فهرست مطالب

Archives of Bone and Joint Surgery - Volume:5 Issue: 3, 2017
  • Volume:5 Issue: 3, 2017
  • تاریخ انتشار: 1396/03/31
  • تعداد عناوین: 13
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  • Mohammad R. Rasouli *, Eugene R. Viscusi Pages 131-132
    In recent years, adductor canal block (ACB) has been introduced as an alternative for femoral nerve block with a great advantage of preserving or minimally reducing quadriceps strength. The technique is relatively easy and is performed under ultrasound guidance. Despite growing evidence regarding efficacy and safety of ACB following knee surgery, use of ACB is still limited to high volume orthopedic centers where trained anesthesiologists in regional anesthesia are available. In this editorial, we aim to briefly review current evidence about ACB.
    Keywords: Adductor canal block, Analgesia, Knee surgery
  • Silke A. Spit, StÉphanie J.E. Becker, Michiel G.J.S. Hageman, David Ring* Pages 133-138
    Background
    It is possible that some hamate hook fractures are not diagnosed or treated, thereby affecting the study of their natural history. Study of the prevalence of incidental hamate hook fractures, nonunions, and other abnormalities on computed tomography (CT) ordered for another reason could document a subset of undiagnosed and untreated hamate hook fractures which might change our understanding about the natural history.
    Methods
    Reports of 2489 hand, wrist, and forearm CT scans for hamate hook abnormalities were searched. We excluded 19 patients with anticipated hamate fractures and 1 patient that had a hamate hook excision. Twenty-eight patients had an unanticipated hamate hook abnormality.
    Results
    There was a significant difference in the prevalence of incidental hamate hook abnormalities by sex but not by age. Among the 28 unexpected hamate hook abnormalities, there were 16 fractures of the base (12 acute, 1 nonunion, and 3 of uncertain age), 5 acute oblique fractures, and 7 tip abnormalities/ossicles. The patient with an incidental nonunion had a CT scan for wrist pain and was diagnosed with gout.
    All fractures involved a direct blow to the hand (distal radius or scaphoid fracture, or crush injury). The 7 patients with a hamate tip abnormality had a CT scan for a distal radius or metacarpal fracture, crush injury or wrist pain. Five acute fractures were treated operatively with excision and the other 23 fractures were treated nonoperatively.
    Conclusion
    Hamate fractures can be diagnosed incidental to other hand and wrist problems on CT.
    Keywords: computed tomography, hamate hook fracture, nonunion, Prevalence
  • William Kirpatrick, Jack Abboudi, Nayoung Kim, Juana Medina, Mitchell Maltenfort, Daniel Seigerman, Kevin Lutksy, Pedro K. Beredjiklian * Pages 139-144
    Background
    The purpose of this study is to evaluate the number of reviews and scores for active members of the American Society for Surgery of the Hand (ASSH) in popular physician rating websites (Healthgrades.com and Vitals.com).
    Methods
    A total of 433 ASSH active members were searched in two popular rating websites for a total of 866 web searches. Demographic data, overall and subcategory scores, number of reviews, and wait times were scored from each member’s webpage.
    Results
    The average number of reviews per surgeon on Healthgrades.com and Vitals.com were 13.8 (range 1-108) and 9.4 (range 0-148), respectively. The average overall score for physicians was 8.1 out of 10 points. For both websites, the vast majority (80-90%) of active members of the ASSH had 20 or less reviews. Multivariate data analysis revealed no statistical differences in overall score by region (P=0.24) or gender (P=0.38). Increasing physician age negatively correlated with overall score (P=0.01). Wait time was not associated with a negative score (P=0.38).
    Conclusion
    Active members of the ASSH received generally positive reviews. The average number of reviews for active members of the ASSH was exceedingly small, bringing into question the legitimacy and validity of these scores. This is especially important when taking into consideration the increasing popularity of these websites, and the reliance of patients on them to obtain physician information. The clinical implication of this study is that physicians have a vested interest in the legitimacy of the data provided by these websites and other physician rating outlets.
