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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  [14 journals]
  • Total Knee Replacement Sizing: Shoe Size is a Better Predictor for Implant
           Size than Body Height

    • Abstract: Background and Purpose- Various sizes of implants need to be available during surgery. The purpose of this paper is to compare body height and shoe size with implant sizes in patients who underwent total knee replacement surgery to see which biomarker is a better predictor for implant size. Methods- A total of 100 knees, 50 female and 50 male knees were matched with body height and shoe size. The femoral anteroposterior and mediolateral width and the tibial anteroposterior and mediolateral width were correlated. Results- The correlation between shoe size and the four knee implant dimensions, femoral AP, ML, and tibial AP and ML were higher than the correlations between height and the same four dimensions. Conclusion- The results indicated that shoe size is a better predictor of component dimensions than body height is.
      PubDate: Fri, 04 Aug 2017 19:30:00 +010
       
  • Intrapelvic Protrusion of a Broken Guide Wire Fragment during Fixation of
           a Femoral Neck Fracture

    • Abstract: Breakage of DHS guide wire during surgery and its migration into the pelvis through the hip joint is a rare complication and its removal can be very challenging for the surgeon. We share our experience of a similar case wherein we used an ‘iliofemoral’ approach to successfully remove the broken transfixing guidewire from the hip joint. Although iliofemoral approach is similar to the lateral window of conventional ilioinguinal approach, yet it is less invasive, has lesser complications, requires less expertise and is easily reproducible by an average orthopaedic trauma surgeon. We recommend that surgical approaches for removal of these broken or migrated wires should be individualized depending upon the exact location of the wire tip in the hip joint or pelvis and need for exposure.
      PubDate: Fri, 04 Aug 2017 19:30:00 +010
       
  • Evaluation of normal ranges of wrist radiologic indexes in Mashhad
           population

    • Abstract: Background: The current study aims to measure the normal wrist indexes in our area, compares it with other present databases and discovers the factors may influence radiographic normal indexes. Methods: 100 healthy participants enrolled in this prospective and cross-sectional study. After performing PA or lateral radiographs, all radiological wrist indexes including first and third metacarpal length, wrist height, ulnar variance, radial tilt, radial inclination, radiolunate angle, capitolunate angle, scapholunate angle, capitate and scaphoid length, lunate and wrist width and Lunate diameter were measured. Results: Regarding gender, statically significant differences was measured in first and third metacarpal length, wrist height, radial tilt, radiolunate angle, capitate and scaphoid length, lunate, and wrist width, lunate length, and Lunate diameter. The significant linear correlation was measured between ulnar variance, scapholunate angle, wrist width and length with age. Conclusion: Our study is useful to obtain radiographic normal values of hand and wrist regarding morphological differences among Iranian.
      PubDate: Fri, 04 Aug 2017 19:30:00 +010
       
  • Effects of human adipose-derived stem cells and platelet-rich plasma on
           healing response of ...

    • Abstract: Object: Due to the known disadvantages of autologous bone grafting, tissue engineering approaches have become an attractive method for ridge augmentation in dentistry. To the best of our knowledge, this is the first study conducted to evaluate the potential therapeutic capacity of PRP-assisted hADSCs seeded on HA/TCP granules on regenerative healing response of canine alveolar surgical bone defects. This could offer a great advantage to alternative approaches of bone tissue healing-induced therapies at clinically chair-side procedures. Methods: Cylindrical through-and-through defects were drilled in the mandibular plate of 5 mongrel dogs and filled randomly as following: I- autologous crushed mandibular bone, II- no filling material, III- HA/TCP granules in combination with PRP, and IV- PRP-enriched hADSCs seeded on HA/TCP granules. After the completion of an 8-week period of healing, radiographic, histological and histomorphometrical analysis of osteocyte number, newly-formed vessels and marrow spaces were used for evaluation and comparison of the mentioned groups. Furthermore, the buccal side of mandibular alveolar bone of every individual animal was drilled as normal control samples (n=5). Results: Our results revealed that hADSCs subcultured on HA/TCP granules in combination with PRP significantly promoted bone tissue regeneration as compared with those defects treated only with PRP and HA/TCP granules (P< 0.05). Conclusion: In conclusion, our results indicated that application of PRP-assisted hADSCs could induce bone tissue regeneration in canine alveolar bone defects and thus, present a helpful alternative in bone tissue regeneration.
      PubDate: Fri, 04 Aug 2017 19:30:00 +010
       
  • Epineural sleeve reconstruction technique for median nerve complete
           transection

    • Abstract: In microsurgical nerve repair, the epineural sleeve technique can be used to bridge short nerve defects and to cover the coaptation site with the epineurium of the nerve stump. The epineurium serves as a mechanical aid to reduce gap size, and increase repair strength, effectively assisting nerve regeneration. This article presents a 32-year-old patient who experienced complete transection of the median nerve at the distal forearm, which was treated with the epineural sleeve graft reconstruction technique. Nerve regeneration was followed-up for 18 months and evaluated with the Rosén and Lundborg scoring system. The final outcome was excellent; at the last follow-up, the patient experienced complete sensory and motor function of the median nerve.
      PubDate: Fri, 28 Jul 2017 19:30:00 +010
       
