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Archives of Bone and Joint Surgery - Volume:4 Issue: 2, Mar 2016

Archives of Bone and Joint Surgery
Volume:4 Issue: 2, Mar 2016

  • تاریخ انتشار: 1395/01/24
  • تعداد عناوین: 21
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  • Mohammad H. Ebrahimzadeh* Pages 94-96
    There is always a concern regarding the "quality" of publications as an index for promotion and career advancement. There are some ways to measure this "quality" including impact factor and SCImago Journal Rank (SJR) as a measure of journals’ level of impact, h-index as a measure of researchers’ level of impact, and visibility and citation as a measure of individual papers’ level of impact.
    Paper publication is bringing revenue to some journals by soliciting money from whom that must publish or perish. This raises the suspicion of fraud toward Open Access journals because sometimes charlatans pocket the money via creating predatory journals or even creating counterfeit websites using terms similar to those already known. For this reason, legitimate Open Access journals have to be authenticated. Tempting emails from Open Access journals showing high indices of quality might entrap the new researchers, which could be prevented by awareness of the below terms [Figure 1].
  • Jorge Chahla, Gilbert Moatshe, Chase Dean, Robert Laprade* Pages 97-103
    Injuries to the posterolateral corner (PLC) comprise a significant portion of knee ligament injuries. A high index of suspicion is necessary when evaluating the injured knee to detect these sometimes occult injuries. Moreover, a thorough physical examination and a comprehensive review of radiographic studies are necessary to identify these injuries. In this sense, stress radiographs can help to objectively determine the extent of these lesions. Non-operative and operative treatment options have been reported depending on the extent of the injury. Complete PLC lesions rarely heal with non-operative treatment, and are therefore most often treated surgically. The purpose of this article was to review the anatomy and clinically relevant biomechanics, diagnosis algorithms, treatment and rehabilitation protocols for PLC injuries.
    Keywords: Anatomical, Fibular collateral ligament, knee, Posterolateral, Popliteus reconstruction, Reconstruction
  • Ioannis Polyzois, Rupen Dattani, Rohit Gupta, Ofer Levy, A. Ali Narvani* Pages 104-108
    Management of first shoulder dislocation following reduction remains controversial. The two main options are immobilisation and arthroscopic stabilisation. The aim of this article is to highlight some of the issues that influence decision making when discussing management options with these patients, including natural history of the first time dislocation, outcomes of surgery and non-operative management particularly on the risk of future osteoarthritis (OA), the effects of delaying surgery and the optimal method of immobilisation.
    Extensive literature review was performed looking for previous publication addressing 4 points. i) Natural history of primary shoulder dislocation ii) Effect of surgical intervention on natural history iii) Risk of long term osteoarthritis with and without surgical intervention iv) Immobilisation techniques post reduction.
    Individuals younger than 25 years old are likely to re-dislocate with non-operative management. Surgery reduces risk of recurrent instability. Patients with recurrent instability appear to be at a higher risk of OA. Those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop OA than those with recurrent instability. Delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. Recent studies have failed to match the preliminary outcomes associated with external rotation braces.
    Defining the best timing and type of treatment remains a challenge and should be tailored to each individual’s age, occupation and degree of physical activity.
    Keywords: dislocation, First time, Immobilisation, Stabilisation
  • Edward K. Rodriguez*, Jeeva Munasinghe Pages 109-115
    Background
    In this feasibility study, a mechanically loaded in-vitro tissue culture model of joint morphogenesis using the isolated lower extremity of the 8 day old chick embryo was developed to assess the effects of mechanical loading on joint morphogenesis.
    Methods
    The developed in-vitro system allows controlled flexion and extension of the chick embryonic knee with a range of motion of 20 degrees from a resting position of 90-100 degrees of flexion. Joint morphogenesis at 2, 3, 4 and 7 days of culture was assessed by histology and micro MRI in 4 specimen types: undisturbed in-ovo control embryos, in-ovo paralyzed embryos, in-vitro unloaded limb cultures, and in-vitro loaded limb cultures. Relative glycosaminoglycan (GAG) concentration across the joint was assessed with an MRI technique referred to as dGEMRIC (delayed gadolinium enhanced MRI of cartilage) where T1 is proportional to glycosaminoglycan concentration.
