Archives of Bone and Joint Surgery
Volume:9 Issue: 2, Mar 2021

There have been studies indicating that the non acute rotator cuff repair can be augmented withreconstituted absorbable collagen scaffold (RACS) which results in better structural integrity and functional outcome.Hence, this review aims to systematically analyse the available evidence based on its methodological quality, techniqueand functional outcome.

Systematic review was carried on PubMed for articles related to non acute rotator cuff repair reconstitutedabsorbable collagen scaffold . Also, Colemans method of scoring was used to assess the methodological quality of thestudies.

Among the studies included, the minimum follow up duration was 12 months. All the studies reportedstatistically significant improved outcomes following repair with reconstituted absorbable collagen scaffold for partialthickness tears, full thickness tears and in massive tears.

Repair reconstituted absorbable collagen scaffold seems to be a viable option to improve the structuralintegrity following non acute rotator cuff repair.Level of evidence: I

Disability following hand and upper extremity conditions is common. Patient-reported outcome measures(PROs) are used to capture patients’ status subjectively. This review has aimed to synthesis the literature regarding theextent and methodological quality of translation, cross-cultural adaptation, and psychometric properties of the hand andupper extremity disability PROs in the Persian language.

Seven electronic databases (MEDLINE, EMBASE, Psychinfo, Scopus, ISI, Science direct, and GoogleScholar) were searched until May 2020. Studies reporting cross-cultural adaptation and psychometric properties testingof the Persian validated disability PROs of the hand and upper extremity were identified. We appraised the eligiblestudies using Guidelines for the Process of Cross-cultural Adaptation of Self-report Measures and COnsensus-basedStandards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist.

Out of 98 identified records, 22 studies on 17 PROs were reviewed. Most of the PROs (47%) were regionspecificand the others were condition-specific (29%) and multi-region (24%). Most of the studies (67%) followed 80to 100% of the recommended steps for cross-cultural adaptation and translation of a PRO. The evidence of internalconsistency, test-retest reliability, and construct validity was available for all the PROs. Structural validity, measurementerror, and responsiveness were evaluated for five, six, and four PROs, respectively. The overall risk of bias ranged from“inadequate” to “very good” for all studies.

A reasonable number of PROs for the evaluation of hand and upper extremity disability are available inthe Persian language. Although all of them are not of very good psychometric properties, they all have sufficient qualityto be used in clinical settings.Level of evidence: II

Soft tissue injury associated with fractures of the distal tibia is a predictive factor for a poor prognosis.The purpose of this study was to investigate factors associated with the need for a flap coverage after distal tibialfracture, and whether there was a difference in functional outcomes between patients with flap coverage or no flapcoverage for a distal tibial fracture.

All fractures of the distal tibia treated in our department between 2010 and 2017 were reviewed. Thefunctional result was assessed using the SF-36 Quality of Life Questionnaire, the Visual Analog Scale (VAS) whenwalking and the AOFAS scale (American Orthopedic Foot and Ankle Society).

132 distal tibia fractures were reviewed, of which 51 required soft tissue flap reconstruction, which wasassociated with open fractures (P<0.001, OR 5.25), high energy trauma (P<0.001, OR 1.7)), the use of external fixation(P<0.001, OR 12.5) and the presence of vascular alterations on the Angio-CT scan (P<0.001). No significant differenceswere found in any of the scales that assessed the functional results between the group of patients who required softtissue flap reconstruction and the group of patients who did not.

We found that the need for a soft tissue flap was associated with the following parameters: open fracture, highenergy of trauma, presence of skin necrosis, the use of external fixation and the existence of vascular injury. In relation tofunctional results, differences were not found between the group that needed coverage with a flap and the one that did not.Level of evidence: III

