Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101Crash in Publication Ethics in 2016 in a Glance: Avoid Paper Retraction11817110.22038/abjs.2017.8171ENMohammad H. EbrahimzadehOrthopedic
Research Center, Mashhad University of Medical Sciences,
Mashhad, Iran0000-0000-0000-0000Amir Reza KachooeiOrthopedic
Research Center, Mashhad University of Medical Sciences,
Mashhad, IranJournal Article20161129 <br /><span style="font-size: small; font-family: Cambria,Cambria;"><span style="font-size: small; font-family: Cambria,Cambria;"><span style="font-family: Verdana;">O</span>n November 1</span></span><sup><span style="font-size: xx-small; font-family: Cambria,Cambria;"><span style="font-size: xx-small; font-family: Cambria,Cambria;">st </span></span></sup><br /> <sup><span style="font-size: small; font-family: Cambria,Cambria;">2016, Springer Nature announced that Springer and BioMed Central are retracting 58 articles published by Iran-based authors across seven journals. The decision was made after thorough investigation following receiving allegations of plagiarism, peer review, and authorship manipulation in an effort to mislead the review system (1, 2). Not all papers were involved with all of the above issues, but each showed the evidence of at least one of these issues. At this time, we are not able to comment on the involvement of each individual author, but this has already added a black sheath to his or her records....</span></sup>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101How do Orthopedic Surgeons Address Psychological Aspects of Illness?29791610.22038/abjs.2016.7916ENAna-Maria VranceanuDepartment of Psychiatry, Behavioral Medicine Service,
Massachusetts General Hospital, Harvard Medical School,
Boston, USA0000-0003-3994-6488Reinier B. BeksDepartment of Orthopaedic Surgery, Hand and Upper
Extremity Service, Massachusetts General Hospital, Harvard
Medical School, USAThierry G. GuittonDepartment of Orthopaedic Surgery, Academic Medical
Center, University of Amsterdam, Amsterdam, the
NetherlandsStein J. JanssenDepartment of Orthopaedic Surgery, Hand and Upper
Extremity Service, Massachusetts General Hospital, Harvard
Medical School, USA0000-0003-3939-7765David RingDepartment of Orthopaedic Surgery, Hand and Upper
Extremity Service, Massachusetts General Hospital, Harvard
Medical School, USA0000-0002-6506-4879Journal Article20160124 <br /> <strong><span style="font-size: xx-small;">Background: </span></strong><br /> <span style="font-size: xx-small; font-family: Arial,Arial;">Orthopaedic surgeons have a pivotal role in transitioning the care of orthopedic patients from a biomedical to a biopsychosocial model. In an effort to foster this transition, we designed a study aimed to determine surgeons’ attitudes and practice of noticing, screening, discussing psychological illness with patients, as well as making referrals to address psychosocial issues in patients in need. Additionally, we asked surgeons to rank order potential barriers to and reasons for referrals to psychosocial treatment. </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;">Orthopaedic surgeons members of the Science and Variation Group and Ankle Platform (N =350) completed demographics, and a 4-part survey assessing the degree to which surgeons notice, assess, screen and refer for psychological treatments, as well ranked ordered barriers to engaging in these processes. </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;">As a group surgeons were neutral to referral for psychological treatment and formal screening of psychological factors, and somewhat likely to notice and discuss psychological factors. Surgeons were more likely to refer for psychological treatment if they engaged in research, or if they reside in South America as opposed to North America. The highest ranked barriers to screening, noticing, discussing and referring for psychological treatment were lack of time, stigma and feeling uncomfortable. </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;">Overall surgeons are likely to notice and discuss psychological factors, but less likely to formally screen or refer for psychological treatment. Transition to biopsychosocial models should focus on problem solving these barriers by teaching surgeons communication skills to increase comfort with discussing psychoemotional factors associated </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">with orthopedic problems. The use of empathic communication can be very helpful in normalizing the difficulty of coping </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">with an orthopedic condition, and may facilitate referral. </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 Surgery2345-46445120170101Qualitative Evaluation of Digital Hand X-rays is Not a Reliable Method to Assess Bone Mineral Density1013786810.22038/abjs.2016.7868ENAndrewJ. MillerDepartment of Orthopaedics, Thomas Jefferson University
Hospital, Philadelphia, USAChristopher JonesDepartment of Orthopaedics, Thomas Jefferson University