    Results
    Average T1 over the entire tissue image for the normal control (IC) knee was 480 msec; for the 4 day loaded specimen average T1 was 354 msec; and for the 7 day loaded specimens T1 was 393 msec. The 4 day unloaded specimen had an average T1 of 279 msec while the 7 day unloaded specimen had an average T1 of 224 msec. The higher T1 values in loaded than unloaded specimens suggest that more glycosaminoglycan is produced in the loaded culture than in the unloaded preparation.
    Conclusion
    Isolated limb tissue cultures under flexion-extension load can be viable and exhibit more progression of joint differentiation and glycosaminoglycan production than similarly cultured but unloaded specimens. However, when compared with controls consisting of intact undisturbed embryos in-ovo , the isolated loaded limbs in culture do not demonstrate equivalent amounts of absolute growth or joint differentiation.
    Keywords: chick embryo, chick embryo culture, Glycosaminoglycan, in, vitro loaded limb culture, joint morphogenesis, paralyzed chick embryo
  • Dimitrios Lyras*, Craig Loucks, Robert Greenhow Pages 116-121
    Background
    The aim of this study is to evaluate the geometry of the distal femur and the proximal tibia in the osteoarthritic knee using 3D reconstructive CT scan imaging.
    Methods
    449 patients with knee osteoarthritis were treated surgically in our center with patient-specific technology total knee arthroplasty. Preoperatively, all the patients underwent a CT scan according to a standard protocol. Using this database, the Hip-Knee-Angle (HKA), the Femur Valgus Angle (FVA), the Tibia Varus Angle (TVA), the Posterior Tibia Slope (PTS), and the angle between the posterior condylar axis and the anatomical transepicondylar axis (PCA) for each patient were recorded and statistically evaluated.
    Results
    In overall, the mean HKA angle was 177.3±5.55, the mean FVA angle was 3.19±2.08, the mean TVA was 3.28±2.35, the PTS angle was 9.02±3.46, and the PCA angle was 2.86±0.78. Evaluation of the correlations between HKA and PCA (r=0.035), HKA and PTS (r=-0.047), and PCA and PTS (r=0.05) showed non-significant relationships (P=0.46, P=0.32, and P=0.29 respectively). No significant differences were revealed from the comparison of male patients with female patients, regarding the mean HKA, FVA, TVA, PTS, and PCA.
    Conclusion
    The posterior condylar axis is a well-defined but not a reliable axis, while the transepicondylar and the anteroposterior are reliable, but not easily defined axes. Given the large ranges and standard deviations of the location of posterior condylar axis, and the important inter- and intraobserver variability in the intraoperative location of the transepicondylar and the anteroposterior axes, the use of a preoperative 3D CT scan is recommended.
    Keywords: 3D CT scan, Knee Geometry, Patient Specific Instruments, Posterior Condylar Axis, Total Knee Arthroplasty
  • Mahmoud Jabalameli, Amin Moradi*, Abolfazl Bagherifard, Mehran Radi, Tahmineh Mokhtari Pages 122-127
    Background
    Evaluating the landmarks for rotation of the distal femur is a challenge for orthopedic surgeons. Although the posterior femoral condyle axis is a good landmark for surgeons, the surgical transepicondylar axis may be a better option with the help of preoperative CT scanning. The purpose of this study was to ascertain relationships among the axes’ guiding distal femur rotational alignment in preoperative CT scans of Iranian patients who were candidates for total knee arthroplasty and the effects of age, gender, and knee alignment on these relationships.
    Methods
    One hundred and eight cases who were admitted to two university hospitals for total knee arthroplasty were included in this study. The rotation of the distal femur was evaluated using single axial CT images through the femoral epicondyle. Four lines were drawn digitally in this view: anatomical and surgical transepicondylar axes, posterior condylar axis and the Whiteside anteroposterior line. The alignment of the extremity was evaluated in the standing alignment view. Then the angles were measured along these lines and their relationship was evaluated.
    Results
    The mean angle between the anatomical transepicondylar axis and posterior condylar axis and between the surgical transepicondylar axis and posterior condylar axis were 5.9 ± 1.6 degrees and 1.6±1.7 degrees respectively. The mean angle between the Whiteside’s anteroposterior line and the line perpendicular to the posterior condylar axis was 3.7±2.1 degrees. Significant differences existed between the two genders in these relationships. No significant correlation between the age of patients and angles of the distal femur was detected. The anatomical surgical transepicondylar axis was in 4.3 degrees external rotation in relation to the surgical transepicondylar axis.
