Plasminogen Activator Inhibitor-1 4G/5G Polymorphism Contributes to Osteonecrosis of the Femoral Head Susceptibility: Evidence from a Systematic Review and Meta-analysis
Mohammad R.
Sobhan
Department of Orthopedics, Shahid Sadoughi University
of Medical Sciences, Yazd, Iran
author
Masoud
Mahdinezhad-Yazdi
Department of Orthopedics, Afshar Hospital, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran
author
Mansour
Moghimi
Department of Pathology, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran
author
Kazem
Aghili
Department of Radiology, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran
author
Mohammadali
Jafari
Department of Emergency Medicine, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran
author
Masoud
Zare-Shehneh
Department of Medical Genetics, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran
author
Hossein
Neamatzadeh
Department of Medical Genetics, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran
author
text
article
2018
eng
Background: The Plasminogen Activator Inhibitor-1 gene 4G/5G (PAI-1 4G/5G) polymorphism has been suggestedto be associated with osteonecrosis of the femoral head (ONFH) susceptibility; however, the results are conflicting andinconclusive. We have carried out a comprehensive meta-analysis to derive a more precise estimation of the association.Methods: A comprehensive search in PubMed, EMBASE, Google Scholar, and ISI Web of Knowledge databaseswas conducted to identify all eligible case-control publications investigating the association between PAI-1 4G/5Gpolymorphism and ONFH risk. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were used toassess the association.Results: A total of six studies with 456 cases and 1,019 controls were included in this review. Three studies werefrom Caucasian descendants and the three others were from East Asian descendants. Overall analysis suggestsa significant association between PAI-1 4G/5G polymorphism and ONFH risk under the allele model (4G vs. 5G:OR =1.540, 95% CI =1.055-2.248, P=0.025) and the recessive model (4G4G vs. 4G5G+5G5G: OR=1.931, 95% CI:1.162-3.207, P=0.011). When stratified by ethnicity, we have found a significant association between PAI-1 4G/5Gpolymorphism and ONFH risk among the Caucasian (4G5G vs. 5G5G: OR=1.806, 95% CI: 1.064-3.067, P=0.029) andEast Asians (4G4G vs. 5G5G: OR=1.619, 95% CI: 1.025-2.556, P=0.039 and 4G4G vs. 4G5G+5G5G: OR=1.665, 95%CI: 1.207-2.297, P=0.002).Conclusion: The present meta-analysis suggested that PAI-1 4G/5G (rs1799889) polymorphism is a potential riskfactor for development of ONFH. However, large-scale and well-designed case-control studies in different ethnicitiesare required to validate these results. Level of evidence: II
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
468
477
https://abjs.mums.ac.ir/article_11648_793ad274f5d0e9af96d48689a887dbb9.pdf
dx.doi.org/10.22038/abjs.2018.31668.1828
Comparison of Custom-made Versus Prefabricated Thumb Splinting for Carpometacarpal Arthrosis: A Systematic Review and Meta-analysis
Aslan
Baradaran
Department of Orthopaedic Surgery, Montréal General
Hospital, McGill University, Canada
author
Ashkan
Baradaran
Orthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran
author
Mohammad H.
Ebrahimzadeh
Orthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran
author
Amir R.
Kachooei
Orthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran
Department of Hand and Orthopaedic Surgery, Rothman
Institute, Thomas Jefferson University, Philadelphia, USA
author
Michael
Rivlin
Department of Hand and Orthopaedic Surgery, Rothman
Institute, Thomas Jefferson University, Philadelphia, USA
author
Pedro
Beredjiklian
Department of Hand and Orthopaedic Surgery, Rothman
Institute, Thomas Jefferson University, Philadelphia, USA
author
text
article
2018
eng
Background: The goal of this study was to compare the two types of orthoses, prefabricated soft splints versus shortthermoplastic custom-made splints, that are the most commonly used for the management of first carpometacarpal(CMC) osteoarthritis (OA).Methods: We conducted a meta-analysis and systematic review in the literature based on the Preferred ReportingItems for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We extracted the outcomes of disabilityscores, pain scores, grip and pinch strength and gathered the unified data accordingly.Results: We included five randomized clinical trials with 230 patients with the mean age of 61 years and the meanfollow-up of 8.1 weeks. The results of the pooled data demonstrated only a statistically significant difference in disabilityscores among splints in favor of the prefabricated splints. The rest of the outcome measures consisting of pain, gripstrength, and pinch strength were not statistically different.Conclusion: According to our systematic review and meta-analysis, both thumb-based splints improved pain andfunction in the first CMC OA in a short-term follow-up, nevertheless the efficacy of prefabricated splints in abatement ofdisability scores was significantly higher than custom-made splints. In contrast, the other outcome measures includingpain, grip and pinch strength were improved identically after wearing either of the splints.Level of evidence: II
