eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
342
345
10.22038/abjs.2017.15397.1374
10312
Preoperative Aspiration Culture (PAC) for the Diagnosis of Infection in a Prosthetic Knee Joint
E. Carlos RODRIGUEZ-MERCHAN
ecrmerchan@hotmail.com
1
Department of Orthopaedic Surgery, La Paz University Hospital- IdiPaz, Paseo de la Castellana, Madrid, Spain
Background: Periprosthetic infection is the most serious joint replacement complication, occurring in 0.8-1.9% of totalknee arthroplasties (TKAs).This review aims to define the role of preoperative aspiration culture (PAC) for diagnosis of TKA infection.Methods: A PubMed (MEDLINE) search related to TKA infection and PAC was analyzed. The main criteria for selectionwere that the articles were focused in the aforementioned question.Results: Twenty articles were found, but only fourteen were selected and reviewed because they were deeplyfocused on the topic. PAC has shown an average sensitivity of 67.6% (range, 28% to 100%) and an averagespecificity of 98.4% (range, 96% to 100%).Conclusion: PAC has moderate to high sensitivity and very high specificity for diagnosing TKA infection.Level of evidence: III
https://abjs.mums.ac.ir/article_10312_eeb5c1181cb0a25a8eefa2b1a3675b7c.pdf
Arthroplasty
Aspiration
Culture
Infection
knee
Preoperative
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
346
352
10.22038/abjs.2018.22652.1590
10301
A challenge on Orthopedic Sciences: The Influence of Spinal Disease and Deformities on Total Hip Arthroplasty: A Review on Literature
Ali Yeganeh
yeganeh471@yahoo.com
1
Mehdi Moghtadaei
mmoghtadaei@gmail.com
2
Mohsen Motalebi
dr.motalebi@ymail.com
3
Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
Department of Orthopedics, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
Background: Adult degenerative disorders of hip and spine are common. The recent studies inconsistently havediscussed about the influence of spinal disorders on total hip arthroplasty (THA). In this review, we discussed clearlyabout these relationships and their effects on the most appropriate position of the acetabular component.Methods: We searched on databases and evaluated the articles about spinopelvic parameters in patients with spinaldisorders who needed THA.Results: The literature search showed a prevalence of 21.2 % to 60.4% of low back pain (LBP) in patients, whoare candidates for primary THA. The coexistence of degenerative disease of hip and spine or other diseases cansignificantly alter spinopelvic alignment. Accordingly, pain management or any other treatment in these patientsrequires proper understanding about the biomechanics of the hip and the spinal and their corresponding interactions.In this review article, we discussed about these interactions and their effects on the most appropriate position of theacetabular component.Conclusion: We concluded that counseling sessions among patients, orthopedic surgeons and spine surgeonscan result in obtaining the best outcome for these individuals.Level of evidence: I
https://abjs.mums.ac.ir/article_10301_b405d6c90be2d5ca78375ae37e512f8d.pdf
hip arthroplasty
Spinal disorders
Spinal parameters
Spinopelvic alignment
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
353
358
10.22038/abjs.2017.25571.1678
10277
Short-Term Results of the DePuy Global Unite Platform Shoulder System: A Two-Year Outcome Study
Gary F. Updegrove
gupdegrove@pennstatehealth.psu.edu
1
Thema A. Nicholson
thema.nicholson@rothmaninstitute.com
2
Surena Namdari
surena.namdari@rothmaninstitute.com
3
Gerald R. Williams
4
Joseph A. Abboud
abboudj@gmail.com
5
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