    Conclusion
    Preoperative CT scanning can help accurately determine rotational landmarks of the distal femur. If one of the reference axes cannot be determined, other reference axes can be used because of the good correlation between these landmarks.
    Keywords: Distal femur, Rotational alignment, Transepicondylar axis, Whiteside line
  • Atul Kamath*, Caitlin Mcauliffe, Laura Kosseim, Finnah Pio, Eric Hume Pages 128-131
    Background
    Malnutrition has been linked to poor outcomes after elective joint arthroplasty, but the risk of unplanned postoperative intensive care unit (ICU) admission in malnourished arthroplasty patients is unknown.
    Methods
    1098 patients were followed as part of a prospective risk stratification program at a tertiary, high-volume arthroplasty center. Chronic malnutrition was defined as preoperative albumin
    Results
    The overall incidence of malnutrition was 16.9% (primary and revision arthroplasty patients). Average BMI was highest for patients in albumin category 3.0-3.5 (BMI 35.7). Preoperative albumin postoperative ICU admission.
    Conclusion
    Patients with poor nutritional status must be counseled on the risks of adverse medical complications.
    Keywords: Albumin, Intensive Care Unit, Malnutrition, Risk Reduction, Total Joint Arthroplasty (replacement)
  • Ibrahim Raphael, Mohammad Rasouli*, Christopher Kepler, Santiago Restrepo, Todd Albert, Kris Radcliff Pages 132-136
    Background
    Hip osteoarthritis (OA) is a major cause of pain and disability that results in considerable social and medical costs. Mechanics such as posture, alignment and orientation of the hips and the spinal column and the relationship between these factors have been implicated in the development of both hip and spine pathologies. This study aims to test the hypothesis if pelvic incidence varies in patients with and without osteoarthritis. We assessed the relationship between spinopelvic alignment as measured by pelvic incidence (PI) and the presence of hip OA.
    Methods
    We collected supine pelvis CT scans of 1,012 consecutive patients not known to have hip OA. Our first group consisted of 95 patients with moderate to severe hip OA as per radiology reports. The second group included 87 patients with no evidence of hip OA. Power analysis revealed the need for 77 patients per group to find a mean difference in PI of 5º or less between both groups. Two trained physicians independently measured the PI to account for inter-observer reliability.
    Results
    Patients with moderate to severe hip OA had a mean PI of 56.5º±12.8º. The mean PI for patients without hip OA was 57.2º±7.5º. An independent samples t-test revealed no significant difference between the PI values of the two groups. Spearman’s correlation coefficient of 0.754 demonstrated a high inter-observer reliability.
    Conclusion
    There was no difference in PI angle of hip OA patients and "healthy" patients. Our measurements of patients without OA were almost identical to the reported normal PI values in the literature. It appears that hip OA is not associated with PI angle, refuting the hypothesis made in previous studies, stating that elevated PI contributes to the future development of hip arthritis. CT scan seems to be a reliable and accurate way of assessing pelvic incidence.
    Keywords: Hip osteoarthritis, Hip, Spine syndrome, Pelvic incidence
  • Saeed Althani, Alisina Shahi*, Timothy Tan, Ali Al Belooshi Pages 137-140
    Background
    Abnormal patellar height is associated with anterior knee pain and several conditions that affect the patellofemoral joint. The aim of this study was to 1) report the incidence of patella alta and patella baja and 2) investigate whether the normal limits of the Insall-Salvati ratio is applicable in adult Middle-Easterners.
    Methods
    A radiographic review of the lateral radiographs of 736 Middle-Eastern knees were performed. Patellar tendon length (TL) and the patellar length (TP) was digitally measured and the ratios of these measures was used to calculate the Insall-Salvati ratio.
    Results
    The overall mean TL/PL ratio was 1.20±0.17. The Insall-Salvati ratio was higher (p=0.0013) in males (1.22± 0.12) than in females (1.18±0.17). According to our measurement, the recommended levels for defining abnormal patellar position should be 0.86 for patella baja and 1.54 for patella alta.
