Editorial: What Is Peer Review?
Amir
Kachooei
Rothman Institute at Thomas Jefferson University
author
Mohammad H.
Ebrahimzadeh
Orthopedic Research Center, Mashhad University of Medical
Sciences, Mashhad, Iran
author
text
article
2022
eng
The first journal that formalized the peer reviewprocess is The Philosophical Transactions of theRoyal Society, the first and longest-running journallaunched in 1665 by Henry Oldenburg (1618- 1677) (1).The review of a research paper starts with the ‘InternalReview’ process. All authors must read the articleand reconcile their comments before submission. Theexternal review process begins after article submission,and the editor assigns the paper to the outside reviewersunrelated to the work of the study. External reviewersevaluate the submitted article for quality, accuracy, andcompleteness based on the journal’s requirements.Reviewers’ feedback includes accepting, rejecting, orrequesting a revision to the article. The editor determinesthe final decision, but the reviewers’ comments andrecommendations show if the article is amenable toimprovement by revision.
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
10
v.
1
no.
2022
1
2
https://abjs.mums.ac.ir/article_19585_73b01ff1397e3731f1c6fea7969cb76d.pdf
dx.doi.org/10.22038/abjs.2022.19585
Distal Radioulnar Joint Instability: Diagnosis and Treatment
E. Carlos
RODRIGUEZ-MERCHAN
Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain.
2 Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
author
Babak
Shojaei
Orthopedic Research Center, Department of Orthopedic, Hand, and Microsurgery, St. Marien Stift Medical Campus, Friesoythe, Germany
author
Amir R.
Kachooei
Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA.
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Iran
author
text
article
2022
eng
Distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) tears are more usual than estimated and are frequently overlooked. Diagnosis is often clinical, which can be confirmed using computed tomography (CT) scan and magnetic resonance imaging (MRI). In doubtful cases, bilateral computed tomography in neutral forearm rotation, supination, and pronation should also be performed. Wrist arthroscopy can be diagnostic and therapeutic for ulnar-sided wrist pain. Two systematic reviews showed equivalent outcomes between open and arthroscopic repair of the TFCC. There is scant proof to advise one technique over the other in clinical practice. TFCC repair and reconstruction are contraindicated when there is a bony deformation of the radius or ulna or osteoarthritis of the DRUJ. With the advancement of implant arthroplasty, salvage procedures are less desirable. Constrained distal radioulnar arthroplasty is stable, and the longevity is encouraging. 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
10
v.
1
no.
2022
3
16
https://abjs.mums.ac.ir/article_18367_dce10fa7c630bfebcd6b7f079c65672e.pdf
dx.doi.org/10.22038/abjs.2021.57194.2833
The Effect of Secretome, Xenogenic Bone Marrow-Derived Mesenchymal Stem Cells, Bone Morphogenetic Protein-2, Hydroxyapatite Granule and Mechanical Fixation in Critical-Size Defects of Rat Models
Ismail
Dilogo
1 Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
2 Stem Cell and Tissue Engineering Research Cluster, Indonesia Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia
3 Stem Cell Medical Technology Integrated Service Unit, Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
author
Jessica
Fiolin
Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
author
Anissa
Canintika
Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
author
Jeanne
Pawitan
2 Stem Cell and Tissue Engineering Research Cluster, Indonesia Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia
3 Stem Cell Medical Technology Integrated Service Unit, Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
4 Department of Histology, Faculty of Medicine Universitas Indonesia
author
Evah
Luviah
Stem Cell and Tissue Engineering Research Cluster, Indonesia Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia
author
text
article
2022
eng
Background: Recent studies have shown that human bone marrow-derived mesenchymal stem cells (hBM-MSCs) have several drawbacks in treating critical-sized bone defect (CSD). Secretome may offer considerable advantages over living cells in terms of potency, manufacturing and storing easiness, and potential as a ready-to-go osteoinductive agent. However, thus far, there are no studies regarding the efficacy of secretome in bone healing. The objective of this study is to investigate the effect of the secretome in rat models with CSD. Methods: This was an experimental study with post-test only control group design using 60 skeletally mature Sprague Dawley rat which was divided evenly into 5 treatment groups (MSC only, Secretome only, MSC + Secretome, MSC + Secretome + BMP-2, Control group using Normal Saline). We used Bone Marrow derived MSC in this research. The critical-sized bone defect was created by performing osteotomy and defect was treated according to the groups. Rats were sacrificed on 2nd and 4th week and we measured the radiological outcome using Radiographic Union Score for Tibia (RUST) and histomorphometric (callus, osseous, cartilage, fibrous, and void area) evaluation using Image J. Results: There was no difference in the weight of rats between groups before and after the intervention. RUST score in all intervention group is significantly higher than the control group, however, the MSC-only group was not statistically significant higher than the control group. There is no statistically significant difference in RUST Score between intervention groups. Histomorphometric evaluation showed that total callus formation is the widest in the MSC+Secretome+BMP-2 combination group while the osseous area is found highest on the secretome-only group. Conclusion: Secretome, whether used solely or combined with BM-MSC and BMP-2, is a novel, potent bone-healing agent for CSD in rat models. 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
10
v.
