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Archives of Bone and Joint Surgery - Volume:3 Issue: 3, May 2015

Archives of Bone and Joint Surgery
Volume:3 Issue: 3, May 2015

  • تاریخ انتشار: 1394/04/04
  • تعداد عناوین: 13
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  • Farzaneh Pouya, Mohammad Amin Kerachian Pages 149-155
    Avascular necrosis of the femoral head (ANFH) is a pathologic process that results from interruption of blood supply to the femur bone resulting in the death of bone cells and collapse of the femoral head. Nontraumatic ANFH continuesto be a significant challenge to orthopedic surgeons. While the exact mechanisms remain elusive, many new insights have emerged from research in the last decade that has given us a clearer picture of the pathogenesis of nontraumatic ANFH. Progression to the end stage of ANFH appears to be related to five main mechanisms: hypercoagulable conditions, angiogenesis suppressions, hyperadipogenesis, heritable states, and switching the bone remodelling into bone resorption. Researchers have been examining the pathogenic mechanisms of ANFH but none of these theories have been firmly confirmed although some appear more plausible than the others. All of these factors can switch bone remodelling into bone resorption, which can further lead to ANFH progression ending up to femoral head collapse.
    Keywords: Avascular, Avascular necrosis, Femur, Osteonecrosis
  • Ali Moradi, Mohammad Hosein Ebrahimzadeh, Jesse Jupiter Pages 156-162
    Radial tunnel syndrome is a disease which we should consider it in elbow and forearm pains. It is diagnosed with lateral elbow and dorsal forearm pain may radiate to the wrist and dorsum of the fingers. The disease is more prevalent in women with the age of 30 to 50 years old. It occurs by intermittent compression on the radial nerve from the radial head to the inferior border of the supinator muscle, without obvious extensor muscle weakness. Compression could happen in five different sites but the arcade of Frose is the most common area that radial nerve is compressed. To diagnosis radial tunnel syndrome, clinical examination is more important than paraclinic tests such as electrodiagnsic test and imaging studies. The exact site of the pain which can more specified by rule of nine test and weakness of the third finger and wrist extension are valuable physical exams to diagnosis. MRI studies my show muscle edema or atrophy along the distribution of the posterior interosseous nerve. Although non-surgical treatments such as rest, NSAIDs, injections and physiotherapy do not believe to have permanent relief, but it is justify undergoing them before surgery. Surgery could diminish pain and symptoms in 67 to 93 percents of patients completely.
    Keywords: Diagnosis, Radial Tunnel Syndrome, Treatment
  • Fatih KÜÇÜkdurmaz, Miguel Gomez, Eric Secrist, Javad Parvizi Pages 163-168
  • Francisco Soldado, Jorge Knorr, Sleiman Haddad, Paula Diaz-Gallardo, Jordi Palau-Gonzalez, Vasco Mascarenhas, Samir Karmali, Jerome Sales De Gauzay Pages 169-172
    Background
    Medial pinning is one of the most controversial aspects of the surgical treatment of supracondylar fractures (SHF) owing to the risk of ulnar nerve injury.
    Aim
    To evaluate the safety and usefulness of medial pinning for SHF using ultrasound imaging for ulnar nerve visualization.
    Methods
    Fifteen children, with a mean age of 60 months, with displaced SHF were treated with a crossed-pinning configuration after fracture reduction. Intraoperative ultrasound was used to guide medial pin insertion to avoid ulnar nerve injury.
    Results
    Cubital tunnel anatomy was easily identified in all children. All children showed a subluxating ulnar nerve that required elbow extension to about 90º before medial pin insertion. None suffered ulnar nerve dysfunction after using the referred technique.
    Conclusions
    Although technically demanding, ultrasound may be a valuable adjuvant to avoid ulnar nerve injury while performing a medial pinning in pediatric SHF.
    Keywords: Elbow pinning, Musculoskeletal ultrasound, Pediatric elbow, Pediatric supracondylar elbow fractures, Ulnar nerve
  • Ahmadreza Afshar, Mohsen Mehdizadeh, Hamidreza Khalkhali Pages 173-178
    Background
    There is no consensus on the best surgical treatment in Kienböck disease. We compared the shortterm outcomes of radial shortening osteotomy and capitate shortening osteotomy in patients affected with this disease.