    Conclusion
    The use of TL/PL ratio demonstrated a higher incidence of patella alta and a higher mean TL/PL ratio compared to other techniques. The normal ranges for the TL/PL differs from western populations and may be attributed to lifestyle differences.
    Keywords: Insall, Salvati ratio, Middle, Easterner, Patellar position
  • Sepideh Sefidbakht, Omid Reza Momenzadeh, Sakineh Dehghani*, Hadi Gerami Pages 141-144
    Background
    Magnetic resonance imaging (MRI) has long been considered a perfect imaging study for evaluation of shoulder pathologies despite occasional discrepancies between MR reports and arthroscopic findings. In this study we aim to evaluate impact of imaging center as an indicator of image quality on accuracy of MRI reports in diagnosis of rotator cuff tendon pathologies.
    Methods
    We reviewed MR reports of 64 patients who underwent arthroscopy in university center hospital. MRIs were done in various centers including both university-affiliated and out-centers. All studies were reported by two radiologists in consensus unaware of the arthroscopic results or previous reports. An inter-observer agreement analysis using the kappa statistics was performed to determine consistency among imaging and surgical reports.
    Results
    Kappa values for out-centers were as follows: 0.785 for biceps, 0.469 for suscapularis, 0.846 for supraspinatus and 0.785 for infraspinatus tendons. In university centers values were 0.799 for biceps, 0.802 for suscapularis, 0.789 for supraspinatus and 0.770 for infraspinatus tendons.
    Conclusion
    Image reporting in university centers with proficient sequences increased accuracy of diagnosis in 3/4 of evaluated features and showed subtle decreased inter-observer agreement in 1/4 of features. Uniformity of the scanners and protocols as well as evaluation on a workstation rather than hard copies cumulatively resulted in a meaningful increase in the accuracy of the same radiologists in diagnosis of rotator cuff tendon tear.
    Keywords: Agreement, Arthroscopy, MRI, Rotator Cuff Tendons, Shoulder joint
  • Majid Sajjadi Saravi, Mohammad Hossein Kariminasab, Mehdi Bari, Salman Ghaffari, Mehran Razavi Pur, Seyed Mohammad Mehdi Daneshpoor, Mahsa Vojodi Yazdi, Mehrnaz Mohammad Davodi, Masoud Shayesteh Azar* Pages 145-149
    Background
    Carpal tunnel syndrome is the most common focal mono-neuropathy. A study was designed to compare the effects of traditional open carpal tunnel release with median neurolysis and Z-plasty reconstruction of the transverse carpal ligament on post-operative hand pain and hand function in patients with idiopathic carpal tunnel syndrome.
    Methods
    Fifty-two patients with idiopathic carpal tunnel syndrome entered the study. The patients were randomly assigned into two groups to undergo simple transverse carpal ligament release or division of the ligament with Z-lengthening reconstruction. Forty-five patients completed the study. Two patients of the simple open surgery group and 5 patients of the Z-plasty reconstruction group did not complete the follow up course. After the procedure, the patients were followed to assess post-operative pain and hand function during a 12-week period.
    Results
    The scores of hand pain on the first day after surgery were not statistically different between the two groups (P=0.213). But the score of hand pain was significantly lower in the Z-plasty reconstruction group at week 1, week 3, and week 6 after surgery (P
    Conclusion
    We observed significant reduction in hand pain, shorter duration of hand pain and shorter period of time to reach normal hand grip by Z-plasty reconstruction of the TCL.
    Keywords: Carpal Tunnel Syndrome, Hand Function, Median Neurolysis, Pillar Pain, Z, plasty
  • Michiel Hageman, Jeroen Bossen, Valentin Neuhaus, Chaitanya Mudgal, David Ring*, Science Variation Group Pages 150-155
    Background
    As part of the process of developing a decision aid for carpal tunnel syndrome (CTS) according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict.
    Methods
    One-hundred-twenty-three observers of the Science of Variation Group (SOVG) and 84 patients with carpal tunnel syndrome completed a survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9).
    Results
    On average, patients had significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons.Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one’s goals in spite of pain), and higher PDRQ (relationship between patient and doctor). Surgeons from Europe have--on average--significantly more decision conflict than surgeons in the United States of America.
    Conclusions
    Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict.
