Journal of Research in Orthopedic Science
Volume:6 Issue: 1, Feb 2019

Elbow stiffness is a debilitating condition with different etiologies including trauma, head injury, and burns, which seriously interferes with the patient’s daily activities. Here, we aimed to report the outcome of elbow release surgery in patients with elbow stiffness caused by different etiologies. In a retrospective study, the outcome of surgery was evaluated in 18 patients with elbow stiffness. The indication for surgery was the functional loss of elbow range of motion that failed at least six months of conservative management. Elbow range of motion was evaluated before and after the surgery. Mayo elbow performance score (MEPS) was used to assess elbow function at the final follow-up session. The mean follow-up period of the patients was 4.5 ± 2.6 years, ranging from 2 to 10 years. The etiology of stiffness was trauma in 11 cases, central nervous system injury in six patients, and burns in one patient. The mean pre-operative supination, pronation, and flexion arc improved by 15.3°, 20.9°, and 62.2° at the final follow-up evaluation, respectively (P = 0.028, P = 0.008, and P < 0.001, respectively). The mean MEPS of the patients was 85 ± 9.1, ranging from 65 to 95. According to the MEPS scores, the functional outcome was excellent in 8 (44.4%) patients, good in 7 (38.9%) patients, and fair in 3 (16.7%) patients. The release of stiff elbow could be regarded as an effective treatment that provides an acceptable gain in the range of motion and considerable improvement of elbow function.

Treatment of Monteggia fracture-dislocations can become quite complicated when the diagnosis is delayed. We report the outcome of open reduction and ulnar osteotomy with annular ligament repair or reconstruction in pediatric patients with neglected Monteggia fracture-dislocation. In a retrospective study, pediatric patients with neglected Monteggia fracture-dislocation who underwent open reduction and ulnar osteotomy with annular ligament repair or reconstruction were included. The radiologic evaluations included the assessment of the union of the osteotomy site and elbow joint degenerative changes or peri-articular ossifications. The clinical evaluation of outcomes included the range of motion (ROM) and the Kim elbow performance score (KEPS). A total number of seven patients with pediatric Monteggia fracture-dislocations and the mean age of 6.6 ± 2.7 years were evaluated. The mean delayed time from injury to surgery was 53.3 ± 31.4 days. The mean follow-up of the patients was 30.8 ± 25.5 months. The mean flexion arc, supination, and pronation were 137.9‎°, 72.1‎°, and 65.7°, respectively. Flexion contracture was present in two cases only. The mean KEPS of the patients was 96.4 ± 6.3. Accordingly, the outcome was excellent in six (85.7%) patients and good in one (14.3%). One ulnar nonunion and one heterotopic ossification were recorded as post-operative complications. No case of subluxation, dislocation, or degenerative joint disease was seen in our series. Radial head reduction and ulnar osteotomy with annular ligament reconstruction result in acceptable radiologic and clinical outcomes in the management of neglected pediatric Monteggia fracture-dislocation.

Application of fix-bearing-(FB) or mobile-bearing (MB) total knee arthroplasty (TKA) is an area of controversy. Introduction of mobile-bearing implants has become an appealing option for some surgeons leading to more favorable structural and weight-bearing outcomes in TKA; however, the beneficial long-term outcome is still unclear. This study was carried out to compare TKA outcomes by MB-versus FB implants with respect to long-term outcome. A total of 140 patients who met our inclusion criteria were enrolled in this retrospective cohort study from March 2015 to April 2016. They were divided into two groups of 85 patients with MB TKA and 55 subjects with FB TKA. The range of motion (ROM), knee injury and osteoarthritis outcomes score (KOOS), and patient satisfaction were compared between two groups. The ROM and KOOS scores were not significantly different between the two groups (P > 0.05). With regard to the patient’s satisfaction, there was no significant difference between the two groups (P > 0.05). According to our results in this retrospective cohort study, regarding the outcome of TKA by MB versus FB implants, we showed comparable mechanical and functional outcome.

