Cyril Jonnes; Shishir Suranigi; Syed Najimudeen
Volume 4, Issue 1 , January 2016, , Pages 23-28
Abstract
Background: Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low-energy trauma like simple falls. Dynamic Hip Screw (DHS) is still considered the gold standard for treating intertrochanteric fractures by ...
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Background: Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low-energy trauma like simple falls. Dynamic Hip Screw (DHS) is still considered the gold standard for treating intertrochanteric fractures by many. Not many studies compare the DHS with Proximal femoral nail (PFN), in Type II intertrochanteric fractures (Boyd and Griffin classification). This study was done to compare the functional and radiological outcome of PFN with DHS in treatment of Type II intertrochanteric fractures. Methods: From October 2012 to March 2015, a prospective comparative study was done where 30 alternative cases of type II intertrochanteric fractures of hip were operated using PFN or DHS. Intraoperative complications were noted. Functional outcome was assessed using Harris Hip Score and radiological findings were compared at 3, 6, and 12 months postoperatively. Results: The average age of the patients was 60 years. In our series we found that patients with DHS had increased intraoperative blood loss (159ml), longer duration of surgery (105min), and required longer time for mobilization while patients who underwent PFN had lower intraoperative blood loss (73ml), shorter duration of surgery (91min), and allowed early mobilization. The average limb shortening in DHS group was 9.33 mm as compared with PFN group which was only 4.72 mm. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early post-op period. At the end of 12th month, there was not much difference in the functional outcome between the two groups. Conclusion: PFN is better than DHS in type II inter-trochanteric fractures in terms of decreased blood loss, reduced duration of surgery, early weight bearing and mobilization, reduced hospital stay, decreased risk of infection and decreased complications.
Dimitrios Lyras; Craig Loucks; Robert Greenhow
Volume 4, Issue 2 , April 2016, , Pages 116-121
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 ...
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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.
Hossein Saremi; Elham Hakhamaneshi; Mohamad Ali Seif Rabiei
Volume 4, Issue 3 , July 2016, , Pages 224-227
Abstract
Background: To evaluate safety and efficacy of percutaneous release of trigger finger in multiple digits involvement in comparison with single digit involvement. Method: A number of 100 patients (131 fingers) were treated by percutaneous release and divided into two groups: single ...
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Background: To evaluate safety and efficacy of percutaneous release of trigger finger in multiple digits involvement in comparison with single digit involvement. Method: A number of 100 patients (131 fingers) were treated by percutaneous release and divided into two groups: single digit (group A) and multiple digits (group B). They were followed up for one year. Success rate, pain, complications and duration of analgesic use were studied and then compared in both groups. Results: All patients in both groups were treated successfully without any recurrence in a one-year follow-up. No complication was observed, but postoperative duration of pain was significantly different between the two groups. Period of painkiller use was also different between the two groups. Conclusion: Percutaneous release is a safe and effective treatment for trigger fingers even if multiple digits are involved. It is also safe in thumb and index finger involvement and diabetic patients.
Arthroscopy & Arthroplasty.
Mohsen Mardani-Kivi; Mahmoud Karimi-Mobarakeh; Ahmadreza Mirbolook; Sohrab Keyhani; Khashayar Saheb-Ekhtiari; Keyvan Hashemi-Motlagh; Parham Porteghali
Volume 4, Issue 4 , October 2016, , Pages 314-317
Abstract
Background: Despite the importance of hamstring tendon autograft, one major disadvantage in applying this technique in the surgical reconstruction of anterior cruciate ligament is individual variability in the tendon diameter. Hence, the purpose of the present study was to use anthropometric ...
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Background: Despite the importance of hamstring tendon autograft, one major disadvantage in applying this technique in the surgical reconstruction of anterior cruciate ligament is individual variability in the tendon diameter. Hence, the purpose of the present study was to use anthropometric parameters such as gender, height and body mass index to predict 4-strand (quadruple) hamstring tendons (gracilis and 2-strand semitendinosus tendons). Methods: This is a cross-sectional study conducted on all consecutive patients who underwent arthroscopic ACL reconstruction between 2013 and 2015. The anthropometric variables (age, gender, height, and body mass index) were recorded. The quadruple hamstring tendon (gracilis and semitendinosus) autografts were measured using sizing cylinders. The relationship between these parameters was statistically determined using the Pearson Spearman test and linear regression test. Results: The mean age of the 178 patients eligible for the study was 29.58±9.93 (118 males and 60 females). The mean hamstring tendon diameter was 7.8±0.7 mm, the mean for males was 7.9±0.6 and for females 7.89± mm (P=0.0001). There were significant correlations between the mean hamstring tendon diameter with BMI (Pearson correlation=0.375, R2=0.380, and P=0.0001), height (Pearson correlation=0.441, R2=0.121, and P=0.0001), and weight (Pearson correlation=0.528, R2= -0.104 and P=0.0001). However,patient’s age and genderwerenot found to be a predictor of the size of the hamstring tendon diameter. Conclusion: Based on findings from this study weight, height, body mass index,and the length of the tendon may be predictors of the hamstring tendon diameter for anterior cruciate ligamentreconstruction. These findings could be used in preoperative planning of patients undergoing ACL reconstruction surgery to estimate the size of the graft and select of the appropriate type of graft.
