Archives of Bone and Joint Surgery
Volume:6 Issue: 2, Mar 2018

Giant cell tumor (GCT) is a primary and benign tumor of bone, albeit locally aggressive in some cases, such as in the epi-metaphyseal region of long bones, predominantly the distal end of femur and proximal end of tibia (1). There are a variety of treatments for a bone affected by GCT, ranging from chemotherapy, radiotherapy, embolization, and cryosurgery, to surgery with the use of chemical or thermal adjuvant (2). Even with advances in new chemotropic drugs, surgery is still the most effective treatment for this kind of tumor (3). The surgery often involves defect reconstruction following tumor removal (4). The aims of treatment are removing the tumor and reconstructing the bone defect in order to decrease the risk of recurrence, and restore limb function, respectively. To achieve these goals, reconstruction is usually accompanied with PMMA bone cement infilling (4). The high heat generated during PMMA polymerization in the body can kill the remaining cancer cells, and hence the chance of recurrence decreases (5). In addition, filling the cavity with bone cement provides immediate stability, enabling patients to return to their daily activities soon (6).
The major drawbacks of the technique of curettage and cementation is the high fracture risk, due to the early loading of the bone, and the insufficient fixation of the cement in the cavity (7). Hence, several methods have been developed to fix the bone cement in order to prevent the postoperative fracture. Pattijn et.al packed the cement with a titanium membrane which was attached to the periosteum with small screws (7). The membrane can make early normal functioning of patients possible, since it partially restore the strength and stiffness of the bone. Cement augmentation with internal fixation is another method to decrease the risk of postoperative fractures (6, 8, 9).

Bone disorders are of significant worry due to their increased prevalence in the median age. Scaffold-based bone tissue engineering holds great promise for the future of osseous defects therapies. Porous composite materials and functional coatings for metallic implants have been introduced in next generation of orthopedic medicine for tissue engineering. While osteoconductive materials such as hydroxyapatite and tricalcium phosphate ceramics as well as some biodegradable polymers are suggested, much interest has recently focused on the use of osteoinductive materials like demineralized bone matrix or bone derivatives. However, physiochemical modifications in terms of porosity, mechanical strength, cell adhesion, biocompatibility, cell proliferation, mineralization and osteogenic differentiation are required. This paper reviews studies on bone tissue engineering from the biomaterial point of view in scaffolding.

Various sizes of implants need to be available during surgery. The purpose of this paper is to compare body height and shoe size with implant sizes in patients who underwent total knee replacement surgery to see which biomarker is a better predictor for preoperative planning to determine implant size.
A total of 100 knees, belonging to 50 females and 50 males, were observed. Participants’ body height and shoe size were collected and correlated to implant sizes of a current, frequently used, standard total knee replacement (TKR) implant. The femoral anteroposterior and mediolateral width and the tibial anteroposterior and mediolateral width were correlated with height and shoe size.
The correlation between shoe size and the four knee implant dimensions, femoral AP, ML, and tibial AP and ML were higher than the correlations between height and the same four dimensions.
The results indicated that shoe size is a better predictor of component dimensions than is body height.

The trapeziometacarpal joint (TMCJ) is inherently unstable, relying on ligament restraint to prevent subluxation. Subluxation of the thumb in a dorsoradial direction is often observed in clinical practice, either after acute ligament injury or more commonly with osteoarthritis (OA). This subluxation follows loss of function of trapeziometacarpal ligaments that stabilise this joint, resisting the deforming force of abductor pollicis longus (APL). The exact ligaments that stabilise and prevent the thumb from the pull of APL causing dorsoradial subluxation remain unknown, although the anterior oblique ligament (AOL) has been implicated. The aim of this study was to measure the direction of subluxation resisted by the AOL.
In this study we used cadaveric limbs and custom made biomechanical testing to measure the influence AOL has in stabilising the thumb against subluxation in three planes: radial, dorsal and dorsoradial. Three fresh frozen hands were dissected to expose the TMCJ, leaving all ligaments, capsule and APL attachment in place. The force required to create a displacement of 5mm between the first metacarpal and the trapezium in these three planes was measured before and after AOL division.
The average force to displace in the dorsoradial plane prior to division was 6.68N, and a statistically significant reduction to 1.15N (P There is clinical significance in reporting quantifiable data in this field, as subluxation of the thumb is often seen with OA. The results of our study provide support for surgical reconstruction of the AOL as the primary surgical stabilizer against dorsoradial subluxation of the thumb.