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
478
485
https://abjs.mums.ac.ir/article_11723_64759c2aa4acaf15c33e9ce7bbb03a40.pdf
dx.doi.org/10.22038/abjs.2018.34688.1909
Increased Risk of Heterotopic Ossification Following Revision Hip Arthroplasty for Periprosthetic Joint Infection
Jorge
Manrique
Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USA
author
Pouya
Alijanipour
Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USA
author
Snir
Heller
Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USA
author
Michael
Dove
Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USA
author
Javad
Parvizi
Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USA
author
text
article
2018
eng
Purpose: To investigate whether surgery for PJI of the hip, the number of procedures and their duration contribute to risk of HO formation. Methods: 56 patients with hip PJI undergoing one-stage (10) or two-stage (46) exchange arthroplasty were matched to 112 patients undergoing revision arthroplasty for aseptic failure based on age, gender, body mass index (BMI), surgical approach (all direct lateral) and date of surgery (2006-2013). Patients with Paget’s disease and ankylosing spondylitis, or preoperative HO were excluded. Perioperative pain management included use of the anti-inflammatory medications in all patients without prophylactic radiotherapy. Six-month postoperative radiographs were reviewed based on Brooker classification. Results: The incidence of overall HO in PJI and aseptic groups was 84% (47/56) and 11% (12/112), respectively. High grade HO (grades 3 and 4) in PJI and aseptic groups were 25% (24/56) and 4% (4/112), respectively. PJI was an independent risk factor for HO in the multivariate analysis (odds ratio of 9.3, 95% CI: 2.9-29.9, p<0.001). Conclusions: Patients undergoing surgical treatment of hip PJI seem to be at increased risk of developing HO compared to aseptic failure. HO prophylaxis regimens may be recommendable in eligible patients undergoing surgical intervention for PJI of the hip.
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
486
491
https://abjs.mums.ac.ir/article_11649_889db86ef32a0535a8b265486c2a5966.pdf
dx.doi.org/10.22038/abjs.2018.31741.1834
Longer Length of Stay Increases 1-year Readmission Rate in Patients Undergoing Hip Fracture Surgery
Tom J.
Crijns
Department of Surgery and Perioperative Care, Dell
Medical School, The University of Texas at Austin, Texas,
USA
author
Tyler
Caton
Department of Orthopaedic Surgery, JPS Health Network,
TX, USA
author
Teun
Teunis
Department of Plastic, Reconstructive and Hand Surgery,
University Medical Center Utrecht, Heidelberglaan,
Utrecht, The Netherlands
author
Jacob T.
Davis
Department of Orthopaedic Surgery, JPS Health Network,
TX, USA
author
Kindra
McWilliam-Ross
Orthopaedic Clinical Nurse Specialist, Texas Health
Harris Methodist Hospital Fort Worth, TX, USA
author
David
Ring
Department of Surgery and Perioperative Care, Dell
Medical School, The University of Texas at Austin, Texas,
USA
author
Hugo B.
Sanchez
Department of Orthopaedic Surgery, Acclaim Physician
group, Ben Hogan Center, TX, USA
author
text
article
2018
eng
Background: Proximal femur fractures are prevalent among the elderly and associated with substantial morbidity,mortality, and early readmission. Early readmission is gaining popularity as a measure of quality of hospital care and canlower reimbursement. A better understanding of the patient and treatment characteristics associated with readmissionmay help inform program improvement initiatives. This study tested the primary null hypothesis that length of stay isnot associated with higher rates of readmission within 30 days and 1 year in patients having operative treatment of aproximal femur fracture, accounting for discharge destination and other factors.Methods: We performed a secondary analysis on a database of 1,061 adult patients, age 55 years or older, admittedfor treatment of a proximal femoral fracture in an urban level 2 trauma center. Multivariable logistic and linear regressionmodels were created to account for the influence of age, sex, race, BMI, American Society of Anesthesiologists score(ASA), fracture type (AO/OTA), fixation type, operating surgeon, operative duration, and discharge destination.Results: In multivariable logistic regression analysis, treatment by surgeon 4 was independently associated with alower 30-day readmission rate. Higher one-year readmission rate was associated with a longer length of stay, ASAclass 3, 4 and 5.Conclusion: The observation that patients cared for by specific surgeons are more likely to experience readmissionwithin one year of surgery for a fracture of the proximal femur, suggests that program improvements to identify anddisseminate best practices might reduce readmission rates.Level of evidence: III
