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Archives of Bone and Joint Surgery - Volume:5 Issue: 5, Sep 2017

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

  • تاریخ انتشار: 1396/07/22
  • تعداد عناوین: 13
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  • Bahador Alami-Harandi, Mohammad Hossein Nabian * Pages 269-271
    Ancient Iran Signs of pierced skulls and healed broken bones have been found in the archaeological site of “Shahr-e Sūkhté” (the Burnt City), a large Bronze Age urban habitation located in Sistan and Baluchistan Province at the southeastern part of Iran, going back to over 4000 years ago. The treatment of patients in ancient Iran was mostly carried out by the spiritualist clergymen1.
    Abu Bakr Mohammad Zakaria Razi, Razes, (854– 925) has described joint sprains, fractures, and bone anomalies in his “The Kitab al-Hawi Fi Tebb”. He was the first to use plaster casts for fracture immobilization. Later, Avicenna (980-1037) used tractions and splints for fracture management. He also used plaster casts, mummies and bitumen to support and protect fractures1.
    Rashid al-Din Fazlullah Hamedani (1247–1318), the powerful vizier of Ghazan, established and endowed "Rab-e-Rashidi", the clinical teaching complex in Tabriz, where orthopedic training as well as the management of fractures was also carried out. However, the establishment was looted and destroyed after the execution of Rashid al-Din Fazlullah. Thereafter, medicine was long declined in Iran, and there was no other place in the name of hospital where patients could be treated2.
    Keywords: Orthopedic, History, Iran
  • Felix Tome-Bermejo *, Angel Pi, Ntilde, Era, Luis Alvarez Pages 272-282
    Osteoporosis has become a major medical problem as the aged population of the world rapidly grows. Osteoporosis predisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concern before performing spine surgery, especially with bone fusions and instrumentation. Osteoporosis has often been considered a contraindication for spinal surgery, while in some instances patients have undergone limited and inadequate procedures in order to avoid concomitant instrumentation. As the population ages and the expectations of older patients increase, the demand for surgical treatment in older patients with osteoporosis and spinal degenerative diseases becomes progressively more important. Nowadays, advances in surgical and anesthetic technology make it possible to operate successfully on elderly patients who no longer accept disabling physical conditions. This article discusses the biomechanics of the osteoporotic spine, the diagnosis and management of osteoporotic patients with spinal conditions, as well as the novel treatments, recommendations, surgical indications, strategies and instrumentation in patients with osteoporosis who need spine operations.
    Keywords: Degenerative scoliosis, Degenerative spondylolisthesis, Fracture, Instrumentation, Osteoporosis, Stenosis
  • Dimitrios N. Lyras *, Robert Greenhow, Craig Loucks Pages 283-289
    Background
    The aim of this study is to evaluate the accuracy of bone cuts and the resultant alignment, using the MyKnee patient specific cutting blocks.
    Methods
    We retrospectively reviewed 132 patients undergoing primary TKR for osteoarthritis by one single surgeon. The operative time, the preoperative Hip-Knee-Ankle (HKA) axis based on the CT-scan, the postoperative HKA axis based on long axis standing x-rays, the planned and the actual size of the femoral and the tibial components, and the number of the recuts which has been made intraoperative were measured.
    Results
    The average preoperative HKA axis was 177.50 (range 163.50 to 1940), whereas the average postoperative HKA axis was 179.40 (range 177.10 to 182.70). No outliers were reported in the study 0%). Intraoperatively, 4 femoral components (3.03%), and 7 tibial components (5.30%) applied to the patients were different than the planned size. There was no need of recuts in any of our cases intraoperatively.
    Conclusion
    The MyKnee system evaluated in this study was shown to be remarkable reliable in the coronal plane alignment, and the prediction of the component size. However, further studies are needed to determine whether there are any clinically important improvements in outcomes or patient satisfaction when using patient-specific cutting blocks for TKA.
    Keywords: CT scan, HKA ankle, Knee alignment, Patient specific instruments, Total knee arthroplasty
  • Ali Andalib, Erfan Sheikhbahaei, Zeynab Andalib, Mohammad A. Tahririan * Pages 290-395
    Background
    Comminuted fractures happen frequently due to traumas. Fixation without opening the fracture site, known as minimally invasive plate osteosynthesis (MIPO), has recently become prevalent. This study has been designed to assess the outcomes of this treatment for tibial and femoral comminuted fractures.
