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Journal Cover Archives of Bone and Joint Surgery
  [7 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2345-4644 - ISSN (Online) 2345-461X
   Published by Mashhad University of Medical Sciences Homepage  [12 journals]
  • Recurrent dislocation of proximal interphalangeal joint of the finger: A
           rare issue in hand surgery

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

    • Abstract:   Progressive osseous heteroplasia is a rare inherited disease that begins with skin ossification and proceeds into the deeper connective tissues. The disease should be distinguished from other genetic disorders of heterotopic ossification including fibrodysplasia ossificans progressiva (FOP) and Albright hereditary osteodystrophy (AHO). We report a case of progressive osseous heteroplasia in a twenty four years old male with a complaint of ankylosis of the entire upper left limb and digital cutaneous lesions and sparing of the other limbs and the axial skeleton. Absence of great toe malformation, presence of cutaneous ossification, dermal bone spicules extruding in fingers, and involvement of just left upper limb were unique findings in contrast with FOP diagnosis in this case. There is no effective treatment or prevention for POH. Awareness of diagnostic features is necessary in early diagnosis of POH.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • The Radiological Prevalence of Incidental Kienböck Disease

    • Abstract:   Background:To determine the prevalence of incidental Kienböck disease.   Methods: A retrospective analysis of 150,912 radiological reports or images obtained over a five year period was performed of 76,174 patients who underwent a radiograph or computed tomography scan which included the wrist, in Edinburgh and Lothian, UK. Results: There were 5 cases of incidental Kienböck disease and 13 cases of symptomatic Kienböck disease. There were no significant differences in age, sex, ethnicity, comorbidities, smoking status, excess alcohol use or Lichtman stage between the incidental and symptomatic Kienböck groups. Conclusion: The radiological prevalence of incidental Kienböck disease was 0.0066% or 7 in 100,000 patients.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Discrete Pathophysiology is Uncommon in Patients with Nonspecific Arm Pain

    • Abstract:   Background: Nonspecific symptoms are common in all areas of medicine. Patients and caregivers can be frustrated when an illness cannot be reduced to a discrete pathophysiological process that corresponds with the symptoms. We therefore asked the following questions: 1) Which demographic factors and psychological comorbidities are associated with change from an initial diagnosis of nonspecific arm pain to eventual identification of discrete pathophysiology that corresponds with symptoms' 2) What is the percentage of patients eventually diagnosed with discrete pathophysiology, what are those pathologies, and do they account for the symptoms' Methods: We evaluated 634 patients with an isolated diagnosis of nonspecific upper extremity pain to see if discrete pathophysiology was diagnosed on subsequent visits to the same hand surgeon, a different hand surgeon, or any physician within our health system for the same pain. Results: There were too few patients with discrete pathophysiology at follow-up to address the primary study question. Definite discrete pathophysiology that corresponded with the symptoms was identified in subsequent evaluations by the index surgeon in one patient (0.16% of all patients) and cured with surgery (nodular fasciitis). Subsequent doctors identified possible discrete pathophysiology in one patient and speculative pathophysiology in four patients and the index surgeon identified possible discrete pathophysiology in four patients, but the five discrete diagnoses accounted for only a fraction of the symptoms. Conclusion: Nonspecific diagnoses are not harmful. Prospective randomized research is merited to determine if nonspecific, descriptive diagnoses are better for patients than specific diagnoses that imply pathophysiology in the absence of discrete verifiable pathophysiology.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Intramuscular Injection Abscess Due to VRSA: A New Health Care Challenge

    • Abstract:   Abscess formation following intramuscular injections is rare and they are most commonly seen in immunocompromised individuals. In this case series we present a cohort of three patients presented to us in a critically ill condition with an abscess due to intramuscular injection. Vancomycin resistant staphylococcus aureus was isolated from all three patients. These patients posed a major challenge to the healthcare system and the treating physician because of the: severity of illness, virulence and resistance of the organism, rarity of the situation, immune state of the patient, and lack of supporting evidence to properly guide management in the use of health resources. To the best of our knowledge, there is no report available in the English literature on vancomycin resistant staphylococcus aureus associated with intramuscular injection abscess.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Aberrant Radial Artery Causing Carpal Tunnel Syndrome

