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Journal Cover   Archives of Bone and Joint Surgery
  [2 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2345-4644 - ISSN (Online) 2345-461X
   Published by Mashhad University of Medical Sciences Homepage  [12 journals]
  • A chick embryo in-vitro model of knee morphogenesis.

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

    • Abstract: ABSTRACTINTRODUCTION: Tuberculosis is an essential problem for healthcare systems especially in developing countries . All newborns are given Bacillus Calmette-Guérin (BCG) vaccine in Iran which is prepared from live bovine tuberculosis bacillus, and is given to protect against tuberculosis . Osteomyelitis secondary to BCG vaccination is rare and usually involves epiphysis of long tubular bones .METHODS:4 patients, 3 males and a female entered this study and were between 11 to 24 months old. The involved bones were first metatarsi, talus, humerus and tibia bone. The main radiologic finding was lytic lesion with cortical destruction and periosteal reaction.RESULTS: 3 patients underwent core needle biopsy and the one with the proximal tibia involvement, underwent open surgery. Pathology report suggested granulomatous osteomyelitis and typical caseous necrosis compatible with tuberculosis. Surgical treatment for these patients was basically curettage and debridement of the bone lesion and involved tissues around. The patients got standard anti TB pharmacotherapy, were completely cured and no short term complication was seen in a one year follow up .CONCLUSION: Our patients had no clear history of contact with TB in their family, so the only source of tuberculosis must be the BCG vaccination. Therefore, BCG osteomyelitis and cold abscess, should be kept in mind when assessing a child presenting chronic symptoms like pain, limping or local swelling of extremities. The long interval time between BCG vaccination and outbreak of the culture-negative abscess is a major point which emphasizes on pathologic evaluation. Imageguided tissue biopsy and PCR studies confirm diagnosis. Early use of a surgical curettage and debridement along with chemotherapy soon afterwards, enabled these children to enjoy a satisfactory clinical outcome.
      PubDate: Sat, 12 Sep 2015 19:30:00 +010
  • An Isolated Mass in the Palm, Starting Manifestation of Sarcoidosis

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

    • Abstract: Background: Scaphoid malunion alters the carpal kinematics and impairs the clinical outcome because of pain, weakness, restricted range of motion and predisposes the wrist joint to early osteoarthritis. The aim of this study was to evaluate the influence of the scaphoid morphology on the clinical outcomes in the patients with reconstructed scaphoid by non-vascularized bone graft.Materials and Methods: 17 male patients with the mean age of 31.7± 3.7 years and mean non-union time of 31.5 ± 14.7 months were available and had informed consent to participate in this retrospective study. Average follow up was 48.8± 9.4 months. At the last follow-up the patients were evaluated clinically for pain, wrist range of motion, grip strength, wrist functional status and radiologically by wrist radiographs and computerized tomography (CT). The overall clinical outcomes were evaluated by Cooney wrist function score. The morphology of the reconstructed scaphoids was evaluated by lateral intraschaphoid angle, antroposterior intraschaphoid angle, dorsal cortical angle, measuring the length (mm), and height-to-length ratio on CT scan. The radiological measurements were compared versus the overall clinical outcomes.Results: There were 7 excellent, 7 good, 3 fair clinical results. The mean Cooney wrist function score was 83 ± 4. The mean lateral intrascaphoid angle was 34.8 ±1.4 degrees, mean antroposterior intrascaphoid angle was 33.4 ± 2.2 degrees, mean dorsal cortical angle was 158.3 ± 4.8 degrees, mean scaphoid lengths was 22.1± 0.7 mm and mean scaphoid height-to-length ratio was 0.74± 0.04. There was no significant correlation between the radiologic measurements and Cooney wrist scores in the patients.Conclusion: In the current study, all the patients had some degrees of scaphoid malunion; however, the radiological measurements of the reconstructed scaphoids did not correlate with the clinical outcomes.
      PubDate: Sun, 16 Aug 2015 19:30:00 +010
  • Fanconi anemia concurrent with an unusual thumb polydactyly

