Elbow
Amir R. Kachooei; David Ring
Volume 5, Issue 6 , November 2017, , Pages 375-379
Abstract
Background: To study if patients that have a second radiograph 2 or more years after nonoperative treatment of an isolated radial head fracture have radiocapitellar osteoarthritis (RC OA). Methods: We used the database of 3 academic hospitals in one health system from 1988 to 2013 to find patients with ...
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Background: To study if patients that have a second radiograph 2 or more years after nonoperative treatment of an isolated radial head fracture have radiocapitellar osteoarthritis (RC OA). Methods: We used the database of 3 academic hospitals in one health system from 1988 to 2013 to find patients with isolated radial head fractures (no associated ligament injury or fracture) that had a second elbow radiograph after more than 2 years from the initial injury. Of 887 patients with isolated radial head fractures, 54 (6%) had an accessible second radiograph for reasons of a second injury (57%), pain (30%), or follow-up visit (13%). Two orthopedic surgeons independently classified the radial head fractures on the initial radiographs using the Broberg and Morrey modified Mason classification, and assessed the development of RC OA on the final radiograph using a binary system (yes/no). Results: Four out of 54 (7.5%) patients had RC OA, one with isolated RC arthrosis that seemed related to capitellar cartilage injury, and 3 that presented with pain and had global OA (likely primary osteoarthritis). Conclusion: With the caveat that some percentage of patients may have left our health system during the study period, about 1 in 887 patients (0.1%) returns with isolated radiocapitellar arthritis after an isolated radial head fracture, and this may relate to capitellar injury rather than attrition. Patients with isolated radial head fractures can consider post-traumatic radiocapitellar arthritis a negligible risk.
Shoulder
Shahryar Ahmadi; Thomas M. Lawrence; Shawn Sahota; Cathy D. Schleck; William S. Harmsen; Robert H. Cofield; John W. Sperling
Volume 6, Issue 5 , September 2018, , Pages 359-364
Abstract
Background: The purpose of this study was to evaluate the value of perioperative tests for the diagnosis of infectionin revision shoulder arthroplasty.Methods: A retrospective analysis was performed on 537 shoulder arthroplasties (429 patients) that underwent revisionshoulder arthroplasty at our institution. ...
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Background: The purpose of this study was to evaluate the value of perioperative tests for the diagnosis of infectionin revision shoulder arthroplasty.Methods: A retrospective analysis was performed on 537 shoulder arthroplasties (429 patients) that underwent revisionshoulder arthroplasty at our institution. Periprosthetic tissue cultures were positive in 169/537 surgeries.Results: White-blood cell count (WBC) was elevated in 3.8% revision arthroplasties. Erythrocyte sedimentation rate (ESR)was elevated in 23.1% revision arthroplasties. The C-reactive protein (CRP) was elevated in 20.8% revision arthroplasties.Bone scans (technetium, indium) were performed on 9.9% patients and it was positive for osteomyelitis in just one revisionarthroplasty. Intra-operative pathology was read as consistent with acute inflammation in 11.9% revision arthroplasties.The positive and negative predictive values for intra-operative pathology were 56.7% and 71.6% respectively.Conclusion: All of the perioperative tests had a high specificity and negative predictive value, but low sensitivity andpositive predictive value.Level of evidence: III
Trauma
Mohamed A. Imam; Ahmed S. Negida; Ahmed Elgebaly; Amr Hussein; Lukas Ernstbrunner; Saqib Javed; Joshua Jacob; Mark Churchill; Paul Trikha; Kevin Newman; David Elliott; Arshad Khaleel
Volume 6, Issue 3 , May 2018, , Pages 176-188
Abstract
Background: There is a general consensus on the management of femoral fractures in children younger than two years and adolescents older than sixteen years. The best treatment for patients younger than sixteen years of age is still debatable. Titanium Elastic Nails (TEN), is widely used with some ...
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Background: There is a general consensus on the management of femoral fractures in children younger than two years and adolescents older than sixteen years. The best treatment for patients younger than sixteen years of age is still debatable. Titanium Elastic Nails (TEN), is widely used with some evidence, nonetheless, we undertook a systematic meta-analysis to assess the efficacy of TEN compared to Spica cast for the management of femoral shaft fracture in children aged between 2 to 16 years old. Methods: A computer literature search of PubMed, Scopus, Web of Science, CINAHL and Cochrane Central was conducted using relevant keywords. We included clinical trials and observational studies that compared TEN versus Spica cast; Records were screened for eligible studies and data were extracted and synthesized using Review Manager version 5.3 for Windows. Our search found 573 unique articles. After screening the abstract and relevant full text, 12 studies with a total of 1012 patients were suitab le for the final analysis Results: In terms terms of union (in weeks), the reported effect sizes favoured the TEN group in two included studies only. Moreover, the overall standardized mean difference in sagittal (SMD -0.48, 95% CI [-0.70 to -0.26], P<0.001) and coronal angulations (SMD -0.66, 95% CI [-1.00 to -0.31], P<0.001) favored TEN fixation in management of femoral fractures younger than 16 years. The reported length of hospital stay was not consistent across studies. The overall risk ratio of malalignment (RR=0.39, 95% CI [0.27 to 0.57], P<0.001) favored the TEN as well as walking independently. Based on our analysis, TEN treatment is superior to traction and hip spica for femoral fractures in patients younger than 16 years old. Conclusion: Based on our analysis we recommend the use of TEN fixation in management of pediatric femoral fractures in patients younger than 16 years. Level of evidence: II
Trauma
Ali Khaji; Bagher Larijani; Seyed Mohammad Ghodsi; Mohammad Ali Mohagheghi; Hamid Reza Khankeh; Soheil Saadat; Seyed Mahmoud Tabatabaei; Davoud Khorasani-Zavareh
Volume 6, Issue 4 , July 2018, , Pages 269-276
Abstract
Ethical issues in Technological disaster: A systematic review of literature Introduction: Industrialization could bring risk of Technological Disaster (TD) such as happened in Chernobyl, Bhopal and Fukushima crisis. little has been discussed about its related ethical issues. In this study, we aimed to ...