    • Abstract:   Anatomical vascular variations are rare causes of carpal tunnel syndrome. An aberrant medial artery is the most common vascular variation, while an aberrant radial artery causing carpal tunnel syndrome is even more rare, with an incidence ranging less than 3%. This article reports a patient with compression of the median nerve at the carpal tunnel by an aberrant superficial branch of the radial artery. An 80- year- old man presented with a 5-year history of right hand carpal tunnel syndrome; Tinel sign, Phalen test and neurophysiological studies were positive. Open carpal tunnel release showed an aberrant superficial branch of the radial artery with its accompanying veins running from radially to medially, almost parallel to the median nerve, ending at the superficial palmar arterial arch. The median nerve was decompressed without ligating the aberrant artery. At the last follow-up, 2 years after diagnosis and treatment the patient is asymptomatic.  
      PubDate: Thu, 30 Jun 2016 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. 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: Thu, 30 Jun 2016 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: Thu, 30 Jun 2016 19:30:00 +010
  • Subchondral Insufficiency Fracture of the Femoral Head Treated with Core
           Decompression and Bone ...

    • Abstract: Subchondral insufficiency fracture of the femoral head (SIFFH) is characterized by acute onset hip pain without overt trauma. It appears as a low intensity band with bone marrow edema on T1-weighted MRI. The most common course of treatment is protected weight bearing for a period of several weeks. Total hip arthroplasty (THA) has been commonly used if the patient does not respond to the initial protected weight bearing treatment. We present a case of a 48-year-old male with SIFFH who was treated with core hip decompression and bone void filler as a hip-preserving alternative to THA. The patient has an excellent clinical and radiographic result at final follow up. Core hip decompression with bone void filler is a less invasive alternative to THA, and may be a preferred initial treatment strategy for SIFFH in the young and active patient who has failed conservative measures.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Epithelialization Over a Scaffold of Antibiotic-Impregnated PMMA Beads: A
           Salvage Technique for ...

    • Abstract:   The management of soft tissue defects in tibial fractures is essential for limb preservation. Current techniques are not without complications and may lead to poor functional outcomes. A salvage method is described using three illustrative cases whereby a combination of flaps and antibiotic-impregnated polymethylmethacrylate beads are employed to fill the bony defect, fight the infection, and provide a surface for epithelial regeneration and secondary wound closure. This was performed after the partial failure of all other options. All patients were fully ambulatory with no clinical, radiographic or laboratory sign of infection at their most recent follow-up. Although our findings are encouraging, this is the first report of epithelialization of the skin on a polymethylmethacrylate scaffold. Further studies investigating the use of this technique are warranted.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Effects of Hip Geometry on Fracture Patterns of Proximal Femur

    • Abstract:   Background: Some studies have previously shown that geometry of proximal femur can affect the probability of fracture and type of fracture. It happens since the geometry of the proximal femur determines how a force is applied to its different parts. In this study, we have compared proximal femur’s geometric characteristics in femoral neck (FNF), intertrochanteric (ITF) and Subtrochanteric (STF) fractures. Methods: In this study, 60 patients who had hip fractures were studied as case studies. They were divided into FNF, ITF and STF groups based on their fracture types (20 patients in each group). Patients were studied with x-ray radiography and CT scans. Radiological parameters including femoral neck length from lateral cortex to center of femoral head (FNL), diameter of femoral head (FHD), diameter of femoral neck (FND), femoral head neck offset (FHNO), neck-shaft angle (alpha), femoral neck anteversion (beta) were measured and compared in all three groups. Results: Amount of FNL was significantly higher in STF group compared to FNF (0.011) while ITF and STF as well as FNT and ITF did not show a significant different. Also, FND in FNF group was significantly lower than the other two groups, i.e. ITF and STF. In other cases there were no instances of significant statistical difference. Conclusion: Hip geometry can be used to identify individuals who are at the risk of fracture with special pattern. Also, it is important to have more studies in different populations and more in men.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Anatomical Variations of Brachial Plexus in Adult Cadavers; A Descriptive