    Keywords: Carpal Tunnel Syndrome, Decision aids, Hand surgery, Shared decision makin
  • Dimitrios N. Lyras *, Konstantinos Kazakos, Konstantinos Tilkeridis, Anna Kokka, Athanasios Ververidis, Sotirios Botaitis, George Agrogiannis Pages 156-160
    Background
    The aim of this study is to find out the spatial and temporal expression of TGF-b1 during the tendon healing, after application of Platelet Rich Plasma (PRP).
    Methods
    A patellar tendon defect model in rabbits was used for this purpose. 48 skeletally mature New Zealand White rabbits, weighing 3.5 kg, were used for this study. Equal numbers of animals from both groups were sacrificed at 4 different time points (1st, 2nd, 3rd, and 4th week). A full thickness patellar tendon substance in the right limb of each animal was excised from its central portion during the operation. PRP with a gel form was applied and filled the tendon defect in PRP group. No PRP was applied in the tendon defect of controls. Histological sections with hematoxylin-eosin and immunohistochemical sections with an anti-TGF-b1 primary antibody were made for the evaluation of the results.
    Results
    A differentiation of the healing process was observed in the PRP group in comparison with the control group. TGF-b1 expression was detected in various cell populations (inflammatory cells, endothelial cells, macrophages, and tenocytes). Both cytoplasmic and nuclear expressions were present. The larger amounts of immunoexpression were localized in epitenon and in the repair site. PRP group showed stronger and more extensive staining at 1st and 2nd week (P
    Conclusions
    Our study demonstrates that locally application of PRP result in an alteration of TGF-b1 expression during the healing of a patellar tendon defect.
    Keywords: Platelet, Rich Plasma, Patellar tendon defect, Rabbits, Tendon healing, TGF, b1
  • Ahmet Kinaci*, Geert Buijze, Diederik Van Leeuwen, Jesse B. Jupiter, Rene K. Marti, Peter Kloen Pages 161-165
    Background
    An intra-articular distal humerus malunion can be disabling. To improve function, reduce pain and/ or prevent further secondary osteoarthritis an intra-articular corrective osteotomy can be considered. Herein we present the indications, practical guidelines for pre- operative planning and surgical technique. Subsequently, we provide long-term results in a small series.
    Methods
    We included six consecutive patients operated for intra-articular distal humerus malunion. Mean follow-up was 88 months. At lastest follow up elbow function was assessed according to standardized questionnaires and classification systems.
    Results
    All six patients healed their osteotomies. Three patients had a postoperative complication which were treated succesfully. Range of motion improved significantly and all patients were satisfied with the outcome. The elbow performance scores were good to excellent in all. Correlation analyses showed that age and level of osteoarthritis are very strong predictors for the long-term elbow function and quality of life.
    Conclusion
    An intra-articular corrective osteotomy for a malunited distal humerus fracture is a worthwhile procedure. Based on our results it should particularly be considered in young patients with minimal osteoarthritis and moderate to severe functional disability and/or pain.
    Keywords: Distal humerus fracture, Distal humerus malunion, Intra, articular corrective osteotomy, Long, term follow, up
  • Tina Shooshtarizadeh, Sajjadeh Movahedinia, Hassan Mostafavi, Khodamorad Jamshidi, Sam Sami Pages 166-172
    Aneurysmal bone cyst (ABC) is a benign expansile bone tumor, most commonly involving the medulla of long bones. ABC rarely arises within the cortex or in the subperiosteal region, radiographically mimicking other conditions, in particular surface osteosarcomathat is low-grade in nature and may go secondary ABC changes, and telangiectatic osteosarcoma. Both of these are sometimes mistaken microscopically for primary ABC. We review the characteristics of ABC cases in our center and report four unusualsurface ABCs arising in the subperiosteal or cortical region of long bones, identified among 38 histologically proven ABCs during a four-year period in our center. The surface ABCs occurred at an older agewith a predilection for diaphysis of femur, tibia, and humerus.
    Keywords: Aneurysmal bone cyst, Cortical, Histopathology, Radiography, Subperiosteal
  • Colin Murphy*, James Gill, Andrew Carrothers, Peter Hull Pages 173-176
    Fractures through the sacroiliac joint are very challenging to treat, technically difficult to reduce through closed methods on account of the multiaxial displacement of fractures fragments, frequently occur in very unwell patients, and have poor outcomes if malreduction is present. We describe a technique utilising the lateral window and a short buttress plate to reduce and stabilize the fragments prior to percutaneous fixation with sacroiliac screws.