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
492
500
https://abjs.mums.ac.ir/article_11651_faf684751c8d01b37b19d1d7d133fde6.pdf
dx.doi.org/10.22038/abjs.2018.31911.1845
Total Hip Replacement Revision in a Single Brand Small Cementless Stem – Our Experience after the Findings of the National Joint Registry
Robert Pearse
Piggott
Department of Trauma and Orthopaedic Surgery, Galway
University Hospitals, Galway, Ireland
author
Rebecca
Lyons
Department of Trauma and Orthopaedic Surgery, Galway
University Hospitals, Galway, Ireland
author
Colin Gerard
Murphy
Department of Trauma and Orthopaedic Surgery, Galway
University Hospitals, Galway, Ireland
author
William
Curtin
Department of Trauma and Orthopaedic Surgery, Galway
University Hospitals, Galway, Ireland
author
text
article
2018
eng
Background: Cementless total hip replacement is the common THR performed in England, Wales, Northern Irelandand the Isle of Man. The Corail stem is the most popular cementless implant and has a ODEP 10A rating. Review ofits performance in the registry identified an increase rate of revision amongst the smaller stem sizes. However, claritywas not provided on the explanation for this finding. We reviewed our own experience of smaller stems with a view tounderstanding the reasons for revision.Methods: We reviewed a single centre, single surgeon experience of the smaller Corail stem sizes for a ten-yearperiod from 2003 to 2013. All data was collected from a prospectively maintained database. Details of clinical andradiological follow up were collected for all patients who had Corail stem size 8 and 9 implanted. Revision for any causewas taken as our endpoint.Results: 542 patients underwent total hip arthroplasty using the Corail stem during the study period. 53 small sizeCorail stems were implanted. The average age was 59 (range 17-88 years) and the average follow up was 41.4 months(range 1-118 months). 6 patients underwent revision during the study period, but only 4 stems required revision.The reasons for revision were aseptic loosening, fracture and metal-on metal complications. Only two stems requiredrevision for stem related factors (3.8%).Conclusion: There was no evidence of an increased rate of revision in the small Corail stems in our cohort.
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
501
507
https://abjs.mums.ac.ir/article_10305_7443375a33ad4e7bdb7882b7a0279908.pdf
dx.doi.org/10.22038/abjs.2017.21354.1551
Functional Outcome and Incidence of Osteoarthritis in Operated Tibial Plateau Fractures
Saranjeet Singh
Jagdev
Department of Orthopaedics, Pramukhswami Medical
College Karamsad, Anand, Gujarat, India
author
Subodh
Pathak
Department of Orthopaedics, Pramukhswami Medical
College Karamsad, Anand, Gujarat, India
author
Himanshu
Kanani
Department of Orthopaedics, Pramukhswami Medical
College Karamsad, Anand, Gujarat, India
author
Abhijeet
Salunke
Department of Orthopaedics, Pramukhswami Medical
College Karamsad, Anand, Gujarat, India
author
text
article
2018
eng
Background: In the challenging tibial condyle fractures despite anatomical joint reconstruction, development ofosteoarthritis may still occur secondary to the initial articular cartilage and meniscal injury. The aim of the study wasto know incidence of osteoarthritis in our operated cases of tibial plateau fracture and to evaluate functional outcome.Methods: Our operated 60 patients of tibial plateau fractures between 2006 to 2013 were evaluated retrospectively.Pre-operative radiographs were classified using Schatzker classification. Patients were followed up clinically andradiologically and were assessed for functional outcome and development of osteoarthritis.Results: The average duration of follow up was 76.32 months ranging from 42 to 130 months. The average age was41.28 (20-73) years. According to Schatzker classification type VI accounted for 32.5% and type V for 20 %. AverageVAS Score was 1.35 ranging from 0 to 4. According to American knee society scoring system, 47patients had excellentand 8 patients had good knee scores, while 52 patients had excellent, 4 patients had good and 1 patient had poorfunctional scores. According to Ahlback classification 25 patients had grade I, while 9 patients had grade II, 7 patientshad grade III and 3 patients had grade IV osteoarthritis of knee.Conclusion: Incidence of osteoarthritis goes higher with Schatzker’s grading. Despite presence of radiological arthritispatients can have good clinical function if the articular reduction and limb alignment are maintained. Treatment goalsshould include a congruent articular reduction, adequate knee stability, anatomical limb alignment and avoidance ofcomplications.Level of evidence: IV
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
508
516
https://abjs.mums.ac.ir/article_10304_0a76bfa0f48d3732e75d98c0a7f93e9d.pdf
dx.doi.org/10.22038/abjs.2017.21582.1555
Lower Bone Mineral Density is Associated with Intertrochanteric Hip Fracture
David N.