    • Abstract:   Background: Variations of the brachial plexus are common and a better awareness of the variations is of crucial importance to achieve successful results in its surgical procedures. The aim of the present study was to evaluate the anatomical variations of the brachial plexus in adult cadavers.   Methods: Bilateral upper limbs of 32 fresh cadavers (21 males and 11 females) consecutively referred to Guilan legal medicine organization from November 2011 to September 2014, were dissected and the trunks, cords and terminal nerves were evaluated. Results: Six plexuses were prefixed in origin. The long thoracic nerve pierced the middle scalene muscle in 6 cases in the supra clavicular zone. The suprascapular nerve in 7 plexuses was formed from posterior division of the superior trunk. Five cadavers showed anastomosis between medial brachial cutaneous nerve and T1 root in the infra clavicular zone. Terminal branches variations were the highest wherein the ulnar nerve received a communicating branch from the lateral cord in 3 cases. The median nerve was formed by 2 lateral roots from lateral cord and 1 medial root from the medial cord in 6 cadavers. Some fibers from C7 root came to the musculocutaneous nerve in 8 cadavers. Conclusion: The correlation analysis between the variations and the demographic features was impossible due to the small sample size. The findings of the present study suggest a meta-analysis to assess the whole reported variations to obtain a proper approach for neurosurgeons.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Factors Associated with Pain, Disability and Quality of Life in Patients
           Suffering from Frozen ...

    • Abstract:  Background: Frozen shoulder is resulting in limb disability and reduction of quality of life but the factors associated with patients’ disability and quality of life is not clear. To assess pain, disability, the quality of life and factors associated with them in patients suffering from frozen shoulder.  Methods: We enrolled 120 patients (37 men and 83 women) with phase-II idiopathic frozen shoulder in our cross-sectional study. Demographic data were collected and shoulder range of motion was measured in four different directions (elevation, abduction, external and internal rotation) in both upper limbs. Patients were asked to fill out Visual Analog Scale for pain (VAS) and, Short-Form Health Survey questionnaire (SF-36) as well as Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. We asked the patients to fill out the Hamilton anxiety and depression questionnaires. Results: The mean of VAS pain, DASH, PCS, and MCS scores were 69(18), 53(17), 35(8.0), and 42(10) respectively. All the domains of SF36 questionnaires where below the normal population except physical function. VAS pain score was correlated to Hamilton depression scores in both bivariate and mulivarilable analysis. DASH score were correlated to sex, age, ROM, and both Hamilton anxiety and depression scores; However, DASH score only impact with Hamilton anxiety and ROM independently. PCS is correlated to age and MCS to Hamilton depression. Conclusion: Patient with frozen shoulder are more suffering from pain and disability secondary to psychiatric parameters such as depression and anxiety than demographic features or even restriction of range of motion.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Evaluation of Clinical Results and Complications of Structural Allograft
           Reconstruction after ...

