third shaft fractures, 5 distal third shaft fractures. The final results were clinically evaluated by using Flynn’s criteria and radiologically by Anthony et al’s criteria.Results: The mean duration of follow-up was 20 months(range 12 – 40 months). All fractures healed radiologically with grade III callus formation at 9 – 12 weeks (mean 9.7 weeks) . The results were analysed using Flynn’s criteria and were excellent in 40 children (83%) and satisfactory in 8 children (17%). The soft tissue discomfort near the knee produced by nail ends was the most common problem in our study (25%). Other complications include limb shortening (n=5), varus malunion (n=4), pin site infection (n=4) and nail migration (n=2). There was no delayed union,non-union or refractures. Conclusion: TEN is minimally invasive, safe, relatively easy to use and an effective treatment for fracture shaft of femur in properly selected children.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • Translation and validation of the Persian version of the Patient Rated
           Wrist Evaluation

    • Abstract: Purpose: the aim of this study was to validate and convert the original version of the PRWE into PersianMethods: One hundred and fourthly one adult patients with upper extremity conditions participated in this ethical board approved study from August 2015 to May 2016. After translating the original version of the PRWE into Persian, all patients filled out the PRWE in addition to the VAS (Visual analogue scale) and DASH questionnaires. For evaluating reliability, after seven days the researchers called back some of the patients who did not receive treatment and asked them to complete the PRWE retest (104 patients).Results: Cronbach’s alpha was calculated as high as 0.934, implying very reliable internal consistency. After each item deletion, the Cronbach’s alpha was still constant (range: 0.926 to 0.936). Intraclass correlation coefficient was 0.952 and this showed excellent test-retest reliability. The correlation coefficient between the PRWE and DASH scores was strong. Multivariable analysis showed an association between the PRWE and years educated.Conclusion: Our study has shown that the Persian version of the PRWE is valid and reliable for patients with upper extreme disabilities.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • Responsiveness of static and dynamic postural balance measures in people
           with anterior cruciate ...

    • Abstract: AbstractBackground: The main goal of physiotherapy for patients with anterior cruciate ligament reconstruction (ACL-R) is to improve postural control and retain knee function. Therefore, clinicians need to use evaluative tools that assess postural changes during physiotherapy. To maximize clinical utility of results obtained through these tools, measures extracted from the tools should have appropriate psychometric properties of reliability, validity and responsiveness. Reliability of postural measures have previously been established, but no study has yet addressed responsiveness of postural measures in these patients. Purpose: To investigate responsiveness and determine minimal clinically important changes (MCIC) of static and dynamic postural measures in patients with (ACL-R) following physiotherapy (n= 54). Methods: Static and dynamic postural measures were evaluated at first occasion and again after four weeks physiotherapy. Static measures were center of pressure (COP) parameters. Dynamic measures included stability indices. For assessing responsiveness, correlation analysis and receiver operating characteristics method were applied. Results: For static measures, results indicated that COP mean velocity, and SD velocity had acceptable responsiveness in both conditions of standing on injured leg with open-eyes with no-cognitive task (ION) and standing on uninjured leg with closed-eyes with no-cognitive task (UCN). For dynamic measures, stability indices in double-leg standing with closed-eyes with cognitive task (DCT) condition attained acceptable responsiveness. MCICs for mean velocity, and SD velocity in anteroposterior and mediolateral directions were 0.28cm/s, 0.008cm/s, 0.02cm/s, respectively in ION condition and were 0.14cm/s, 0.07cm/s, 0.06cm/s, respectively in UCN condition. Also, MCICs for anteroposterior, mediolateral and total stability indices were 0.51◦, 0.37◦, 0.34◦, respectively in DCT condition. Conclusions: Present findings provide evidence for selection of appropriate static and dynamic postural measures for assessment of changes in these patients. MCICs for these measures were determined, which provide practical information for clinicians to make decision about clinical significance of changes in patients' status.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • OSTEOPOROSIS AND THE MANAGEMENT OF SPINAL DEGENERATIVE DISEASE (I)

    • Abstract: Osteoporosis has become a major medical problem as the aged population of the world rapidly grows. Osteoporosis predisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concern before performing spine surgery, especially with bone fusions and instrumentation. Osteoporosis has often been considered a contraindication for spinal surgery, while in some instances patients have undergone limited and inadequate procedures in order to avoid concomitant instrumentation. As the population ages and the expectations of older patients increase, the demand for surgical treatment in older patients with osteoporosis and spinal degenerative diseases becomes progressively more important. Nowadays, advances in surgical and anesthetic technology make it possible to operate successfully on elderly patients who no longer accept disabling physical conditions. This article discusses the biomechanics of the osteoporotic spine, the diagnosis and management of osteoporotic patients with spinal conditions, as well as the novel treatments, recommendations, surgical indications, strategies and instrumentation in patients with osteoporosis who need spine operations.
      PubDate: Wed, 08 Mar 2017 20:30:00 +010
       
