Archives of Bone and Joint Surgery
Volume:7 Issue: 5, Sep 2019

Acromial stress fracture (ASF) is a unique complication of reverse shoulder arthroplasty (RSA) thatcan have substantial influence on clinical results. The purpose of this review is to describe demographics, functionaloutcomes, and union rates for cases of RSA complicated by ASF. A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to identify studies that reported results of RSA complicated by ASF. Searches wereperformed using PubMed and Scopus up to January 1, 2018. Five articles met inclusion and exclusion criteria. ASF occurred in 61 (6.9%) of 874 RSA cases identified. 82% of patients who sustained an ASF were female.ASF cases were, on average, 7 years older than cases that were not complicated by ASF. While improved compared totheir preoperative state, patients who sustained an ASF demonstrated significantly less improvement in pain, function,and ROM compared to RSA patients without ASF. Women and older patients appear to be at greater risk for an ASF after RSA. Though nonunion rates arehigh, fair outcomes can still be achieved in cases of ASF after RSA. Further study is needed to identify modifiable andnon-modifiable risk factors associated with the development of ASF.Level of evidence: IV

We used a database of patients treated at three hospitals to study the primary null hypothesis that thereare no factors associated with unplanned reoperations or adverse events after surgical repair for diaphyseal claviclefracture. Additionally we addressed the following secondary study questions: 1. What is the prevalence of unplannedreoperations or adverse events after surgical repair for diaphyseal clavicle fracture? 2. Is early implant loosening orbreakage after surgical repair for diaphyseal clavicle fracture related to fixation type? 3. Is the type of fixation associatedwith the prevalence of brachial plexus palsy after surgical repair of a diaphyseal clavicle fracture? We retrospectively analyzed 249 adult patients who had surgery for a diaphyseal clavicle fracture todetermine factors associated with unplanned reoperations or adverse events. Thirty-two patients (13%) had at least oneunplanned reoperation or adverse event. Four of 249 patients (1.6%) developed early implant loosening or breakage.Patients that had local implant irritation, planned implant removal, or sensory symptoms thought to be due to nerveirritation were not included in the reported unplanned reoperations or adverse event rate. Only female sex was associated with unplanned reoperations or adverse events after surgery for diaphysealclavicle fracture. No other patient, technical, or injury related factors tested in this study were associated with unplannedreoperations or adverse events. Patients that have surgery for diaphyseal clavicle fracture have an approximately 13% risk of an unplannedsecond surgery or an adverse event. Women can be counseled that they are three times as likely as men to have anunplanned reoperations or adverse event.Level of evidence: III

Recognition of total elbow arthroplasties (TEAs) on plain radiographs is difficult due to a multitude ofdifferent types and models. Especially if surgery reports and documentation are not available, lost or when the primarysurgery was performed in another hospital the prosthesis type may be undeterminable. Therefore we investigatedin this platform study if a flowchart aids in recognition of thirteen different total elbow arthroplasty models on plainradiographs. An online questionnaire on the Shoulder and Elbow Platform was developed. Plain radiographs of thirteenTEA models were shown with and without the help of an especially developed flowchart describing distinguishingfeatures. Ten orthopedic surgeons specialized in upper extremity surgery completed the study. Recognition rates of thethirteen total elbow arthroplasty models ranged between 20 and 100 percent without the flowchart. Using the flowchartrecognition varied between 40 and 90 percent. The recognition rates with the flowchart were not significantly higher.Inter-observer reliability did not increase on a significant level. Correct recognition of total elbow arthroplasty models with plain radiographs remains imperfect with ourdeveloped flowchart. The flowchart increased correct recognition rates and inter-observer reliability.Level of evidence: II

The most common pediatric elbow fracture is supracondylar humeral fracture which accounts for 60% ofelbow fractures in children. The aim of this study was to evaluate the results of open reduction and internal fixation oftype III supracondylar humeral fractures using a Triceps sparing posterior approach. In total, 98 patients were evaluated from June 2007 to 2014. According to the results, the mean age of the patients was 6.4 years. The ratios of males to females and theright to left hand were 2.06 and 2.26, respectively. Totally, 82% of fractures happened in the dominant hand which wasright. The patients underwent surgery within approximately 50.16 hours after injury. Anatomic reduction and internalfixation were performed under direct vision with no need for image intensifier. The mean time of follow-up was 14.3months, and all fractures healed clinically and radiologically. Moreover, the maximum lack of an extension was 15° andthe obtained mean was 3.5°. Additionally, the mean final Bauman angle difference with healthy elbow was determinedat 2.4°. The rate of complications was 19.3%, including pin tract infections (7%), pin loosening (3%), heterotopicossification (4%), and wound dehiscence (1%). Furthermore, there were 4 cases (4%) of anterior interosseous nervepalsy, two of which happened before surgery, and the other two following the surgery. All of these complications wereresolved within 3 to 10 weeks spontaneously. This approach helped preserve the extensor mechanism and ulnar nerve intact to have an acceptableskin scar esthetically along with satisfactory postoperative function.Level of evidence: IV