    • Abstract:   Background: Massive bone allograft is an option in cases of limb preservation and reconstruction after massive benign and malignant bone tumor resection. The purpose of this study was to analyze the outcome of these procedures at Imam Reza Hospital, Mashhad University of Medical Sciences. Methods: In this study, 113 cases have been presented. Eleven cases were excluded (patients has a traumatic defect or they passed away before the completion of the study’s two-year follow up period). Each patient completed a questionnaire, went through a physical examination and, if indicated, X-ray information was collected. The patients were divided into three groups: chemotherapy, chemotherapy plus radiation therapy, and no-adjuvant-therapy. Results: Fifty-four cases were male and the mean age was 24.5±5.39. The number of cases and indications for surgery were: 33 cases of aggressive benign tumors or low grade malignant bone tumors (large bone defects) including 16 germ cell tumors, eight aneurysmal bone cysts, five low grade osteosarcomas, and four chondrosarcomas. Another 69 cases were high-grade malignant bone tumors including 42 osteosarcomas, 21 Ewing’s sarcoma, and six other high grade osteosarcomas. Patients were divided into three groups: the first group received no adjuvant therapy, the second group received chemotherapy, and the third group received chemotherapy plus radiotherapy. The location of tumors were as follows: eight cases in the pelvic bone, 12 in the proximal femur, 18 in the femoral shaft, 36 in the distal femur, 12 in the proximal tibia, and 16 in the humeral bone. The 12 cases of proximal femoral defects were reconstructed by allograft composite prosthesis, 18 diaphyseal defects with intercalary allograft, and 36 distal femoral defects were reconstructed using osteoarticular allograft. The rate of deep infection was 7:8% (eight patients) and in this regard, we found a significant difference among the three groups, such that most cases of infection occurred in the adjuvant chemotherapy plus radiation therapy group. Allograft fracture occurred in six patients and prevalence was the same in all groups. Only in six cases of radio-chemotherapy nonunion occurred, so we used autogenous bone graft for union. Local recurrence was observed in six patients: three belonged to the adjuvant chemotherapy group and the other three were in the chemo-radiotherapy group; no significant difference was observed between these two groups. However, there was a significant difference between these two and the group that received no adjuvant therapy. Also, there were 11 cases of metastases and Restriction of knee joint motion occurred in 48 cases of osteo-cartilaginous grafts of the distal femur and proximal tibia. Conclusion: Although structural allograft is an appropriate choice in limb reconstruction after massive resection of involved tissues in malignant and invasive bone tumors, the risk of complications such as nonunion and infection in massive allograft increases in cases of adjuvant (chemotherapy and radiotherapy) modalities of treatment. Whereas the rate of tumor recurrence, metastasis, and restrictions in range of motion during a short term follow up after implantation showed no significant difference among the evaluated groups. Consequently, further attention and constant periodic visits of the patients and checking for local recurrence and distant metastasis should be done after surgery.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Economic Effects of Anti-Depressant Usage on Elective Lumbar Fusion

    • Abstract:   Background: It has been suggested, although not proven, that presence of concomitant psychiatric disorders may increase the inpatient costs for patients undergoing elective surgery. This study was designed to test the hypothesis that elective lumbar fusion surgery is more costly in patients with under treatment for depression. Methods: This is a retrospective case-control study of 142 patients who underwent elective lumbar fusion. Of those 142 patients, 41 patients were chronically using an antidepressant medication that considered as a "study group", and 101 patients were not taking an antidepressant medication that considered as a "control group". Data was collected for this cohort regarding antidepressant usage patient demographics, length of stay (LOS), age-adjusted Charlson comorbidity index scores and cost. Costs were compared between those with a concomitant antidepressant usage and those without antidepressant usage using multivariate analysis. Results: Patients using antidepressants and those with no history of antidepressant usage were similar in terms of gender, age and number of operative levels. The LOS demonstrated a non-significant trend towards longer stays in those using anti-depressants. Total charges, payments, variable costs and fixed costs were all higher in the antidepressant group but none of the differences reached statistical significance. Using Total Charges as the dependent variable, gender and having psychiatric comorbidities were retained independent variables. Use of an antidepressant was independently predictive of a 36% increase in Total Charges . Antidepressant usage as an independent variable also conferred a 22% increase in cost and predictive of a 19% increase in Fixed Cost . Male gender was predictive of a 30% increase in Total Charges . Conclusion: This study suggests use of antidepressant in patients who undergo elective spine fusion compared with control group is associated with increasing total cost and length of hospitalization, although none of the differences reached statistical significance.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Percutaneous Release of Trigger Fingers: Comparing Multiple Digits with
           Single Digit Involvement

    • Abstract:   Background: To evaluate safety and efficacy of percutaneous release of trigger finger in multiple digits involvement in comparison with  single digit involvement.   Method: A number of 100 patients (131 fingers) were treated by percutaneous release and divided into two groups: single digit (group A) and multiple digits (group B). They were followed up for one year. Success rate, pain, complications and duration of analgesic use were studied and then compared in both groups. Results: All patients in both groups were treated successfully without any recurrence in a one-year follow-up. No complication was observed, but postoperative duration of pain was significantly different between the two groups. Period of painkiller use was also different between the two groups. Conclusion: Percutaneous release is a safe and effective treatment for trigger fingers even if multiple digits are involved. It is also safe in thumb and index finger involvement and diabetic patients.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Progression of Heterotopic Ossification around the Elbow after Trauma