Background: The Global Unite Shoulder System is the next generation of implant from the Depuy Global Shoulderline. The primary feature of the Global Unite is adaptability through the interchangeable modular bodies, modular suturecollars, and stems. Short-term functional and radiographic outcomes of the Global Unite Platform Shoulder Systemwere assessed as well as complication and revision rates.Methods: 95 subjects were enrolled prospectively between 2013 and 2015 that underwent anatomic or reverseshoulder arthroplasty utilizing the DePuy Global Unite Anatomic Platform Shoulder System. Functional outcome data(ASES and SANE) as well as radiographic data was collected on these patients pre-operatively, and at 6 months, 1year and 2 years post-operatively.Results: The cohort consisted of 97 shoulders in 95 patients of which 54 (56.8%) are males and 41 (43.2%) are female.There were 55/97 (56.7%) were primary anatomic total shoulder arthroplasties, 37/97 (38.1%) primary reverse shoulderarthroplasties, and 3/97 (3.1%) revision procedures to a reverse shoulder arthroplasty. Outcome scores demonstratedan increase in ASES score from a mean of 33.00 to 79.56 and SANE score of 21.30 to 84.08.Conclusion: The Depuy Global Unite shoulder system demonstrated very good short-term results in this two-year outcomestudy. Functional outcome scores are similar to current literature for anatomic and reverse primary cases. Radiographicmeasures at two years are promising with only 2 cases of grade 1 scapular notching and one case of grade 2 scapularnotching. Overall the Depuy Global Unite is a versatile shoulder system with very good early outcomes.Level of evidence: IV
https://abjs.mums.ac.ir/article_10277_d39df5e26163a1956b0748894cb747da.pdf
Anatomic Total Shoulder Arthroplasty
Convertible
Modular
Reverse shoulder arthroplasty
Revision Shoulder Arthroplasty
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
359
364
10.22038/abjs.2017.24928.1671
10283
Significance of Perioperative Tests to Diagnose the Infection in Revision Total Shoulder Arthroplasty
Shahryar Ahmadi
ahmadismd@gmail.com
1
Thomas M. Lawrence
lawrence.thomas@mayo.edu
2
Shawn Sahota
sahota.shawn@gmail.com
3
Cathy D. Schleck
schleck.cathy@mayo.edu
4
William S. Harmsen
harmsen.william@mayo.edu
5
Robert H. Cofield
cofield.robert@mayo.edu
6
John W. Sperling
sperling.john@mayo.edu
7
The Department of Orthopedic Surgery, Rochester, USA
The Department of Orthopedic Surgery, Rochester, USA
The Department of Orthopedic Surgery, Rochester, USA
The Department of Orthopedic Surgery, Rochester, USA
The Department of Orthopedic Surgery, Rochester, USA
The Department of Orthopedic Surgery, Rochester, USA
The Department of Orthopedic Surgery, Rochester, USA
Background: The purpose of this study was to evaluate the value of perioperative tests for the diagnosis of infectionin revision shoulder arthroplasty.Methods: A retrospective analysis was performed on 537 shoulder arthroplasties (429 patients) that underwent revisionshoulder arthroplasty at our institution. Periprosthetic tissue cultures were positive in 169/537 surgeries.Results: White-blood cell count (WBC) was elevated in 3.8% revision arthroplasties. Erythrocyte sedimentation rate (ESR)was elevated in 23.1% revision arthroplasties. The C-reactive protein (CRP) was elevated in 20.8% revision arthroplasties.Bone scans (technetium, indium) were performed on 9.9% patients and it was positive for osteomyelitis in just one revisionarthroplasty. Intra-operative pathology was read as consistent with acute inflammation in 11.9% revision arthroplasties.The positive and negative predictive values for intra-operative pathology were 56.7% and 71.6% respectively.Conclusion: All of the perioperative tests had a high specificity and negative predictive value, but low sensitivity andpositive predictive value.Level of evidence: III
https://abjs.mums.ac.ir/article_10283_1c3f50cf21e4116d392ee2ba77841aab.pdf
Infection in Revisions Shoulder Arthroplasty
Perioperative Tests
shoulder
Shoulder Arthroplasty
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
365
370
10.22038/abjs.2018.15441.1377
10827
The Best Option in Treatment of Modified Mason Type III Radial Head Fractures: Open Reduction and Internal Fixation Versus Radial Head Excision
Ahmadreza Zarifian
ahmadrezazarifian@gmail.com
1
Hassan Rahimi Shoorin
rahimih@mums.ac.ir
2
Mohammad Hallaj Moghaddam
halajm@mums.ac.ir
3
