Archives of Bone and Joint Surgery
Volume:5 Issue: 4, Jul 2017

“Those who cannot remember the past are condemned to repeat it” [1]. The famous quote from Hispanic American philosopher George Santayana reminds us of the critical importance of constantly reflecting on the most important lessons garnered from both our own personal experiences and those of our peers. In 49 years of academic orthopedic practice, I have frequently reflected on the most important lessons I have learned, and to which, in addition to hard work and perhaps simple luck, I attribute much of my success

replacement (TAR) in patients with advanced ankle osteoarthritis (OA). AJD could a tenable option to ankle fusion or TAR.

A review has been performed on the role of AJD in advanced OA of the ankle. The exploration machine was MedLine. The keywords utilized were: joint distraction ankle. Three hundred and eleven articles were found. Of the above-mentioned, only 14 were chosen and analyzed because they were rigorously focused on the issue and the question of this paper.

Forty-seven patients met inclusion criteria with 15 in the acute RSA group and 32 in the secondary RSA group. The acute RSA group demonstrated better external rotation (28˚) than the secondary RSA group (18˚, P=0.0495). The acute RSA group showed a trend towards better Single Assessment Numeric Evaluation (SANE) scores. Tuberosity healing rate was higher in the acute RSA group.

The types of articles published until now have a poor level of evidence (levels III and IV). The overall number of patients managed until now by way of AJD is 249. The published mean follow-up is very variable, from 1 year to 12 years. The rate of good outcomes ranged between 73% and 91%. The percentage of failure (final ankle arthrodesis or TAR) ranged between 6.2% and 44%. A minimum of 5.8 mm of distraction gap must be achieved. Ankle function after AJD deteriorates over time. Putting together ankle movement and distraction will result in an early and maintained profitable influence on outcome.

This study compared the outcomes between patients with proximal humerus fractures (PHF) who underwent acute reverse total shoulder arthroplasty (RSA) to those who underwent an alternative initial treatment before requiring (secondary) RSA.
Patients who underwent RSA after suffering a PHF were identified. Two year clinical follow-up was required for inclusion. Patients were divided into an acute group (RSA secondary RSA group was subdivided by initial treatment (non-operative, hemiarthroplasty, open reduction internal fixation (ORIF)). Clinical and radiographic outcomes were compared.
Forty-seven patients met inclusion criteria with 15 in the acute RSA group and 32 in the secondary RSA group. The acute RSA group demonstrated better external rotation (28˚) than the secondary RSA group (18˚, P=0.0495). The acute RSA group showed a trend towards better Single Assessment Numeric Evaluation (SANE) scores. Tuberosity healing rate was higher in the acute RSA group.
While acute and secondary RSA can yield successful outcomes, acute RSA results in a higher tuberosity healing rate and improved external rotation.

Locking plate fixation is increasingly used for first metatarsophalangeal joint (MTP-I) arthrodesis. Still there is few comparable clinical data regarding this procedure.
We retrospectively evaluated 60 patients who received an arthrodesis of the MTP-I between January 2008 and June 2010. With 20 patients each we performed a locking plate fixation with lag screw, arthrodesis with crossed-screwsor with a nonlocking plate with lag screw.
There were four non-unions in crossed-screws patients and one nonunion in non-locked plate group. All the patients in locking plate group achieved union. 90% of the patients were completely or mildly satisfied in locking plate group, whereas this rate was 80% for patients in both crossed screws and non-locking plate groups.
Use of dorsal plating for arthrodesis of MTP1 joint either locking or non-locking were associated with high union rate and acceptable and comparable functional outcome. Although nonunion rate was high using two crossed screws but functional outcome was not significantly different compare to dorsal plating.
Level of evidence:Ш, retrospective comparative study

To evaluate general anesthesia with sevoflurane vs spinal anesthesia with low dose lidocaine 5% on hemodynamics changes in patients undergoing hip fracture surgery.
In this randomized double blind trial 100 patients (50 patients in each group) older than 60 years under hip surgery were randomized in general anesthesia with sevoflurane and spinal anesthesia with lidocaine 5%. Hemodynamic changes including mean arterial pressure (MAP) and heart rate, blood loss, pain severity, nausea and vomiting and opioids consumption were compared in two groups.
During surgery, difference between two groups regarding changes in mean arterial pressure was not significant, but the changes in heart rate were significantly different. Mean arterial pressure changes during recovery between two groups were significantly different. But there was no significant difference in heart rate changes. Bleeding in the sevoflurane group was significantly more than spinal group (513.ml vs. 365 ml). Moreover, AS Score, opioid consumption, and the nausea and vomiting in spinal anesthesia group was significantly lower than the sevoflurane group.
We showed that general anesthesia with sevoflurane and spinal anesthesia with low dose lidocaine 5% have comparable effects on hemodynamics changes in patients undergoing hip fracture surgery. However postoperative pain score, vomiting and morphine consumption in patients with spinal anesthesia were lower than general anesthesia.

