2024-03-28T21:55:10Z
https://abjs.mums.ac.ir/?_action=export&rf=summon&issue=526
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Greetings from the Editor
Mohammad Hosein
Ebrahimzadeh
It is my great honor announcing the promotion of the Archives of Bone and Joint Surgery (ABJS) to the level of being available on the PubMed Central site. Being precise, one year ago in September 2013, we published the first issue of the ABJS. Diligently thereafter, we published four subsequent issues with the fifth being in front of you. We set this as our first goal to reach visibility on PubMed striving to raise the quality. We greatly hope that the orthopedics science may be exalted by this voluntary contribution. Hereby, I would like to specially thank to Sarah Post Calhoun and Wayne Jack Logue, from NLM/PMC, for their continuous support, giving direction, and cooperation. I am grateful to my colleagues, Dr Amir Reza Kachooei; the Managing Editor, Dr Ali Moradi; the Editorial Manager and Saeideh Erfani; the Administrative Staff for their endeavor and being compassionate in this path. I also would like to thank Dr Farshid Bagheri, Dr Ali Birjandinejad, Dr Farzad Omidi-Kashani and Dr Mohsen Mardani-Kivi; the Deputy Editors whose continuous efforts from early 2013 has brought the journal to appreciation of scientific excellence. My sincere thanks to all Editorial Board members and reviewers, who have contributed towards the excellence of the journal by putting efforts and expending their valuable time to evaluate the submitted manuscripts. I send my special thanks to Iranian Knee Surgery Arthroscopy & Sports Traumatology (ISKAST), Iranian Orthopedic Association (IOA), Iranian Society of Shoulder and Elbow Surgeons, and Deputy of Research at Mashhad University of Medical Sciences for their supports. I would like to thank the prime industry sponsers, Osveh Asia Medical Instrument Co. and Tehran Sutures Co. (Zimmer Distributer in Iran), for their financial support. Again I would like to appreciate all contributing authors particularly my outstanding colleagues who wrote an Editorial for us, Prof. Jupiter from Harvard University, Boston, MA, Prof. Pietro Ruggieri from Rissuli Insitiu, Bleona, Italy, Prof. Javad Parvizi from Rothman Institute at Thomas Jefferson University, Philadelphia, Prof. Mudgal from Harvard University, Boston, MA, and Prof Reinhard Graf from Allgemeines und Orthopädisches LKH Stolzalpe, Austria and Prfo. Hadi Makhmalbaf from Mashhad University of Medical Sciences, Mashhad, Iran (1-6). Iranian literature in orthopedics goes back to the time of Razi (Rhazes), who was the first to design guidelines for diagnosis and treatment of the osteoarticular tuberculosis, diagnosis and managemet of fractures and dislocations (7). We, as Iranian Orthopedic Community, have a long way to run to reach to the level of becoming a global reference in medicine over the 21st century. Finally I wish this journal could build a network of clinical orthopedic scientists, biomedical orthopedic scientists, and orthopedic societies to join and share their ideas, evidences, techniques and results for a better care of orthopedic patients around the world. This collaboration will melt the ice that may have surrounded the human community, to understand more about each others and to help as much as possible. Stated by Prof. Jesse Jupiter in his Editoral for inauguration of ABJS “I am very confident that this Journal will permit others to have a window into the advances being made by Iranian Orthopedic surgeons as well as providing a platform for others to contribute their own knowledge and ideas. In a small way, this Journal will serve to continue efforts to expand our global Orthopedic Surgical community and serve to stimulate our political leaders to do likewise.”(1).
GREETINGS
EDITOR
2014
09
01
126
127
https://abjs.mums.ac.ir/article_3389_36ec108d567e4145e12d86e87c0108ac.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Biopsy in Musculoskeletal Tumors
Mohammad
Gharehdaghi
Diagnosis of bone tumors is based on careful evaluation of clinical, imaging and a pathologic findings. So the biopsy of bone and soft tissue sarcomas is the final step in evaluation and a fundamental step in the diagnosis of the lesion. It should not be performed as a shortcut to diagnosis (1). The biopsy should be performed in order to confirm the diagnosis and differentiate among few diagnoses after careful staged studies. Real and artificial changes in imaging studies will be superimposed after performing biopsy, which may alter the interpretation if done after biopsy is taken (1). The correct management of a sarcoma depends on the accurate diagnosis. Inadequate, inapprppriate, or inaccurate non-representative biopsy leads to poorer outcome in terms of survivorship and limb salvage. An incorrect, unplanned incision and biopsy may unnecessarily contaminate uninvolved compartments which may convert a salvageable limb to amputation. Anatomic approach along with the proper biopsy techniques may lead to success or catastrophe. It is clear that in patients with inappropriate biopsy, the chance of the need to change the treatment to more radical than would originally be expected is significantly higher. Also it is more probable to need to convert curative to palliative treatment and to require adjuvant radiotherapy in patients with inappropriate biopsies. Patients with sarcoma are best served by early referral to a specialized center where staged investigations and biopsy can be performed with minimal morbidity (3). Open biopsy is still considered the gold standard; however, recent studies suggest comparable results with percutaneous core needle biopsy. Our study on 103 consecutive CNB and open biopsy showed comparable results as well. Surgeons need to answer to two questions prior to performing a biopsy: 1- Where is the best part of the lesion to be biopsied? 