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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]
  • 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
  • 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: Tue, 31 May 2016 19:30:00 +010
  • Epithelialization over a scaffold of antibiotic-impregnated PMMA beads: a
           report of three cases

    • 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: Wed, 27 Apr 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: Wed, 27 Apr 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
  • Percutaneous release of trigger fingers: Comparing multiple digits with
           single digit involvement

    • Abstract: Percutaneous release of trigger fingers: Comparing multiple digits with single digit involvementAbstractPurpose: To evaluate safety and effectiveness of percutaneous release of trigger finger in multiple digits involvement compared to a single digit involvement.Method: A number of 100 patients (131 fingers) were treated by percutaneous release and divided in 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 compared in both groups.Results: All patients of both groups were treated successfully without any relapse in the one year follow-up. There was no complication but duration of pain was significantly different three weeks after surgery in both groups. Duration of using pain killers was different too. Conclusion: Percutaneous release is a safe and effective treatment for trigger fingers even when multiple digits are involved. It is also safe in thumb and index finger involvement and diabetic patients.
      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
  • 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 (p=0.003). Antidepressant usage as an independent variable also conferred a 22% increase in cost and predictive of a 19% increase in Fixed Cost (p=0.04, p=0.037 respectively). Male gender was predictive of a 30% increase in Total Charges (p=0.008).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: Sun, 03 Apr 2016 19:30:00 +010
  • Iranian Joint Registry(Iranian National Hip and Knee Arthroplasty

    • Abstract:    Periodic evaluation and monitoring the health and economic outcome of joint replacement surgery is a common and popular process under the territory of joint registries in many countries. In this article we introduce the methodology used for the foundation of the National Iranian Joint Registry (IJR) with a joint collaboration of the Social Security Organization (SSO) and academic research departments considering the requirements of the Iran’s Ministry of Health and Education.      
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Neglected Alkaptonuric Patient Presenting with Steppage Gait

    • Abstract:   Even though intervertebral disc degeneration can be found in the natural course of alkaptonuria, detection of the disease by black disc color change in a patient without any other presentation of alkaptonuria is an exceptionally rare condition. We have reported a very rare case of alkaptonuria presented with low back pain and steppage gait in a 51-year-old male with a complaint of chronic low-back pain and steppage gait who was operated on for prolapsed lumbar disc herniation. Intraoperatively his lumbar disk was discovered to be black. The alkaptonuria diagnosis was considered after histopathological examination of the black disc material and elevated urinary concentration of homogentisic acid confirmed the diagnosis. To our knowledge, this presentation has not been reported previously in literature.  
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Interstitial Tear of the Subscapularis Tendon, Arthroscopic Findings and
           Technique of Repair

    • Abstract:   Tears of the subscapularis tendon have been significantly recognized as a source of shoulder pain and dysfunction in the past decade, thanks to arthroscopic evaluation of the shoulder and biomechanical and anatomical studies of the tendon. Current classification of subscapularis tendon tear is based on insertion site of the tendon. Recently, a classification for non-insertional types of subscapularis tendon tear has been published. Interstitial tear of subscapularis tendon has not been described in classifications available in the literature. This report describes significant interstitial tear of the subscapularis tendon. This tear looks normal in superior, bursal and articular sides. Then its specific arthroscopic findings as "Air bag sign" and repair technique of the pathology is explained .
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Fanconi Anemia Concurrent with an Unusual Thumb Polydactyly: A Case Report

    • Abstract:   This case report presents a case of Fanconi’s Anemia with an unusual thumb polydactyly 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 carpometacarpal joint but its morphology did not match with any classification described for thumb polydactyly. Although his thumb polydactyly 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 polydactyly of the current case has not yet reported.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Treatment of displaced Sacroiliac fracture using the lateral window for
           short plate buttress ...