    • Abstract:  Background: This study addresses the null hypothesis that there is no expansion of heterotopic ossification (HO) in the elbow beyond what can be seen early on.   Methods: The area of HO was measured on lateral radiographs of 38 consecutive patients that had operative treatment of HO between 2000 and 2013. Measurements from radiographs obtained between 3 to 7 weeks were compared to measurements from radiographs made 3 months or more after injury. Results: There was no significant difference between the average area of HO on the first (median 2.8 square centimeters, Q1: 1.5, Q3: 5.1) and later radiographs (median of 2.8 square centimeters, Q1: 1.4, Q3: 5.0) (P = 0.99). Discussion: According to our results the area of HO does not expand beyond what can be seen early in the disease process.  
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Surgical Management of Hip Problems in Myelomeningocele: A Review Article

    • Abstract:   Background: Children with myelomeningocele (MMC) develop a wide variety of hip deformities such as muscle imbalance, contracture, subluxation, and dislocation. Various methods and indications have been introduced for treatment of muscle imbalances and other hip problems in patients with MMC but there is no study or meta-analysis to compare the results and complications. This review aims to find the most acceptable approach to hip problems in patients with MMC. Methods: MEDLINE was searched up to April 2015. All study designs that reported on the outcomes of hip problems in MMC were included. From 270 screened citations, 55 were strictly focused on hip problem in MMC were selected and reviewed. Results: Complex osseous and soft tissue reconstructive procedures to correct hip dysplasia and muscle balancing around the hip are rarely indicated for MMC patients without good quadriceps power. Conclusion: Over the years a consensus on the best algorithm for treatment of hip dislocation in myelomeningocele has been missing, however, muscular balancing with/out osseous procedure seems a reasonable approach especially in unilateral mid-lumbar MMC.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • High Tibial Osteotomy: A Systematic Review and Current Concept

    • Abstract: High tibia osteotomy is a common procedure in orthopedic surgery. A precise overview on indications, patients selection, pre-operative planning, surgical technique, methods of fixation, and complications have been presented. This paper focused on the points that should be considered to achieve good long-term outcomes. High tibia osteotomy is a common procedure in orthopedic surgery. A precise overview on indications, patients selection, pre-operative planning, surgical technique, methods of fixation, and complications have been presented. This paper focused on the points that should be considered to achieve good long-term outcomes.
      PubDate: Thu, 30 Jun 2016 19:30:00 +010
  • Assessment of diagnostic value of Single view static & dynamic
           technique in diagnosis of ...

    • Abstract: Purpose: Developmental dysplasia of hip (DDH) is a common childhood disorder and ultrasonography examination is routinely used for screening purposes. In this study, we aimed to evaluate a modified combined static and dynamic ultrasound technique in the detection of DDH and to compare with the static and dynamic ultrasound techniques results.Methods: In this cross-sectional study, during 2013- 2015, 300 high risk infants were evaluated by ultrasound for DDH. Both hips were examined with three techniques: static, dynamic and Single view static & dynamic technique. Statistical analysis was performed by SPSS version 11.5.Results: Patients aged 9 days to 83 weeks and 75% were between 1 to 3 months old. Among 600 hip joints, about 5% were immature in static sonography and almost all of them were unstable in dynamic techniques. 0.3% of morphologically normal hips were unstable in dynamic sonography and 9% of unstable hips had normal morphology. The mean β angle differences in coronal view before and after stress maneuver was 14.43±5.47 in unstable hips. Single view static & dynamic technique revealed all cases with acetabular dysplasia, instability and dislocation except two dislocations that were diagnosed by dynamic transverse view. In two patients, Ortolani maneuver showed femoral head reversibility in dislocated hips. Single view static & dynamic technique was diagnostic in more than 99% patients. Conclusion: Single view static & dynamic technique not only is a fast and easy technique, but also, it is of high diagnostic value in assessment of DDH.
      PubDate: Fri, 17 Jun 2016 19:30:00 +010
  • Relation between cervical injuries and helmet use, collision type and
           speed in motorcycle ...