2- What is the safest route without contaminating other anatomic structures? (4) Carcinomas are homogeneous, and a simple CNB is usually sufficient for diagnosis, but in soft tissue sarcomas, the periphery of the tumor is the growing part and usually represents the authentic underlying malignancy. The center of the tumor may be hemorrhagic or necrotic, thus taking biopsy from this part may distract from the correct diagnosis.Extraosseus part of a bone sarcoma is as representative as bony component of the tumor. Violating the bone and weakening the cortex may predispose it to pathologic fracture, so biopsy of an extraosseus part is sufficient for the diagnosis if present (3). The biopsy tract “open or CNB” is contaminated by tumor cells and should be widely excised if a wide excision or amputation is performed. For this reason, excision of the biopsy incision or needle entrance should be planned along with the definitive tumor excision to prevent complications and the need for altering the treatment strategy (Figure A, B, C). Open incisional biopsy provides sufficient material for microscopic diagnosis as well as immune- histochemical, cytogenetic, or electron microscopic studies. It has some disadvantages such as wound healing problems, infection, tumor cell contamination, and nerve and vessel injuries (1). For open biopsies, the incision should be as small as necessary and longitudinal. Transverse incisions are not advisable. To perform an intraosseus biopsy, the window should be circular or oblong, and as small as needed to prevent a pathologic fracture. Closing this window by PMMA prevents tumor cell contamination. Compressing the PMMA exceeds the chance of metastasis. As a rule, culture what you biopsy and biopsy what you culture. Use of a tourniquet without exsanguinations helps better visualization and meticulous hemostasis which prevents spreading of the tumor cells in hematoma. Importantly, it should be deflated before closing the wound (3). The port of entry of drains, if necessary, must be in line and proximity to the skin incision, because this tract is also contaminated and must be excised with the surgical specimen. Imaging-guided core needle biopsy is a well-established technique for the diagnosis of bone and soft tissue tumors and tumor-like lesions in specialized orthopedic oncology centers. Although large lesions of the limbs can easily be biopsied without image guidance, lesions in the spine, para spinal area, and pelvis are difficult to target, therefore taking the advantage of C.T. guidance will improve the accuracy of targeting the lesion for biopsy purposes. We can benefit from image intensifiers for targeting limb lesions rather than C.T. guidance. Also sonographic guide can be applied for soft tissue lesions (Figure D, E, F). In soft tissue tumors, the results of percutaneous CNB are relatively inferior compared to open biopsy whereas almost equal results are expected for bony tumors except for low-grade chondrosarcoma. CNB is a safe, minimally invasive, and cost effective technique for the diagnosis of bone lesions if done by an experienced orthopedic oncologic surgeon and be evaluated by an experienced anatomical bone pathologist (1, 3). For soft tissue tumors, CNB results depend on the size of the lesion, its location and amount of tumor necrosis. Guided needle biopsy have become the standard technique in most orthopedic oncologic centers. The accuracy of this method in our center is more than 90% for bone tumors. Cores should be taken in different directions including areas of central necrotic tissues but from a single well planned entrance. The procedure is quick, especially for bone CNB or soft tissue FNA and CNB, and the diagnosis can be achieved within 24 – 48 hours. The material should be sufficient for immunohistochemistry evaluations as well (1-3). Because I have seen 3 cases of tumor implantation at the towel clips puncture site including 2 chondrosarcomas and a case of malignant schowanoma, so I highly suggest that never crush the skin by towel clips especially when you do an open incisional biopsy (4). In summery open, needle or core biopsies should be performed by a surgeon who is responsible for definitive surgery of a tumor after complete staged evaluation to minimize the biopsy complications if we expect a successful outcome and longer survival (1-3).
2014
09
01
128
129
https://abjs.mums.ac.ir/article_3390_e74f7f522f47be71b901cfd7b90f277e.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in Total Hip Replacement
Vasileios
Sakellariou
Michael
Christodoulou
Gregory
Sasalos
George
Babis
Developmental dysplasia of the hip (DDH) or congenital hip dysplasia (CDH) is the most prevalent developmental childhood hip disorder. It includes a wide spectrum of hip abnormalities ranging from dysplasia to subluxation and complete dislocation of the hip joint. The natural history of neglected DDH in adults is highly variable. The mean age of onset of symptoms is 34.5 years for dysplastic DDH, 32.5 years for low dislocation, 31.2 years for high dislocation with a false acetabulum, and 46.4 years for high dislocation without a false acetabulum. Thorough understanding of the bony and soft tissue deformities induced by dysplasia is crucial for the success of total hip arthroplasty. It is important to evaluate the existing acetabular deformity three-dimensionally, and customize the correction in accordance with the quantity and location of ace tabular deficiencies. Acetabular reconstruction in patients with DDH is hallenging. Interpretation of published data is difficult and should be done with caution because most series include patients with different types of hip disease. In general, the complication rate associated with THA is higher in patients with hip dysplasia than it is in patients with osteoarthritis. Overall, clinical and functional outcomes following THA in patients hip dysplasia (DDH) differ from those treated for primary hip osteoarthritis, possibly due to the lower age and level of activity. Although function scores decline with age, the scores for pain and range of motion presented with a statistically significant improvement in the long-term.