  • Chronic recurrent multifocal osteomyelitis in a 9-year-old boy

    • Abstract: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare aseptic, auto-inflammatory bone disorder. CRMO presents with bone pain with or without fever. The diagnosis of CRMO is a diagnosis of exclusion and should be included in the differential diagnosis of chronic inflammatory bone lesions in children. Cultures of the bone are typically sterile, antibiotic therapy does not result in clinical improvement whereas anti-inflammatory drugs improve the condition. Furthermore, biopsy should be considered in chronic and relapsing bone pain and swelling unresponsive to treatment.Herein, we present a nine-year-old boy complaining of recurrent pain in his upper and lower extremities. On examination he had mild fever and cervical lymphadenopathy. He also had experienced bone pain and weight loss in the recent month. Based on biopsy and bone scan he was finally diagnosed with CRMO. Naproxen and Pamidronate was prescribed and he was getting better and returned to normal life and activity without need to corticosteroids.
      PubDate: Sun, 05 Mar 2017 20:30:00 +010
       
  • Case Reports: Stories Worth Telling in Today`s Bone and Joint Literature

    • Abstract: Case reports are considered as the lowest level of evidence while at the same time they are frontiers of evidence collection. case reports are professional stories about novel medical events and will worth publication only if they possess complexity, proper data collection, justified diagnosis, and legitimate intervention as well as appropriate language, punctuation, and syntax. A case report must clearly reflect the author’s reputation and proficiency in both practice and writing....
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
       
  • Patient Complaints Emphasize Non-Technical Aspects of Care at a Tertiary
           Referral Hospital

    • Abstract: Background:Patient concerns represent opportunities for improvement in orthopaedic care. Thisstudy’s objectiveis to identify the nature and prevalence of unsolicited patient complaints regarding orthopaedic care ata tertiary referral hospital. The primary null hypothesis that there are no demographic factors associatedwith complaint types was tested. Secondarily we determined if the overall complaint number and typesdifferedby year.Methods:Complaints to the hospital ombudsperson by orthopaedic patients between January 1997 and June 2013 werereviewed. 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 andavailability, humaneness, disrespect, and billing compared to men. The overall number of complaints peakedin 1999. The most common issue was access and availability followed by communication, and humaneness/disrespect.Conclusion:Half of concerns voiced by patients addressed interpersonal issues. The largest category was related toaccess and availability. Quality improvement efforts can address technology to improve access and availability as wellas empathy and communication strategies.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
       
  • A Randomized Controlled Pilot Study of Educational Techniques in Teaching
           Basic Arthroscopic ...

    • Abstract: Background: Little is known about how to introduce complex technologies like arthroscopy into low-income countries. Thus, we compared low- versus high-resource intensive methods of teaching basic arthroscopic skills in a randomized controlled trial in Haiti.Methods: Forty-eight Haitian orthopaedic surgeons and residents attending an orthopaedic conference in Haiti were block randomized to receive instruction through a composite video (Control) or a composite video plus hands-on teaching with an expert visiting surgeon (Intervention). A low-fidelity surgical simulator tested visualization and triangulation skills. Participants completed a pre- and post-test where the goal was to sequentially tap the most numbers in 2.5 minutes. Outcome metrics included highest tapped number, number of errors, visualization loss, and number of lookdowns.Multivariate linear regression was used to confirm randomization and compare outcomes between groups.Results: Seventy-five percent of initially randomized attendees participated with similar attrition rates between both groups. All participants who performed a pre-test completed a post-test. In terms of highest tapped number, treatment and control groups significantly improved compared to pre-test scores, with mean improvement of 3.2% (P=0.007) and 2.2% (P=0.03), respectively. Improvement between treatment and control groups was not statistically different (P=0.4). No statistically significant change was seen with regard to other metrics.Conclusion: We describe a protocol to introduce basic arthroscopic skills in a low-income country using a low-resource intensive teaching method. However, this method of learning may not be optimal given the failure to improve in all outcome measures.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
       
  • Gravity Reduction View: A Radiographic Technique for the Evaluation and
           Management of Weber B ...

    • Abstract: Background: While various radiographic parameters and application of manual/gravity stress have been proposed to elucidate instability for Weber B fibula fractures, the prognostic capability of these modalities remains unclear. Determination of anatomic positioning of the mortise is paramount. We propose a novel view, the Gravity Reduction View (GRV), which helps elucidate non-anatomic positioning and reducibility of the mortise.Methods: The patient is positioned lateral decubitus with the injured leg elevated on a holder with the fibula directed superiorly. The x-ray cassette is placed posterior to the heel, with the beam angled at 15˚ of internal rotation to obtain a mortise view. Our proposed treatment algorithm is based upon the measurement of the medial clear space (MCS) on the GRV versus the static mortise view (and in comparison to the superior clear space (SCS)) and is based on reducibility of the MCS. A retrospective review of patients evaluated utilizing the GRV was performed.Results: 26 patients with Weber B fibula fractures were managed according to this treatment algorithm. Mean age was 50.57 years old (range: range:18-81, SD=19). 17 patients underwent operative treatment and 9 patients were initially treated nonoperatively. 2 patients demonstrated late displacement and were treated surgically. Using this algorithm, at a mean follow-up of 26 weeks, all patients had a final MCS that was less than the SCS (final mean MCS 2.86 mm vs. mean SCS of 3.32) indicating effectiveness of the treatment algorithm.Conclusion: The GRV is a novel radiographic view in which deltoid competency, reducibility and initial positioning of the mortise are assessed by comparing a static mortise view with the appearance of the mortise on the GRV. We have developed a treatment algorithm based on the GRV and have found it to be useful in guiding treatment and successful at achieving anatomic mortise alignment.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
       