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Ethical issues in Technological disaster: A systematic review of literature Introduction: Industrialization could bring risk of Technological Disaster (TD) such as happened in Chernobyl, Bhopal and Fukushima crisis. little has been discussed about its related ethical issues. In this study, we aimed to investigate ethical issues have been stated for technological disasters. Material and Methods: A systematic search was conducted on the main international literature databases including Pubmed, Embase, Scopus and ISI (Jan 1, 2000 to March 30, 2014). From 64 articles were eligible for investigation of ethical issues in Natural disaster, 6 was related to Technological Disaster. The articles were in English language. Result: Our result show that there are six articles discussing ethical issues during Technological disaster. All of them are related to nuclear crisis in Fukushima resulting from Japan tsunami 2011. These articles discussed mainly three ethical issues in providing medical care to victims of Technological Disasters as follow: 1- Duty of care 2- Mandatory evacuation and Resource Allocation. Conclusion: Victim health is the main factor for making decision and implementation of any programs during response to disasters. Mandatory Evacuation for reasons other than providing health to people (such as: maintain public order) and if bring health risk to people will be unjustified. Duty of health workers for providing care is based on General beneficence meanwhile it is necessary to provide facilities to protect them from dangers that treat them in the field. For act ethically, Health workers must have adequate preparedness for response to T-D meanwhile it is necessary to provide guidelines for individuals that participation in relief operation. It is necessary to discuss more about Technological Disaster Ethics especially in industrial countries and where there is especial industrial with potential of huge crises.
Hand
Mark R. McCann; Philippa A. Rust; Robert Wallace
Volume 6, Issue 2 , March 2018, , Pages 105-111
Abstract
Background: The trapeziometacarpal joint (TMCJ) is inherently unstable, relying on ligament restraint to preventsubluxation. Subluxation of the thumb in a dorsoradial direction is often observed in clinical practice, either after acuteligament injury or more commonly with osteoarthritis (OA). This subluxation ...
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Background: The trapeziometacarpal joint (TMCJ) is inherently unstable, relying on ligament restraint to preventsubluxation. Subluxation of the thumb in a dorsoradial direction is often observed in clinical practice, either after acuteligament injury or more commonly with osteoarthritis (OA). This subluxation follows loss of function of trapeziometacarpalligaments that stabilise this joint, resisting the deforming force of abductor pollicis longus (APL). The exact ligamentsthat stabilise and prevent the thumb from the pull of APL causing dorsoradial subluxation remain unknown, although theanterior oblique ligament (AOL) has been implicated. The aim of this study was to measure the direction of subluxationresisted by the AOL.Methods: In this study we used cadaveric limbs and custom made biomechanical testing to measure the influence AOLhas in stabilising the thumb against subluxation in three planes: radial, dorsal and dorsoradial. Three fresh frozen handswere dissected to expose the TMCJ, leaving all ligaments, capsule and APL attachment in place. The force requiredto create a displacement of 5mm between the first metacarpal and the trapezium in these three planes was measuredbefore and after AOL division.Results: The average force to displace in the dorsoradial plane prior to division was 6.68N, and a statistically significantreduction to 1.15N (P<0.001) was found after division of the AOL. A statistically significant increase in force (P<0.001)from 2.89N to 4.04N was seen in the radial plane, while no change was seen dorsally (P=0.98), with average forces of2.74N and 2.62N found pre and post division.Conclusion: There is clinical significance in reporting quantifiable data in this field, as subluxation of the thumb is oftenseen with OA. The results of our study provide support for surgical reconstruction of the AOL as the primary surgicalstabilizer against dorsoradial subluxation of the thumb.
Arash Amiri; Hamidreza Yazdi; Ali Torkaman; Ara Nazarian; Jim S Wu; Margaret Babikian; Mohammad Ghorbanhoseini
Volume 6, supplement 1 , June 2018, , Pages 4-5
Abstract
This was Presented in 5th International congress of Iranian Iranian Society of Knee Surgery, Arthroscopy, and Sports Traumatology (ISKAST), 14-17 Feb 2018- Kish, Iran
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This was Presented in 5th International congress of Iranian Iranian Society of Knee Surgery, Arthroscopy, and Sports Traumatology (ISKAST), 14-17 Feb 2018- Kish, Iran
Shoulder
John G. Horneff; Usman Ali Syed; Adam Seidl; Jessica Britton; Gerald Williams; Joseph Abboud
Volume 7, Issue 1 , January and February 2019, , Pages 12-18
Abstract
Background: The purpose of this study was to determine a correlation between surgical case order and the length ofoperative time, total length of time in the operating room, time until discharge from the hospital, and the incidence ofintraoperative complications for primary total shoulder arthroplasty ...