Acetabulum
Arthroplasty
Congenital
Developmental
Hip
2014
09
01
130
136
https://abjs.mums.ac.ir/article_3353_0acce6731c88d6569725184185d2b6f2.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Medial Unicompartmental Osteoarthritis (MUO) of the Knee: Unicompartmental Knee Replacement (UKR) or Total Knee Replacement (TKR)
E. Carlos
RODRIGUEZ-MERCHAN
The aim of this review article is to analyze the clinical effectiveness of total knee replacement (TKR) compared to unicompartmental knee replacement (UKR) in patients with medial unicompartmental osteoarthritis (MUO) in terms of survival rates, revision rates and postoperative complications. The search engine was MedLine. The keywords used were: medial knee osteoarthritis. Three thousand and ninety-six articles were found on 28 April 2014. Of those, only twenty-eight were selected and reviewed because they were strictly focused on the topic of this article. Compared with those who have TKR, patients who undergo UKR have higher revision rates and lower survival rates at 5, 10 and 15 years. The reported overall risk of postoperative complications for patients undergoing TKR is 11%, compared with 4.3% for patients undergoing UKR. In conclusion, UKR have higher revision rates and lower survival rates than TKR. There is, however, an increased risk of postoperative complications after TKR.
Comparative results
knee
Medial osteoarthritis
TKR
UKR
2014
09
01
137
140
https://abjs.mums.ac.ir/article_3233_3013cb42f77d5a62586227fb8e53b84f.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Intraarticular Administration of Tranexamic Acid Following Total Knee Arthroplasty: A Case-control Study
M.N
Tahmasebi
Kaveh
Bashti
MR
Sobhan
GH
Ghorbani
Background: Tranexamic acid (TXA) has received extensive attention in management of blood loss in orthopedic surgeries. However, the ideal method of TXA administration is still controversial. This study aims to determine whether intraarticular injection of TXA reduces blood loss after total knee arthroplasty (TKA). Methods: Through a retrospective case-control study consecutive TKA patients receiving intraarticular TXA (Case group) were compared with similar patients undergoing TKA using traditional blood management strategy (Control group). Hemoglobin levels (Hb) before and after the surgery, need for transfusion, and reoperation due to massive blood loss were compared between the two groups. Results: Fifty TXA patients were compared with 50 patients of the control group. There was no significant difference between the two groups in terms of age, gender, and preoperative Hb. Postoperative blood loss and transfusion rate were significantly reducedin TXA patients compared to the control group (P<0.05). Conclusions: Our study revealed that intraarticular administration of TXA reduces postoperative blood loss as well as need for blood transfusion in patients undergoing TKA.
Blood loss
hemostasis
Intraarticular Injection
Total knee arthroplasty
Tranexamic acid
Transfusion
2014
09
01
141
145
https://abjs.mums.ac.ir/article_3356_166ec5ac6679a3a1616715f08ace5c4f.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Soluble Mediators in Posttraumatic Wrist and Primary Knee Osteoarthritis
Teun
Teunis
Michiel
Beekhuizen
Gerjo V.M.
Van Osch
Arnold H.
Schuurman
Laura B.
Creemers
L. Paul
van Minnen
Background: New discoveries about the pathophysiology changed the concept that all forms of osteoarthritis are alike; this lead to the delineation of different phenotypes such as age, trauma or obese related forms. We aim to compare soluble mediator profiles in primary knee and posttraumatic wrist osteoarthritis. Based on the general faster progression rate of wrist osteoarthritis, we hypothesize a more inflammatory profile. Methods: We collected synovial fluid from 20 primary osteoarthritic knee and 20 posttraumatic osteoarthritic wrist joints. 17 mediators were measured by multiplex enzyme-linked immunosorbent assay: chemokine ligand 5, interferon-γ, leukemia inhibitory factor, oncostatin-M, osteoprotegerin, tumor necrosis factor-α, vascular endothelial growth factor, interleukin (IL)-1α, IL-1β, IL-1 receptor antagonist, IL-4, IL-6, IL-7, IL-8, IL-10, IL-13 and IL-17. Results: Ten mediators were higher in posttraumatic osteoarthritic synovial fluid: tumor necrosis factor-α (TNFα), IL-1α, IL-1RA, IL-6, IL-10, IL-17, oncostatin-M, interferon-γ, chemokine ligand 5 and leukemia inhibitory factor(P<0.001). IL-1ß, IL-4, IL-7 were not detected, TNFα was not detected in knee osteoarthritic synovial fluid. IL-8, IL-13, osteoprotegerin and vascular endothelial growth factor levels did not differ between the synovial fluid types. Conclusions: In general wrist osteoarthritis seems characterized by a stronger inflammatory response than primary knee osteoarthritis. More pronounced inflammatory mediators might offer a paradigm for the faster progression of posttraumatic osteoarthritis. Increase of specific mediators could form a possible target for future mediator modulating therapy in wrist osteoarthritis.
