Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Save the Meniscus, A Good Strategy to Preserve the Knee141442710.22038/abjs.2019.45438.2242ENMohammad RaziDepartment of Orthopedic Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran0000-0003-0273-5599SM Javad MortazaviTehran University of Medical Sciences
Joint Reconstruction Research Center0000-0003-4189-7777Journal Article20191230With increasing life expectancy, the demand for preservation of native articular cartilage is increasing to delay joint arthroplasties. In the knee, there are many different strategies to preserve the articular cartilage including but not limited to corrective osteotomies, chondral injury restoration, intraarticular injection of cells or growth factors(PRP). However, One of the most important strategies in knee preservation is meniscal preservation. It was highlighted again in the 4th international meeting The Meniscus held in Bologna late in January 2016. As the loss of the meniscus can be regarded as a pre-arthritic condition, a knee surgeon must save the meniscuses much as he or she can.Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Available Findings Fail to Provide Strong Evidence of the Role of Bone Morphogenic Protein-2 in Femoral Head Osteonecrosis5101396910.22038/abjs.2019.30467.1785ENAli ParsaMassachusetts General
Hospital at Harvard Medical School, Boston, USA
Orthopedic Research Center, Department of Orthopedic
Surgery, Mashhad University of Medical Science,
Mashhad, Iran0000-0002-7374-0814Hamed VahediRothman Orthopedic at Thomas Jefferson University,
Philadelphia, PA, USAKaran GoswamiRoyal London Hospital, London, UKArash AalirezaieRothman Orthopedic at Thomas Jefferson University,
Philadelphia, PA, USA0000-0003-3895-2878Journal Article20180310Despite widespread research on non-traumatic femoral head osteonecrosis (FHON), there is no consensus about preventative treatment options. Insufficient blood supply and increased intra-osseous pressure are the initiating events in the majority of cases. BMPs are growth factors that belong to the transforming growth factor β (TGFβ) superfamily. Two specific formulations of BMPs have already been approved by the FDA: 1. BMP-2 (Infused, Medtronic) for the treatment of tibial open fractures and spinal fusion; 2. BMP-7 (OP-1, Stryker) in the setting of long bone non-unions. To our knowledge there is no published work reviewing the utility of BMP-2 in the setting of FHON.<br /> Online databases (EMBASE, Cochrane, MEDLINE and PubMed) for literature relating to the use of BMP-2 in the treatment of FHON on 2nd June 2017. Animal studies: A total of 169 animal subjects with induced FHON were treated with BMP-2 in all the included in vivo studies.<br /> Improved histological parameters, areas of revascularization, areas of new bone formation and osteoid deposition were seen in all studies. The number of osteoclasts decreased post operatively, in the ibandronate and BMP-2 group. Human studies: In combination, 96 human hips were treated in two studies utilizing BMP-2 and mean follow-up was at least five years. Success rate of BMP-2 was above 80 % (based on Harris score and WOMAC score) in both studies. Both are level III studies.<br /> The present review of animal and clinical studies could not find well-designed prospective comparable studies with large sample size and preliminary evidence is not sufficient to supports the utilization of BMP-2, and its impact on the midterm outcomes of FHON. Level of evidence: IIIMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101The Use of Antibiotic Impregnated Cement Spacers in the Treatment of Infected Total Joint Replacement: Challenges and Achievements11201425110.22038/abjs.2019.42018.2141ENOmid ShahpariOrthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran0000-0002-5583-9378Alireza MousavianOrthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran0000-0003-4718-2705Nafiseh ElahpourOrthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, IranMichael-Alexander MalahiasDepartment of Hand-Upper Limb and Microsurgery,
Hospital KAT, Athens, Greecehttps://orcid.org/00Mohammad H. EbrahimzadehOrthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran0000-0003-4417-9877Ali Moradi PhDBone and Joint Research
Lab, Orthopedic Research Center, Ghaem Hospital, Mashhad,
Iran0000-0003-3866-0867Journal Article20190722Two stage total hip arthroplasty revision surgery includes foreign material debridment, insertion of antibiotic impregnated<br />cement spacer, and finally, reimplantation of the prosthesis. This review has aimed to evaluate the efficacy of antibiotic<br />impregnated cement spacers in infection control and eradication in arthroplasties.<br />A total of 85 articles on total hip arthroplasty were used in this narrative literature review.<br />High concentrations of the antibiotic in targeted drug delivery by means of using antibiotic impregnated cement<br />spacers is effective against infections while reduces the side effects of systemic antibiotic therapy. This results in<br />prevention of bone and muscle atrophy as well as size discrepancy. Also, antibiotic impregnated cement spacers<br />reduce dead space and help stabilize the limb in total hip arthroplasty. Despite all reported drawbacks, antibiotic<br />impregnated cement spacers seem effective in eradicationg infections, although a consensus has not been yet<br />achieved.<br />Level of evidence: IMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101The Prevalence of Calcifications at the Origin of the Extensor Carpi Radialis Brevis Increases with Age21261249810.22038/abjs.2019.31558.1823ENMatthew TarabochiaHand Service, Department of Orthopedic Surgery,