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Background: The purpose of this study was to determine a correlation between surgical case order and the length ofoperative time, total length of time in the operating room, time until discharge from the hospital, and the incidence ofintraoperative complications for primary total shoulder arthroplasty cases.Methods: A retrospective review was conducted of records for all individual primary total shoulder arthroplasty andreverse total shoulder arthroplasty at a single hospital. In order to compare true parameters and minimize variables,only the cases performed by one senior author were analyzed. Operative and hospital records were reviewed.Results: There were 162 primary TSA and with the following order: 55 first order cases, 46 second order cases, 34third order cases, 21 fourth order cases, and six fifth order cases. There were 71 primary rTSA patients included (27:27:10:6:1). Length of stay was statistically increased for both female gender (8.3%; 95% confidence interval (CI)= 0.5-16.7%; P=0.0386) and fourth case order compared to first case (13.3%; 95% CI = 0.6%; 27.6%) P=0.041). For reverseTSA, there was no analyzed predictor that was significant.Conclusion: Even between anatomic TSA and reverse TSA patients, there was variability in what factors played apart in case inpatient length of stay. As such, we believe that this study highlights that case order can have an effecton operating room parameters for shoulder arthroplasty patients. The need for larger studies remains to better definethat effect.Level of evidence: IV
Trauma
Tom J. Crijns; Tyler Caton; Teun Teunis; Jacob T. Davis; Kindra McWilliam-Ross; David Ring; Hugo B. Sanchez
Volume 6, Issue 6 , November 2018, , Pages 492-500
Abstract
Background: Proximal femur fractures are prevalent among the elderly and associated with substantial morbidity,mortality, and early readmission. Early readmission is gaining popularity as a measure of quality of hospital care and canlower reimbursement. A better understanding of the patient and treatment ...
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Background: Proximal femur fractures are prevalent among the elderly and associated with substantial morbidity,mortality, and early readmission. Early readmission is gaining popularity as a measure of quality of hospital care and canlower reimbursement. A better understanding of the patient and treatment characteristics associated with readmissionmay help inform program improvement initiatives. This study tested the primary null hypothesis that length of stay isnot associated with higher rates of readmission within 30 days and 1 year in patients having operative treatment of aproximal femur fracture, accounting for discharge destination and other factors.Methods: We performed a secondary analysis on a database of 1,061 adult patients, age 55 years or older, admittedfor treatment of a proximal femoral fracture in an urban level 2 trauma center. Multivariable logistic and linear regressionmodels were created to account for the influence of age, sex, race, BMI, American Society of Anesthesiologists score(ASA), fracture type (AO/OTA), fixation type, operating surgeon, operative duration, and discharge destination.Results: In multivariable logistic regression analysis, treatment by surgeon 4 was independently associated with alower 30-day readmission rate. Higher one-year readmission rate was associated with a longer length of stay, ASAclass 3, 4 and 5.Conclusion: The observation that patients cared for by specific surgeons are more likely to experience readmissionwithin one year of surgery for a fracture of the proximal femur, suggests that program improvements to identify anddisseminate best practices might reduce readmission rates.Level of evidence: III
Orthotics & Prosthetics
Martin Kiechle; Andreas Thannheimer; Sven Hungerer; Jan Friederichs; Volker Bühren; Christian Von Rüden
Volume 7, Issue 2 , March and April 2019, , Pages 112-117
Abstract
Background: Aim of this study was to compare the clinical and radiological long-term outcomes following operativetreatment of comminuted radial head fractures using 1) primary radial head resection arthroplasty, 2) acute radial headresection, or 3) necessary secondary prosthetic removal. Additionally, ...
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Background: Aim of this study was to compare the clinical and radiological long-term outcomes following operativetreatment of comminuted radial head fractures using 1) primary radial head resection arthroplasty, 2) acute radial headresection, or 3) necessary secondary prosthetic removal. Additionally, we evaluated complex radial head fracturescombined with elbow dislocation and verified the hypothesis of whether primary radial head resection arthroplasty couldcontribute to ligament healing.Methods: In a comparative retrospective cohort study between 2004 and 2014, 87 (33 female, 54 male) patients withcomminuted radial head fractures with a median age of 45 (range 18-77) years were included and followed-up clinicallyand radiologically. Functional results were evaluated according to MEPS, DASH, Broberg and Morrey, and VAS scores.Results: After a median range of 46 months postoperatively, 48 patients (group 1) obtained an acute radial headresection arthroplasty (MEPS: 70 points, Broberg and Morrey: 63 points, DASH: 34 points, VAS: 3.3 points). Twentypatients (group 2) were treated by radial head resection (MEPS: 63 points, Broberg and Morrey: 50 points, DASH: 49points, VAS 4.2 points) and 19 patients (group 3) needed secondary prosthesis removal (MEPS: 73 points, Brobergand Morrey: 66 points, DASH: 38 points, VAS: 2.8 points). The overall outcome demonstrated a trend towards betterresults and the Kellgren-Lawrence grade of postoperative osteoarthritis was significantly better in groups 1 and 3compared to group 2 (P=0.02).Conclusion: Clinical and radiological long-term results of this study demonstrate a trend towards a better outcomeafter acute radial head resection arthroplasty compared to primary radial head resection, especially in complex fracturesassociated with elbow dislocation. Furthermore, our results encourage the use of primary radial head replacement incases of comminuted non-reconstructable radial head fractures.Level of evidence: III
Elbow
Saeed Kokly; Alessandro Castagna; Mehdi Aarabi
Volume 7, Issue 5 , September 2019, , Pages 416-421
Abstract
Background: The most common pediatric elbow fracture is supracondylar humeral fracture which accounts for 60% ofelbow fractures in children. The aim of this study was to evaluate the results of open reduction and internal fixation oftype III supracondylar humeral fractures using a Triceps sparing posterior ...