Meysam Fathi Vavsari
maisam.fathi@yahoo.com
4
Mohammad Gharedaghi
5
Ali Moradi
moradial@mums.ac.ir
6
Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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
https://abjs.mums.ac.ir/article_10827_67f52f1aab95c89781b633d338712935.pdf
Excision
Mason type III
Open reduction and internal fixation
ORIF
Radial head fractures
Resection
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
371
375
10.22038/abjs.2017.23467.1619
10298
Economic Analysis of the Cost of Implants Used for Treatment of Distal Radius Fractures
Suneel Bhat
suneel.b.bhat@gmail.com
1
Frederick Liss
fred.liss@rothmaninstitute.com
2
Pedro Beredjiklian
pedro.beredjiklian@rothmaninstitute.com
3
Rothman Institute at the Thomas Jefferson University
Thomas Jefferson University Hospital
Rothman Institute
Jefferson Medical College
Background: There are a number of different implant choices for surgical treatment of distal radius fractures, oftendetermined by surgeon preference or availability. Although no one volar plate demonstrates superior outcomes, thereare significant cost differences absorbed by hospitals and surgical centers. This purpose of this study is to characterizethe economic implications of implant selection in the surgical management of distal radius fractures.Methods: A retrospective review of billing records at a mid-size community surgicenter was conducted for CPT codes25607, 25608, and 25609 between 1/1/2014 and 6/1/2014, and associated implant costs and facility reimbursementswere collected. A unique stochastic simulation model was developed from derived probabilities, reimbursements, andcosts, and analyzed by Monte Carlo simulation.Results: Reimbursement to the facility for distal radius ORIF cases ranged from $1,102.20 to $7,393.86, with anaverage of $3,824.56. Per case operating costs to the facility ranged from $1,250 to $7,270, with an average of$2,817.42. In the US, variations in implant cost 25% above or below the mean translates to annual operating profitsrealized by facilities ranging from a loss of $57,047,720 to profits of $55,189,729. On average, per case operatingcosts for distal radius fractures need to be less than $2956 fo r facilities to realize a per case profit.Conclusion: Value based purchasing is by necessity becoming integrated into clinical decision making byorthopaedic surgeons. Variations of 25% around the mean per case operating cost can vary facility operating marginsby $112,237,450 annually. Arming the orthopaedic surgeon with the realities of the cost of implant selection in theoperative management of distal radius fractures will lead to better value based decision making, substantial costsavings to the US hospital system, and ultimately payers and patients.Level of evidence: II
https://abjs.mums.ac.ir/article_10298_2082dac4a5651a88bdbc98547c9ab94d.pdf
Cost
Distal radius fracture
Economic analysis
Implants
Wrist
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
376
380
10.22038/abjs.2017.25955.1698
10273
Long- Stem Total Knee Arthroplasty for Proximal Tibial Stress Fractures in the Elderly Patients
Mahmoud Jabalameli
jabalamelimd@yahoo.com
1
Hosseinali A. Hadi
hosseinali_hadi@yahoo.com
2
Abolfazl Bagherifard
bagherifd@gmail.com
3
Mohammad Rahbar
k.rahbar@yahoo.com
4
Mohammadreza Minator Sajjadi
arashsajadi55@yahoo.com
5
Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Taleghani Hospital Research Development Unit, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Background: Presentation of proximal tibia stress fracture is not infrequent among elderly patients due to their poorbone stock. Optimal management of patients with severe gonarthrosis of the knee and concurrent tibial stress fracture isnot known yet. In this study we report the outcome of primary total knee arthroplasty (TKA) using stemmed componentsin elderly patients.Methods: Between 2009 and 2014, a total of 16 elderly patients with proximal tibial stress fractures and concurrentgonarthrosis were treated with TKA using long stemmed components. The