Treatment recommendations for trapeziometacarpal (TMC) arthrosis are highly variable from surgeonto surgeon. This study addressed the influence of viewing radiographs on a decision to offer surgery for TMC arthrosis. In an online survey, 92 hand surgeons viewed clinical scenarios and were asked if they would offer surgeryto 30 patients with TMC arthrosis. Forty-two observers were randomly assigned to review clinical information aloneand 50 to review clinical information as well as radiographs. The degree of limitation of daily activities, time sincediagnosis, prior treatment, pain with grind, crepitation with grind, and metacarpal adduction with metacarpophalangealhyperextension were randomized for each patient scenario to determine the influence of these factors on offers ofsurgery. A cross-classified binary logistic multilevel regression analysis identified factors associated with surgeon offerof surgery. Surgeons were more likely to offer surgery when they viewed radiographs (42% vs. 32%, P = 0.01). Otherfactors associated variation in offer of surgery included greater limitation of daily activities, symptoms for a year,prior splint or injection, deformity of the metacarpophalangeal joint. Factors not associated included limb dominance,prominence of the TMC joint, crepitation with the grind test, and pinch and grip strength. Surgeons that view radiographs are more likely to offer surgery to people with TMC arthrosis.Surgeons are also more likely to offer surgery when people do not adapt with time and nonoperative treatment.Given the notable influence of surgeon bias, and the potential for surgeon and patient impatience with theadaptation process, methods for increasing patient participation in the decision-making process merit additionalattention and study.Level of evidence: Not applicable.

This randomized clinical trial was undertaken to document the clinical presentation of de Quervain’s disease and evaluate the outcome of management with triamcinolone acetonide (TAC) injection versus surgical decompression.

Half of the patients were assigned to the corticosteroid injection group (group A) and half to the surgery group (group B). In group A, 40 mg of TAC was injected into the affected first extensor compartment. In group B, surgical decompression of first extensor compartment was performed.

There were 56 patients with 38 (67.85 %) females and 18(32.14%) males. The age range was 23-66 years. In group A, one injection was employed among 7(25%) patients whereas two injections among 21(75%) patients. Local complications with injections were observed among 7 patients. Symptomatic relief with injection at 6-weeks was observed among 25% patients whereas recurrence at one year was observed among 9(32.14%) patients. In group B, no critical complications were encountered following surgery; all the patients had symptomatic relief at 6-weeks and there was no case with recurrence at one year.

Surgical decompression provided superior results in terms of providing symptomatic relief at 6-weeks among all patients, absence of complications and no recurrence. The corticosteroid injections (CSI) were associated with the need for repeat injections among 75% cases and a recurrence rate of 32.14% at one year, rendering it to be comparatively a poorer choice. Level of evidence: II

The aim of this study was to assess the functional outcomes and time to improve after the modified arthroscopic technique (recession technique) by using a knife to sharply cut the extensor carpi radialis brevis (ECRB) tendon origin in patients with recalcitrant tennis elbow.

In a prospective study, we included 11 consecutive patients. Following the routine elbow arthroscopy and after exposing the ECRB tendon, we used a knife (no. 11 blade) to cut the tendon at the level of radiocapitellar articulation while avoiding the lateral collateral ligament, which is considered a tendon recession as is done in spastic muscles. Patients were followed up for 1, 3, 6, and 12 month intervals and were asked to fill the Mayo Elbow Performance Index (MEPI), Quick Disabilities of the Arm Shoulder Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE).

The mean PRTEE, QuickDASH, and MEPI scores showed significant improvement over time (P<0.001). There were 5 excellent, 5 good and 1 fair results based on MEPI. The patient with fair result was the only patient with existing varus instability on examination under anesthesia although we could not elicit the test positive on clinical examination. Substantial functional and pain improvement was reported almost 6 months after surgery. We did not find any nerve injury or post-operative infection.

Arthroscopic recession surgery by using a knife is a safe and effective way in managing recalcitrant tennis elbow although patients should be informed of the expected time to improve. A simple tendon recession by a sharp cut is a time-saving technique that works effectively and is comparable with the piecemeal shaving. Clinical Relevance: The modified muscle recession technique is a rapid and safe way to manage the recalcitrant tennis elbow arthroscopically while the outcomes are comparable to the routine piecemeal shaving of the pathologic tissue. Level of evidence: IV