Bernstein
University of Rochester School of Medicine & Dentistry,
Rochester, USA
author
Jacob T.
Davis
Department of Orthopaedic Surgery, JPS Health Network,
Fort Worth, USA
author
Carson
Fairbanks
Department of Orthopaedic Surgery, JPS Health Network,
Fort Worth, USA
author
Kindra
McWilliam-Ross
Texas Health Harris Methodist Hospital Fort Worth, Fort
Worth, USA
author
David
Ring
Department of Surgery and Perioperative Care, Dell
Medical School, The University of Texas at Austin, Austin,
Texas, USA
author
Hugo B.
Sanchez
Department of Orthopaedic Surgery, Acclaim Physician
Group, Ben Hogan Center, Fort Worth, USA
author
text
article
2018
eng
Background: A better understanding of how bone mineral density and vitamin D levels are associated with femoralneck and intertrochanteric hip fractures may help inform healthcare providers. We asked: 1) In patients age ≥ 55 years,is there a difference in quantitative ultrasound of the heel (QUS) t-score between patients with fractures of the femoralneck and those with fractures of the intertrochanteric region, accounting for other factors 2) In patients age ≥ 55 years,is there a difference in vitamin D level between those with fractures of the femoral neck and those with fractures of theintertrochanteric region, accounting for other factors? 3) Is there an association between vitamin D level and QUS t-score?Methods: In this retrospective cohort study, 1,030 patients were identified using CPT codes for fixation of hip fracturesbetween December 2010 and September 2013. Patients ≥ 55 years of age who underwent operative management fora hip fracture following a fall from standing height were included. Three orthopaedic surgeons categorized fracture typeusing patient radiographs. Upon hospital admission, QUS t-scores and vitamin D levels were determined. Descriptivestatistics, bivariate analyses and multivariable regression were performed.Results: Accounting for potential confounders, patients with lower QUS t-scores were more likely to have intertrochantericfemur fractures than femoral neck fractures. In a bivariate analysis, there was no association between vitamin D leveland either fracture type. There was no association between vitamin D level and bone mineral density.Conclusion: Patients with lower bone density that fracture their hips are more likely to fracture in the intertrochantericregion than the femoral neck, but vitamin D levels are unrelated. Awareness of this association emphasizes theimportance of bone mineral density screening to assist with intertrochanteric hip fracture prevention.Level of evidence: III
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
517
522
https://abjs.mums.ac.ir/article_10300_414408fe13f9455b5d66372fbe43ab4e.pdf
dx.doi.org/10.22038/abjs.2017.22909.1606
Early Regain of Function and Proprioceptive Improvement Following Knee Arthroplasty
Wolfgang
Fitz
Brigham and Women’s Hospital, Boston, MA, USA
author
Pinak
Shukla
Great Plains Orthopedics, North Platte, NE, USA
author
Ling
Li
Brigham and Women’s Hospital, Boston, MA, USA
author
Richard D.
Scott
Brigham and Women’s Hospital, Boston, MA, USA
author
text
article
2018
eng
Background: Techniques that allow early muscle activation, such as closed kinetic chain (CKC) and open kineticchain (OKC) exercises, may play a beneficial role in the early rehabilitation of the reconstructed knee. However,current rehabilitation regimens have not been shown to reverse post-operative quadriceps activation failureand weakness. To investigate whether patients who use a continuous active motion (CAM) device that followsclosed kinetic chain principles have better early post-operative functional improvements than patients who use acontinuous passive motion (CPM) device that follows the principles of open kinetic chain principles. A prospectiverandomized controlled trial with non-blinded study staff. A tertiary care clinic at a teaching hospital. A total of 110patients signed the consent form and 83 patients participated in the study.Methods: Patients were randomly assigned to use either the CPM device for 4 hours daily for 3 weeks (controlgroup), or a CAM device for 3 sessions of 20 minutes for 3 weeks (intervention group), starting 24 hours afterknee replacement surgery.The primary outcome measure was to identify the superiority, inferiority, or equivalenceof one device at week 4 after knee arthroplasty using various functional outcome measures such as kinesthesia,quadriceps strength, coordination, general orthopaedic outcome measures and narcotic consumption.Results: At 4 weeks, all outcome measurements were comparable between the two groups, with the exceptionof sit-to-stand test: in the treatment group the time was significantly shorter compared to the control group(P=0.016). Balance was significantly better in both control (P=0.001) and treatment group (P=0.032) comparedto prior surgery.Conclusion: Most clinical centers would like to expedite functional recovery of knee arthroplasty patients withoutincreasing the risk of falls. We observed balance and kinesthesia improvements after surgery using eitherdevice which may be important to benefit fast recovery programs. Further research is warranted to see whetheradditional active closed kinetic chain exercised following knee replacement surgery could improve specificfunctional outcomes such the observed sit-to-stand test.
