Samundeeswari Saseendar; Saseendar Shanmugasundaram; Srinivas BS Kambhampati
Articles in Press, Accepted Manuscript, Available Online from 30 December 2019
Abstract
Proximal fibular osteotomy is a surgical procedure that has evoked significant interest and controversy in the recent past. Vaishya et al have made a significant effort in compiling the available evidence on the topic. However, we would like to make some significant suggestions and additions to the findings ...
Read More
Proximal fibular osteotomy is a surgical procedure that has evoked significant interest and controversy in the recent past. Vaishya et al have made a significant effort in compiling the available evidence on the topic. However, we would like to make some significant suggestions and additions to the findings in their manuscript.
Matthew Daniel Riedel; Ian T. Watkins; Johnathon R. McCormick; Hans P. Van Lancker
Articles in Press, Accepted Manuscript, Available Online from 30 December 2019
Abstract
Article Highlights: 1) This article provides a full anticoagulant reference for the practicing orthopaedic surgeon which can be used in any clinical scenario, whether urgent or elective surgical intervention is required 2) A comprehensive list of anticoagulant reversal agents and drugs with short half-lives ...
Read More
Article Highlights: 1) This article provides a full anticoagulant reference for the practicing orthopaedic surgeon which can be used in any clinical scenario, whether urgent or elective surgical intervention is required 2) A comprehensive list of anticoagulant reversal agents and drugs with short half-lives (for bridging) are described with the intention to provide the data needed to safely manage a patient peri-operatively during urgent orthopaedic surgical care (i.e. fracture or infection) 3) Half-life and method of excretion for all drugs are included with the intention to accurately guide decisions regarding the appropriate timing of scheduling elective orthopaedic surgical care with regards to anticoagulant metabolism and effect 4) The practicing orthopaedic surgeon using this guide should always consider medical co-management of these complex patients as their medical co-morbidities may not be amenable to anticoagulant reversal or peri-operative cessation of therapy, even for a short period 5) The data contained in this article stands to serve as a foundation upon which institution-specific guidelines regarding the peri-operative management of orthopedic patients on long-term anticoagulation can be developed
Adel Ebrahimpour; Mohammadreza Chehrassan; Mehrdad Sadighi; Mehdi Azizmohammad Looha; Amin Karimi; Atieh Akbari; Alireza Raeisi; Mohammad Esmaeil Akbari
Articles in Press, Accepted Manuscript, Available Online from 14 January 2020
Abstract
Introduction: The effect of race and ethnicity on some kind of malignant bone tumors including Ewing sarcoma has been proven in different studies. In order to evaluate the latter, national cancer registries may help to increase understanding about potential cancer causes, prevention and control strategies ...
Read More
Introduction: The effect of race and ethnicity on some kind of malignant bone tumors including Ewing sarcoma has been proven in different studies. In order to evaluate the latter, national cancer registries may help to increase understanding about potential cancer causes, prevention and control strategies and apply these findings to control health problems among population with similar characteristics. Method and Materials: A national population-based cancer registry study based on all patients affected by Ewing Sarcoma registered in the Iran National Cancer Registry (INCR) between 2008 and 2015 was designed. Demographic data of microscopically confirmed cases of bone Ewing sarcoma were registered. Patients with Ewing sarcoma were divided in groups to describe the primary site of the tumor (including axial or appendicular bones) and analyzed. In order to analyze the survival rate, randomized selection of the patient through the INCR data-base was made. Results: Approximately 678 malignant Ewing sarcoma of the bone were identified through the INCR. The mean age of Ewing sarcoma in Iran was 21.53 years. Nearly half of patients were observed at the age group of 15-24. The total crude incidence rate of Ewing sarcoma was 1.29 in 1 million. The mean 5 year survival rate was 47%. The Mean survival rate for study population was 5.53. Conclusion: The crude incidence rate of Ewing sarcoma in Iran is relatively lower respect to other registries. The majority of patients are in 15-25 years group and shows affection by Ewing sarcoma in an older age. Socioeconomic factors had direct influence on survival rate. This research has been performed at Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Anne-Britt Dekker; David Bandell; Joost T.P. Kortlever; Inger Schipper; David Ring
Articles in Press, Accepted Manuscript, Available Online from 01 February 2020
Abstract
Background. Remote video consultations on musculoskeletal illness are relatively convenient and accessible, and use fewer resources. However, there are concerns about technological and privacy issues, the possibility of missing something important, and equal access to all patients. We measured patient ...