1
no.
2022
17
22
https://abjs.mums.ac.ir/article_17783_864c77f1e0c86314c7a37e6824f2fb3e.pdf
dx.doi.org/10.22038/abjs.2021.49539.2458
Impact of the National Lockdown Due to the COVID-19 Pandemic On Upper Limb Trauma Workload in Central London: A Multi-Centre Longitudinal Observational Study During Implementation and Ease of National Lockdown
Catrin
Morgan
Chelsea and Westminster NHS Foundation Trust, London, England, UK
author
Kapil
Sugand
Imperial College Healthcare NHS Trust, London, England, UK
author
Thomas
Ashdown
Imperial College Healthcare NHS Trust, London, England, UK
author
Nikita
Nathoo
Chelsea and Westminster NHS Foundation Trust, London, England, UK
author
Robert
Macfarlane
Chelsea and Westminster NHS Foundation Trust, London, England, UK
author
Rory
Dyke
Imperial College Healthcare NHS Trust, London, England, UK
author
Chang
Park
Imperial College Healthcare NHS Trust, London, England, UK
author
Arash
Aframian
Chelsea and Westminster NHS Foundation Trust, London, England, UK
author
Peter
Domos
Barnet Hospital, Royal Free NHS Foundation Trust, London, England UK
author
Maxim
Horwitz
Chelsea and Westminster NHS Foundation Trust, London, England, UK
author
Khaled
Sarraf
Imperial College Healthcare NHS Trust, London, England, UK
author
Rupen
Dattani
Chelsea and Westminster NHS Foundation Trust, London, England, UK
author
text
article
2022
eng
Background: This study assessed the impact of the COVID-19 pandemic on acute upper limb referrals and operative case-mix at the beginning and ease of British lockdown. Methods: A longitudinal multicentre observational cohort study was conducted for both upper limb trauma referrals and operative case-mix over a 12-week period (6 weeks from the beginning and 6 weeks from the ease of the national lockdown). Statistical analysis included median (± median absolute deviation), risk and odds ratios, and Fisher’s exact test to calculate the statistical significance, set at p ≤ 0.05. Results: There was a 158% (n = 456 vs. 177) increase in upper limb referrals and 133% (n = 91 vs. 39) increase in the operative trauma caseload at the ease of lockdown compared with its commencement. An increase in sporting injuries was demonstrated (p=0.02), specifically cycling (p=0.004, OR=2.58). A significant increase in COVID-19 testing was demonstrated during the ease of lockdown (p=0.0001) with more patients having their management changed during the early pandemic (9.6% vs. 0.7%, p=0.0001). Of these patients, 47% went on to have delayed surgery within 6 months. No patients who underwent surgery tested positive for COVID-19 infection within 14 days post-operatively and no mortalities were recorded at 30 days. Conclusion: The ease of lockdown has seen upper limb referrals and operations more than double compared to early lockdown. With no patients testing positive for COVID-19 within 14 days of the procedure, this demonstrates that having upper limb surgery during the current pandemic is safe. 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
10
v.
1
no.
2022
23
31
https://abjs.mums.ac.ir/article_17787_e49d1806c6c3418f47dc1ef0fbba1c92.pdf
dx.doi.org/10.22038/abjs.2021.53205.2639
Comparison of Contemporary Surgical Indications for Revision Total Knee Arthroplasty between 2005–2011 and 2012–2017 in a Referral Center
Hanifi
UCPUNAR
Department of Orthopedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
author
Yalkin
CAMURCU
Department of Orthopedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
author
Abdul
BUYUK
2Department of Orthopedics and Traumatology, Baltalimani Bone and Joint Diseases Education and Research Hospital, Turkey
author
Abdurrahman
AYDIN
2Department of Orthopedics and Traumatology, Baltalimani Bone and Joint Diseases Education and Research Hospital, Turkey
author
Suleyman
TAS
2Department of Orthopedics and Traumatology, Baltalimani Bone and Joint Diseases Education and Research Hospital, Turkey
author
Vedat
SAHIN
Department of Orthopedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
author
text
article
2022
eng
Background: Different causative factors for revision total knee arthroplasty (TKA) surgeries are elucidated in the arthroplasty registry data of different countries and the patient records at tertiary care centers. We aimed to determine the changes in the causes for revision TKAs before and after 2011 (The year that the Musculoskeletal Infection Society proposed a new definition for periprosthetic joint infection) and the changes in the demographics of patients who underwent revision TKAs during the same time intervals. Methods: Patients who underwent revision TKAs between 2004 and 2017 were evaluated. A total of 291 patients operated before (period 1, n = 139) and after (period 2, n = 152) 2011 were included, while 53 patients with inconclusive diagnoses were excluded. The demographic data of patients and the causes for revision TKAs were collected and compared between the two periods. Results: Infection was the most common cause of revision TKAs during periods 1 (58%) and 2 (48%). Aseptic loosening (46%) and infection (37%) were the 2 most common causes for late revisions during period 2. Aseptic loosening almost doubled during period 2 compared with that in period 1. Age, sex, and body mass index distribution in patients were similar across both the periods. Conclusion: Although the incidence of aseptic loosening has significantly increased since 2011, infection is still the most common cause for revision knee arthroplasty surgery. 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
10
v.