The characteristic clinical presentation of glomus tumors and the low negative predictive value of themagnetic resonance imaging (MRI) raise the question whether MRI improves their management. Therefore, this studyaimed to investigate whether MRI improved the management of glomus tumors. In total, 87 patients with a histologically confirmed glomus tumor were treated over a 25-year period andanalyzed retrospectively. Multivariable logistic regression analysis was used to evaluate the independent predictors ofan MRI request during the management of glomus tumors. According to the results, the patients who were treated by orthopaedic surgeons were more likely to have anMRI during the management of a glomus tumor. The role of an MRI during the management of a glomus tumor is unclear. Orthopaedic surgeons aremore likely to request an MRI. Furthermore, visible lesions with characteristic symptoms probably do not benefitfrom MRI. However, it may help to be sure that the highest-quality MRI is used with the best possible coil for thefinger.Level of evidence: IV

This study aimed to introduce a modified technique for minimally invasive Achilles tendon (AT) rupture repairusing gift box sutures. The preliminary clinical and functional outcomes were investigated among a number of patients.

In a consecutive case series study, 24 patients with acute AT rupture underwent modified minimally invasiveAT repair using two mini-incisions and gift box sutures. The patients were followed up for 24 months. The AT rupturescore (ATRS) and the American Orthopedic Foot and Ankle Society (AOFAS) measure score were obtained from allpatients. The other measured variables included pain intensity and satisfaction using a visual analog scale (VAS), calfatrophy, the range of sagittal ankle motion, development of wound complications, sural nerve injury, and re-rupture.

After two years, the mean scores of AOFAS and ATRS were obtained at 83±4 and 81.9±6.3, respectively.Approximately 87.5 % of the patients regained their previous level of activity. The mean VAS score was 7.7±0.9 regardingthe satisfaction with the outcomes. Moreover, isokinetic testing of plantar flexion and dorsiflexion strength were 82.7±5.8and 87.7±4.1%, respectively, compared to those of the normal side. The calf atrophy was not statistically significant.In total, five patients reported pain during their activities. The range of operated ankle motion decreased significantly,compared to that of the other side; however, the differences were not significant functionally. There was no patient withwound complications, nerve injury, or complaint about problem with footwear.

Minimally invasive repair of acute AT rupture using two mini-incisions and gift box sutures offers goodfunctional and clinical outcomes without wound complications which can be usually observed following open repair ofAT ruptures.Level of evidence: III

Intra-articular injection of Platelet-rich plasma (PRP) is an effective method for the treatment of patientswith knee osteoarthritis (OA). This study aimed to assess the effects of PRP injection on OA, based on gene expressionanalysis.

A sample of 30 subjects with knee OA was asked to complete the Persian versions of the Intermittent andConstant Osteoarthritis Pain (ICOAP) and Knee and Osteoarthritis Outcome Score (KOOS). Thereafter, the expressionof IGF-1, HIF-1, cartilage oligometric matrix protein (COMP), and bone morphogenetic proteins (BMP2) were comparedin the patient before and 1 month after PRP injection using real-time polymerase chain reaction (PCR).

According to the results of the study, the expression of IGF-1, HIF-1, COMP and BMP2 were reported to behigher in subjects with PRP injection; however, only the up-regulation of IGF-1 was statistically significant (P<007).Moreover, the significant change in the KOOS and ICOAP scores was attributed to PRP injection (P<0.01).

Intra-articular injections of PRP were reported to ease the pain, decrease the stiffness, and improvequality of life in patients with knee OA through the promotion of IGF-1 expression.Level of evidence: V

Patellar crepitus after total knee arthroplasty (TKA) is not uncommon. The choice between patellarresurfacing or retention in TKA has remained controversial. Therefore, this randomized controlled trial aimed to evaluatethe impact of patellar resurfacing on the incidence of patellar crepitus. In addition, we compared the clinical outcomesand satisfaction between the patients who underwent patellar retention or resurfacing.

A total of 63 patients randomly received patellar resurfacing or non-resurfacing TKA by one surgeon at ImamKhomeini Hospital Complex, Tehran University of Medical Sciences, Iran during May 2014-February 2017. Finally,29 patients in the resurfaced group and 44 subjects with retained patella were evaluated pre-op and in an averagefollow-up period of 8.68 months using the clinical Knee Society Score (KSS), functional KSS, and Knee injury andOsteoarthritis Outcome Score (KOOS).

Our findings demonstrated no significant difference between the two groups regarding the satisfactionof patients, KSS, and KOOS. It was shown that the latter scores improved in both groups in the follow-up period.Nonetheless, patellar crepitus was not statistically different between the two groups.