Massachusetts General Hospital, Massachusetts, Boston,
USAStein JanssenStein J. Janssen, Hand Service,
Department of Orthopedic Surgery, Massachusetts General
Hospital, Massachusetts, Boston, USA0000-0003-3939-7765Paul T. OginkHand Service, Department of Orthopedic Surgery,
Massachusetts General Hospital, Massachusetts, Boston,
USADavid RingDepartment of Surgery and Perioperative Care, Dell
Medical School, The University of Texas at Austin, Austin,
Texas, USA0000-0002-6506-4879Neal C. ChenHand Service, Department of Orthopedic Surgery,
Massachusetts General Hospital, Massachusetts, Boston,
USA0000-0002-8967-9018Journal Article20180520Background: Enthesopathy of the extensor carpi radialis brevis origin [eECRB] is a common idiopathic, noninflammatory<br />disease of middle age that is characterized by excess glycosaminoglycan production and frequently<br />associated with radiographic calcification of its origin. The purpose of our study was to assess the relationship of<br />calcification of the ECRB and advancing age.<br />Methods: We included 28,563 patients who received an elbow radiograph and assessed the relationship of calcifications<br />of the ECRB identified on radiograph reports with patient age, sex, race, affected side, and ordering indication using<br />multivariable logistic regression.<br />Results: Calcifications of the ECRB were independently associated with age (OR:1.04; p <0.001); radiographs<br />ordered for atraumatic pain (OR2.6; p <0.001) or lateral epicondylitis (OR5.5; p <0.001); and Hispanic ethnicity (OR1.5;<br />p <0.001) and less likely to be found at the left side (OR0.68; p <0.001). Similarly, incidental calcifications of the ECRB,<br />those on radiographs not ordered for atraumatic pain or lateral epicondylitis, were independently associated with<br />age (OR1.03; p <0.001) and Hispanic ethnicity (OR1.5; p <0.024) and less likely to be found on the left side (OR0.71;<br />p <0.001).<br />Conclusion: We observed that about nine percent of people have ECRB calcification by the time they are in their sixth<br />decade of life and calcifications persist in the absence of symptoms which supports the idea that eECRB is a common,<br />self-limited diagnosis of middle age.<br />Level of evidence: IIMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Radiographic Predictors for Short-term Functional Outcome after Radial Head Arthroplasty in Patients with Persistent Symptoms after Treatment for Radial Head27321363810.22038/abjs.2019.31727.1832ENFemke M.A.P. ClaessenOrthotrauma Research Center Amsterdam, University of
Amsterdam, Amsterdam, the Netherlands; Department of
Orthopaedic Surgery, Hand and Upper Extremity Service,
Massachusetts General Hospital, Boston, MA, USA0000-0003-0778-850XBexkens, RensOrthotrauma Research Center Amsterdam, University of
Amsterdam, Amsterdam, the Netherlands; Department of
Orthopaedic Surgery, Hand and Upper Extremity Service,
Massachusetts General Hospital, Boston, MA, USAI. F. KoddeDepartment of Orthopaedic Surgery, Academic Medical
Center, Amsterdam, the Netherlands; Department of
Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital,
Breda, the NetherlandsJob N. DoornbergAcademic Medical Center, Amsterdam, the Netherlands,
Department of Orthopaedic Surgery, Upper Limb Unit,
Amphia Hospital, Breda, the Netherlands0000-0002-1270-2742Michel P. J. V. BekeromDepartment of Orthopaedic Surgery, Shoulder and
Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam,
the Netherlands0000-0002-1184-0529Denise EygendaalOrthopaedic Surgeon, Department of Orthopaedic
Surgery, Upper Limb Unit, Amphia Hospital, Breda, the
Netherlands0000-0002-7415-2301Journal Article20180508Background: Evaluation of the accurate position after radial head arthroplasty remains a challenge for surgeons.<br />Standard radiographs are used to evaluate the position of the implant, however, results regarding radiographic<br />deficiencies on clinical outcome are not consistent. In this retrospective study our main aim was to determine if subtle<br />radiographic deficiencies after radial head arthroplasty can predict functional outcomes measured with the Mayo Elbow<br />Performance Score (MEPS).<br />Methods: A total of 24 patients, that had a press-fit bipolar radial head arthroplasty because of persistent symptoms<br />after treatment of a radial head fracture, were included. The mean follow-up time was 27 months and the MEPS was<br />assessed at the final follow-up. Three upper extremity orthopaedic surgeons evaluated 12 potential deficiencies on<br />anteroposterior and lateral radiographs in consensus agreement.