Trauma
Reza Firoozabadi; William W. Cross III; James C. Krieg; Milton L. “Chip” Routt, Jr.
Volume 5, Issue 2 , March 2017, , Pages 96-102
Abstract
Background:Management of acetabular fractures in the senior population can be one of the most challenging injuries tomanage. Furthermore, treating surgeons have a paucity of information to guide the treatment in this patient population.The purpose of this study was to determine: (1) demographic and epidemiologic ...
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Background:Management of acetabular fractures in the senior population can be one of the most challenging injuries tomanage. Furthermore, treating surgeons have a paucity of information to guide the treatment in this patient population.The purpose of this study was to determine: (1) demographic and epidemiologic data, (2) mortality rates for nonoperativecompared to operative management at different time points, (3) common fracture configurations, and (4) fracture fixationstrategies in senior patients treated with acetabular fractures.Methods:Retrospective review of prospectively gathered data at a Level I trauma center over a five-year period. 1123acetabular fractures were identified. 156 of them were for patients over the age of 65 (average age of 78).Results:Falls and motor vehicle accidents accounted for the two most common mechanisms of injury. 82% of patientshad significant medical comorbidities. 51 patients (33%) died within one year, in which 75% of them died within 90 daysof their acetabular fracture. 84% of the deceased patients, i.e. from the group of 51 patients, had non-operative treatment.For patients treated with traction alone, there was a 79% one-year mortality and 50% mortality rate within 90 days. Withinthe entire cohort, 70% had either an associated both-column (ABC) or anterior column/posterior hemitransverse (AC/PHT)fracture pattern. Fifty-seven patients (36.5%) underwent open reduction and internal fixation using standard reductiontechniques and surgical implants via two main surgical exposures of ilioinguinal (69%) and Kocher-Langenbeck (29%).Conclusion:Geriatric patients with acetabular fractures are uncommon accounting for only 14% of all acetabularfractures. Patients who undergo surgery show lower mortality rates. ABC and AC/PHT fracture patterns are the two mostcommon fracture patterns. Routine fixation constructs and implants can be used to manage these challenging fractures.Most patients are unable to return to their homes and instead require skilled nursing facility during their convalescence.
General Orthopedics
Mohammad Ali Tahririan; Mehdi Motififard; Ali Omidian; Hossein Akbari Aghdam; Amir Esmaeali
Volume 5, Issue 1 , January 2017, , Pages 22-27
Abstract
Background: The main purpose of this study was to determine the relationship between serum vitamin D and the status of bone mineral density in patients with low-energy hip and distal radius fracture. Methods: This retrospective case-control study was performed between January 2013 and January ...
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Background: The main purpose of this study was to determine the relationship between serum vitamin D and the status of bone mineral density in patients with low-energy hip and distal radius fracture. Methods: This retrospective case-control study was performed between January 2013 and January 2014. Participants aged 55 years or older were divided to case group including 85 patients with low-energy hip fracture and 83 patients with low-energy distal radius fractures, and 82 subjects as a matched control group. Bone mineral density was measured with dual energy X-ray absorptiometry and serum sample was obtained to check vitamin D, calcium, phosphorus, alkaline phosphatase, and protein. Results: Study subjects for final evaluation consisted of 78 in hip and distal radius fracture groups and 80 in control group. There were no significant differences in the mean serum levels of calcium, phosphorus and alkaline phosphatase between the three groups. The overall mean serum level of vitamin D3 was significantly different among the three groups. Similar results were observed with hip and spine t-score between the groups. Conclusion: There is not only a direct relation between serum vitamin D and the risk of low energy hip and distal radius fractures, but also a significant relation between low bone density in hip and spine area with low serum calcium was observed.
Tumor
Khodamorad Jamshidi; Mehrdad Bahrabadi; Alireza Mirzaei
Volume 5, Issue 5 , September 2017, , Pages 296-301
Abstract
Background: There is no consensus regarding the best method of reconstruction in pediatric population following thewide resection of malignant bone tumors. More exploration of the complications of osteoarticular reconstruction leads toless existing controversy of this type of reconstruction, which is ...
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Background: There is no consensus regarding the best method of reconstruction in pediatric population following thewide resection of malignant bone tumors. More exploration of the complications of osteoarticular reconstruction leads toless existing controversy of this type of reconstruction, which is the main point of this article.Methods: Long-term outcomes and complications of osteoarticular allograft reconstruction of primary distal femoral bonesarcomas in 22 children with mean age of 10.7 years old were reviewed in this study. Musculoskeletal Tumor Society(MSTS) scoring system was used for functional evaluation of the allografts.Results: With an average follow-up time of 81 months, the outcomes of 16 patients with allografts at the final follow upwere evaluated. As expected, Limb length discrepancy (LLD) was observed in all patients (mean LLD= 2.73cm), whichwas significantly correlated to allograft survival time (P<0.001). Degenerative joint disease (DJD) was also seen in allpatients and its grade was also significantly correlated to allograft survival time (P<0.001). The mean MSTS-score was74% at the latest follow-up, ranging from 60% to 90%. Five and 10 year survival rate of allografts were found to be 93.3%and 62.2%, respectively.Conclusion: Osteoarticular allograft reconstruction could result in several complications including DJD. Despite itsconsiderable biologic advantage over endoprosthesis, osteoarticular allograft reconstruction is a long-lasting but still atemporary solution before performing megaprosthesis. This allows patients to preserve their remaining physis for limbgrowth and become old enough for an adult megaprosthesis.
