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Archives of Bone and Joint Surgery - Volume:4 Issue: 3, 2016
  • Volume:4 Issue: 3, 2016
  • تاریخ انتشار: 1395/04/28
  • تعداد عناوین: 18
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  • Taghi Baghdadi, Reza Abdi*, Ramin Zargarbashi, Hossein Aslani Pages 197-203
    Background
    Children with myelomeningocele (MMC) develop a wide variety of hip deformities such as muscle imbalance, contracture, subluxation, and dislocation. Various methods and indications have been introduced for treatment of muscle imbalances and other hip problems in patients with MMC but there is no study or meta-analysis to compare the results and complications. This review aims to find the most acceptable approach to hip problems in patients with MMC.
    Methods
    MEDLINE was searched up to April 2015. All study designs that reported on the outcomes of hip problems in MMC were included. From 270 screened citations, 55 were strictly focused on hip problem in MMC were selected and reviewed.
    Results
    Complex osseous and soft tissue reconstructive procedures to correct hip dysplasia and muscle balancing around the hip are rarely indicated for MMC patients without good quadriceps power.
    Conclusion
    Over the years a consensus on the best algorithm for treatment of hip dislocation in myelomeningocele has been missing, however, muscular balancing with/out osseous procedure seems a reasonable approach especially in unilateral mid-lumbar MMC.
    Keywords: Hip dislocation, Hip dysplasia, Myelomeningocele, Meningomyelocele, Spina bifida, Teratology
  • Soheil Sabzevari, Adel Ebrahimpour, Mostafa Khalilipour Roudi, Amir R. Kachooei* Pages 204-212
    High tibia osteotomy is a common procedure in orthopedic surgery. A precise overview on indications, patients selection, pre-operative planning, surgical technique, methods of fixation, and complications have been presented. This paper focused on the points that should be considered to achieve good long-term outcomes.
    High tibia osteotomy is a common procedure in orthopedic surgery. A precise overview on indications, patients selection, pre-operative planning, surgical technique, methods of fixation, and complications have been presented. This paper focused on the points that should be considered to achieve good long-term outcomes.
    Keywords: Tibia, Osteotomy, Systematic Review
  • Joost Kortlever, Stein Janssen, Jeroen Molleman, Michiel Hageman, David Ring* Pages 213-219
    Background
    Nonspecific symptoms are common in all areas of medicine. Patients and caregivers can be frustrated when an illness cannot be reduced to a discrete pathophysiological process that corresponds with the symptoms. We therefore asked the following questions: 1) Which demographic factors and psychological comorbidities are associated with change from an initial diagnosis of nonspecific arm pain to eventual identification of discrete pathophysiology that corresponds with symptoms? 2) What is the percentage of patients eventually diagnosed with discrete pathophysiology, what are those pathologies, and do they account for the symptoms?
    Methods
    We evaluated 634 patients with an isolated diagnosis of nonspecific upper extremity pain to see if discrete pathophysiology was diagnosed on subsequent visits to the same hand surgeon, a different hand surgeon, or any physician within our health system for the same pain.
    Results
    There were too few patients with discrete pathophysiology at follow-up to address the primary study question. Definite discrete pathophysiology that corresponded with the symptoms was identified in subsequent evaluations by the index surgeon in one patient (0.16% of all patients) and cured with surgery (nodular fasciitis). Subsequent doctors identified possible discrete pathophysiology in one patient and speculative pathophysiology in four patients and the index surgeon identified possible discrete pathophysiology in four patients, but the five discrete diagnoses accounted for only a fraction of the symptoms.
    Conclusion
    Nonspecific diagnoses are not harmful. Prospective randomized research is merited to determine if nonspecific, descriptive diagnoses are better for patients than specific diagnoses that imply pathophysiology in the absence of discrete verifiable pathophysiology.
    Keywords: Arm, Discrete, Nonspecific, pain, Pathophysiology
  • Saroj K. Golay*, Philippa Rust, David Ring Pages 220-223
    Background
    To determine the prevalence of incidental Kienböck disease.
    Methods
    A retrospective analysis of 150,912 radiological reports or images obtained over a five year period was performed of 76,174 patients who underwent a radiograph or computed tomography scan which included the wrist, in Edinburgh and Lothian, UK.
    Results
    There were 5 cases of incidental Kienböck disease and 13 cases of symptomatic Kienböck disease. There were no significant differences in age, sex, ethnicity, comorbidities, smoking status, excess alcohol use or Lichtman stage between the incidental and symptomatic Kienböck groups.
    Conclusion
    The radiological prevalence of incidental Kienböck disease was 0.0066% or 7 in 100,000 patients.