Read More
Background. Remote video consultations on musculoskeletal illness are relatively convenient and accessible, and use fewer resources. However, there are concerns about technological and privacy issues, the possibility of missing something important, and equal access to all patients. We measured patient characteristics associated with willingness to conduct a remote video musculoskeletal upper extremity consultation. Methods. One hundred and five patients seeking specialty musculoskeletal care completed questionnaires addressing (1) demographics, (2) access to a device, internet, and space to conduct a remote video consultation, (3) health literacy, (4) pain intensity, (5) magnitude of limitations of the upper extremity, (6) self-efficacy, and (7) rated willingness to conduct a remote video musculoskeletal consultation (11-point ordinal scale). A multivariable linear regression analysis sought factors independently associated with patient willingness to conduct remote video musculoskeletal upper extremity consultations. Results. Patient education level (4 years of college) and accessibility to a space suitable for remote video consultations were independently associated with interest in remote video consultations. Sociodemographic factors, health literacy, accessibility to a device or internet, and amount of perceived pain and disability were not. Discussion. We speculate that education level and suitable space might be surrogates for trust and privacy concerns. Future research might measure the ability of interventions to gain trust and ensure privacy to increase willingness to engage in remote video musculoskeletal consultations. Key words: remote consultations, virtual visits, orthopedic surgery, musculoskeletal illness Level of evidence: level II prognostic study
Stéphanie Becker; Wendy E. Bruinsma; Thierry G Guitton; Chantal M.A.M. van der Horst; Simon Strackee; David Ring
Articles in Press, Accepted Manuscript, Available Online from 01 February 2020
Abstract
Object: Treatment recommendations for trapeziometacarpal (TMC) arthrosis are highly variable from surgeon to surgeon. This study addressed the influence of viewing radiographs on a decision to offer surgery for TMC arthrosis. Methods: In an online survey, 92 hand surgeons viewed clinical scenarios and ...
Read More
Object: Treatment recommendations for trapeziometacarpal (TMC) arthrosis are highly variable from surgeon to surgeon. This study addressed the influence of viewing radiographs on a decision to offer surgery for TMC arthrosis. Methods: In an online survey, 92 hand surgeons viewed clinical scenarios and were asked if they would offer surgery to 30 patients with TMC arthrosis. Forty-two observers were randomly assigned to review clinical information alone and 50 to review clinical information as well as radiographs. The degree of limitation of daily activities, time since diagnosis, prior treatment, pain with grind, crepitation with grind, and metacarpal adduction with metacarpophalangeal hyperextension were randomized for each patient scenario to determine the influence of these factors on offers of surgery. A cross-classified binary logistic multilevel regression analysis identified factors associated with surgeon offer of surgery. Results: Surgeons were more likely to offer surgery when they viewed radiographs (42% vs. 32%, P = 0.01). Other factors associated variation in offer of surgery included greater limitation of daily activities, symptoms for a year, prior splint or injection, deformity of the metacarpophalangeal joint. Factors not associated included limb dominance, prominence of the TMC joint, crepitation with the grind test, and pinch and grip strength. Conclusions: Surgeons that view radiographs are more likely to offer surgery to people with TMC arthrosis. The observation that surgeons are also more likely to offer surgery when people do not adapt with time and nonoperative treatment, and persist with greater pain intensity and magnitude of limitations than people with similar radiographs. Given the notable influence of surgeon biases, and the potential for surgeon and patient impatience with the adaptation process, methods for increasing patient participation in the decision-making process merit additional attention and study.
Charlie Humes; Stephanie Aguero; Jorge Chahla; Abdullah Foad
Articles in Press, Accepted Manuscript, Available Online from 01 February 2020
Abstract
ABSTRACT: An increasingly popular method for post-operative rehabilitation of an ACL reconstruction, as a substitute for traditional therapy, is blood flow restriction therapy (BFR). BFR therapy utilizes a pneumatic cuff to simulate strenuous exercise in an effort to stimulate muscle recruitment, mitigate ...
Read More
ABSTRACT: An increasingly popular method for post-operative rehabilitation of an ACL reconstruction, as a substitute for traditional therapy, is blood flow restriction therapy (BFR). BFR therapy utilizes a pneumatic cuff to simulate strenuous exercise in an effort to stimulate muscle recruitment, mitigate atrophy, and promote hypertrophy in patients with load-bearing limitations. Because this is a relatively new form of therapy, there is a lack of established literature and protocol that is preventing widespread use of the therapy. This article will seek to confirm the value and validity of the utilization of BFR therapy. In order to validate the utilization of BFR, an evaluation of the science underlying BFR will be discussed as well as the technique and exercises performed during therapy. Furthermore, analysis of other BFR literature, such as case series, will be utilized to lend further credence to the obtained conclusions. Based on examination of the literature, BFR therapy mitigates atrophy through type II muscle recruitment while also stimulating hypertrophy in patients, supporting its validity in a post-operative rehabilitation setting. Moreover, positive results from prior BFR literature also lend credence to its value as a substitute for traditional therapy in patients who have weight-bearing limitations, specifically those who are recovering from anterior cruciate ligament reconstructions.
