Journal of Research in Orthopedic Science
Volume:2 Issue: 1, Feb 2015

Both primary and secondary tumors can develop in distal phalanx of the hand presenting as lytic lesions. The presence of a lytic lesion in the distal phalanx has been a dilemma making the differential diagnoses, prognosis, and treatment of these lesions challenging. This study was designed to evaluate the patients who were presented with a lytic lesion in their distal phalangeal bone of the hand. Patients and In this retrospective study, we reviewed the final diagnosis, clinical presentation, treatment, and outcomes of the lytic lesions in distal phalangeal bones of the hand in 14 patients who were referred to our hospital from 2008 to 2013. The mean age of our patients was 36.14 ± 15.8 years. Thumb and middle finger were the most common involved digits (four cases of each) followed by the index finger (three patients). Enchondroma was the most common final diagnosis (five patients) followed by giant cell tumor and glomus tumor (two cases of each). Painless mass was the chief complaint of most patients with enchondroma, whereas pain and swelling were the chief compliant of others. Enchonromas were located in the proximal part of the distal phalanx and other lytic lesions were seen in the distal part. Because of the diverse diagnosis for the lytic lesions in the distal phalanx of the hand, a complete tumor work-up should be performed to evaluate the condition properly, especially in distally located lesions.

Context: There is a need to find the best choice of preop antibiotic prophylaxis to prevent Periprosthetic Joint Infection (PJI) in the situations where the first generation cephalosporins are not indicated. Evidence Acquisition: Delegates in Workgroup 3 of the Consensus Meeting on PJI reviewed the English literature for relevant articles. Totally, 51 of 221 articles were relevant to the five following questions regarding perioperative antibiotic prophylaxis to prevent PJI. The choice of antibiotics for patients with preexisting prostheses, such as heart valves, is similar to that for routine elective arthroplasty. Currently, teicoplanin and vancomycin are reasonable alternatives when routine antibiotic prophylaxis cannot be administered. In a patient with a known anaphylactic reaction to penicillin, vancomycin or clindamycin should be administered as prophylaxis. Teicoplanin is an option only in countries where it is available. In a patient with a reported non-anaphylactic reaction to penicillin, a second generation cephalosporin can be used safely, as there is limited cross-reactivity. Penicillin skin testing may be helpful in certain situations to clarify whether the patient has a true penicillin allergy. Recommendations for choice of perioperative antibiotic prophylaxis in hip and knee arthroplasty were provided based on evidences in the literature and consensus of expert delegates from consensus meeting.

Fingertip injuries are among the most prevalent hand injuries. The fingertip has important sensory and functional role. When the size of fingertip skin defect is large, full thickness skin grafting is necessary. There are several donor sites for obtaining skin graft; however, there is no study concerning the best region of harvesting skin graft compatible with the fingertip. This study was designed to compare the skin grafts harvested from wrist and groin for fingertip skin loss. Patients and A total of 72 patients in need of skin grafting were randomized to two group of 36 to receive skin graft harvested from the wrist or from the groin regions. The patients included 71 males and only one female patient who was in the wrist harvested group. All the patients were operated by one technique. The minimum follow-up period was 18 months. The grafted skin was evaluated clinically regarding two-point discrimination (TPD), light touch, ulcer, graft contracture, hair growth on the grafted skin, and color difference between the graft and recipient site, which was evaluated with photo analyzer in Photoshop software. The grafted skins were compared between groups. Clinically, TPD and light touch were better (lower thresholds) in the wrist group (P < 0.05). Moreover, The amount of skin contracture, color difference between grafted skin and recipient site, and hair follicle counts were less in the wrist group (P < 0.001). In both groups, there were no ulcer and fissuring. For fingertip injures, full thickness skin grafts harvested from the wrist have significantly better cosmetic and functional results including better TPD and light touch, less hair follicles, less color difference, and less contracture.

Osteoid Osteoma (OO) is uncommon in the carpal bones and extremely rare in the trapezium. We report the third case of OO of the trapezium. Patient was a 45- year -old man with chronic left wrist pain for 19 months. Pain was intense at night and responsive to nonsteroidal anti-inflammatory drugs. There was a local tenderness on the trapezium. The wrist X-ray images revealed normal findings, but bone scan, computed tomographic scan, and magnetic resonance imaging indicated OO as the possible diagnosis. The patient was treated by curettage and bone graft of the trapezium. Histopathologic examination confirmed the diagnosis of OO. OO of the trapezium should be included in differential diagnosis list in patients with chronic wrist pain.