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
523
531
https://abjs.mums.ac.ir/article_10299_143d55158b6fa31a70ae45215d82756c.pdf
dx.doi.org/10.22038/abjs.2017.22936.1607
The Midterm Results of the Delta Xtend Reverse Shoulder System: A Five-Year Outcome Study
John G.
Horneff
The Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USA
author
Thema A.
Nicholson
The Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USA
author
Surena
Namdari
The Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USA
author
Gerald R.
Williams
The Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USA
author
Joseph A.
Abboud
The Rothman Institute at Thomas Jefferson University,
Philadelphia, PA, USA
author
text
article
2018
eng
Background: The purpose of this study was to examine the mid-term functional outcomes, radiographic results,and revision rates of patients treated with the Delta Xtend Reverse Shoulder System for both primary and revisionarthroplasty indications.Methods: A retrospective review was conducted of records for all individuals who underwent a reverse shoulderarthroplasty using the Delta Xtend Reverse Shoulder Prosthesis at a single institution. Radiographic analysis as well aspain and functional measures using the ASES, Quick DASH, SST, SF-12, Penn, SANE, EQ-5D and VAS, and VR-12scores. Patients were evaluated for five-year outcomes.Results: Fifty patients were available for 5-year outcomes. Thirty-three cases were primary arthroplasty cases and17 were revision arthroplasty cases. Postoperative radiographs at five years out from surgery were available for 46patients. The mean AGT overall was 32.6mm: 31.7mm the primary cases and 34.8mm for revision cases. Sirveauxscapular notching was: 65.2% (30/46) at Grade 0, 23.9% (11/46) at Grade 1, and 10.9% (5/46) at Grade 2. Overall,32/46 of stems were in neutral position, 10/46 were in valgus position, and 4/46 were in varus position. There was nosignificant correlation between stem position and scapular notching. The mean outcome scores for all patients at fiveyears were good to excellent. Two revision patients demonstrated loosening of the humeral stem on radiographs. Ninepatients demonstrated calcification of the long head of the triceps tendon.Conclusion: In conclusion, the Delta Xtend Reverse Shoulder System has shown to be a reliable arthroplastysystem for patients with CTA or failed prior arthroplasty. Patients are generally quite functional at five years out fromtheir reverse shoulder arthroplasty using this implant. Radiographic measures used to interpret the status of theimplant demonstrate that AGT is well maintained and scapular notching is minimal for the majority of cases.Level of evidence: IV
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
532
538
https://abjs.mums.ac.ir/article_10278_2f40cb3e48ac23f05cab0e1800ca4dbe.pdf
dx.doi.org/10.22038/abjs.2017.25570.1677
Bedside Ultrasonography for Early Diagnosis of Occult Radial Head Fractures in Emergency Room: A CTComparative Diagnostic Study
Michael-Alexander
Malahias
Orthopaedic Department, National and Kapodistrian
University of Athens, School of Medicine, Athens, Greece
author
Philip-Panagiotis
Manolopoulos
European University of Cyprus, School of Medicine,
Nicosia, Cyprus
author
Vikram
Kadu
Department of Orthopaedics, ACPM Medical College,
Dhule, Maharashtra, India
author
Omid
Shahpari
Orthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran
author
Dimitrios
Fagkrezos
Department of Radiology, “Konstantopouleio” Hospital,
Athens, Greece
author
Maria-Kyriaki
Kaseta
Orthopaedic Department, National and Kapodistrian
University of Athens, School of Medicine, Athens, Greece
author
text
article
2018
eng
Background: Some of the Mason type I fractures cannot be detected on early radiographic images. These occultfractures are considered as a diagnostic challenge for physicians. Our aim was to determine the value of bedsideultrasonography for the detection of Mason I radial head fractures that are non-visible in early X-ray’s.Methods: A prospective blind single-center diagnostic study was conducted (from June 2012 till May 2013) concerning23 patients who were clinically suspicious of having a radial head fracture. These patients were evaluated with abedside high frequency ultrasound in the Emergency Room (E.R.). The two sonographic criteria that were consideredto be diagnostic for fracture were: a. effusion besides the radial head-neck and b. cortical discontinuity of the radialhead or neck. All patients also underwent a Computed Tomography (CT) as the gold standard imaging modality fordiagnosis of occult radial head fractures.Results: Fifteen out of 23 patients were diagnosed with radial head fracture using both ultrasound and CT. On the otherhand, there were three patients with negative ultrasound and positive CT, in addition two patients were found positive inthe ultrasonographic exam, while this result was not confirmed by the CT scan. In comparison with CT, ultrasound examappeared to have 83.3% sensitivity, 60% specificity, 88.2% positive prognostic value and 50% negative prognosticvalue (when at least one diagnostic sonographic criterion was positive). The accuracy of the sonographic study for thediagnosis of the aforementioned fractures was 78.2%. Effusion in contact with the radial neck was the most sensitivesonographic sign (14/15 of the true positive radial head ultrasounds).Conclusion: Bedside ultrasound in the E.R. was proven to be a sensitive tool for early (day-1) diagnosis of the occultradial head fractures. It could be used as an adjacent imaging modality in patients suspicious for radial head fracture,when the initial X-rays are negative.Level of evidence: II