    • Abstract: Objective: Spinal injuries are among the most important injuries in motorcyclists accounting for 1 to 5% of all injuries in this group with the frequency rising as high as 11% in severe and fatal cases .The most commonly involved areas are thoracic and cervical spines. Injuries to these areas can lead to significant morbidities with life-long complications. In this study, we aim to evaluate the relation of some risk factors including speed of motorcycle at the crash, the type and the mechanism of collision and using helmet with the rate and severity of cervical injury in motorcyclists. Patients and Methods: We retrospectively analyzed the medical files of patients with the cervical spinal injury due to motorcycle crash, diagnosed according to ICD10, who were admitted to Shahid Kamyab Trauma Center in Mashhad, Iran from January 2011 to January 2012. Medical files involved in motorcycle crashes were selected and patients who met the inclusion criteria were enrolled to the study. Characteristics of each motorcycle collision for each patient were determined by a traffic specialist from Traffic Police Department. Finally, the medical records were evaluated by a neurosurgery resident to identify the type of the neck injury and determine the Injury Scale Score to assess the severity of the injury. Data was analyzed using SPSS software version 18. Results: A total of 176 patients (mean age: 31.4, 97% male) met the inclusion criteria. Most of the accidents had occurred in rural and suburb roads outside the cities. Of the studied patients, 25 (14.2%) were found to have cervical spine fractures, 27 (15.3%) had neck strain or sprain and 153 (58.5%) had simply neck pain with no sever injuries. Neck fracture was significantly more common among the motorcyclists who had helmet when compared with nonhelmeted ....
      PubDate: Fri, 15 Apr 2016 19:30:00 +010
  • Complicated Congenital Dislocation of the Knee: A Case Report

    • Abstract: We report the case of a 7-year-old girl presenting symptoms of bilateral stiff knee, marked anterior bowing of both legs and inability to walk without aid.Radiologic investigation revealed bilateral knee joint dislocation accompanied by severe anterior bowing of both tibia proximally, and posterior bowing of both femur distally, suggesting a complicated case of congenital dislocation of the knee. Open reduction and proximal tibial osteotomy was performed in two stages to achieve an almost aligned and reduced knee joints. The patient was completely independent in performing her daily activities.If closed reduction for congenital dislocation of the knee should be performed, after every manipulation, patella should be manipulated passively. Passive motionof patella should be confirmed; otherwise, the knee is manipulated at physeal plateeither in distal femur or proximal tibia or even a metaphyseal fracture may occur.
      PubDate: Wed, 06 Apr 2016 19:30:00 +010
  • Predictors of Upper-Extremity Physical Function in Older Adults

    • Abstract: Background: Little is known about the influence of habitual participation in physical exercise and diet on upper-extremity physical function in older adults. Purposes: To assess the relationship of general physical exercise and diet to upper-extremity physical function and pain intensity in older adults. Methods: A cohort of 111 patients 50 or older completed a sociodemographic survey, the Rapid Assessment of Physical Activity (RAPA), an 11-point ordinal pain intensity scale, a Mediterranean diet questionnaire, and three Patient- Reported Outcomes Measurement Information System (PROMIS) based questionnaires: Pain Interference to measure inability to engage in activities due to pain, Upper-Extremity Physical Function, and Depression. Multivariable linear regression modeling was used to characterize the association of physical activity, diet, depression, and pain interference to pain intensity and upper-extremity function.Results: Higher general physical activity was associated with higher PROMIS Upper-Extremity Physical Function (r= 0.24, P= 0.011) and lower pain intensity (r=-0.21, P= 0.025) in bivariate analyses. Adherence to the Mediterranean diet did not correlate with PROMIS Upper-Extremity Physical Function or pain intensity in bivariate analysis. In multivariable analyses factors associated with higher PROMIS Upper-Extremity Physical Function were male sex, non-traumatic diagnosis and PROMIS Pain Interference, with the latter accounting for most of the observed variability (37%). Factors associated with greater pain intensity in multivariable analyses included fewer years of education and higher PROMIS Pain Interference. Conclusions: General physical activity and diet do not seem to be as strongly or directly associated with upper-extremity physical function as pain interference.
      PubDate: Wed, 06 Apr 2016 19:30:00 +010
  • Proximity of vital structures to the clavicle: comparison of fractured and
           non-fractured side