    Methods
    A total of 60 patients with comminuted femoral or tibial fractures were operated with MIPO method in this cross-sectional study at Alzahra university hospital in 2015. Eleven patients were excluded due to lack of adequate follow-ups. Patients’data including union time; infection in the fractured site; hip and knee range of motion; and any malunion or deformities like limb length discrepancy were collected after the surgery in every session.
    Results
    Among 32 femoral and 17 tibial fractures, union was completed in48 patients, while only one patient with femoral fracture had nonunion. The mean union time was 18.57±2.42 weeks. Femur fractures healed faster than tibia (17.76±2.36 compared to 19±2.37 weeks, respectively, P=0.09). None of the patients suffered from infections or fistula. The range of motion in hip and knee remained intact in approximately all patients. Malunion happened in 3 patients; 100 internal rotation in 1 patient; and 1cm limb shortening in 2 patients.
    Conclusion
    According to the result of this study, MIPO is a simple and effective method of fixation with a high rate of union as well as minimal complications for comminuted fractures of long bones. Infection is rare, and malunion or any deformity is infrequent. MIPO appears to be a promising and safe treatment alternative for comminuted fractures.
    Keywords: Comminuted fractures, Femur, Minimally invasive plate osteosynthesis, MIPO, Plate osteosynthesis, Tibia
  • Khodamorad Jamshidi, Mehrdad Bahrabadi *, Alireza Mirzaei Pages 296-301
    Background
    There is no consensus regarding the best method of reconstruction in pediatric population following the wide resection of malignant bone tumors. More exploration of the complications of osteoarticular reconstruction leads to less existing controversy of this type of reconstruction, which is the main point of this article.
    Methods
    Long-term outcomes and complications of osteoarticular allograft reconstruction of primary distal femoral bone sarcomas in 22 children with mean age of 10.7 years old were reviewed in this study. Musculoskeletal Tumor Society (MSTS) scoring system was used for functional evaluation of the allografts.
    Results
    With an average follow-up time of 81 months, the outcomes of 16 patients with allografts at the final follow up were evaluated. As expected, Limb length discrepancy (LLD) was observed in all patients (mean LLD= 2.73cm), which was significantly correlated to allograft survival time (P
    Conclusion
    Osteoarticular allograft reconstruction could result in several complications including DJD. Despite its considerable biologic advantage over endoprosthesis, osteoarticular allograft reconstruction is a long-lasting but still a temporary solution before performing megaprosthesis. This allows patients to preserve their remaining physis for limb growth and become old enough for an adult megaprosthesis.
    Keywords: Distal Femoral Tumor, Osteoarticular Allograft, pediatric
  • Mohammad M. Sarzaeem, Mohammad M. Omidian *, Gholamhossein Kazemian, Aalireza Manafi Pages 302-307
    Background
    Proximal tibial fractures in elderly patients with osteoporosis or knee osteoarthritis (OA) are challenging cases. In the current study, we present our experience with uncommon acute primary total knee arthroplasty (PTKA) in this patient population.
    Methods
    PTKAs were performed following proximal tibial fractures in 30 consecutive patients over 60 years of age with osteoporosis or knee OA between 2005 and 2009. Three constrained condylar knees (CCK) and no hinged knee prosthesis were used. Patients were followed up for 4.5±1.1 years.
    Results
    Patients were discharged after 4.6±1.2 days. The postoperative Tegner activity scale (3.5±1.3) was improved significantly compared to the preoperative scale (2.5±1.2) (P
    Conclusion
    PTKA following a proximal tibial fracture in elderly patients with osteoporosis or knee degeneration can be considered as a safe alternative for open reduction and internal fixation. PTKA resulted in immediate weight-bearing, improved functional status and patients’ satisfaction. However, functional outcomes were dependent on the general condition of 24 the patient. Also, constrained knee prostheses were not necessary for a vast majority of the patients.