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
539
546
https://abjs.mums.ac.ir/article_11642_a18584fa6ff560a09665abff8bc54050.pdf
dx.doi.org/10.22038/abjs.2018.29588.1765
Effects of Zoledronic Acid and Vitamin E on Surgical– Induced Osteonecrosis of the Femoral Head in Rabbit
Kaveh
Gharanizadeh
Bone and Joint Reconstruction Research Center, Shafa
Orthopedic Hospital, Iran University of Medical Sciences
(IUMS), Tehran, Iran
author
Sina
Aminizadeh
Bone and Joint Reconstruction Research Center, Shafa
Orthopedic Hospital, Iran University of Medical Sciences
(IUMS), Tehran, Iran
author
Nima
Molavi
Bone and Joint Reconstruction Research Center, Shafa
Orthopedic Hospital, Iran University of Medical Sciences
(IUMS), Tehran, Iran
author
Amir
Darbandi
Rajaie Cardiovascular, Medical and Research Centre, Iran
University of Medical Sciences (IUMS), Tehran, Iran
author
Shabnam
Nadjafi
Iran University of Medical Sciences (IUMS), Tehran, Iran
author
Mahsa
Fadavighaffari
Iran University of Medical Sciences (IUMS), Tehran, Iran
author
Tina
Shooshtarizadeh
Bone and Joint Reconstruction Research Center, Shafa
Orthopedic Hospital, Iran University of Medical Sciences
(IUMS), Tehran, Iran
author
text
article
2018
eng
Background: Femoral head osteonecrosis is a progressive disease with disabling outcomes in hip joint if not treated.This study was designed to compare the effects of zoledronic acid plus vitamin E versus zoledronic acid alone insurgical induced femoral head osteonecrosis in rabbits.Methods: 26 Japanese white adult normal male rabbits at 28-32 weeks old were undertaken surgical femoraldislocation to devastate the femoral neck vessels; the femoral neck vessels were ligated and the hip was relocated.Next, the first 10 rabbits received zoledronic acid injections at 1st and the 4th weeks; the second group (10 rabbits)received zoledronic acid injections at 1st and the 4th week along with daily oral vitamin E for 12 weeks; and thethird group was considered as non-treated control group. Radiographic and postmortem pathological assessmentsincluding the Ficat classification, epiphyseal quotient (EQ), new bone formation, and residual necrotic bone (RNB)were performed and compared after week 12.Results: A significant difference was found between the combination therapy group and the control group in Ficatclassification at 12th weeks (P=0.048), but, the difference between monotherapy and combination therapy groups at12th weeks was nonsignificant (P=0.37). Also, both treated groups had significant difference with the control group forRNB (P=0.015). There were no significant differences between the three groups for Ficat classification at the 6th week(P=0.65); EQ at 6th (P=0.59) and 12th week (P=0.64); and NBF (P=0.55).Conclusion: Although zoledronic acid therapy along with vitamin E could improve some radiologic and pathologicalindices related to femoral head osteonecrosis, vitamin E showed a relative impact.Level of evidence: I
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
547
553
https://abjs.mums.ac.ir/article_10293_fa1c7d7be739f70b1599712a441c5398.pdf
dx.doi.org/10.22038/abjs.2017.24074.1629
Staphylococcus aureus Colonization in Patients Undergoing Total Hip or Knee Arthroplasty and Costeffectiveness of Decolonization Programme
Hosseinali
Hadi
Orthopedic Department, Arak university of medical
sciences, Arak, Iran
author
Mahmood
Jabalamoli
Bone and Joint Reconstruction Research Center, Shafa
Yahyaian Hospital, Iran university of medical sciences,
Tehran, Iran
author
Abolfazl
BagheriFard
Bone and Joint Reconstruction Research Center, Shafa
Yahyaian Hospital, Iran university of medical sciences,
Tehran, Iran
author
Ehsanollah
Ghaznavi-Rad
Department of Microbiology and Immunology, Arak
University of Medical Sciences, Arak, Iran
author
Ahmadreza
Behrouzi
Orthopedic Surgery, Valiasr Hospital, Arak University of
Medical Sciences
author
Ali
Joorabchi
Department of Microbiology and Immunology, Arak
University of Medical Sciences, Arak, Iran
author
Amir
Azimi
Orthopedic Department, Arak university of medical
sciences, Arak, Iran
author
text
article
2018
eng