    Keywords: fracture, Pelvic trauma, Sacrum
  • Hossein Saremi Pages 177-180
    Tears of the subscapularis tendon have been significantly recognized as a source of shoulder pain and dysfunction in the past decade, thanks to arthroscopic evaluation of the shoulder and biomechanical and anatomical studies of the tendon. Current classification of subscapularis tendon tear is based on insertion site of the tendon. Recently, a classification for non-insertional types of subscapularis tendon tear has been published. Interstitial tear of subscapularis tendon has not been described in classifications available in the literature. This report describes significant interstitial tear of the subscapularis tendon. This tear looks normal in superior, bursal and articular sides. Then its specific arthroscopic findings as "Air bag sign" and repair technique of the pathology is explained .
    Keywords: Interstitial tear, Partial tear, Subscapularis tendon
  • Cynthia Watkins, Michael Rivlin*, Pedro Beredjiklian Pages 181-184
    Tendon transfers in hand patients are a commonly performed procedure after extensor tendon rupture. However, the standard side to side technique is not applicable in every patient. We present a case of a musician with unique demands to demonstrate the option to customize surgical technique and therapy regimen to the unique needs of each patient. An extensor indicis proprius to extensor digitorum communis transfer was performed in a 73 year old musician. A controlled active motion therapy protocol was followed. The patients musical practice regimen was incorporated into the therapy. The patient was able to independently extend her ring and small fingers in order to play her instrument and resumed play within one month postoperatively.
    A patient’s functional goals including avocations need to be considered when selecting the appropriate surgical and therapeutic approach
    Keywords: Musician, Rehabilitation, Tendon, Transfer
  • Ahmadreza Afshar Pages 185-187
    This case report presents a case of Fanconi’s Anemia with an unusual thumb polydactyly in a 2-year old boy. The extra thumb had no nail, nail bed and distal phalanx. The extra thumb had no active motion.The duplication of the thumb occurred at the carpometacarpal joint but its morphology did not match with any classification described for thumb polydactyly. Although his thumb polydactyly was apparent at birth, Fanconi’s anemia was not suspected until during a routine pre-operative laboratory test (CBC) for the elective surgery of his thumb. An early diagnosis of FA is important and the hand surgeons may be the first to have the opportunity to suspect and diagnose the underlying life threatening disorder. This case report presented an opportunity to diagnosis a fatal disorder by a routine pre operative laboratory test. To the best of my knowledge, the phenotype of the thumb polydactyly of the current case has not yet reported.
    Keywords: Congenital anomaly, Fanconi anemia, Thumb duplication, Thumb polydactyly
  • Babak Mirzashahi*, Abbas Tafakhori, Arvin Najafi, Mahmoud Farzan Pages 188-191
    Even though intervertebral disc degeneration can be found in the natural course of alkaptonuria, detection of the disease by black disc color change in a patient without any other presentation of alkaptonuria is an exceptionally rare condition. We have reported a very rare case of alkaptonuria presented with low back pain and steppage gait in a 51-year-old male with a complaint of chronic low-back pain and steppage gait who was operated on for prolapsed lumbar disc herniation. Intraoperatively his lumbar disk was discovered to be black. The alkaptonuria diagnosis was considered after histopathological examination of the black disc material and elevated urinary concentration of homogentisic acid confirmed the diagnosis. To our knowledge, this presentation has not been reported previously in literature.
    Keywords: Alkaptonuria, Black disc material, Herniation, Lumbar disc, Ochronosis, Steppage gait
  • Hamidreza Aslani*, Seyed Taghi Nourbakhsh, Farivar A. Lahiji, Keykavoos Heydarian, Mahmood Jabalameli Pages 192-196
    Periodic evaluation and monitoring the health and economic outcome of joint replacement surgery is a common and popular process under the territory of joint registries in many countries. In this article we introduce the methodology used for the foundation of the National Iranian Joint Registry (IJR) with a joint collaboration of the Social Security Organization (SSO) and academic research departments considering the requirements of the Iran’s Ministry of Health and Education.
    Keywords: Arthroplasty, Hip, Iran, knee, Registry national