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

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

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

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

    • Abstract: Purpose: Postoperative pain is a common side effect following surgery which can significantly reduce surgical quality and patient's satisfaction. The analgesic effects of morphine and buprenorphine have been compared in few studies. We aimed to compare the efficacy of a single dose of intravenous morphine with sublingual buprenorphine in postoperative pain control following closed reduction surgery. Method: This triple blind clinical trial was conducted on 90 patients referred for undergoing closed reduction orthopedic surgery. They were older than 18 years, in classes I and II of American Society of Anesthesiologists (ASA) with an operation time of 30-90 minutes. Patients were divided into two groups of buprenorphine (4.5µg/kg sublingually) and morphine (0.2mg/kg intravenously). Baseline characteristics, vital signs, pain score, level of sedation and pharmacological side effects were recorded in the recovery room (at 0 and 30 minutes), and in the ward (at 3, 6 and 12 hours). SPSS ver. 19 was used for data analysis; the significance level was set at PResults: Ninety patients were studied, 60 males and 30 females with mean age of 37.7±16.2 yrs. There was no significant difference between the two groups in terms of baseline characteristics. Pain score in the morphine group was significantly higher than the bupernorphine group with an average of 2.5 scores (p<0.001). Postoperative mean heart rate in the buprenorphine group was four beats lower than morphine group (p<0.001). 48.6% and 86.7% of the cases in the buprenorphine and morphine group were conscious in recovery, respectively (p=0. 001) with a higher rate of pruritus in the latter group (p=0.001).Conclusion: Sublingual buprenorphine administration before anesthesia induction in closed reduction surgery can lead to better postoperative pain control in comparison to intravenous morphine. Due to simple usage and longer postoperative sedation, sublingual buprenorphine is recommended as an appropriate drug in closed reduction surgery.
      PubDate: Fri, 14 Aug 2015 19:30:00 +010
  • Introduction of a new suture method in repair of peripheral nerves injured
           with a sharp mechanism

    • Abstract: Introduction: the standard method for repair of an injured peripheal nerve is epineural repair with separate sutures. Herein we describe a method in which the nerve is sutured with continous sutures. In fact this method has not been utilized for nerve repair previously and our purpose was to compare it to the standard method. If it proved to be successful it would replace the standard method in certain circumstances. Materials and methods: The proposal of the clinical trial was given a reference number form the ethics comitee. 25 dogs in which the scaitic nerve was cut by a sharp blade under genaeral anesthesia were divided randomly into three groups: control (5 dogs), repair of sciatic nerve with simple sutures (10) and repair with continous sutures (10). In the control group the nerve was not repaired at all. After 6 weeks the dogs were killed and the nerve was studied by light and electronic microscopes. The amount of consumed suture material, time of repair, myelin thickness and axon diiameter were examined. Ultrastructural studies were performed to assess degeneration and regeneration findings.Results: time of repair and the amount of consumed suture material were significantly lower in the continous group (P<0.001). No difference was found with regard to light microscopy findings and regeneration was confirmed by electron microscopy in the continous group.Conclusion: the method described in the present study, provided a result similar to the standard method. Though undobtfully it has some limitations, can replace the standard method in many circumstances.
      PubDate: Fri, 07 Aug 2015 19:30:00 +010
  • Intamuscular lipoma of the thenar: a rare case

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

    • Abstract: Background: The present study was designed to ascertain the serial changes on distal radius radiographic parameters attributable to aging.Materials and Methods: In the prospective study, the sample consisted of 120 healthy individuals who were divided into 4 age groups each containing 15 men and 15 women. In the group with less than 20 years old, only ulnar variance (UV) can be investigated. Wrist radiography was taken and then parameters of the distal radius were measured and compared base on age and sex.Results: Average UV was -2.48 mm and -1.6 mm in 2-9 and 10-19 years old age groups, respectively. Besides, in the above 20 years old, average of the radial inclination (RI), palmar tilt (PT), radial length (RL), and UV was 23.7º, 12.4º, 10.5 mm, and +1.1 mm, respectively. Considering the UV, no significant difference was found between 2-9 and 10-19 years old age groups as well as among the above 20 years old age groups. However, a significant difference was observed between below 20 years old and above it. The study results revealed no significant difference between men and women in any of the study age groups. Conclusion: There is a significant UV change toward less negative UV with aging till maturity.
      PubDate: Tue, 04 Aug 2015 19:30:00 +010
  • Unusual presentation of synovial sarcoma as meniscal cyst: A case report