Cytokines
knee
Osteoarthritis
Posttraumatic
Wrist
2014
09
01
146
150
https://abjs.mums.ac.ir/article_3355_59ba0d275f17ee873e598639eb9927d0.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
In-Hospital Outcomes after Hemiarthroplasty versus Total Hip Arthroplasty for Isolated Femoral Neck Fractures
Timothy
Voskuijl
Valentin
Neuhaus
Ahmet
Kinaci
Mark
Vrahas
David
Ring
Background: Previous studies suggest total hip arthroplasty may have some benefits compared to hemi-arthroplasty for displaced intracapsular femoral neck fractures in patients more than 60 years of age. The primary research question of our study was whether in-hospital adverse events, post-operative length of stay (LOS) and mortality in patients 60 year of age or older differed between total hip and hemi-arthroplasty for femoral neck fracture. Methods: We obtained data on 82951 patients more than 60 years of age with an isolated femoral neck fracture treated with either hemi-arthroplasty or total hip arthroplasty in 2009 or 2010 from the National Hospital Discharge Survey (NHDS) database. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9, CM) was used to code diagnoses, comorbidities, complications, and procedures. Results: Controlling for demographics and comorbidities, patients treated with hemi-arthroplasty had a 40% (95% CI 1.4-1.5) higher risk of adverse events compared to patients treated with a total hip arthroplasty. Length of stay and in-hospital mortality did not differ between these groups. Conclusions: The observed advantage for total hip arthroplasty might reflect greater infirmity in hemi-arthroplasty patients that was not accounted for by ICD-9 codes alone.
complication
femoral neck fracture
Hemiarthroplasty
Inpatient
Length of stay
Mortality
Total hip
arthroplasty
2014
09
01
151
156
https://abjs.mums.ac.ir/article_3354_33375ee2879ae3bb3bb59bac3f101988.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Long Term Outcomes of Total Hip Arthroplasty in Young Patients under 30
Emilios
Pakos
Nikolaos
Paschos
Theodoros
Xenakis
Background: We aimed to report outcomes of total hip arthroplasty (THA) in very young patients under the year of 30. Methods: Thirty patients (45 hips) with various indications for THA were retrospectively reviewed radiologically and clinically and analyzed regarding survival, reasons of failure, factors associated with outcomes and postoperative complications. Results: Within a mean follow-up time of 116 months the 10-year survival rate was 90.3%. All hips were revised due to aseptic loosening. No association was found among the tested parameters with increased revision rates.Three complications associated with the THA were recorded and managed conservatively. All patients had statistically significant improved clinical scores compared to the pre-operative period, despite the underlying disorder that compromised the condition in the majority of the patients. Conclusions: Our study showed excellent long term outcomes of THA in patients younger than 30 years of age, comparable with those in older patients.
Aseptic loosening
Congenital hip disease
Juvenile rheumatoid arthritis
Total hip arthroplasty
Young
patients
2014
09
01
157
162
https://abjs.mums.ac.ir/article_3392_1fc2fd02b40ad15c2de7a1f39e3872b4.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Hemodynamic and Arterial Blood Gas Parameters during Cemented Hip Hemiarthroplasty in Elderly Patients
Mehran
Soleymanha
Abbas
Sedighinejhad
Mohammad
Haghighi
Bahram
Naderi
Ahmadreza
Mirblok
Mohsen
Mardani kivi
Background: Patients undergoing cemented hip hemiarthroplasty may develop bone cement implantation syndrome (BCIS) which is a leading cause of intraoperative complications. The purpose of this study was to evaluate cardiovascular changes during cemented hip hemiarthroplasty in elderly patients. Methods: Cemented hip hemiarthroplasty was performed on 72 patients with femoral neck fracture. All patients were catheterized with a radial artery catheter to assess mean arterial pressure (MAP) and arterial blood gas (ABG) in these time points: just before cementation, just after cementation (0th), 5 min (5th) and 10 min (10th ) after cementation, and at the end of surgery (END). Also, systolic and diastolic blood pressure (SBP & DBP), heart rate and any arrhythmia or cardiac arrest was evaluated. Results: Seventy-two patients (33 females, 39 males; mean age: 66.8±7 years) were evaluated. All parameters changed during cementation with a significant drop in MAP, SBP, and DBP immediately after cementation and pH and base excess decreased significantly (P<0.001) with no changes in O2 saturation. Mean heart rate rose until the 5th and then decreased dramatically with no bradycardia presentation. During cementation, 12 patients showed arrhythmia, but no cardiac-arrest was observed. Conclusions: Under strict observation of a anesthesiology care team, hemiarthroplasty can be a safe method for femoral neck fracture in elderly osteoporotic patients without severe cardiopulmonary compromise.
