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Archives of Bone and Joint Surgery - Volume:5 Issue: 1, 2017
  • Volume:5 Issue: 1, 2017
  • تاریخ انتشار: 1395/11/04
  • تعداد عناوین: 14
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  • Mohammad H. Ebrahimzadeh, Amir Reza Kachooei Page 1
    On November 1st
    2016, Springer Nature announced that Springer and BioMed Central are retracting 58 articles published by Iran-based authors across seven journals. The decision was made after thorough investigation following receiving allegations of plagiarism, peer review, and authorship manipulation in an effort to mislead the review system (1, 2). Not all papers were involved with all of the above issues, but each showed the evidence of at least one of these issues. At this time, we are not able to comment on the involvement of each individual author, but this has already added a black sheath to his or her records....
    Keywords: Publication Ethics
  • Ana, Maria Vranceanu, Reinier B. Beks, Thierry G. Guitton, Stein J. Janssen, David Ring Pages 2-9
    Background
    Orthopaedic surgeons have a pivotal role in transitioning the care of orthopedic patients from a biomedical to a biopsychosocial model. In an effort to foster this transition, we designed a study aimed to determine surgeons’ attitudes and practice of noticing, screening, discussing psychological illness with patients, as well as making referrals to address psychosocial issues in patients in need. Additionally, we asked surgeons to rank order potential barriers to and reasons for referrals to psychosocial treatment.
    Methods
    Orthopaedic surgeons members of the Science and Variation Group and Ankle Platform (N =350) completed demographics, and a 4-part survey assessing the degree to which surgeons notice, assess, screen and refer for psychological treatments, as well ranked ordered barriers to engaging in these processes.
    Results
    As a group surgeons were neutral to referral for psychological treatment and formal screening of psychological factors, and somewhat likely to notice and discuss psychological factors. Surgeons were more likely to refer for psychological treatment if they engaged in research, or if they reside in South America as opposed to North America. The highest ranked barriers to screening, noticing, discussing and referring for psychological treatment were lack of time, stigma and feeling uncomfortable.
    Conclusion
    Overall surgeons are likely to notice and discuss psychological factors, but less likely to formally screen or refer for psychological treatment. Transition to biopsychosocial models should focus on problem solving these barriers by teaching surgeons communication skills to increase comfort with discussing psychoemotional factors associated with orthopedic problems. The use of empathic communication can be very helpful in normalizing the difficulty of coping with an orthopedic condition, and may facilitate referral.
    Keywords: Biopsychosocial model, Psychological treatment, Referral, Surgeons
  • Andrewj. Miller, Christopher Jones, Frederick Liss, Jack Abboudi, William Kirkpatrick, Pedro Beredjiklian Pages 10-13
    Object: The gold standard for evaluating bone mineral density is dual energy x-ray absorptiometry (DEXA). Prior studies have shown poor reliability using analog wrist X-rays in diagnosing osteoporosis. Our goal was to investigate if there was improved diagnostic value to visual assessment of digital hand X-rays in osteoporosis screening. We hypothesized that similar to analog counterparts, digital hand X-rays have poor correlation and reliability in determining bone mineral density (BMD) relative to DEXA.
    Methods
    We prospectively evaluated female patients older than 65 years who presented to our hand clinic with digital hand and wrist X-rays as part of their evaluation over six months. Patients who had a fracture and were without DEXA scans within the past two years were excluded. Five fellowship-trained hand surgeons, blinded to DEXA T-scores, evaluated the x-rays over two assessments separated by four weeks and classified them as osteoporotic, osteopenic, or normal BMD. Accuracy relative to DEXA T-score, interobserver and intraobserver rates were calculated.
    Results
    Thirty four patients met the inclusion criteria and a total of 340 x-rays reviews were performed. The assessments were correct in 169 cases (49%) as compared to the DEXA T-scores. A mean weighted kappa coefficient of agreement between observers was 0.29 (range 0.02-0.41) reflecting a fair agreement. The first and second assessment for all five physicians was 0.46 (range 0.19-0.78) reflecting a moderate agreement. Grouping osteoporosis and osteopenia together compared to normal, the accuracy, interobserver and intraobserver rates increased to 63%, 0.42 and 0.54 respectively.