diagnosis of stress fractures was confirmedbased on the radiographic changes. A standing alignment view was obtained for all patients preoperatively. Union ofthe fracture site was investigated using plain anteroposterior (AP) and lateral leg x-rays.Results: All patients experienced significant relieve of symptoms. The Knee Society score and Knee Society functionalscore averaged 86±4 and 85±6, respectively. The mean arc of motion of the knee was 118°±2° at the latest follow-up. Allstress fractures resolved at a mean of 8.3±1.1 weeks. The medial proximal tibial angle was increased from 74.7°±5.7°preoperatively to 90.3°±1.1° (P<0.05) postoperatively. Tegner activity scale was increased from 2.1±1.3 to 3.4±0.9(P<0.05).Conclusion: According to our findings, patients with stress fracture of proximal tibia and concurrent gonarthrosiscan be treated with primary TKA using stemmed components that may bypass the stress fracture and allowhealing of the fracture.Level of evidence: IV
https://abjs.mums.ac.ir/article_10273_6caf86a5de2dcdcad66d88b15ea7438d.pdf
KNEE ARTHROPLASTY FOR PROXIMAL TIBIAL STRESS FRACTURE
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
381
389
10.22038/abjs.2018.25844.1684
10275
How Much Bone Cement Is Utilized for Component Fixation in Primary Cemented Total Knee Arthroplasty?
Bhava R.J. Satish
drbrjorthocentre@gmail.com
1
Mohan Thadi
thadimohan@hotmail.com
2
Subbiahgounder Thirumalaisamy
tmstms@hotmail.com
3
Apsingi Sunil
apsingi@gmail.com
4
Praveen L. Basanagoudar
praveen.ortho@gmail.com
5
Bernard Leo
drleobernard@gmail.com
6
BRJ Orthocentre and MAK Hospital, Eru Company Stop, Mettupalayam Road, Coimbatore, India
Amrita Institute of Medical Sciences, Ponekkara, Edappally, Kochi, Kerala, India
Kovai Medical Centre Hospital, Avanashi road, Peelamedu, Coimbatore, Tamil Nadu, India
Maxcure Hospitals, Hitech City, Madhapur, Hyderabad, Telangana, India
Sagar Hospital Banashankari, DSI Institutions kumarasamy layout, Bangalore, India
BRJ Orthocentre and MAK Hospital, Eru Company Stop, Mettupalayam Road, Coimbatore, India
Background: No scientific evidence exists regarding the amount of bone cement used and discarded in primarycemented Total knee arthroplasty (TKA). The aim of this study was to identify the exact amount of bone cement utilizedfor component fixation in primary TKA.Methods: In a prospective study carried out at five centers, 133 primary cemented TKAs were performed. One packof 40g Palacos bone cement (PBC 40) was hand mixed and digitally applied during the surgery. After fixation of theTKA components, the remaining bone cement was methodically collected and weighed on a digital weighing scale. Theactual quantity of cement utilized for component fixation was calculated.Results: On an average, 22.1 g of bone cement was utilized per joint, which accounted to 39 % of 57 g, the solidifieddry weight of PBC 40. Among 133 knees, the cement usage was 20 % to 50% in 109 knees, more than 50% in 20 kneesand less than 20% in 4 knees. Knees which received larger sized femoral implant required more cement compared tomedium and small sizes. Knees which had pulse lavage had more cement utilization compared to knees which hadsimple syringe lavage before implantation.Conclusion: Large quantity of bone cement was handled than actual requirements in primary TKA when astandard 40g pack was used with the digital application technique, resulting in sizeable discard of bone cement.Customizing cement pack according to the implant size can potentially avoid this cement wastage. Futureresearch is required to study the utility and economic impact of smaller packs (20 g or 30 g) of bone cement inprimary TKA.Level of evidence: IV
https://abjs.mums.ac.ir/article_10275_2affe7e152c3b7822678ed4a98c9ff17.pdf
Bone cement quantity
Cement utility
Primary knee arthroplasty
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
390
396
10.22038/abjs.2017.24739.1649
10285
Does Adding Lidocaine to Intrathecal Bupivacaine Affect Hemodynamic Parameters during Hip Fracture Surgery?