Quadriceps and Achilles tendon ruptures are well-known entity following tendonitis and tendon weakening in some of the chronic and systemic underlying disease. We report a very rare case with simultaneous Achilles and bilateral quadriceps tendon ruptures in a patient with chronic renal failure (CRF) in a 48-year-old man. The ruptured tendons were treated surgically with good outcome. Multiple tendons injury should be considered to prevent delayed diagnosis in patients with CRF who presented with tendon rupture.

Context: Appropriate management of soft-tissue and bone tumor needs correct diagnosis. Sometimes, diagnosis can be made by history, physical examination and imaging. An incompetently performed biopsy not only may fail in making the proper diagnosis, but also has a negative impact on survival and local control. Evidence Acquisition: To reach the most accurate information in the field of biopsy of the musculoskeletal tumor, based on the intensive literature review of the most prestigious journals and textbooks in the field of the musculoskeletal tumor surgery and our experiences in the only referral center in our country for more than 25 years, this current concept review was prepared. Fine needle aspiration (FNA) has the highest accuracy in homogenous tumor as well as malignant myeloma and metastatic carcinoma. Core needle biopsy (CNB) is usually selected as the first biopsy modality. Incisional biopsy is indicated in difficult cases when a larger specimen is necessary for diagnosis. In malignant bone tumors, soft tissue component is as much representative as bony component. Biopsy should be considered as a final diagnostic procedure. Not all bone and soft tissue lesions need biopsy. FNA, CNB and incisional biopsy should be performed as their precisely defined indications.

Giant cell tumor of the tendon sheath (GCTTS) is the most common benign tumor of the hand following the ganglion cyst. It is more prevalent in women in third through fifth decades of life. The aim of the study was to investigate the demographic and clinical characteristics as well as the rate of recurrence of GCTTS in an Iranian population. Patients and Medical records of 47 patients with GCTTS were reviewed. Data on demographic characteristics as well as clinical and intraoperative findings were collected. Plain X-rays, magnetic resonance, and ultrasonographic images were observed. Patients were asked about the recurrence of the GCTTS after mean interval of 4.9 ± 2.6 years. Females were predominantly involved (70.2%). Patients aged 38.5 ± 16.2 years at the time of surgery. The middle finger was the most common site of the lesion (27.6%) followed by index finger (25.5%) and thumb (21.3%). The volume of the lesions averaged 3.9 ± 5.5 cm3. The GCTTS had invaded the skin (1 patient), bone (1 patient), tendon pulley (6 patients), tendon (4 patients), and digital nerve (2 patients). Osseous erosion was found in two patients. After exact excision, the tumor recurred in four patients (8.5%). None of the variables affected the risk of recurrence. The characteristics of our patients were greatly similar to the previous studies. Exact and complete excision of the lesion under magnification was the keystone of decreased rate of GCTTS recurrence.

Seizure is a known cause of shoulder dislocation and has been reported as the adverse effect of tramadol consumption, with both therapeutic use and overdose. The present study aimed to determine the prevalence and type of the shoulder dislocation due to tramadol-induced seizure. Patients and This prospective and descriptive cross-sectional study was performed on patients with tramadol-induced shoulder dislocation referred to Shafa Orthopedic Hospital, Tehran, Iran, from October 2012 to April 2013. The patients'' data on age, sex, ingested dose of tramadol, previous history of tramadol or other drug abuse, history of previous tramadol-induced seizure before presentation, side and type of the dislocation, and presence of accompanying fractures were recorded. A total of 72 patients with shoulder dislocation were admitted during the study period. According to our eligibility criteria, 15 patients (20.83%) were included. All patients had consumed tramadol orally during the preceding four hours of seizure. The dosage of tramadol consumption ranged from 100 to 3500 mg (mean, 650 mg). All of patients were male aging between 22-43 years old (mean age, 29 ± 2.0 years). The side of dislocation was right in 9 (60%), left in 4 (26.66%), and bilateral in two patients (13.33%). All the dislocations were anterior, except one (6.66%). Five patients (33.33%) had a history of another episode of previous tramadol-induced seizure. Four patients (26.66%) had accompanying greater tuberosity fractures. In patient with shoulder dislocation and without any obvious trauma, tramadol-induced seizure should be considered. Tramadol should be prescribed cautiously and patients should be informed of its adverse effects including seizure-induced shoulder dislocation.