ABG
Bone cement
Hemiarthroplasty
Hemodynamics
Mean arterial pressure
2014
09
01
163
167
https://abjs.mums.ac.ir/article_3232_7737ec81a350ed8d983198c184c763dc.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Management of Hip Fractures in Lateral Position without a Fracture Table
Hamid
Pahlavanhosseini
Sima
Valizadeh
Seyyed Hossein
Saeed Banadaky
Mohammad Hossein
Akhavan Karbasi
Seyed Mohammad Jallil
Abrisham
Hossein
Fallahzadeh
Background: Hip fracture Management in supine position on a fracture table with biplane fluoroscopic views has some difficulties which leads to prolongation of surgery and increasing x- rays’ dosage. The purpose of this study was to report the results and complications of hip fracture management in lateral position on a conventional operating table with just anteroposterior fluoroscopic view. Methods: 40 hip fractures (31 trochanteric and 9 femoral neck fractures) were operated in lateral position between Feb 2006 and Oct 2012. Age, gender, fracture classification, operation time, intra-operation blood loss, reduction quality, and complications were extracted from patients’ medical records. The mean follow-up time was 30.78±22.73 months (range 4-83). Results: The mean operation time was 76.50 ± 16.88 min (range 50 – 120 min).The mean intra-operative blood loss was 628.75 ± 275.00 ml (range 250-1300ml). Anatomic and acceptable reduction was observed in 95%of cases. The most important complications were malunion (one case in trochanteric group), avascular necrosis of oral head and nonunion (each one case in femoral neck group). Conclusions: It sounds that reduction and fixation of hip fractures in lateral position with fluoroscopy in just anteroposterior view for small rural hospitals may be executable and probably safe.
Fluoroscopy
Fracture table
Hip fracture
Lateral position
Trauma
2014
09
01
168
173
https://abjs.mums.ac.ir/article_3361_1c77cc1d6bbb1d08ad422118a2544d3a.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
How to Treat the Complex Unstable Intertrochanteric Fractures in Elderly Patients? DHS or Arthroplasty
Ebrahim
Hasankhani
Farzad
Omidi-Kashani
Hossein
Hajitaghi
Golnaz
Hasankhani
Background: Due to difficulty in obtaining anatomical reduction, management of the unstable intertrochanteric fractures in elderly osteoporotic patients is challenging. The purpose of this study is to compare the results of hip arthroplasty (total, hemi, or bipolar) with DHS in the elderly patients with unstable intertrochanteric fractures. Methods: We prospectively studied and followed-up 80 old patients with complex unstable intertrochanteric fracture from January 2007 to December 2010. Depending on the time of the patients’ admission, we alternatively treated them by DHS and arthroplasty, and placed them in Groups A and B, respectively. We followed them up radiologically and also clinically by Harris Hip Score for more than 24 months. Statistical analysis was performed using SPSS version 11.5 for Windows. Results: The mean length of follow-up and age were 34.3±4.1 months (ranged; 24-59) and the 75.2±5.2 years (ranged; 58-96), respectively. Comparing Group A with B, demographic data, mean blood loss, duration of operation, time to walking and duration of hospital stay had no significant difference but overall device related complications were significantly higher in Group A. Functional scores were also higher in Group B, but this difference was not significant statistically. In both groups, the patients with Type A3 compared with Type A2, had more duration of surgery and blood loss. Conclusions: Arthroplasty is an alternative treatment in elderly patients with unstable intertrochanteric fractures and can provide good and satisfactory clinical outcomes associated with low complication and mortality rates.
Arthroplasty
Dynamic hip screw
intertrochanteric fracture
Unstable fracture
2014
09
01
174
179
https://abjs.mums.ac.ir/article_3359_f29301fef9513c348d830c03ea8c567e.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ) Implant Arthroplasty
Amir Reza
Kachooei
Samantha M
Chase
Jesse
Jupiter
Background: Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ) such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna. The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker) prosthesis. Methods: We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months). Also, patients were contacted prospectively by phone in order to minister the disabilities of the armshoulder and hand (DASH), patient rated wrist evaluation (PRWE), and visual analogue scale (VAS), and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median followup time of 60 months (range: 2 to 102 months). Results: No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively. Conclusions: Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation.
Aptis
Arthroplasty
Distal radioulnar joint
Scheker
2014
09
01
180
184
https://abjs.mums.ac.ir/article_3393_7e1fd5d271d5a30f8e8b1e807154d877.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Progression of Carpal Tunnel Syndrome According to Electrodiagnostic Testing in Nonoperatively Treated Patients
Mark
van Suchtelen
Stephanie
Becker
Jillian
Gruber
David
Ring
Background: This study tested the null hypothesis that nonoperatively treated patients would not show disease progression of carpal tunnel syndrome (CTS) over time according to median nerve distal motor latency (DML) on two electrodiagnostic tests. Methods: This retrospective study analyzed sixty-two adult nonoperatively treated patients who were diagnosed with CTS confirmed by a minimum of two electrodiagnostic tests at our institution between December 2006 and tober 2012. A Wilcoxon signed-rank test was conducted to test the difference between electrodiagnostic measurements between the first and last test. Results: The mean time between the first and last electrodiagnostic test was 26±12 months (range, 12 to 55 months). The only electrodiagnostic measurement that increased significantly was the difference between median and ulnar DML on the same side (r=0.19, P =0.038). The time between the electrodiagnostic tests was significantly longer for patients with at least 10% worsening of the DML at the second test compared to cases of which the DML did not worsen or improve a minimum of 10% (P =0.015). Conclusions: There is evidence that—on average—idiopathic median neuropathy at the carpal tunnel slowly progresses over time, and this can be measured with electrodiagnostics, but studies with a much longer interval between lectrodiagnostic tests may be needed to determine if it always progresses.