    Keywords: evaluation, hand, internet, patient, rating, site, surgeon
  • Seyed Mohammad J. Abrisham, Fathollah Bouzarjomehri, Reza Nafisi-Moghadam, Mohammad R. Sobhan*, Mahdie Gadimi, Fereshte Omidvar Pages 145-148
    Background
    This study has aimed to measure the patient dose in entire spine radiography by EOS system in comparison with the digital radiography.
    Methods
    EOS stereo-radiography was used for frontal and lateral view spine imaging in 41 patients in a prospective analytical study. A calibrated dose area product (DAP) meter was used for calibration of the DAP in EOS system. The accuracy and precision of the system was confirmed according to the acceptance testing. The same procedure was used for 18 patients referred for lumbar spine digital radiology (overall 36 images).
    Results
    Although radiation fields in the EOS were almost twice of that in digital radiology, and the average peak tube voltage (kVp), current supply to the tube (mA), and the average size and age of the patients referred for EOS imaging were greater than digital radiology, however, the average DAP in EOS was 1/5 of that in digital radiology system. Also, the average dose in the EOS was about 1/20 of that in digital radiology.
    Conclusion
    The patient dose in EOS imaging system was lower in comparison with digital radiology (1/20).
    Keywords: digital radiography, Dose Area Product, dosimetry, EOS, Stereo Radiography
  • Evaluation of Changes in the Tibiotalar joint after High Tibial Osteotomy
    Seyed Morteza Kazemi, Mohammad Qoreishi *, Ehsan Behboudi, Alireza Manafi, Seyed Kamyar Kazemi Pages 149-152
    Background
    There are limited studies regarding the effects of high tibial osteotomy (HTO) on other areas of lower extremity. In current study, we investigated the changes of tibiotalar joint following HTO.
    Methods
    A total of 39 patients with genu varum requiring HTO were enrolled in this before and after study. The genu varus, joint diversion (JDA), lateral distal tibial (LDTA) and lateral distal tibial-ground surface (LDT-GSA) angles were measured before the operation and compared with 6 months after the surgery.
    Results
    Twenty threeout of39 patients (59%) were females. The genu varus angle decreased significantly (130±1.70versus 0.60±10). No significant changes were seen in JDA (P=0.45) and LDTA (P=0.071). LDT-GSA changed significantly (P=0.011) from 8.10±10 in varus to -0.30±0.50 in valgus.
    Conclusion
    Although HTO did not change the JDA and LDTA, however, significant change in LDT-GSAindicates that HTO can significantly decrease the shearing forces exerted on the ankle joint.
    Keywords: ankle joint, genu varum, High tibial osteotomy, lateral distal tibial angle, lower extremity, joint diversion angle, Tibiotalar joint
  • Neda Mostafaee *, Mohammad J. Shaterzadeh Yazdi, Hossein Negahban, Shahin Goharpey, Mohammad Mehravar, Nahid Pirayeh Pages 153-167
    Background
    The main goal of physiotherapy for patients with anterior cruciate ligament reconstruction (ACL-R) is to improve postural control and retain knee function. Therefore, clinicians need to use evaluative tools that assess postural changes during physiotherapy. To maximize the clinical utility of the results of these tools, the extracted measures should have appropriate psychometric properties of reliability, validity and responsiveness. No study has yet addressed responsiveness of postural measures in these patients. This study was designed to investigate the responsiveness and determine the minimal clinically important changes (MCIC) of static and dynamic postural measures in patients with (ACL-R) following physiotherapy.
    Methods
    Static and dynamic postural measures were evaluated at first occasion and again after four weeks physiotherapy. The static measures consisted of center of pressure (COP) parameters while dynamic measures included the stability indices. Correlation analysis and ROC curve were applied for assessing the responsiveness.