    Keywords: Incidental, Kienböck disease, Lunate, Prevalence
  • Hossein Saremi*, Elham Hakhamaneshi, Mohammad Ali Seif Rabiei Pages 224-227
    Background
    To evaluate safety and efficacy of percutaneous release of trigger finger in multiple digits involvement in comparison with single digit involvement.
    Method
    A number of 100 patients (131 fingers) were treated by percutaneous release and divided into two groups: single digit (group A) and multiple digits (group B). They were followed up for one year. Success rate, pain, complications and duration of analgesic use were studied and then compared in both groups.
    Results
    All patients in both groups were treated successfully without any recurrence in a one-year follow-up. No complication was observed, but postoperative duration of pain was significantly different between the two groups. Period of painkiller use was also different between the two groups.
    Conclusion
    Percutaneous release is a safe and effective treatment for trigger fingers even if multiple digits are involved. It is also safe in thumb and index finger involvement and diabetic patients.
    Keywords: Multiple digits, Percutaneous release, Trigger finger
  • Dirk P. Ter Meulen, Sjoerd Nota, Michiel Hageman, David Ring* Pages 228-230
    Background
    This study addresses the null hypothesis that there is no expansion of heterotopic ossification (HO) in the elbow beyond what can be seen early on.
    Methods
    The area of HO was measured on lateral radiographs of 38 consecutive patients that had operative treatment of HO between 2000 and 2013. Measurements from radiographs obtained between 3 to 7 weeks were compared to measurements from radiographs made 3 months or more after injury.
    Results
    There was no significant difference between the average area of HO on the first (median 2.8 square centimeters, Q1: 1.5, Q3: 5.1) and later radiographs (median of 2.8 square centimeters, Q1: 1.4, Q3: 5.0) (P = 0.99).
    Discussion
    According to our results the area of HO does not expand beyond what can be seen early in the disease process.
    Keywords: Disease progression, Elbow, Heterotopic, Injuries, Ossification
  • Amirali Sayadipour*, Chrisopher K. Kepler, Rajnish Mago, Kenneth M. Certa, Mohammad R. Rasouli, Alexander R. Vaccaro, Todd J. Albert, David G. Anderson Pages 231-235
    Background
    It has been suggested, although not proven, that presence of concomitant psychiatric disorders may increase the inpatient costs for patients undergoing elective surgery. This study was designed to test the hypothesis that elective lumbar fusion surgery is more costly in patients with under treatment for depression.
    Methods
    This is a retrospective case-control study of 142 patients who underwent elective lumbar fusion. Of those 142 patients, 41 patients were chronically using an antidepressant medication that considered as a "study group", and 101 patients were not taking an antidepressant medication that considered as a "control group". Data was collected for this cohort regarding antidepressant usage patient demographics, length of stay (LOS), age-adjusted Charlson comorbidity index scores and cost. Costs were compared between those with a concomitant antidepressant usage and those without antidepressant usage using multivariate analysis.
    Results
    Patients using antidepressants and those with no history of antidepressant usage were similar in terms of gender, age and number of operative levels. The LOS demonstrated a non-significant trend towards longer stays in those using anti-depressants. Total charges, payments, variable costs and fixed costs were all higher in the antidepressant group but none of the differences reached statistical significance. Using Total Charges as the dependent variable, gender and having psychiatric comorbidities were retained independent variables. Use of an antidepressant was independently predictive of a 36% increase in Total Charges . Antidepressant usage as an independent variable also conferred a 22% increase in cost and predictive of a 19% increase in Fixed Cost . Male gender was predictive of a 30% increase in Total Charges .
    Conclusion
    This study suggests use of antidepressant in patients who undergo elective spine fusion compared with control group is associated with increasing total cost and length of hospitalization, although none of the differences reached statistical significance.
    Keywords: Antidepressants, Costs, Comorbidities, Elective lumbar fusion surgery, Length of hospitalization
  • Mohammad Gharedaghi, Mohammad Taghi Peivandi, Mehdi Mazloomi, Hasan Rahimi Shoorin*, Mohammad Hasani, Parham Seyf, Fatemeh Khazaee Pages 236-242
    Background
    Massive bone allograft is an option in cases of limb preservation and reconstruction after massive benign and malignant bone tumor resection. The purpose of this study was to analyze the outcome of these procedures at Imam Reza Hospital, Mashhad University of Medical Sciences.
    Methods
    In this study, 113 cases have been presented. Eleven cases were excluded (patients has a traumatic defect or they passed away before the completion of the study’s two-year follow up period). Each patient completed a questionnaire, went through a physical examination and, if indicated, X-ray information was collected. The patients were divided into three groups: chemotherapy, chemotherapy plus radiation therapy, and no-adjuvant-therapy.