    • Abstract: Periarticular cyst and cystic soft tissue lesion around the knee are common. Synovial sarcoma is a rare and malignant soft tissue tumor accounting for approximately 5% of soft tissue sarcoma. A case is presented where lesion adjacent to the joint line of the knee was diagnosed clinically and on imaging as a meniscal cyst. MRI signal was homogenous and no concomitant meniscal tears were seen. The tissue diagnosis was monophasic synovial sarcoma.
      PubDate: Fri, 31 Jul 2015 19:30:00 +010
  • Extra-articular diffuse giant cell tumor of the tendon sheath: A report of
           2 cases.

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

    • Abstract: Dislocation of the first carpometacarpal (CMC) is a rare occurrence. Treatment of this dislocation varies from closed reduction and casting to ligament repair. Neglected dislocation or incomplete reduction of the 1st CMC cause chronic instability and painful arthritis, muscle imbalance and decreased grip force.In our study 6 patients is evaluated that were visited in less than 24 hours from their injury .All were primarily reduced and except one patient later injured ligament were repaired. All patient after 6 months had normal range of motion without pain and they had not any complaint.Stability at the 1st CMC joint is dependent on static and dynamic forces. However, dislocation of the 1st CMC occur rare, but important function of the thumb specially in gripping and grasping makes it a significant problem. Injured ligament should repair for increased stability of 1st CMC joint, because neglected dislocation or incomplete reduction cause chronic instability and painful arthritis
      PubDate: Sat, 11 Jul 2015 19:30:00 +010

    • Abstract: The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL) surgery failure, concentrating on preventing and resolving such situations. The study particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. It is often possible to identify a primary or secondary cause of ACL surgery failure and even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol therefore should be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure because of the fact that this is a revision surgery. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient.
      PubDate: Sat, 11 Jul 2015 19:30:00 +010
  • How much are emergency medicine specialists' decisions reliable in the
           diagnosis and treatment ...

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

    • Abstract: Purpose: Surgeons performing an ilioinguinal exposure for acetabular fracture surgery need to be aware of aberrant findings such as inguinal hernias and spermatic cord lesions. The purpose of this study is to report these occurrences in a clinical series of adult males undergoing acetabular fracture fixation and a series of adult male cadavers. The secondary aim is to characterize these abnormalities to aid surgeons in detecting these abnormalities preoperatively and coordinating a surgical plan with a general surgeon.Methods: Clinical study- Retrospective review of treated acetabular fractures through an ilioinguinal approach. Incidence of inguinal canal and spermatic cord abnormalities requiring general surgery consultation were identified. Corresponding CT scans were reviewed and radiographic characteristics of the spermatic cord abnormalities and/or hernias were noted.Cadaveric study- 18 male cadavers dissected bilaterally using an ilioinguinal exposure. The inguinal canal and the contents of the spermatic cord were identified and characterized.Results: Clinical Study- 5.7% (5/87) of patients had spermatic cord lesion and/or inguinal hernia requiring general surgical intervention. Preoperative pelvic CT scan review identified abnormalities noted intraoperatively in four of the five patients. Cord lipomas visualized as enlargements of the spermatic cord with homogeneous density. Hernias visualized as enlarged spermatic cords with heterogeneous density. Cadaver Study- 31% (11/36) of cadavers studied had spermatic cord and/or inguinal canal abnormalities. Average cord diameter in those with abnormalities was 24.9 mm (15-28) compared to 16 mm (11-22) in normal cords, which was statistically significant.Conclusion: The clinical and cadaveric findings emphasize the importance of understanding inguinal abnormalities and the value of detecting them preoperatively. The preoperative pelvic CT scans were highly sensitive in detecting inguinal abnormalities.
      PubDate: Sat, 11 Jul 2015 19:30:00 +010
  • Treatment outcome of intramedullary fixation with a locked rigid nail in
           humeral shaft fractures