<br />Results: The median MEPS was 97.5 (Interquartile Range 82.5-100). No association was found between the presence<br />of subtle radiographic deficiencies and MEPS.<br />Conclusion: Functional outcome of the elbow after uncemented press-fit bipolar radial head arthroplasty is not<br />associated with subtle radiographic deficiencies. Therefore, surgeons might accept small imperfections on postoperative<br />radiographs.<br />Level of evidence: IVMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Misinformation in News Coverage of Professional and College Athlete Musculoskeletal Ailments33371274910.22038/abjs.2019.34844.1916ENLayla A.HaidarDell Medical School0000-0002-7328-1566Joost T.P.KortleverDell Medical School0000-0003-3825-5546David RingDell Medical School -- The University of Texas at Austin0000-0002-6506-4879Journal Article20181003Background: The general population’s understanding of musculoskeletal health is likely influenced by media reports of the ailments of prominent athletes. We assessed factors independently associated with debatable or potentially misleading medical statements in mainstream sports media coverage of the ailments of professional and college athletes.<br />Methods: We identified and assessed 200 Internet media reports of musculoskeletal ailments of prominent athletes between February 19th and March 26th, 2018. We recorded medical statements about mechanism, diagnosis, treatment, and prognosis. We then classified those statements as accurate, debatable, or possibly misleading. We created a multivariable logistic regression model to identify factors independently associated with debatable or possibly misleading statements.<br />Results: Forty-five percent of statements were debatable or possibly misleading. Statements about diagnosis (Odds Ratio [OR]=0.17; p < 0.001), treatment (OR=0.33; P=0.007), or prognosis (OR=0.27; P=0.003) and statements about shoulder and elbow ailments were more likely to be inaccurate compared to statements about mechanism and statements about knee ailments (OR=3.3; P=0.04) respectively.<br />Conclusion: Coverage of sports ailments in the mainstream media are a common source of misinformation. Ailments of prominent athletes may represent a useful opportunity to teach people about musculoskeletal health.<br />Level of evidence: Not applicable.Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Cost Effectiveness of Laminar Flow Systems for Total Shoulder Arthroplasty: Filtering Money from the OR?38431250610.22038/abjs.2018.34938.1918ENDaniel Davis E.Department of Orthopaedic Surgery, The Rothman
Institute at Thomas Jefferson University, Philadelphia, PA, USA0000-0003-4640-4409Benjamin ZmistowskiDepartment of Orthopaedic Surgery, The Rothman
Institute at Thomas Jefferson University, Philadelphia, PA, USAJoseph AbboudDepartment of Orthopaedic Surgery, The Rothman
Institute at Thomas Jefferson University, Philadelphia, PA, USASurena NamdariDepartment of Orthopaedic Surgery, The Rothman
Institute at Thomas Jefferson University, Philadelphia, PA, USA000000028222554xJournal Article20181008Background: Laminar flow ventilation systems were developed to reduce surgical contamination in joint arthroplasty<br />to avoid periprosthetic joint infection (PJI). The goals of this study are to evaluate the cost-effectiveness and economic<br />viability of installing and maintaining a laminar flow system in an operating room.<br />Methods: A Monte Carlo simulation was used to evaluate the cost effectiveness of laminar flow. The variables included<br />were cost to treat PJI, incidence of PJI, cost of laminar flow, years of operating room use, and arthroplasty volume as<br />the dependent variable.<br />Results: Laminar flow would be financially-justified when 1,217 (SD: 319) TSA cases are performed annually with<br />assumed 10% reduction in PJI from laminar flow and 487 (SD: 127) with assumed 25% reduction. In a high volume OR,<br />laminar flow costs $25.24 per case (assuming 10% reduction) and $8.24 per case (assuming 25% reduction). Laminar<br />flow would need to reduce the incidence of PJI by 35.1% (SD: 9.1) to be a cost-effective strategy.<br />Conclusion: This analysis demonstrates the substantial arthroplasty volume and large reduction in PJI rates required to<br />justify the installation and maintenance costs of this technology. This high cost of implementation should be considered<br />prior to installing laminar flow systems.<br />Level of evidence: IIMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101A Preliminary Investigation of Cast Anxiety in General Orthopaedic Practice44491250810.22038/abjs.2019.35375.1931ENCarlo RossUniversity of Manchester Faculty of Medicine and Biological Sciences
Manchester NHS Foundation Trust Hospital0000-0003-4226-8278Mohamad AlqubaisiManchester University NHS Foundation Trust,