Hospital, Philadelphia, USA0000-0003-1478-488xFrederick LissDepartment of Orthopaedics, Thomas Jefferson University
Hospital, Philadelphia, USAJack AbboudiDepartment of Orthopaedics, Thomas Jefferson University
Hospital, Philadelphia, USAWilliam KirkpatrickDepartment of Orthopaedics, Thomas Jefferson University
Hospital, Philadelphia, USAPedro BeredjiklianDepartment of Orthopaedics, Thomas Jefferson University
Hospital, Philadelphia, USA0000-0001-7625-6270Journal Article20160511<strong>Object:</strong> The gold standard for evaluating bone mineral density is dual energy x-ray absorptiometry (DEXA). Prior studies have shown poor reliability using analog wrist X-rays in diagnosing osteoporosis. Our goal was to investigate if there was improved diagnostic value to visual assessment of digital hand X-rays in osteoporosis screening. We hypothesized that similar to analog counterparts, digital hand X-rays have poor correlation and reliability in determining bone mineral density (BMD) relative to DEXA.<br /><strong>Methods: </strong>We prospectively evaluated female patients older than 65 years who presented to our hand clinic with digital hand and wrist X-rays as part of their evaluation over six months. Patients who had a fracture and were without DEXA scans within the past two years were excluded. Five fellowship-trained hand surgeons, blinded to DEXA T-scores, evaluated the x-rays over two assessments separated by four weeks and classified them as osteoporotic, osteopenic, or normal BMD. Accuracy relative to DEXA T-score, interobserver and intraobserver rates were calculated.<br /><strong>Results: </strong>Thirty four patients met the inclusion criteria and a total of 340 x-rays reviews were performed. The assessments were correct in 169 cases (49%) as compared to the DEXA T-scores. A mean weighted kappa coefficient of agreement between observers was 0.29 (range 0.02-0.41) reflecting a fair agreement. The first and second assessment for all five physicians was 0.46 (range 0.19-0.78) reflecting a moderate agreement. Grouping osteoporosis and osteopenia together compared to normal, the accuracy, interobserver and intraobserver rates increased to 63%, 0.42 and 0.54 respectively.<br /><strong>Conclusion</strong>: Abnormally low BMD is a common occurrence in patients treated for upper extremity disorders. There is poor accuracy relative to DEXA scan and only fair agreement in diagnosing osteoporosis using visual assessments of digital x-rays. Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101Preliminary Results of a Consecutive Series of Large & Massive Rotator Cuff Tears Treated with Arthroscopic Rotator Cuff Repairs Augmented with Extracellular Matrix1421793210.22038/abjs.2016.7932ENPaolo ConsigliereRowley Bristow Orthopaedic Unit, Ashford and St Peter’s
Hospitals NHS FT, Chertsey, Surrey, UK0000-0003-4282-1539Ioannis PolyzoisRowley Bristow Orthopaedic Unit, Ashford and St Peter’s
Hospitals NHS FT, Chertsey, Surrey, UKTanaya SarkhelRowley Bristow Orthopaedic Unit, Ashford and St Peter’s
Hospitals NHS FT, Chertsey, Surrey, UKRohit GuptaRowley Bristow Orthopaedic Unit, Ashford and St Peter’s
Hospitals NHS FT, Chertsey, Surrey, UKOfer LevyThe Reading Shoulder Unit, Royal Berkshire NHS
Foundation Trust, Berkshire, UKA Ali NarvaniRowley Bristow Orthopaedic Unit, Ashford and St Peter’s
Hospitals NHS FT, Chertsey, Surrey, UK0000-0001-9000-4504Journal Article20160618 <br /><strong><span style="font-size: xx-small;">Background: </span></strong><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Recurrence rate of rotator cuff tears is still high despite the improvements of surgical techniques, materials used and a better knowledge of the healing process of the rotator cuff tendons. Large to massive rotator cuff tears are particularly associated with a high failure rate, especially in elderly. </span></span><br />Augmentation of rotator cuff repairs with extracellular matrix or synthetic patches has gained popularity in recent years with the aim of reducing failure.The aim of this study was to investigate the outcome of rotator cuff repairs augmented with denatured extracellular matrix in a series of patients who underwent arthroscopic rotator cuff repair for large to massive tears.<br /><span style="font-size: xx-small;"><strong>Methods: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Ten consecutive patients, undergoing arthroscopic rotator cuff repair with extracellular matrix augment for large and massive tears, were prospectively enrolled into this single surgeon study. All repairs were performed arthroscopically with a double row technique augmented with extracellular matrix. </span></span><br />Oxford Shoulder Score, Constant Score and pain visual analogue scale (VAS) were used to monitor the shoulder function and outcome pre-operatively and at three, six and 12-month follow-up. Minimum follow up was tree months. Mean follow up was 7 months.