Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Restoring Nature Through Individualized Anatomic Anterior Cruciate Ligament Reconstruction Surgery289290754410.22038/abjs.2016.7544ENAmir Ata Rahnemai-AzarUniversity of Pittsburgh Medical Center, Pennsylvania, USASoheil SabzevariUniversity of Pittsburgh Medical Center, Pennsylvania, USA0000-0002-3643-7074Sebastián IrarrázavalUniversity of Pittsburgh Medical Center, Pennsylvania, USATom ChaoUniversity of Pittsburgh Medical Center, Pennsylvania, USAFreddie FuUniversity of Pittsburgh Medical Center, Pennsylvania, USAJournal Article20160721Anterior cruciate ligament (ACL) reconstruction surgery has significantly evolved in recent years. This has led to development of new technologies that facilitate the diagnosis of ACL injury and the application of state of the art methods for treatment. In particular, individualized anatomical ACL reconstruction aims to restore native ACL function. Treatment is tailored to each patient based on each individual’s characteristics. Individualized treatment approach continues after reconstruction surgery and during rehabilitation period and return to sporting activities.Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Anatomical Individualized ACL Reconstruction291297754310.22038/abjs.2016.7543ENAmir Ata Rahnemai-AzarDepartment of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USASoheil SabzevariDepartment of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA0000-0002-3643-7074Sebastián IrarrázavalDepartment of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USATom ChaoDepartment of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USAFreddie FuDepartment of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USAJournal Article20160721 <br /><span style="font-size: xx-small;">The anterior cruciate ligament (ACL) is composed of two bundles, which work together to provide both antero-posterior and rotatory stability of the knee. Understanding the anatomy and function of the ACL plays a key role in management of patients with ACL injury. Anatomic ACL reconstruction aims to restore the function of the native ACL. Femoral and tibial tunnels should be placed in their anatomical location accounting for both the native ACL insertion site and bony landmarks. One main component of anatomical individualized ACL reconstruction is customizing the treatment according to each patient’s individual characteristics, considering preoperative and intraoperative evaluation of the native ACL and knee bony anatomy. Anatomical individualized reconstruction surgery should also aim to restore the size of the native ACL insertion as well. Using this concept, while single bundle ACL reconstruction can restore the </span><span style="font-size: xx-small;">function of the ACL in some patients, double bundle reconstruction is indicated in others to achieve optimal outcome. </span><br /> Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001The Effect of Patellofemoral Pain Syndrome on Gait Parameters: A Literature Review298306754110.22038/abjs.2016.7541ENMokhtar ArazpourDepartment of Orthotics and Prosthetics, University of
Social Welfare and Rehabilitation Science, Tehran, Knee
and Sport Medicine Education and Research Center, Milad
Hospital, Tehran, IranFateme BahramianKnee and Sport Medicine Education and Research Center,
Milad Hospital, Tehran, IranAtefe AboutorabiDepartment of Orthotics and Prosthetics, University of
Social Welfare and Rehabilitation Science, Tehran, Knee
and Sport Medicine Education and Research Center, Milad
Hospital, Tehran, IranSeyed Taghi NourbakhshOrthopedic Surgeon, Knee and Sport Medicine Research
and Education Center, Milad Hospital, Tehran, IranArdeshir AlidoustiHormozgan University of Medical Sciences, Knee and
Sport Medicine Research and Education Center, Milad
Hospital, Tehran, IranHamidreza AslaniShahid Beheshti University of Medical Sciences, Knee and
Sport Medicine Education and Research Center, Milad
Hospital, Tehran, Iran0000-0002-3257-8312Journal Article20160609 <br /><strong><span style="font-size: xx-small;">Background: </span></strong><br /><span style="font-size: xx-small; font-family: Arial,Arial;">Patellofemoral pain syndrome (PFPS) is one of the most frequent causes of anterior knee pain in adolescents and adults. This disorder can have a big effect on patients’ ability and quality of life and gait. </span><br /> <br />Methods: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">This review included all articles published during 1990 to 2016. An extensive literature search was performed in databases of Science Direct, Google Scholar, PubMed and ISI Web of Knowledge using OR, AND, NOT between the </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">selected keywords. Finally, 16 articles were selected from final evaluation. </span></span></span></strong><br />Results: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">In PFPS subjects, there was lower gait velocity, decreased cadence, and reduced knee extensor moment in the loading response and terminal stance, delayed peak rear foot eversion during gait and greater hip adduction compared to healthy subjects, while for hip rotation, there was controversy in studies. </span></span></span></strong><br />Conclusion: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Changes in the walking patterns of PFPS subjects may be associated with the strategy used for the reduction of patellofemoral joint reaction force and pain. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Unicompartmental Knee Osteoarthritis (UKOA): Unicompartmental Knee Arthroplasty (UKA) or High Tibial Osteotomy (HTO)?307313581510.22038/abjs.2015.5815ENE. Carlos RODRIGUEZ-MERCHANDepartment of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain0000-0002-6360-0113Journal Article20150510 <br /><strong><span style="font-size: xx-small;">Background: </span></strong><br /><span style="font-size: xx-small; font-family: Arial,Arial;">The aim of this review article is to analyze the results of high tibial osteotomy compared to unicompartmental knee arthroplasty in patients with unicompartmental knee osteoarthritis. </span><br /> <br />Methods: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">The search engine used was PubMed. The keywords were: "high tibial osteotomy versus unicompartmental knee arthroplasty". Twenty-one articles were found on 28 February 2015, but only eighteen were selected and reviewed because they strictly focused on the topic. </span></span></span></strong><br />Results: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">In a meta-analysis the ratio for an excellent outcome was higher in unicompartmental knee arthroplasty than high tibial osteotomy and the risks of revision and complications were lower in the former. A prospective comparative study showed that unicompartmental knee arthroplasty offers better long-term success (77% for unicompartmental knee arthroplasty and 60% for high tibial osteotomy at 7-10 years). However, a review of the literature showed no evidence of superior results of one treatment over the other. A multicenter study stated that unicompartmental knee osteoarthritis without constitutional deformity should be treated with unicompartmental knee arthroplasty while in cases with constitutional deformity high tibial osteotomy should be indicated. A case control study stated that unicompartmental knee arthroplasty offers a viable alternative to high tibial osteotomy if proper patient selection is done. </span></span></span></strong><br />Conclusion: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">The literature is still controversial regarding the best surgical treatment for unicompartmental knee osteoarthritis (high tibial osteotomy or unicompartmental knee arthroplasty). However, unicompartmental knee arthroplasty utilization is increasing, while high tibial osteotomy utilization is decreasing, and a meta-analysis has shown better outcomes and less risk of revision and complications in the former. A systematic review has found that with correct patient selection, both procedures show effective and reliable results. However, prospective randomized studies are needed in order to answer the question of this article. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Predicting the Hamstring Tendon Diameter Using Anthropometric Parameters314317753510.22038/abjs.2016.7535ENMohsen Mardani-KiviGuilan Road Trauma Research Center, Poursina Hospital,