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Background: The most common pediatric elbow fracture is supracondylar humeral fracture which accounts for 60% ofelbow fractures in children. The aim of this study was to evaluate the results of open reduction and internal fixation oftype III supracondylar humeral fractures using a Triceps sparing posterior approach.Methods: In total, 98 patients were evaluated from June 2007 to 2014.Results: According to the results, the mean age of the patients was 6.4 years. The ratios of males to females and theright to left hand were 2.06 and 2.26, respectively. Totally, 82% of fractures happened in the dominant hand which wasright. The patients underwent surgery within approximately 50.16 hours after injury. Anatomic reduction and internalfixation were performed under direct vision with no need for image intensifier. The mean time of follow-up was 14.3months, and all fractures healed clinically and radiologically. Moreover, the maximum lack of an extension was 15° andthe obtained mean was 3.5°. Additionally, the mean final Bauman angle difference with healthy elbow was determinedat 2.4°. The rate of complications was 19.3%, including pin tract infections (7%), pin loosening (3%), heterotopicossification (4%), and wound dehiscence (1%). Furthermore, there were 4 cases (4%) of anterior interosseous nervepalsy, two of which happened before surgery, and the other two following the surgery. All of these complications wereresolved within 3 to 10 weeks spontaneously.Conclusion: This approach helped preserve the extensor mechanism and ulnar nerve intact to have an acceptableskin scar esthetically along with satisfactory postoperative function.Level of evidence: IV
Hand
Kevin Lutsky; Charles Leinberry; Greg Gallant; Robert Takei; Moody Kwok; Pedro Beredjiklian
Volume 7, Issue 3 , May 2019, , Pages 235-238
Abstract
Background: Distribution of radiographic images in the outpatient setting on compact discs-recordable (CD-R) iscommonplace. Opening, manipulating and interpreting these can be challenging. This study evaluated the availabilityand ease of use of CD-R to evaluate digital images in an outpatient orthopedic ...
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Background: Distribution of radiographic images in the outpatient setting on compact discs-recordable (CD-R) iscommonplace. Opening, manipulating and interpreting these can be challenging. This study evaluated the availabilityand ease of use of CD-R to evaluate digital images in an outpatient orthopedic setting.Methods: 118 CD-R containing diagnostic studies were evaluated by seven board certified orthopaedic surgeons.Surgeon age and self-perceived “tech savvy” scores were tabulated using a visual analog scale (VAS). Surgeonsevaluated: ability and number of computers to open, autorun, and specific reader software. Time to load was recordedin seconds, type of study, presence of “not for diagnostic use”, and if the disc required additional software. Studies weregraded using a VAS for ease of opening, ability to move from image to image and/or between series, to manipulatethe image, and to zoom and pan.Results: There were 79 radiographs, 29 MRI’s, and 10 CT scans. Seven (6%) had to be manually opened andfour (3%) required software installation. Thirteen (11%) contained a warning that the studies should not be used fordiagnostic purposes. Six (5%) of the studies could not be opened. For the opened studies, average time from diskinsertion to image was 43.7 seconds overall (range 3-350), 65.3 seconds (range 21-191) for MRI and CT, and 35.2seconds (range 5-177) for radiographs.Conclusion: The present digital imaging systems include different software types and a variety of interfaces.Improving this would decrease time and effort necessary to open and evaluate these studies, and improveefficiency.Level of evidence: III
Elbow
Matthew Tarabochia; Stein Janssen; Paul T. Ogink; David Ring; Neal C. Chen
Volume 8, Issue 1 , January 2020, , Pages 21-26
Abstract
Background: Enthesopathy of the extensor carpi radialis brevis origin [eECRB] is a common idiopathic, noninflammatorydisease of middle age that is characterized by excess glycosaminoglycan production and frequentlyassociated with radiographic calcification of its origin. The purpose of our study was ...
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Background: Enthesopathy of the extensor carpi radialis brevis origin [eECRB] is a common idiopathic, noninflammatorydisease of middle age that is characterized by excess glycosaminoglycan production and frequentlyassociated with radiographic calcification of its origin. The purpose of our study was to assess the relationship ofcalcification of the ECRB and advancing age.Methods: We included 28,563 patients who received an elbow radiograph and assessed the relationship of calcificationsof the ECRB identified on radiograph reports with patient age, sex, race, affected side, and ordering indication usingmultivariable logistic regression.Results: Calcifications of the ECRB were independently associated with age (OR:1.04; P<0.001); radiographsordered for atraumatic pain (OR2.6; P<0.001) or lateral epicondylitis (OR5.5; P<0.001); and Hispanic ethnicity (OR1.5;P<0.001) and less likely to be found at the left side (OR0.68; P<0.001). Similarly, incidental calcifications of the ECRB,those on radiographs not ordered for atraumatic pain or lateral epicondylitis, were independently associated withage (OR1.03; P<0.001) and Hispanic ethnicity (OR1.5; P<0.024) and less likely to be found on the left side (OR0.71;P<0.001).Conclusion: We observed that about nine percent of people have ECRB calcification by the time they are in their sixthdecade of life and calcifications persist in the absence of symptoms which supports the idea that eECRB is a common,self-limited diagnosis of middle age.Level of evidence: II
Shoulder
Mihir Sheth; Daniel Sholder; Joseph Abboud; Mark Lazarus; Gerald Williams Jr; Surena Namdari
Volume 8, Issue 2 , March 2020, , Pages 147-153
Abstract
Background: The projected increase in revision shoulder arthroplasty has increased interest in the outcomes of theseprocedures. Glenoid component removal and conversion to a hemiarthroplasty (HA) is an option for aseptic glenoidloosening after anatomic total shoulder arthroplasty (aTSA).Methods: We identified ...