Knee
Seyed Morteza Kazemi; Mohamad Qoreishi; Ehsan Behboudi; Alireza Manafi; Seyed Kamyar Kazemi
Volume 5, Issue 3 , May 2017, , Pages 149-152
Abstract
Background: There are limited studies regarding the effects of high tibial osteotomy (HTO) on other areas of lower extremity. In current study, we investigated the changes of tibiotalar joint following HTO. Methods: A total of 39 patients with genu varum requiring HTO were enrolled in this before and ...
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Background: There are limited studies regarding the effects of high tibial osteotomy (HTO) on other areas of lower extremity. In current study, we investigated the changes of tibiotalar joint following HTO. Methods: A total of 39 patients with genu varum requiring HTO were enrolled in this before and after study. The genu varus, joint diversion (JDA), lateral distal tibial (LDTA) and lateral distal tibial-ground surface (LDT-GSA) angles were measured before the operation and compared with 6 months after the surgery. Results: Twenty threeout of39 patients (59%) were females. The genu varus angle decreased significantly (130±1.70versus 0.60±10). No significant changes were seen in JDA (P=0.45) and LDTA (P=0.071). LDT-GSA changed significantly (P=0.011) from 8.10±10 in varus to -0.30±0.50 in valgus. Conclusion: Although HTO did not change the JDA and LDTA, however, significant change in LDT-GSAindicates that HTO can significantly decrease the shearing forces exerted on the ankle joint.
Hip
Mohammad Haghighi; Abbas Sedighinejad; Bahram Naderi Nabi; Mohsen Mardani-kivi; Samaneh Ghazanfar Tehran; Seyed Abdollah Mirfazli; Ahmad Reza Mirbolok; Nasim Ashoori Saheli
Volume 5, Issue 4 , July 2017, , Pages 226-230
Abstract
Background: To evaluate general anesthesia with sevoflurane vs spinal anesthesia with low dose lidocaine 5% onhemodynamics changes in patients undergoing hip fracture surgery.Methods: In this randomized double blind trial 100 patients (50 patients in each group) older than 60 years underhip surgery were ...
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Background: To evaluate general anesthesia with sevoflurane vs spinal anesthesia with low dose lidocaine 5% onhemodynamics changes in patients undergoing hip fracture surgery.Methods: In this randomized double blind trial 100 patients (50 patients in each group) older than 60 years underhip surgery were randomized in general anesthesia with sevoflurane and spinal anesthesia with lidocaine 5%.Hemodynamic changes including mean arterial pressure (MAP) and heart rate, blood loss, pain severity, nausea andvomiting and opioids consumption were compared in two groups.Results: During surgery, difference between two groups regarding changes in mean arterial pressure was notsignificant, but the changes in heart rate were significantly different. Mean arterial pressure changes during recoverybetween two groups were significantly different. But there was no significant difference in heart rate changes. Bleedingin the sevoflurane group was significantly more than spinal group (513.ml vs. 365 ml). Moreover, AS Score, opioidconsumption, and the nausea and vomiting in spinal anesthesia group was significantly lower than the sevofluranegroup.Conclusion: We showed that general anesthesia with sevoflurane and spinal anesthesia with low dose lidocaine 5%have comparable effects on hemodynamics changes in patients undergoing hip fracture surgery. However postoperativepain score, vomiting and morphine consumption in patients with spinal anesthesia were lower than general anesthesia.
Hand
Suneel B. Bhat; Asif M. Ilyas
Volume 5, Issue 6 , November 2017, , Pages 380-383
Abstract
Background: Osteoporosis is a common condition among the elderly population, and is associated with an increased risk of fracture. One of the most common fragility fractures involve the distal radius, and are associated with risk of subsequent fragility fracture. Early treatment with bisphosphonates ...
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Background: Osteoporosis is a common condition among the elderly population, and is associated with an increased risk of fracture. One of the most common fragility fractures involve the distal radius, and are associated with risk of subsequent fragility fracture. Early treatment with bisphosphonates has been suggested to decrease the population hip fracture burden. However, there have been no prior economic evaluations of the routine treatment of distal radius fracture patients with bisphosphonates, or the implications on hip fracture rate reduction. Methods: Age specific distal radius fracture incidence, age specific hip fracture rates after distal radius fracture with and without risendronate treatment, cost of risendronate treatment, risk of atypical femur fracture with bisphosphonate treatment, and cost of hip fracture treatment were obtained from the literature. A unique stochastic Markov chain decision tree model was constructed from derived estimates. The results were evaluated with comparative statistics, and a one-way threshold analysis performed to identify the break-even cost of bisphosphonate treatment. Results: Routine treatment of the current population of all women over the age of 65 suffering a distal radius fracture with bisphosphonates would avoid 94,888 lifetime hip fractures at the cost of 19,464 atypical femur fractures and $19,502,834,240, or on average $2,186,617,527 annually, which translates to costs of $205,534 per hip fracture avoided. The breakeven price point of annual bisphosphonate therapy after distal radius fracture for prevention of hip fractures would be approximately $70 for therapy annually. Conclusion: Routine treatment of all women over 65 suffering distal radius fracture with bisphosphonates would result in a significant reduction in the overall hip fracture burden, however at a substantial cost of over a $2 billion dollars annually. To optimize efficiency of treatment either patients may be selectively treated, or the cost of annual bisphosphonate treatment should be reduced to cost-effective margins.