Reza Firoozabadi; Eric Y. Chen; Moamen Elhaddad; Paul Tornetta III
Articles in Press, Accepted Manuscript, Available Online from 01 February 2020
Abstract
Abstract Background: Conventional fixation methods of posterior wall acetabular fractures feature the use of plating and lag screws. However, fixation of posterior wall fractures with buttress plating alone offers potential advantages by avoiding the hardware complications related to hardware placement ...
Read More
Abstract Background: Conventional fixation methods of posterior wall acetabular fractures feature the use of plating and lag screws. However, fixation of posterior wall fractures with buttress plating alone offers potential advantages by avoiding the hardware complications related to hardware placement through the wall fragment. The purpose of this study was to examine if buttress plating alone, without screw fixation through the wall would be a viable method of treating these fractures. Our hypothesis was that this technique would not result in loss of reduction. Methods: Retrospective chart review of consecutive series of patients with isolated posterior wall acetabular fractures treated by two independent surgeons at two Level I Trauma centers without screw fixation across the fracture (Boston Medical Center/Harborview Medical Center). Primary outcome measure was loss of reduction (“posterior wall escape”) Results: All 72 fractures treated without a screw through the posterior wall fragment maintained reduction at an average of 1.6 years post-operatively. For fractures fixed with buttress plating alone, 92 % were reduced within 2 mm of being anatomic compared to 94 % of fractures that had screws cross the fracture. Conclusion: The described buttress plating technique without screw fixation in the wall is an acceptable form of fixation for posterior wall acetabular fractures without the theoretical risk of intra-wall screw fixation. Level of Evidence: Level III, Therapeutic-Investigating the results of a treatment Keywords: posterior wall, acetabular fractures, buttress plating, loss of reduction, marginal impaction
Stephen R Selverian; Christopher Jones
Articles in Press, Accepted Manuscript, Available Online from 01 February 2020
Abstract
Background: Proximal interphalangeal (PIP) fracture-dislocation is a relatively common injury that results from “jamming” a finger. Treatment hinges on the degree of articular surface involvement, which determines stability of the joint. For unstable injuries, a variety of surgical interventions ...
Read More
Background: Proximal interphalangeal (PIP) fracture-dislocation is a relatively common injury that results from “jamming” a finger. Treatment hinges on the degree of articular surface involvement, which determines stability of the joint. For unstable injuries, a variety of surgical interventions have been described including extension block pinning, open reduction internal fixation, volar plate arthroplasty, static or dynamic external fixation, and hemi-hamate reconstruction. We present the case of an unstable, subacute ring finger PIP dorsal fracture dislocation for which the above options were not possible or desirable to the patient. Methods: We performed temporary bridge plate fixation of the joint, based on the success of a similar procedure used to treat comminuted and unstable distal radius fractures. Results: The procedure allowed immediate return to work, which was the patients’ primary goal, and resulted in a reasonable short-term outcome, similar to other mentioned procedures. Conclusion: Temporary bridge plate fixation can be considered among treatment choices for PIP fracture dislocation when other, more established options are not possible or desirable.
Mohammad Tahami; Arash Sharafat Vaziri; Mohammad Naghi Tahmasebi
Articles in Press, Accepted Manuscript, Available Online from 01 February 2020
Abstract
Surgical reattachment of medial meniscus posterior root tear (MMPRT) with transtibial sutures can delay the presence of medial knee joint compartment osteoarthritis.Most of suture configurations are placed five mm away from the torn margin in the meniscal substance which is already degenerated and may ...
Read More
Surgical reattachment of medial meniscus posterior root tear (MMPRT) with transtibial sutures can delay the presence of medial knee joint compartment osteoarthritis.Most of suture configurations are placed five mm away from the torn margin in the meniscal substance which is already degenerated and may decrease the pull out strengths of repair construct.The number of meniscus penetration may also be important considering meniscus tissue damage with more complex suture techniques impose the risk of suture cut out through the meniscus substance. We introduce our loop-post suture construct technique which is simple, cheap and reproducible.
