Journal of Research in Orthopedic Science
Volume:3 Issue: 4, Nov 2016

Context: There is a need to determine if body exhaust suits which were initially used and recommended by Sir John Charnley has a role in minimizing bacterial shedding in the operating room.
Evidence Acquisition: The English literature search conducted for relevant articles. 14 articles were relevant to the role of body exhaust system in total joint replacement.
There is controversial evidences regarding the role of body exhaust system in reducing pei-prosthetic joint infection but most evidences agree that its role in protecting operating room personnel could not be denied.
There is not enough evidence to indicate that use of body exhaust suits could reduce risk of infection, however there are some evidences showing increased protection of surgical team by using body exhaust system.

High-pressure injections into the hand, burden devastating and permanent functional impairments. Many materials including paint, paint thinner, gasoline, oil and grease are reported as the causative agents. These injuries need multiple procedures and reconstructions most of the time and 40% of the injuries may end with amputation of the injured part.
The aim of this study was to report the treatment outcomes and methods of treatments of patients with high-pressure injection injuries of the hand.
We retrospectively reviewed the medical records, imaging files and demographic data of patients, who were treated at our center due to the high-pressure injuries to their hands. We recorded the kind of the injected materials, time to the first treatment procedure, times of operation, and methods of their treatments. The outcomes of the injuries as well as the deficiency of the digital joints motion were also reported.
Nine cases with high-pressure injury of the hand were enrolled in this study. All patients were male with mean age of 26.88 ± 7.52. Mean follow-up time was 28.55 ± 12.49 months. The dominant hand was the right side in seven patients and left in two patients. Injury was in the left hand of seven patients and right hand of two patients. Index finger was the most common involved part (five cases) followed by the thumb (two cases). Injected material was grease in seven cases, water-base paint and water, each in one case.Mean time delay to the first treatment procedure was 29.16 ± 25.66 hours for seven patients. This was exceptionally long for two patients (seven days and 24 months). Type of treatment was debridement and skin graft for three cases, debridement and cross finger flap for two cases, debridement for two cases and nerve graft for one case. Amputation of the necrotic digit was performed for one case. Mean hospitalization time was 8.33 ± 3.64 days for all patients.Mean total active range of motion (TAROM) deficit was 18.57 ± 13.13 degrees for seven cases. In one case, mean deficit of II to IV fingers was 170. Seven cases returned to their previous occupation. There was no correlation between time to first treatment procedure and TAROM deficit.
These benign-looking injuries should not be underestimated and classic management including immediate surgical decompression is recommended to minimize the functional impairments.

The correlation between depression and pain is reported in several chronic diseases including osteoarthritis (OA). This depression could lead to more pain perception and is considered as one of the confounding factors of the association between radiographic symptoms and the pain level in patients with OA.
Assessment of comorbid depression and its predictors could significantly improve assessment and management of the OA. The current study aimed to evaluate the association between depression and pain in patients with OA and explore the determinants of this depression in Iranian population with OA, as well.
The study evaluated the clinico-socio-demographic predictors of depression in 100 patients with OA. Depression was recorded using Beck depression inventory-II (BDI-II) and pain was measured by self-reporting visual analogue scale (VAS).
Depression score was significantly higher in younger (P = 0.04), unmarried (P = 0.01), physically inactive (P = 0.03) and patients with higher grade of OA (P = 0.02). In addition, a significant correlation was observed between comorbid depression and pain (r = 0.381, P = 0.008, 95% confidence interval), OA grade (r = 0.332, P = 0.009, 95% CI) and age (r = -0.259, P = 0.024, 95% CI).
Given the confounding role of comorbid depression in the assessment and management of OA, and the high prevalence of depression in patients with OA, the predictors of comorbid depression in these patients should be considered to improve the outcome of therapeutic interventions.

We examined the feasibility and effectiveness of a community-based progressive aquatic exercise program for community dwelling older adults, with moderate to severe knee osteoarthritis (OA).
The purposes of this study were to 1, assess the effects of a progressive aquatic exercise program on the walking ability, stair climbing ability, quadriceps muscle strength, as well as self-reported symptoms, function, and quality of life in community dwelling adults with moderate to severe knee OA and; 2, assess the feasibility of a community-based aquatic program for community dwelling adults with knee OA.
Seventeen volunteers (12 women (x = 61.1 years) and 5 men (x = 69.0 years)) participated in a progressive 8 - 10 week aquatic exercise program, consisting of 20 - 24, 1-hour sessions. Outcome measures, acquired twice before beginning the exercise protocol as well as after 4 and 8 weeks of exercise, included the Knee Injury and Osteoarthritis outcome score (KOOS) instrument, a 2 minute walk test (2MWT), a 10 step stair climb for time, and an isometric knee extension strength assessment.
Significant improvements were detected in 2 MWT, 10 step stair climb, right quadriceps isometric force development, and the KOOS symptoms and stiffness subscale. Significant improvement was found on KOOS function subscales between baseline testing sessions and maintained at follow-up. Non-significant improvements were identified in left quadriceps isometric force development, KOOS pain, and KOOS quality of life.
These data suggest that a community-based, progressive aquatic exercise program is feasible and results in measurable improvements in function without worsening symptoms. Further study is warranted to investigate the impact of a longer program and the role of aquatic exercise in the long-term management of patients with knee OA.

Larsen syndrome is a congenital skeletal disorder manifested by several facial, ligamentous and spinal complications. Cervical kyphosis is one of the serious manifestations of the Larsen syndrome. However, there is no consensus regarding the best procedure of cervical kyphosis management in these patients.
A 1-year-old boy with the diagnosis of the Larsen syndrome was admitted to our hospital and undergone several corrective surgeries for knee, hip and foot deformities. At the age of 2 years, scoliosis was diagnosed and surgically managed. At the same time, cervical kyphosis was observed and monitored until the symptoms of neurological deficit due to cord compression led to the correction of cervical Kyphosis at the age of 4.5 years. Accordingly, an anterior/posterior (360 degree) cervical spinal fusion surgery was performed. Subsequently, cervicothoracic fusion was performed to correct cervicothoracic instability. No neurological complications were reported afterward.
In spite of existing controversy around the best method of cervical kyphosis management in Larsen syndrome’s patients older than 2- year old, anterior release and posterior fixation followed by anterior spinal fusion and strut grafting led to the satisfactory result in our case.

Osteosarcoma is the second most common primary bone tumor, however, osteosarcoma of the foot and especially of the toe phalanges are very rare.
The current report includes the radiological, pathological, and short term clinical results of a conventional high grade osteosarcoma of the little toe in a 17-year-old adolescent. He referred to the center with a painful swelling at posterolateral aspect of his left fifth toe. Imaging studies were consistent with an aggressive lesion. Biopsy confirmed the diagnosis of conventional osteosarcoma.
In case of osteosarcoma of little toe proximal phalanx in patients with a bone destructive lesion, malignancy should always be considered.