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

    • Abstract: Dear Editor,We have greatly enjoyed reading the case report entitled “‘Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature in the issue of Arch Bone Jt Surg. 2015;3(2) with great interest. We would like to commend the authors for their detailed and valuable work. Although various case reports have described postoperative distal femur fracture at a range of time intervals (1,2) intraoperative intra-articular distal femur fracture is a unique entity.However, we believe that some important additional observations seem necessary to be contributed through this study. In this article, the authors stated that, to the best of their knowledge, there is no other case report in the literature introducing a femoral condyle fracture during arthroscopic ACL reconstruction or revision reconstruction. Nevertheless, we would like to call the attention of the readers to the fact that that the literature contains one additional case report re‌porting on intraoperative distal femoral coronal plane (Hoffa) fracture during primary ACL reconstruction (2). Werner BC and Miller MD presented of case report of an intraoperative distal femoral coronal plane (Hoffa) fracture that occurred during independent femoral tunnel drilling and dilation in a primary ACL reconstruction. As in the their case, this type of fracture can occur with appropriately placed femoral tunnels, but the risk can increase with larger graft diameters in patients with smaller lateral femoral condyles The patient was treated with open reduction and internal fixation, without compromise of graft stability and with good recovery of function. We believe that tailoring graft size to the size of the patient is important to prevent similar adverse events.
      PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Pedicle Subtraction Osteotomy in a 5-Year-Old Child with Congenital

    • Abstract: Vertebral anomalies may also distort the normal regional or global spinal alignment and necessitate some therapeutic interventions. Hemiepiphysiodesis is a traditional procedure usually described for these young patients but in more severe cases some type of osteotomy seems to be necessary. In this technical note, we describe a 5-year-old boy with failed previous hemiepiphysiodesis surgery, who was successfully treated with one level pedicle subtraction osteotomy. This procedure not only corrects the kyphotic deformity at the time of the procedure (not relying on future spinal growth), but also avoids more hazardous anterior approach.
      PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Hip Arthroplasty and its Revision in a Child: Case Report and Literature

    • Abstract: Juvenile idiopathic arthritis is the leading cause of hip replacement in young children. However, arthroplasty in this population is challenging with several concerns about quality of the growing bone, young age for revision surgery, and difficulties in potential several revisions. In this study we introduce a case of a 12-year old who is one of the youngest patients to undergo revision hip arthroplasty. The index operation was done as a hybrid replacement, cemented for stem and press fit for acetabular component. Two years later revision was done with severe femoral deficiency. This second procedure was challenging but with short-term promising results. So we reviewed the literature for arthroplasty in this young population regarding recent findings and trends. According to the literature survival of the prosthesis is longer with a cemented acetabular component and press fit stem; however, there are evidences that show poor outcome of joint replacement after the first revision in juvenile idiopathic arthritis patients.
      PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Overlapped Pubic Symphysis; a Case Report and Review of the Literature

    • Abstract: Overlapped pubic symphysis is a rare but serious pelvic injury. This study presents a case of overlapped dislocation of the pubic symphysis. He was managed by closed reduction under general anesthesia. The patient had urethral transsection.At the latest follow up, seven months post injury; he was able to walk well without any pelvic pain. However, his urologic problems were continued. We also reviewed the literature and analyzed the data of the previous reports as well as the current case collectively. The two terms of “locked pubic symphysis” and “overlapped pubic symphysis”have been used synonymously in the literature. Overlapped pubic symphysis is commonly associated with fracture of the sacrum and urethral injury in the male patients. After closed or open reduction, if pelvic instability persists, it needs anterior and may posterior internal fixation to achieve a stable pelvis.
      PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Factors Associated with Operative Treatment of De Quervain Tendinopathy