Richard Dimock; Kashif Memon; Paolo Consigliere; Ioannis Polyzois; Mohamed A Imam; A Ali Narvani
Articles in Press, Accepted Manuscript, Available Online from 01 February 2020
Abstract
Posterior shoulder dislocation, whilst uncommon, is frequently missed and often associated with a significant defect on the antero-medial aspect of the humeral head (the reverse Hill-Sachs lesion). Several techniques for stabilisation have been described, depending on the size of the lesion. We describe ...
Read More
Posterior shoulder dislocation, whilst uncommon, is frequently missed and often associated with a significant defect on the antero-medial aspect of the humeral head (the reverse Hill-Sachs lesion). Several techniques for stabilisation have been described, depending on the size of the lesion. We describe an additional technique for stabilising the shoulder following posterior dislocation by augmenting the reverse Hill-Sachs lesion with layers of extracellular matrix, thus further filling the defect.
Ali Moradi; Reza Binava; Saeed Eslami Hasan Abadi; Mohammad Hossein Ebrahimzadeh
Articles in Press, Accepted Manuscript, Available Online from 01 February 2020
Abstract
Purpose: Different surgical procedures have been proposed for treatment of Distal Radioulnar Joint (DRUJ) arthrosis and other conditions. In this study, we aimed to introduce a new design of DRUJ prosthesis base on Suave Kapadji Procedure and evaluate its short-term results. Darrach and Suave Kapadji ...
Read More
Purpose: Different surgical procedures have been proposed for treatment of Distal Radioulnar Joint (DRUJ) arthrosis and other conditions. In this study, we aimed to introduce a new design of DRUJ prosthesis base on Suave Kapadji Procedure and evaluate its short-term results. Darrach and Suave Kapadji techniques are two well-known salvage procedures. To avoid the disadvantages of these procedures, various implant designs have been proposed for DRUJ substitution. Methods: Before and after insertion of the intraosseous DRUJ prosthesis in five patients, indexes such as range of motion, grip and pinch strengths were measured and recorded and three questionnaires (Quick DASH, VAS-Pain, and PRWE) were filled out. Results: The patients were followed up for 27.6 months. All patients completed the follow-up period with no complication except one who came with dislocation secondary to forearm malunion and proximal forearm impingement. In comparison with before operation, all indexes improved. Conclusion: The intraosseous distal radioulnar prosthesis can be an alternative option for replacement of DRUJ.
E. Carlos RODRIGUEZ-MERCHAN
Articles in Press, Accepted Manuscript, Available Online from 02 March 2020
Abstract
Introduction: The Cochrane Library makes the outcomes of well-conducted controlled trials quickly accessible and is an essential resource for evidence-based medicine. Purpose: The purpose of this article is to review the data on the surgical treatment of knee osteoarthritis currently provided by the ...
Read More
Introduction: The Cochrane Library makes the outcomes of well-conducted controlled trials quickly accessible and is an essential resource for evidence-based medicine. Purpose: The purpose of this article is to review the data on the surgical treatment of knee osteoarthritis currently provided by the Cochrane database of systematic reviews (CDBSR). Results: The main results included the following: Joint lavage and arthroscopic debridement have no benefit for osteoarthritis; valgus high tibial osteotomy (HTO) reduces pain and improves knee function in patients with medial compartmental osteoarthritis of the knee; in primary total knee arthroplasty (TKA) cemented fixation of the tibial components demonstrated less displacement compared with cementless fixation (with and without hydroxyapatite) after a follow‐up of two years; however, the cemented fixation presented a greater risk of future aseptic loosening than cementless fixation; clinically irrelevant differences have been found between retention and sacrifice of the posterior cruciate ligament (PCL) in primary TKA; moderate‐ to low‐quality evidence suggests that mobile-bearing prostheses can have similar effects on various parameters compared with fixed-bearing prostheses in PCL-retaining TKA. Conclusion: The CDBSR discourages joint lavage and arthroscopic debridement, demonstrates the utility of the valgus HTO in patients with medial compartmental osteoarthritis of the knee, and suggests that the various design types in primary TKA offer similar results.
Allison Michelle Apfel; Ronald A. Navarro; William E. Burfeind; Charles Lin; Mark T. Dillon
Articles in Press, Accepted Manuscript, Available Online from 02 March 2020
Abstract
The purpose of this study was to determine the patient characteristics and rate at which patients who underwent rotator cuff repair(RCR) progressed to shoulder arthroplasty. Methods This was a retrospective study of patients who underwent RCR in a large, closed healthcare system in 2008. The EMR was ...