Carpal tunnel syndrome
Electrodiagnostic test
Nonoperative treatment
Progression
Upper extremity
2014
09
01
185
191
https://abjs.mums.ac.ir/article_3231_9e80599cb43f2f58185e926cb1dda524.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Predictors of Missed Research Appointments in a Randomized Placebo-Controlled Trial
Stéphanie J.E.
Becker
Thierry
Guitton
David
Ring
Background: The primary aim of this study was to determine predictors of missed research appointments in a prospective andomized placebo injection-controlled trial with evaluations 1 to 3 and 5 to 8 months after enrollment. Methods: This study represents a secondary use of data from 104 patients that were enrolled in a prospective randomized ontrolled trial of dexamethasone versus lidocaine (placebo) injection for various diagnoses. Patients were enrolled between June 2003 and February 2008. Sixty-three patients (61%) had lateral epicondylosis, 17 patients (16%) had trapeziometacarpal arthrosis, and 24 patients (23%) had de Quervain syndrome. Each patient completed a set of questionnaires at time of enrollment. Bivariable and multivariable analyses were used to determine factors associated with missed research appointments. Results: Fourteen patients (13%) did not return for the first follow-up and 33 patients (32%) did not return for the second follow-up. The best multivariable logistic regression model for missing the first research visit explained 35% of the variability and included younger age, belief that health can be controlled, and no college education. The best model for missing the second research visit explained 17% of the variability and included greater pain intensity, less personal responsibility for health, and diagnosis (trapeziometacarpal arthrosis and de Quervain syndrome). Conclusions: Younger patients with no college education, who believe their health can be controlled, are more likely to miss a research appointment when enrolled in a randomized placebo injection-controlled trial.
De Quervain syndrome
Lateral epicondylosis
Loss to follow-up
Missed research appointments
Randomized placebo-controlled trial
Trapeziometacarpal arthrosis
2014
09
01
192
198
https://abjs.mums.ac.ir/article_3230_92bca7523b45f3f533bc5590d4f84a3b.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Current Rates of Publication for Podium and Poster Presentations at the American Society for Surgery of the Hand Annual Meetings
Joshua M.
Abzug
Meredith
Osterman
Michael
Rivlin
Ebrahim
Paryavi
A. Lee
Osterman
Background: Research projects are presented at the Annual Meetings of the American Society for Surgery of the Hand (ASSH). It is unknown how many achieve publication in peer-reviewed journals. We sought to determine current rates of publication of podium and poster presentations. Methods: All ASSH podium and poster presentations from 2000 to 2005 were reviewed, and an Internet-based search using PubMed and Google was conducted to determine whether the presented studies had been published. Times to publication and journal names were recorded. Data were analyzed with descriptive statistics. Fisher’s exact test was conducted to compare current trends with previous trends. Results: Of 1127 podium and poster presentations reviewed, 46% were published in peer-reviewed journals. Forty-seven percent of published presentations (242 presentations) were in Journal of Hand Surgery , and 11% (59 entations) were in Journal of Bone and Joint Surgery . Forty-five percent of presentations were published within 2 years and 66% within 3 years. The publication rate for podium presentations was significantly higher than that previously reported for Journal of Hand Surgery, at 54% compared with 44% (P=0.004). Conclusions: Currently, fewer than half of the studies presented at Annual Meetings of the ASSH achieve publication in peer-eviewed journals. Presentations are most likely to be published within 3 years, and almost half are published in Journal of Hand Surgery .
American Society for Surgery of the Hand
Peer-reviewed journals
Podium presentation
Poster
presentation
Publication rate
2014
09
01
199
202
https://abjs.mums.ac.ir/article_3237_8c399e9d77d6dca2b8ed04efa6a23c28.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Anterior Ankle Arthrodesis with Molded Plate: Technique and Outcomes
Mohammad
Gharehdaghi
Hasan
Rahimi
Alireza
Mousavian
Background: There is still controversy regarding the best technique for ankle arthrodesis to acheive stable rigid fixation along with reconstructing a functional plantigrade foot. Moreover, existing techniques have complictions related to stability, soft tissue covering, fusion rate, and exposure. Methods: With the anterior approach exactly on the tibialis anterior sheath, the joint was exposed and previous hardware, if any, was removed and with the safe direct approach, the ankle, hindfoot, and indirectly the subtalar joints were accessed. Then fresh cancellous bone was obtained and complete denudation was preformed. Lastly, a narrow 4.5 millimeter plate was carefully placed on what was determined to be the best final position.In this prospective study, 12 patients with severe ankle pain and arthritis enrolled from February 2010 to January 2012. Eight of them had posttraumatic arthritis and deformity with hardware, two had rheumatoid arthritis, one had poliomyelitis with severe deformity of the foot and knee, and another had chronic ulcerative ynovitis of the ankle joint. The patients were assessed clinically and radiographically for an average of two years (range: 13 months to 4 years) for functional recovery, range of motion, stability of the ankle, and imaging evidence of union. Results: Ankle deformities and pain in all 12 cases were corrected. With a short healing time and rapid recovery period, after six weeks all of the patients could walk independently. Also, scores of the Manchester–Oxford Foot Questionnaire (MOXFQ) improved significantly from 69 preoperatively to 33 postoperatively). Conclusions: Anterior ankle arthrodesis with molded plating can be an easy and safe way to manage deformities and it has excellent fusion rate and sufficient rigid fixation.