Given the fact that the carpal tunnel syndrome (CTS) happens as a consequence of the median nerve entrapment, besides other known factors, the shape and anthropometric characteristics of the carpal tunnel, wrist, and hand could be considered as a predisposing risk factor for idiopathic CTS. The aim of this study was to evaluate the morphology and radiologic scales in CTS hands. In this prospective study, patients who underwent upper extremity electrodiagnostic studies were enrolled for hand morphologic and radiographic indexes. Patients were divided into CTS suffering and CTS symptom-free groups according to nerve conduction velocity (NCV) findings. A true posteroanterior radiograph of the hands was pas performed for each participant. Metacarpal length to wrist length index (carpal ratio), metacarpal length to metacarpal width index, third to first metacarpal length, hand length index, and hand volume index were measured in both groups. Significant differences were seen between the two groups regarding the body mass index (P< 0.001), metacarpal length divided by metacarpal width index (P=0.08), first metacarpal length divided by third metacarpal length (P=0.002), wrist circumference divided by distal flexor wrist crease to the tip of the third finger (P< 0.001), distal flexor wrist crease to the tip of the third finger divided by hand volume (P=0.05), and distal flexor wrist crease to the tip of the third finger divided by wrist circumference (P< 0.001). Multivariable analysis of hand indices were statically significant for the first metacarpal length divided by third metacarpal length (P=0.00), wrist circumference divided by distal flexor wrist crease to the tip of the third finger (P=0.138), and distal flexor wrist crease to the tip of the third finger divided by wrist circumference (P=0.117). However, first metacarpal length divided by third metacarpal length and third metacarpal length divided by palm height were associated with higher CTS occurrences. Receiver operating characteristic curve analysis demonstrated cutoff points which were possible to estimate only for first metacarpal length divided by third metacarpal length and wrist circumference divided by distal flexor wrist crease to the tip of the third finger. Based on our findings, CTS hand is characterized by shorter fingers compared to thumb and wrist (metacarpal length to wrist length and hand length indexes), wider (metacarpal length to metacarpal width index), and bulkier (hand volume index) compared to non-CTS hands. The severity of CTS was correlated with a higher carpal ratio. In conclusion, CTS hands are bulkier with wider palms and shorter fingers compared to thumb. In this study, the thumb to the third metacarpal length was proved to be the best index for diagnosis of “CTS hand”. Level of evidence: I

The association of the ulnar styloid fracture with distal radius fracture is common and the necessity of ulnar styloid fixation is still controversial. We aim to investigate the effect of ulnar styloid fracture fixation on the final outcome of the distal radius fracture treatment. In a two-arm randomized clinical trial, patients with Fernandez type I distal radius fracture associated with ulnar styloid fracture in the base were enrolled. Patients were divided into two groups of the ulnar styloid fracture being fixed and it being remained unfixed. Patients were followed up for 12 months using pain visual analogue scale (VAS), quick form of the Disabilities of the Arm, Shoulder and Hand (DASH) score questionnaire, Mayo performance score as well as the wrist range of motion and grip strength evaluation. DASH score during three and six months after styloid fixation demonstrated higher scores (P-value= 0.03 and 0.00) and was proved significant, however, the two groups did not differ on the other variables. It could be concluded that ulnar styloid fixation using pin and wire have an adverse effect on distal radius fixation outcome. Level of evidence: Level I

The aim of this study was to evaluate the factors influencing patient reported outcome measures (PROM) of biceps tenodesis after the rupture of proximal long head of the biceps tendon. Retrospective chart review was conducted to identify patients with complete proximal rupture of the long head of the biceps that underwent biceps tenodesis between 2002-2017. This yielded 42 patients, of which 23 (55%) completed the PROMIS Pain Interference, PROMIS Upper Extremity, Quick DASH, and a custom biceps tear questionnaire, at a median of 8.5 years (IQR:5.2-12) post-operatively. The median age of the respondents was 57 years (IQR: 43-61). The majority of patients (n=12, 52%) underwent tenodesis using suture anchor fixation, while the remaining underwent tenodesis with interference screw technique (n=6, 26%), key hole technique (n=1, 4.3%), or tunnel technique (n=1, 4.3%). A bivariate analysis was performed to evaluate factors influencing the PROMs. Six patients (27%) reported persistent biceps cramping at a median of 8.2 years post-operatively, negatively impacting PROMs, and this was associated with older age. Six patients (27%) had post-operative complications, including infection, pain, stiffness, and re-rupture, of which four patients (17%) underwent reoperation. Patients with activity/sports-induced injury or those that underwent tenodesis using a suture anchor technique demonstrated better PROMs. Post-operative biceps cramping persists in almost one-third of patients and significantly impacts PROMs. Patient activity level and the use of suture anchor technique for tenodesis were independent predictors of improved biceps tenodesis outcome scores. Level of evidence: IV