    • Abstract:   Fractures through the sacroiliac joint are very challenging to treat, technically difficult to reduce through closed methods on account of the multiaxial displacement of fractures fragments, frequently occur in very unwell patients, and have poor outcomes if malreduction is present. We describe a technique utilising the lateral window and a short buttress plate to reduce and stabilize the fragments prior to percutaneous fixation with sacroiliac screws.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Aneurysmal Bone Cyst: An Analysis of 38 Cases and Report of Four Unusual
           Surface Ones

    • Abstract:   Aneurysmal bone cyst (ABC) is a benign expansile bone tumor, most commonly involving the medulla of long bones. ABC rarely arises within the cortex or in the subperiosteal region, radiographically mimicking other conditions, in particular surface osteosarcomathat is low-grade in nature and may go secondary ABC changes, and telangiectatic osteosarcoma. Both of these are sometimes mistaken microscopically for primary ABC. We review the characteristics of ABC cases in our center and report four unusualsurface ABCs arising in the subperiosteal or cortical region of long bones, identified among 38 histologically proven ABCs during a four-year period in our center. The surface ABCs occurred at an older agewith a predilection for diaphysis of femur, tibia, and humerus.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Corrective Osteotomy for Intra-articular Distal humerus Malunion

    • Abstract:   Background: An intra-articular distal humerus malunion can be disabling. To improve function, reduce pain and/ or prevent further secondary osteoarthritis an intra-articular corrective osteotomy can be considered. Herein we present the indications, practical guidelines for pre- operative planning and surgical technique. Subsequently, we provide long-term results in a small series. Methods: We included six consecutive patients operated for intra-articular distal humerus malunion. Mean follow-up was 88 months. At lastest follow up elbow function was assessed according to standardized questionnaires and classification systems. Results: All six patients healed their osteotomies. Three patients had a postoperative complication which were treated succesfully. Range of motion improved significantly and all patients were satisfied with the outcome. The elbow performance scores were good to excellent in all. Correlation analyses showed that age and level of osteoarthritis are very strong predictors for the long-term elbow function and quality of life. Conclusion: An intra-articular corrective osteotomy for a malunited distal humerus fracture is a worthwhile procedure. Based on our results it should particularly be considered in young patients with minimal osteoarthritis and moderate to severe functional disability and/or pain.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Temporal and Spatial Expression of TGF-b1 in the Early Phase of Patellar
           Tendon Healing after ...

    • Abstract:   Background:The aim of this study is to find out the spatial and temporal expression of TGF-b1 during the tendon healing, after application of Platelet Rich Plasma (PRP). Methods: A patellar tendon defect model in rabbits was used for this purpose. 48 skeletally mature New Zealand White rabbits, weighing 3.5 kg, were used for this study. Equal numbers of animals from both groups were sacrificed at 4 different time points (1st, 2nd, 3rd, and 4th week). A full thickness patellar tendon substance in the right limb of each animal was excised from its central portion during the operation. PRP with a gel form was applied and filled the tendon defect in PRP group. No PRP was applied in the tendon defect of controls. Histological sections with hematoxylin-eosin and immunohistochemical sections with an anti-TGF-b1 primary antibody were made for the evaluation of the results. Results: A differentiation of the healing process was observed in the PRP group in comparison with the control group. TGF-b1 expression was detected in various cell populations (inflammatory cells, endothelial cells, macrophages, and tenocytes). Both cytoplasmic and nuclear expressions were present. The larger amounts of immunoexpression were localized in epitenon and in the repair site. PRP group showed stronger and more extensive staining at 1st and 2nd week (P<0.0001), whereas control group showed more extensive staining at the 3rd and 4th week (P<0.0001). Conclusions: Our study demonstrates that locally application of PRP result in an alteration of TGF-b1 expression during the healing of a patellar tendon defect.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Assessing Practitioners’ and Patients’ Needs Regarding Shared
           Decision-making and Decision Aids

    • Abstract:   Background: As part of the process of developing a decision aid for carpal tunnel syndrome (CTS) according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict. Methods: One-hundred-twenty-three observers of the Science of Variation Group (SOVG) and 84 patients with carpal tunnel syndrome completed a 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 significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons.Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one’s goals in spite of pain), and higher PDRQ (relationship between patient and doctor). Surgeons from Europe have--on average--significantly more decision conflict than surgeons in the United States of America. Conclusions: Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • A Comparison of Hand Pain and Hand Function after Z-plasty Reconstruction
           of the Transverse ...