1
no.
2022
32
37
https://abjs.mums.ac.ir/article_17779_da40ee580f1315a7c63b33a08c1ca90e.pdf
dx.doi.org/10.22038/abjs.2021.47457.2326
Urine Dipstick Leukocyte Esterase in the Rapid Diagnosis of Septic Arthritis
Hossein
Aslani
Tabriz University of Medical Sciences, Tabriz, Iran
author
Mohamad Reza
Pasha Zanoosi
Department of Orthopedics, Shohada hospital, Tabriz University of Medical sciences, Tabriz, Iran
author
Amir Mohamad
Navali
Tabriz University of Medical Sciences, Tabriz, Iran
author
text
article
2022
eng
Background: This study aimed to evaluate the sensitivity and specificity of the leukocyte esterase (LE) band in two groups of patients receiving and not receiving antibiotics and compare the results. Methods: This prospective cross-sectional study was conducted on 105 joints with clinical suspicion of infectious arthritis (based on Kocher criteria) admitted in Shohada Hospital, Tabriz, Iran, within 2017-2018. Patients were divided into two groups, including receiving antibiotics (n=29; group 1) and not receiving antibiotics (n=76; group 2). Articular fluid aspiration was performed under sterile conditions with an 18-gauge angiocath with at least 1 ml volume of the hip, knee, ankle, elbow, and shoulder joints. Polymorphonuclear cell percentage count, cell count, Gram staining (GS), culture, and leukocyte esterase test were performed immediately after the aspiration of the specimens. Results: Levels of synovial fluid white blood cell count, serum white blood cell count, PMN, serum glucose, erythrocyte sedimentation rate, C-reactive protein, and time of aspiration (TOA) were significantly higher in the group receiving antibiotics (P<0.05). Synovial glucose levels were significantly lower in the group receiving antibiotics. Furthermore, the positive frequency of glucose esterase, blood culture, GS, serum culture, and ultimate diagnosis of septic arthritis tests were significantly lower in the antibiotic receiving group (P<0.05). The sensitivity, specificity, and positive predictive value of the leukocyte esterase test were obtained at 100%, 0%, and 96.55% in the antibiotic receiving group, respectively. Moreover, in the group not receiving antibiotics, the sensitivity, specificity, positive predictive value, and negative predictive value of the leukocyte esterase test were estimated at 72.22%, 92.50%, 89.66%, 78.72%, respectively. Conclusion: Antibiotic use and the prolongation of TOA lead to increased inflammatory products, which is interfering with lab variables. As a result, they increase the sensitivity of the test. The sensitivity and specificity of the leukocyte esterase test in patients who did not receive antibiotics showed that this was a suitable and reliable laboratory method for the rapid detection of infectious arthritis that required an emergency rescue procedure. 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
10
v.
1
no.
2022
38
44
https://abjs.mums.ac.ir/article_17780_4ce8755c464d9f8845133ba558d0c579.pdf
dx.doi.org/10.22038/abjs.2021.47573.2334
The Outcomes of Soft-Tissue Repair for Posterior Instability Surgery
Hassanin
Alkaduhimi
Massachusetts General Hospital, Orthopaedic Sports Department, Harvard Medical School, Boston, Massachusetts, U.S.A 2 Shoulder and elbow unit, Joint Research, OLVG Amsterdam, the Netherlands
author
N.F.J.