Abbas Sedighinejad
a_sedighinejad@yahoo.com
1
Bahram Nadei Nabi
naderi_bahram@yahoo.com
2
Hossein Ettehad
h_ettehad70@yahoo.com
3
Ahmadreza Mirbolook
ahmadreza.mirblook@yhaoo.com
4
Zahra Atrkarroushan
atrkarroushan@gmail.com
5
Samaneh Ghazanfar Tehran
tehranisamaneh88rasht@gmail.com
6
Gelareh Biazar
gelaehbiazar1386@gmail.com
7
Mohammad Haghighi
manesthesist@gmail.com
8
Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
Guilan University of Medical Sciences (GUMS), Rasht, Iran
Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
Background: Hip fracture is one of the most common problems in elderly that needs surgical repair. As, the majority ofthese patients have chronic diseases, they are at increased risk of peri-operative mortality and morbidity. The purposeof this study was to evaluate spinal anesthesia with bupivacaine vs bupivacaine in combination with lidocaine in termsof hemodynamic changes in patients undergoing hip fracture surgery.Methods: This double-blind clinical trial was conducted on 292 patients undergoing surgery for hip fracture underspinal anesthesia. Patients were allocated into two groups of B (10 mg of hyperbaric 0.5% Bupivacaine) and BL (5 mghyperbaric Bupivacaine 0.5% plus 50 mg Lidocaine 5%). Sensory and motor block and hemodynamic changes wereconsecutively measured before spinal anesthesia (T0), immediately after spinal injection (T1), every 5 minutes for halfan hour (T2- T7), and at 45 minutes (T8) and 60 minutes (T9) after injection.Results: Patients in the two groups were homogeneous in demographic characteristics including age, sex, BMI, ASAClass, baseline blood pressure and heart rate. The onsets of sensory and motor blocks in group BL were faster thangroup B (P=0.0001). Also, the durations of sensory and motor blocks in group B were significantly longer than groupBL (P=0.0001). The BL group had a significantly lower systolic blood pressure in all periods (P<0.05). Although theheart rate in the BL group was lower than group B at all time points, this difference was only significant during T2-T3(P=0.033 and P=0.0001, respectively). Group BL had significantly more episodes of hypotension, bradycardia, nauseaand vomiting (P=0.0001, P=0.023, P=0.003, and P=0.033, respectively).Conclusion: According to our findings, using Lidocaine 50 mg in combination with Bupivacaine 5 mg, compared withBupivacaine 10 mg alone for spinal anesthesia in hip fracture fixation surgeries was associated with more hypotensionand bradycardia. As a result, combination of Bupivacaine with Lidocaine at this dose is not recommended for inductionof anesthesia in these patients.Level of evidence: II
https://abjs.mums.ac.ir/article_10285_e14701187f282ed3a00059a953a4f100.pdf
Bradycardia
Bupivacaine
Hemodynamics
Hypotension
Lidocaine
Pelvic surgery
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
397
401
10.22038/abjs.2017.24932.1666
10282
Clinical Outcomes after Microdiscectomy for Recurrent Lumbar Disk Herniation: A Single-Center Study
Hosein Mashhadinejad
mashhadinejadh@mums.ac.ir
1
Ebrahim Sarabi
drsarabi6060@yahoo.com
2
Sara Mashhadinezhad
sara.mashhadinezhad@gmail.com
3
Babak Ganjeifar
b_ganjeifar@yahoo.com
4
Department of Neurological Surgery, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
Department of Neurological Surgery, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
Department of Cardiology, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
Department of Neurological Surgery, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
