Journal of Research in Orthopedic Science
Volume:1 Issue: 3, Aug 2014

Antibiotics are the most common additives used in irrigation solutions for open fractures. Nonetheless, there have been few studies exploring the effects of antibiotics on articular cartilage. The purpose of this study was to evaluate the delayed effect of intra-articular injection of cefazolin, gentamicin and vancomycin on articular cartilage. Regarding the characteristics of antibiotic solutions, we proposed they may have potential toxicity on articular cartilage and this effect may be manifested as a delayed phenomenon due to changes in matrix and cell viability. A sample of 20 rabbits was chosen and assigned into 4 groups (each containing 5 animals). A course of antibiotics including gentamicin, vancomycin and cefazolin was injected in both knees of test rabbits. Normal saline was injected to controls. After 8 weeks, articular cartilage of distal femurs was harvested and analyzed using confocal microscopy and Real time PCR. According to confocal microscopy results, gentamicin and vancomycin had significant decrease in live chondrocyte cell number, however, cefazolin had no effect. Quantitative analysis showed no significant difference between antibiotics and control group. We found that cefazolin can be safely used for intra-articular injections, but vancomycin and gentamicin should be used cautiously.

We approached a histopathologic study of idiopathic carpal tunnel syndrome (CTS) to identify its probable causative factors. The purpose of this study was to assess the prevalence of inflammation and fibrosis in the transverse carpal ligament (TCL) and flexor tenosynovium (FT) in severe idiopathic carpal tunnel syndrome. Thirty nine patients with severe idiopathic CTS undergoing open carpal tunnel release between 2008 and 2010 were selected. The TCL and FT biopsy specimens were analyzed to assess the prevalence of inflammation and fibrosis. The mean age of cases was 49 years (16 to 81). Ten (25.64%) were male and 29 (74.36%) female. Fibrous thickening was observed in 11 hands (28%); TCL fibrous thickening in 9 (21.95%), FT fibrous thickening in 1 (2.43%) and in one hand (2.43%) fibrous thickening was present in both of TCL and FT. Inflammatory changes were observed in four (10%) specimens; one (2.43%) in TCL, two (4.87%) in FT and one (2.43%) in both TCL and FT. Histopathologic study of TCL and FT in idiopathic CTS showed inflammation and fibrosis in some cases.

Considering high incidence of anterior cruciate ligament (ACL) reconstruction using autograft or allograft for replacement of ACL ruptures, the present study was designed to compare the treatment results of allograft and autograft in ACL reconstruction. In this cross-sectional study, 58 cases with isolated ACL reconstruction (20 cases with allograft, 38 with autograft) were evaluated using the stability tests of International Knee Documentation Committee (IKDC) and Lysholm knee questionnaire, and mean range of motion (ROM), clinical results for Lachman and pivot-shift tests. Mean ages for allograft group was 27.45(24-38) years and in autograft group 30.21(21-49). There was no statistically significant difference in both groups regarding to performed tests. Based on the achieved results and similar treatment outcomes for autograft and allograft groups, use of allograft for reconstruction of ACL is recommended.