Hilgersom
Massachusetts General Hospital, Orthopaedic Sports Department, Harvard Medical School, Boston, Massachusetts, U.S.A
author
Denise
Eygendaal
Orthopaedic Department, Amphia Ziekenhuis, Breda, the Netherlands 3 Orthopaedic Department, Academic Medical Center, Amsterdam, the Netherlands
author
M.P.J.
van den Bekerom
Shoulder and elbow unit, Joint Research, OLVG Amsterdam, the Netherlands
author
Luke
Oh
Massachusetts General Hospital, Orthopaedic Sports Department, Harvard Medical School, Boston, Massachusetts, U.S.A
author
text
article
2022
eng
Background: This study aimed to assess the results after soft-tissue posterior instability surgery and address possible challenges during these operations.Methods: The databases of two tertiary hospitals were reviewed to identify patients treated for posterior shoulder instability between 2000 and 2015. Out of 198 treated patients, 19 cases underwent surgery with a mean follow-up of 35 months. Chart review was performed to obtain recurrence rates, revision rates, return to sport, persistent pain, subjective instability, subjective feeling of being better, complications, and range of motion after operative treatment of posterior shoulder instability. These outcomes were compared using the Fisher’s exact and Mann-Whitney U tests. Results: After surgery, 6 (32%) patients had a recurrent subluxation, and 11 (58%) cases had persistent pain; moreover, 5 (26%) patients had a persistent feeling of instability, and 10 (53%) cases did not feel improvement after the operation. Furthermore, 10 (53%) patients required a revision, and there were 7 (37%) cases with a complication. Postoperatively, 75% of the patients had a full forward flexion, and 93% of the cases had full internal rotation; however, 64% of them had restrictions in external rotation. Conclusion: There is a high rate of recurrent instability, need for revision, and complications after soft-tissue posterior instability surgery. Postoperative external rotation was impaired in most patients. Patients should be informed about these unsatisfactory results. 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
10
v.
1
no.
2022
45
51
https://abjs.mums.ac.ir/article_17893_72a3551d92c53d8316f5621e9bd5fd99.pdf
dx.doi.org/10.22038/abjs.2021.41491.2121
Lung Injuries Associated with Scapular Fractures in Adult Traumatic Patients
Najmeh
Zarei Jelyani
Emergency Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
author
Ali Reza
Torabi Jahromi
Emergency Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran.
author
Razieh Sadat
Mousavi-Roknabadi
1 Emergency Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran.
2 Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
author
Saeid
Esmaeilian
Radiology Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
author
Pourya
Medhati
Emergency Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran.
author
text
article
2022
eng
Background: Scapular fractures are among the orthopedic injuries, which are associated with other injuries, such as lung injuries. This study aimed to evaluate the prevalence of lung injuries associated with scapular fractures in traumatic patients referred to a main trauma center in the south of Iran. Methods: The present retrospective cross-sectional study was conducted from April 2016 to June 2019 on adult traumatic patients, who were referred to one of the main trauma centers in the south of Iran, and their data were recorded in the hospital information system. The patients with chest computed tomography, and those whose scapula fractures were reported and confirmed by a radiologist were included in this study. All patients' data were extracted from their medical files and then analyzed. Results: A total of 100 patients were enrolled, and the majority (78%) of the cases were male. The mean±SD age of the patients was 40.71±14.071 years, and 55% of the cases had lung injuries (P=0.158). Furthermore, most of the causes of scapular fracture were due to car-motorcycle accidents (30%) and car overturning (27%). Lung contusion (31%) and hemothorax (30%) were the most types of lung injuries. The mean±SD duration of hospitalization was estimated at 4.94±7.90 days. The mean age (OR=-0.207, P=0.039) and intensive care unit admission rate (OR=0.267, P=0.007) were statistically different in patients with and without lung injuries. Conclusion: Although scapula fractures were not significantly associated with lung injuries in this study, the occurrence of 55% of the lung injuries was clinically important, which should be considered by emergency physicians. 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
10
v.
1
no.
2022
52
55
https://abjs.mums.ac.ir/article_17786_7ede35497fdb95e17796b52dbdf203c7.pdf
dx.doi.org/10.22038/abjs.2021.53063.2632
Incidence of Operating Room Fires During Hand Surgical Procedures
Kevin
Lutsky
Rothman Orthopedics, Hand & Upper Extremity Surgery
925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
author
Lili
Schindelar
Department of Orthopedic Surgery, Thomas Jefferson University, Sidney Kimmel Medical Center, Philadelphia, PA, USA
author
Daniel
Seigerman
Rothman Orthopedics, Hand & Upper Extremity Surgery
925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
author
Chistopher
Jones
Rothman Orthopedics, Hand & Upper Extremity Surgery
925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
author
Brian
Katt
Rothman Orthopedics, Hand & Upper Extremity Surgery
925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
author
Pedro K.