Read More
The purpose of this study was to determine the patient characteristics and rate at which patients who underwent rotator cuff repair(RCR) progressed to shoulder arthroplasty. Methods This was a retrospective study of patients who underwent RCR in a large, closed healthcare system in 2008. The EMR was queried for rotator cuff repair CPT with ICD-9 codes for rotator cuff. The resultant dataset was then cross-referenced with a separate internal shoulder arthroplasty registry to determine which patients went onto shoulder arthroplasty. Demographic variables, descriptors of tear pathology and repair characteristics were collected and compared between patients who subsequently underwent shoulder arthroplasty and those that did not. Results 882 rotator cuff repair patients were included within this study. Of the initial 882 cuff repairs, there were 12 patients (1.4%) that went on to have arthroplasty. Patients who underwent shoulder arthroplasty after RCR were significantly older at time of surgery and had greater comorbidity burdens. Patients who ended up with shoulder arthroplasty had the procedure an average of 4.77 ± 3.28 (SD) years after RCR, with 11 of 12 patients having a diagnosis of rotator cuff arthropathy at the time of shoulder replacement. Discussion/Conclusions In a closed system, tracking RCRs over 9.1 years revealed a small number that went on to subsequent shoulder arthroplasty. Patients who underwent arthroplasty were significantly older and had greater comorbidity burdens than those who did not. Patients who underwent shoulder arthroplasty usually either had shoulder arthroplasty within 1 year or after 5 years. Enhanced understanding of which patients may progress to arthroplasty may provide a better initial choice of operative intervention in those patients.
Khalil Kimiafar; Majid Khadem Rezaiyan; Mohsen Saberifar; Mahdi Mohammadi; Mohammadsadegh Zarei; Alireza Omranzadeh; masoumeh sarbaz; Ali Moradi
Articles in Press, Accepted Manuscript, Available Online from 02 March 2020
Abstract
Introduction: Injury is one of the leading causes of death and disability worldwide. Lower extremity injuries put a heavy burden on communities. The aim of this study is to assess the prevalence of lower extremity injuries in Mashhad, Iran. Method: The data from 57430 patients with lower extremity injuries ...
Read More
Introduction: Injury is one of the leading causes of death and disability worldwide. Lower extremity injuries put a heavy burden on communities. The aim of this study is to assess the prevalence of lower extremity injuries in Mashhad, Iran. Method: The data from 57430 patients with lower extremity injuries collected from all traumatology hospitals in Mashhad were analyzed in this retrospective descriptive cross-sectional study to determine the prevalence of lower extremity injuries in Mashhad, Iran between March 2011 and March 2015. Result: The prevalence of lower extremity injury in the general population of Mashhad was 0.34%. The mean age of the casualties was 33.7±19.8 years, and 77.9% were male. Knee and lower leg injuries had the highest frequency (61%). The mean hospitalization period was 7.7±12.6 days. The highest mortality rate (MR) (2%) and discharge against medical advice (DAMA) (11%) were observed in hip and thigh injuries. DAMA (8.8% vs. 6.7%, p<0.001) and MR (1.7% vs. 1.5%, P=0.005) was higher in females. However, the hospitalization period was longer in males (8±13) compared to females (6.8±10.1 days) (P<0.001). The prevalence rate was declining in during the study period. Conclusion: The declining trend of lower extremity injuries is promising. However, the higher mortality rate of females needs more attention. These findings can be used for better management of traumatic patients. Keywords: injury; lower extremity; prevalence
Ashok Kumar; Anikait Ghosh Kadamb; Krish Ghosh Kadamb
Articles in Press, Accepted Manuscript, Available Online from 02 March 2020
Abstract
Osteoarthritis is the most common chronic degenerative disorder causing painful, deformed, stiff joint leading to progressive deterioration of quality of life. Mesenchymal Stem Cell (MSC) therapy in osteoarthritis has generated great interest and is offered with the unlimited potential of healing and ...
Read More
Osteoarthritis is the most common chronic degenerative disorder causing painful, deformed, stiff joint leading to progressive deterioration of quality of life. Mesenchymal Stem Cell (MSC) therapy in osteoarthritis has generated great interest and is offered with the unlimited potential of healing and regeneration. Current literature regarding their proper name, optimal sources, mechanisms of action, dosage and route of administration, efficacy, and safety is debatable. This index review article has tried to connect these puzzling pieces of available information and brought clarity on some of these important issues. The author believes that Maintenance Stem Cells (MSC) may be a more suitable term than mesenchymal stem cell or medicinal signaling cells as their origin might not be limited to mesodermal tissue; they have been shown capable of self-renewal, differentiation and maintaining a cascade of healing & possibly regeneration at the implanted site. Only a small percentage of implanted MSC survive and rest undergo apoptosis after releasing growth factors, cytokines, and extracellular vesicles. These surviving MSC become active due to conformational changes induced by anti-environment stimuli and undergo limited self-renewal, proliferation, and differentiation but only a few of them might incorporate into the host tissues, chondrocytes or chondroblast; these cells generate & maintain a momentum of series of regenerative activities to improve the function of joint, stabilize or possibly enhance the cartilage quality. More randomized studies with long term follow-up are required to bring clarity on their ideal source, expansion, culture technique, optimum dosage and route of administration and long-term safety issues.