  • Acetabular Fractures in the Senior Population– Epidemiology,
           Mortality and Treatments

    • Abstract: Background:Management of acetabular fractures in the senior population can be one of the most challenging injuries tomanage. Furthermore, 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 nonoperativecompared to operative management at different time points, (3) common fracture configurations, and (4) fracture fixationstrategies 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. 1123acetabular fractures were identified. 156 of them were for patients over the age of 65 (average age of 78).Results:Falls and motor vehicle accidents accounted for the two most common mechanisms of injury. 82% of patientshad significant medical comorbidities. 51 patients (33%) died within one year, in which 75% of them died within 90 daysof their acetabular fracture. 84% of the deceased patients, i.e. from the group of 51 patients, had non-operative treatment.For patients treated with traction alone, there was a 79% one-year mortality and 50% mortality rate within 90 days. Withinthe 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 reductiontechniques and surgical implants via two main surgical exposures of ilioinguinal (69%) and Kocher-Langenbeck (29%).Conclusion:Geriatric patients with acetabular fractures are uncommon accounting for only 14% of all acetabularfractures. Patients who undergo surgery show lower mortality rates. ABC and AC/PHT fracture patterns are the two mostcommon 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: Tue, 28 Feb 2017 20:30:00 +010
       
  • Does Tranexamic Acid Reduce Bleeding during Femoral Fracture
           Operation?

    • Abstract: Background:Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead topostoperative acute anemia and some other complications.Tranexamic acid (TA) is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusionrequirements during some elective surgeries (1-3).The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA) on intraoperative blood loss and asubsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting.Methods:Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullarynailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. GroupI, the intervention group with eighteen patients received 15 mg/kg (TA) via intravenous infusion before surgical incision.Patients in the placebo group received an identical volume of normal saline.Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobinchange as well as transfusion rates and volumes were compared between the two groups.Results:Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups,respectively (P=0.570). Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group(5.6%) compared to the placebo group (30%) (P=0.06). No significant difference in The Allowable Blood Loss during thesurgery was found between the two groups (P=0.894).Conclusion:Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion duringtraumatic femoral fracture operation.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
       
  • Prognostic Factors Affecting the Results of Modified Thompson
           Quadricepsplasty for the ...

    • Abstract: Background: Knee extension contracture is a disabling complication after fractures around the knee. In this study we aimed to study factors influencing the outcomes of quadricepsplasty for the treatment of traumatic knee extension contracture. We hypothesized that there is no factor influencing the final range of knee motion.Methods: In this retrospective study, we included 64 patients who underwent modified Thompson quadricepsplasty between 2008 to 2011 with a mean follow-up time of 36 months.Results:The mean change in flexion was 66 degrees. Using Judet criteria, results were excellent in 41 patients (64%), good in 15 (23%), fair in 4 (6%) and poor in 4 (6%). Preoperative arc of flexion, duration of extension contracture, number of previous surgeries on the limb, and BMI of the patients were independently influencing the final flexion.Conclusion: Modified Thompson quadricepsplasty is associated with high number of excellent and good results especially when it is performed earlier in more severe contractures. Preoperative arc of flexion, interval between trauma surgery and quadricepsplasty, the number of prior surgeries, and BMI influence the outcomes of quadricepsplasty.
      PubDate: Tue, 28 Feb 2017 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: Tue, 28 Feb 2017 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: Tue, 28 Feb 2017 20:30:00 +010
       
  • Recurrent Dislocation of the Proximal Interphalangeal Joint of the Finger:
           A Rare Issue in Hand ...

    • 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: Tue, 28 Feb 2017 20:30:00 +010
       
  • Stress Fracture of the Lateral Femoral Condyle afterTotal Knee
           Arthroplasty

    • Abstract: Background: This is to assess one of the rare complications after total knee replacement and to assess risk factors of failure.Methods: 11 patients with varus knee and an average age of 67 years underwent TKA between 2005 and 2013. All patients returned with a sudden sharp knee pain, disability to walk and significant decrease in ROM about 4 to 8 weeks after surgery. Radiographic examination revealed a lateral femoral condylar stress fracture.Results: After analyzing the images, we found common characteristics among all patients, which might be attributable to the later fracture including varus deformity>25, femoral component lateralization, and valgus correction.Conclusion: Surgeons should be aware of the risk factors to consider before, during, and after surgery.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
       
  • Challenges in Evaluating Sleep Disturbances in Patients with Hand and
           Upper Extremity Disease

    • Abstract: Challenges in Evaluating Sleep Disturbances in Patients with Hand and Upper Extremity Disease
      PubDate: Tue, 28 Feb 2017 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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 psoriasis.in 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
       
 
 
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