Beredjiklian
Rothman Orthopedics, Hand & Upper Extremity Surgery
925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
author
text
article
2022
eng
Background: The purpose of the present study is to report the incidence of operating room fires during hand surgical procedures. Methods: The clinic and OR electronic medical records of seven fellowship-trained orthopedic hand surgeons at a single, large practice were retrospectively reviewed. All upper extremity procedures performed between June 2014 to June 2019 in both hospital and surgery center settings were included in the review. Demographic data was collected. The incidence of operating room fires was determined. Results: A total of 18,819 hand and upper extremity surgical procedures were included. There were 16,767 (89.1%) cases performed in a surgery center, while 2,052 (10.9%) of cases were performed in a hospital. There were 12,691 (67.4%) soft tissue procedures and 6,127 (32.6%) bony procedures performed. Chlorhexidine gluconate preparation solution was used in 9607 cases (51%). Chloraprep solution was used in 6280 cases (33.4%). Betadine was used in 2,932 cases (15.6%). One surgeon has monopolar electrocautery only available during cases. Five surgeons have bipolar available, and one has both mono and bipolar electrocautery available. There were no fires (0%) identified during the study period. Conclusion: The incidence of operating room fires during hand surgical procedures is extremely low. While hand surgeons can be reassured that the likelihood of an operating room fire is minimal, surgeons should not become complacent and should maintain a high level of vigilance to prevent these potentially devastating occurences. 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
10
v.
1
no.
2022
56
59
https://abjs.mums.ac.ir/article_17781_786de8c7f1ac9abae04037fba974cff0.pdf
dx.doi.org/10.22038/abjs.2021.47850.2382
Clinical Scenario and Imaging with Illustrations of Giant Cell Tumor of Bone: A Retrospective Analysis
Nadeem
Ali
Govt Medical College Srinagar, India
author
Azad Ahmad
Shah
Govt Medical College Srinagar, India
author
Ibreez
Rakshan
Govt Medical College Srinagar, India
author
Altaf Ahmad
Kawoosa
Govt Medical College Srinagar, India
author
Mohammad Umar
Mumtaz
Govt Medical College Srinagar, India
author
text
article
2022
eng
Background: The giant cell tumour of the bone has a spectrum of clinical-radiological presentation. This study aims to describe this varied presentation in our institution. Methods: This retrospective study was conducted on twenty-nine pathologically labelled cases of giant cell tumours of the bone. The medical records for their clinical presentation and diagnostic imaging studies were studied and evaluated. Results: Mean age of the patients at presentation was 35.3±12.9 years. Pain, local swelling and restricted joint function were seen in 93 %, 58.6 % and 52 % patients, respectively. The cortical breach was seen in 15 (51.7 %) and 22 (75.9 %) lesions on plain radiographs and CT images, respectively. 14(48.3 %) cases had soft tissue invasion on MRI at presentation. 26 (89.7 %) lesions were located within 1 cm from the articular cartilage. The solid tumour component was hypo to iso-intense in signal intensity in 27 (93.1 %) lesions in T1 weighted and 21 (72.4 %) in T2 weighted images. 14 (48.3 %) had hyperintense cystic areas, and fluid-fluid levels, suggestive of aneurysmal bone cysts, were seen in 4 (13.8 %) cases on T2 weighted images. Hypo-echoic nodular areas in solid tumour component, suggestive of hemosiderin deposits, were present in 3 (10.3 %) lesions on T1 and T2 weighted images. Conclusion: The tumour classically presents as an epiphysial-metaphyseal, eccentric, expansile, lytic lesion in a skeletally mature patient. The MRI picture is variable and the surgeon should have a sound knowledge of these variations to obtain a biopsy sample from a proper site of the lesion and to avoid misdiagnosis especially of a primary ABC. 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
10
v.
1
no.