Manchester, England, UKAnand PillaiManchester University NHS Foundation Trust,
Manchester, England, UKJournal Article20181019Background: Anxiety following casting is an unrecognised complication that results in frequent visits to fracture clinic in the UK. There is a paucity of research regarding this complication. Failure to recognise Cast Anxiety (CA) leads to increased visits, frequent cast changes and possible failure of treatment despite no objective problems with the cast. Prior research has suggested a possible link between CA and claustrophobia but lacks statistical evidence. The Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-V) categorizes claustrophobia as a Specific Phobia (SP) and questionnaires for both claustrophobia and SP exist. As such, the main purpose of this study is to examine the statistical correlation between the SP Questionnaire and the Claustrophobia Questionnaire to identify if a link exists between CA and claustrophobia. The secondary goal is to develop a screening questionnaire to identify those at high risk of CA, the significance of which lies in possible prevention of failure of surgical treatment and frequent visits to fracture clinic.<br />Methods: Self-report questionnaires were distributed to patients attending fracture clinic and accident emergency for review/ cast application/ problems with the cast over a one month period, no preference between upper or lower limb casts. This group completed both self-report questionnaires (N=157). From this group, patients were identified as having CA if they required frequent cast changes and frequent visits to fracture clinic despite no objective problems with the cast, or had themselves described feelings of anxiety/ claustrophobia. Follow up interviews with patients identified<br />as having CA were undertaken. On the basis of the data gathered, a screening questionnaire was developed and distributed to a second group of patients with the same inclusion and exclusion criteria (N=50).<br />Results: A correlation between the two questionnaires was found: N= 157, r= 0.522, Pidentified as encompassing CA: Anxiety, Cognition and Physiological responses and Behaviour, evidencing an anxiety based disorder. The screening questionnaire identified over 80% of patients suffering from CA when scoring > 20/26. *Any patient scoring = 20/26 should be considered high risk of CA.<br />Conclusion: Based on this data, CA fits the criteria of an anxiety based condition. The modified screening tool permits early identification of individuals at high risk of CA. Usage of the screening tool is encouraged prior to casting and for future research modifications. Early identification will allow consideration of an alternative treatment option, anticipatory conversation and could prevent the failure of treatment.<br />Level of evidence: IIMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Humeral-sided Radiographic Changes Following Reverse Total Shoulder Arthroplasty50571221710.22038/abjs.2019.36065.1951ENTyler J. BroilnDepartment of Orthopaedic Surgery and Biomedical
Engineering, University of Tennessee-Campbell Clinic,
Memphis, TN, USA0000-0001-7632-2565Ryan M. CoxDepartment of Orthopaedic Surgery, Rothman Institute-
Thomas Jefferson University Hospitals, Philadelphia, PA,
USAJohn G. HorneffDepartment of Orthopaedic Surgery, Rothman Institute-
Thomas Jefferson University Hospitals, Philadelphia, PA,
USA0000-0003-4802-9913Surena NamdariDepartment of Orthopaedic Surgery, Rothman Institute-
Thomas Jefferson University Hospitals, Philadelphia, PA,
USA0000-0002-8222-554XJoseph A. AbboudDepartment of Orthopaedic Surgery, Rothman Institute-
Thomas Jefferson University Hospitals, Philadelphia, PA,
USA0000-0002-3845-7220Kristen NicholsonDepartment of Orthopaedic Surgery, Rothman Institute-
Thomas Jefferson University Hospitals, Philadelphia, PA,
USAMatthew L. RamseyDepartment of Orthopaedic Surgery, Rothman Institute-
Thomas Jefferson University Hospitals, Philadelphia, PA,
USADepartment of Orthopaedic Surgery, Rothman Institute-
Thomas Jefferson University Hospitals, Philadelphia, PA,
USAJournal Article20181113Background: We sought to characterize humeral-sided radiographic changes at a minimum of 2 years after reverse<br />shoulder arthroplasty (RSA) to determine their association with specific implantation techniques.<br />Methods: The immediate and most recent postoperative anteroposterior radiographs of 120 shoulders with primary RSA<br />and a minimum of 2-years of radiographic follow-up were analyzed (mean follow-up 35.2 months). Stress shielding was<br />evaluated by measuring cortical thickness at 4 different locations. Three independent examiners evaluated radiographs<br />for humeral osteolysis, radiolucent lines, stress shielding, stem loosening, and scapular notching.