  • Acute Combined Median and Radial Nerve Palsies after Distal Humeral Shaft
           Fracture

    • Abstract: We report a case of a 29-year-old man who presented with a distal humeral shaft fracture sustained by blunt trauma. Physical examination and nerve conduction study were consistent with injury to the median and radial nerves proximal to the elbow. The patient underwent open reduction and internal fixation of the humeral shaft fracture with neurolysis of the median and radial nerves. Repeat electromyography at 6 months postoperatively showed recruitment of motor units in all muscles sampled, in keeping with clinical improvement. At 16 months follow-up, the patient was full strength in all muscle groups, was back to all activities with no restrictions, and was discharged from follow-up. Our case describes clinical improvement after surgical intervention in a patient with combined median and radial nerve palsies following distal humeral shaft fracture.
      PubDate: Fri, 21 Jul 2017 19:30:00 +010
       
  • Important Lessons Learned From Nearly a Half-Century of Orthopedic
           Practice

    • Abstract: “Those who cannot remember the past are condemned to repeat it” [1]. The famous quote from Hispanic American philosopher George Santayana reminds us of the critical importance of constantly reflecting on the most important lessons garnered from both our own personal experiences and those of our peers. In 49 years of academic orthopedic practice, I have frequently reflected on the most important lessons I have learned, and to which, in addition to hard work and perhaps simple luck, I attribute much of my success
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • Joint Distraction in Advanced Osteoarthritis of the Ankle

    • Abstract: replacement (TAR) in patients with advanced ankle osteoarthritis (OA). AJD could a tenable option to ankle fusion orTAR.Methods: A review has been performed on the role of AJD in advanced OA of the ankle. The exploration machinewas MedLine. The keywords utilized were: joint distraction ankle. Three hundred and eleven articles were found. Ofthe above-mentioned, only 14 were chosen and analyzed because they were rigorously focused on the issue and thequestion of this paper.Results: Forty-seven patients met inclusion criteria with 15 in the acute RSA group and 32 in the secondary RSA group.The acute RSA group demonstrated better external rotation (28˚) than the secondary RSA group (18˚, P=0.0495). Theacute RSA group showed a trend towards better Single Assessment Numeric Evaluation (SANE) scores. Tuberosityhealing rate was higher in the acute RSA group.Conclusion: The types of articles published until now have a poor level of evidence (levels III and IV). The overallnumber of patients managed until now by way of AJD is 249. The published mean follow-up is very variable, from 1year to 12 years. The rate of good outcomes ranged between 73% and 91%. The percentage of failure (final anklearthrodesis or TAR) ranged between 6.2% and 44%. A minimum of 5.8 mm of distraction gap must be achieved. Anklefunction after AJD deteriorates over time. Putting together ankle movement and distraction will result in an early andmaintained profitable influence on outcome.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • Early Versus Late Reverse Shoulder Arthroplasty for Proximal Humerus
           Fractures: Does It Matter'

    • Abstract: Background: This study compared the outcomes between patients with proximal humerus fractures (PHF) whounderwent acute reverse total shoulder arthroplasty (RSA) to those who underwent an alternative initial treatmentbefore requiring (secondary) RSA.Methods: Patients who underwent RSA after suffering a PHF were identified. Two year clinical follow-up was requiredfor inclusion. Patients were divided into an acute group (RSA secondary RSA group was subdivided by initial treatment (non-operative, hemiarthroplasty, open reduction internalfixation (ORIF)). Clinical and radiographic outcomes were compared.Results: Forty-seven patients met inclusion criteria with 15 in the acute RSA group and 32 in the secondary RSA group.The acute RSA group demonstrated better external rotation (28˚) than the secondary RSA group (18˚, P=0.0495). Theacute RSA group showed a trend towards better Single Assessment Numeric Evaluation (SANE) scores. Tuberosityhealing rate was higher in the acute RSA group.Conclusion: While acute and secondary RSA can yield successful outcomes, acute RSA results in a higher tuberosityhealing rate and improved external rotation.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • First Metatarsophalangeal Joint Arthrodesis: A Retrospective Comparison of
           Crossed-screws, ...

    • Abstract: Background:Locking plate fixation is increasingly used for first metatarsophalangeal joint (MTP-I) arthrodesis. Still there is few comparable clinical data regarding this procedure. Methods:We retrospectively evaluated 60 patients who received an arthrodesis of the MTP-I between January 2008 and June 2010. With 20 patients each we performed a locking plate fixation with lag screw, arthrodesis with crossed-screwsor with a nonlocking plate with lag screw. Results: There were four non-unions in crossed-screws patients and one nonunion in non-locked plate group. All the patients in locking plate group achieved union. 90% of the patients were completely or mildly satisfied in locking plate group, whereas this rate was 80% for patients in both crossed screws and non-locking plate groups. Conclusions: Use of dorsal plating for arthrodesis of MTP1 joint either locking or non-locking were associated with high union rate and acceptable and comparable functional outcome. Although nonunion rate was high using two crossed screws but functional outcome was not significantly different compare to dorsal plating. Level of evidence:Ш, retrospective comparative study
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • Is Spinal Anesthesia with Low Dose Lidocaine Better than Sevoflorane
           Anesthesia in Patients ...