2022
60
66
https://abjs.mums.ac.ir/article_17784_8b713c85ec2775da2b53b61bd38bcf0f.pdf
dx.doi.org/10.22038/abjs.2021.50922.2522
Soft Tissue Sarcoma of Extremities: Descriptive Epidemiological Analysis According to National Population-based Study
Adel
Ebrahimpour
1 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences
author
Mohammadreza
Chehrassan
1 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
author
Mehrdad
Sadighi
1 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
author
Amin
Karimi
Department of Orthopedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
author
Mehdi
Azizmohammad Looha
Department of Biostatics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
author
meisam
jafari kafiabadi
1 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
author
Farsad
Biglari
2 Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 5 Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences
author
Mohammad Esmaeil
Akbari
Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
author
text
article
2022
eng
Background: Soft-Tissue Sarcoma (STS) is a heterogeneous group of neoplasms of mesenchymal origin, occurring in connective tissues. According to previously conducted studies, STS accounts for approximately 1% and 7-%15% of adult and pediatric malignancies, respectively. Almost 50%-60% of sarcomas arise from extremities and usually present as a large painless or rarely painful soft-tissue mass. The present study aimed to describe the epidemiology of soft-tissue sarcomas, especially in the Iranian population. Methods: This epidemiological study of limb soft-tissue sarcoma was conducted based on Iran National Cancer Registry data (INCR) between 2009 and 2014. Patients with soft-tissue sarcoma confirmed by histopathological studies were included, and data were classified based on the International Classification of Diseases for Oncology (first revision-third edition [ICD-O-3]) and analyzed. Descriptive analysis was performed to extract age-standardized and age-specific incidence rates. Results: A total of 2, 593 patients (1,476 males and 1,117 females) were enrolled and assessed in the present study. The age-standardized incidence rate(ASIR) of total soft tissue sarcomas was 6.34 per million person-years. In addition, the highest and lowest ASIR scores stratified by age were observed in patients aged above 65 and under 0 with the value of 19.61 (95% CI:17.91-21.30) and 1.91 (95% CI 1.69, 2.13) per million, respectively. Limb soft tissue sarcomas stratified by gender were dominant in males, and it was statistically significant (P<0.05). The most common extremity soft tissue sarcomas subtypes were mesenchymal tumor (12.26%), spindle cell sarcoma (12.18%), and malignant fibrous histiocytoma (11.45%). Conclusion: As evidenced by the results of the present study, the ASIR of soft tissue sarcoma dramatically increased with age, and the peak ASIR occurred in the age range of above 65 years. The incidence rate of soft tissue sarcomas analyzed by disease site was higher in hip and lower limb than upper limb and pelvis region, and it was detected consistently in all age groups and both genders. 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
10
v.
1
no.
2022
67
77
https://abjs.mums.ac.ir/article_17791_9999f8cbb672851dd9a2ddf56dbe2b17.pdf
dx.doi.org/10.22038/abjs.2021.53750.2676
The Frequency of Burnout among Iranian Orthopedic Surgeons and Residents
Mohammad
Ghoraishian
Department of Orthopedic Surgery Research Center,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran
author
Hadi
Zare Mehrjardi
Clinical Research Development Center of Shahid
Sadoughi Hospital, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran
author
Jafar
Askari
Department of Medical Psychology, Research Center
of Addiction and Behavioral Sciences, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran
author
Seyed-Mohammad Jalil
Abrisham
Department of Orthopedic Surgery Research Center,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran
author
Mohammad Reza
Sobhan
Department of Orthopedic Surgery Research Center,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran
author
text
article
2022
eng
Background: Burnout is an emotional, psychological, and physical exhaustion syndrome with feelings of negativismtoward one’s job and reduced attention to clients. This complication is caused by the lack of control over workrelatedstress. Physicians, especially surgeons, are at higher risk for burnout due to critical responsibility and heavyworkload. Given the importance and consequences of this dilemma, the present study aimed to investigate thefrequency of burnout among orthopedic surgeons and residents.Methods: The present cross-sectional, analytical study was conducted in 2019 in the cities of Tehran and Yazd, inIran. A total of 180 orthopedic surgeons and residents participated in the study. A demographic characteristics formand the Maslach Burnout Inventory (MBI) were employed to assess burnout in the participants.Results: The mean age of the participants was 42.8 years, and 94.4%, 23.9%, 52.2%, and 23.9% of the participantswere male, residents, general orthopedic specialists, and fellowship-trained orthopedics, respectively. Out of 180participants, 90 (50%) cases were suffering from burnout, of whom 26.7%, 16.1%, and 7.2% got a pathologicalscore in one, two, and three criteria. No significant relationship was observed between burnout and gender, maritalstatus, years of experience, and the average number of surgeries per week. However, there was a significantassociation between burnout and younger age, lower academic rank or being a resident, working in the publicsector, and spending less time in leisure and sports activities.Conclusion: The prevalence of burnout (50%) among orthopedists was remarkable and worrying. The frequencyof burnout was higher among residents and the ones working in the public sector. This study demonstrates that theissue of burnout and its related risk factors have to be addressed in Iranian orthopedic surgeons and residents.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
10
v.
1
no.