<br /><span style="font-size: xx-small;"><strong>Results: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Mean Constant score improved from 53 (SD=4) pre-operatively to 75 (SD=11) at final follow up. Mean Oxford score also increased from 30 (SD=8) pre-operatively to 47 (SD=10) at the final follow up. The visual analogue scale (VAS) improved from seven out of 10 (SD=2) preoperatively to 0.6 (SD=0.8) at final follow up. Additionally, there was significant improvement at three months mark in Constant score. </span></span><br /><span style="font-size: xx-small;"><strong>Conclusion: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Arthroscopic repair and augmentation of large and massive rotator cuff tears with extracellular matrix patch has good early outcome. </span></span>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101Relationship between Bone Mineral Density and Serum Vitamin D with Low Energy Hip and Distal Radius Fractures: A Case-Control Study2227793610.22038/abjs.2016.7936ENMohammad Ali TahririanDepartment of Orthopedics, Kashani Hospital, Isfahan
University of Medical Sciences, Isfahan, Iran0000-0003-2122-1091Mehdi MotififardDepartment of Orthopedics, Kashani Hospital, Isfahan
University of Medical Sciences, Isfahan, IranAli OmidianDepartment of Orthopedics, Kashani Hospital, Isfahan
University of Medical Sciences, Isfahan, IranHossein Akbari AghdamDepartment of Orthopedics, Kashani Hospital, Isfahan
University of Medical Sciences, Isfahan, Iran0000-0001-6983-4458Amir EsmaealiDepartment of Orthopedics, Kashani Hospital, Isfahan
University of Medical Sciences, Isfahan, IranJournal Article20160308 <br /> <strong><span style="font-size: xx-small;">Background: </span></strong><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The main purpose of this study was to determine the relationship between serum vitamin D and the status of bone mineral density in patients with low-energy hip and distal radius fracture. </span></span><br /> <span style="font-size: xx-small;"><strong>Methods: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">This retrospective case-control study was performed between January 2013 and January 2014. Participants aged 55 years or older were divided to case group including 85 patients with low-energy hip fracture and 83 patients with low-energy distal radius fractures, and 82 subjects as a matched control group. Bone mineral density was measured with dual energy X-ray absorptiometry and serum sample was obtained to check vitamin D, calcium, phosphorus, alkaline phosphatase, and protein. </span></span><br /> <span style="font-size: xx-small;"><strong>Results: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Study subjects for final evaluation consisted of 78 in hip and distal radius fracture groups and 80 in control group. There were no significant differences in the mean serum levels of calcium, phosphorus and alkaline phosphatase between the three groups. The overall mean serum level of vitamin D3 was significantly different among the three groups. </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Similar results were observed with hip and spine t-score between the groups. </span></span><br /> <span style="font-size: xx-small;"><strong>Conclusion: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">There is not only a direct relation between serum vitamin D and the risk of low energy hip and distal radius </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">fractures, but also a significant relation between low bone density in hip and spine area with low serum calcium was observed. </span></span>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101Analgesia Following Arthroscopy – a Comparison of Intraarticular Bupivacaine and/or Midazolam and or Fentanyl2831785710.22038/abjs.2016.7857ENMahmoud NahravaniDepartment of Anesthesiology Ghaem Hospital, Mashhad
University of Medical Sciences, Mashhad, IranSeyed Mostafa Moosavi TekyeDepartment of Anesthesiology Ghaem Hospital, Mashhad
University of Medical Sciences, Mashhad, IranMohammad AlipourAssistant Professor of Anesthesiology
Ghaem Hospital,
Mashhad University of Medical Science
Mashhad, 91766-99199, Iran0000-0003-1512-2804Hadi MakhmalbafOrthopedic Research Center, Ghaem Hospital, Mashhad
University of Medical Sciences, Mashhad, Iran0000-0002-3344-8632Monnavar Afzal AghaeeMashhad University of Medical Sciences, Mashhad, IranJournal Article20150224 <br /> <strong><span style="font-size: xx-small;">Background: </span></strong><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Arthroscopic intervention is very common for conducting orthopedic surgeries. After a knee arthroscopic surgery, different drugs are used through intra-articular administration to induce analgesia. The aim of this study was to evaluate analgesic effects of Bupivacaine (marcaine), Bupivacaine plus midazolam, and Bupivacaine plus fentanyl in reducing pain after knee arthroscopic surgery. </span></span><br /> <span style="font-size: xx-small;"><strong>Methods: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Frothy five