Guilan University of Medical Sciences, Rasht, IranMahmoud Karimi-MobarakehKerman University of medical sciencesOrthopedic Department, Bahonar Hospital, Kerman
University of Medical Sciences, Kerman, Iran0000-0002-1838-698XAhmadreza MirbolookOrthopedic Research Center, Poursina Hospital, Guilan
University of Medical Sciences, Rasht, IranSohrab KeyhaniOrthopedics Department, School of Medicine, Shahid
Beheshti University of Medical Sciences, Tehran, Iran0000-0002-4455-5214Khashayar Saheb-EkhtiariGuilan Road Trauma Research Center, Poursina Hospital,
Guilan University of Medical Sciences, Rasht, IranKeyvan Hashemi-MotlaghGuilan Road Trauma Research Center, Poursina Hospital,
Guilan University of Medical Sciences, Rasht, IranParham PorteghaliOrthopedic Research Center, Poursina Hospital, Guilan
University of Medical Sciences, Rasht, IranJournal Article20151014 <br /> <strong><span style="font-size: xx-small;">Background: </span></strong><br /> <span style="font-size: xx-small; font-family: Arial,Arial;">Despite the importance of hamstring tendon autograft, one major disadvantage in applying this technique in the surgical reconstruction of anterior cruciate ligament is individual variability in the tendon diameter. Hence, the purpose of the present study was to use anthropometric parameters such as gender, height and body mass index to predict 4-strand (quadruple) hamstring tendons (gracilis and 2-strand semitendinosus tendons). </span><br /> <br /> Methods:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">This is a cross-sectional study conducted on all consecutive patients who underwent arthroscopic ACL reconstruction between 2013 and 2015. The anthropometric variables (age, gender, height, and body mass index) were recorded. The quadruple hamstring tendon (gracilis and semitendinosus) autografts were measured using sizing cylinders. The relationship between these parameters was statistically determined using the Pearson Spearman test and linear regression test. </span></span></span></strong><br /> Results:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">The mean age of the 178 patients eligible for the study was 29.58±9.93 (118 males and 60 females). The mean hamstring tendon diameter was 7.8±0.7 mm, the mean for males was 7.9±0.6 and for females 7.89± mm (</span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">=0.0001). </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">There were significant correlations between the mean hamstring tendon diameter with BMI (Pearson correlation=0.375, </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">R</span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">2</span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">=0.380, and </span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">=0.0001), height (Pearson correlation=0.441, R</span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">2</span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">=0.121, and </span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">=0.0001), and weight (Pearson correlation=0.528, R</span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">2</span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">= -0.104 and </span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">=0.0001). However,patient’s age and genderwerenot found to be a predictor of the size of the hamstring tendon diameter. </span></span></span></strong><br /> Conclusion:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Based on findings from this study weight, height, body mass index,and the length of the tendon may be predictors of the hamstring tendon diameter for anterior cruciate ligamentreconstruction. These findings could be used </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">in preoperative planning of patients undergoing ACL reconstruction surgery to estimate the size of the graft and select of the appropriate type of graft. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Proximity of Vital Structures to the Clavicle: Comparison of Fractured and Non-fractured Side318322669810.22038/abjs.2016.6698ENFrans MulderHand and Upper Extremity Service, Department of
Orthopaedic Surgery, Massachusetts General Hospital,
Boston, MA, USAJos MellemaHand and Upper Extremity Service, Department of
Orthopaedic Surgery, Massachusetts General Hospital,
Boston, MA, USADavid RingDepartment of Surgery and Perioperative
Care, Dell Medical School, The University of Texas at Austin, Austin,
Texas, USA; 1400 Barbara Jordan Blvd. Suite 2.834; MC: R1800, Austin,
TX 787230000-0002-6506-4879Journal Article20151030 <br /><strong><span style="font-size: xx-small;">Background: </span></strong><br /><span style="font-size: xx-small; font-family: Arial,Arial;">Previous anatomic and radiological studies have described the relationship of the clavicle to major neurovascular structures in healthy subjects. We were curious about this relationship in patients with a clavicle fracture and if it is different from non-fractured clavicles. </span><br /> <br />Methods: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">We retrospectively identified all patients with a clavicle fracture between July 2001 and October 2013 in two level 1 trauma centers. Patients aged 18 years or greater with an acute unilateral clavicle fracture and a chest CT scan </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">in the supine position displaying both clavicles and the complete fracture were included. Seventy patients were available </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">for study. The distance was measured from the fracture site and from the closest clavicular cortex to the closest major artery, major vein, and inner surface of the thoracic cavity. CT data was evaluated in OsiriX DICOM viewer software with the use of three-dimensional Multiplanar Reconstruction. </span></span></span></strong><br />Results: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Compared to the fractured side, the clavicle was significantly closer to the artery and vein on the non-fractured </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">side (</span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">=0.0025 respectively). There was a significant difference in the median distance of the fracture site </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">to the artery, vein, and inner surface of thoracic cavity between the different types of fractures (</span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;"><0.001). A post-hoc comparison showed significant differences in all distances between fracture types, except for the distance of proximal </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">third compared to middle third fractures to the closest artery (</span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">=0.41). There was no significant difference in distance when the arm is up overhead compared to down by the side of the body in computed tomography (CT) scans. </span></span></span></span></strong><br />Conclusions: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">A fracture of the clavicle changes the relationship of the clavicle to major vital structures. The minimum distance of the clavicle to the closest artery and vein is significantly less on the non-fractured side, compared to the </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">fractured side. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Potential Role of Local Estrogen in Enhancement of Fracture Healing: Preclinical Study in Rabbits323329753610.22038/abjs.2016.7536ENMohammad TahamiBone and Joint Research Centre, Shiraz University of