somayeh hosseinzadeh; Mansour Eslami; Mohammad Taghipour; Raheleh Mehr Aein; Hemmat Gholinia; ali barzegari
Articles in Press, Accepted Manuscript, Available Online from 02 March 2020
Abstract
Background: Patellar tendon moment arm length changes at different knee flexion angles have not been determined in in vivo studies.We aimed to determine patellar tendon moment arm lengths in four different knee angles using Magnetic Resonance Imaging (MRI) to predict in vivo changes in the moment arm ...
Read More
Background: Patellar tendon moment arm length changes at different knee flexion angles have not been determined in in vivo studies.We aimed to determine patellar tendon moment arm lengths in four different knee angles using Magnetic Resonance Imaging (MRI) to predict in vivo changes in the moment arm length from different knee angles during running. Methods: The moment-arm length of patellar tendon was measured as the perpendicular distance from muscle–tendon line of action to the knee joint axis of rotation at 0 (full extension), 20, 40 and 60 degrees flexion of knee by using MRI method. A repeated measure ANOVA method was applied to compare the moment arms length among four degrees of knee flexion (p<0.05). A regression analysis was used to predict the patellar tendon moment arm’s length during different knee joint angles. Results: Mean and standard deviation of patellar tendon moment arm lengths in the four angles at 0, 20, 40 and 60 degrees of knee flexion were observed 42.55±4.20, 39.91±2.98, 37.73±2.87 and 36.18±2.90 mm, respectively (p<0.05). A regression analysis provided an equation to predict the patellar tendon moment arm’s length from different knee joint angles during running. Conclusion: patellar tendon moment arm lengths values decreased from knee extension to flexion in a linear manner. These findings have important implications for estimating patellar tendon moment arm lengths using a regression equation model from different knee joint angles.
Daniel E Davis; RYAN COX; Manan Patel; Mark Lazarus; Matthew Ramsey; Surena Namdari
Articles in Press, Accepted Manuscript, Available Online from 02 March 2020
Abstract
Study Design: Retrospective, case series Background: The primary goals of total shoulder arthroplasty (TSA) are to relieve pain, improve range of motion, and restore function. Physical therapy is commonly used to help achieve these goals. Recent evidence has pointed to the success and safety of a purely ...
Read More
Study Design: Retrospective, case series Background: The primary goals of total shoulder arthroplasty (TSA) are to relieve pain, improve range of motion, and restore function. Physical therapy is commonly used to help achieve these goals. Recent evidence has pointed to the success and safety of a purely physician-guided, home-based or internet-based, program versus the traditional therapist guided program. Objectives: The purpose of this study was to evaluate outcomes of TSA in patients using a web-based, home therapy program. Methods: A retrospective review was performed of TSA patients who were given the option of using a web-based, home therapy program. Functional outcomes were collected preoperatively, 6-month, and 12-month post-operative examinations. Physical examination parameters were recorded at preoperative, 3-month, 6-month, and 12-month time-points. Results: Forty-seven patients used the web-based, home therapy program and had complete follow-up data at all time intervals. All mean range of motion parameters and functional scores improved significantly from preoperatively to postoperatively. There was one reported complication in a patient who sustained a subscapularis rupture and underwent subsequent open repair at 10 months postoperatively. Conclusion: This study demonstrates successful improvements in range of motion and functional outcomes in a subset of patients who utilized an online therapy program after TSA. Future study will be necessary to directly compare results in patients enrolled in formal, outpatient therapy programs and to determine barriers to utilization of web-based therapy programs. Level of Evidence: Level IV – retrospective case series
Brian Katt; Nailah F. Mubin; Pedro K. Beredjiklian
Articles in Press, Accepted Manuscript, Available Online from 02 March 2020
Abstract
Background: Compartment syndrome occurs when increasing pressures in a fascial compartment impair circulatory flow. It is most common in lower leg or upper extremity after a traumatic injury such as a fracture. Atraumatic posterior thigh compartment syndrome is a rare but serious condition. Urgent management ...