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Background: The projected increase in revision shoulder arthroplasty has increased interest in the outcomes of theseprocedures. Glenoid component removal and conversion to a hemiarthroplasty (HA) is an option for aseptic glenoidloosening after anatomic total shoulder arthroplasty (aTSA).Methods: We identified patients who had undergone revision shoulder arthroplasty over a 15-year period. 17 patientsmet inclusion and exclusion criteria, and a retrospective chart review was conducted for pre-surgical and operativedata. We contacted patients at a mean follow-up of 70 months from revision surgery for implant survival, reoperationsand functional outcomes scores.Results: Implant survival was estimated to be 88% at 2 years and 67% at 5 years. Mean ASES score for survivingimplants was 58 ± 22. Mean SANE score was 54 ± 24, and mean VAS pain score was 3.5 ± 2.8. Mean SF-12 Mentaland Physical scores were 46 ± 15 and 38 ± 10, respectively. Five patients (50% of those with surviving implants)reported being either very satisfied or satisfied with the status of their shoulder. There were complications in 6 patients(35%) and 5 patients (29%) required reoperation.Conclusion: HA following failed aTSA due to glenoid loosening produced modest clinical results and satisfaction rates.Reverse arthroplasty may be a more reliable treatment strategy in this patient population.Level of evidence: IV
Spine
Babak Ganjeifar; Ehsan Keykhosravi; Gholamreza Bahadorkhan; Hossein Mashhadinezhad; Mohammad R. Ehsaei; Fariborz Samini; Masoud Pishjoo; Abdolreza Mahmoodi; Hamid Rezaei
Volume 7, Issue 4 , July 2019, , Pages 321-324
Abstract
Background: Thoracolumbar spinal fractures include a range of injuries of various severities from simple apophysealfractures to neurological injury and complex fractures associated with vertebral dislocation. The treatment ofthoracolumbar fractures is challenging, especially due to the difficulty of ...
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Background: Thoracolumbar spinal fractures include a range of injuries of various severities from simple apophysealfractures to neurological injury and complex fractures associated with vertebral dislocation. The treatment ofthoracolumbar fractures is challenging, especially due to the difficulty of evaluating the posterior ligamentous complex(PLC). The purpose of this study was to evaluate the diagnostic value of computed tomography (CT) scan in predictingPLC injuries in the patients with thoracolumbar spinal fractures referring to the referral center of spinal trauma in theeast north of Iran in 2016.Methods: This retrospective study was conducted on patients with thoracolumbar injuries referring to Shahid KamyabHospital in Mashhad, east north of Iran, in 2016. The data were collected by entering the data of medical records intospecial forms. The classification of spinal fractures was accomplished using the AO Spine Classification System.Results: According to the results, 71 (71.7%) patients were male, and the subjects had a mean age of 44.6±17.7 years.The PLC injury was observed in 28 (28.3%) patients. The PLC injury showed a significant relationship with facet jointwidening, increased interspinous process distance, and spinous process avulsion fracture (P<0.05).Conclusion: As the findings of this study indicated, the diagnostic results of PLC injury by means of CT scan wassimilar to those obtained by magnetic resonance imaging in patients with thoracolumbar spinal fractures.Level of evidence: III
Shoulder
Soheil Sabzevari; Mostafa Khalilipour Roudi; Jay Kalawadia; Albert Lin
Volume 7, Issue 6 , November 2019, , Pages 493-497
Abstract
Background: To describe a case series of young adult patients with isolated chronic proximal biceps tendinitisrefractory to conservative care found to have anatomic long head biceps tendon (LHBT) origin variations who underwentarthroscopic-assisted subpectoral biceps tenodesis.Methods: Patients were ...