Whilst traumatology around elderly population becomes more and more popular nowadays, the knowledge of local bone quality prior to osteosynthesis is of paramount importance. Assessment of the local bone mechanical properties provides essential information related to implant stability and can support treatment strategies in a timely manner. In the acute setting, dual-energy X-ray absorptiometry and quantitative computer tomography cannot be used routinely, and up till now no known intraoperative methods have been established. A novel technique was developed to determine the local bone strength. A feasibility and sensitivity analysis were performed on synthetic cancellous bone models of various densities [including osteoporotic ranges (0.12 - 0.48g/ cm3 )] by testing the permeability of different rod probe designs. The Intraoperative Osseomechanical Strength Measurement (IOSM) method revealed high sensitivity for the evaluation of local density on synthetic bone material. Among the indenter designs tested, the one with 40° sharp apex and 5 mm diameter reflected accurately the density changes of the synthetic bones. It was also associated with less invasiveness posing no risk for the primary implant stability of the osteosynthesis that may follow. The IOSM method using the indicated indenter design on synthetic cancellous models appears to be a minimal invasive technique with high accuracy in identifying different bone densities . Further studies on human bone material are now focused on the evaluation of the IOSM sensitivity compared to the gold standards (Dual-energy X-ray absorptiometry and quantitative computer tomography). Level of evidence: V

Several procedures and types of osteotomies have been described for hallux valgus (HV) correction. Percutaneous techniques may lead to an early regain of function reducing morbidity and recovery time. In this study, we aimed to evaluate the clinical and radiographic outcomes of percutaneous hallux valgus (HV) correction. One hundred and twenty-four feet treated with the percutaneous technique between May 2011 and December 2015 were included in our study. All patients underwent resection of the medial metatarsal exostosis, complete first metatarsal distal osteotomy, adductor hallucis tendon release and Akin osteotomy of the proximal phalanx. Pre- and postoperative X-rays were clinically assessed. The mean hallux valgus angle (HVA) and the intermetatarsal angle (IMA) decreased significantly from the preoperative assessment to the final follow-up. The AOFAS score improved from a mean preoperative value of 70.2 to 93.8 at the final follow-up. Percutaneous complete distal osteotomy in hallux valgus correction is a safe, reliable and effective procedure for the correction of symptomatic mild hallux valgus. Nevertheless, it requires appropriate surgical experience and patient aftercare in order to achieve the best result. Level of evidence: IV

To evaluate the association between social distancing quantified by mobile phone data and the current prevalence of COVID-19 infections in the U.S. per capita. Data were accessed on April 4, 2020, from Centers for Disease Control and Prevention, Google COVID-19 Community Mobility Report, and the United States Census Bureau to report prevalence of COVID-19 infections, mobility data, and population per state, respectively. Mobility data points were defined as daily length of visit or time spent in a single location based on mobile phone users shared locations from February 7 – March 29, 2020. Multivariable linear regression was used to evaluate relationships between normalized per capita infection prevalence and six parameters of social distancing. Mobility data indicated the following percent changes compared to median values of baseline activity: -50% in transit stations, -45% in retail/recreation, -36% in workplaces, -23% in grocery/pharmacy, -19% in parks, and +12% in residential living areas. Multivariable linear regression revealed significant correlation between prevalence of infection per capita and parameters of social distancing (R= 0.604, P= 0.002). Time at home was not an independent predictor for prevalence of infection per capita (beta= 0.016; 95% CI, -0.003 to 0.036; P= 0.09). Based on mobility reports from mobile phone GPS data and six characteristics of social distancing, significant associations were identified between geographic activity and prevalence of COVID-19 infections in the U.S. per capita. Mobile phone data utilizing ‘location history’ may be warranted to monitor the effectiveness of social distancing parameters on reducing prevalence of COVID-19 in the U.S. Level of evidence: IV