Medical Sciences, Shiraz, Iran0000-0002-3722-8426Behrooz HaddadUniversity College London Hospital, 235 Euston Road,
London, NW1 2BU UKArmin AbtahianBone and Joint Research Centre, Shiraz University of
Medical Sciences, Shiraz, IranAli HashemiBone and Joint Research Centre, Shiraz University of
Medical Sciences, Shiraz, Iran0000-0001-6978-2854Amir AminianBone and Joint Research Centre, Shiraz University of
Medical Sciences, Shiraz, Iran0000-0002-7765-7444Sujith KonanUniversity College London Hospital, 235 Euston Road,
London, NW1 2BU UKJournal Article20160307 <br /> <br /> <br /><strong><span style="font-size: xx-small;">Background: </span></strong><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Effects of estrogen on bone metabolism and its protective role on prevention of osteoporosis are well </span></span><br /> <br /><span style="font-size: xx-small; font-family: Arial,Arial;">documented. However, the efficacy of estrogen treatment on bone healing is not well investigated. The drug can be delivered both systemically or locally to the bone with differences in concentrations and side effects. The aim of this study was to investigate the effect of local and systemic administration of estrogen on the fracture healing process. </span><br /> <br /> <br /> <br />Methods: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;"><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Standardized tibial fractures with 4 millimeter gaps were created in twenty four </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">adult male Dutch rabbits. </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Fractures were fixed using intramedullary wires and long leg casts. Rabbits were randomly divided into three groups. Group A was treated with twice a week administration of long acting systemic estrogen; group B was treated with a similar regimen given locally at the fracture gap; and group C received sham normal saline injections (control). Fracture healing was assessed at six weeks post fracture by gross examination, radiographic and histomorphometric analysis. </span></span></span></strong></span></span></span></strong><br />Results: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;"><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Group B had significantly higher gross stability, radiographic union and gap reduction than the two other groups. Histomorphometric analysis showed higher </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">cartilaginous proportion of periosteal callus area in the control group. </span></span></span></strong></span></span></span></strong><br />Conclusions: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;"><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Our results showed that </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">estrogen may enhance fracture healing of long bone in rabbits. Furthermore, local estrogen treatment might have better effect than systemic treatment</span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">. </span></span></span></strong></span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Long-term Results, Functional Outcomes and Complications after Open Reduction and Internal Fixation of Neglected and Displaced Greater Tuberosity of Humerus Fractures330336754010.22038/abjs.2016.7540ENMorteza Nakhaei AmroodiBone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, IR IranVahid BehshadBone and Joint Reconstruction Research Center, Shafa
Orthopedic Hospital, Iran University of Medical Sciences,
Tehran, IranPaniz MotaghiIran University of Medical Scirences, Tehran, Iran0000-0003-3000-171XJournal Article20160730 <br /> <strong><span style="font-size: xx-small;">Background: </span></strong><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Humerus fractures include 5% to 8% of total fractures. Non-union and delayed union of GT (GT) fractures </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">is uncommon; however they present a challenge to the orthopedic surgeons. Significant controversy surrounds optimal </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">treatment of neglected fractures. The purpose of this article was to perform a comparative study to evaluate the outcomes </span></span><br /> <span style="font-size: xx-small; font-family: Arial,Arial;">of open reduction and internal fixation (ORIF) of neglected GT fractures. </span><br /> <br /> Methods:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">We retrospectively evaluated the results of surgical intervention in 12 patients with displaced nonunion of GT </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">fractures who were referred to our center. Before and minimally 25 months after surgery ROM, muscle forces, Constant Shoulder Score (Constant-Murley score) (CSS), Visual Analogue Scale (VAS), Activities of Daily Living (ADL) Score and American Shoulder and Elbow Surgeons (ASES) Score were all recorded. Additionally, the results were compared with </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">undamaged shoulder. </span></span></span></strong><br /> Results:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Between March 2006 and January 2013, 12 patients underwent surgical intervention and followed for 36.2 months in average. All fractures healed. Anatomic reduction achieved only in 6 cases with no report of avascular necrosis or infection. All ROMs and muscle forces increased significantly (Mean Forward Flexion: 49.16 to 153.3, Mean Internal Rotation: 3 to 9, Mean External Rotation: -5 to 27.5) (</span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P </span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">value<0.0001). All functional scores including CSS, VAS, ADL and ASES score improved significantly (Mean VAS: 6.5 to 1.3, Mean CSS: 29.83 to 86, Mean ADL: 6.6 to 27.1, Mean ASES: 28.6 to 88.9) (</span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P </span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">value<0.0001). </span></span></span></strong><br /> Conclusion:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">ORIF for neglected and displaced GT fractures has satisfactory functional outcomes, despite of non-</span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">anatomical reduction of the fracture. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Does Computed Tomography Change our Observation and Management of Fracture Non-Unions?337342753410.22038/abjs.2016.7534ENYdo V. KleinlugtenbeltDepartment of Orthopaedic and Trauma Surgery, Joint
Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the
Netherlands.