<br />Results: The cortical diameter, marker of external stress shielding, significantly decreased from initial to most<br />recent measurement (p <0.001), but did not differ between cemented and uncemented groups. Cemented stems had<br />significantly more osteolysis and radiolucent lines; uncemented stems had significantly more internal stress shielding<br />(p <001). The presence of scapular notching was significantly correlated with the presence of humeral osteolysis<br />(p <0.001). Three (2.5%) stems were deemed “at risk” for loosening and 2 (1.7%) were loose.<br />Conclusion: Cemented humeral stems were associated with an increased rate of radiolucent lines and osteolysis,<br />whereas uncemented stems were associated with more internal stress shielding. Humeral cortical thickness significantly<br />decreased over time regardless of fixation. There was an association between scapular notching and increased<br />humeral osteolysis.<br />Level of evidence: IIIMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Gorham-Stout Disease of the Shoulder: Clinical, Pathologic and Therapeutic Considerations58691251910.22038/abjs.2019.37156.1990ENMohamad Y.Fares1-The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
2-Faculty of Medicine, American University of Beirut, Beirut, Lebanon
3-College of Medical, Veterinary, and Life0000-0001-8228-3953Jawad FaresDepartment of Neurological Surgery, Feinberg School of Medicine, Northwestern University0000-0002-5368-8764Youssef FaresNeuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, LebanonJoseph AAbboudThe Rothman Institute
The Sidney Kimmel Medical College at Thomas Jefferson University0000-0002-3845-7220Journal Article20190107Background: Gorham-Stout disease (GSD) is a rare skeletal disorder characterized by massive osteolysis of a bony area in the body. When it hits the shoulder, the patient is faced with a debilitating limitation in terms of motion, stability and quality of life. GSD etiology and pathology are unknown and, as a result, therapeutic modalities remain unclear. The aim of this paper is to explore and offer medical insight into the possible etiologies, pathologies and therapeutic modalities of Gorham-Stout Disease in the shoulder.<br /><br />Methods: We explored PubMed/Medline for GSD cases in the shoulder. The search involved all articles published from database inception until February 1, 2019. Only articles published in English were included. Demographics and clinical information extrapolated from the reported cases were analyzed to deduce patterns and infer conclusions. <br /><br />Results: Only 32 studies met our criteria, with a total of 37 cases (n=37). Males predominated in 21 cases (57%). Twelve cases (32%) were younger than 18 years, and 18 cases (49%) were aged between 18 and 65 years. Shoulder pain was the predominant reporting symptom. The humerus was the most common shoulder site affected (54%), followed by the scapula (35%) and the clavicle (30%). Almost half of the cases affected the right shoulder (51%), the left shoulder was affected in 16 cases (43%). Conservative treatment was opted in 17 cases (46%), while surgery was performed in 13 cases (35%). Good outcomes were reported in 28 cases (76%), while death occurred twice (5%).<br /><br />Conclusion: Understanding the demographics and clinical characteristics of GSD in the shoulder region will help in formulating better therapeutic interventions and preventive health policies.Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Morphometric Assessment of the Residual Width of the Distal Hamate Articular Surface after Graft Harvest for Hemi-hamate Arthroplasty70741364110.22038/abjs.2019.38351.2014ENLudovico LucentiDepartment of Orthopaedics and Traumatology,
University Hospital Policlinico Vittorio Emanuele,
University of Catania, Catania, Italy0000-0002-9514-9304Kevin F. LutskyDepartment of Orthopaedic Surgery Sidney Kimmel
Medical College, Thomas Jefferson University,
Philadelphia, PA, USA0000000313932264Lauren BannerDepartment of Orthopaedic Surgery Sidney Kimmel
Medical College, Thomas Jefferson University,
Philadelphia, PA, USAZachary LazevNew York Institute of Technology College of
Osteopathic Medicine, New York, New York, USAPedro K. BeredjiklianDepartment of Orthopaedic Surgery Sidney Kimmel
Medical College, Thomas Jefferson University,
Philadelphia, PA, USA0000-0001-7625-6270Journal Article20190210Background: The hemi-hamate arthroplasty (HHA) can restore joint congruity and stability in chronic fracturedislocations<br />of the proximal interphalangeal joint (PIPJ). Purpose of this study was to compare the width of the distal<br />hamate articular surface (DHAS) to the width of the base of the middle phalanges (P2) of the fingers. We hypothesized<br />the dimensions of the width of the DHAS would be similar to those of P2, leaving a small amount of residual DHAS<br />width after autograft harvest.<br />Methods: Fifty-nine CT scans of the hand without any bony pathology were evaluated. Three observers measured the<br />following parameters and compared: (a) Width of the DHAS in the axial and coronal planes; (b) Width of the P2 articular<br />bases of all four fingers; (c) Maximum capitate length (MaxCap) in the coronal plane.