According to the results of the present study, patellar resurfacing did not lead to decreased patellarcrepitus or enhanced clinical outcomes of TKA.Level of evidence: I

Some disasters, such as earthquake and flood make the majority of affected people homeless. Theaccommodation of these people in temporary shelters and camps requires some specific ethical issues. The aim of thepresent study was to discuss ethical issues regarding living in camps following natural disasters. This study is conducted utilizinga qualitative content analysis approach. The required data were collectedfrom four Focus Group Discussions (FGDs). Subsequently, 11 in-depth interviews were completed using the individualswho had the experience of receiving care following natural disasters and continued until data saturation. Data wereanalyzed using Graham content analysis method. According to the results obtained from affected people’s views, the most important ethical issues that are notconsidered important in temporary shelters and camps include:1) the violation of privacy,2) the shortage of basic needs(e.g., food, water, and sanitation) and type and quality of services rendered,3) lack of attention to cultural and religiousviews of the affected people, 4) cause of evacuation, 5)lack of co-operation among disaster managers, 6)respecting theproperties of the affected people, 7)conditions and geographic location of camps, 8)property care, and 9)communitybasedcare. Without paying attention to ethical issues, living in temporary shelters (i.e., camps) violates the dignity ofaffected people and then the affected people will not have appropriate cooperation with the managers. All these issuesexpose them to more harm than before.Level of evidence: VI

The surgical management of Knee Osteoarthritis (KOA), so far, mainly revolved around arthroscopic procedures,arthroplasty (total: TKA and unicompartmental: UKA) or high tibial osteotomy (HTO). Recently, another minimallyinvasive surgical treatment of proximal fibular osteotomy (PFO) has been proposed for the management of KOA. ThePFO has been found to be useful in the management of pain in KOA. The success of PFO depends on the correctlocation of the osteotomy and the right surgical technique. However, the experience of this procedure is minimal. Still,many questions need to be answered about the PFO viz. selection of best candidates and likely duration of pain relief.More multicentric, comparative and prospective studies are needed on a more substantial number of patients, theoverlong follow-up to confirm its validity and recommendation for routine use for KOA.Level of evidence: IV

The purpose of this study was to introduce a technical tip for the preparation of tibial tunnel in a posteriorcruciate ligament (PCL) reconstruction to reduce the chance of popliteal artery injury and duration of the surgery.

This study included 18 patients who underwent PCL reconstructions at Imam Khomeini University Hospital,Tehran, Iran, between 2016 and 2017. In all patients, the PCL tibial aimer device was inserted from the anteromedialportal and its tip aimed 8-9 mm below shiny white fibers in PCL facet. Subsequently, the smooth guide pin was insertedfrom anteromedial tibial cortex and advanced just to the posterior cortex but not through it based on the measurementof tibial tunnel length. Thereafter, the reaming was done over the guide pin. As the pin was engaged in the posteriorcortex, it was assured that it would not run before the reamer to the popliteal fossa. The pin was removed when thereamer touched the posterior cortex, and the reaming continued until reamer’s head appeared in the PCL facet. Othersteps of standard arthroscopic PCL reconstruction were done in this study. All patients were subjected to computedtomography scans.

The mean age of the patients and the mean duration of surgery were 25±3 years and 95 min, respectively.There was no vascular injury, and the position of the tibial tunnel in all cases was accurate. Moreover, the meandistance between the centers of the tibial tunnel to champagne-glass drop-off of the posterior cortex of tibia wasobtained at 7.42 mm (range: 4.6-10.4 mm).

This study showed that avoiding the penetration of posterior cortex of the tibia by means of the pin duringtibial tunnel preparation for PCL reconstruction is a safe, reproducible, and time-saving technique. This techniqueeliminates the need for fluoroscopy during the procedure.Level of evidence: IV

Intraosseous lipoma is a rare, benign primary tumor occurring in the bone. Herein, we reported a 45-year-old manwith chronic right posterior heel pain. In this study, the man was treated conservatively due to plantar fasciitis. Duringa one-month follow-up visit, the patient had no symptoms of relief in the right heel pain. Initially, calcaneal X-raywas taken, which revealed an expansile unicameral lytic lesion with central calcification on the right calcaneus.Moreover, computed tomography scan revealed an expansile lytic lesion on the right calcaneus. The diagnosis wasconfirmed as calcaneal lipoma in magnetic resonance imaging. The patient underwent curettage and autogenousiliac crest corticocancellous bone graft under general anesthesia. In a 3-month postoperative follow-up, the patientreturned to full ambulation. Postoperative radiographs demonstrated continued remodeling and healing of the graftsite. The purpose of this article was to increase awareness among clinicians about the existence of this rare causeof calcaneal pain.Level of evidence: V

Fake and misconducted scientific articles are misleading the researchers; it can also impose a huge cost on the academic centers and health system. Finally invalidated published research may give rise to incorrect treatment guidelines that may harm the patients. Based on our search in retraction watch database, 10 retracted orthopedic articles were from Iran. All the reported retracted article from Iran in this website was 569 items and total orthopedic articles retracted in others country sum up to 54. If we measure the ratio, then published orthopedic articles from Iran included 18.5% of the total orthopedic articles in the world and 1.7% of the total retracted articles from Iran. It seems that use of the ethical code issued by the Ethics Committee of the universities can be helpful in publishing honest research. It is also important to use the academic e-mail address which shows the authors organizational affiliation. The policy of introduction reviewer must be changed by journals. Regarding to the historical background of orthopedics in Iran, It is our duty to protect our dignity.