patients who were candidate for knee arthroscopy were divided into three groups. Group A, B and </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">C received Bupivacaine (50 mg), Bupivacaine (50 mg) plus midazolam (50 μg/kg), and Bupivacaine (50 mg) plus fentanyl (3 μg/kg), respectively. The analgesic solutions were diluted with normal saline up to 20 ml. The analgesic effects were </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">evaluated by VAS during first 24 hrs after surgery. With the VAS > 4, extra analgesic (pethidine) was administrated for </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">patient. </span></span><br /> <span style="font-size: xx-small;"><strong>Results:</strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The amount of induced analgesia and need for extra analgesic was different between groups; however, it was not statistically significant (p<0.109). The amount of administered analgesic (pethidine) in first 24 hours post-operatively was 275 mg for group A, while it was 150 mg for group B and 75 mg for group C. In group A, 46.67% of patients required further analgesic while this was 26.67% and 13.34% for groups B and C respectively (p<0.109). </span></span><br /> <span style="font-size: xx-small;"><strong>Conclusion: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Intra-articular administration of studied drugs in all three groups reduced post-operation pain. The amount </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">of induced analgesia was the highest for group C, while group B drugs induced better analgesia compared to group C. </span></span>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101The Zeitgeist of Challenging the Evidence. A Perspective on the International Consensus Meeting on Periprosthetic Joint Infection3238793410.22038/abjs.2016.7934ENHangama C. FayazDepartment of Orthopaedic Surgery, Harvard Medical
School, Massachusetts General Hospital, Boston, MA, USA0000-0003-4654-2457Jesse B. JupiterDepartment of Orthopaedic Surgery, Harvard Medical
School, Massachusetts General Hospital, Boston, MA, USAJournal Article20160110 <br /><strong><span style="font-size: xx-small;">Background: </span></strong><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The economic burden of the treatment of periprosthetic joint infection (PJI) is high and the treatment of PJI has a high degree of international controversy. Several papers have declared the International Consensus </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Meeting on Periprosthetic Joint Infection (ICMPJI) to be the "flawless pledge of international academics" to overcome the challenges of musculoskeletal infections. The purpose of this paper is to highlight for the first time some essential insights into the key dilemmas that are associated with this international consensus process. </span></span><br /><span style="font-size: xx-small;"><strong>Methods: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The proceedings of the ICMPJI was reviewed, and the critical consensus agreements that were reached were communicated via e-mail to 48 leading orthopaedic surgeons, microbiologists and statisticians around the world. Of these, 30 responded, 8 did not, and 10 of respondents were not aware of the ICMPJI. </span></span><br /><span style="font-size: xx-small;"><strong>Results: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">A thorough review of the ICMPJI proceedings identified a clear need to resolve some of the dilemmas that we highlight in this paper. The Delphi procedure has been described as a survey technique that enables a group dynamic-based practice. Although there have been several published reports on this procedure, its scientific merit is still being debated. Several challenges and questions have been raised regarding the application of the Delphi technique, but there is no doubt that it is a vital approach for achieving consensus on subjects where none currently exists. </span></span><br /><span style="font-size: xx-small;"><strong>Conclusion: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Performing prospective clinical studies in this area is currently the best and only option to overcome this </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">challenge. In the long term, this approach will not only incorporate the standard of clinical evidence but also adopt regional mores for treating infection, which include patient values, cultural differences and local financial resources. </span></span>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101Minimally Invasive Surgical Approach to Distal Fibula Fractures: A Technique Tip3945796610.22038/abjs.2016.7966ENTyler A. GonzalezDepartment of Orthopaedic Surgery, Massachusetts General
Hospital, Boston, USABonnie ChienDepartment of Orthopaedic Surgery, Massachusetts General
Hospital, Boston, USAMohammad GhorbanhoseiniOrthopedic Surgeon, Harvard Medical School, BIDMC, Carl