    Conclusion
    Abnormally low BMD is a common occurrence in patients treated for upper extremity disorders. There is poor accuracy relative to DEXA scan and only fair agreement in diagnosing osteoporosis using visual assessments of digital x-rays.
    Keywords: DEXA scan, Digital X-ray, Osteoporosis, Qualitative assessment
  • Paolo Consigliere, Ioannis Polyzois, Tanaya Sarkhel, Rohit Gupta, Ofer Levy, A. Ali Narvani Pages 14-21
    Background
    Recurrence rate of rotator cuff tears is still high despite the improvements of surgical techniques, materials used and a better knowledge of the healing process of the rotator cuff tendons. Large to massive rotator cuff tears are particularly associated with a high failure rate, especially in elderly.
    Augmentation of rotator cuff repairs with extracellular matrix or synthetic patches has gained popularity in recent years with the aim of reducing failure.The aim of this study was to investigate the outcome of rotator cuff repairs augmented with denatured extracellular matrix in a series of patients who underwent arthroscopic rotator cuff repair for large to massive tears.
    Methods
    Ten consecutive patients, undergoing arthroscopic rotator cuff repair with extracellular matrix augment for large and massive tears, were prospectively enrolled into this single surgeon study. All repairs were performed arthroscopically with a double row technique augmented with extracellular matrix.
    Oxford Shoulder Score, Constant Score and pain visual analogue scale (VAS) were used to monitor the shoulder function and outcome pre-operatively and at three, six and 12-month follow-up. Minimum follow up was tree months. Mean follow up was 7 months.
    Results
    Mean Constant score improved from 53 (SD=4) pre-operatively to 75 (SD=11) at final follow up. Mean Oxford score also increased from 30 (SD=8) pre-operatively to 47 (SD=10) at the final follow up. The visual analogue scale (VAS) improved from seven out of 10 (SD=2) preoperatively to 0.6 (SD=0.8) at final follow up. Additionally, there was significant improvement at three months mark in Constant score.
    Conclusion
    Arthroscopic repair and augmentation of large and massive rotator cuff tears with extracellular matrix patch has good early outcome.
    Keywords: Augmentation, Double, row technique, Extracellular matrix, Owl technique, Patch, Rotator cuff repair, Rotator cuff tear, Scaffold, Tendinopathy
  • Mohammad Ali Tahririan, Mehdi Motififard, Ali Omidian, Hossein Akbari Aghdam, Amir Esmaeali Pages 22-27
    Background
    The main purpose of this study was to determine the relationship between serum vitamin D and the status of bone mineral density in patients with low-energy hip and distal radius fracture.
    Methods
    This retrospective case-control study was performed between January 2013 and January 2014. Participants aged 55 years or older were divided to case group including 85 patients with low-energy hip fracture and 83 patients with low-energy distal radius fractures, and 82 subjects as a matched control group. Bone mineral density was measured with dual energy X-ray absorptiometry and serum sample was obtained to check vitamin D, calcium, phosphorus, alkaline phosphatase, and protein.
    Results
    Study subjects for final evaluation consisted of 78 in hip and distal radius fracture groups and 80 in control group. There were no significant differences in the mean serum levels of calcium, phosphorus and alkaline phosphatase between the three groups. The overall mean serum level of vitamin D3 was significantly different among the three groups. Similar results were observed with hip and spine t-score between the groups.
    Conclusion
    There is not only a direct relation between serum vitamin D and the risk of low energy hip and distal radius fractures, but also a significant relation between low bone density in hip and spine area with low serum calcium was observed.
    Keywords: Bone mineral density, Distal radius fracture, hip fracture, Low energy fracture, Vitamin D
  • Mahmoud Nahravani, Seyed Mostafa Moosavi Tekye, Mohammad Alipour, Hadi Makhmalbaf, Monnavar Afzal Aghaee Pages 28-31
    Background
    Arthroscopic intervention is very common for conducting orthopedic surgeries. After a knee arthroscopic surgery, different drugs are used through intra-articular administration to induce analgesia. The aim of this study was to evaluate analgesic effects of Bupivacaine (marcaine), Bupivacaine plus midazolam, and Bupivacaine plus fentanyl in reducing pain after knee arthroscopic surgery.
