Journal of Research in Orthopedic Science
Volume:2 Issue: 4, Nov 2015

Context: There is a need to find the optimal postoperative duration and the choice of starting antibiotics for cases who presumed infected or at the time of second stage exchange arthroplasty in two-stage revision of infected cases. Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on PJI reviewed English literature for relevant articles. Sixty-two of 221 articles were relevant to the 5 following questions regarding perioperative antibiotic prophylaxis to prevent periprosthetic joint infection. Postoperative antibiotics should not be administered for greater than 24 hours after surgery. In a patient with a presumed infection when culture results are pending, empiric antibiotic coverage should depend on the local microbiological epidemiology. Culture data should assist in the tailoring of antibiotic regimens. The appropriate preoperative antibiotic for the second stage should include coverage of the prior organism (s). Cemented arthroplasty components should be inserted with antibiotic-laden bone cement (strong consensus). Recommendations for choice, duration 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.

Carpal tunnel syndrome (CTS) is the most frequent entrapment syndrome of the upper limp, which leads to compression of the median nerve at the level of the wrist. Any early diagnosis based on the radiological and clinical findings is essential to find a risk factor preventing permanent nerve damage and functional sequelae. The main aim of this study was to evaluate and determine trapeziohamate distance as a risk factor for incident CTS. Patients and The subjects in this case-control study were patients divided into an experimental group (n = 38) and control group (n = 23). Prospective study was conducted on 33 female and 5 male patients with CTS and 21 females and 2 males in control group. Subjects were selected from patients and their relatives who referred to our hand surgery department. In total, 61 subjects were examined. Gender and age as the personal factors, dominant hand, diabetes mellitus (DM), occupation and trapeziohamate distances were evaluated in all patients and control group. Mean values of trapeziohamate distance as a risk factor for experimental and control groups were measured. Levene’s test and Student’s t test were used to analyse the collected data using Statistical Package for Social Science. The risk of CTS was higher in women and housekeeper. There was a significant difference between the two groups for trapeziohamate distance. The mean of trapeziohamate distance in control group (23.39) was significantly higher than the mean of experimental group (21.02). Our study confirmed that the incidence of CTS is higher in women and housekeeper and trapeziohamate distance is a dependent risk factor for the carpal tunnel syndrome.

Although anterior shoulder dislocation is the most prevalent type of body dislocation, irreducible anterior shoulder dislocation is seldom reported in the literature, which is usually due to physical obstacles. This study presents our findings regarding the causes of irreducibility of anterior shoulder dislocation associated with displaced fracture of the greater tuberosity. Patients and CT scans, open reduction of the joint, and internal fixation of the tuberosity was performed in seven patients with irreducible anterior shoulder dislocation associated with displaced fracture of the greater tuberosity. As confirmed by intraoperative findings, the CT scans showed the cause of irreducible shoulder dislocation in six cases was the interposition of the long head of biceps (LHB) in the anterior of the head that was displaced from the fracture line between the greater and lesser tuberosities. In another case, the greater and lesser tuberosities were attached to each other and were separated from the head. This fractured part was trapped. We suggest that performing CT scans in all cases of anterior shoulder dislocations with displaced fracture of the greater tuberosity can help surgeons to diagnose the accompanying fractures and possible complications, such as irreducibility. If the fracture line passes through the bicipital groove or in the case of a shield fracture, possible irreducibility should be borne in mind.

Vitamin D deficiency is common in all age groups throughout the world, and results in abnormalities in calcium, phosphorous and bone metabolism that can lead to muscle weakness, osteomalacia and osteopenia. This study was designed to investigate the prevalence of vitamin D deficiency in patients with nonspecific pain for whom no specific causes such as trauma, infection, tumor, and inflammatory disorders could be identified. Patients and This cross-sectional study included 438 patients with nonspecific musculoskeletal pain seen at our clinic. After evaluating their vitamin D status, we treated two groups of patients: those with vitamin D deficiency (< 20 ng/mL) and those with insufficiency (20 - 29 ng/mL). We treated our patients with 50,000 units of vitamin D every week for 6 - 8 weeks. After treatment we evaluated pain relief of patient and level of 25 hydroxi vitamin D. A total of 438 patients (52 men and 386 women) participated in the study. There was no statistically significant correlation between sex and symptoms. Deficiency was more frequent in females but the difference compared to males was not statistically significant. Approximately half of the patients (47%) comprised the vitamin D-deficient group. Most patients (86.5%) had insufficient or deficient levels (< 30 ng/mL) of vitamin D. The most prevalent vitamin D status in men was insufficiency, whereas the most prevalent status in women was deficiency. Spearman’s correlation coefficient showed weak positive correlations between vitamin D status and the number of pregnancies (r = 0.14). More than 90% of our patients reported that pain and muscle weakness responded to treatment after 3 weeks. Because osteomalacia is a common cause of persistent, nonspecific musculoskeletal pain, screening all patients with these symptoms for hypovitaminosis D should be standard practice in clinical care.

Playing football, both at the amateur and professional level, associates an increased risk of injury. A documented report on injury location, type and incidence, in correlation with sports intensity, professionalism level and age, would be of support for implementing preventing measures and appropriate training programs, to reduce the incidence of football related injury. This study aimed to assess the incidence, type and location of injuries during one season, in an amateur football club and design strategies and preventive measures. Patients and A population of 308 players were studied, aged between 5 and 29 years old (20 subjects over-19, 38 under-19, 38 under-16, 57 under-14, 57 under-12, 44 under-10 and 54 under-8 years old, respectively) distributed over 20 teams. In total, 339 cases of injury occurred. The population injured the most was the under-19 group and the most prevalent type of injuries was muscular (40.7%) and ligament (16.5%). The most common location was the lower limbs (78.6%) and, specifically, the thigh (39.8%). Physical load periods (September and February) were highlighted as the months of highest incidence and the average number of visits per injury was 1.34. A statistically significant relationship between hours of training and injuries was noted. In the literature, there are similar publications, who studied these variables, separately. This work provides us with a certain amount of descriptive results, which may serve as a model for future research projects, performing interventions by coaches and medical services of football clubs, to reduce the injuries incidence, especially in the months of greatest physical load and, therefore, improve the performance. Football is a safe sport to practice, at any age, because injuries, regularly, are not serious and it is highly recommended, given the amount of health benefits obtained.

Metacarpophalangeal (MCP) joints dislocations are rare, especially the simultaneous complex dislocations of four MCP joints. Although there are over 100 reported cases of MCP joint dislocation, the vast majority involves the index finger and is extremely rare in the long or ring fingers. Up to present, only three cases of simultaneous complex dorsal dislocation of four joints were described in the literature. We present a rare case of complex dorsal dislocation of four MCP joints. Physical examination and radiographic evaluation revealed open dorsal MCP joint dislocation of index, middle, ring and little fingers. Any attempt of closed reduction was unsuccessful, before surgery. The patient in the case underwent open reduction and, after surgery, the injured hand was placed in a short extension block splint and controlled active motion, while in splint, was encouraged, immediately. This approach resulted in an uneventful recovery. We described the complex dorsal MCP joint dislocation of four joints, which is defined as irreducible and complete dislocation, most often because of volar plate interposition. Although the dorsal and volar approaches are common methods of treatment, in complex MCP joint dislocations, however, to our knowledge, the dorsal approach has better advantages, compared with the volar type.