    • Abstract: Purpose: Previous anatomic and radiological studies have described the relationship of the clavicle to major neurovascular structures in healthy subjects. We were curious about this relationship in patients with a clavicle fracture and if it is different from non-fractured clavicles.Methods: We retrospectively identified all patients with a clavicle fracture between July 2001 and October 2013 in two level 1 trauma centers. Patients aged 18 years or greater with an acute unilateral clavicle fracture and a chest CT scan in the supine position displaying both clavicles and the complete fracture were included. Seventy patients were available for study. The distance was measured from the fracture site and from the closest clavicular cortex to the closest major artery, major vein, and inner surface of the thoracic cavity. CT data was evaluated in OsiriX DICOM viewer software with the use of three-dimensional Multiplanar Reconstruction. Results: Compared to the fractured side, the clavicle was significantly closer to the artery and vein on the non-fractured side (pConclusions: A fracture of the clavicle changes the relationship of the clavicle to major vital structures. The minimum distance of the clavicle to the closest artery and vein is significantly less on the non-fractured side, compared to the fractured side.
      PubDate: Sun, 03 Apr 2016 19:30:00 +010
  • Inter-observer agreement between 2-dimensional CT versus 3-dimensional
           I-Space model in the ...

    • Abstract: Purpose: The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space) in diagnosing acute occult scaphoid fractures. Methods and materials: A convenient cohort of 24 patients with a CT-scan from prior studies, without a scaphoid fracture on radiograph, yet high clinical suspicion of a fracture, were included in this study. CT-scans were evaluated in the I-Space by 7 observers of which 3 observers assessed the scans in the I-Space twice. The observers in this study assessed in the I-Space whether the patient had a scaphoid fracture. The kappa value was calculated for inter- and intra-observer agreement. Results: The Kappa value varied from 0.11 to 0.33 for the first assessment. For the three observers who assessed the CT-scans twice; observer 1 improved from a kappa of 0.33 to 0.50 (95% CI 0.26-0.74, P=0.01), observer 2 from 0.17 to 0.78 (95% CI 0.36-1.0, P<0.001), and observer 3 from 0.11 to 0.24 (95% CI 0.0-0.77, P=0.24).  Conclusion: Following our findings the I-Space has a fast learning curve and has a potential place in the diagnostic modalities for suspected scaphoid fractures.
      PubDate: Mon, 07 Mar 2016 20:30:00 +010
  • Axillary artery injury associated with proximal humerus fracture: a report
           of 6 cases

    • Abstract: Proximal humerus fractures are common, but associated injury of the axillary artery is uncommon. The majority of published blunt traumatic axillary artery injuries are associated with anterior glenohumeral dislocation; a few are associated with isolated proximal humerus fractures or fracture-dislocation. Experience within our institution demonstrates that axillary artery injury is often unrecognized on initial presentation owing to palpable peripheral pulses and the absence of ischemia and places the hand at risk of necrosis and amputation if there is prolonged ischemia and the forearm at risk of compartment syndrome after revascularization. Accurate physical examination in combination with a low threshold for Doppler examination or angiography can establish the diagnosis of axillary artery injury. We present 6 cases of axillary artery injury associated with proximal humerus fractures in order to highlight the potential for this vascular injury in the setting of a proximal humerus fracture.
      PubDate: Fri, 15 Jan 2016 20:30:00 +010
  • Assessment of decisional conflict about the treatment of trigger finger,
           comparing patients and ...

    • Abstract: Background: As an early step in the development of a decision aid for idiopathic trigger finger (TF) we were interested in the level of decisional conflict experienced by patients and hand surgeons. This study tested the null hypothesis that there is no difference in decisional conflict between patients with one or more idiopathic trigger fingers and hand surgeons. Secondary analyses address the differences between patients and surgeons regarding the influence of the DCS-subcategories on the level of decisional conflict, as well as the influence of patient and physician demographics, the level of self-efficacy, and satisfaction with care on decisional conflict. Methods: One hundred and five hand surgeon-members of the Science of Variation Group (SOVG) and 84 patients with idiopathic TF completed the survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). Results: On average, patients had decisional conflict comparable to physicians, but by specific category patients felt less informed and supported than physicians. The only factors associated with greater decisional conflict was the relationship between the patient and doctor. Conclusions: There is a low, but measurable level of decisional conflict among patients and surgeons regarding idiopathic trigger finger. Studies testing the ability of decision aids to reduce decisional conflict and improve patient empowerment and satisfaction with care are merited.
      PubDate: Tue, 12 Jan 2016 20:30:00 +010
  • Ossified Dorsal Wrist Ganglion Cyst - A Case Report