    • Abstract: Background: To evaluate general anesthesia with sevoflurane vs spinal anesthesia with low dose lidocaine 5% onhemodynamics changes in patients undergoing hip fracture surgery.Methods: In this randomized double blind trial 100 patients (50 patients in each group) older than 60 years underhip surgery were randomized in general anesthesia with sevoflurane and spinal anesthesia with lidocaine 5%.Hemodynamic changes including mean arterial pressure (MAP) and heart rate, blood loss, pain severity, nausea andvomiting and opioids consumption were compared in two groups.Results: During surgery, difference between two groups regarding changes in mean arterial pressure was notsignificant, but the changes in heart rate were significantly different. Mean arterial pressure changes during recoverybetween two groups were significantly different. But there was no significant difference in heart rate changes. Bleedingin the sevoflurane group was significantly more than spinal group (513.ml vs. 365 ml). Moreover, AS Score, opioidconsumption, and the nausea and vomiting in spinal anesthesia group was significantly lower than the sevofluranegroup.Conclusion: We showed 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 postoperativepain score, vomiting and morphine consumption in patients with spinal anesthesia were lower than general anesthesia.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • Questionable Word Choice in Scientific Writing in Orthopedic Surgery

    • Abstract: Background: Given the strong influence of thoughts, emotions, and behaviors on musculoskeletal symptoms andlimitations it’s important that both scientific and lay writing use the most positive, hopeful, and adaptive words andconcepts consistent with medical evidence. The use of words that might reinforce misconceptions about preferencesensitiveconditions (particularly those associated with age) could increase symptoms and limitations and might alsodistract 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 specificterms misused per article per journalResults: Eighty percent of all orthopedic scientific articles reviewed had questionable use of at least one term. Tearwas most questionably used with respect to rotator cuff pathology. The words fail and require were the most commonquestionably used terms overall.Conclusion: The use of questionable words and concepts is common in scientific writing in orthopedic surgery. It’sworth considering whether traditional ways or referring to musculoskeletal illness merit rephrasing.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • Is It “Fractured” or “Broken”' A Patient Survey Study to
           Assess Injury Comprehension ...

    • Abstract: the bone is “fractured” or “broken”. While orthopaedic surgeons consider these terms synonymous, patients appear tocomprehend the terms as having different meanings. Given the commonality of this frequently posed question, it may beimportant for providers to assess patients’ level of understanding in order to provide optimal care. The purpose of thisstudy is to evaluate patients’ comprehension and understanding regarding the use of the terms fractured and broken.Methods: A survey was administered as a patient-quality measure to patients, family members and/or other non-patientspresenting to an orthopaedic outpatient clinic at an academic teaching hospital.Results: 200 responders met inclusion criteria. Only 45% of responders understood the terms fractured and brokento be synonymous. Age, gender, nor ethnicity correlated with understanding of terminology. Responders described a“fractured” bone using synonyms of less severe characteristics for 55.7% of their answers and chose more severecharacteristics 44.3% of the time, whereas responders chose synonyms to describe a "broken” bone with more severecharacteristics as an answer in 62.1% of cases and chose less severe characteristics 37.9% of the time. The differencefor each group was statistically significant (P=0.0458 and P ≤0.00001, respectively).There was no correlation betweenlevel of education nor having a personal orthopaedic history of a previous fracture with understanding the termsfracture and broken as synonymous. Having an occupation in the medical field (i.e. physician or physical/occupationaltherapist) significantly improved understanding of terminology.Conclusion: The majority of people, regardless of the age, gender, race, education or history of previous fracture, maynot understand that fractured and broken are synonymous terms. Providers need to be cognizant of the terminology theyuse when describing a patient’s injury in order to optimize patient understanding and care.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • Psychometric Properties of the Persian Version of the Patient Rated Wrist
           Evaluation

    • Abstract: Background: The patient-rated wrist evaluation (PRWE) score is one of the most common clinical instruments usedas an outcome measurement tool for distal radius fractures and other upper extremity conditions. The purpose of thisstudy was to translate the PRWE into its Persian version and to evaluate its validity and reliability in patients with upperextremity conditions.Methods: One hundred and fourthly one adult patients with upper extremity conditions participated in this ethical boardapproved study from August 2015 to May 2016. After translating the original version of the PRWE into Persian, allpatients filled out the PRWE in addition to the VAS (Visual analogue scale) and DASH questionnaires. For evaluatingreliability, after three days the researchers called back some of the patients who did not receive treatment or anychanges in symptoms 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 itemdeletion, the Cronbach’s alpha was still constant (range: 0.926 to 0.936). Intraclass correlation coefficient was 0.952and this showed excellent test-retest reliability. The correlation coefficient between the PRWE and DASH scores wasstrong. 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 upperextremity conditions.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • The Effect of Sagittal Femoral Bowing on the Femoral Component Position in
           Total Knee Arthroplasty