Background: Revision discectomy is the principal procedure for recurrent lumbar disk herniation (RLDH). The clinicaloutcomes after this procedure are as good as or slightly poorer than those produced by primary discectomy. In thisstudy, the clinical outcomes of patients treated with microsurgical discectomy for RLDH were analyzed.Methods: We examined 179 patients undergoing lumbar microdiscectomy surgery for RLDH. The visual analoguescale (VAS), Prolo scoring system, and Oswestry Disability Index (ODI) were used for evaluating the improvementof symptoms and functional outcomes.Results: Among 179 patients, 101 (56%) obtained good and excellent Prolo scores (group 1), while 78 (44%)obtained fair or poor results (group 2). There was no significant difference between the groups regarding age(P=0.515), gender (P=0.545), body mass index (P=0.523), diabetes mellitus (P=0.074), smoking (P=0.100),interval between primary and revision surgeries (P=0.749), and surgical outcomes (P=0. 749). However, significantimprovements were achieved in VAS scores for back (P=0.197) and radicular pain (P=0.606), as well as ODI scores(P= 0.000). Based on the findings, only ODI scores showed a significant inter-group difference in the 12-monthfollow-up (P=0.038).Conclusion: Limited microsurgical discectomy could be considered as the main surgical method in patients with RLDHwithout overt instabilities.Level of evidence: IV
https://abjs.mums.ac.ir/article_10282_d3e7b20cb87719ae138b5af9e311a17e.pdf
Disc herniation
lumbar
Outcome assessment
Recurrence
Revision surgery
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
402
411
10.22038/abjs.2018.26300.1695
10832
Evaluation of Clinical and Radiological Results of Calcaneal Lengthening Osteotomy in Pediatric Idiopathic Flexible Flatfoot
Taghi Baghdadi
taghibaghdadi@hotmail.com
1
Hamed Mazoochy
hmazoochy@hotmail.com
2
Mohammad Reza Guiti
m_guity@yahoo.com
3
Nima Heidari khabbaz
nima.heidari@bartshealth.nhs.uk
4
Tehran University of Medical Science, Tehran, Iran
Tehran University of Medical Science, Tehran, Iran
Tehran University of Medical Science, Tehran, Iran
The Royal London Limb Reconstruction Service St Bartholomew’s and Royal London Hospital Barts Health NHS Trust, London, UK
Background: Flexible idiopathic flatfoot is the most common form of flatfoot. First line treatments are parentalreassurance and conservative measures; however, surgical treatment may be needed in some cases. A numberof surgical techniques with varying results have been described in the literature. Here, we present our clinical andradiological outcomes of calcaneal lengthening osteotomy for pediatric idiopathic flexible flatfoot.Methods: Calcaneal lengthening osteotomy was performed in 20 patients, 30 feet, with idiopathic flexible flatfootthat were resistant to conservative treatment between 2007 and 2011. Patients were evaluated according to ACFASuniversal evaluation scoring scale and radiographic indexes. The mean follow up duration was 23.1 ± 9.9 months.Results: The average age was 10.4 ± 0.9 years. Achilles tendon lengthening was performed in 28 feet. ACFAS scoreat the final follow up had improved significantly compared to pre-operative score (37 to 88, P<0.0001). Radiographicparameters also showed significant improvement after surgery ((P<0.0001)). Distal segment displacement and hardwareirritation as postop complications were observed in 2 and 3 cases, respectively, with no long-term clinical impact.Conclusion: Calcaneal lengthening osteotomy is an appropriate and safe operation in symptomatic idiopathicflexible flat foot that is resistant to conservative treatment.Level of evidence: IV
https://abjs.mums.ac.ir/article_10832_59666c3310f8f8e65102cddafa2cc381.pdf
Flat foot
Idiopathic
Pediatric
Radiograph
Surgery
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
412
419
10.22038/abjs.2017.24180.1632
10290
The Outcomes of Pilon Fracture Treatment: Primary Open Reduction and Internal Fixation Versus Two stage Approach
Mohammadreza Minator Sajjadi
arashsajadi55@yahoo.com
1
Adel Ebrahimpour