    Methods
    Frothy five patients who were candidate for knee arthroscopy were divided into three groups. Group A, B and C received Bupivacaine (50 mg), Bupivacaine (50 mg) plus midazolam (50 μg/kg), and Bupivacaine (50 mg) plus fentanyl (3 μg/kg), respectively. The analgesic solutions were diluted with normal saline up to 20 ml. The analgesic effects were evaluated by VAS during first 24 hrs after surgery. With the VAS > 4, extra analgesic (pethidine) was administrated for patient.
    Results
    The amount of induced analgesia and need for extra analgesic was different between groups; however, it was not statistically significant (p
    Conclusion
    Intra-articular administration of studied drugs in all three groups reduced post-operation pain. The amount of induced analgesia was the highest for group C, while group B drugs induced better analgesia compared to group C.
    Keywords: Analgesia, Bupivacaine, Fentanyl, Intra, articular, Knee arthroscopy, Midazolam
  • Hangama C. Fayaz, Jesse B. Jupiter Pages 32-38
    Background
    The economic burden of the treatment of periprosthetic joint infection (PJI) is high and the treatment of PJI has a high degree of international controversy. Several papers have declared the International Consensus Meeting on Periprosthetic Joint Infection (ICMPJI) to be the "flawless pledge of international academics" to overcome the challenges of musculoskeletal infections. The purpose of this paper is to highlight for the first time some essential insights into the key dilemmas that are associated with this international consensus process.
    Methods
    The proceedings of the ICMPJI was reviewed, and the critical consensus agreements that were reached were communicated via e-mail to 48 leading orthopaedic surgeons, microbiologists and statisticians around the world. Of these, 30 responded, 8 did not, and 10 of respondents were not aware of the ICMPJI.
    Results
    A thorough review of the ICMPJI proceedings identified a clear need to resolve some of the dilemmas that we highlight in this paper. The Delphi procedure has been described as a survey technique that enables a group dynamic-based practice. Although there have been several published reports on this procedure, its scientific merit is still being debated. Several challenges and questions have been raised regarding the application of the Delphi technique, but there is no doubt that it is a vital approach for achieving consensus on subjects where none currently exists.
    Conclusion
    Performing prospective clinical studies in this area is currently the best and only option to overcome this challenge. In the long term, this approach will not only incorporate the standard of clinical evidence but also adopt regional mores for treating infection, which include patient values, cultural differences and local financial resources.
    Keywords: Delphi Procedure, International Consensus Meeting, Level of Evidence, Periprosthetic Joint Infection, Quality of patient care, Trans, continental controversy
  • Tyler A. Gonzalez, Bonnie Chien, Mohammad Ghorbanhoseini, John Y. Kwon Pages 39-45
    Wound complications following ankle fracture surgery are a major concern. Through the use of minimally invasive surgical techniques some of these complications can be mitigated. Recent investigations have reported on percutaneous fixation of distal fibula fractures demonstrating similar radiographic and functional outcomes to traditional open approaches. The purpose of this manuscript is to describe in detail the minimally invasive surgical approach for distal fibula fractures.
    Keywords: Ankle fractures, Distal fibula fracture, Minimally invasive surgery, Wound complications
  • Ramin Haj Zargarbashi, Hirbod Nasiri Bonaki, Shayan Zadegan, Taghi Baghdadi, Mohammad Hossein Nabian, Mehdi Ramezan Shirazi Pages 46-51
    Developmental dysplasia of the hip (DDH) and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS) (n=20) and pediatric orthopedic surgeons (POS) (n=20), were asked to answer an 8-item questionnaire on DDH and flexible flatfoot. The questions were provided with two- or multiple choices and a single choice was accepted for each one. Chi-square and Fisher’s exact tests was performed to compare the responses. For a neonate with limited hip abduction, hip ultrasonography was the agreed-upon approach in both groups (100% POS vs 71% GOS), and for its interpretation 79% of POS relied on their own whereas 73% of GOS relied on radiologist’s report (P=0.002). In failure of a 3-week application of the Pavlik harness, ending it and closed reduction (57% POS vs. 41% GOS) followed by surgery quality assessment with CT scan (64% POS vs. 47% GOS) and without the necessity for avascular necrosis evaluation (79% POS vs. 73% GOS) were the choice measures. In case of closed reduction failure, open reduction via medial approach was the favorite next step in both groups (62% POS and 80% GOS). For the patient with flexible flat foot, reassurance was the choice plan of 79% of pediatric orthopedists. Our findings demonstrated significant disagreements among the orthopedic surgeons. This proposes insufficiency of high-level evidence.