Background: Periprosthetic joint infection is a devastating complication of total joint arthroplasty. It seems that thepatient’s skin, nose, throat, and urine are important sites for microbial colonization. Colonization with staphylococcusaureus, especially methicillin resistant increases the risk of periprosthetic joint infection. The aim of this study was toassess the prevalence of staphylococcus aureus colonization in patients candidate for arthroplasty in central Iran aswell as cost-effectiveness of decolonization program for prevention of post-arthroplasty infection.Methods: A total of 226 patient candidates for total joint arthroplasty were enrolled in this prospective cross-sectionalstudy between January 2014 and January 2016. Specimens from nose, throat, groin skin, and urine were sent forbacteriologic culture and sensitivity test. Analysis cost-effectiveness was then performed for decolonization programme.Results: Patients had positive cultures from nose (15.9%), throat (4.4%), groin skin (3.1%), and urine (0.9%). Ingeneral, 20.8% of the patients had positive cultures for staphylococcus aureus, among whom, 1.8% were methicillinresistant. Based on cost-effectiveness analysis, decolonization program leads to 80% reduction in costs.Conclusion: According to our results, although colonization with methicillin sensitive staphylococcus aureus in patientsundergoing hip or knee arthroplasty is lower than other studies but colonization with methicillin resistant staphylococcusaureus is similar to others. Also, decolonization programme in these patients was found to be very cost-effective.Level of evidence: II
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
554
559
https://abjs.mums.ac.ir/article_10833_b7843630c759368d83f680bcfb348010.pdf
dx.doi.org/10.22038/abjs.2018.26735.1709
The Ratio of Lumbar to Hip Motion during the Trunk Flexion in Patients with Mechanical Chronic Low Back Pain According to O’Sullivan Classification System: A Cross-sectional Study
Majid
Shahbazi Moheb Seraj
Department of Physiotherapy, School of Rehabilitation
Sciences, Iran University of Medical Sciences
author
javad
Sarrafzadeh
Department of Physiotherapy, School of Rehabilitation
Sciences, Iran University of Medical Sciences
author
Nader
Maroufi
Department of Physiotherapy, school of Rehabilitation Sciences, Iran University of Medical Sciences.
author
Ismail
Ebrahimi Takamjani
Department of Physiotherapy, school of Rehabilitation Sciences, Iran University of Medical Sciences.
author
Amir
Ahmadi
Department of Physiotherapy, school of Rehabilitation Sciences, Iran University of Medical Sciences.
author
Hossein
Negahban
Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
Orthopedic research center, Mashhad University of Medical Sciences, Mashhad, Iran.
author
text
article
2018
eng
Background: Static and dynamic postures of lumbopelvic in low back pain (LBP) are considered as two importantaspects of clinical assessment and management of LBP. Thus, the focus of the current study was to compare theposture and compensatory strategy of hip and lumbar region during trunk flexion between LBP subgroupsand healthsubjects. LBP cases are subdivided into active extension pattern (AEP) and flexion pattern (FP) based on O’Sullivan’sclassification system (OCS).Methods: This work was a cross-sectional study involving 72 men, 21 low back pain patients with FP and 31 low backpain patients with AEP and 20 healthy groups. Lumbar and hip angles during trunk flexion were measured by a 3Dmotion analysis system in neutral standing posture and end-range of trunk flexion. The participants were asked to fullbend without any flexion of the knees. The bending speed was preferential. Hip and lumbar ranges of motion weredivided into four quartiles (Q). The quartiles were compared between groups. Data analysis was performed using onewayanalysis of variance (ANOVA) and independent t-test.Results: There was no statistically significant difference in lumbar lordosis in standing and full trunk flexion positionsbetween the healthy groups and heterogeneous LBP groups. In addition, there was not any statistically significantdifference between the healthy group and the homogenous LBP group (FP and AEP). Moreover, no statistically significantdifference was observed in hip angles during standing between the healthy group and the heterogeneous LBP group,and between the healthy group and the homogenous LBP group (FP and AEP). In full trunk flexion position, there wasstatistically significant difference in hip angles between the healthy group and the heterogeneous LBP group (P=0.026).In this position, the difference in hip angles between the healthy group and FP group was statistically significant(P<0.05). In the second Q, there was no significant difference between the healthy group and the heterogeneous LBPgroup (P=0.062), however, there was a significant difference between FP group and the healthy group in the fourthQ of the total hip range of motion. There was no statistically significant difference between the healthy group and theheterogeneous LBP group (P=0.054) but there was a difference between FP group and the healthy group. Lumbar/hipmotion ratio (L/H ratio) was different between and within the subgroups in the second Q.Conclusion: This study supported the subgrouping of LBP and showed that the difference between subgroups couldbe determined effectively through subdividing the total range of lumbar and hip motions into smaller portions. It ispossible that the neuromuscular system selects different strategies to compensate and prevent further injury of thechain components (muscle, joint, nerve and etc.).Level of evidence: IV
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
560
569
https://abjs.mums.ac.ir/article_11158_9bc72abcace6dcf4b943c4046350a950.pdf
dx.doi.org/10.22038/abjs.2018.30940.1803
It’s Not About The Biceps
Job N.