<br />Results: The residual DHAS on the coronal plane after graft harvest (bone remaining on the radial and ulnar aspects<br />each, not accounting for saw blade or osteotomy width thickness) among all patients was 1.3, 0.9, 1.4, and 2.4 mm for<br />the index, long, ring and small fingers respectively. There was a strong correlation between DHAS and MaxCap r=0.76.<br />Conclusion: There is likely to be a very small amount of residual hamate articular surface width left after the graft is<br />harvested if the entire base of P2 is reconstructed.<br />Level of evidence: IIIMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Reverse Shoulder Arthroplasty is Superior to Hemiarthroplasty for Cuff Tear Arthropathy with Preserved Motion75821291710.22038/abjs.2019.38427.2016ENJonathan D. BarlowThe Mayo Clinic, Rochester, MN, USAGrant JamgochianThe Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USAZachary WellsThe Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USA0000-0003-4998-7048Dexter Kenneth BatemanRobert Wood Johnson University Hospital, New
Brunswick, NJ, USAAmber A. SchmerfeldThe Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USAJoseph A. AbboudThe Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USA0000-0002-3845-7220Gerald R. WilliamsThe Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USAJournal Article20190213Background: It is unclear whether hemiarthroplasty (HA) or reverse shoulder arthroplasty (RS) are superior for patients<br />with cuff tear arthropathy (CTA) and preserved preoperative motion (elevation >90˚).<br />Methods: This was a retrospective, single institution study. Patients who underwent RSA or HA for CTA were included if<br />they had preserved preoperative motion with a minimum of 2 years of follow-up, or until complication/revision. Shoulder<br />ROM and functional outcomes scores were obtained.<br />Results: Twenty-six HAs and 21 RSAs were evaluated at mean of 38.6 months (HA) and 36.3 months (RSA). Patients<br />in the RSA group were significantly older at surgery (73.9 versus 65.1 years; P=0.003). Postoperatively, the mean<br />change in active elevation was -15° for HA versus 26° for RSA, with RSA having significantly greater active elevation<br />(153° versus 123°; P=0.01). There were no significant differences in final internal or external rotation between groups.<br />Superior outcomes were seen for RSA versus HA for ASES score (84 vs. 66, P=0.003), Simple Shoulder Test (8.8 vs.<br />7.3, P=0.3), Single Assessment Numeric Evaluation (85 vs. 70, P=0.017), and 100mm VAS pain (7 vs. 33, p <0.001).<br />Conclusion: In patients with CTA and preserved preoperative forward elevation, RSA provided greater pain relief,<br />superior functional outcomes, and better ROM compared with HA.<br />Level of evidence: IVMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Magnetic Resonance Imaging Assessment of Hip Abductor after Total Hip Arthroplasty Using a Direct Lateral Approach83881360410.22038/abjs.2019.38549.2020ENAlireza Manafi RasiDepartment of Orthopedic Surgery, Imam Hossein
Hospital, Shahid Beheshti University of Medical Science,
Tehran, Iran0000-0001-6355-704XReza ZandiDepartment of Orthopedic Surgery, Taleghani Hospital,
Shahid Beheshti University of Medical Science, Tehran,
Iran0000-0002-0095-6745Mohamad QoreishiDepartment of Orthopedic Surgery, Akhtar Hospital,
Shahid Beheshti University of Medical Science, Tehran,
Iran0000-0002-8975-3951Ali HabibollahzadehDepartment of Orthopedic Surgery, Imam Hossein
Hospital, Shahid Beheshti University of Medical Science,
Tehran, Iran0000-0002-3128-3862Journal Article20190223Background: Surgical techniques and rehabilitations after total hip arthroplasty (THA) play a significant role in the<br />improvement of pain and limping. This study aimed to assess hip abductor muscle’s diameter and its strength after 6<br />months postoperative THA performed by Hardinge approach.<br />Methods: After obtaining the patients’ demographic characteristics, the preoperative values of patients’ hip abductor<br />muscle diameter were measured using magnetic resonance imaging, and were compared with postoperative values 6<br />months later. Moreover, the hip abductor muscle’s strength was assessed using the Trendelenburg test.<br />Results: A total of 88 patients participated in this study with a mean age of 47.3±1.574 years. It should be noted that<br />55.7% of the participants were male. Muscle diameter decreased from a mean value of 27.07±7.485 preoperative to<br />mean value of 25.64±7.353 mm postoperative (p <0.001). Moreover, the degrees of Trendelenburg test (i.e., mild or<br />severe) decreased after surgery (p <0.001). There was no significant difference between the frequencies of different<br />grades of limping according to the studied variables.<br />Conclusion: A decrease was observed in gluteus medius muscle diameter, and the Trendelenburg test results were<br />improved in this study. Moreover, the difference between pre- and postoperative gluteus medius muscle diameters were<br />measured using MRI. It can be concluded that MRI is not an appropriate diagnostic tool for the assessment of abductor<br />strength after THA in the 6-month postoperative visit. Accordingly, it is suggested to evaluate muscle strength before<br />and after each surgery to schedule the following treatment protocol required for each patient.<br />Level of evidence: IVMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Experimental Study on Protective Role of NSAID on Articular Cartilage Destruction in Septic Arthritis89931397110.22038/abjs.2019.37045.2001ENSeyed Mohammad TahamiBone and Joint research Center, Shiraz University of