    • Abstract: Background: In the current study, we investigated that how sagittal femoral bowing can affect the sagittal alignment ofthe femoral component in total knee arthroplasty (TKA).Methods: There were 25 patients underwent TKA. Long leg radiography in lateral view was performed. The sagittalfemoral 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 as8.4±2.9 degrees and 1.7±0.9 degrees, respectively. The flexion alignment of the component was significantly correlatedwith SFB.Conclusion: Mechanical alignment of the limb in both coronal and sagittal axes should be preserved in TKA. SFB cansignificantly increased the flexion alignment of the femoral component.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • Anatomical Repair of Stener-like Lesion of Medial Collateral Ligament: A
           case Series and ...

    • Abstract: Medial collateral ligament tears usually will be treated through non-surgical methods, but, in some cases such as thosewith tears at the distal insertion where the reduction could be blocked by the pes anserine tendons (Stener-like lesion), surgerywill be performed. Here, we present a surgical technique in such cases. In this retrospective case series, we describesix patients diagnosed with Stener-like lesion based on clinical evaluation and imaging results. In the one-year follow-upvisit, there was no complaining of pain or joint instability and full range of motion and negative valgus stress test werereported in all cases. The results showed this surgical technique is a useful and safe treatment approach in such cases.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • Closed Internal Degloving of the Flank

    • Abstract: Originally described in 1853 by Dr. Morel-Lavellee, closed internal degloving injuries represent an important, althoughuncommon, source of morbidity in trauma patients. These injuries are typically the result of a shearing or crushing force thattraumatically separates the skin and subcutaneous tissue from the underlying fat. This results in disruption of perforatingblood vessels and lymphatics, leading to hematoma/seroma formation. We describe two cases in which industrial crushinjuries resulted in lumbar transverse process fracture. Both patients developed closed degloving injuries of the flank. Tothe author’s knowledge, this is the first case series describing the occurrence of closed internal degloving injuries of theflank with transverse process fractures. We advise that a high level of suspicion for these lesions to occur with transversespinal fractures should be maintained, as they may arise several years after initial injury.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • Persistent Medial Subluxation of the Ulna with Radiotrochlear Articulation

    • Abstract: Two patients-one with a terrible triad fracture dislocation and one with an anterior olecranon fracture dislocation—weretreated for maltracking of the elbow (medial subluxation). The radial head articulated with the lateral trochlea while theulnar trochlear notch was perched over the medial trochlea. The late revision surgery could not correct the subluxationbecause the joints were accustomed to the new alignment, however the overall function was reasonable.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • First use of a brief 60-second mindfulness exercise in an orthopedic
           surgical practice; Results ...

    • Abstract: Background: Mindfulness based interventions may be useful for patients with musculoskeletal conditions in orthopedic surgical practices as adjuncts to medical procedures or alternatives to pain medications. However, typical mindfulness programs are lengthy and impractical in busy surgical practices. We tested the feasibility, acceptability and preliminary effect of a brief, 60-second mindfulness video in reducing pain and negative emotions in patients presenting to an orthopedics surgical practice. Methods: This was an open pilot study. Twenty participants completed the Numerical Rating Scale to assess pain intensity, the State Anxiety subscale of the State Trait Anxiety Scale to assess state anxiety, and emotional thermometers to assess distress, anxiety, anger and depression immediately prior to and following the mindfulness video exercise. At the end of the exercise patients also answered three questions assessing satisfaction with the mindfulness video. Results: Feasibility of the mindfulness video was high (100%). Usefulness, satisfaction and usability were also high. Participants showed improvements in state anxiety, pain intensity, distress, anxiety, depression and anger after watching the video. These changes were both statistically significant and clinically meaningful, when such information was available. Conclusion: People with musculoskeletal pain seeking orthopedic care seem receptive and interested in brief mindfulness exercises that enhance comfort and calm.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • Single cut distal femoral varus osteotomy (SCFO): A preliminary study