Read More
Background: Compartment syndrome occurs when increasing pressures in a fascial compartment impair circulatory flow. It is most common in lower leg or upper extremity after a traumatic injury such as a fracture. Atraumatic posterior thigh compartment syndrome is a rare but serious condition. Urgent management with emergent fasciotomy is required so as to prevent serious complications and long term neurological deficits.
Case: We document a case of atraumatic posterior thigh compartment syndrome that presented as an acute sciatic nerve palsy and required emergent fasciotomy. The patient was successfully treated with fasciotomy however his course was complicated by rhabdomyolysis induced acute renal failure that required hemodialysis.
Level of Evidence: Level V
Khodamorad Jamshidi; Mehryar Khadem; Tina Shooshtarizadeh; Alireza Mirzaei
Articles in Press, Accepted Manuscript, Available Online from 02 March 2020
Abstract
The diagnosis of synovial chondromatosis (SCM) is usually delayed, as the arthroscopic-guided synovial biopsy is postponed owing to its invasive nature. We report the timely diagnosis of a giant solitary synovial chondromatosis of the hip in a 32-year-old woman using ultrasound-guided ...
Read More
The diagnosis of synovial chondromatosis (SCM) is usually delayed, as the arthroscopic-guided synovial biopsy is postponed owing to its invasive nature. We report the timely diagnosis of a giant solitary synovial chondromatosis of the hip in a 32-year-old woman using ultrasound-guided synovial biopsy. This technique revealed to be safe and successful in the diagnosis of SCM, when the imaging studies were obscure. Moreover, it avoided the potential arthroscopy-associated complications. We recommend ultrasound-guided synovium biopsy as a less invasive and less complicated technique for the early diagnosis of SCM in future workouts.
Navin Fernando; Shawn Schoch; Moamen Elhaddad; Jonah Hebert Davies; Reza Firoozabadi
Articles in Press, Accepted Manuscript, Available Online from 02 March 2020
Abstract
Background: Polymethylmethacrylate antibiotic impregnated beads can be an effective treatment for chronic osteomyelitis or an adjuvant in the treatment of open fractures. It remains unclear however whether the beads cause long-term adverse events if not removed. The purpose of this study was to determine ...
Read More
Background: Polymethylmethacrylate antibiotic impregnated beads can be an effective treatment for chronic osteomyelitis or an adjuvant in the treatment of open fractures. It remains unclear however whether the beads cause long-term adverse events if not removed. The purpose of this study was to determine if removal of antibiotic beads was required in order to avoid long term complications. Methods: A retrospective chart review was conducted on patients with an extremity or pelvis fracture that had implantation of polymethylmethacrylate (PMMA) antibiotic beads over a five-year period. Results: Fifty-one patients met inclusion criteria for this study; thirty-seven patients (73%) did not have complications after surgical debridement and placement of PMMA antibiotic beads necessitating removal. Conclusion: Our findings suggest that polymethylmethacrylate antibiotic beads can be utilized as a means of delivering high-dose concentrations of local antibiotics and do not have to be removed in all patients. Level of Evidence: Level III, Therapeutic-Investigating the results of a treatment
Mostafa Shahrezaee; Mohammad Einafshar; Mohammad Hossein Shahrezaee; Reza Sharifzadeh
Articles in Press, Accepted Manuscript, Available Online from 02 March 2020
Abstract
Object: To quantify the relationship between bone drilling process parameters (i.e. feed rate, resting time, exit rate and drill bit diameter) and drilling outcome parameters (i.e. thrust force and maximum temperature). Methods: Ten millimeters cortical bovine samples were used to determine the effects ...
Read More
Object: To quantify the relationship between bone drilling process parameters (i.e. feed rate, resting time, exit rate and drill bit diameter) and drilling outcome parameters (i.e. thrust force and maximum temperature). Methods: Ten millimeters cortical bovine samples were used to determine the effects of four independent parameters i.e. two drills bit diameter, six different feed rates, three various resting times and three different exit rates on thrust force and maximum temperature. Twenty-eight stainless steel orthopedic drill bits with a diameter of 2.5 and 3.2 mm as well as orthopedic handpiece attached to the 500 N load cell and an accurate linear variable differential transformer (LVDT) to obtain forces. Two k- type thermocouples were used to record the temperature-time curve adjacent to the drilling site. ANOVA two-way and post hoc Tukey-Kramer honesty tests were applied statistically. Results: Maximum thrust force (MTF) decreased by almost 230% by increasing drill bit diameter from 2.5 to 3.2 mm in the lowest feed rate. MTF increased by 335% while the maximum temperature (MT) decreased by 69% by increasing feed rates from 0.5 to 3 mm/sec. Also, MT decreased by 67% by increasing exit rate from 1 to 3 mm/sec. A slight increase was observed in MT by increasing the resting time from 0 to 2 seconds (p>0.05). Conclusions: The desire drilling is drilling with lower thrust force and lower final temperature of bone. Increasing feed rate can cause an increase in thrust force while decreasing the final temperature. The maximum final temperature is highest in two first feed rate values, thus the desired value for feed rate would be 90 mm/min. Resting time has no significant effects on final temperature. So for a more accurate, efficient and uniform drill hole, resting time will be helpful.