    • Abstract:   Background: Carpal tunnel syndrome is the most common focal mono-neuropathy. A study was designed to compare the effects of traditional open carpal tunnel release with median neurolysis and Z-plasty reconstruction of the transverse carpal ligament on post-operative hand pain and hand function in patients with idiopathic carpal tunnel syndrome. Methods: Fifty-two patients with idiopathic carpal tunnel syndrome entered the study. The patients were randomly assigned into two groups to undergo simple transverse carpal ligament release or division of the ligament with Z-lengthening reconstruction. Forty-five patients completed the study. Two patients of the simple open surgery group and 5 patients of the Z-plasty reconstruction group did not complete the follow up course. After the procedure, the patients were followed to assess post-operative pain and hand function during a 12-week period. Results: The scores of hand pain on the first day after surgery were not statistically different between the two groups (P=0.213). But the score of hand pain was significantly lower in the Z-plasty reconstruction group at week 1, week 3, and week 6 after surgery (P<0.001). However, at week 12, no patient complained of hand pain in both groups. Considering hand function, no patient had normal hand grip after the first week, but after three weeks, a significantly higher proportion of patients in the Z-plasty reconstruction group had reached near normal hand grip (76.1% vs. 29.1%;). However, at weeks 6 and 12, the differences were not statistically different between the two groups. Conclusion: We observed significant reduction in hand pain, shorter duration of hand pain and shorter period of time to reach normal hand grip by Z-plasty reconstruction of the TCL.
      PubDate: Thu, 31 Mar 2016 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: Thu, 31 Mar 2016 19:30:00 +010
  • Position of the Patella among Emirati Adult Knees. ...

    • Abstract:   Background: Abnormal patellar height is associated with anterior knee pain and several conditions that affect the patellofemoral joint. The aim of this study was to 1) report the incidence of patella alta and patella baja and 2) investigate whether the normal limits of the Insall-Salvati ratio is applicable in adult Middle-Easterners. Methods: A radiographic review of the lateral radiographs of 736 Middle-Eastern knees were performed. Patellar tendon length (TL) and the patellar length (TP) was digitally measured and the ratios of these measures was used to calculate the Insall-Salvati ratio. Results: The overall mean TL/PL ratio was 1.20±0.17. The Insall-Salvati ratio was higher (p=0.0013) in males (1.22± 0.12) than in females (1.18±0.17). According to our measurement, the recommended levels for defining abnormal patellar position should be 0.86 for patella baja and 1.54 for patella alta. Conclusion: The use of TL/PL ratio demonstrated a higher incidence of patella alta and a higher mean TL/PL ratio compared to other techniques. The normal ranges for the TL/PL differs from western populations and may be attributed to lifestyle differences.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • MRI-Arthroscopic Correlation in Rotator Cuff Tendon Pathologies; A
           Comparison between Various ...

    • Abstract:   Background: Magnetic resonance imaging (MRI) has long been considered a perfect imaging study for evaluation of shoulder pathologies despite occasional discrepancies between MR reports and arthroscopic findings. In this study we aim to evaluate impact of imaging center as an indicator of image quality on accuracy of MRI reports in diagnosis of rotator cuff tendon pathologies. Methods: We reviewed MR reports of 64 patients who underwent arthroscopy in university center hospital. MRIs were done in various centers including both university-affiliated and out-centers. All studies were reported by two radiologists in consensus unaware of the arthroscopic results or previous reports. An inter-observer agreement analysis using the kappa statistics was performed to determine consistency among imaging and surgical reports. Results: Kappa values for out-centers were as follows: 0.785 for biceps, 0.469 for suscapularis, 0.846 for supraspinatus and 0.785 for infraspinatus tendons. In university centers values were 0.799 for biceps, 0.802 for suscapularis, 0.789 for supraspinatus and 0.770 for infraspinatus tendons. Conclusion: Image reporting in university centers with proficient sequences increased accuracy of diagnosis in 3/4 of evaluated features and showed subtle decreased inter-observer agreement in 1/4 of features. Uniformity of the scanners and protocols as well as evaluation on a workstation rather than hard copies cumulatively resulted in a meaningful increase in the accuracy of the same radiologists in diagnosis of rotator cuff tendon tear.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Pelvic Incidence in Patients with Hip Osteoarthritis