    • Abstract: Single cut distal femoral varus osteotomy (SCFO): A preliminary study Abstract: Background: Genu valgum usually originates from the distal femoral deformity and distal femoral varus osteotomy is the treatment of choice. The osteotomy must be included both angulation and translation components because the osteotomy site usually is not at the apex of deformity. Patellar-tracking improvement not only depends on valgus correction but also it may be partially due to centralization of the trochlear groove under the femoral anatomical axis (FAA). Questions/purposes: We asked whether we could accurately correct the deformities based on our preoperative goals for mechanical axis correction and centralize the trochlear groove under the FAA by one cut osteotomy' This study describes a new lateral single cut distal femoral osteotomy (SCFO), corrects both angulation and translation components simultaneously. material and method: This study was done on 12 young adult patients with femoral juxta-articular genu valgum deformity using SCFO. The average age at operation was 21 years (range 16-25). SCFO is a kind of closing-opening distal femoral osteotomy can correct the valgus deformity of the distal femoral fragment and translate it by one oblique cut. It centralizes the trochlear groove under FAA. We compared preoperative and postoperative radiographic and clinical parameters (mechanical tibiofemoral angle, knee ROM, IKDC subjective score) for all patients. Time to union was recorded. Follow-up was 24 months. Results: The average mechanical tibiofemoral angle improved from 15.5(10-23 degree) to 1 (-2 to +2). IKDC subjective score slightly improved from preoperative (65) to 2-year follow-up (71). Centralization of trochlea achieve in all patients. Conclusions: SCFO can be a reasonable alternative for correction of the femoral genu valgum deformity. It can centralize the patellar groove under FAA with satisfactory results. Level of Evidence: Level IV We declare no conflict of interest.
      PubDate: Fri, 30 Jun 2017 19:30:00 +010
       
  • Epidemiology of joint dislocations and ligamentous/tendinous injuries
           among 2,700 patients: ...

    • Abstract: Purpose: The epidemiology of traumatic dislocations and ligamentous/tendinous injuries is poorly understood. In this study, we aimed to evaluate the prevalence and distribution of various dislocations and ligamentous/tendinous injuries in a tertiary orthopedic hospital in Iran. Methods: In a 5-year prospective study, musculoskeletal injuries of an academic tertiary health care center in Tehran were recorded. Demographic details of patients with diagnosis of pure dislocations and ligamentous/tendinous injuries were extracted. Type and site of injuries were classified according to specific age/gender groups. Result: Of 18,890 admitted patients, 628 (3.3%) were diagnosed with dislocations and 2,081 (11%) were diagnosed with ligamentous/tendinous injuries. The total Male/Female ratio was 4.2:1 in patients with dislocations and 1.7:1 in patients with ligamentous/tendinous injuries. The most prevalent site of dislocation was shoulder (50.6%), followed by fingers (10.1%), toes (7.6%), hip (7.3%), and elbow (6.5%). Ankle was the most common site of ligamentous/tendinous injury (53.5%), followed by midfoot (12.3%), knee (8.3%), hand (7%), and shoulder (5%). The mean age of the patients was 35.0 (SD = 18.2) in dislocations and 31.3 (SD = 15.1) in ligamentous/tendinous injuries. There was no seasonal variation. Conclusion: Shoulder dislocation and ankle ligamentous injury are the most frequent injuries. Dislocations and ligamentous/tendinous injuries are more common in younger population. Dislocations and ligamentous/tendinous injuries have different distribution patterns in specific age and sex groups. Epidemiologic studies can help to develop and evaluate injury prevention strategies, resource allocation, and training priorities.
      PubDate: Sun, 28 May 2017 19:30:00 +010
       
  • Comparison of Clinical Outcomes Between Different Femoral Tunnel Positions
           after Anterior ...

    • Abstract: Purpose: This study investigated whether a change in the femoral tunnel position in both axial and coronal planes can significantly alter the postoperative functional and clinical outcomes of the patients. Method: This comparative, retrospective, single-center study was performed on 44 patients who had underwent single-bundle Anterior Cruciate Ligament Reconstruction (ACLR). To evaluate the tunnel position in coronal and axial planes, radiographic assessments were done. Based on radiographic data, the patients were classified into 4 groups. The time interval between surgery and last visit averaged 23.6 ± 2.2 months (18-30 mos.). Lysholm knee score, and Cincinnati score were completed for all of the patients. Furthermore, the Lachman, anterior drawer and pivot-shift tests were performed. Results: Of the 44 patients included in the study, 9 patients (20.4%) were classified as the low-anterior group, 17(38.6%) were classified as the low-posterior group and 18(40.9%) were classified as the high-posterior group. None of the patients were included in high-anterior group. A greater mean Lysholm score (96±3) in low-posterior group was the only significant difference between the three groups. Conclusion: Findings of the current study demonstrated that low-posterior placement of the femoral tunnel in the intrercondylar notch, based on both anteroposterior (AP) and tunnel-view x-rays, is associated with better clinical outcomes in short-term than the routine tunnel placements.
      PubDate: Wed, 24 May 2017 19:30:00 +010
       
  • Total Knee Arthroplasty in Patients with Retention of Prior Hardware
           Material: What is the Outcome'