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Background: To describe a case series of young adult patients with isolated chronic proximal biceps tendinitisrefractory to conservative care found to have anatomic long head biceps tendon (LHBT) origin variations who underwentarthroscopic-assisted subpectoral biceps tenodesis.Methods: Patients were included in this retrospective case series if they met all the following criteria: 1) had ananomalous origin of the LHBT without any pre-operative or concurrent pathologies at the time of surgery, 2) had nontraumaticanterior shoulder pain refractory to conservative care for >6 months, 3) pain relief with ultrasound guidedsteroid injections into the bicipital tendon sheath, and 4) routine radiographs and MRI-arthrogram demonstratingno pathology. All patients underwent arthroscopic assisted mini-open subpectoral biceps tenodesis. Pre- and postoperativeactive range of motion (ROM), strength, visual analog scale (VAS) for pain, and subjective shoulder values(SSV) were evaluated. Statistical analysis was done using repeated measure ANOVA.Results: Seven patients mean age of 18.4 ± 3.5 years old were included in this study. Arthroscopic examinationrevealed anomalous origins of the LHBT in all patients with the following distribution: medial to superior labrum (x2),proximal insertion to the supraspinatus confluent with the superior labrum (x2), insertion into the superior capsulartissues at the rotator interval (x2), and bifid LHBT (x1). VAS score and SSV were significantly improved at 3 months(PConclusion: Anomalous origins of the LHBT may be a predisposing factor for chronic biceps tendinitis refractory tonon-operative treatment in young adults. Biceps tenodesis seems to offer improvements in function and pain.Level of evidence: IV
Mohammad Emami; Ali Reza Manafi; Behroz Hashemi; Ali Nemati; Saeed Safari
Volume 1, Issue 1 , September 2013, , Pages 14-17
Abstract
Background: At present, there is no consensus on an appropriate treatment modality for intertrochanteric fractures in the elderly with background diseases. The aim of the present study was to compare treatment outcomes of intertrochanteric fractures reduced with dynamic hip screws (DHS) and bipolar hemiarthroplasty ...
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Background: At present, there is no consensus on an appropriate treatment modality for intertrochanteric fractures in the elderly with background diseases. The aim of the present study was to compare treatment outcomes of intertrochanteric fractures reduced with dynamic hip screws (DHS) and bipolar hemiarthroplasty in elderly patients with background medical conditions. Methods: In this randomized clinical trial, 60 patients with intertrochanteric fractures, who were 45-60 years old, were randomly divided into DHS and bipolar groups. After treatment, the two groups were compared in relation to complications and mortality rates, functional status using the Harris Hip Score (HHS), range of movement and severity of pain using the visual analogue score (VAS). Results: HHS (86±9 vs. 75±7.6), range of flexion (105±11 degrees vs. 90±17 degrees) and external rotation (35±7 degrees vs. 20±7 degrees) were significantly higher in the bipolar group compared to the DHS group (P<0.05). However, there were no significant differences in pain severity between the two groups. Conclusion: Reduction of intertrochanteric fractures in elderly patients with background medical conditions is more effective and less problematic with the bipolar technique compared to DHS and is better tolerated by patients, because this technique is associated with improvements in functional status and hip joint movement range.
E Carlos Rodriguez-Merchan; Luis Moraleda; Primitivo Gomez-Cardero
Volume 1, Issue 2 , December 2013, , Pages 59-63
Abstract
Background: Fractures of the femoral shaft are mostly the result of high-energy accidents that also cause multiple trauma injuries, in particular ipsilateral knee and hip injuries. The purpose of this study was to investigate the incidence of injuries associated with femoral shaft fractures and ...
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Background: Fractures of the femoral shaft are mostly the result of high-energy accidents that also cause multiple trauma injuries, in particular ipsilateral knee and hip injuries. The purpose of this study was to investigate the incidence of injuries associated with femoral shaft fractures and how many of them were undetected. Methods: We studied 148 patients (150 femoral shaft fractures) with an average age of 52 (range: 18-97). Femoral shaft fractures were treated with antegrade intramedullary nailing in 118 cases (78.7%), and with open reduction and internal fixation in 32 cases (21.3%). Unlocked reamed intramedullary nailing was performed in Winquist type I and type II fractures, while statically locked unreamed intramedullary nailing was carried out in Winquist type III and type IV fractures. Results: There were 70 patients with associated injuries (46.4%). The associated injuries went undetected in 18 out of 70 patients (25.5%). Six femoral nonunions (4%) occurred in patients under 70 years of age (high-energy accidents) treated by open reduction and internal fixation. Conclusion: Injuries associated with femoral shaft fractures were very frequent (46.4%) in our series, with 25.5% undetected. Open reduction and internal fixation was a poor prognostic factor of nonunion in these fractures.
Haitao Tan; Xiang Luo; Keqin Yang; Jianzhong Jiang; Pingou Wei; Jinming Zhao
Volume 2, Issue 1 , March 2014, , Pages 11-16
Abstract
Background: To introduce our experience of using the free neurovascular flap from great and second toe. Methods: Thirteen patients (fifteen fingers) sought surgical treatment for soft tissue defects of the hand at our medical institutin between March 2006 and September 2009. In two patients, ...
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Background: To introduce our experience of using the free neurovascular flap from great and second toe. Methods: Thirteen patients (fifteen fingers) sought surgical treatment for soft tissue defects of the hand at our medical institutin between March 2006 and September 2009. In two patients, fibular side skin-nail flaps of great toe were applied to cover the dorsal defect of distal thumb. In twelve, in the treatment of pulp defect of finger with fibular side flap of great toe or tibial side flap of second toe. In one, in the treatment of defect of distal middle with composite flap with distal digital bone of second toe. Results: All flaps were survived. The average subjective satisfaction score was 8.08 (range 4-10). Nine patients (69%) experienced cold intolerance, and 2 patients (15%) dysesthesia. The Semmes-Weinstein sensitivity score was between 3.47and 4.72 on the flap, and 0-4.18 on the donor site. The mean two-point discrimination was 6.8 mm (range 4-12). Grip strength was 10% less than in the unaffected hand. The proximal interphalangeal mobility loss was less than 15 degrees. Conclusions: Our results indicated that these free flaps from toe are useful for patients with a small soft-tissue defect in hand.