    • Abstract:   Background: Hip osteoarthritis (OA) is a major cause of pain and disability that results in considerable social and medical costs. Mechanics such as posture, alignment and orientation of the hips and the spinal column and the relationship between these factors have been implicated in the development of both hip and spine pathologies. This study aims to test the hypothesis if pelvic incidence varies in patients with and without osteoarthritis. We assessed the relationship between spinopelvic alignment as measured by pelvic incidence (PI) and the presence of hip OA. Methods: We collected supine pelvis CT scans of 1,012 consecutive patients not known to have hip OA. Our first group consisted of 95 patients with moderate to severe hip OA as per radiology reports. The second group included 87 patients with no evidence of hip OA. Power analysis revealed the need for 77 patients per group to find a mean difference in PI of 5º or less between both groups. Two trained physicians independently measured the PI to account for inter-observer reliability. Results: Patients with moderate to severe hip OA had a mean PI of 56.5º±12.8º. The mean PI for patients without hip OA was 57.2º±7.5º. An independent samples t-test revealed no significant difference between the PI values of the two groups. Spearman’s correlation coefficient of 0.754 demonstrated a high inter-observer reliability. Conclusion: There was no difference in PI angle of hip OA patients and "healthy" patients. Our measurements of patients without OA were almost identical to the reported normal PI values in the literature. It appears that hip OA is not associated with PI angle, refuting the hypothesis made in previous studies, stating that elevated PI contributes to the future development of hip arthritis. CT scan seems to be a reliable and accurate way of assessing pelvic incidence.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Malnutrition in Joint Arthroplasty: Prospective Study Indicates Risk of
           Unplanned ICU Admission

    • Abstract:   Background: Malnutrition has been linked to poor outcomes after elective joint arthroplasty, but the risk of unplanned postoperative intensive care unit (ICU) admission in malnourished arthroplasty patients is unknown. Methods: 1098 patients were followed as part of a prospective risk stratification program at a tertiary, high-volume arthroplasty center. Chronic malnutrition was defined as preoperative albumin <3.5 g/dL. Results: The overall incidence of malnutrition was 16.9% (primary and revision arthroplasty patients). Average BMI was highest for patients in albumin category 3.0-3.5 (BMI 35.7). Preoperative albumin <3.0 and <3.5 g/dL translated to 15.4% and 3.8% rates of unplanned ICU admission, respectively, indicating nutritional status to be a factor in postoperative ICU admission. Conclusion: Patients with poor nutritional status must be counseled on the risks of adverse medical complications.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Evaluation of distal femoral rotational alignment with spiral CT scan
           before total knee ...

    • Abstract:   Background: Evaluating the landmarks for rotation of the distal femur is a challenge for orthopedic surgeons. Although the posterior femoral condyle axis is a good landmark for surgeons, the surgical transepicondylar axis may be a better option with the help of preoperative CT scanning. The purpose of this study was to ascertain relationships among the axes’ guiding distal femur rotational alignment in preoperative CT scans of Iranian patients who were candidates for total knee arthroplasty and the effects of age, gender, and knee alignment on these relationships. Methods: One hundred and eight cases who were admitted to two university hospitals for total knee arthroplasty were included in this study. The rotation of the distal femur was evaluated using single axial CT images through the femoral epicondyle. Four lines were drawn digitally in this view: anatomical and surgical transepicondylar axes, posterior condylar axis and the Whiteside anteroposterior line. The alignment of the extremity was evaluated in the standing alignment view. Then the angles were measured along these lines and their relationship was evaluated. Results: The mean angle between the anatomical transepicondylar axis and posterior condylar axis and between the surgical transepicondylar axis and posterior condylar axis were 5.9 ± 1.6 degrees and 1.6±1.7 degrees respectively. The mean angle between the Whiteside’s anteroposterior line and the line perpendicular to the posterior condylar axis was 3.7±2.1 degrees. Significant differences existed between the two genders in these relationships. No significant correlation between the age of patients and angles of the distal femur was detected. The anatomical surgical transepicondylar axis was in 4.3 degrees external rotation in relation to the surgical transepicondylar axis. Conclusion: Preoperative CT scanning can help accurately determine rotational landmarks of the distal femur. If one of the reference axes cannot be determined, other reference axes can be used because of the good correlation between these landmarks.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Analysis of the geometry of the distal femur and proximal tibia in the
           osteoarthritic knee. ...