Medical Sciences, Shiraz, Iran0000-0002-3722-8426Amir AminianBone and Joint research Center, Shiraz University of
Medical Sciences, Shiraz, Iran0000-0003-4374-6147Negar AzarpiraTransplant Research Center, Shiraz University of
Medical Sciences, Shiraz, IranJournal Article20190131Background: Surgical drainage and antibiotic therapy are the cornerstones of treatment protocols in septic arthritis; however, in some circumstances, the diagnosis and initiation of treatment may be retarded by slow disease progression or the time when the patient’s condition precludes early surgery. Therefore, it is beneficial to find ways to reduce the amount of articular injury. This study aimed to evaluate the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on the prevention of articular cartilage damage in an animal model of staphylococcal septic arthritis.<br />Methods: Knee joints of 40 rabbits were infected by the intra-articular injection of 105 colony-forming units of Staphylococcus aureus. Subsequently, they were categorized into four groups. The first (i.e., control group) and second groups were treated with a placebo and intramuscular injection of Ceftriaxone, respectively. Moreover, the third and fourth groups were treated with Naproxen alone and a combination of Ceftriaxone and Naproxen, respectively. All medications were started 24 h after the inoculation of microorganisms into the knee joint and continued for 3 days. Following that, the cartilage was evaluated using the International Cartilage Repair Society (ICRS) Visual Histological Assessment Scale.<br />Results: The group treated with the combination of Ceftriaxone and Naproxen obtained better results in terms of cell viability in tibial side cartilage and surface in both tibial and femoral cartilages (p <0.0125), compared to the group treated with antibiotics alone.<br />Conclusion: According to the results, in case of septic arthritis, the early administration of NSAID in conjunction with an appropriate systemic antibiotic may decrease further articular cartilage damage that is evoked by an infection.<br />Level of evidence: IIIMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Avascular Necrosis of the Scaphoid Preiser Disease94981397310.22038/abjs.2019.39187.2047ENFemke M.A.P. ClaessenOrthopaedic Hand and Upper Extremity Service,
Massachusetts General Hospital, Harvard Medical School,
Boston, MA, USA0000-0003-0778-850XIlse ScholOrthopaedic Hand and Upper Extremity Service,
Massachusetts General Hospital, Harvard Medical School,
Boston, MA, USAGregory P. KolovichOrthopaedic Hand and Upper Extremity Service,
Massachusetts General Hospital, Harvard Medical School,
Boston, MA, USADavid RingThe University of Texas at Austin, Austin, TX, USA0000-0002-6506-4879Journal Article20190606No consensus regarding optimal treatment or etiology of Preiser disease exists. We described the epidemiology,<br />classification and treatment characteristics of 18 patients with Preiser disease. Patients with changes related to previous<br />trauma, and without radiographs were excluded. Based on the radiographs at diagnosis, we classified 13 scaphoids as<br />Herbert Lanzetta stage II, four as stage III, and one as stage IV. In 12 patients nonspecific treatment was offered and<br />only two patients received surgical treatment. We found that chosen treatment is not associated with the severity of<br />Herbert Lanzetta stage and the outcome is not influenced by chosen treatment.<br />Level of evidence: IMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Implant Removal Matrix for the Upper Extremity Orthopedic Surgeon991111251310.22038/abjs.2019.36525.1962ENPatrick K. CroninHarvard University, Combined Orthopaedic Residency
Program, Boston, MA, USA0000-0002-7290-5840Ian T. WatkinsBeth Israel Deaconess Medical Center, Department of
Orthopaedic Surgery, Boston, MA, USAMatthew RiedelHarvard University, Combined Orthopaedic Residency
Program, Boston, MA, USA0000-0001-6640-7071Philip B. KaiserHarvard University, Combined Orthopaedic Residency
Program, Boston, MA, USAJohn Y. KwonBeth Israel Deaconess Medical Center, Department of