high tibial osteotomy (HTO) is a recommended treatment for medial compartment knee osteoarthritis. Newer cartilage regenerative procedures may add benefits to the result of HTO. In this prospective study we investigate safety and also results of HTO associated with bone marrow derived cells (BMDC) transplantation in relatively young and middle aged active individuals with early osteoarthritis of the knee and our hypothesis is combination of these procedures is safe and leads to better outcome.
24 patients (with mean age of 47.9 years) with varus knee and symptomatic medial compartment osteoarthritis were treated with medial opening-wedge high tibial osteotomy in conjunction with transplantation of bone marrow derived cells into the chondral lesions. Clinical outcome was assessed by IKDC score, KOOS score, VAS and Tegner scores and radiographic study was performed preoperatively and at follow-ups.
there were no major complications during operation and postoperative follow-ups.all the clinical scores significantly were improved for the IKDC score (from 32.7 15 to 64 21), KOOS score (from30 11 to 68 19), VAS (from7.5 to 3), and Tegner score (from 1.2 to 2.1).
HTO in conjunction with BMDC transplantation is a safe and feasible treatment for early medial compartment osteoarthritis in varus knees and associated with good results in short term follow up.

The purpose of this study was validation of the Persian translation of the Swiss Spinal Stenosis Questionnaire in order to be used by Iranian researchers.
A total of 104 patients with spinal stenosis diagnosis, who were candidates for operative treatment were entered into the study. The patients completed the translated questionnaire in the 1st and the 7th days of admission and 6 months after surgery. Visual analogue scale was used to determine the severity of the pain in the1st day and the 6th month. Discriminant validity, convergent validity, test-retest reliability, internal consistency, ability to detect changes and sensitivity to clinical changes were assessed for the statistical purposes.
Cronbach’s α was more than 0.9 for all the items. ICC was about 0.9 for all the items. For symptoms, physical and total items, Cronbach’s α was 0.942, 0.957, 0.926 and Intraclass correlation were 0.891, 0.918, 0.862, respectively. Paired t-test was significantly different between the 1st day and the 6th month questionnaire. There was a positive correlation either between the first VAS and the 1st day questionnaire (1st day Q) (r=0.892, P=0.000) or between the 6th month VAS and 6th month Q (r=0.940, P=0.000). The Pearson’s correlation between the difference of the total scores of the 1st day and the 6th month and satisfaction score after surgery showed negative correlation (r= -0.746, P=0.000). The effect size was 2.55.
The Iranian version of the Swiss Spinal Stenosis has excellent internal consistency, excellent reliability, good ability to alter with changes, especially parallel with clinical improvement, excellent ability to detect changes, and well either convergent or discriminant validity.

There is no difference in the functional outcomes 6 months after total knee arthroplasty (TKA) for knee osteoarthritis between patellar resurfacing and non-resurfacing. Thus, we have performed this study to compare the short-term clinical outcomes of TKA performed with and without the patella resurfacing.
A total of 50 patients with osteoarthritis of the knee (OAK) were randomized to receive patellar resurfacing (n=24; resurfaced group) or to retain their native patella (n=26; non-resurfaced group) based on envelope selection and provided informed consent. Disease specific outcomes including Knee Society Score (KSS), Knee Society Function Score (KSKS-F), Kujala Anterior Knee Pain Scale (AKPS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Short Form 36 (SF-36), and functional patella-related activities were measured within six months of follow-up.
There was no significant difference between the resurfaced and non-resurfaced groups in pre and postoperative improvement of range of motion (ROM) (P=0.421), KSS (P=0.782, P=0.553), KSKS-F (P=0.241, P=0.293), AKPS (P=0.128, P=0.443), WOMAC (P=0.700, P=0.282), and pain scores (P=0.120, P 0.508). There was no difference in ROM between resurfaced and non-resurfaced group pre (15.24° and 15.45°) and post-operative (18.48° and 18.74). No side effects related to patella was observed in any of the groups. Revision was required in none of the participants.
The results showed no significant difference between patellar resurfacing and non-resurfacing in TKA for all outcome measures in a short term.