adel.ebrahimpour@gmail.com
2
Mohamad A. Okhovatpour
okhovatpour@gmail.com
3
Amin Karimi
aminkarimi79@yahoo.com
4
Reza Zandi
reza.zandi.md@gmail.com
5
Amir Sharifzadeh
amirshmd@yahoo.com
6
Taleghani Hospital, Research Development Unit, Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Taleghani hospital, research development unit, Department of orthopaedic surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Taleghani hospital, research development unit, Department of orthopedics surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Taleghani Hospital, Research Development Unit, Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Taleghani hospital, research development unit, Department of orthopedics surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Taleghani Hospital, Research Development Unit, Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Background: Pilon fracture is one of the challenging injuries in orthopedic surgery. Associated soft tissue injury is animportant factor in choosing treatment options. Two major methods of treatment are considered as one-stage openreduction internal fixation (ORIF) and two-stage treatment (primary external fixation and secondary ORIF). The latter ismost accepted in literature. In the current study, we compared the results of these two methods.Methods: In a retrospective study, 41 patients were assigned to two groups containing one-stage primary ORIF (21patients) group, and two-stage group included external fixation and secondary ORIF (20 patients). The rate of infection(superficial or deep infection, osteomyelitis), malunion, nonunion, duration of hospital stay, neurovascular injury, painintensity, and patients’ satisfaction with AOFAS score, were compared between the two groups.Results: There was no significant difference between the two groups in measured variables except hospital staywhich was significantly longer for the two-stage group.Conclusion: Based on our findings, we recommend using one stage ORIF for a patient with Pilon fractures type Cand Tscherne 1, 2 if the patient is planned to be operated on during the first 24 hours after the injury.Level of evidence: II
https://abjs.mums.ac.ir/article_10290_64ee2ea10cd2bcddd528c09337cb0565.pdf
External fixation
Infection
Open reduction internal fixation
Pilon fracture
Two-stage surgery
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2018-09-01
6
5
420
423
10.22038/abjs.2017.25391.1672
10279
An Anteriorly Presenting ‘Wrap Around’ Popliteal Cyst
Daniel Bowen
danbowen@doctors.org.uk
1
James Gill
james.ritchie.gill@gmail.com
2
Pamela Garcia Pulido
garciapulido@doctors.org.uk
3
Joel Thomas Kirk Melton
joel.melton@addenbrookes.nhs.uk
4
Mervyn Cross
mervcros@ozemail.com
5
Department of Trauma and Orthopaedics, Cambridge University Hospital, Addenbrooke’s, Cambridge, United Kingdom
Department of Trauma and Orthopaedics, Cambridge University Hospital, Addenbrooke’s, Cambridge, United Kingdom
Department of Trauma and Orthopaedics, Cambridge University Hospital, Addenbrooke’s, Cambridge, United Kingdom
Department of Trauma and Orthopaedics, Cambridge University Hospital, Addenbrooke’s, Cambridge, United Kingdom
Australian Institute for Musculoskeletal Research, North Sydney Orthopaedic and Sports Medicine Centre, Australia
The article describes a case in which a popliteal cyst was identified presenting as a mass on the anterior aspect of theright tibia. This occurred as a result of polyethylene wear debris from previous total knee arthroplasty. Although alternativediagnoses for an anterior tibial mass are more likely, a popliteal cyst must be considered, particularly if the patient has ahistory of total knee arthroplasty.
https://abjs.mums.ac.ir/article_10279_8b8cf7c191e6a77f68519c91f08cebeb.pdf
Baker’s
Cyst
Popliteal