Doornberg
Department of Orthopaedic Surgery, Amphia Hospital,
Breda, The Netherlands
Department of Orthopaedic Surgery, Academic Medical
Center Amsterdam, The Netherlands
author
Jetske
Viveen
Department of Orthopaedic Surgery, Amphia Hospital,
Breda, The Netherlands
author
David
Ring
Comprehensive Care Dell Medical School University of
Texas, Austin, TX, USA
author
Annechien
Beumer
Department of Orthopaedic Surgery, Amphia Hospital,
Breda, The Netherlands
author
Denise
Eygendaal
Department of Orthopaedic Surgery, Amphia Hospital,
Breda, The Netherlands
Department of Orthopaedic Surgery, Academic Medical
Center Amsterdam, The Netherlands
author
Bertram
The
Department of Orthopaedic Surgery, Amphia Hospital,
Breda, The Netherlands
author
text
article
2018
eng
In the biomedical paradigm all symptoms and limitations are ascribed to discrete pathophysiology. However, abiopsychosocial health model that accounts for the important influence of mind-set and circumstances on illness maybe preferable in the vast majority of cases. Some of the shortcomings of the biomedical model include an overrelianceon tests and treatments. One major issue of the biomedical model is the raging epidemic of opioid misuse and opioidrelated overdose deaths as previously reported in North America.Emblematic of these issues is a 56-year-old male that had surgery for a rupture of the distal biceps in our clinic withpsychosocial aspects of the illness that were underappreciated by the care team and had disastrous opioidcentricattempts at pain control leading to threats to hospital staff, and finally resulting in forcible removal by hospital securityfrom the ward and national police from the hospital. One might argue that there is no higher priority than rejecting thebiomedical model, understanding illness is its full complexity, and learning from the world’s mistakes so that we don’trepeat them.Level of evidence: V
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
570
576
https://abjs.mums.ac.ir/article_10826_3f0d3401e255b934bdcee67906de2afe.pdf
dx.doi.org/10.22038/abjs.2018.30877.1802
Knee and Hip Joint Replacement Surgery in a Patient with Ochronotic Arthropathy: Surgical Tips
Hamed
Mazoochy
Department of Trauma and Orthopaedic, Shahid
Modarress Hospital, Saveh, Markazi, Iran
author
Mohammad
Razi
Department of Orthopaedic Surgery and Department
of Sports Medicine, Iran University of Medical sciences,
Tehran, Iran
author
text
article
2018
eng
Ochronosis or black joints disorder is a rare autosomal recessive disorder caused by deficiency of homogentisic acidoxidase. Orthopaedic manifestations are common and mostly involve spine and large joints such as knee and hip.Arthropathy is progressive and will eventually leads to arthroplasty. Not being familiar with this disorder might lead todevastating complications. We present a 57 year-old woman with Ochronosis who successfully underwent cementedcruciated substituted knee replacement and cementless hip replacement. Proper orthopaedic and anesthetic preoperativepreparation, soft tissue specially patella tendon management throughout operation and meticulous bleedingcontrol during surgery are crucial. The results of the knee and the hip replacement surgery in this patient are satisfactory,after 24 months and 18 months follow-up, respectively. If Orthopaedic surgeons and anesthesiologists are well prepared,the outcome of joint replacement in Ochronosis patients will be as satisfactory as patients with primary osteoarthritis.Level of evidence: V
The Archives of Bone and Joint Surgery
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
2345-4644
6
v.
6
no.
2018
577
581
https://abjs.mums.ac.ir/article_11256_168bc20be4af50a6c02f9da4f34e6f0a.pdf
dx.doi.org/10.22038/abjs.2018.29808.1773