Orthopaedic Surgery, Boston, MA, USAJournal Article20181128Orthopedic implant removal is a commonly performed procedure. While implant removal can be associated with<br />improved symptoms, risks of the surgery are notable. Stripped screws, broken and retained hardware, and morbidity<br />associated with soft tissue compromise during difficult removal are all common. Familiarity with the instruments is<br />critical to procedure success. The purpose of this study is to assist removal of unfamiliar screws in upper extremity<br />surgery by offering a reference for screw and driver compatibility across manufacturers.<br />Inclusion of device manufacturers was determined by market share. Screw size, drive configuration, and screw removal<br />system compatibility data was collected and recorded. Screw, guide-wire, and screwdriver compatibility was assessed<br />and compared to two commonly utilized universal implant-removal sets.<br />Eight upper extremity implant vendors were included. The data was compiled in table format according to manufacturer<br />and sub-categorized to facilitate screw identification according to radiographically identifiable characteristics.<br />The diversity of orthopaedic implants in upper extremity surgery requires careful preoperative planning to identify the<br />appropriate equipment for implant removal.<br />The goal of this work is to provide a centralized reference of commonly implanted screws, guide-wires, and drivers for<br />the upper extremity to facilitate removal.<br />Level of evidence: VMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Anterolateral Meniscofemoral Ligament Associated with Ring-shaped Lateral Meniscus and Congenital Absence of Anterior Cruciate Ligament, Managed with Ligament Reconstruction1121161412810.22038/abjs.2019.14128ENMohammad RaziDepartment of Orthopedic Surgery, Rasoul Akram
Hospital, Iran University of Medical Sciences, Tehran, Iran0000-0003-0273-5599Hamed MazoochyDepartment of Orthopaedic Surgery, Atieh private
Hospital, Tehran, Iran0000-0001-9653-9403Elaheh Ziaei Ziabari*Harvard Medical School, Boston, USA
* Iran University of Science and Technology, Tehran, IranHaleh DadgostarSports Medicine Department, Rasoul Akram Hospital,
Iran University of Medical Sciences, Tehran, Iran
6 Bone and Joint Reconstruction Research Center, Shafa
Orthopedic Hospital, Iran University of Medical Sciences,
Tehran, Iran0000-0002-0855-1486Alireza Askari*Bone and Joint Reconstruction Research Center, Shafa
Orthopedic Hospital, Iran University of Medical Sciences,
Tehran, Iran
*Department of Orthopedics, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran0000-0001-6366-8284Peyman Arasteh*Noncommunicable Diseases Research Center, Fasa
University of Medical
Sciences, Fasa, Iran
* Department of MPH, Shiraz University of Medical
Sciences, Shiraz, Iran0000-0001-6499-9093Journal Article20190411A 24 year old otherwise healthy male was presented with a chief complaint of giving way in the left knee. MRI reported<br />complete anterior cruciate ligament (ACL) tearing. Arthroscopy showed ACL agenesis, ring-shaped lateral meniscus,<br />and an anomalous thick band extending from the anterior horn of the lateral meniscus to the intercondylar notch of the<br />lateral femoral condyle, which is known as the anterolateral meniscofemoral ligament (MFL). The MFL was attached<br />to the anatomic site of anteromedial bundle of ACL. ACL reconstruction surgery was performed using central 1/3 bone<br />tendon bone graft.<br />Practitioners should be aware that ACL reconstruction in lateral meniscofemoral ligament with associated ACL agenesis<br />is a treatment option in which the preservation of MFL, as the stabilizer of anterior horn of lateral meniscus, should be<br />considered during ACL reconstruction as a good treatment choice.<br />Level of evidence: VMashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic AssociationThe Archives of Bone and Joint Surgery2345-46448120200101Glomus Tumor of Uncertain Malignant Potential in Thumb: A Case Report and Review of Literature1171201250710.22038/abjs.2019.35225.1928ENKeivan RahbariOrthopedics Department, Imam Hospital Complex,
Tehran University of Medical Sciences, Tehran, Iran0000000182806697Mahmoud FarzanOrthopedics Department, Imam Hospital Complex,
Tehran University of Medical Sciences, Tehran, IranHana SaffarDepartment of Pathology, Cancer Institute, Imam
Hospital Complex, Tehran university of Medical
Sciences, Tehran, IranAmir R. FarhoudOrthopedics Department, Imam Hospital Complex, Joint
Reconstruction Research Center, Tehran University of
Medical Sciences, Tehran Iran0000-0001-5236-7363Journal Article20190113Malignant transformation of glomus tumor is exceedingly rare and most common reported in lower extremity and abdominal viscera. We could find only 6 previous case report of malignant glomus tumor in the hand. Although large and deeply located glomus tumors are considered to be malignant, evidence has shown that most of these cases were clinically benign. These lesions are better considered as glomus tumor of uncertain malignant potential. Due to rarity of malignant glomus tumor, decision for operative treatment must be based on few case reports. In this article we review the literature for malignant glomus tumor of hand and their management, also we report a 49 year-old man with glomus tumor of uncertain malignant potential in thumb who was treated by wide amputation<br />Level of evidence: IV