    Keywords: Knee osteoarthritis, Osteoporosis, Proximal tibial fracture, Total knee arthroplasty
  • Sezai Ozkan, Jos J. Mellema, David Ring*, Neal C. Chen Pages 308-314
    Background
    To examine whether interobserver reliability, decision-making, and confidence in decision-making in the treatment of distal radius fractures changes if radiographs are viewed on a messenger application on a mobile phone compared to a standard DICOM viewer.
    Methods
    Radiographs of distal radius fractures were presented to surgeons on either a smart phone using a mobile messenger application or a laptop using a DICOM viewer application. Twenty observers participated: 10 (50%) were randomly assigned to the DICOM viewer group and 10 (50%) to the mobile messenger group. Each observer was asked to evaluate the cases and (1) classify the fracture type according to the AO classification, (2) recommend operative or conservative treatment and (3) rate their confidence about this decision.
    Results
    There was no significant difference in interobserver reliability for AO classification and recommendation for surgery for distal radius fractures in both groups. The percentage of recommendation for surgery was significantly higher in the messenger application group compared to the DICOM viewer group (89% versus 78%, P=0.019) and the confidence for treatment decision was significantly higher in the mobile messenger group compared to the DICOM viewer group (8.9 versus 7.9, P=0.026).
    Conclusion
    Messenger applications on mobile phones could facilitate remote decision making for patients with distal radius fractures, but should be used with caution.
    Keywords: Decision-making, Distal radius, Interobserver agreement, Messaging application, Teleconsultation
  • Alexander W. Aleem*, Usman Ali M. Syed, Thema Nicholson, Charles L. Getz, Surena Namdari, Pedro K. Beredjiklian, Joseph A. Abboud Pages 315-321
    Background
    Corticosteroid injections are used to treat a variety of orthopedic conditions with the goal of decreasing pain and inflammation. Administration of systemic or local corticosteroids risks temporarily increasing blood glucose levels, especially diabetic patients. The purpose of this study is to quantify the effects of corticosteroid injections on blood glucose levels in diabetic patients with shoulder pathology.
    Methods
    Diabetic patients who regularly monitored their blood glucose levels and were indicated for a subacromial corticosteroid injection were included in this prospective investigation. The typical normal morning fasting glucose and most recent hemoglobin A1c level was recorded for each patient. After injection, patients were contacted daily to confirm their fasting morning glucose level for 10 days post-injection.
    Results
    Seventeen consecutive patients were enrolled. Patients with hemoglobin A1c of
    Conclusion
    After corticosteroid injection, patients with well-controlled diabetes experience smaller elevations and faster return to baseline glucose levels than patients with poor control. Insulin dependent diabetics experienced similar findings as patients with poor control. Future studies are needed to evaluate dosing to optimize the risks of blood glucose elevation while maintaining therapeutic benefit.
    Keywords: Corticosteroid injection, Diabetic response to corticosteroid injection, Glucose response to corticosteroid, Pain relief with steroid injection, Shoulder injection, Shoulder pain
  • Reza Abdi, Ramin Hajzargarbashi *, Mohammad H. Ebrahimzadeh Pages 322-327
    Background
    Genu valgum usually originates from a deformity of distal femur that is often corrected by distal femoral varus osteotomy. The osteotomy includes both components of angulationcorrection and translation because the site of osteotomy is not commonly at the apex of deformity. Improvement of patellar tracking not only depends on valgus correction, but also it may be partially due to centralization of the trochlear groove under the femoral anatomical axis (FAA). We asked whether we could accurately correct the deformities based on our preoperative goals for the correction of the mechanical axis and centralization of the trochlear groove under the FAA by using a single bone cut. This study describes a new lateral single cut distal femoral osteotomy (SCFO) that enables concurrent correction of angulation and translation.
    Methods
    This study was done on 12 young adult patients with femoral juxta-articular genu valgum deformity using SCFO. The average age at operation was 21 years (range: 16-25). SCFO is a type of closing-opening distal femoral osteotomy that corrects the valgus deformity of the distal femur while the translation of the distal fragment is done using one oblique cut. It centralizes the trochlear groove under the FAA. We compared the pre and postoperative radiographic and clinical variables including mechanical tibiofemoral angle, knee range of motion (ROM), International knee documentation committee (IKDC) score and the time to union. Mean follow-up of the patients was 24 months.