2022
78
84
https://abjs.mums.ac.ir/article_17634_24aba53722948630b3cd9c89b358d680.pdf
dx.doi.org/10.22038/abjs.2021.52914.2625
Incidence of Radiolucent Lines after Cemented Total Knee Arthroplasty
Hannah
Ng
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
author
Gabriel
Tan
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
author
Ryan
Tan
Yong Loo Lin School Of Medicine, National University of Singapore
author
Chung Yuan
Kau
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
author
text
article
2022
eng
Background: Cemented Total Knee Arthroplasty (TKA) provides excellent long-term survival rates and functional results, however, radiolucent lines (RLLs) often appear during early post-operative follow-up and their incidence and clinical significance are unknown. The primary aim was to establish the incidence, location, frequency, and time taken for RLLs to appear within the first year after a primary cemented TKA with an anatomic tibial baseplate (Smith and Nephew, LEGION Total Knee System). Methods: This was a retrospective analysis of 135 primary cemented TKA in 131 patients over three years. We compared demographics, serial radiographs, and early clinical and functional outcomes. Results: There were 65 TKAs (48%) in 62 patients who had RLLs within the first year post-operatively. Most were females (58.8%). Mean age was 68.3 ± 7.9 years. There were 88 RLLs, with the most and second commonest location at the medial tibial baseplate (38%) and anterior femoral flange (23%). 89% were in the bone-cement interface. The largest average length of RLLs were at the anterior flange of the femoral component (1.98 ± 1.33 mm). The average time to development was 6.5 ± 4.1 months. None of these patients had infections nor required revision. Patients with RLLs did not do worse in functional and clinical scoring at 1-year. Conclusion: There was a 48% incidence of physiological RLLs after cemented TKA, with the highest occurrence at the medial tibial baseplate at 38%. These radiolucent lines did not affect early post-operative clinical and functional outcomes of patients. 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
10
v.
1
no.
2022
85
91
https://abjs.mums.ac.ir/article_17793_71159862c16b754544090f190b0cb6dd.pdf
dx.doi.org/10.22038/abjs.2021.54610.2723
The Effects of Distal Pole Scaphoid Resection on Wrist Biomechanics
Amir
Kachooei
Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
author
Stephen
Hioe
Joint Base Elmendorf-Richardson Hospital USAF, USA
author
Megan
Jimenez
Inspira Health Network, NJ, USA
author
Christopher M.
Jones
Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA
author
Michael
Rivlin
Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA
author
text
article
2022
eng
Background: Distal pole scaphoid resection (DPSR) is an effective way to manage chronic scaphoid non-union with limited degenerative arthritis. Studies have reported positive results in terms of pain relief, wrist range of motion and grip strength, and patient satisfaction. However, the biomechanical consequences of DPSR remain unclear. This study evaluates the effects of DPSR on carpal mechanics by assessing changes in radiographic parameters with varying quantities of scaphoid removal. Methods: Six fresh frozen cadaveric upper extremities were used. Resections of 25%, 50%, and 75% of the length of each scaphoid were performed under fluoroscopic image guidance. For the intact scaphoid and each resection level, the following radiographic parameters were assessed: radiolunate and capitolunate angles; carpal height and first metacarpal subsidence ratios, and ulnar carpal translation. Measurements were then repeated for grip and pinch as well as radial and ulnar wrist deviation positions. Radial styloid to trapezium distance in wrist radial deviation was also measured to assess for impingement. Results: There was a statistically significant increase in the mean radiolunate angle with increasing scaphoid resection quantities. No statistically significant correlations were found between radial styloid clearance and increasing scaphoid resection percentages. Changes in the remaining variables did not reach statistical significance. Conclusion: Increasing levels of scaphoid resection is associated with progressive signs of carpal malalignment best depicted by increasing radiolunate angles. Diminishing radial styloid clearance was clinically evident as more scaphoid was resected. For this, prophylactic radial styloidectomy may be considered to avoid bony impingement. 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
10
v.
1
no.
2022
92
97
https://abjs.mums.ac.ir/article_17898_ff86b3554c31c9803a4d955092308c1e.pdf
dx.doi.org/10.22038/abjs.2021.55049.2738
The Opioid Risk Tool: Can this Validated Tool Predict Post-Operative Opioid Dependence Following Arthroscopic Rotator Cuff Repair?
Dennis
DeBernardis
Rowan University School of Osteopathic Medicine, Department of Orthopedic Surgery, Stratford, NJ, USA
author
James
Stenson Jr.
Rowan University School of Osteopathic Medicine, Department of Orthopedic Surgery, Stratford, NJ, USA
author
Quincy
Cheesman
Rowan University School of Osteopathic Medicine, Department of Orthopedic Surgery, Stratford, NJ, USA
author
Luke
Austin
The Rothman Institute at Jefferson University, Philadelphia, PA, USA
author
text
article
2022
eng
Background: Numerous attempts have been made to decrease the incidence of opioid dependence after orthopedic surgeries. However, no effective means of preoperative risk stratification currently exists. The purpose of this study was to determine the ability of the Opioid Risk Tool (ORT) to predict the rate of opioid dependence 2 years after arthroscopic rotator cuff repair (ARCR). Methods: We prospectively evaluated all patients undergoing primary ARCR at a single institution over a 1.5 year period with a minimum of 2-year follow-up. All patients completed the ORT prior to surgery and were stratified into Low, Moderate, and High risk categories. The primary outcome was postoperative opioid dependence, defined as receiving a minimum of 6 opioid prescriptions within 2 years following surgery. Secondary outcomes included the total number of morphine milligram equivalents prescribed, total number of opioid prescriptions filled, and total number of opioid pills prescribed during this time interval. All outcome variables were compared amongst Low, Moderate, and High risk groups. Assessment of a statistical correlation between each outcome variable and individual numerical ORT scores (1-9) was performed. Results: A total of 137 patients were included for analysis. No statistically significant difference was noted in any primary or secondary outcome variable when compared between Low, Moderate, and High risk groups. The total cohort demonstrated a 19% rate of post-operative opioid dependence. No correlation was identified between any outcome variable and individual numerical ORT scores. A greater rate of dependence and quantity of opioids prescribed was noted amongst patients with a history of prior opioid use. Conclusion: The ORT was not predictive of the risk of opioid dependence or quantity of opioids prescribed after ARCR. Attention should be focused on alternative means of identification and management of patients at risk for opioid dependence after orthopedic procedures, including those with a history of prior opioid use. 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
10
v.