    • Abstract:   Background: The aim of this study is to evaluate the geometry of the distal femur and the proximal tibia in the osteoarthritic knee using 3D reconstructive CT scan imaging. Methods: 449 patients with knee osteoarthritis were treated surgically in our center with patient-specific technology total knee arthroplasty. Preoperatively, all the patients underwent a CT scan according to a standard protocol. Using this database, the Hip-Knee-Angle (HKA), the Femur Valgus Angle (FVA), the Tibia Varus Angle (TVA), the Posterior Tibia Slope (PTS), and the angle between the posterior condylar axis and the anatomical transepicondylar axis (PCA) for each patient were recorded and statistically evaluated. Results: In overall, the mean HKA angle was 177.3±5.55, the mean FVA angle was 3.19±2.08, the mean TVA was 3.28±2.35, the PTS angle was 9.02±3.46, and the PCA angle was 2.86±0.78. Evaluation of the correlations between HKA and PCA (r=0.035), HKA and PTS (r=-0.047), and PCA and PTS (r=0.05) showed non-significant relationships (P=0.46, P=0.32, and P=0.29 respectively). No significant differences were revealed from the comparison of male patients with female patients, regarding the mean HKA, FVA, TVA, PTS, and PCA. Conclusion: The posterior condylar axis is a well-defined but not a reliable axis, while the transepicondylar and the anteroposterior are reliable, but not easily defined axes. Given the large ranges and standard deviations of the location of posterior condylar axis, and the important inter- and intraobserver variability in the intraoperative location of the transepicondylar and the anteroposterior axes, the use of a preoperative 3D CT scan is recommended.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • A Chick Embryo in-Vitro Model of Knee Morphogenesis

    • Abstract:   Background: 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: Thu, 31 Mar 2016 19:30:00 +010
  • Traumatic First Time Shoulder Dislocation: Surgery vs Non-operative

    • Abstract:   Management of first shoulder dislocation following reduction remains controversial. The two main options are immobilisation and arthroscopic stabilisation. The aim of this article is to highlight some of the issues that influence decision making when discussing management options with these patients, including natural history of the first time dislocation, outcomes of surgery and non-operative management particularly on the risk of future osteoarthritis (OA), the effects of delaying surgery and the optimal method of immobilisation. Extensive literature review was performed looking for previous publication addressing 4 points. i) Natural history of primary shoulder dislocation ii) Effect of surgical intervention on natural history iii) Risk of long term osteoarthritis with and without surgical intervention iv) Immobilisation techniques post reduction. Individuals younger than 25 years old are likely to re-dislocate with non-operative management. Surgery reduces risk of recurrent instability. Patients with recurrent instability appear to be at a higher risk of OA. Those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop OA than those with recurrent instability. Delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. Recent studies have failed to match the preliminary outcomes associated with external rotation braces. Defining the best timing and type of treatment remains a challenge and should be tailored to each individual’s age, occupation and degree of physical activity.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Posterolateral Corner of the Knee:Current Concepts

    • Abstract:   Injuries to the posterolateral corner (PLC) comprise a significant portion of knee ligament injuries. A high index of suspicion is necessary when evaluating the injured knee to detect these sometimes occult injuries. Moreover, a thorough physical examination and a comprehensive review of radiographic studies are necessary to identify these injuries. In this sense, stress radiographs can help to objectively determine the extent of these lesions. Non-operative and operative treatment options have been reported depending on the extent of the injury. Complete PLC lesions rarely heal with non-operative treatment, and are therefore most often treated surgically. The purpose of this article was to review the anatomy and clinically relevant biomechanics, diagnosis algorithms, treatment and rehabilitation protocols for PLC injuries.
      PubDate: Thu, 31 Mar 2016 19:30:00 +010
  • Validated Measures of Publication Quality: Guide for Novice Researchers to
           Choose an ...