Comminuted distal femur fractures are associated with a high complication rate and their treatment is difficult. This type of fracture is more common in young people with major trauma and following motor vehicle accidents. In old patients with osteoporosis the fractures are often closed and occur following a minor trauma. The aim of our study was to compare the outcomes and complications of treatment of intra-articular distal femur fractures using locking and nonlocking condylar buttress plates. In this retrospective study, 79 patients undergoing surgery due to type C distal femur fractures (T or Y condylar fracture) from 2008-2010 were included. Patients with comorbidities such as diabetes or end stage diseases and patients with other lower extremity fractures on the same side were excluded. For each patient demographic data including age, sex, mechanism of injury, and type of injury was collected. All patients were followed for at least one year postoperatively for complications such as infection, non-union, and malunion. In this study 58 patients (73%) were male and 21 (23%) female. The mean age of the locking group was 37.4 ± 17.3 years and the nonlocking group 40.6 ± 17.3 years. There were no significant differences between the two groups in age and sex. In the locking group 36 patients (80%) had closed fractures and 9 (20%) open fractures and in the nonlocking group 25 patients (73.4%) had closed fractures and 9 (26.6%) open fractures. In both groups 5 patients had infections (11.1% in the locking group and 14.7% in the nonlocking group) and two patients each had nonunion (4.4% and 5.9% respectively). In the locking group 4 patients (8.9%) and in the nonlocking group 6 patients (17.6%) had plate failure. In our study the effects of treatment with both locking and nonlocking condylar buttress plates regarding infection and nonunion were similar but malunion and plate failure were higher in the nonlocking group. Nonetheless, this difference was not statistically significant.

Rotational positioning of femoral component is a critical aspect of total knee arthroplasty and evaluation of the landmarks for rotation of distal femur is a challenge. Most orthopedic surgeons prefer to use more available posterior femoral condyle axis, but other landmarks especially surgical transepicondylar axis may be more valid. Preoperative CT scan can help to evaluate these landmarks more accurately. The purpose of our study was to ascertain the relationships among the described axes guiding distal femur rotational alignment in CT scan of Iranian healthy population and the effects of age and gender on these relationships. Ninety cases aged between 16 and 75 years presenting with acute tibial plateau or patella fracture were included in this study. The rotation of distal femur was evaluated using the single axial CT image through the femoral epicondyles. Four lines were drawn digitally in this view: anatomical & surgical transepicondylar axes, posterior condylar axis and Whiteside’s anteroposterior line. Then we measured the angles among these lines and analyzed the data and evaluated the relationship between them. In 82 patients, mean angle between anatomical transepicondylar axis and posterior condylar axis and between surgical transepicondylar axis and posterior condylar axis were 5.68°±1.89 ° and 1.9°±1.85° respectively. Mean angle between Whiteside’s anteroposterior line and posterior condylar axis was 3.89°±1.64°. There were significant differences between the two genders in these relationships. No significant correlation between patients’ age and angles of distal femur was detected. There was a good correlation between anatomical and surgical axes situations, as anatomical transepicondylar axis was in 3.78° externally rotation related to surgical transepicondylar axis. Preoperative CT scan can help to determine rotational landmarks of distal femur more accurately. If one of the reference axes could not be determined, we can use other reference axes because of good correlations between these landmarks.

Locally destructive aneurysmal bone cysts are blood-filled reactive lesions of bone and in spite of destructive nature, are not considered to be true neoplasms. The accepted treatment for this lesion is curettage and bone grafting. Endoscopic curettage without bone grafting has been reported recently in treatment of aneurysmal bone cysts without aneurysmal dilatation and for small lesions. We present good results with endoscopic curettage without bone grafting in two patients with large and expanded aneurysmal bone cysts of the proximal humerus.

The questions of type of antibiotics and optimal timing of administration for prophylaxis of PJI are of the most important ones for all arthroplasty surgeons. All delegates of consensus meeting on periprosthetic joint infection voted on the following statements regarding optimal timing and antibiotic prophylaxis for prevention of infection in hip and knee arthroplasties. Consensus: The preoperative dose of antibiotics should be administered within one hour of surgical incision; this can be extended to two hours for vancomycin and fluoroquinolones. Furthermore, surveillance measures are critical in ensuring clinician compliance with this ob-jective. Delegate vote: Agree: 97%, Disagree: 2%, Abstain: 1% (strong consensus) Consensus: A first or second-generation cephalosporin (cefazolin or cefuroxime) should be administered for routine perioperative surgical prophylaxis. Isoxazolyl penicillin is used as an appropriate alternative. Delegate vote: Agree: 89%, Disagree: 8%, Abstain: 3% (strong con-sensus)