1
no.
2022
98
103
https://abjs.mums.ac.ir/article_18364_1896581286fee483f344546316142270.pdf
dx.doi.org/10.22038/abjs.2021.55165.2746
Percutaneous Curettage and Local Autologous Cancellous Bone Graft: A Simple and Efficient Method of Treatment for Benign Bone Cysts
Mohammed
Alisi
Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
author
Freih
Abu Hassan
Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
author
Yazan
Hammad
Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
author
Aws
Khanfar
Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
author
Omar
Samarah
Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
author
text
article
2022
eng
Background: Several treatment modalities have been reported to minimize the recurrence after surgical treatment of benign bone cysts. In this study, we evaluated local tumor control, recurrence rate, and bone healing of benign bone cysts after treatment with a simple technique, percutaneous curettage and a local autologous cancellous bone graft. Methods: Retrospective analysis of the records of 16 patients diagnosed with benign bone cysts between 2003 and 2010. We documented the demographic data, radiographic signs of healing (progressive decrease in radiolucency, remineralisation, ossification, consolidation of the cyst, and reconstitution of the bone), healing rate, postoperative complications, and recurrence. Results: Seven of the 16 patients (43.75%) were diagnosed with a simple bone cyst (SBC), while nine (56.25%) had an aneurysmal bone cyst (ABC). On average, radiographic signs of healing were present within 3–6 months, but in two patients these signs presented after 16 months. During the follow-up period, there was no difference in the healing rate between patients with SBC and ABC; no signs of deep or superficial wound infection, no postoperative fracture, and no recurrence in any case over an average of 6.3 years of follow-up. Conclusion: Treatment of benign bone cysts (SBC/ABC) with minimally invasive percutaneous curettage and a local autologous cancellous bone graft is a simple and effective modality with a promising outcome in the local control of recurrence and in enhancing bony consolidation. 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
10
v.
1
no.
2022
104
111
https://abjs.mums.ac.ir/article_17794_aa3a066a0ece64d2d3686242e7dbbf72.pdf
dx.doi.org/10.22038/abjs.2021.55189.2747
A Rare Case of Flexor Digitorum Accessorius Longus Muscle Presenting as Tarsal Tunnel Syndrome
Hossein
Ettehadi
1 The Orthopaedic Foot and Ankle Unit, Netcare Linksfield
Hospital, Johannesburg, South Africa.
2 Department of Orthopaedic Surgery, University of the
Witwatersrand, Johannesburg, South Africa
author
Nikiforos Pandelis
Saragas
1 The Orthopaedic Foot and Ankle Unit, Netcare Linksfield
Hospital, Johannesburg, South Africa.
2 Department of Orthopaedic Surgery, University of the
Witwatersrand, Johannesburg, South Africa
author
Paulo
Ferrao
1 The Orthopaedic Foot and Ankle Unit, Netcare Linksfield
Hospital, Johannesburg, South Africa.
2 Department of Orthopaedic Surgery, University of the
Witwatersrand, Johannesburg, South Africa
author
text
article
2022
eng
Tarsal tunnel syndrome (TTS) is a relatively uncommon nerve entrapment neuropathy. Many pathologies are reported aspossible causes for TTS. The diagnosis of TTS can be difficult and often missed. We present a rare case of TTS due toan accessory flexor digitorum longus muscle. Together with a high index of suspicion, MRI is the investigation of choice inmaking the diagnosis. These patients are best managed with excision or transposition of the flexor digitorum accessoriuslongus (FDAL) and neurolysis of the posterior tibial nerve and its branches.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
10
v.
1
no.
2022
112
116
https://abjs.mums.ac.ir/article_17044_c93f35cb8a5d7efe4e8a544f504470bc.pdf
dx.doi.org/10.22038/abjs.2020.47749.2345