J. Shapiro Department of Orthopaedics, Boston, USAJohn Y. KwonDepartment of Orthopaedic Surgery, Harvard Medical School,
Division of Foot and Ankle Surgery, BIDMC, Department of
Orthopaedic Surgery, BIDMC, Boston, USAJournal Article20160716 <br /> <span style="font-size: xx-small;">Wound complications following ankle fracture surgery are a major concern. Through the use of minimally invasive surgical </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">techniques some of these complications can be mitigated. Recent investigations have reported on percutaneous fixation of distal fibula fractures demonstrating similar radiographic and functional outcomes to traditional open approaches. The purpose of this manuscript is to describe in detail the minimally invasive surgical approach for distal fibula fractures. </span></span>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101Comparison of Pediatric and General Orthopedic Surgeons’ Approaches in Management of Developmental Dysplasia of the Hip and Flexible Flatfoot: the Road to Clinical Consensus4651814810.22038/abjs.2017.8148ENRamin Haj ZargarbashiOrthopedics and Trauma Surgery Department, Children’s
Hospital Medical Center, Tehran University of Medical
Sciences, Tehran, IranHirbod Nasiri BonakiSchool of Medicine, Tehran University of Medical
Sciences, Tehran, Iran0000-0001-9051-2154Shayan ZadeganSina Trauma and Surgery Research Center, Tehran
University of Medical Sciences, Tehran, IranTaghi BaghdadiOrthopedics and Trauma Surgery Department, Imam
Khomeini Hospital, Tehran University of Medical
Sciences, Tehran, Iran0000-0002-3015-3767Mohammad Hossein NabianOrthopedics and Trauma Surgery Department, Children’s
Hospital Medical Center, Tehran University of Medical
Sciences, Tehran, Iran0000-0002-4144-3188Mehdi Ramezan ShiraziOrthopedics and Trauma Surgery Department, Imam
Khomeini Hospital, Tehran University of Medical
Sciences, Tehran, IranJournal Article20160614 <br /> <span style="font-size: xx-small;">Developmental dysplasia of the hip (DDH) and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS) (n=20) and pediatric orthopedic surgeons (POS) (n=20), were asked to answer an 8-item questionnaire on DDH and flexible flatfoot. The questions were provided with two- or multiple choices and a single choice was accepted for each one. Chi-square and Fisher’s exact tests was performed to compare the responses. For a neonate with limited hip abduction, hip ultrasonography was the agreed-upon approach in both groups (100% POS vs 71% GOS), and for its interpretation 79% of POS relied on their own whereas 73% of GOS relied on radiologist’s report (</span><em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">P=0.002</span></span></em><span style="font-size: xx-small;">). In failure of a 3-week application of the Pavlik harness, ending it and closed reduction (57% POS vs. 41% GOS) followed by surgery quality assessment with CT scan (64% POS vs. 47% GOS) and without the necessity for avascular necrosis evaluation (79% POS vs. 73% GOS) were the choice measures. In case of closed reduction failure, open reduction via medial approach was the favorite next step in both groups (62% POS and 80% GOS). For the patient with flexible flat foot, reassurance was the choice plan of 79% of pediatric orthopedists. Our findings demonstrated significant disagreements among the orthopedic surgeons. This proposes insufficiency of high-level evidence. </span>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101Axillary Artery Injury Associated with Proximal Humerus Fracture: A Report of 6 Cases5257632610.22038/abjs.2016.6326ENRinne M. PetersDepartment of Orthopaedic Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA,
USA0000-0002-1484-4226Mariano E. MenendezDepartment of Orthopaedic Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA,
USAJos J. MellemaDepartment of Orthopaedic Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA,
USADavid RingDepartment of Orthopaedic Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA,
USA0000-0002-6506-4879R. Malcolm SmithDepartment of Orthopaedic Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA,
USAJournal Article20151123 <br /><span style="font-size: xx-small;">Proximal humerus fractures are common, but associated injury of the axillary artery is uncommon. The majority of published blunt traumatic axillary artery injuries are associated with anterior glenohumeral dislocation; a few are associated with isolated proximal humerus fractures or fracture-dislocation. Experience within our institution demonstrates that axillary artery injury is often unrecognized on initial presentation owing to palpable peripheral pulses and the absence of ischemia and places the hand at risk of necrosis and amputation if there is prolonged ischemia and the forearm at risk of compartment syndrome after revascularization. Accurate physical examination in combination with a low threshold for Doppler examination or angiography can establish the diagnosis of axillary artery injury. We present 6 cases of axillary artery injury associated