Given the strong influence of thoughts, emotions, and behaviors on musculoskeletal symptoms and limitations it’s important that both scientific and lay writing use the most positive, hopeful, and adaptive words and concepts consistent with medical evidence. The use of words that might reinforce misconceptions about preferencesensitive conditions (particularly those associated with age) could increase symptoms and limitations and might also distract patients from the treatment preferences they would select when informed and at ease.
We reviewed 100 consecutive papers published in 2014 and 2015 in 6 orthopedic surgery scientific journals. We counted the number and proportion of journal articles with questionable use of one or more of the following words: tear, aggressive, required, and fail. For each word, we counted the rate of misuse per journal and the number of specific terms misused per article per journal
Eighty percent of all orthopedic scientific articles reviewed had questionable use of at least one term. Tear was most questionably used with respect to rotator cuff pathology. The words fail and require were the most common questionably used terms overall.
The use of questionable words and concepts is common in scientific writing in orthopedic surgery. It’s worth considering whether traditional ways or referring to musculoskeletal illness merit rephrasing.

the bone is “fractured” or “broken”. While orthopaedic surgeons consider these terms synonymous, patients appear to comprehend the terms as having different meanings. Given the commonality of this frequently posed question, it may be important for providers to assess patients’ level of understanding in order to provide optimal care. The purpose of this study is to evaluate patients’ comprehension and understanding regarding the use of the terms fractured and broken.
A survey was administered as a patient-quality measure to patients, family members and/or other non-patients presenting to an orthopaedic outpatient clinic at an academic teaching hospital.
200 responders met inclusion criteria. Only 45% of responders understood the terms fractured and broken to be synonymous. Age, gender, nor ethnicity correlated with understanding of terminology. Responders described a “fractured” bone using synonyms of less severe characteristics for 55.7% of their answers and chose more severe characteristics 44.3% of the time, whereas responders chose synonyms to describe a "broken” bone with more severe characteristics as an answer in 62.1% of cases and chose less severe characteristics 37.9% of the time. The difference for each group was statistically significant (P=0.0458 and P ≤0.00001, respectively).There was no correlation between level of education nor having a personal orthopaedic history of a previous fracture with understanding the terms fracture and broken as synonymous. Having an occupation in the medical field (i.e. physician or physical/occupational therapist) significantly improved understanding of terminology.
The majority of people, regardless of the age, gender, race, education or history of previous fracture, may not understand that fractured and broken are synonymous terms. Providers need to be cognizant of the terminology they use when describing a patient’s injury in order to optimize patient understanding and care.

The patient-rated wrist evaluation (PRWE) score is one of the most common clinical instruments used as an outcome measurement tool for distal radius fractures and other upper extremity conditions. The purpose of this study was to translate the PRWE into its Persian version and to evaluate its validity and reliability in patients with upper extremity conditions.
One hundred and fourthly one adult patients with upper extremity conditions participated in this ethical board approved study from August 2015 to May 2016. After translating the original version of the PRWE into Persian, all patients filled out the PRWE in addition to the VAS (Visual analogue scale) and DASH questionnaires. For evaluating reliability, after three days the researchers called back some of the patients who did not receive treatment or any changes in symptoms and asked them to complete the PRWE retest (104 patients).
Cronbach’s alpha was calculated as high as 0.934, implying very reliable internal consistency. After each item deletion, the Cronbach’s alpha was still constant (range: 0.926 to 0.936). Intraclass correlation coefficient was 0.952 and this showed excellent test-retest reliability. The correlation coefficient between the PRWE and DASH scores was strong. Multivariable analysis showed an association between the PRWE and years educated.
Our study has shown that the Persian version of the PRWE is valid and reliable for patients with upper extremity conditions.

In the current study, we investigated that how sagittal femoral bowing can affect the sagittal alignment of the femoral component in total knee arthroplasty (TKA).
There were 25 patients underwent TKA. Long leg radiography in lateral view was performed. The sagittal femoral bowing (SFB) and component alignment in relation to the sagittal mechanical axis and distal anterior cortical line (DACL) were measured. Finally, the correlation of component alignment and SFB was examined.
Mean SFB was 7±2.7 degrees. The component was in flexion position in relation to mechanical axis and DACL as 8.4±2.9 degrees and 1.7±0.9 degrees, respectively. The flexion alignment of the component was significantly correlated with SFB.
Mechanical alignment of the limb in both coronal and sagittal axes should be preserved in TKA. SFB can significantly increased the flexion alignment of the femoral component.

Medial collateral ligament tears usually will be treated through non-surgical methods, but, in some cases such as those with tears at the distal insertion where the reduction could be blocked by the pes anserine tendons (Stener-like lesion), surgery will be performed. Here, we present a surgical technique in such cases. In this retrospective case series, we describe six patients diagnosed with Stener-like lesion based on clinical evaluation and imaging results. In the one-year follow-up visit, there was no complaining of pain or joint instability and full range of motion and negative valgus stress test were reported in all cases. The results showed this surgical technique is a useful and safe treatment approach in such cases.

Originally described in 1853 by Dr. Morel-Lavellee, closed internal degloving injuries represent an important, although uncommon, source of morbidity in trauma patients. These injuries are typically the result of a shearing or crushing force that traumatically separates the skin and subcutaneous tissue from the underlying fat. This results in disruption of perforating blood vessels and lymphatics, leading to hematoma/seroma formation. We describe two cases in which industrial crush injuries resulted in lumbar transverse process fracture. Both patients developed closed degloving injuries of the flank. To the author’s knowledge, this is the first case series describing the occurrence of closed internal degloving injuries of the flank with transverse process fractures. We advise that a high level of suspicion for these lesions to occur with transverse spinal fractures should be maintained, as they may arise several years after initial injury.

Two patients-one with a terrible triad fracture dislocation and one with an anterior olecranon fracture dislocation—were treated for maltracking of the elbow (medial subluxation). The radial head articulated with the lateral trochlea while the ulnar trochlear notch was perched over the medial trochlea. The late revision surgery could not correct the subluxation because the joints were accustomed to the new alignment, however the overall function was reasonable.