    • Abstract: Background: There is an information gap in literature regarding postoperative outcome of total knee arthroplasty (TKA) in patients with hardware in-situ from the previous knee surgery. The present study aims to evaluate impact of retained hardware on short-term outcome of TKA patients. Methods: Perioperative radiographs of patients who had undergone TKA between 2007 and 2012 were reviewed and patients in whom partial or complete retention of hardware was evident after TKA were included. These patients were matched in 1 to 2 ratio based on age (+/- 2 years), gender, surgeon and year of surgery to a group of patients that underwent primary TKA without hardware in the affected knee. The average follow up of these patients was 43.45 (range 12-155.2) months. Complication rates were compared between the two groups using statistical tests that took into account the matched data structure. Results: We included a total of 55 cases and 110 controls. The incidence of complications was higher, although not all statistically significant, in the case group. Only mechanical complications were significantly different in the cases group (5.5% versus 0%, p=0.01). Time to event analysis using the mixed-effects Cox model didn’t show a statistically significant difference between two groups for various outcomes. Conclusions: Presence of retained hardware around the knee may predispose the patient to a higher rate of complications particularly mechanical complications of the implant after TKA. Further studies are required to investigate impact of retained hardware around the knee in patients undergoing TKA.
      PubDate: Fri, 12 May 2017 19:30:00 +010
       
  • Preoperative Sterilization Preparation of the Shoulder: A Comparative
           Study Evaluating Gauze ...

    • Abstract: Introduction: Surgical site infection (SSI) remains a concern in shoulder surgery, especially during arthroplasty. While many studies have explored the characteristics and efficacy of different sterilizing solutions, no study has evaluated the method of application. The purpose of this study was to compare two popular pre-surgical preparatory applications (two 4 x 4 cm gauze sponges and applicator stick) in their ability to cover the skin of the shoulder. Methods: Two orthopedic surgeons simulated the standard pre-surgical skin preparation on 22 shoulders of volunteer subjects. Each surgeon alternated between an applicator stick and two sterile 4x4 cm gauze sponges. Skin preparation was performed with a commercially available solution that can be illuminated under UV-A light. Advanced image-analysis software was utilized to determine un-prepped areas. A two-tailed paired t-test was performed to compare percentage of un-prepped skin. Results: The applicator stick method resulted in a significantly higher percentage of un-prepped skin (27.25%, Range 10-49.3) than the gauze sponge method (15.37%, Range 5-32.8, p=0.002). Based on image evaluation, most un-prepped areas were present around the axilla [Figure 1]. Conclusion: Based on our findings, the use of simple gauze sponges for pre-surgical preparatory application of sterilization solution may result in a lower percent of un-prepped skin than commercially available applicator stick. Orthopaedic surgeons and operating room staff should be careful during the pre-surgical sterile preparation of the shoulder, especially the region around the axilla, in order to reduce the potential risk of surgical site infection.
      PubDate: Wed, 10 May 2017 19:30:00 +010
       
  • OSTEOPOROSIS AND THE MANAGEMENT OF SPINAL DEGENERATIVE DISEASE (II)

    • Abstract: Osteoporosis has become a major medical problem as the aged population of the world rapidly grows. Osteoporosis predisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concern before performing spine surgery, especially with bone fusions and instrumentation. Osteoporosis has often been considered a contraindication for spinal surgery, while in some instances patients have undergone limited and inadequate procedures in order to avoid concomitant instrumentation. As the population ages and the expectations of older patients increase, the demand for surgical treatment in older patients with osteoporosis and spinal degenerative diseases becomes progressively more important. Nowadays, advances in surgical and anesthetic technology make it possible to operate successfully on elderly patients who no longer accept disabling physical conditions. This article discusses the biomechanics of the osteoporotic spine, the diagnosis and management of osteoporotic patients with spinal conditions, as well as the novel treatments, recommendations, surgical indications, strategies and instrumentation in patients with osteoporosis who need spine operations.
      PubDate: Wed, 10 May 2017 19:30:00 +010
       
  • A single femoral component for all total hip replacements performed by a
           trust' Does this ...

    • Abstract: Background: Hospitals may be under pressure to implement cost saving strategies regarding prosthesis choice. This may involve the use of components which are not the first preference of individual surgeons, or those they have little experience with. We aim to examine the effect of standardizing the type of femoral stem used in a single trust, and determine whether this is safe practice, particularly in those who have never used this particular stem before. Methods: We report results at 2 years of 151 primary total hip arthroplasties performed using a single femoral stem. Data was split into 2 groups: those in which the operating surgeon was previously using this femoral stem, and those who were not. Radiographic outcomes measured were leg length discrepancy, cement mantle grade, and femoral stem alignment. We also report on clinical outcomes, complications, and construct survivability. Results: No significant differences in clinical outcomes were observed. Cement quality was generally worse in those with no prior use of this stem. Leg length inequality was greater in those previously using the stem (+1.57mm vs 3.83mm), however this did not correlate to clinical outcomes. Alignment was similar between the groups (p = 0.464) Conclusion: Our findings suggest that although clinical outcomes are similar at 2 years, radiological differences can be observed even at this early stage in follow up. Choice of components for arthroplasty should remain surgeon led until long term follow up studies can prove otherwise.
      PubDate: Wed, 10 May 2017 19:30:00 +010
       