    Results
    Fifty-four cases were male and the mean age was 24.5±5.39. The number of cases and indications for surgery were: 33 cases of aggressive benign tumors or low grade malignant bone tumors (large bone defects) including 16 germ cell tumors, eight aneurysmal bone cysts, five low grade osteosarcomas, and four chondrosarcomas. Another 69 cases were high-grade malignant bone tumors including 42 osteosarcomas, 21 Ewing’s sarcoma, and six other high grade osteosarcomas. Patients were divided into three groups: the first group received no adjuvant therapy, the second group received chemotherapy, and the third group received chemotherapy plus radiotherapy. The location of tumors were as follows: eight cases in the pelvic bone, 12 in the proximal femur, 18 in the femoral shaft, 36 in the distal femur, 12 in the proximal tibia, and 16 in the humeral bone. The 12 cases of proximal femoral defects were reconstructed by allograft composite prosthesis, 18 diaphyseal defects with intercalary allograft, and 36 distal femoral defects were reconstructed using osteoarticular allograft. The rate of deep infection was 7:8% (eight patients) and in this regard, we found a significant difference among the three groups, such that most cases of infection occurred in the adjuvant chemotherapy plus radiation therapy group. Allograft fracture occurred in six patients and prevalence was the same in all groups. Only in six cases of radio-chemotherapy nonunion occurred, so we used autogenous bone graft for union. Local recurrence was observed in six patients: three belonged to the adjuvant chemotherapy group and the other three were in the chemo-radiotherapy group; no significant difference was observed between these two groups. However, there was a significant difference between these two and the group that received no adjuvant therapy. Also, there were 11 cases of metastases and Restriction of knee joint motion occurred in 48 cases of osteo-cartilaginous grafts of the distal femur and proximal tibia.
    Conclusion
    Although structural allograft is an appropriate choice in limb reconstruction after massive resection of involved tissues in malignant and invasive bone tumors, the risk of complications such as nonunion and infection in massive allograft increases in cases of adjuvant (chemotherapy and radiotherapy) modalities of treatment. Whereas the rate of tumor recurrence, metastasis, and restrictions in range of motion during a short term follow up after implantation showed no significant difference among the evaluated groups. Consequently, further attention and constant periodic visits of the patients and checking for local recurrence and distant metastasis should be done after surgery.
    Keywords: Allograft, Bone tumor, Chemotherapy, Limb, salvage, Radiotherapy
  • Farshid Bagheri, Mohammad Hosein Ebrahimzadeh*, Ali Moradi, Hamid Farahpour Bidgoli Pages 243-247
    Background
    Frozen shoulder is resulting in limb disability and reduction of quality of life but the factors associated with patients’ disability and quality of life is not clear. To assess pain, disability, the quality of life and factors associated with them in patients suffering from frozen shoulder.
    Methods
    We enrolled 120 patients (37 men and 83 women) with phase-II idiopathic frozen shoulder in our cross-sectional study. Demographic data were collected and shoulder range of motion was measured in four different directions (elevation, abduction, external and internal rotation) in both upper limbs. Patients were asked to fill out Visual Analog Scale for pain (VAS) and, Short-Form Health Survey questionnaire (SF-36) as well as Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. We asked the patients to fill out the Hamilton anxiety and depression questionnaires.
    Results
    The mean of VAS pain, DASH, PCS, and MCS scores were 69(18), 53(17), 35(8.0), and 42(10) respectively. All the domains of SF36 questionnaires where below the normal population except physical function. VAS pain score was correlated to Hamilton depression scores in both bivariate and mulivarilable analysis. DASH score were correlated to sex, age, ROM, and both Hamilton anxiety and depression scores; However, DASH score only impact with Hamilton anxiety and ROM independently. PCS is correlated to age and MCS to Hamilton depression.
    Conclusion
    Patient with frozen shoulder are more suffering from pain and disability secondary to psychiatric parameters such as depression and anxiety than demographic features or even restriction of range of motion.
    Keywords: Adhesive capsulaitis, Disability, Frozen shoulder, pain, Quality of life, Shoulder
  • Seyyed Morteza Kazemi, Mohammad Qoreishy*, Ali Keipourfard, Mohammadreza Minator Sajjadi, Shahram Shokraneh Pages 248-252
    Background
    Some studies have previously shown that geometry of proximal femur can affect the probability of fracture and type of fracture. It happens since the geometry of the proximal femur determines how a force is applied to its different parts. In this study, we have compared proximal femur’s geometric characteristics in femoral neck (FNF), intertrochanteric (ITF) and Subtrochanteric (STF) fractures.