    Methods
    In a retrospective study of 21 patients with Lichtman stage IIIA of Kienböck disease, 12 patients with an average follow up of 3.2 ± 0.6 years had radial shortening osteotomy (group I) and 9 patients with an average follow up of 3.1 ± 0.7 years had capitate shortening osteotomy (group II). The two groups were comparable in age, sex, operated side, initial Lichtman stage, and follow-up duration. At the last follow-up the patients were evaluated for pain, wrist range of motion, grip strength, wrist functional status and change in their Lichtman stage. The overall results were evaluated by the Cooney wrist function score and DASH score.
    Results
    All the patients in the two groups had improvement of their wrist pains. According to the Cooney wrist function score group I had 1 excellent, 9 good, and 2 fair scores and group II had 1 excellent, 6 good, and 2 fair scores. Comparisons between the means of pain VAS scores, wrist range of movement, grip strength, DASH score, and Cooney wrist function score in the two groups were not significant. Also, the changes of the Lichtman stage in the two groups were not significant.
    Conclusions
    Both groups had reasonable short-term outcomes. We were unable to recognize a substantial clinical difference between the two surgical treatments in short-term outcomes.
    Keywords: Capitate shortening osteotomy, Kienböck disease, Radial shortening osteotomy
  • Amir Mohammad Navali, Hossein Aslani Pages 179-183
    Background
    Parts of the implants placed over the meniscus during meniscal repair can wear down the cartilage in the contact zones and cause chronic synovitis. Placing horizontal sutures under the meniscus may overcome this potential hazard. The purpose of this prospective study was to evaluate the midterm results of arthroscopic meniscal repair using submeniscally placed out-in horizontal sutures.
    Methods
    One hundred and three meniscal repairs with submeniscal horizontal out-in technique in 103 patients were performed between 2009 and 2012. Our indications for meniscal repair were all longitudinal tear in red-red and redwhite zone with acceptable tissue quality. Clinical evaluation included the Tegner and Lysholm knee scores and clinical success was defined as absence of joint-line tenderness, locking, swelling, and a negative McMurray test.
    Results
    The average follow-up was 19 months (range, 14 to 40 months). The time interval from injury to meniscal repair ranged from 2 days to 390 days (median, 96 days). At the end of follow-up, the clinical success rate was 86.5%. Fourteen of 103 repaired menisci (13.5%) were considered failures according to Barrett’s criteria. The mean Lysholm score significantly improved from 39.6 preoperatively to 84.5 postoperatively (P˂0.001). Eighty five patients (82.5%) had an excellent or good result according to Lysholm knee score. Tegner activity score improved significantly (P˂0.01) from an average of 3.4 (range, 2-6) preoperatively to 5.9 (range, 5-8) postoperatively. Statistical analysis showed that age, simultaneous anterior cruciate ligament reconstruction, chronicity of injury did not affect the clinical outcome.
    Conclusion
    Our results showed that acceptable midterm results are expected from submeniscal horizontal out-in repair technique. This technique is cheap, safe and has the advantage of avoiding chondral abrasion caused by solid implants and suture materials placed over the meniscus.
    Keywords: Clinical result, Meniscus, Repair, Suture technique
  • Mohammad Rasouli, Jessica Viola, Mitchell Maltenfort, Alisina Shahi, Javad Parvizi, James Krieg Pages 184-192
    Background
    Little is known about trends and predictors of hardware related infection following open reduction and internal fixation (ORIF) of extremity fractures, one of the major causes of failure following ORIF. The present study was designed and conducted to determine trends and predictors of infection-related hardware removal following ORIF of extremities using a nationally representative database.
    Methods
    We used Nationwide Inpatient Sample data from 2002 to 2011 to identify cases of ORIF following upper and lower extremity fractures, as well as cases that underwent infection-related hardware removal following ORIF. Multivariate analysis was performed to identify independent predictors of infection-related hardware removal, controlling for patient demographics and comorbidities, hospital characteristics, site of fracture, and year.