  • DDH Epidemiology Revisited , Do We Need New Strategies'

    • Abstract: DDH Epidemiology Revisited , Do We Need New Strategies' Abstract Introduction: Developmental Dysplasia of the Hip (DDH), is well known to pediatric orthopedists but its etiology still remains unknown. Although a vast majority of research are dedicated to this, but the results are confusing and inadequate. Material and method: 1073 neonates’ hips were examined by sonography and the results were classified according to Graf’s classification. Pathologic hips were cross checked by known risk factors for DDH. Result: There is a significant correlation between DDH occurrence and breech presentation, torticollis, positive family history, metatarsus adductus and oligohydramnious. Conclusion:Incidence of DDH is significantly high in this group of neonates. This make us reevaluate our current approach to this condition .We need to improve our screening protocols with the help of trained pediatricians, sonographists and other health professions. Keywords: congenital hip dysplasia, medical sonography, incidence study.
      PubDate: Mon, 24 Apr 2017 19:30:00 +010
       
  • Blood Glucose Levels in Diabetic Patients Following Corticosteroid
           Injections into the ...

    • Abstract: Introduction Corticosteroid injections are used to treat a variety of orthopedic conditions with the goal of decreasing pain and inflammation. Administration of systemic or local corticosteroids risks temporarily increasing blood glucose levels, especially diabetic patients. The purpose of this study is to quantify the effects of corticosteroid injections on blood glucose levels in diabetic patients with shoulder pathology. Methods Diabetic patients who regularly monitored their blood glucose levels and were indicated for a subacromial corticosteroid injection were included in this prospective investigation. The typical normal morning fasting glucose and most recent hemoglobin A1c level was recorded for each patient. After injection, patients were contacted daily to confirm their fasting morning glucose level for 10 days post-injection. Results Seventeen consecutive patients were enrolled. Patients with hemoglobin A1c of < 7% had an average rise in blood glucose of 38 mg/dL compared to 98 mg/dL in the poorly controlled group after injection (p < 0.001). Well-controlled patients’ glucose levels returned to near baseline levels around post-injection day 8, while poorly controlled patients levels remained elevated. Similarly, insulin-dependent diabetic patients had an average increase in fasting glucose level of 99 mg/dL versus 50 mg/dL in non-insulin-dependent diabetic patients (p<0.001). Conclusions After corticosteroid injection, patients with well-controlled diabetes experience smaller elevations and faster return to baseline glucose levels than patients with poor control. Insulin dependent diabetics experienced similar findings as patients with poor control. Future studies are needed to evaluate dosing to optimize the risks of blood glucose elevation while maintaining therapeutic benefit.
      PubDate: Sat, 15 Apr 2017 19:30:00 +010
       
  • Dupuytren’s Disease: Predicting Factors and Associated Conditions.
           ...

    • Abstract: Object: Conflicting studies link several conditions and risk factors to Dupuytren’s disease (DD). A questionnaire-based case-control study was set to investigate associated conditions and clinical features of DD in a sample of Italian patients. The main purpose was the identification of predicting factors for: DD development; involvement of multiple rays; involvement of both hands; development of radial DD; development of recurrences and extensions. Material and Methods: A self-administered questionnaire was used to investigate medical and drug histories, working and life habits, DD clinical features, familial history, recurrences and extensions. Binary logistic regression, Mann Whitney U-test and Fisher’s exact test were used for the statistical analysis. Results: A role in DD development was found for male sex, cigarette smoking, diabetes and heavy manual work. The development of aggressive DD has been linked to age, male sex, high alcohol intake, dyslipidemias and positive familial history. Conclusions: Further studies might explain the dual relationship between ischemic heart disease and DD. According to our results, the questionnaire used for this study revealed to be an easy-handling instrument to analyze the conditions associated to DD. Nevertheless, its use in further and larger studies is needed to confirm our results as well as the role of the questionnaire itself as investigation tool for clinical studies.
      PubDate: Sat, 15 Apr 2017 19:30:00 +010
       
  • Economic Analysis of Bisphosphonate Use after Distal Radius Fracture for
           Prevention of Hip Fracture