with proximal humerus fractures in order to highlight the potential for this vascular injury in the setting of a proximal humerus fracture. </span>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101Total Knee Arthroplasty in Severe Unstable Knee: Case-Report and Literature Review5862785810.22038/abjs.2016.7858ENMohammad Naghi TahmasebiShariati Hospital, Tehran University of Medical Siences, Tehran, Iran0000-0003-4644-6756Gholamreza Ghorbani AmjadShariati Hospital, Tehran University of Medical Siences, Tehran, Iran0000000222960745Mohammad Hasan KasebImam khomeni , Tehran University of Medical Siences, Tehran, IranKaveh BashtiShariati Hospital, Tehran University of Medical Siences, Tehran, IranJournal Article20160422 <br /> <span style="font-size: xx-small;">Multiplanar or global laxity in arthritic knee is rare , most of this patients have neuromuscular disorder (post poliomyelitis , spinal dystrophy) or history of knee trauma. Ligament insufficiency and severe bone loss is significant in this patient. The estimated prevalence for the concurrence of charcot marie-tooth (CMT) with myasthenia gravis (MG) suggests an extremely rare event. We have presented a 54-year-old female patient with CMT and MG complaining of progressive pain, swelling, and crepitation of the knee joints who had been undergone total knee arthroplasty (TKA) with rotating hinge prosthesis. She had an acute myasthenia crisis soon after operation with prolonged intubation and intensive care unit admission. Radiographies and physical examination revealed bilateral severe unstable arthritic knee joints and left knee posterior dislocation. Short-term postoperative follow-up revealed improved knee function and resolution of all symptoms in the operated side. </span>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101Intrapelvic Protrusion of a Broken Guide Wire Fragment during Fixation of a Femoral Neck Fracture6365524610.22038/abjs.2015.5246ENAhmadreza AfsharDepartment of Orthopaedics, Urmia University of Medical
Sciences, Urmia, Iran0000-0002-3676-5932Journal Article20150511 <br /> <span style="font-size: xx-small;">During fixation of a femoral neck fracture in a 23-year-old male patient with cannulated screws, a broken guide wire fragment inadvertently advanced through the hip joint and protruded into the pelvis. A second surgical approach was needed to remove the broken fragment from the pelvis. Awareness of such a potentially devastating complication will make surgeons more cautious during implementation of orthopedic instruments and increases patient’s safety during surgery. </span>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101Osteochondritis Dissecans of the Humeral Head: A Case Report and Review of the Literature6669786210.22038/abjs.2016.7862ENDavod JafariBone and Joint Reconstruction Research Center, Shafa
Orthopedic Hospital, Iran University of Medical Sciences,
Tehran, IranHooman ShariatzadehBone and Joint Reconstruction Research Center, Shafa
Orthopedic Hospital, Iran University of Medical Sciences,
Tehran, IranFarid Najd MazharBone and Joint Reconstruction Research Center, Shafa
Orthopedic Hospital, Iran University of Medical Sciences,
Tehran, IranMohammad Ali OkhovatShahid Beheshti University of Medical Sciences, Tehran, Iran0000-0001-6779-6662Mehran RazavipourBone and Joint Reconstruction Research Center, Shafa
Orthopedic Hospital, Iran University of Medical Sciences,
Tehran, Iran0000-0002-2290-3214Journal Article20150812 <br /> <span style="font-size: xx-small;">Osteochondritis dissecans (OCD) is a common joint disorder in knee, ankle and elbow, however it can be rarely found in glenohumeral joint. In this study, we report an asymptomatic case of humeral head OCD, which was detected incidentally following a trauma. X-rays showed an area of lucency around an oval bony fragment measuring about 1 cm on the superior aspect of the humeral head. However, the patient was pain-free and the shoulder range of motion was normal. </span>Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46445120170101Loosening of Total Knee Arthroplasty after Brucellosis Infection: A Case Report7071815010.22038/abjs.2017.19756.1512ENMohammad Ali SazgariKnee and Sport Medicine Research Center, Milad Hospital,
Tehran, IranFateme BahramianKnee and Sport Medicine Research Center, Milad Hospital,
Tehran, IranFateme MirzaeeKnee and Sport Medicine Research Center, Milad Hospital,
Tehran, IranZohreh ZafaraniKnee and Sport Medicine Research Center, Milad Hospital,
Tehran, IranHamid Reza AslaniKnee and Sport Medicine Research Center, Milad Hospital,
Tehran, Iran0000-0002-3257-8312Journal Article20161013 <br /> <span style="font-size: xx-small;">In this report we describe a 78-year-old man whose total knee arthroplasty showed the symptoms of infection with brucella with radiographic signs of loosening 5 years after the index surgery. The patient was treated successfully after a 2-stage revision arthroplasty surgery along with using rifampicin and doxycycline for 8 weeks. </span>