Surgical fixation of hip fractures within 24–48 hours of hospital presentation is associated with decreased rates of postoperative morbidity and death, and recently, hospitals nationwide have implemented strategies to expedite surgery. Our aim was to describe how time-to-surgery and short-term complication rates have changed using the National Surgical Quality Improvement Program database from 2011 to 2017. We identified more than 73,000 patients aged ≥65 years who underwent surgical fixation. Poisson regression adjusting for comorbidities, surgery type, type of anesthesia, patient sex, and patient age was performed to quantify annual changes in time-to-surgery. Annual changes in 30-day postoperative complications were analyzed using a generalized linear model with binomial distribution. A significant decrease in time-to-surgery was observed during the study period (mean 30 hours in 2011 versus 26 hours in 2017; P<0.001). Time-to-surgery decreased by 2% annually during the 7-year period (0.5 hour/year, 95% CI: -35, -23; P<0.001). The all-cause 30-day complication rate also decreased annually (annual risk difference: −0.35%, 95% CI: −0.50%, −0.20%; P<0.001). For individual complications, we found significant decreases in deep infection (-0.2%, P=0.002), reintubation (-0.3%, P=0.001), urinary tract infection (-2.5%, P<0.001), and death (-1.3%, P=0.03). We found significant but small increases of pulmonary embolism (0.3%, P=0.03) and myocardial infarction (0.1%, P=0.02). Higher rates of complications were associated with increased time-to-surgery (P<0.001). From 2011 to 2017, time-to-surgery for hip fracture decreased significantly, as did short-term postoperative rates of all-cause complications and death. Longer time-to-surgery was associated with increased number of complications. Level of evidence: III

Nonspecific chronic neck pain is increasing according to work-related gestures and modern lifestyle. Myofascial pain syndrome is a common problem and may be a primary disease. This study was designed to evaluate the prevalence of cervical myofascial pain syndrome in patients with chronic non-specific neck pain with normal MRI. We also examined the correlation between patients’ age as well as pain severity and duration. Patients with neck pain radiating to their upper extremity were examined despite normal MRI findings. We evaluated 10 different muscles based on myofascial pain syndrome criteria and also recorded pain intensity and functional ability using visual analogue scale and neck disability index, respectively. A physical therapist with at least 10 years of clinical experience with myofascial pain syndrome performed all physical examinations A total of 126 patients (69 females and 57 males) participated in this study, out of whom, 14 patients (11.1%) had no muscular involvement, while 112 cases (88.9%) revealed at least one trigger point. The infraspinatus and scalene muscles were the most commonly involved muscles accounting for 38.9% and 34.9% of all the involvements, respectively. The severity of pain was significantly associated with the disability of the patients (r=0.64, P<0.001). However, the correlation between pain and the number of trigger points was not significant (r=-0.19, P=0.31). Finally, the least significantly correlated variables were disability and the number of trigger points (r=-0.17, P=0.05). Patient’s age was significantly correlated neither with the number of trigger points (r=-0.04, P=0.62), nor the pain duration (r=0.07, P=0.39). Myofascial pain syndrome is a common disorder in patients with nonspecific chronic neck pain, despite normal MRI findings. Although, pain is not correlated with the number of trigger points in these patients, we demonstrated a small correlation between patients’ disability and the latter variable. Level of evidence: II

The diagnosis of synovial chondromatosis (SCM) is usually delayed, as the arthroscopic-guided synovial biopsy is postponed owing to its invasive nature. We report the timely diagnosis of a giant solitary synovial chondromatosis of the hip in a 32-year-old woman using ultrasound-guided synovial biopsy. This technique revealed to be safe and successful in the diagnosis of SCM, when the imaging studies were obscure. Moreover, it avoided the potential arthroscopy-associated complications. We recommend ultrasound-guided synovium biopsy as a less invasive and less complicated technique for the early diagnosis of SCM in future workouts. Level of evidence: V

A part of every science is its history of development. Many individuals and events around the world, as have been attested on the stamps issued from different countries, have contributed to evolve the science of orthopedic surgery; however, some may have been ignored. The current brief history tries to present an insight to major milestones in the history of orthopedic science and also the involved people. Philatelic version of orthopedic history by no mean is a comprehensive history. Orthopedic surgery and science does continue to progress. Certain peaks and memorable events in orthopedic science may appear on postal stamps in future. Level of evidence: V