    Keywords: Congenital hip dislocation, Consensus, Flatfoot, Orthopedics, Pediatrics
  • Rinne M. Peters, Mariano E. Menendez, Jos J. Mellema, David Ring, R. Malcolm Smith Pages 52-57
    Proximal humerus fractures are common, but associated injury of the axillary artery is uncommon. The majority of published blunt traumatic axillary artery injuries are associated with anterior glenohumeral dislocation; a few are associated with isolated proximal humerus fractures or fracture-dislocation. Experience within our institution demonstrates that axillary artery injury is often unrecognized on initial presentation owing to palpable peripheral pulses and the absence of ischemia and places the hand at risk of necrosis and amputation if there is prolonged ischemia and the forearm at risk of compartment syndrome after revascularization. Accurate physical examination in combination with a low threshold for Doppler examination or angiography can establish the diagnosis of axillary artery injury. We present 6 cases of axillary artery injury associated with proximal humerus fractures in order to highlight the potential for this vascular injury in the setting of a proximal humerus fracture.
    Keywords: Axillary, Artery, Fracture, Humerus, Injury, Proximal
  • Mohammad Naghi Tahmasebi, Gholamreza Ghorbani Amjad, Mohammad Hasan Kaseb, Kaveh Bashti Pages 58-62
    Multiplanar or global laxity in arthritic knee is rare , most of this patients have neuromuscular disorder (post poliomyelitis , spinal dystrophy) or history of knee trauma. Ligament insufficiency and severe bone loss is significant in this patient. The estimated prevalence for the concurrence of charcot marie-tooth (CMT) with myasthenia gravis (MG) suggests an extremely rare event. We have presented a 54-year-old female patient with CMT and MG complaining of progressive pain, swelling, and crepitation of the knee joints who had been undergone total knee arthroplasty (TKA) with rotating hinge prosthesis. She had an acute myasthenia crisis soon after operation with prolonged intubation and intensive care unit admission. Radiographies and physical examination revealed bilateral severe unstable arthritic knee joints and left knee posterior dislocation. Short-term postoperative follow-up revealed improved knee function and resolution of all symptoms in the operated side.
    Keywords: Charcot marie, tooth, CMT, MG, Myasthenia gravis, TKA, Total knee Arthroplasty, Unstable knee
  • Ahmadreza Afshar Pages 63-65
    During fixation of a femoral neck fracture in a 23-year-old male patient with cannulated screws, a broken guide wire fragment inadvertently advanced through the hip joint and protruded into the pelvis. A second surgical approach was needed to remove the broken fragment from the pelvis. Awareness of such a potentially devastating complication will make surgeons more cautious during implementation of orthopedic instruments and increases patient’s safety during surgery.
    Keywords: Cannulated screw, Complication, Femoral neck fracture, Guide wire, Patient's safety
  • Davod Jafari, Hooman Shariatzadeh, Farid Najd Mazhar, Mohammad Ali Okhovat, Mehran Razavipour Pages 66-69
    Osteochondritis dissecans (OCD) is a common joint disorder in knee, ankle and elbow, however it can be rarely found in glenohumeral joint. In this study, we report an asymptomatic case of humeral head OCD, which was detected incidentally following a trauma. X-rays showed an area of lucency around an oval bony fragment measuring about 1 cm on the superior aspect of the humeral head. However, the patient was pain-free and the shoulder range of motion was normal.
    Keywords: Glenohumeral joint, Humerus, Osteochondritis dissecans
  • Mohammad Ali Sazgari, Fateme Bahramian, Fateme Mirzaee, Zohreh Zafarani, Hamid Reza Aslani Pages 70-71
    In this report we describe a 78-year-old man whose total knee arthroplasty showed the symptoms of infection with brucella with radiographic signs of loosening 5 years after the index surgery. The patient was treated successfully after a 2-stage revision arthroplasty surgery along with using rifampicin and doxycycline for 8 weeks.
    Keywords: Brucellosis, Knee arthroplasty, Knee replacement, Loosening