    • Abstract: INTRODUCTION Osteoporosis is a common condition among the elderly population, and is associated with an increased risk of fracture. One of the most common fragility fractures involve the distal radius, and are associated with risk of subsequent fragility fracture. Early treatment with bisphosphonates has been suggested to decrease the population hip fracture burden. However, there have been no prior economic evaluations of the routine treatment of distal radius fracture patients with bisphosphonates, or the implications on hip fracture rate reduction. METHODS Age specific distal radius fracture incidence, age specific hip fracture rates after distal radius fracture with and without risendronate treatment, cost of risendronate treatment, risk of atypical femur fracture with bisphosphonate treatment, and cost of hip fracture treatment were obtained from the literature. A unique stochastic Markov chain decision tree model was constructed from derived estimates. The results were evaluated with comparative statistics, and a one-way threshold analysis performed to identify the break-even cost of bisphosphonate treatment. RESULTS Routine treatment of the current population of all women over the age of 65 suffering a distal radius fracture with bisphosphonates would avoid 94,888 lifetime hip fractures at the cost of 19,464 atypical femur fractures and $19,502,834,240, or on average $2,186,617,527 annually, which translates to costs of $205,534 per hip fracture avoided. The breakeven price point of annual bisphosphonate therapy after distal radius fracture for prevention of hip fractures would be approximately $70 for therapy annually. CONCLUSION Routine treatment of all women over 65 suffering distal radius fracture with bisphosphonates would result in a significant reduction in the overall hip fracture burden, however at a substantial cost of over a $2 billion dollars annually. To optimize efficiency of treatment either patients may be selectively treated, or the cost of annual bisphosphonate treatment should be reduced to cost-effective margins.
      PubDate: Sat, 15 Apr 2017 19:30:00 +010
       
  • Giant cell tumor of the sacrum: Series of 19 patients and review of the
           literature.

    • Abstract: Abstract: Introduction: There are still some debates regarding the best treatment of Giant Cell Tumor (GCT) of the sacrum. Since GCT of this location is rare, therapeutic strategies are mainly based on the treatment of GCT in other anatomic locations. The objective of this study was to evaluate the oncologic and clinical results of surgical management of sacral GCT with and without local adjuvant therapy. Methods: Medical records of 19 patients diagnosed with GCT of the sacrum, were retrospectively reviewed. Sixteen patients were treated by intralesional curettage and three patients with marginal resection. Musculoskeletal tumor society (MSTS) score was used for the evaluation of functional outcome. Results: Prolonged pain was the most common complication after treatment. Mean Pre and post-operative pain based on visual analogue scale (VAS)was 6.1 ± 1.99 and 3.05 ± 1.64, respectively. Postoperative neurologic deficit appeared in six patients. In addition, infection occurred in five patients. One case of spinopelvic instability was also observed after surgery. At average follow up of 158.5 ± 95.9 months (range 25 to 316 months), recurrence was seen in eight (42.7%) out of seventeen patients treated by intralesional curettage. The size of the tumor significantly correlated with the tumor recurrence (r=0.654, p=0.001). Mean MSTS score was 74.7 ± 16.78. Those patients, in whom sacral nerve roots remained intact before and after surgery, had better functional outcome. Conclusion: Preservation of sacral nerve roots is associated with better functional outcome and less pain. Although an acceptable surgical outcome was observed in our cohort, the problem of local recurrence still warrants further investigations for better local control of the tumor.
      PubDate: Sat, 15 Apr 2017 19:30:00 +010
       
  • Brucella Arthritis Following Total Knee Arthroplasty in a Patient with
           Hemophilia: a Case Report

    • Abstract: Total knee arthroplasty is a rewarding procedure in patients with hemophilia and end stage knee hemophilic arthropathy. However, this procedure may be associated with complications such as infection. There periprosthetic joint infection in patients with hemophilia is very well known, though we are not aware of any previous report on Brucella infection in this group of patients. We report a 28 years old man with Brucella infection of total knee replacement who underwent conservative treatment at the beginning and finally by two stage revision. We believe that this report will alert physicians who work in endemic area for brucellosis to consider this in differential diagnosis and do the right intervention at the right time.
      PubDate: Sat, 08 Apr 2017 19:30:00 +010
       
  • Measurement of posterior tibial slope using magnetic resonance imaging

    • Abstract: Background: Posterior tibial slope (PTS) is an important factor in the knee joint biomechanics and one of the bone features, which leads to knee joint stability. Posterior tibial slope affects flexion gap, knee joint stability and posterior femoral rollback that are related to wide range of knee motion. During high tibial osteotomy and total knee arthroplasty (TKA) surgery, proper retaining the mechanical and anatomical axis is important. The aim of this study was to evaluate the value of posterior tibial slope in medial and lateral compartments of tibial plateau and to assess the relationship among the slope with age, gender and other variables of tibial plateau surface. Materials and methods: This descriptive study was conducted on 132 healthy knees (80 males and 52 females) with a mean age of 38.26±11.45 (20-60 years) at a medical center in Mashhad, Iran. All patients required to MRI admitted for knee pain with uncertain clinical history and physical examination that were reported healthy at knee examination were enrolled in the study. Results: The mean posterior tibial slope was 7.78±2.48 degrees in the medial compartment and 6.85±2.24 degrees in lateral compartment. No significant correlation was found between age and gender with posterior tibial slope (P≥0.05), but there was significant relationship among PTS with mediolateral width, plateau area and medial plateau. Conclusions: Comparison of different studies revealed that the PTS value in our study is different from other communities, which genetic and racial factors can be involved in these differences. The results of our study are useful to PTS reconstruction in surgeries.
      PubDate: Sat, 08 Apr 2017 19:30:00 +010
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
 
 
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