Knee
Jorge Manrique; Mohammad Rasouli; Camilo Restrepo; Mitchell G. Maltenfort; Jonathan Beri; Jeffrey Oliver; Raj Patel; Javad Parvizi
Volume 6, Issue 1 , January 2018, , Pages 23-26
Abstract
Background: There is an information gap in literature regarding postoperative outcome of total knee arthroplasty (TKA)in patients with hardware in-situ from the previous knee surgery. The present study aims to evaluate impact of retainedhardware on short-term outcome of TKA patients.Methods: Perioperative ...
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Background: There is an information gap in literature regarding postoperative outcome of total knee arthroplasty (TKA)in patients with hardware in-situ from the previous knee surgery. The present study aims to evaluate impact of retainedhardware on short-term outcome of TKA patients.Methods: Perioperative radiographs of patients who had undergone TKA between 2007 and 2012 were reviewedand patients in whom partial or complete retention of hardware was evident after TKA were included. These patientswere matched in 1 to 2 ratio based on age (+/- 2 years), gender, surgeon and year of surgery to a group of patientsthat underwent primary TKA without hardware in the affected knee. The average follow up of these patients was 43.45(range 12-155.2) months. Complication rates were compared between the two groups using statistical tests that tookinto account the matched data structure.Results: We included a total of 55 cases and 110 controls. The incidence of complications was higher, although notall statistically significant, in the case group. Only mechanical complications were significantly different in the casesgroup (5.5% versus 0%, P=0.01). Time to event analysis using the mixed-effects Cox model didn’t show a statisticallysignificant difference between two groups for various outcomes.Conclusion: Presence of retained hardware around the knee may predispose the patient to a higher rate ofcomplications particularly mechanical complications of the implant after TKA. Further studies are required to investigateimpact of retained hardware around the knee in patients undergoing TKA.
Shoulder
Daniel Tobert; Mariano Menendez; David C. Ring; Neal C. Chen
Volume 6, Issue 4 , July 2018, , Pages 277-281
Abstract
Background: The ”July effect” is a colloquialism asserting an increased rate of errors at the start of the academicyear in teaching hospitals. This retrospective population-based study evaluated for the presence of the July effect inperforming shoulder arthroplasty.Methods: Using the Nationwide ...
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Background: The ”July effect” is a colloquialism asserting an increased rate of errors at the start of the academicyear in teaching hospitals. This retrospective population-based study evaluated for the presence of the July effect inperforming shoulder arthroplasty.Methods: Using the Nationwide Inpatient Sample for 2002 through 2011, a total of 178,590 patients undergoingshoulder arthroplasty at academic medical centers were identified and separated into 2 groups: 1) patients admittedduring July and 2) patients admitted between August and June. Multivariable logistic regression was used to identifyassociations with inpatient mortality and adverse events, blood transfusion, prolonged length of stay (>75th percentile)and non-routine discharge.Results: After adjusting for patient, procedure, and hospital characteristics in multivariable modeling, admission inJuly was not associated with increased risk for inpatient mortality (OR 1.6) aggregate morbidity, blood transfusion,prolonged length of stay, and non-routine discharge.Conclusion: This nationwide database analysis shows that shoulder arthroplasty at academic medical centers is notassociated with increased perioperative morbidity and resource utilization during the month of July.
Arthroscopy & Arthroplasty.
Robert Pearse Piggott; Rebecca Lyons; Colin Gerard Murphy; William Curtin
Volume 6, Issue 6 , November 2018, , Pages 501-507
Abstract
Background: Cementless total hip replacement is the common THR performed in England, Wales, Northern Irelandand the Isle of Man. The Corail stem is the most popular cementless implant and has a ODEP 10A rating. Review ofits performance in the registry identified an increase rate of revision amongst the ...
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Background: Cementless total hip replacement is the common THR performed in England, Wales, Northern Irelandand the Isle of Man. The Corail stem is the most popular cementless implant and has a ODEP 10A rating. Review ofits performance in the registry identified an increase rate of revision amongst the smaller stem sizes. However, claritywas not provided on the explanation for this finding. We reviewed our own experience of smaller stems with a view tounderstanding the reasons for revision.Methods: We reviewed a single centre, single surgeon experience of the smaller Corail stem sizes for a ten-yearperiod from 2003 to 2013. All data was collected from a prospectively maintained database. Details of clinical andradiological follow up were collected for all patients who had Corail stem size 8 and 9 implanted. Revision for any causewas taken as our endpoint.Results: 542 patients underwent total hip arthroplasty using the Corail stem during the study period. 53 small sizeCorail stems were implanted. The average age was 59 (range 17-88 years) and the average follow up was 41.4 months(range 1-118 months). 6 patients underwent revision during the study period, but only 4 stems required revision.The reasons for revision were aseptic loosening, fracture and metal-on metal complications. Only two stems requiredrevision for stem related factors (3.8%).Conclusion: There was no evidence of an increased rate of revision in the small Corail stems in our cohort.