    Results
    For all ORIF procedures, the highest rate of hardware removal related to infection was observed in tarsal fractures (5.56%), followed by tibial (3.65%) and carpal (3.37%) fractures. Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Tarsal fractures(odds ratio (OR)=1.06, 95% confidence interval (CI): 1.04-1.09, P<0.001), tibial fractures (OR=1.04, 95% CI: 1.03-1.06, P <0.001) and those patients with diabetes mellitus (OR=2.64, 95% CI: 2.46-2.84, P<0.001), liver disease (OR=2.04, 95% CI: 1.84- 2.26, P <0.001), and rheumatoid arthritis (OR=2.06, 95% CI:1.88-2.25 P <0.001) were the main predictors of infection-related removals; females were less likely to undergo removal due to infection (OR= 0.61, 95% CI: 0.59-0.63 P <0.001).
    Conclusions
    Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Diabetes, liver disease, and rheumatoid arthritis were important predictors of infection-related hardware removal. The study identified some risk factors for hardwarerelated infection following ORIF, such as diabetes, liver disease, and rheumatoid arthritis,that should be studied further in an attempt to implement strategies to reduce rate of infection following ORIF.
    Keywords: Hardware Removal, Infection, NIS, ORIF
  • Ali Karbalaeikhani, Alireza Saied, Afshin Heshmati Pages 193-197
    Background
    The standard methods for reconstruction of soft tissue defects in the leg include gastrocnemius flap for proximal third defects, soleus flap for middle third and free flap in the distal third. However, there are problems with the use of free flap, like increased operative time, damage of major vessels and the need for experienced microsurgeon. Mathods: This prospective study was undertaken on 23 patients (20 male and 3 female) with the mean age 32.13 years (14 to 65). This group consisted of all of the patients referred to Dr Bahonar Hospital, Kerman with soft tissue defects between April 2011 and April 20012 and would give informed consent for participation in the study and treatment of the defect with muscle flaps. 8 patients with proximal third defects were treated with were treated with gastrocnemius flap, 4 with middle third defects with soleus flap and 3 with reverse soleus flap and 8 with distal third defects with reverse soleus flap. The patients were followed up for at least 1 year. Finally the results were analyzed by SPSS 16.
    Results
    In patients with soft tissue defect in proximal and middle third of leg repair was successful in all. In 5 patients with soft tissue defect in distal third of leg repair was complete but in 3 of them flap failure was seen. Overall success rate for reverse soleous flap was 72.7%.
    Conclusion
    The success rate of the flap for the upper and lower thirds was similar to other studies and seems that this is the standard method. In the distal third defects the reverse soleous flap failed in 3 cases and it seems that preoperative investigations such as angiography must be performed before embarking on such a procedure.
    Keywords: Gastrocnemius, Muscle flap, Reconstruction, Soleus
  • Amir Reza Kachooei, Sjoerd P.F.T. Nota, Mariano Esteban Menendez, George S.M. Dyer, David Ring Pages 198-203
    Background
    Geographic and doctor-to-doctor variations in care are a focus of quality and safety efforts in medicine. This study addresses factors associated with variation in the rate of operative treatment of de Quervain tendinopathy.
    Methods
    We used a database including all patient encounters at 2 large medical centers, to study the experience of 10 hand surgeons and 1 physiatrist working in a hand surgery office in the treatment of 2,513 patients with de Quervain tendinopathy over a 12-year period. Survival analysis using the Kaplan-Meier method was used to compare surgery rates and time to surgery. Cox multivariable regression analysis was applied to identify factors associated with operative treatment.
    Results
    One hundred ninety nine (7.9%) patients had surgery. The odds of operative treatment were 1.7 times greater after corticosteroid injection and varied more than 10-fold among providers. There was substantial variation in the overall rate of surgery by provider. Corticosteroid injection delayed surgery slightly, but was associated with a higher rate of surgery.
    Conclusion
    Providers have substantial influence on treatment of de Quervain tendinopathy. The use of decision aids and other methods that help involve the patient in decision-making merit investigation as interventions to help reduce doctor-to-doctor variation.