    • Abstract: Background:  Geographic and doctor-to-doctor variations in care are a focus of quality and safety efforts in medicine. This study addresses factors associated with variation in the rate of operative treatment of de Quervain tendinopathy.   Methods: We used a database including all patient encounters at 2 large medical centers, to study the experience of 10 hand surgeons and 1 physiatrist working in a hand surgery office in the treatment of 2,513 patients with de Quervain tendinopathy over a 12-year period. Survival analysis using the Kaplan-Meier method was used to compare surgery rates and time to surgery. Cox multivariable regression analysis was applied to identify factors associated with operative treatment. Results:  One hundred ninety nine (7.9%) patients had surgery. The odds of operative treatment were 1.7 times greater after corticosteroid injection and varied more than 10-fold among providers. There was substantial variation in the overall rate of surgery by provider. Corticosteroid injection delayed surgery slightly, but was associated with a higher rate of surgery.  Conclusion:  Providers have substantial influence on treatment of de Quervain tendinopathy. The use of decision aids and other methods that help involve the patient in decision-making merit investigation as interventions to help reduce doctor-to-doctor variation.
      PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Effectiveness of the Gastrocsoleous Flap for Coverage of Soft Tissue
           Defects in Leg with ...

    • Abstract: Background: The standard methods for reconstruction of soft tissue defects in the leg include gastrocnemius flap for proximal third defects, soleus flap for middle third and free flap in the distal third. However, there are problems with the use of free flap, like increased operative time, damage of major vessels and the need for experienced microsurgeon. Mathods: This prospective study was undertaken on 23 patients (20 male and 3 female) with the mean age 32.13 years (14 to 65). This group consisted of all of the patients referred to Dr Bahonar Hospital, Kerman with soft tissue defects between April 2011 and April 20012 and would give informed consent for participation in the study and treatment of the defect with muscle flaps. 8 patients with proximal third defects were treated with were treated with gastrocnemius flap, 4 with middle third defects with soleus flap and 3 with reverse soleus flap and 8 with distal third defects with reverse soleus flap. The patients were followed up for at least 1 year. Finally the results were analyzed by SPSS 16. Results: In patients with soft tissue defect in proximal and middle third of leg repair was successful in all. In 5 patients with soft tissue defect in distal third of leg repair was complete but in 3 of them flap failure was seen. Overall success rate for reverse soleous flap was 72.7%. Conclusion: The success rate of the flap for the upper and lower thirds was similar to other studies and seems that this is the standard method. In the distal third defects the reverse soleous flap failed in 3 cases and it seems that preoperative investigations such as angiography must be performed before embarking on such a procedure.
      PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Hardware Removal Due to Infection after Open Reduction and Internal
           Fixation: Trends and Predictors

    • Abstract: Background:  Little is known about trends and predictors of hardware related infection following open reduction and internal fixation (ORIF) of extremity fractures, one of the major causes of failure following ORIF. The present study was designed and conducted to determine trends and predictors of infection-related hardware removal following ORIF of extremities using a nationally representative database. Methods:  We used Nationwide Inpatient Sample data from 2002 to 2011 to identify cases of ORIF following upper and lower extremity fractures, as well as cases that underwent infection-related hardware removal following ORIF. Multivariate analysis was performed to identify independent predictors of infection-related hardware removal, controlling for patient demographics and comorbidities, hospital characteristics, site of fracture, and year.  Results:   For all ORIF procedures, the highest rate of hardware removal related to infection was observed in tarsal fractures (5.56%), followed by tibial (3.65%) and carpal (3.37%) fractures. Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Tarsal fractures(odds ratio (OR)=1.06, 95% confidence interval (CI): 1.04-1.09, P<0.001), tibial fractures (OR=1.04, 95% CI: 1.03-1.06, P <0.001) and those patients with diabetes mellitus (OR=2.64, 95% CI: 2.46-2.84, P<0.001), liver disease (OR=2.04, 95% CI: 1.84- 2.26, P <0.001), and rheumatoid arthritis (OR=2.06, 95% CI:1.88-2.25 P <0.001) were the main predictors of infection-related removals; females were less likely to undergo removal due to infection (OR= 0.61, 95% CI: 0.59-0.63 P <0.001).  Conclusions:  Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Diabetes, liver disease, and rheumatoid arthritis were important predictors of infection-related hardware removal. The study identified some risk factors for hardwarerelated infection following ORIF, such as diabetes, liver disease, and rheumatoid arthritis,that should be studied further in an attempt to implement strategies to reduce rate of infection following ORIF. 
      PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Clinical Results of Meniscal Repair Using Submeniscal Horizontal Sutures