    Methods
    In this study, 60 patients who had hip fractures were studied as case studies. They were divided into FNF, ITF and STF groups based on their fracture types (20 patients in each group). Patients were studied with x-ray radiography and CT scans. Radiological parameters including femoral neck length from lateral cortex to center of femoral head (FNL), diameter of femoral head (FHD), diameter of femoral neck (FND), femoral head neck offset (FHNO), neck-shaft angle (alpha), femoral neck anteversion (beta) were measured and compared in all three groups.
    Results
    Amount of FNL was significantly higher in STF group compared to FNF (0.011) while ITF and STF as well as FNT and ITF did not show a significant different. Also, FND in FNF group was significantly lower than the other two groups, i.e. ITF and STF. In other cases there were no instances of significant statistical difference.
    Conclusion
    Hip geometry can be used to identify individuals who are at the risk of fracture with special pattern. Also, it is important to have more studies in different populations and more in men.
    Keywords: Femur, Fracture, Geometry, Hip
  • Mohammadreza Emamhadi, Shahrokh Yousefzadeh Chabok, Fariborz Samini, Babak Alijani*, Hamid Behzadnia, Fariborz Ayati Firozabadi, Zoheir Reihanian Pages 253-258
    Background
    Variations of the brachial plexus are common and a better awareness of the variations is of crucial importance to achieve successful results in its surgical procedures. The aim of the present study was to evaluate the anatomical variations of the brachial plexus in adult cadavers.
    Methods
    Bilateral upper limbs of 32 fresh cadavers (21 males and 11 females) consecutively referred to Guilan legal medicine organization from November 2011 to September 2014, were dissected and the trunks, cords and terminal nerves were evaluated.
    Results
    Six plexuses were prefixed in origin. The long thoracic nerve pierced the middle scalene muscle in 6 cases in the supra clavicular zone. The suprascapular nerve in 7 plexuses was formed from posterior division of the superior trunk. Five cadavers showed anastomosis between medial brachial cutaneous nerve and T1 root in the infra clavicular zone. Terminal branches variations were the highest wherein the ulnar nerve received a communicating branch from the lateral cord in 3 cases. The median nerve was formed by 2 lateral roots from lateral cord and 1 medial root from the medial cord in 6 cadavers. Some fibers from C7 root came to the musculocutaneous nerve in 8 cadavers.
    Conclusion
    The correlation analysis between the variations and the demographic features was impossible due to the small sample size. The findings of the present study suggest a meta-analysis to assess the whole reported variations to obtain a proper approach for neurosurgeons.
    Keywords: Anatomical variations, Brachial plexus, Cords, Peripheral nerves, Trunks
  • Karim Z. Masrouha, Youssef El, Bitar, Marc Najjar, Said Saghieh* Pages 259-263
    The management of soft tissue defects in tibial fractures is essential for limb preservation. Current techniques are not without complications and may lead to poor functional outcomes. A salvage method is described using three illustrative cases whereby a combination of flaps and antibiotic-impregnated polymethylmethacrylate beads are employed to fill the bony defect, fight the infection, and provide a surface for epithelial regeneration and secondary wound closure. This was performed after the partial failure of all other options. All patients were fully ambulatory with no clinical, radiographic or laboratory sign of infection at their most recent follow-up. Although our findings are encouraging, this is the first report of epithelialization of the skin on a polymethylmethacrylate scaffold. Further studies investigating the use of this technique are warranted.
    Keywords: Infection, Open tibial fracture, Polymethylmethacrylate, Soft tissue defect
  • Hiren Patel, Atul Kamath* Pages 264-268
    Subchondral insufficiency fracture of the femoral head (SIFFH) is characterized by acute onset hip pain without overt trauma. It appears as a low intensity band with bone marrow edema on T1-weighted MRI. The most common course of treatment is protected weight bearing for a period of several weeks. Total hip arthroplasty (THA) has been commonly used if the patient does not respond to the initial protected weight bearing treatment. We present a case of a 48-year-old male with SIFFH who was treated with core hip decompression and bone void filler as a hip-preserving alternative to THA. The patient has an excellent clinical and radiographic result at final follow up. Core hip decompression with bone void filler is a less invasive alternative to THA, and may be a preferred initial treatment strategy for SIFFH in the young and active patient who has failed conservative measures.