Trauma
Mohamed A. Imam; James Holton; Abdel Hassan; Ahmed Matthana
Volume 6, Issue 3 , May 2018, , Pages 189-195
Abstract
Background: The importance of the syndesmosis in ankle stability is well recognized. Numerous means of fixation have been described for syndesmotic injuries including the suture button technique. Significant cost limits the use the commercially available options. We, therefore, designed a cheap ...
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Background: The importance of the syndesmosis in ankle stability is well recognized. Numerous means of fixation have been described for syndesmotic injuries including the suture button technique. Significant cost limits the use the commercially available options. We, therefore, designed a cheap and readily available alternative construct. We aim to assess the results of using a novel suture-button construct in treatment of syndesmotic ankle injuries. Methods: Fifty-two patients (34 males and 18 females) fulfilled our inclusion/exclusion criteria. Five patients were lost to follow-up. The remaining 47 patients were successfully followed up for a minimum of 24 months. The pre and post-surgery American Orthopedic Foot and Ankle Society scores (AOFAS) together with reported complications and post-operative radiological analysis were assessed. In this innovative construct, we utilized polyester braided surgical sutures jointly with double mini two- holed plates, a No.2 polygalactin 910 suture, a 4 mm drill bit, together with a 15 cm long suture needle with slotted end. This technique was supported with the use of the image intensifier. Results: The AOFAS score improved significantly from a mean of 32.4 to 94.2 (P˂0.004). Radiologically, the medial clear space (MCS), tibio-fibular clear space (TFCS) (P=0.05) and tibio-fibular overlap (TFO) measurements showed a significant improvement postoperatively (P=0.02). Patients reported good satisfaction rates with a 96% success rate (95% CI: 94.0% to 99.3%). Conclusion: We have observed that this low cost suture button construct is a simple, safe and cost effective treatment option for acute syndesmotic injuries. Level of evidence: IV
Knee
Marco Cavallo; Sayyed-Hadi Sayyed-Hosseinian; Alessandro Parma; Roberto Buda; Massimiliano Mosca; Sandro Giannini
Volume 6, Issue 2 , March 2018, , Pages 112-118
Abstract
Purpose: high tibial osteotomy (HTO) is a recommended treatment for medial compartment knee osteoarthritis. Newer cartilage regenerative procedures may add benefits to the result of HTO. In this prospective study we investigate safety and also results of HTO associated with bone marrow derived cells ...
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Purpose: high tibial osteotomy (HTO) is a recommended treatment for medial compartment knee osteoarthritis. Newer cartilage regenerative procedures may add benefits to the result of HTO. In this prospective study we investigate safety and also results of HTO associated with bone marrow derived cells (BMDC) transplantation in relatively young and middle aged active individuals with early osteoarthritis of the knee and our hypothesis is combination of these procedures is safe and leads to better outcome. Methods: 24 patients (with mean age of 47.9 years) with varus knee and symptomatic medial compartment osteoarthritis were treated with medial opening-wedge high tibial osteotomy in conjunction with transplantation of bone marrow derived cells into the chondral lesions. Clinical outcome was assessed by IKDC score, KOOS score, VAS and Tegner scores and radiographic study was performed preoperatively and at follow-ups. Results: there were no major complications during operation and postoperative follow-ups.all the clinical scores significantly were improved for the IKDC score (from 32.7 +/-15 to 64+/- 21), KOOS score (from30 +/- 11 to 68 +/- 19), VAS (from7.5 to 3), and Tegner score (from 1.2 to 2.1). Conclusions: HTO in conjunction with BMDC transplantation is a safe and feasible treatment for early medial compartment osteoarthritis in varus knees and associated with good results in short term follow up.
Hand
Ahmadreza Zarifian; Hassan Rahimi Shoorin; Mohammad Hallaj Moghaddam; Meysam Fathi Vavsari; Mohammad Gharedaghi; Ali Moradi
Volume 6, Issue 5 , September 2018, , Pages 365-370
Abstract
Background: Radial head fractures commonly occur during elbow traumas. Among those, treatment of Mason type IIIfractures is still under controversy. Common treatment methods for these fractures include open reduction and internalfixation (ORIF) as well as radial head excision. In this study, we compared ...
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Background: Radial head fractures commonly occur during elbow traumas. Among those, treatment of Mason type IIIfractures is still under controversy. Common treatment methods for these fractures include open reduction and internalfixation (ORIF) as well as radial head excision. In this study, we compared long-term outcomes of both methods intreatment of patients with Mason type III fractures of radial head.Methods: Fifteen men and five women with Mason type III radial head fractures were evaluated retrospectively. Tenpatients had undergone excision whereas the other ten patients had been treated with ORIF. Outcomes were assessedbased on stability and range of motion of the elbow joint, grip strength, and pain. Data were gathered using Mayo elbowperformance index (MEPI), Oxford elbow score, and disability of arm-shoulder-hand (DASH), along with the short form(SF)-36 questionnaire.Results: The mean age of the subjects was 36.25±9.22 years and the mean follow-up time was 25.05±11.43months. The ranges of extension and supination, and frequency of pain reporting was significantly different betweenthe groups. The average grip strength in the operated side was significantly higher in the ORIF group, comparedwith the excision (P= 0.03). Ten (100%) patients of ORIF group and 5 (50%) patients of excision group had elbowjoint stability (P=0.01). Mean MEPI and DASH scores were significantly higher in ORIF group (Prespectively).Conclusion: The results are in favor of ORIF method. Therefore, this method is recommended and preferredover excision in treating radial heads with Mason type III frac ture.Level of evidence: III
Soheil Sabzevari; Amir Reza Kachooei; Juan Giugale; Albert Lin
Volume 6, supplement 1 , June 2018, , Pages 6-6
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
General Orthopedics
Lisanne J. H. Smits; Suzanne C. Wilkens; David Ring; Thierry G. Guitton; Neal C. Chen
Volume 7, Issue 2 , March and April 2019, , Pages 118-135
Abstract
Background: When the best treatment option is uncertain, a patient’s preference based on personal values should bethe source of most variation in diagnostic and therapeutic interventions. Unexplained surgeon-to-surgeon variation intreatment for hand and upper extremity conditions suggests that ...