    • Abstract: Background:  Parts of the implants placed over the meniscus during meniscal repair can wear down the cartilage in the contact zones and cause chronic synovitis. Placing horizontal sutures under the meniscus may overcome this potential hazard. The purpose of this prospective study was to evaluate the midterm results of arthroscopic meniscal repair using submeniscally placed out-in horizontal sutures.  Methods:  One hundred and three meniscal repairs with submeniscal horizontal out-in technique in 103 patients were performed between 2009 and 2012. Our indications for meniscal repair were all longitudinal tear in red-red and redwhite zone with acceptable tissue quality. Clinical evaluation included the Tegner and Lysholm knee scores and clinical success was defined as absence of joint-line tenderness, locking, swelling, and a negative McMurray test. Results:  The average follow-up was 19 months (range, 14 to 40 months). The time interval from injury to meniscal repair ranged from 2 days to 390 days (median, 96 days). At the end of follow-up, the clinical success rate was 86.5%.  Fourteen of 103 repaired menisci (13.5%) were considered failures according to Barrett’s criteria. The mean Lysholm score significantly improved from 39.6 preoperatively to 84.5 postoperatively (P˂0.001). Eighty five patients (82.5%) had an excellent or good result according to Lysholm knee score. Tegner activity score improved significantly (P˂0.01) from an average of 3.4 (range, 2-6) preoperatively to 5.9 (range, 5-8) postoperatively. Statistical analysis showed that age, simultaneous anterior cruciate ligament reconstruction, chronicity of injury did not affect the clinical outcome.  Conclusion:  Our results showed that acceptable midterm results are expected from submeniscal horizontal out-in repair technique. This technique is cheap, safe and has the advantage of avoiding chondral abrasion caused by solid implants and suture materials placed over the meniscus.
      PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Short-Term Clinical Outcomes of Radial Shortening Osteotomy and Capitates
           Shortening Osteotomy ...

    • Abstract: Background:  There is no consensus on the best surgical treatment in Kienböck disease. We compared the shortterm outcomes of radial shortening osteotomy and capitate shortening osteotomy in patients affected with this disease.  Methods:  In a retrospective study of 21 patients with Lichtman stage IIIA of Kienböck disease, 12 patients with an average follow up of 3.2 ± 0.6 years had radial shortening osteotomy (group I) and 9 patients with an average follow up of 3.1 ± 0.7 years had capitate shortening osteotomy (group II). The two groups were comparable in age, sex, operated side, initial Lichtman stage, and follow-up duration. At the last follow-up the patients were evaluated for pain, wrist range of motion, grip strength, wrist functional status and change in their Lichtman stage. The overall results were evaluated by the Cooney wrist function score and DASH score.  Results:  All the patients in the two groups had improvement of their wrist pains. According to the Cooney wrist function score group I had 1 excellent, 9 good, and 2 fair scores and group II had 1 excellent, 6 good, and 2 fair scores. Comparisons between the means of pain VAS scores, wrist range of movement, grip strength, DASH score, and Cooney wrist function score in the two groups were not significant. Also, the changes of the Lichtman stage in the two groups were not significant. Conclusions:  Both groups had reasonable short-term outcomes. We were unable to recognize a substantial clinical difference between the two surgical treatments in short-term outcomes. 
      PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Reliability, Readability and Quality of Online Information about
           Femoracetabular Impingement

    • PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Ultrasound-guided Percutaneous Medial Pinning of Pediatric Supracondylar
           Humeral Fractures to ...