    Keywords: FEMORAL HEAD INSUFFICIENCY FRACTURE TREATED WITH BONE VOID SUPPORT
  • Shishir Suranigi*, Kanagasabai Rengasamy, Syed Najimudeen, James Gnanadoss Pages 269-272
    Osteochondroma or exostosis is the most common benign bone tumor, and occurring frequently in the proximal humerus, tibia, and distal femur. It rarely affects talus. Osteochondroma of talus is a very rare etiology of tarsal tunnel syndrome (TTS). We report a rare case of extensive osteochondroma of the talus in a 60 year old female presenting with multiple swellings around the ankle and symptoms suggestive of tarsal tunnel syndrome. En-block excision of the multiple masses was done. Histopathological examination confirmed the diagnosis of osteochondroma. Although most of the osteochondromas are being treated conservatively, those presenting with multiple swellings, restriction of movements and compressive neuropathies should be treated with surgical excision. Excision is a successful method of treatment for symptomatic osteochondromas with low recurrence.
    Keywords: Exostosis, Osteochondroma, Talus, Tarsal tunnel syndrome
  • Olga D. Savvidou*, Andreas F. Mavrogenis, Vassilios Sakellariou, George D. Chloros, Thomas Sarlikiotis, Panayiotis J. Papagelopoulos Pages 273-276
    Two rare cases of extra-articular diffuse variant giant cell tumor of the tendon sheath are presented, at the elbow of a 68-year-old female and the foot of a 56-year-old male. Both patients presented with a palpable masses and marginal excision was performed; histological sections confirmed the diagnosis of extra-articular giant cell tumor. No adjuvant therapy was administered. At the last follow-up, minimum 24 months after excision both patients were disease-free.
    Keywords: Diffuse variant, Giant cell tumor of the tendon sheath, Pigmented villonodular synovitis (PVNS)
  • Senthil Sambandam*, Ganeshkumar Jayasree Rohinikumar, Arif Gul, Varatharaj Mounasamy Pages 277-281
    Abscess formation following intramuscular injections is rare and they are most commonly seen in immunocompromised individuals. In this case series we present a cohort of three patients presented to us in a critically ill condition with an abscess due to intramuscular injection. Vancomycin resistant staphylococcus aureus was isolated from all three patients. These patients posed a major challenge to the healthcare system and the treating physician because of the: severity of illness, virulence and resistance of the organism, rarity of the situation, immune state of the patient, and lack of supporting evidence to properly guide management in the use of health resources. To the best of our knowledge, there is no report available in the English literature on vancomycin resistant staphylococcus aureus associated with intramuscular injection abscess.
    Keywords: Immunocompromised patients, Intramuscular injection, VRSA
  • Zinon T. Kokkalis, Konstantinos E. Tolis, Panayiotis D. Megaloikonomos, Georgios N. Panagopoulos, Vasilios G. Igoumenou, Andreas F. Mavrogenis* Pages 282-284
    Anatomical vascular variations are rare causes of carpal tunnel syndrome. An aberrant medial artery is the most common vascular variation, while an aberrant radial artery causing carpal tunnel syndrome is even more rare, with an incidence ranging less than 3%. This article reports a patient with compression of the median nerve at the carpal tunnel by an aberrant superficial branch of the radial artery.
    An 80- year- old man presented with a 5-year history of right hand carpal tunnel syndrome; Tinel sign, Phalen test and neurophysiological studies were positive. Open carpal tunnel release showed an aberrant superficial branch of the radial artery with its accompanying veins running from radially to medially, almost parallel to the median nerve, ending at the superficial palmar arterial arch. The median nerve was decompressed without ligating the aberrant artery. At the last follow-up, 2 years after diagnosis and treatment the patient is asymptomatic.
    Keywords: Aberrant radial artery, Carpal tunnel syndrome, Vascular variations
  • Ali Birjandinejad, Mohammad, Hossein Taraz, Jamshidi, Sayyed, Hadi Sayyed, Hosseinian* Pages 285-288
    Progressive osseous heteroplasia is a rare inherited disease that begins with skin ossification and proceeds into the deeper connective tissues. The disease should be distinguished from other genetic disorders of heterotopic ossification including fibrodysplasia ossificans progressiva (FOP) and Albright hereditary osteodystrophy (AHO). We report a case of progressive osseous heteroplasia in a twenty four years old male with a complaint of ankylosis of the entire upper left limb and digital cutaneous lesions and sparing of the other limbs and the axial skeleton. Absence of great toe malformation, presence of cutaneous ossification, dermal bone spicules extruding in fingers, and involvement of just left upper limb were unique findings in contrast with FOP diagnosis in this case. There is no effective treatment or prevention for POH. Awareness of diagnostic features is necessary in early diagnosis of POH.
    Keywords: Congenital abnormalities, Heterotopic ossification, Progressive osseous heteroplasia