Division of Orthopaedic Surgery, McMaster University,
Canada.
Department of Orthopaedic and Trauma Surgery,
Deventer ziekenhuis, Deventer, the NetherlandsVanessa A.B. ScholtesDepartment of Orthopaedic and Trauma Surgery, Joint
Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the
NetherlandsJay ToorDivision of Orthopaedic Surgery, McMaster University,
CanadaChristian AmaechiDepartment of Orthopaedic and Trauma Surgery, Joint
Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the
NetherlandsMario MaasDepartment of Radiology, Academic Medical Center,
University of Amsterdam, Amsterdam, the NetherlandsMohit BhandariDivision of Orthopaedic Surgery, McMaster University,
CanadaRudolf W. PoolmanDepartment of Orthopaedic and Trauma Surgery, Joint
Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the
Netherlands0000-0003-3178-2247Peter KloenDepartment of Orthopaedic and Trauma Surgery, Academic
Medical Centre, University of Amsterdam, Amsterdam, the
NetherlandsJournal Article20160418 <br /> <strong><span style="font-size: xx-small;">Background: </span></strong><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">The purpose of this study was to determine whether Multi-Detector Computed Tomography (MDCT) </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">in addition to plain radiographs influences radiologists’ and orthopedic surgeons’ diagnosis and treatment plans for </span></span><br /> <span style="font-size: xx-small; font-family: Arial,Arial;">delayed unions and non-unions. </span><br /> <br /> Methods:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">A retrospective database of 32 non-unions was reviewed by 20 observers. On a scale of 1 to 5, observers rated on X-Ray and a subsequent Multi Detector Helical Computer Tomography (MDCT) scan was performed to determine the following categories: "healed", "bridging callus present", "persistent fracture line" or "surgery advised". Interobserver </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">reliability in each category was calculated using the Interclass Correlation Coefficient (ICC). The influence of the MDCT scan on the raters’ observations was determined in each case by subtracting the two scores of both time points. </span></span></span></strong><br /> Results:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">All four categories show fair interobserver reliability when using plain radiographs. MDCT showed no improvement, the reliability was poor for the categories "bridging callus present" and "persistent fracture line", and fair for "healed" and "surgery advised". In none of the cases, MDCT led to a change of management from nonoperative to operative treatment or vice versa. For 18 out of 32 cases, the treatment plans did not alter. In seven cases MDCT led to operative treatment while on X-ray the treatment plan was undecided. </span></span></span></strong><br /> Conclusion:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">In this study, the interobserver reliability of MDCT scan is not greater than conventional radiographs for determining non-union. However, a MDCT scan did lead to a more invasive approach in equivocal cases. Therefore a MDCT is only recommended for making treatment strategies in those cases. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Inter-observer agreement between 2-dimensional CT versus 3-dimensional I-Space model in the Diagnosis of Occult Scaphoid Fractures343347659810.22038/abjs.2016.6598ENTessa DrijkoningenOrthopaedic Hand and Upper Extremity Service,
Massachusetts General Hospital, Boston, USARobert KnotterEmergency Department, Reinier de Graaf Gasthuis, Delft,
The NetherlandsFrank J. BeeresSurgery Department, Medisch Centrum Haaglanden, Den
Haag, The NetherlandsEmile G. CoerkampRadiology Department, Medisch Centrum Haaglanden,
Den Haag, The NetherlandsAnton H.J. KoningDepartment of Bioinformatics, Erasmus MC University
Medical Center, Rotterdam, NetherlandsSteven J. RhemrevSurgery Department, Medisch Centrum Haaglanden, Den
Haag, The NetherlandsJournal Article20151012 <br /><strong><span style="font-size: xx-small;">Background: </span></strong><br /><span style="font-size: xx-small; font-family: Arial,Arial;">The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space) in diagnosing acute occult scaphoid fractures. </span><br /> <br />Methods: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">A convenient cohort of 24 patients with a CT-scan from prior studies, without a scaphoid fracture on radiograph, yet high clinical suspicion of a fracture, were included in this study. CT-scans were evaluated in the I-Space by 7 observers of which 3 observers assessed the scans in the I-Space twice. The observers in this study assessed in the I-Space whether the patient had a scaphoid fracture. The kappa value was calculated for inter- and intra-observer agreement. </span></span></span></strong><br />Results: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">The Kappa value varied from 0.11 to 0.33 for the first assessment. For the three observers who assessed the </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">CT-scans twice; observer 1 improved from a kappa of 0.33 to 0.50 (95% CI 0.26-0.74, </span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">=0.01), observer 2 from 0.17 to 0.78 (95% CI 0.36-1.0, </span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;"><0.001), and observer 3 from 0.11 to 0.24 (95% CI 0.0-0.77, </span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">=0.24). </span></span></span></strong><br />Conclusion: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Following our findings the I-Space has a fast learning curve and has a potential place in the diagnostic </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">modalities for suspected scaphoid fractures. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001A Slightly Dorsally Tilted Lunate on MRI can be Considered Normal348352613910.22038/abjs.2015.6139ENAnne-Carolin DoringOrthopaedic Hand and Upper Extremity Service, Yawkey
Center, Suite 2100, Massachusetts General Hospital, Boston,
MA, USACeleste L. OverbeekOrthopaedic Hand and Upper Extremity Service, Yawkey
Center, Suite 2100, Massachusetts General Hospital, Boston,
MA, USATeun TeunisOrthopaedic Hand and Upper Extremity Service, Yawkey