    • Abstract: Background:  Medial pinning is one of the most controversial aspects of the surgical treatment of supracondylar fractures (SHF) owing to the risk of ulnar nerve injury.  Aim: To evaluate the safety and usefulness of medial pinning for SHF using ultrasound imaging for ulnar nerve visualization.   Methods: Fifteen children, with a mean age of 60 months, with displaced SHF were treated with a crossed-pinning configuration after fracture reduction. Intraoperative ultrasound was used to guide medial pin insertion to avoid ulnar nerve injury. Results:  Cubital tunnel anatomy was easily identified in all children. All children showed a subluxating ulnar nerve that required elbow extension to about 90º before medial pin insertion. None suffered ulnar nerve dysfunction after using the referred technique. Conclusions:  Although technically demanding, ultrasound may be a valuable adjuvant to avoid ulnar nerve injury while performing a medial pinning in pediatric SHF.  
      PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Avascular Necrosis of the Femoral Head: Are Any Genes Involved'

    • Abstract: Avascular necrosis of the femoral head (ANFH) is a pathologic process that results from interruption of blood supply to the femur bone resulting in the death of bone cells and collapse of the femoral head. Nontraumatic ANFH continuesto be a significant challenge to orthopedic surgeons. While the exact mechanisms remain elusive, many new insights have emerged from research in the last decade that has given us a clearer picture of the pathogenesis of nontraumatic ANFH. Progression to the end stage of ANFH appears to be related to five main mechanisms: hypercoagulable conditions, angiogenesis suppressions, hyperadipogenesis, heritable states, and switching the bone remodelling into bone resorption. Researchers have been examining the pathogenic mechanisms of ANFH but none of these theories have been firmly confirmed although some appear more plausible than the others. All of these factors can switch bone remodelling into bone resorption, which can further lead to ANFH progression ending up to femoral head collapse.
      PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Radial Tunnel Syndrome, Diagnostic and Treatment Dilemma

    • Abstract: Radial tunnel syndrome is a disease which we should consider it in elbow and forearm pains. It is diagnosed with lateral elbow and dorsal forearm pain may radiate to the wrist and dorsum of the fingers. The disease is more prevalent in women with the age of 30 to 50 years old. It occurs by intermittent compression on the radial nerve from the radial head to the inferior border of the supinator muscle, without obvious extensor muscle weakness. Compression could happen in five different sites but the arcade of Frose is the most common area that radial nerve is compressed. To diagnosis radial tunnel syndrome, clinical examination is more important than paraclinic tests such as electrodiagnsic test and imaging studies. The exact site of the pain which can more specified by rule of nine test and weakness of the third finger and wrist extension are valuable physical exams to diagnosis. MRI studies my show muscle edema or atrophy along the distribution of the posterior interosseous nerve. Although non-surgical treatments such as rest, NSAIDs, injections and physiotherapy do not believe to have permanent relief, but it is justify undergoing them before surgery. Surgery could diminish pain and symptoms in 67 to 93 percents of patients completely.
      PubDate: Tue, 30 Jun 2015 19:30:00 +010
  • Assessment of Correlation between MRI and Arthroscopic Pathologic Findings
           in Shoulder Joint.

    • Abstract: Abstract:Background: The objective of this study was to determine sensitivity, specificity, positive and negative predictive values (PPV and NPV) of MRI for shoulder joint pathologies, regarding arthroscopy as the standard for diagnosis. Materials and Methods: Eighty patients with shoulder joint disorders, whom underwent finally arthroscopy, were studied. Based on patients' medical history and physical examinations, shoulder MRI was requested if paraclinical investigations were necessary. Radiologist reported it for several predetermined structures. In the condition that non-surgical therapies failed, arthroscopy of the affected shoulder was done and the same structures were inspected. Subsequently, sensitivity, specificity, PPV and NPV of MRI were determined regarding arthroscopy results.Results: Highest sensitivity, specificity, PPV and NPV were recognized in MRI reported pathologies of Hill-Sach lesion (0.910), infra-spinatous tendon (0.985), supra-spinatous tendon (0.930) and biceps tendon (0.954), respectively. Rotator interval (0.250), biceps labrum complex (0.805), subscapularis tendon (0.538) and anterior labrum lesions (0.604) had the lowest sensitivity, specificity, PPV and NPV, respectively.Conclusion: However the results indicate that MRI can be a useful tool in ruling out possible abnormalities in shoulder and giving clue to the most possible diagnosis, some practical tricks in it’s performance and experience of radiologist over time with suitable feedback by surgeon is necessary.
      PubDate: Fri, 26 Jun 2015 19:30:00 +010
  • Operating Room Time Savings with the Use of Splint Packs: A Randomized
           Controlled Trial