Ankle
Arthrodesis
Plating
2014
09
01
203
209
https://abjs.mums.ac.ir/article_3236_0f389d4aa359914c2de74b465171810e.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
The Comparison of Results of Treatment of Midshaft Clavicle Fracture between Operative Treatment with Plate and Non-Operative Treatment
Mohsen
Khorami
Hamid Reza
Arti
Mohammad
Fakour
Hossein
Mokarrami
Abdolhossein
Mahdi Nasab
Farid
Shahrivar
Background: Clavicle fractures are common and usually heal without complications. In this study, we evaluated the outcomes of non-operative versus operative management of displaced fractures. Methods: In a prospective clinical trial study, sixty-five patients with displaced clavicle mid-shaft fractures were nonrandomly divided in two treatment groups. The first group underwent non-operative treatment with figure of 8 bandage (30 patients), and the other underwent operative treatment with plate fixation (35 patients). Figure of 8 bandage and 3.5 millimeter DCP plate with at least six cortical screws were used in non-operative and operative groups respectively. We followed up all patients at weeks 2, 6 and 12, and at month sixth. In addition to clinical examination and x-ray evaluation, we assessed satisfaction, DASH and Constant Shoulder Score for each individual. Results: The average durations of union were 19.3 and 24.4 weeks in operative and non-operative groups respectively (P=0.006). Satisfaction with operative treatment was 74.3% and with non-operative treatment was 66.7%, showing no significant difference (P=0.500). The non-union rate was 5.7% in the operative group and 13.3% in the non-operative group (P=0.518). A significant difference between the two groups in terms of DASH and Constant Shoulder Scores after the six-month follow-up was not found (P=0.352). Conclusions: According to our results, we recommend operative treatment in mid-shaft clavicle fractures only when there is a definitive indication.
Clavicle
Constant Shoulder Score
DASH score
Internal Fixation
Non-operative management
2014
09
01
210
214
https://abjs.mums.ac.ir/article_3351_72ead05a83a288552accc99de031ce10.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
A Comparison of Glenohumeral Internal and External Range of Motion and Rotation Strength in Healthy and Individuals with Recurrent Anterior Instability
Amirreza
Sadeghifar
Shahab
Ilka
Hasan
Dashtbani
Mansour
Sahebozamani
Background: The glenohumeral joint becomes dislocated more than any other major joint because it maintains a wide range of motion and its stability is inherently weak. The most common complication following acute initial shoulder dislocation is recurrent dislocation or chronic instability. Imbalance of strength and range of motion in individuals with anterior dislocation can be a contributing factor in recurrent dislocation as well. Methods: This case-control study consisted of 24 individuals with a mean age of 24.29±4.33 years, and a mean dislocation rate of 5.37±3.62 times. Isometric cuff strength was measured using a handheld dynamometer and for range of motion, the Leighton flexometer was used in internal and external rotational motions of both upper extremities. Independent t-test was used for data analysis. Results: The internal and external range of motion of the injured glenohumeral joint was lower than the uninjured joint (P<0.001). Similarly, the internal and external rotation strength of the injured joint was lower than the uninjured joint (P<0.001). Conclusions: According to previous data, imbalance of strength and range of motion in individuals with anterior shoulder dislocation can be a contributing factor in long-term disability and increased recurrent dislocation and our finding confirm decreased range of motion and strength in our patients. Hence, proper exercise and rehabilitation plans need to be developed for those suffering from this complication.