Habib Reshadi; Alireza Rouhani; Saeid Mohajerzadeh; Marvan Moosa; Asghar Elmi
Volume 2, Issue 2 , June 2014, , Pages 106-110
Abstract
Background: Although the majority of soft tissue masses are benign, it is important to consider malignancy in differential diagnoses. Because most soft tissue sarcomas present as a painless mass, clinicians must watch for signs suggestive of malignancy, including large size, rapid growth, and ...
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Background: Although the majority of soft tissue masses are benign, it is important to consider malignancy in differential diagnoses. Because most soft tissue sarcomas present as a painless mass, clinicians must watch for signs suggestive of malignancy, including large size, rapid growth, and site deep into the deep fascia.The purpose of this study was to determine the relative prevalence according to sex and age, site of tumor, skeletal distribution, and treatment (surgery, chemotherapy and radiotherapy) before and after surgery, and ascertain the relative frequency of these tumors in specific anatomic sites and age groups based on pathological studies. Methods: A total of 308 patients, with a musculoskeletal tumor were evaluated retrospectively. All of the patients enrolled into this study were referred to the Beirouni Hospital of Damascus University with a proven diagnosis of alignant soft tissue tumors from the beginning of January 2008 until the end of 2010. The prevalence of the malignant soft tissue tumors in these patients was analyzed. For purposes of analysis, all lesions were placed in 1 of 9 categories: hand and wrist, forearm, humorous (arm), proximal limb girdle (axilla and shoulder), foot and ankle, thigh, hip and buttocks region, trunk, and other lesions. Age and sex also were recorded. Results: Malignant tumors consisted of seven diagnostic categories: malignant fibrous histiocytoma (23%), liposarcoma (22%), rhabdomyosarcoma (9%), leiomyosarcoma (8%), malignant schwannoma (5%), dermatofibrosarcoma protuberans (5%), synovial sarcoma (10%), fibrosarcoma (13%), extraskeletal chondrosarcoma (1%), and extraskeletal Ewing sarcoma (4%). Conclusions: Despite the multitude of pathologic possibilities, most malignant soft-tissue tumors are classified into a small number of diagnoses. These may be further defined when the site of the lesion and the age of the patient are considered. Knowledge of tumor prevalence will assist radiologists in establishing a suitably ordered differential diagnosis when a soft-tissue tumor has a nonspecific radiologic appearance.
M.N Tahmasebi; Kaveh Bashti; MR Sobhan; GH Ghorbani
Volume 2, Issue 3 , September 2014, , Pages 141-145
Abstract
Background: Tranexamic acid (TXA) has received extensive attention in management of blood loss in orthopedic surgeries. However, the ideal method of TXA administration is still controversial. This study aims to determine whether intraarticular injection of TXA reduces blood loss after total ...
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Background: Tranexamic acid (TXA) has received extensive attention in management of blood loss in orthopedic surgeries. However, the ideal method of TXA administration is still controversial. This study aims to determine whether intraarticular injection of TXA reduces blood loss after total knee arthroplasty (TKA). Methods: Through a retrospective case-control study consecutive TKA patients receiving intraarticular TXA (Case group) were compared with similar patients undergoing TKA using traditional blood management strategy (Control group). Hemoglobin levels (Hb) before and after the surgery, need for transfusion, and reoperation due to massive blood loss were compared between the two groups. Results: Fifty TXA patients were compared with 50 patients of the control group. There was no significant difference between the two groups in terms of age, gender, and preoperative Hb. Postoperative blood loss and transfusion rate were significantly reducedin TXA patients compared to the control group (P<0.05). Conclusions: Our study revealed that intraarticular administration of TXA reduces postoperative blood loss as well as need for blood transfusion in patients undergoing TKA.
M.N Tahmasebi; Kaveh Bashti; MR Sobhan; GH Ghorbani
Volume 2, Issue 4 , October 2014, , Pages 260-264
Abstract
We presented a female patient with RA complaining of progressive pain, swelling, and crepitation of the knee joints that was diagnosed with bilateral synovial chondromatosis (SC) of both knees. Radiographies revealed characteristic findings of SC including multiple calcified multifaceted loose bodies ...
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We presented a female patient with RA complaining of progressive pain, swelling, and crepitation of the knee joints that was diagnosed with bilateral synovial chondromatosis (SC) of both knees. Radiographies revealed characteristic findings of SC including multiple calcified multifaceted loose bodies within both knees. Removal of cartilaginous segments as well as total synovectomy was performed arthroscopically on the left side and via open surgery on the right side. Short-term postoperative follow-up of our patient revealed improved knee function and resolution of all symptoms.
Jan Paul Briët; Stéphanie J.E. Becker; Thijs C.H. Oosterhoff; David Ring
Volume 3, Issue 1 , January 2015, , Pages 19-21
Abstract
Background: Giant cell tumor of tendon sheath (GCTTS) is often thought of as a volar finger mass. We hypothesized that GCTTS are equally common on the dorsal and volar aspects of the hand. In addition, we hypothesized that there are no factors associated with the location (volar versus dorsal) ...