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Background: When the best treatment option is uncertain, a patient’s preference based on personal values should bethe source of most variation in diagnostic and therapeutic interventions. Unexplained surgeon-to-surgeon variation intreatment for hand and upper extremity conditions suggests that surgeon preferences have more influence than patientpreferences.Methods: A total of 184 surgeons reviewed 18 fictional scenarios of upper extremity conditions for which operativetreatment is discretionary and preference sensitive, and recommended either operative or non-operative treatment.To test the influence of six specific patient preferences the preference was randomly assigned to each scenario in anaffirmative or negative manner. Surgeon characteristics were collected for each participant.Results: Of the six preferences studied, four influenced surgeon recommendations. Surgeons were more likelyto recommend non-operative treatment when patients; preferred the least expensive treatment (adjusted OR,0.82; 95% CI, 0.71 – 0.94; P=0.005), preferred non-operative treatment (adjusted OR, 0.82; 95% CI, 0.72 – 0.95;P=0.006), were not concerned about aesthetics (adjusted OR, 1.15; 95% CI, 1.0 – 1.3; P=0.046), and when patientsonly preferred operative treatment if there is consensus among surgeons that operative treatment is a useful option(adjusted OR, 0.78; 95% CI, 0.68 – 0.89; P<0.001).Conclusion: Patient preferences were found to have a measurable influence on surgeon treatment recommendationsthough not as much as we expected-and surgeons on average interpreted surgery as more aesthetic. This emphasizesthe importance of strategies to help patients reflect on their values and ensure their preferences are consistent withthose values (e.g. use of decision-aids).Level of evidence: III
Shoulder
Mihir Sheth; Daniel Sholder; Eric M. Padegimas; Thema A. Nicholson; Charles L. Getz; Matthew L. Ramsey; Gerald R. Williams; Surena Namdari
Volume 7, Issue 1 , January and February 2019, , Pages 19-23
Abstract
Background: While outcomes of primary anatomic total shoulder arthroplasty (aTSA) are generally favorable, resultsafter revision procedures are less reliable. This study examines the functional outcomes, complications, and implantsurvival in patients who underwent revision of aTSA to aTSA.Methods: Patients ...
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Background: While outcomes of primary anatomic total shoulder arthroplasty (aTSA) are generally favorable, resultsafter revision procedures are less reliable. This study examines the functional outcomes, complications, and implantsurvival in patients who underwent revision of aTSA to aTSA.Methods: Patients who underwent revision aTSA were identified from 2008-2015. Demographic, clinical, surgical,and outcomes data were analyzed. Patient-reported outcomes including the American Shoulder and Elbow SurgeonsScore (ASES), Single Assessment Numerical Evaluation (SANE), Visual Analog Scale for pain (VAS), the Short Form-12 Health Survey (SF-12), and patient satisfaction were recorded.Results: Twenty patients underwent revision from a primary aTSA to aTSA (55% male, 62.0±6.8 years-old). RevisionaTSA occurred at 2.5±3.4 years after index surgery. Seven (35%) required future revision at 1.8±1.9 years after revisionaTSA. Among the 13 patients who did not undergo revision, twelve (92.3%) had over two-year follow-up (4.0±2.4years). Average ASES score was 70.1±23.5, SANE 66.0±29.4, VAS 2.7±3.0, SF-12 Mental 52.4±10.5, SF-12 Physical36.8±8.9, and satisfaction of 3.6±1.2.Conclusion: Results of revision aTSA to aTSA were unpredictable and the revision rate was high. The cases that donot undergo revision had satisfactory, but inconsistent functional results. Reverse arthroplasty may be more reliable inthis patient population.Level of evidence: IV
Saeed Kokly; Alessandro Castagna; Mohammadreza Guiti
Volume 7, Issue 4 , July 2019, , Pages 325-330
Abstract
Background: Distal humeral fractures accounts for approximately 2% of all fractures and nearly one-third of humeralfractures in adults. In this regard, Modified Tension Bind Wiring (MTBW) technique was used for the fixation of the distalhumeral fractures type A2 and C1 (AO) to evaluate the early movement ...