Center, Suite 2100, Massachusetts General Hospital, Boston,
MA, USA0000-0001-5660-0695Stéphanie J.E. BeckerOrthopaedic Hand and Upper Extremity Service, Yawkey
Center, Suite 2100, Massachusetts General Hospital, Boston,
MA, USADavid RingChief Orthopaedic Hand Service, Yawkey Center, Suite
2100, Massachusetts General Hospital, Boston, MA, USAJournal Article20140906 <br /><strong><span style="font-size: xx-small;">Background: </span></strong><br /><span style="font-size: xx-small; font-family: Arial,Arial;">Abnormal angulation of the lunate can be an indication of intercarpal pathology. On magnetic resonance images (MRIs) the lunate often looks dorsally angulated, even in healthy wrists. The tilt on individual slices can also be different and might be misinterpreted as pathological, contributing to inaccurate diagnoses and unnecessary surgery. The primary aim of this study was to determine the average radiolunate angle on sagittal wrist MRI images as well as the radiolunate angle in the most radial, central and most ulnar part of the lunate; also the interobserver reliability was determined. </span><br /> <br />Methods: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">140 MRIs from adult, non-pregnant patients presenting to the outpatient hand and upper extremity service between 2010 and 2013 with wrist pain were used for this retrospective study. One author measured the radiolunate and capitolunate angle (i.e., tangential and axial method) in all MRIs. Additionally, two authors measured the same angles independently in 46 MRIs to analyze interobserver reliability. </span></span></span></strong><br />Results: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">The average radiolunate angle was 8.7 degrees dorsal. There were no significant differences in the radiolunate </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">angles between the different parts of the lunate. A very good interrater agreement was measured considering the radiolunate angle and capitolunate angle (tangential and axial method). </span></span></span></strong><br />Conclusions: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Our study showed that the lunate appears slightly dorsally angulated on an MRI of a healthy wrist. Regarding the radiolunate angle, 10 to 15 degrees of dorsal tilt can be considered normal. This study provides reference information of normal anatomy for carpal axial alignment that may facilitate diagnoses of wrist pathology. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Assessment of Decisional Conflict about the Treatment of Trigger Finger, Comparing Patients and Physicians353358631910.22038/abjs.2016.6319ENMichiel G.J.S. HagemanYawkey Center, Massachusetts General Hospital, Boston,
USAAnne Caroline DöringYawkey Center, Massachusetts General Hospital, Boston,
USASilke A. SpitYawkey Center, Massachusetts General Hospital, Boston,
USAThierry G. GuittonYawkey Center, Massachusetts General Hospital, Boston,
USADavid RingChief Orthopaedic Hand
Service, Yawkey Center, Suite 2100, Massachusetts General
Hospital, 55 Fruit Street, Boston, USA0000-0002-6506-4879Science Of Variation GroupYawkey Center, Massachusetts General Hospital, Boston,
USAJournal Article20151121 <br /><strong><span style="font-size: xx-small;">Background: </span></strong><br /><span style="font-size: xx-small; font-family: Arial,Arial;">As an early step in the development of a decision aid for idiopathic trigger finger (TF) we were interested in the level of decisional conflict experienced by patients and hand surgeons. This study tested the null hypothesis that there is no difference in decisional conflict between patients with one or more idiopathic trigger fingers and hand surgeons. Secondary analyses address the differences between patients and surgeons regarding the influence of the DCS-subcategories on the level of decisional conflict, as well as the influence of patient and physician demographics, the level of self-efficacy, and satisfaction with care on decisional conflict. </span><br /> <br />Methods: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">One hundred and five hand surgeon-members of the Science of Variation Group (SOVG) and 84 patients with idiopathic TF completed the survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). </span></span></span></strong><br />Results: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">On average, patients had decisional conflict comparable to physicians, but by specific category patients felt less informed and supported than physicians. The only factors associated with greater decisional conflict was the relationship between the patient and doctor. </span></span></span></strong><br />Conclusions: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">There is a low, but measurable level of decisional conflict among patients and surgeons regarding idiopathic trigger finger. Studies testing the ability of decision aids to reduce decisional conflict and improve patient empowerment and satisfaction with care are merited. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Predictors of Upper-Extremity Physical Function in Older Adults359365671210.22038/abjs.2016.6712ENHugo H. HermanussenOrthopaedic Hand and Upper Extremity Service
Massachusetts General Hospital, Boston, USAMariano E. MenendezOrthopaedic Hand and Upper Extremity Service
Massachusetts General Hospital, Boston, USANeal C. ChenOrthopaedic Hand and Upper Extremity Service
Massachusetts General Hospital, Boston, USA0000-0002-8967-9018David RingMassachusetts General Hospital, Boston, USA0000-0002-6506-4879Ana-Maria VranceanuMassachusetts General Hospital, Behavioral Med Services,