    • Abstract: Ganglion cysts are the most common wrist tumors, and 60 -70% originate dorsally from the scapholunate interval. Ossification of these lesions is exceedingly rare, with only one such lesion located in the finger reported in the literature. We present a case of an ossified dorsal wrist ganglion in a 68 year old woman.
      PubDate: Wed, 06 Jan 2016 20:30:00 +010
  • A slightly dorsally tilted lunate on MRI can be considered normal

    • Abstract: Background: Abnormal angulation of the lunate can be an indication of intercarpal pathology. On magnetic resonance images (MRIs) the lunate often looks dorsally angulated, even in healthy wrists. The tilt on individual slices can also be different and might be misinterpreted as pathological, contributing to inaccurate diagnoses and unnecessary surgery. The primary aim of this study was to determine the average radiolunate angle on sagittal wrist MRI images as well as the radiolunate angle in the most radial, central and most ulnar part of the lunate; also the interobserver reliability was determined. Methods: 140 MRIs from adult, non-pregnant patients presenting to the outpatient hand and upper extremity service between 2010 and 2013 with wrist pain were used for this retrospective study. One author measured the radiolunate and capitolunate angle (i.e., tangential and axial method) in all MRIs. Additionally, two authors measured the same angles independently in 46 MRIs to analyze interobserver reliability.Results: The average radiolunate angle was 8.7 degrees dorsal. There were no significant differences in the radiolunate angles between the different parts of the lunate. A very good interrater agreement was measured considering the radiolunate angle and capitolunate angle (tangential and axial method).Conclusions: Our study showed that the lunate appears slightly dorsally angulated on an MRI of a healthy wrist. Regarding the radiolunate angle, 10 to 15 degrees of dorsal tilt can be considered normal. This study provides reference information of normal anatomy for carpal axial alignment that may facilitate diagnoses of wrist pathology.
      PubDate: Mon, 07 Dec 2015 20:30:00 +010
  • Unicompartmental knee osteoarthritis (UKOA): Unicompartmental knee
           arthroplasty (UKA) or high ...

    • Abstract: PURPOSE: The aim of this review article is to analyze the results of high tibial osteotomy (HTO) compared to unicompartmental knee arthroplasty (UKA) in patients with unicompartmental knee osteoarthritis (UKOA). METHODS: The search engine was PubMed. The keywords used were: `high tibial osteotomy versus unicompartmental knee arthroplasty´. Twenty-one articles were found on 28 February 2015, but only eighteen were selected and reviewed because they were strictly focused on the topic of this article. RESULTS: In a meta-analysis the ratio for an excellent outcome was higher in UKA than HTO and the risks of revision and complications were lower in UKA than HTO. A prospective comparative study showed that UKA offers better long-term success (77% for UKA and 60% for HTO at 7-10 years). A review of the literature showed no evidence of superior results of one treatment over the other. A multicenter study stated that UKOA without constitutional deformity should be treated with UKA while in cases with constitutional deformity HTO should be indicated. A case control study stated that UKA offers a viable alternative to HTO if proper patient selection is done. CONCLUSION: The literature is still controversial regarding the best surgical treatment for UKOA (HTO or UKA). However, UKA utilization is increasing while HTO utilization is decreasing, and a meta-analysis has shown better outcomes in UKA than HTO and less risk of revision and complications in UKA than in HTO. A systematic review has found that with the correct patient selection, both HTO and UKA show effective and reliable results. Prospective randomized studies are needed for the future to answer the question of this article.
      PubDate: Fri, 20 Nov 2015 20:30:00 +010
  • Intrapelvic protrusion of a broken guide wire fragment during fixation of
           a femoral neck fracture

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