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Background: Distal humeral fractures accounts for approximately 2% of all fractures and nearly one-third of humeralfractures in adults. In this regard, Modified Tension Bind Wiring (MTBW) technique was used for the fixation of the distalhumeral fractures type A2 and C1 (AO) to evaluate the early movement and complications of the patients.Methods: This study was conducted on 25 patients, who were subjected to open reduction and internal fixation usingMTBW techniques, to evaluate the incidence of complications.Results: The mean age of the participants was 53.7 years. Out of 25 patients, 16 cases had C1 and 6 individualssuffered from A2. The mean tourniquet time was 43 min. The mean union time was 12.24 weeks and the mean durationof the follow-ups was 13.72 months. The mean values for the lack of extension, flexion, and range of motion were 18o,124o, and 106o, respectively. Wound haematoma and dehiscence were observed in two cases, who were treated afterconservative treatment. During 15-90 days, there were no signs of neurapraxia injuries. The non-union of olecranonosteotomy site was seen in one case, who was treated by the MTBW technique. Since the range of motion was lessthan 100o in 4 patients, device removal was performed 6 months after the surgery when the range of motion wasincreased by nearly 12o. Moreover, patients were diagnozed with no serious complications, such as the nonunion offracture site, malunions, and deep infection. The radiological examination of the patients revealed the success of theirtreatment.Conclusion: Based on the obtained results, it can be concluded that MTBW is an effective technique in fracturefixation, which allows gentle early motion. Moreover, this cost-effective technique decreased the surgery duration,tourniquet time, and damage caused by soft tissue stripping.Level of evidence: IV
Tissue Engineering
Achmad Kamal; Othdeh Samuel Halomoan Siahaan; Jessica Fiolin
Volume 7, Issue 6 , November 2019, , Pages 498-505
Abstract
Background: BMP-2 has a crucial role in the treatment of extensive bone defect. However, data about the optimaldosage of BMP-2 in the massive bone defect casesis rare.Methods: Twenty-five SD rats were randomly allocated into a control group of hydroxyapatite (HA) alone (Group I),HA+BMP-2 1μg/mL (Group ...
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Background: BMP-2 has a crucial role in the treatment of extensive bone defect. However, data about the optimaldosage of BMP-2 in the massive bone defect casesis rare.Methods: Twenty-five SD rats were randomly allocated into a control group of hydroxyapatite (HA) alone (Group I),HA+BMP-2 1μg/mL (Group II), HA+BMP-2 5 ug/mL (Group III), HA+BMP-2 10 μg/mL (Group IV), and HA+BMP-2 20ug/mL (Group V). Osteotomies were performed in each group with 10 mm bone defect in the right femur, followed byfixation and filling the defect. The fracture healing was evaluated by histomorphometry, and radiographs using RUSTscore.Results: We found there were significant differences in the mean total area of callus between the treatment groups(P<0.001); there were significant differences in the mean area of woven bone between group II, III, IV, and V with thecontrol group (respectively P=0.009, P=0.016, P=0.009 and P=0.016), the area of the cartilage between the treatmentgroups and control group (respectively P=0.009, P=0.009, P=0.009 and P=0.028). A statistically significant differencewas found in the average area of fibrosis between group II and control group, group IV and control group (respectivelyP=0.047 and P=0.009). RUST scores showed significant differences between the control group and group II, III, IV, V(respectively P=0.005, P=0.006, P=0.005 and P=0.006).Conclusion: The administration of BMP-2 stimulates the formation of bone bridging in a massive bone defect. Thebone bridging filling massive bone defect depends on the dose or concentration of BMP-2. Administration of an optimaldose (10 μg/mL) of BMP-2 demonstrates better result than lower or higher dose for massive bone defect healing in SDrate.Level of evidence: II
Tumor
Claudia Antoinette Bargon; Amin Mohamadi; Mojtaba Talaei-Khoei; David C. Ring; Chaitanya S. Mudgal
Volume 7, Issue 5 , September 2019, , Pages 422-428
Abstract
Background: The characteristic clinical presentation of glomus tumors and the low negative predictive value of themagnetic resonance imaging (MRI) raise the question whether MRI improves their management. Therefore, this studyaimed to investigate whether MRI improved the management of glomus tumors.Methods: ...
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Background: The characteristic clinical presentation of glomus tumors and the low negative predictive value of themagnetic resonance imaging (MRI) raise the question whether MRI improves their management. Therefore, this studyaimed to investigate whether MRI improved the management of glomus tumors.Methods: In total, 87 patients with a histologically confirmed glomus tumor were treated over a 25-year period andanalyzed retrospectively. Multivariable logistic regression analysis was used to evaluate the independent predictors ofan MRI request during the management of glomus tumors.Results: According to the results, the patients who were treated by orthopaedic surgeons were more likely to have anMRI during the management of a glomus tumor.Conclusion: The role of an MRI during the management of a glomus tumor is unclear. Orthopaedic surgeons aremore likely to request an MRI. Furthermore, visible lesions with characteristic symptoms probably do not benefitfrom MRI. However, it may help to be sure that the highest-quality MRI is used with the best possible coil for thefinger.Level of evidence: IV
Shoulder
Brian K. Lee; Grant C. Jamgochian; Usman Ali M. Syed; Charles L. Getz; Christopher C. Dodson; Surena Namdari; Matthew L. Ramsey; Gerald R. Williams; Joseph A. Abboud; Mark D. Lazarus
Volume 7, Issue 3 , May 2019, , Pages 239-245
Abstract
Background: Reconstructions of acute acromioclavicular (AC) dislocations have been thought to result in superioroutcomes than chronic dislocations. The use of tendon graft in reconstructions has demonstrated favorablebiomechanical properties. To determine whether utilizing tendon graft during repair ...