    • Abstract:   There is always a concern regarding the "quality" of publications as an index for promotion and career advancement. There are some ways to measure this "quality" including impact factor and SCImago Journal Rank (SJR) as a measure of journals’ level of impact, h-index as a measure of researchers’ level of impact, and visibility and citation as a measure of individual papers’ level of impact. Paper publication is bringing revenue to some journals by soliciting money from whom that must publish or perish. This raises the suspicion of fraud toward Open Access journals because sometimes charlatans pocket the money via creating predatory journals or even creating counterfeit websites using terms similar to those already known. For this reason, legitimate Open Access journals have to be authenticated. Tempting emails from Open Access journals showing high indices of quality might entrap the new researchers, which could be prevented by awareness of the below terms [Figure 1]. ...
      PubDate: Thu, 31 Mar 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
  • 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 surgeries of the plexus. In the present study, our aim was to evaluate the anatomical variations of the brachial plexus in adult cadavers.Materials and Methods: In the present observational study, 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. In the supra clavicular zone, the long thoracic nerve pierced the middle scalene muscle in 6 cases. In 7 plexuses, the suprascapular nerve was formed from posterior division of the superior trunk. In the infra clavicular zone, 5 cadavers showed the anastomosis between medial brachial cutaneous nerve and T1 root. Terminal branches variations were the highest wherein: the ulnar nerve received a communicating branch from 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. In 8 cadavers, some fibers came to musculocutaneous nerve from C7 root. 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: Mon, 22 Feb 2016 20:30:00 +010
  • Myelomeningocele: A review article about the different surgical treatment
           of the hip problems.

    • Abstract: Myelomeningocele: A review article about the different surgical treatment of the hip problems.Reza Abdi,Taghi baghdadi,Ramin Hajzargarbashi,Mehdi Ramezan ShiraziKeywords: hip dislocation, teratologic, myelomeningocele, sharrard,hip dysplasia, meningomyelocele, spina bifidaAbstract:Children with myelomeningocele develop a wide variety of hip deformities such as muscle imbalance, contracture, subluxation, or dislocation. Until now various methods and indications have been introduced for treatment of muscle imbalance and the other hip problems in patients with MMC but there is not any study or meta-analysis to compare the results and complications. So we review the articles to find the most acceptable approach to hip problem in patients with MMC. Until April 2015, 270 articles were retrieved and then 53 were selected and reviewed if they were strictly focused on the topic of this article.
      PubDate: Fri, 19 Feb 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
  • Evaluation of clinical results and complications of structural allograft
           reconstruction after ...

    • Abstract: Introduction In cases of Limbs preservation and reconstruction, after massive benign and malignant bone tumors resection, massive bone allograft is an option . The purpose of this study is to analyze the outcome of these procedures in at Emam Reza Hospital-Mashhad University of Medical Sciences Method: In this study we are going to present 113 cases but 11 cases were excluded (traumatic defect or patients that passed away in less than 2 years of follow up) , a questioner form , physical exam and if indicated x.ray information were collected and the Patients were divided into three groups of chemotherapy ( 46), chemotherapy plus radiation therapy( 23), and no-adjuvant-therapy recipients ( 33 Results: 54 cases were male, the mean age was 24.5+/- 5.39 and indications for operation were; 33 cases of aggressive benign tumors or low grade malignant bone tumors ( large bone defects ) and 69 cases of high grade malignant bone tumors . First group recieved no adjuvant therapy, but second devided to cases who recieved chemotherapy or whom recieved chemotherapy plus radiotherapy. The localization of tumors were as following , 8 cases in pelvic bone , 12 proximal femur, 18 femoral shaft, 36 distal femur, 12 proximal tibia and 16 cases were located in humeral bone. In 12 cases of proximal femoral defects we reconstacted theme by allograft composite prosthesis, 18 diaphyseal defects with intercalary allograft and 36 of distal femoral defects were reconstructed by using osteoarticullar allograft. The Rate of deep infection was 7/8 % (8 patients)
      PubDate: Tue, 12 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
  • 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: Wed, 06 Jan 2016 20:30:00 +010
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