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

    • Abstract: BACKGROUND:No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstructionHYPOTHESIS:There is similar functional outcome after rigid fix compared to other methods of fixation which has been publishedSTUDY DESIGN:Retrospective observational study METHODS:A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months.RESULTSIn our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively.Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26 .Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test p<0.001CONCLUSIONArthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation
      PubDate: Sun, 10 May 2015 19:30:00 +010
  • Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A
           Case Study

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

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

    • Abstract: Background: Articular cartilage injuries are a common clinical problem at the time of ACL reconstruction with an incidence of 16-46%.Good results of ACL reconstruction combined with chondral lesions treatment have been published in some studies.Material and Method: After statistical analysis 30 patients were selected and divided in 2 groups. First group consisted of 15 patients who have isolated ACL tear without any other concomitant injuries and the second group consisted of 15 patients with ACL tear and concomitant high grade (grade 3 or 4 of outerbridge classification) contained articular cartilage injuries during arthroscopy. Group 1 underwent ACL reconstruction and group 2 underwent ACL reconstruction combined with chondroplasty via drilling and micro fracture technique. For each patient Lysholm knee score questionnaire was filled before operation, 6 months and1 year later after surgery.Results: The mean of Lysholm knee score in both group improved as follows: 9.6 point after 6month and 16.06 point after 1year in group 1 and 23.26 point after 6 month and 30.66 after 1 year in group 2 that was statistically significant (p value <0.05).Conclusion: Improvement in Lysholm knee score in both groups showed that ACL reconstruction concomitant with high grade chondral injury chondroplasty with microfracture and drilling technique have good results and is accompanying with satisfaction in patients and improves their quality of life.Key words: Anterior Cruciate Ligament,Chondral injury,Lysholm knee score
      PubDate: Mon, 04 May 2015 19:30:00 +010
  • Risk of Spermatic Cord Injury During Anterior Pelvic Ring and Acetabular
           Surgery: An Anatomical ...

    • Abstract: Introduction: Anterior pelvic ring surgery includes a variety of plating techniques and insertion of retrograde superior pubic ramus screws. Anterior acetabular surgery also includes fixation through an ilioinguinal or Stoppa approach. These exposures risk injury to the spermatic cord and accompanying genital branch of the genitofemoral nerve. The primary aim of this study was to identify the distance between the midline and the spermatic cords in adult male cadaveric specimens. The secondary aim was to determine spermatic cord diameters and measure the distance between the spermatic cord and implant during instrumentation of a retrograde superior pubic ramus medullary screw. Materials and Methods: Extended Pfannenstiel and Stoppa approaches were performed on 18 embalmed male cadavers bilaterally. Spermatic cord characteristics were recorded and a number of measurements were performed to determine the distance of implants and the midline from the spermatic cord. Results: The average distance between the midline and spermatic cords was 34.2 mm. The average distance between the spermatic cord and implant was 18.2 mm. Eleven of the thirty-six dissections had abnormalities including cord lipomas and inguinal hernias. The average cord diameter was 18.6 mm. The average cord diameter in those with abnormalities was 24.9 mm and 16 mm in those without abnormalities, this difference was statistically significant. Discussion: Due to the proximity of the spermatic cord, the surgeon should either formally expose the cord or limit lateral dissection from the midline during Pfannenstiel and Stoppa exposures. Similarly, the surgeon should use soft-tissue sleeves and oscillating drills to avoid injury to the contralateral spermatic cord during the insertion of retrograde superior pubic ramus medullary screws.
      PubDate: Sun, 03 May 2015 19:30:00 +010
  • Knee fusion or above-the-knee amputation after failed two-stage
           reimplantation total knee ...

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