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Background: Reconstructions of acute acromioclavicular (AC) dislocations have been thought to result in superioroutcomes than chronic dislocations. The use of tendon graft in reconstructions has demonstrated favorablebiomechanical properties. To determine whether utilizing tendon graft during repair of acute AC dislocations results insuperior outcomes and lower complication rate.Methods: A retrospective review of AC reconstructions was conducted. Reconstructions performed within 3 weeks ofinjury were included. Inclusion criteria included age over 18, grade 3-5 AC joint separation, and no previous ipsilateralshoulder injury. Primary outcome measure was radiographic loss of reduction. Secondary outcomes included ASESand SANE scores.Results: Of 47 reconstructions of acute AC joint separations, 35 utilized fixation without a tendon graft, while 12underwent an anatomic reconstruction with tendon graft. Repairs without the use of graft resulted in 8 (23%) casesof loss of reduction, while tendon graft augmented repairs resulted in 5 (42%). This difference was not statisticallysignificant (P = 0.22). No patients required reoperation. There was no statistical difference in the ASES and SANEscores between the two groups. Furthermore, we found no significant difference in ASES or SANE scores in patientswho maintained reduction postoperatively versus those that lost reduction.Conclusion: A greater but not statistically significant rate of loss of reduction was observed in the group reconstructedwith the use of a tendon graft. Further research is needed to determine whether the use of tendon graft is beneficial inthe treatment of acute AC joint separations.Level of evidence: IV
Arthroscopy & Arthroplasty.
Femke M.A.P. claessen; Bexkens, Rens; I. F. Kodde; Job N. Doornberg; Michel P. J. V. Bekerom; Denise Eygendaal
Volume 8, Issue 1 , January 2020, , Pages 27-32
Abstract
Background: Evaluation of the accurate position after radial head arthroplasty remains a challenge for surgeons.Standard radiographs are used to evaluate the position of the implant, however, results regarding radiographicdeficiencies on clinical outcome are not consistent. In this retrospective study ...
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Background: Evaluation of the accurate position after radial head arthroplasty remains a challenge for surgeons.Standard radiographs are used to evaluate the position of the implant, however, results regarding radiographicdeficiencies on clinical outcome are not consistent. In this retrospective study our main aim was to determine if subtleradiographic deficiencies after radial head arthroplasty can predict functional outcomes measured with the Mayo ElbowPerformance Score (MEPS).Methods: A total of 24 patients, that had a press-fit bipolar radial head arthroplasty because of persistent symptomsafter treatment of a radial head fracture, were included. The mean follow-up time was 27 months and the MEPS wasassessed at the final follow-up. Three upper extremity orthopaedic surgeons evaluated 12 potential deficiencies onanteroposterior and lateral radiographs in consensus agreement.Results: The median MEPS was 97.5 (Interquartile Range 82.5-100). No association was found between the presenceof subtle radiographic deficiencies and MEPS.Conclusion: Functional outcome of the elbow after uncemented press-fit bipolar radial head arthroplasty is notassociated with subtle radiographic deficiencies. Therefore, surgeons might accept small imperfections on postoperativeradiographs.Level of evidence: IV
Arthroscopy & Arthroplasty.
Alexander kreines; Manuel Pontes; Elizabeth Ford; Kristen Herbst; Jeff Murray; Brian Busconi; Sean McMillan
Volume 8, Issue 2 , March 2020, , Pages 154-161
Abstract
Background: To retrospectively review surgical outcomes of prospectively collected data on a series of patients whounderwent revision of a type II SLAP repair to arthroscopic biceps tenodesis due to an unsuccessful outcome.Methods: A retrospective review was performed on a cohort of patients who underwent ...
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Background: To retrospectively review surgical outcomes of prospectively collected data on a series of patients whounderwent revision of a type II SLAP repair to arthroscopic biceps tenodesis due to an unsuccessful outcome.Methods: A retrospective review was performed on a cohort of patients who underwent arthroscopic biceps tenodesisfor a failed type II SLAP repair from 2010 to 2014. Range of motion (ROM) in four planes was measured pre-andpostoperatively. In addition, all patients completed the American Shoulder Elbow Surgeons (ASES) standardizedshoulder assessment form, the Visual Analogue Scale (VAS) for pain, and the Short Form-12 (SF-12) scores.Results: Overall, 26 patients met inclusion criteria. All 26 patients were available for follow-up at a minimum of twoyears (100% follow-up). The mean age of the patients was 37(range 26-54), 85% were male, and 58% were overheadlaborers. Clinical as well as statistical improvement was noted following tenodesis across all outcome measurements(P<0.01). Additionally, ROM improved in all four planes (P<0.01). The rate of return to work was 85% with workers’compensation status leading to inferior outcomes. Two complications were noted which required an additional surgery.Conclusion: Arthroscopic biceps tenodesis demonstrates to be an effective treatment for a failed type II SLAP repairwith improved patient satisfaction, pain relief, and range of motion at two-years follow-up with a low complication rate.Level of evidence: III