    Results
    The average mechanical tibiofemoral angle improved from 16 degrees (10-23) to 1 degrees (-2 to ). IKDC subjective score slightly improved from preoperative (65) to 2-year follow-up (71). Centralization of the trochlea was achieved in all patients.
    Conclusion
    SCFO can be a reasonable alternative for correction of the distal femur genu valgum deformity. It can centralize the patellar groove under the FAA with satisfactory clinical outcomes.
    Keywords: Femoral osteotomy, Genu valgum, SCFO, Single cut, Valgus
  • Zohreh Zafarani, Fateme Mirzaee, Mohamadreza Guity, Hamid Reza Aslani * Pages 328-331
    Partial thickness rotator cuff tears (PTRCTs) are a common pathology among shoulder disorders in people over 50 years. Treatment of PTRCTs remains controversial. Most studies on the treatment of PTRCTs have explained surgical techniques or outcomes; few studies have centralized on the conservative and new management of PTRCTs, like treatment with Platelet-rich plasma (PRP). These case series study have been conducted on Platelet-rich plasma (PRP) injection, as a concentrated source of autologous platelets in blood plasma, contains several different growth factors and othercytokines that can stimulate healing of soft tissue. PRP injection showed positive effect on improving PTRCTs complains. This method improved pain, function, DASH score and shoulder joint range motion in. Because of PRP products are safe and easy to prepare and apply, and also according to improving patient’s condition, this method can be used to treat PTRCTs.
    Keywords: Partial thickness rotator cuff tears, Platelet-rich plasma, PRP injection
  • Efstathios G. Ballas *, Konstantinos Raptis, Ioannis P. Stathopoulos, Nikolaos A. Stavropoulos, Sarantis-Petros G. Spyridonos Pages 332-336
    Isolated scaphoid dislocations are extremely rare injuries and are commonly associated with significant ligamentous disruptions. A dorsiflexion-supination force upon the hand is considered as the most common mechanism of injury. Different treatment options have been proposed for the management of this uncommon entity, ranging from conservative treatment with closed reduction and casting to a wide range of open or percutaneous surgical techniques. In this article, we reported ona case of this rare injury managed with open reduction and pinning along with ligamentous reconstruction.
    Keywords: Carpal scaphoid, Complete, Dislocation, Isolated
  • Ali A. Esmailiejah, Mohammadreza Abbasian *, Farshad Safdari Pages 337-341
    Traumatic anterior dislocation of the hip is an extremely rare condition in children and open dislocation is even rarer. This isusually caused by high-energy trauma. In the current study, we present a case of an eight-year-old child suffering from an open anterior–inferior dislocation of the right hip concomitant with pelvic ring disruption and an ipsilateral open distal femoral fracture (Salter-Harris type 4, Gustilo type IIIA) caused by a traffic accident. The patient underwent successful emergent open reduction due to the buttonholed femoral head after appropriate irrigation and debridement. Successful recovery was achieved and the patient was discharged after two weeks. After nine months of follow-up, the X-ray images showed slight changes related to the osteonecrosis of the femoral head. Long-term follow-up over a period of six years showed sufficient range of motion. The patient’s gait was normal and he was satisfied with the outcome. In addition, slight non-progressive osteonecrotic changes were obvious in the right hip.
    Keywords: Dislocation, Hip, Open fracture
  • Seyed Mohammad J. Mortazavi, Mohammad R. Sobhan, Hamed Mazoochy Pages 342-346
    Total knee arthroplasty (TKA) is a rewarding procedure in patients with hemophilia and end stage knee hemophilic arthropathy. However, this procedure might be associated with complications such as infection. There periprosthetic joint infection in patients with hemophilia is very well known, though we are not aware of any previous report on Brucella infection in this group of patients. Here, we reported a 28-year old man with Brucella infection of total knee replacement who initially underwent a conservative treatment followed bya two-stage revision. We believe that this report will alert physicians who work in endemic area for brucellosis to consider this in differential diagnosis and do the right intervention at the right time.
    Keywords: Arthritis, Brucella, Hemophilia, Total knee arthroplasty