Good clinical outcome and return to sport and daily functions after anatomical arthroscopic anterior cruciate ligament (ACL) reconstruction is goal standard in this surgery. but to date, there are different challenging issues between orthopedic surgeons regarding graft selection and surgical techniques.
We retrospectively reviewed the patients who underwent anatomical arthroscopic one bundle ACL reconstruction with quadruple hamstring tendon autograft from 2010 to 2016 in our orthopedic sport medicine center. Eighty-two eligible patients (82 knees) who had met our inclusion criteria were examined in terms of knee stability by clinical examinations and KT 2000 arthrometer and - also were evaluated regarding variables related to their health and knee status with a mean 48months follow-up.
Seventy-seven patients (93.9%) were male and the other 5 cases (6.1%) were female. The mean age was 33 ± 8.06 years old at the time of surgery and mean BMI amount was 26.81 ± 3.72. 78 patients (95%) returned to pre-injury sport activity level after ACL reconstruction and two patients (2.4%) had re rupture. 63 patients (76.8%) had negative anterior drawer and 67patients (81.8%) negative lachman tests respectively. 10 patients (13%) were found to have positive pivot shift tests which was correlated with pain and a less KOOS scores with a significant difference (P= 0.03). 72 patients (87%) had negative tests in active and 70 85.4%) had less than 3 mm side to side difference in manual testing by KT2000. Final KOOS score was 70.87 ± 19.7 . Mean Lysholm score was 90 ± 4.77. Mean International Knee Documentation Committee (IKDC) score of this study was 85 ± 14.11. Patients who had concomitant partial meniscectomy had significantly lower IKDC scores (P The use of quadrupled hamstring tendon autograft besides the most important part of the treatment which is the surgical technique would yield to excellent results in ACL reconstruction both subjectively and objectively. In addition, patient selection and surgeon’s experience should be considered in determining the treatment plan for the patients.

In microsurgical nerve repair, the epineural sleeve technique can be used to bridge short nerve defects and to cover the coaptation site with the epineurium of the nerve stump. The epineurium serves as a mechanical aid to reduce gap size, and increase repair strength, effectively assisting nerve regeneration. This article presents a 32-year-old patient who experienced complete transection of the median nerve at the distal forearm, which was treated with the epineural sleeve graft reconstruction technique. Nerve regeneration was followed-up for 18 months and evaluated with the Rosén and Lundborg scoring system. The final outcome was excellent; at the last follow-up, the patient experienced complete sensory and motor function of the median nerve.

Lateral Ankle sprain (LAS) is a common sports injury associated with recurrent ankle sprain, chronic ankle instability (CAI) and post-traumatic ankle osteoarthritis (PTOA). Platelet Rich Plasma (PRP) has been increasingly used for herapeutic applications in sports-related injuries, and is thought to stimulate tissue healing. We reported a case of LAS with complete tear of anterior talofibular ligament, which showed complete healing of ligament and early ankle stabilization after PRP. The healing is supported by dynamic ultrasound images and magnetic resonance imaging. We therefore proposed that PRP may serve as an alternative non-surgical treatment option in LAS in future research, with the potential to prevent the development of CAI and PTOA.

We report a case of a 29-year-old man who presented with a distal humeral shaft fracture sustained by blunt trauma. Physical examination and nerve conduction study were consistent with injury to the median and radial nerves proximal to the elbow. The patient underwent open reduction and internal fixation of the humeral shaft fracture with neurolysis of the median and radial nerves. Repeat electromyography at 6 months postoperatively showed recruitment of motor units in all muscles sampled, in keeping with clinical improvement. At 16 months follow-up, the patient was full strength in all muscle groups, was back to all activities with no restrictions, and was discharged from follow-up. Our case describes clinical improvement after surgical intervention in a patient with combined median and radial nerve palsies following distal humeral shaft fracture.

Breakage of DHS guide wire during surgery and its migration into the pelvis through the hip joint is a rare complication and its removal can be very challenging for the surgeon. We share our experience of a similar case wherein we used an ‘iliofemoral’ approach to successfully remove the broken transfixing guidewire from the hip joint. Although iliofemoral approach is similar to the lateral window of conventional ilioinguinal approach, yet it is less invasive, has lesser complications, requires less expertise and is easily reproducible by an average orthopaedic trauma surgeon. We recommend that surgical approaches for removal of these broken or migrated wires should be individualized depending upon the exact location of the wire tip in the hip joint or pelvis and need for exposure.