Anterior shoulder instability
Glenohumeral joint
Range of motion
Strength
2014
09
01
215
219
https://abjs.mums.ac.ir/article_3352_ab2889796c7d210b4d4432a739c605f2.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Clinical Outcomes after Arthroscopic Release for Recalcitrant Frozen Shoulder
Mohammad Hosein
Ebrahimzadeh
Ali
Moradi
Mostafa
Khalili Pour
Mohammad
Hallaj-Moghaddam
Amir Reza
Kachooei
Background: To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Methods: Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant, University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient. Results: The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion. Conclusions: According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid-term outcomes
Frozen shoulders
arthroscopic release
recalcitrant
Outcome
2014
09
01
220
224
https://abjs.mums.ac.ir/article_3360_54a1aefd2065561cd24e19b731be5d2f.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Epidemiology of Hand Injuries in Children Presenting to an Orthopedic Trauma Center in Southeast of Iran
Maryam
Mirzaie
Ali
Parsa
Maryam
Salehi
Mohammad
Hallaj Moghadam
Mostafa
Dahmardehei
Neda
Mirzaie
Background: Hand injuries are among the most common childhood injuries. No study has been performed regarding the epidemiology of hand injuries in the pediatric population of Iran. This study aimed to examine the epidemiology of hand injuries among children in southeast of Iran. Methods: This cross-sectional study was performed via census sampling on patients, aged 16 years or less, with a final diagnosis of hand injury. Patients presenting to the orthopedic department of Khatam-al-Anbia General Hospitalof Zahedan, Iran, were selected from March 2012 to December 2013. Data were analyzed trospectively, using a chart review. Results: Two-hundred patients (136 males and 64 females with the mean age of 13±2.8 years) with 205 hand injuries were included in this study. As the results indicated, door-related injuries were the most common type (25%), accounting for 24% and 28% of injuries in male and female patients, respectively (P=0.016). Most injuries occurred at home (64%) and the lowest number was reported at school(22%) (P=0.012). Compared to boys, girls were more likely to be injured at home (78% vs. 57%) (P=0.13). In addition, the dominant hand was mostly injured by doors (28%). The most common type of injury was laceration(81%) and the least common type was finger amputation (7%); also, children with finger amputation were significantly younger than those with other types of hand injuries (P<0.001).Thumb alone (20%) and index and middle fingers together with anequal percentage (3.5%) were the most commonly injured digits. Also, the mean hospitalization cost was 297± 38 dollars. Conclusions: Most hand injuries occurred at home and were door-related; they were also more frequentamong younger children. Prospective studies in order to identify specific protective door devices could potentially decrease the frequency of these injures.
Childhood
Epidemiology
Hand injury
2014
09
01
225
231
https://abjs.mums.ac.ir/article_3394_2372f8e305e21f5e36aef8b37c5cc791.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Intra-articular Ganglion Cyst of the Long Head of the Biceps Tendon Originating from the Intertubercular Groove
hossein
saremi
Alireza
Yavarikia
Ali
karbalaikhani
Ganglion cysts commonly occur around the shoulder, mostly in the spinoglenoid and suprascapular notches. We report a very rare case of intra articular Ganglion cyst of the long head of the biceps tendon that originated from the bicipital groove as a rare cause of shoulder pain.
Ganglion cyst
Intraarticular
Long head of biceps tendon
shoulder
2014
09
01
232
233
https://abjs.mums.ac.ir/article_3234_bac46946967a5b35e88b4b063c97cf9a.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Osteoid Osteoma in the Neck of the Scapula; A Misleading Case
Alireza
Rouhani
Saeid
Mohajerzadeh
Marouf
Ansari
Osteoid osteoma is a benign bone tumor that when located on the base of the coracoids process of the scapula is very rare and diagnosis and treatment is often delayed because of its rarity. Almost any bone can be involved, but half of cases involve the femur or tibia. The radiologic features of osteoid osteoma are well known, but these tumors may present with unusual features and be easily misdiagnosed. In this report, we present a case of osteoid osteoma of the neck of the left scapula that took almost 27 months to be diagnosed accurately.
Misleading
Osteoid Osteoma
Scapula
2014
09
01
234
237
https://abjs.mums.ac.ir/article_3235_4cd98e8ff5aaeaacdebee0d31229fb3b.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Bilateral Intraosseous Tumor of the Calcaneus with Imaging-Pathologic Discordance A Case Report and Literatures Review
Mohammad
Hassani
Mohammad
Gharehdaghi
Alireza
Khooei
Elaheh
Ghodsi
Hedieh
Nazarzadeh
A case of bilateral intraosseous tumor of the calcaneus with different MRI imaging is presented. On the left, radiological findings suggest intraosseous lipoma, but on the right-sided lesion, imaging studies were not convincing. The microscopic report showed foreign body granulomatous reaction, a rare clinical pathological discordant.
Bone tumor
calcaneus
Intraosseous lipoma
2014
09
01
238
242
https://abjs.mums.ac.ir/article_3362_d5098f0896cbc29fabbeb1f6910d2caa.pdf
The Archives of Bone and Joint Surgery
ABJS
2345-4644
2345-4644
2014
2
3
Multiple Rib Exostoses in a Boy: A Rare CaseResulting in Surgery Secondary to Cosmetic Concerns
Seyed Hosein
Fattahi Masoum
Ali
Moradi
Mohammad Hosein
Ebrahimzadeh
A seven year-old boy with several painless masses on the ribs and shoulder was referred to our hospital. The masses were so prominent that they prevented the child’s sleep. Since the patient had been ridiculed by his friends due to the rib prominences, he had refused to attend school. After clinical and radiological evaluations, the masses were diagnosed as hereditary multiple exostoses of the shoulder and ribs. He underwent surgery for cosmetic reasons resulting in the patient’s return to a normal life.
Hereditary Multiple Exostosis (HME)
osteochondroma
Rib exostosis
Rib tumors
2014
09
01
243
245
https://abjs.mums.ac.ir/article_3357_7bd1a919be1325ef8508effc75ad0b51.pdf