Boston, USA0000-0003-3994-6488Journal Article20160103 <br /><strong><span style="font-size: xx-small;">Background: </span></strong><br /><span style="font-size: xx-small; font-family: Arial,Arial;">Little is known about the influence of habitual participation in physical exercise and diet on upper-extremity physical function in older adults. To assess the relationship of general physical exercise and diet to upper-extremity physical function and pain intensity in older adults. </span><br /> <br />Methods: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">A cohort of 111 patients 50 or older completed a sociodemographic survey, the Rapid Assessment of Physical Activity (RAPA), an 11-point ordinal pain intensity scale, a Mediterranean diet questionnaire, and three Patient- Reported Outcomes Measurement Information System (PROMIS) based questionnaires: Pain Interference to measure inability to engage in activities due to pain, Upper-Extremity Physical Function, and Depression. Multivariable linear regression modeling was used to characterize the association of physical activity, diet, depression, and pain interference to pain intensity and upper-extremity function. </span></span></span></strong><br />Results: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Higher general physical activity was associated with higher PROMIS Upper-Extremity Physical Function and lower pain intensity in bivariate analyses. Adherence to the Mediterranean diet did not correlate with PROMIS Upper-Extremity Physical Function or pain intensity in bivariate analysis. In multivariable analyses factors associated with higher PROMIS Upper-Extremity Physical Function were male sex, non-traumatic diagnosis and PROMIS Pain Interference, with the latter accounting for most of the observed variability (37%). Factors associated with greater pain intensity in multivariable analyses included fewer years of education and higher PROMIS Pain Interference. </span></span></span></strong><br />Conclusions: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">General physical activity and diet do not seem to be as strongly or directly associated with upper-extremity physical function as pain interference. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Surgical Treatment of Tennis Elbow; Minimal Incision Technique366370753910.22038/abjs.2016.7539ENMorteza Nakhaei AmroodiShafa Orthopedic Hospital, Iran University of Medical
Sciences, Tehran, IranAli MahmuudiShafa Orthopedic Hospital, Iran University of Medical
Sciences, Tehran, IranMostafa SalariyehShafa Orthopedic Hospital, Iran University of Medical
Sciences, Tehran, IranArash AmiriShafa Orthopedic Hospital, Iran University of Medical
Sciences, Tehran, IranJournal Article20160515 <br /> <strong><span style="font-size: xx-small;">Background: </span></strong><br /> <span style="font-size: xx-small; font-family: Arial,Arial;">When non-operative treatment of tennis elbow fails; a surgical procedure can be performed to improve the associated symptoms. Different surgical techniques for treatment of lateral epicondylitis are prescribed. The purpose of this study was to evaluate the clinical outcomes of surgical treatment for tennis elbow based on small incision techniques. </span><br /> <br /> Methods:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">This technique was performed on 24 consecutive patients between June 2011 and July 2013. Outcomes were assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE), Nirschl’s staging system and visual analog scale (VAS) for pain and satisfaction criteria. </span></span></span></strong><br /> Results:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">There were 15 female and 9 male patients in the study. The mean duration of symptoms before surgery was 3.7 years. The average duration of follow-up was 34.8 months. The post-operative outcome was good to excellent in most patients. The mean VAS score improved from 7.2 to 3.5 points. The total PRTEE improved from 68.7 to 15.8 points. </span></span></span></strong><br /> Conclusion:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">This procedure provides a low complication rate which is associated with a high rate of patient satisfaction. Therefore, we suggest this option after failed conservative management of tennis elbow. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Assessment of Diagnostic Value of Single View Dynamic Technique in Diagnosis of Developmental Dysplasia of Hip: A Comparison with Static and Dynamic Ultrasond Techniques371375704510.22038/abjs.2016.7045ENSeyed Ali AlamdaranSurgical Oncology Research Center, Faculty of Medicine,
Imam Reza Hospital, Mashhad University of Medical
Sciences, Mashhad, Iran
Department of Radiology, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran0000-0002-5966-2856Sahar KazemiDepartment of Radiology, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, IranAli ParsaOrthopedic Research Center, Mashhad University of Medical
Sciences, Mashhad, Iran0000-0002-7374-0814Mohammad Hallaj MoghadamOrthopedic Research Center, Mashhad University of Medical
Sciences, Mashhad, Iran0000-0002-1259-2299Ali FeyziDepartment of Radiology, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, IranReza MardaniDepartment of Radiology, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, IranJournal Article20150221 <br /> <br /> <br /><strong><span style="font-size: xx-small;">Background: </span></strong><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Developmental dysplasia of hip (DDH) is a common childhood disorder, and ultrasonography examination </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">is routinely used for screening purposes. In this study, we aimed to evaluate a modified combined static and dynamic </span></span><br /> <br /><span style="font-size: xx-small; font-family: Arial,Arial;">ultrasound technique for the detection of DDH and to compare with the results of static and dynamic ultrasound techniques. </span><br /> <br /> <br /> <br />Methods:<br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;"><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">In this cross-sectional study, during 2013- 2015, 300 high-risk infants were evaluated by ultrasound for </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">DDH. Both hips were examined with three techniques: static, dynamic and single view static and dynamic technique. Statistical analysis was performed using SPSS version 11.5. </span></span></span></strong></span></span></span></strong><br />Results:<br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;"><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Patients aged 9 days to 83 weeks. 75% of the patients were 1 to 3 months old. Among 600 hip joints, </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">about 5% were immature in static sonography and almost all of them were unstable in dynamic techniques. 