Recent evidence supports the superiority of surgery over conservative treatment in the management of medial humeral epicondylar fractures (MHEF) with the displacement of more than 2 mm, regardless of other indications for surgical intervention. We evaluate this strategy in a cohort of pediatric MHEF with more than 2 mm displacement. A total of 10 pediatric patients with MHEF and more than 2 mm displacement were included in the study. Relative and absolute indications for surgical intervention were present in five and one patient, respectively. No surgical indication was present in the other four cases. Elbow dislocation had occurred in three cases. All the patients were treated with open reduction and internal fixation (ORIF). The outcome measures included: Radiographic union, elbow range of motion, and Mayo elbow performance score (MEPS). At the final follow-up session, the mean flexion was 129° ± 6.1°. Flexion contracture and hyperextension were seen in three (30%) and one (10%) patient, respectively. The mean supination and pronation were 81° ± 3.2° and 80.5° ± 1.6°, respectively. MEPS was 100 (excellent) in nine patients and 55 (poor) in one patient. Radiographic union was observed in all the patients. In one patient, ulnar nerve neurolysis was performed 23 months after the initial surgery due to severe tenderness around the medial epicondyle. ORIF management of MHEF is an easy procedure with a low complication rate and satisfactory outcomes. Thus, we suggest the surgical approach for all pediatric patients with MHEF and displacement of > 2 mm, regardless of the presence of other indications for surgery.

Femoral nonunion is an important complication, which can occur after intramedullary nailing and it requires surgical intervention. Plate augmentation over intramedullary nail is emerging as an acceptable option with satisfactory results for femoral nonunion. The aim of the present study was to determine whether plate augmentation over retained intramedullary nail is an effective treatment for nonunion of femoral shaft fracture. Overall, 35 cases of femoral nonunion, initially treated with intramedullary nailing, were managed with plating augmentation. Patients with oligotrophic or atrophic nonunion also received iliac cancellous auto graft. The outcome was evaluated by the rate and duration of union and complications were recorded. All patients achieved bony union during an average time of 21 weeks (± 3.94) and no union occurred later than 35 weeks. In plain radiography, evidence of callus formation was seen at mean time of 10 weeks. There was no statistically significant difference in union time among different types of nonunion (P: 0.466) while a significant difference was noticed in the time for callus formation (P < 001). Also, no complications were observed. Plating augmentation is an effective and safe treatment option for nonunion of femoral shaft fractures.

Bizarre parosteal osteochondromatous proliferation (BPOP), also known as the Nora’s lesion, is a part of the spectrum of reactive lesions with a difficult diagnosis. To date, only limited number of Nora’s lesions have been reported in the literature. Here, we report a case of Nora’s lesion and discuss the differential diagnosis of the case. A 34-year-old male that was referred to the hand clinic of our center with a painful lump at the dorsoulnar aspect of the first metacarpal bone of his left hand. The diagnosis of BPOP was suspected using its clinical and radiographic characteristics. Subsequently, excisional biopsy was performed and the extracted lesion was sent to the pathology for definitive diagnosis. The histopathologic evaluation confirmed the diagnosis of BPOP. One year follow-up of the patient showed no radiographic or clinical sign of recurrence. BPOP can be confused with malignant lesions such as parosteal osteosarcoma and chondrosarcoma. Thus care should be taken to combine the radiographic and pathologic information in the correct diagnosis of this lesion, especially when the BPOP presents with atypical features.

Gorham-Stout syndrome is a rare disease, which results in spontaneous bone resorption. Failure to proper diagnosis of this syndrome can lead to unnecessary bone surgeries. A 13 years old girl with right hip pain, limping, and proximal femur lytic lesions underwent three surgeries without the exact diagnosis. Surgical curettage, bone graft, and internal fixation failed miserably. According to the imaging studies and the biopsy results of bone lesions that showed lymphangiomatosis, accompanied by skin and spleen lesions, a rare presentation of the Gorham-Stout syndrome was diagnosed. Bisphosphonate treatment provides a significant recovery in her symptoms and imaging studies confirmed bone improvement.

Sciatica is a radiating pain that starts from the buttock to the legs. Any condition that affects the sciatic nerve within its intraspinal or extraspinal course may cause sciatica. The most common etiology is the lumbar disc herniation; however, bone tumors around the hip joint are rarely reported. Herein, we report a case of solitary osteochondroma of proximal femur that caused sciatic nerve entrapment. The diagnosis was delayed due to the low level of suspicion and incorrect diagnostic imaging. Patients with sciatica should be thoroughly evaluated and extraspinal causes including space-occupying lesions along the course of the sciatic nerve should be kept in mind, particularly when the symptoms do not respond to conservative management in recalcitrant cases with negative lumbar imaging findings.

Stress fracture is a common diagnosis of pain in the lower extremity in the lack of obvious trauma history. Nowadays, with better recognition of its pathophysiology and advanced diagnostic facilities, it is more convenient to distinguish stress fracture. But in some cases, it is troublesome to differentiate stress fracture from serious conditions such as neoplasm. The current case report described an unusual case of proximal fibula stress fracture presenting with mass and local tenderness without history of trauma or vigorous activity.