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Background: Giant cell tumor of tendon sheath (GCTTS) is often thought of as a volar finger mass. We hypothesized that GCTTS are equally common on the dorsal and volar aspects of the hand. In addition, we hypothesized that there are no factors associated with the location (volar versus dorsal) and largest measured dimension of a GCTTS. Methods: A total of 126 patients with a pathological diagnosis of a GCTTS of the hand or finger were reviewed. Basic emographic and GCTTS specific information was obtained. Bivariable analyses were used to assess predicting factors for location (volar or dorsal side) and largest measured diameter of a GCTTS. Results: Seventy-two tumors (57%) were on the volar side of the hand, 47 (37%) were dorsal, 6 (4.8%) were both dorsal and volar, and one was midaxial (0.79%). The most common site of a GCTTS was the index finger (30%). There were no factors significantly associated with the location (volar or dorsal, n=119) of the GCTTS. There were also no factors significantly associated with a larger diameter of a GCTTS. Conclusions: A GCTTS was more frequently seen on the volar aspect of the hand. No significant factors associated with the location or an increased size of a GCTTS were found in this study.
Deep Sharma; Pooja Dhiman; Jagdish Menon; Komuravalli Varun krishna
Volume 3, Issue 2 , April 2015, , Pages 94-98
Abstract
Background: Sternocostoclavicular joint (SCCJ) swelling is an underdiagnosed, albeit important entity in clinical practice. The present study was conducted in order to identify the incidence and common causes of this entity. Methods: Patients presenting to the Orthopaedic ...
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Background: Sternocostoclavicular joint (SCCJ) swelling is an underdiagnosed, albeit important entity in clinical practice. The present study was conducted in order to identify the incidence and common causes of this entity. Methods: Patients presenting to the Orthopaedic Clinic with a swelling of the sternocostoclavicular joint, during the study period of two years were included, and detailed history was obtained from the patient. Baseline investigations (total and differential leukocyte count, ESR, CRP, X-ray and CT) wereperformed. Magnetic resonance imaging,FNAC or joint aspiration was performed whenever clinically or radiologically indicated. Results: A total of 21 patients were enrolled into the study for a duration of 2 years. Patients mainly presented with both pain and swelling of the SCCJ with predominant right sided involvement. Osteoarthritis was the most frequent diagnosis followed by infections, primary bone/cartilage tumor, and metastasis. Conclusions: Although most of the patients with SCCJ swelling have a benign etiology, it is not wise to dismiss thisswelling as degenerative changes. Serious conditions like septic arthritis or neoplasia, may masquerade with similar presentations such as osteoarthritis. It would be therefore imperative to rule out all of these potentially life threatening conditions using thorough clinic-radiological workups.
Ahmadreza Afshar; Mohsen Mehdizadeh; Hamidreza Khalkhali
Volume 3, Issue 3 , July 2015, , Pages 173-178
Abstract
Background: There is no consensus on the best surgical treatment in Kienböck disease. We compared the shortterm outcomes of radial shortening osteotomy and capitate shortening osteotomy in patients affected with this disease. Methods: In a retrospective study of 21 patients with ...
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Background: There is no consensus on the best surgical treatment in Kienböck disease. We compared the shortterm outcomes of radial shortening osteotomy and capitate shortening osteotomy in patients affected with this disease. Methods: In a retrospective study of 21 patients with Lichtman stage IIIA of Kienböck disease, 12 patients with an average follow up of 3.2 ± 0.6 years had radial shortening osteotomy (group I) and 9 patients with an average follow up of 3.1 ± 0.7 years had capitate shortening osteotomy (group II). The two groups were comparable in age, sex, operated side, initial Lichtman stage, and follow-up duration. At the last follow-up the patients were evaluated for pain, wrist range of motion, grip strength, wrist functional status and change in their Lichtman stage. The overall results were evaluated by the Cooney wrist function score and DASH score. Results: All the patients in the two groups had improvement of their wrist pains. According to the Cooney wrist function score group I had 1 excellent, 9 good, and 2 fair scores and group II had 1 excellent, 6 good, and 2 fair scores. Comparisons between the means of pain VAS scores, wrist range of movement, grip strength, DASH score, and Cooney wrist function score in the two groups were not significant. Also, the changes of the Lichtman stage in the two groups were not significant. Conclusions: Both groups had reasonable short-term outcomes. We were unable to recognize a substantial clinical difference between the two surgical treatments in short-term outcomes.
Hamid Namazi; Rohallah Khaje
Volume 3, Issue 4 , October 2015, , Pages 250-253
Abstract
Background: The present study was designed to ascertain serial changes on distal radius radiographic parameters attributable to aging. Methods: In this prospective study, the sample consisted of 120 healthy individuals who were divided into four age groups each containing ...
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Background: The present study was designed to ascertain serial changes on distal radius radiographic parameters attributable to aging. Methods: In this prospective study, the sample consisted of 120 healthy individuals who were divided into four age groups each containing 15 males and 15 females. In the two below-20-year-old groups, only ulnar variance could be investigated. Wrist radiography was taken and then parameters of the distal radius were measured and compared based on age and sex. Results: Average UV was -2.48 mm and -1.6 mm in the 2-9 and 10-19-year-old age groups, respectively. Also, in the two above-20-year-old groups, the average radial inclination (RI), palmar tilt (PT), radial length (RL), and UV was 23.7º, 12.4º, 10.5 and +1.1 mm, respectively. Considering ulnar variance, no significant difference was found between the 2-9- and 10-19-year-old groups, as well as among the two above-20-year-old groups. However, a significant difference was observed between the below 20 and above 20 groups. The study results showed no significant differences between males and females in any of the study groups. Discussion: There is significant ulnar variance change toward less negative ulnar variance with aging until maturity.