0.3% of morphologically normal hips were unstable in dynamic sonography and 9% of unstable hips had normal morphology. The mean β angle differences in coronal view before and after stress maneuver was 14.43±5.47° in unstable hips. Single view static and dynamic technique revealed that all cases with acetabular dysplasia, instability and dislocation, except two dislocations, were detected by dynamic transverse view. For two cases, Ortolani maneuver showed femoral head reversibility in dislocated hips. Using single view static and dynamic technique was indicative and applicable for </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">detection of more than 99% of cases. </span></span></span></strong></span></span></span></strong><br />Conclusion:<br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;"><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Single view static and dynamic technique not only is a fast and easy technique, but also it is of high </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">diagnostic value in assessment of DDH. </span></span></span></strong></span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Assessment of Coronal Radiographic Parameters of the Spine in the Treatment of Adolescent Idiopathic Scoliosis376380753810.22038/abjs.2016.7538ENMohsen KaramiDepartment of Orthopedic Surgery, Taleghani Hospital,
School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, IranArash MalekiDepartment of Orthopedic Surgery, Mofid Children
Hospital, School of Medicine, Shahid Beheshti University
of Medical Sciences, Tehran, Iran0000-0002-0053-5406Keyan MazdaRobert Debre Hospital, Paris 7 University, Paris, FranceJournal Article20160409 <br /> <strong><span style="font-size: xx-small;">Background: </span></strong><br /> <span style="font-size: xx-small; font-family: Arial,Arial;">To determine the most important preoperative factors that affect postoperative coronal parameters of scoliotic curves. </span><br /> <br /> Methods:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">All Adolescent Idiopathic Scoliosis (AIS) patients included in the study were classified according to Lenke and King Classification. The fusion levels were selected according to the rigidity of the existing curves (correction less than 50%), tilt of T1 and shoulders, sagittal angle of the curves and with considering stable and neutral end vertebra. The radiographic coronal parameters: shoulders tilt angle, iliolumbar angle and coronal balance were measured in all patients before, after, and in the last follow- up visit. </span></span></span></strong><br /> Results:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">One hundred twenty patients after mean of 25 months follow-up (18-40 months) were included in the study. Before operation, abnormal coronal balance (more than 2 cm shift) was noticed in 46 patents (38%) and in the last visit, was noted in 22 patients (18%). Multivariate regression analysis revealed a significant predictive value of the preoperative coronal balance on the last visit coronal balance (P value=0.01). </span></span></span></strong><br /> Conclusion:<br /> <strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Preoperative coronal balance is very important to make a balanced spine after surgery. Other parameters like Lenke classification or main thoracic overcorrection did not affect postoperative coronal decompensation. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Spinopelvic Fixation of Sacroiliac Joint Fractures and Fracture-Dislocations: A Clinical 8 Years Follow-Up Study381386753710.22038/abjs.2016.7537ENMohammad R. SobhanShahid Sadoughi University of Medical Sciences, Shahid
Sadoughi Hospital, Yazd, Iran0000-0002-7940-8222Seyed Mohammad J. AbrishamShahid Sadoughi University of Medical Sciences, Shahid
Sadoughi Hospital, Yazd, Iran0000-0002-7940-8222Mahmood VakiliSchool of Medicine, Shahid Sadoughi University of Medical
Sciences, Yazd, IranSaeed ShirdelYazd University of Medical Sciences, Shahid Sadoughi
Hospital, Yazd, IranJournal Article20160409 <br /><strong><span style="font-size: xx-small;">Background: </span></strong><br /><span style="font-size: xx-small; font-family: Arial,Arial;">Pelvic ring injuries and sacroiliac dislocations have significant impacts on patient’s quality of life. Several techniques have been described for posterior pelvic fixation. The current study has been designed to evaluate the spinopelvic method of fixation for sacroiliac fractures and fracture-dislocations. </span><br /> <br />Methods: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Between January 2006 and December 2014, 14 patients with sacroiliac joint fractures, dislocation and fracture-dislocation were treated by Spinopelvic fixation at Shahid Sadoughi Training Hospital, Yazd, Iran. Patients were seen in follow up, on average, out to 32 months after surgery. Computed tomographic (CT) scans of patients with sacral fractures were reviewed to determine the presence of injuries. A functional assessment of the patients was performed using Majeed’s score. Patient demographics, reduction quality, loss of fixation, outcomes and complications, return to activity, and screw hardware characteristics are described </span></span></span></strong><br />Results: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">The injury was unilateral in 11 (78.5%) patients and bilateral in 3 (21.5%). Associated injuries were present in all patients, including fractures, dislocation and abdominal injuries. Lower limb length discrepancy was less than 10 mm in all patients except two. Displacement, as a measure of quality of reduction was less than 5 mm in 13 patients. The mean Majeed score was 78/100. Wound infection and hardware failure were observed in 3 (21.4%) and 1 (7.1%) cases, respectively. In this study most patients (85%) return to work postoperatively. </span></span></span></strong><br />Conclusion: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">According to the findings, spinopelvic fixation is a safe and effective technique for treatment of sacroiliac injuries. This method can obtain early partial to full weight bearing and possibly reduce the complications. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Psychometric Properties of the Persian Version of the Simple Shoulder Test (SST) Questionnaire387392754510.22038/abjs.2016.7545ENMohammad H. EbrahimzadehOrthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran0000-0003-4417-9877Ehsan VahediOrthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran0000-0002-3999-9072Aslan BaradaranOrthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran0000-0002-5291-4141Ali BirjandinejadOrthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran8690-8076-0001-0000Seyyed-Hadi Seyyed-HoseinianOrthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran0000-0002-5422-7919Farshid BagheriOrthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran0000-0001-8629-1854Amir R. KachooeiOrthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran0000-0001-7795-1830Journal Article20150610 <br /><strong><span style="font-size: xx-small;">Background: </span></strong><br /><span style="font-size: xx-small; font-family: Arial,Arial;">To validate the Persian version of the simple shoulder test in patients with shoulder joint problems. </span><br /> <br />Methods: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Following Beaton`s guideline, translation and back translation was conducted. We reached to a consensus on the Persian version of SST. To test the face validity in a pilot study, the Persian SST was administered to 20 individuals </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">with shoulder joint conditions. We enrolled 148 consecutive patients with shoulder problem to fill the Persian SST, shoulder specific measure including Oxford shoulder score (OSS) and two general measures including DASH and SF-36. To measure the test-retest reliability, 42 patients were randomly asked to fill the Persian-SST for the second time after one week. Cronbach’s alpha coefficient was used to demonstrate internal consistency over the 12 items of Persian-SST. </span></span></span></strong><br />Results: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">ICC for the total questionnaire was 0.61 showing good and acceptable test-retest reliability. ICC for individual items ranged from 0.32 to 0.79. The total Cronbach’s alpha was 0.84 showing good internal consistency over the 12 items of the Persian-SST. Validity testing showed strong correlation between SST and OSS and DASH. The correlation with OSS was positive while with DASH scores was negative. The correlation was also good to strong with all physical and most mental subscales of the SF-36. Correlation coefficient was higher with DASH and OSS in compare to SF-36. </span></span></span></strong><br />Conclusion: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Persian version of SST found to be valid and reliable instrument for shoulder joint pain and function assessment in Iranian population. </span></span></span></strong>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Arthroscopic Bridge Technique for PCL Avulsion: Surgical Technique and Key Points393395754210.22038/abjs.2016.7542ENSeyed Taghi NourbakhshKnee and Sport Medicine Research and Education Center,
Milad Hospital, Tehran, IranFateme BahramianKnee and Sport Medicine Research and Education Center,
Milad Hospital, Tehran, IranZohreh ZafaraniKnee and Sport Medicine Research and Education Center,
Milad Hospital, Tehran, IranArdeshir AlidoustiMedical Student Hormozgan University of Medical
Sciences, Knee and Sport Medicine Research and
Education Center, Milad Hospital, Tehran, IranHamidreza AslaniShahid Beheshti University of Medical Sciences, Knee and
Sport Medicine Education and Research Center, Tehran, Iran0000-0002-3257-8312Journal Article20160615This study redescribes an arthroscopic bridge technique for repair of avulsion of the posterior cruciate ligament. The procedure is performed step-to-step. In this technique we created two bone tunnels in the anterior aspect of the tibia and inferior medial of the tibia tuberosity and then create suture fixation of the fragment using the suture bridge. The arthroscopic bridge technique was used in 3 patients. All were satisfied and returned to activities. This technique is a safe and effective method of repair of PCL avulsion that allows active mobilization with minimal risk of complicationMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Complicated Congenital Dislocation of the Knee: A Case Report396398671110.22038/abjs.2016.6711ENFirooz MadadiShahid Beheshti University of Medical Sciences, Tehran,
IranMohammad A. TahririanIsfahan University of Medical Sciences, Isfahan, Iran0000-0003-2122-1091Mohsen KaramiShahid Beheshti University of Medical Sciences, Tehran,
IranFiroozeh MadadiShahid Beheshti University of Medical Sciences, Tehran,
IranJournal Article20151221 <br /> <span style="font-size: xx-small;">Congenital dislocation of the knee (CDK) is a rare disorder. We report the case of a 7-year-old girl with bilateral knee stiffness, marked anterior bowing of both legs, and inability to walk without aid.</span><br /> Radiologic investigation revealed bilateral knee joint dislocation accompanied by severe anterior bowing of both tibia proximally and posterior bowing of both femur distally, demonstrating a complicated congenital knee dislocation. Two-staged open reduction with proximal tibial osteotomy was performed to align the reduced knee joints. The patient was completely independent in her daily activities after surgical correction.<br /> Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46444420161001Ossified Dorsal Wrist Ganglion Cyst: A Case Report399401630310.22038/abjs.2016.6303ENJuana MedinaOrtopedia y traumatología, Fundación Santa Fe de
Bogotá, Bogotá, D.C., Cundinamarca, Colombia, USA0000-0003-1290-3410Michael RivlinRothman Institute of Orthopedics, Thomas Jefferson
University, Philadelphia, PA, USAJoanna ChanDepartment of Pathology and Laboratory Medicine,
Jefferson University Hospital, Philadelphia, PA, USAPedro BeredjiklianRothman Institute of Orthopedics, Thomas Jefferson
University, Philadelphia, PA, USA0000-0001-7625-6270Journal Article20151020 <br /> <span style="font-size: xx-small;">Ganglion cysts are the most common wrist tumors, and 60 -70% originate dorsally from the scapholunate interval. </span><span style="font-size: xx-small; font-family: Arial,Arial;">Ossification of these lesions is exceedingly rare, with only one such lesion located in the finger reported in the literature. We present a case of an ossified dorsal wrist ganglion in a 68-year-old woman. </span><br />