    Keywords: Cortisone injection, De Quervain tendinopathy, Decision aid, Operative treatment, Variation
  • Farzad Omidi-Kashani Pages 204-206
    Vertebral anomalies may also distort the normal regional or global spinal alignment and necessitate some therapeutic interventions. Hemiepiphysiodesis is a traditional procedure usually described for these young patients but in more severe cases some type of osteotomy seems to be necessary. In this technical note, we describe a 5-year-old boy with failed previous hemiepiphysiodesis surgery, who was successfully treated with one level pedicle subtraction osteotomy. This procedure not only corrects the kyphotic deformity at the time of the procedure (not relying on future spinal growth), but also avoids more hazardous anterior approach.
    Keywords: Children, Congenital Kyphosis, Pedicle subtraction osteotomy
  • Mohammad Gharehdaghi, Hasan Rahimi, Reza Eshraghi, Alireza Mousavian, Maryam Asadian Pages 207-211
    Juvenile idiopathic arthritis is the leading cause of hip replacement in young children. However, arthroplasty in this population is challenging with several concerns about quality of the growing bone, young age for revision surgery, and difficulties in potential several revisions. In this study we introduce a case of a 12-year old who is one of the youngest patients to undergo revision hip arthroplasty. The index operation was done as a hybrid replacement, cemented for stem and press fit for acetabular component. Two years later revision was done with severe femoral deficiency. This second procedure was challenging but with short-term promising results. So we reviewed the literature for arthroplasty in this young population regarding recent findings and trends. According to the literature survival of the prosthesis is longer with a cemented acetabular component and press fit stem; however, there are evidences that show poor outcome of joint replacement after the first revision in juvenile idiopathic arthritis patients.
    Keywords: Arthritis, Idiopathic, Juvenile, Revision, Total hip replacement
  • Ahmadreza Afshar, Mehdi Koushkzari Pages 212-216
    Overlapped pubic symphysis is a rare but serious pelvic injury. This study presents a case of overlapped dislocation of the pubic symphysis. He was managed by closed reduction under general anesthesia. The patient had urethral transsection.At the latest follow up, seven months post injury; he was able to walk well without any pelvic pain. However, his urologic problems were continued. We also reviewed the literature and analyzed the data of the previous reports as well as the current case collectively. The two terms of “locked pubic symphysis” and “overlapped pubic symphysis”have been used synonymously in the literature. Overlapped pubic symphysis is commonly associated with fracture of the sacrum and urethral injury in the male patients. After closed or open reduction, if pelvic instability persists, it needs anterior and may posterior internal fixation to achieve a stable pelvis.
    Keywords: Locked pubic symphysis, Overlapped pubic symphysis, Pelvic fracture, Urethral injury
  • Selahattin Ozyurek Pages 217-217
    We have greatly enjoyed reading the case report entitled “‘Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature in the issue of Arch Bone Jt Surg. 2015;3(2) with great interest. We would like to commend the authors for their detailed and valuable work. Although various case reports have described postoperative distal femur fracture at a range of time intervals (1,2) intraoperative intra-articular distal femur fracture is a unique entity.However, we believe that some important additional observations seem necessary to be contributed through this study. In this article, the authors stated that, to the best of their knowledge, there is no other case report in the literature introducing a femoral condyle fracture during arthroscopic ACL reconstruction or revision reconstruction. Nevertheless, we would like to call the attention of the readers to the fact that that the literature contains one additional case report re porting on intraoperative distal femoral coronal plane (Hoffa) fracture during primary ACL reconstruction (2). Werner BC and Miller MD presented of case report of an intraoperative distal femoral coronal plane (Hoffa) fracture that occurred during independent femoral tunnel drilling and dilation in a primary ACL reconstruction. As in the their case, this type of fracture can occur with appropriately placed femoral tunnels, but the risk can increase with larger graft diameters in patients with smaller lateral femoral condyles The patient was treated with open reduction and internal fixation, without compromise of graft stability and with good recovery of function. We believe that tailoring graft size to the size of the patient is important to prevent similar adverse events.
    Keywords: Anterior cruciate ligament(ACL), Femur, Fracture, Reconstruction