Ömer Faruk Elmas; Asuman Kilitci; Belkız Uyar; Mehmet Gamsızkan
Articles in Press, Accepted Manuscript, Available Online from 02 March 2020
Abstract
Subungual exostosis is a benign osteo-chondral overgrowth occurring on the distal phalanx beneath the nail plate. Dermatoscopic features of subungual exostosis have been described in a few studies, however, intraoperative dermatoscopic findings of the entity has not been described yet. Here we report ...
Read More
Subungual exostosis is a benign osteo-chondral overgrowth occurring on the distal phalanx beneath the nail plate. Dermatoscopic features of subungual exostosis have been described in a few studies, however, intraoperative dermatoscopic findings of the entity has not been described yet. Here we report intraoperative dermatoscopy of subungual exostosis in a young female patient.
Hamidreza Yazdi; Mohammad TAHER Ghaderi
Articles in Press, Accepted Manuscript, Available Online from 02 March 2020
Abstract
The causes of malalignment in total knee arthroplasty can be categorized into three different groups; 1) Errors in bone cuts 2) Errors in implant fixations, and 3) The method of setting down the cutting guides (1). We would like to announce that more several distal femoral valgus cut errors may occur ...
Read More
The causes of malalignment in total knee arthroplasty can be categorized into three different groups; 1) Errors in bone cuts 2) Errors in implant fixations, and 3) The method of setting down the cutting guides (1). We would like to announce that more several distal femoral valgus cut errors may occur during total knee replacement.
Hip
Ali A. Esmailiejah; Mohammadreza Abbasian; Farshad Safdari
Volume 5, Issue 5 , September 2017, , Pages 337-341
Abstract
Traumatic anterior dislocation of the hip is an extremely rare condition in children and open dislocation is even rarer. Thisisusually caused by high-energy trauma. In the current study, we present a case of an eight-year-old child suffering froman open anterior–inferior dislocation of the right ...
Read More
Traumatic anterior dislocation of the hip is an extremely rare condition in children and open dislocation is even rarer. Thisisusually caused by high-energy trauma. In the current study, we present a case of an eight-year-old child suffering froman open anterior–inferior dislocation of the right hip concomitant with pelvic ring disruption and an ipsilateral open distalfemoral fracture (Salter-Harris type 4, Gustilo type IIIA) caused by a traffic accident. The patient underwent successfulemergent open reduction due to the buttonholed femoral head after appropriate irrigation and debridement. Successfulrecovery was achieved and the patient was discharged after two weeks. After nine months of follow-up, the X-ray imagesshowed slight changes related to the osteonecrosis of the femoral head. Long-term follow-up over a period of six yearsshowed sufficient range of motion. The patient’s gait was normal and he was satisfied with the outcome. In addition, slightnon-progressive osteonecrotic changes were obvious in the right hip.
Arthroscopy & Arthroplasty.
Seyed Mohammad J. Mortazavi; Mohammad R. Sobhan; Hamed Mazoochy
Volume 5, Issue 5 , September 2017, , Pages 342-346
Abstract
Total knee arthroplasty (TKA) is a rewarding procedure in patients with hemophilia and end stage knee hemophilicarthropathy. However, this procedure might be associated with complications such as infection. There periprostheticjoint infection in patients with hemophilia is very well known, though we ...
Read More
Total knee arthroplasty (TKA) is a rewarding procedure in patients with hemophilia and end stage knee hemophilicarthropathy. However, this procedure might be associated with complications such as infection. There periprostheticjoint infection in patients with hemophilia is very well known, though we are not aware of any previous report on Brucellainfection in this group of patients. Here, we reported a 28-year old man with Brucella infection of total knee replacementwho initially underwent a conservative treatment followed bya two-stage revision. We believe that this report will alertphysicians who work in endemic area for brucellosis to consider this in differential diagnosis and do the right interventionat the right time.