    Results
    The meanand SD velocity of COP had acceptable responsiveness in both conditions of standing on injured leg with open-eyes and on uninjured leg with closed-eyes, both with nocognitive task. For dynamic measures, stability indices in double-leg standing with closed-eyes with cognitive task condition attained acceptable responsiveness. MCICs for mean and SD velocity in anteroposterior and mediolateral directions were 0.28cm/s, 0.008cm/s, 0.02cm/s, respectively in standing on injured leg with open-eyes; and 0.14cm/s, 0.07cm/s, 0.06cm/s, respectively in uninjured leg with closed-eyes condition. Also, MCICs for anteroposterior, mediolateral and total stability indices were 0.51◦, 0.37◦, 0.34◦, respectively in DCT condition.
    Conclusion
    Our findings provide evidence for selection of appropriate static and dynamic postural measures for assessment of changes in these patients. MCICs for these measures were determined, which provide practical information for clinicians to make decision on clinical significance of changes in patients’ status.
    Keywords: Anterior cruciate ligament reconstruction, Physiotherapy, Postural balance measures, Responsiveness
  • Taghi Baghdadi, Nima Bagheri *, Arvin Najafi, Pejman Mansouri, Mahmoud Farzan Pages 168-173
    Background
    The aim of this study was to evaluate the idiopathic congenital clubfoot deformity treated by Ponseti method to determine the different factors such as radiological investigations that may have relations with the risk of failure and recurrence in mid-term follow-up of the patients.
    Methods
    Since 2006 to 2011, 226 feet from 149 patients with idiopathic congenital clubfoot were treated with weekly castings by Ponseti method. Anteroposterior and lateral foot radiographies were performed at the final follow-up visit and the data from clinical and radiological outcomes were analysed.
    Results
    In our patients, 191(84.9%) feet required percutaneous tenotomy. The successful correction rate was 92% indication no need for further surgical correction. No significant correlation was found between the remained deformity rate and the severity of the deformity and compliance of using the brace (P=0.108 and 0.207 respectively). The remained deformity rate had an inverse association with the beginning age of treatment (P=0.049). No significant correlation was found between the percutaneous tetonomy and passive dorsiflexion range (P=0.356).
    Conclusion
    According to our results treatment with the Ponseti method resulted in poor or no correlation. The diagnosis of clubfoot is a clinical judgment; therefore, the outcome of the treatment must only be clinically evaluated. Although the Ponseti method can retrieve the normal shape of the foot, it fails to treat the bone deformities and eventually leads to remained radiologic deformity. Further studiesare suggested to define a different modification that can address the abnormal angles between the foot and ankle bones to minimize the risk of recurrence.
    Keywords: Club foot, Ponseti method, radiologic evaluation
  • Omid Yazdanpanah, Mahmoud Karimi Mobarakeh *, Masoud Nakhaei, Mohammad R. Baneshi Pages 174-180
    Background
    Knee malalignment is an important modifiable cause of osteoarthritis (OA). Surgical therapeutic procedures depend on proper knee alignment assessment. The purpose of this study was to compare knee alignment parameters between double and single leg weight-bearing radiographs and to evaluate the reproducibility of inter- and intra-observer measurements.
    Methods
    One hundred eight patients (59 male and 49 female) with knee deformity visited at Kerman Knee Clinic were selected. Full limb anteroposterior (AP) Radiographs were taken for each participant in double and single leg weight-bearing positions. Hip-Knee-Ankle Angle (HKAA), Medial-Proximal-Tibial Angle (MPTA), Lateral-Distal-Femoral Angle (LDFA) and Joint-Line-Convergence Angle (JLCA) measured. Images stored on PC were examined by three observers to assess inter and intra observer reproducibility. Data analysis was done by SPSS software.
    Results
    The mean age of patients was 48.4 (±6.84) years, mean BMI was 26.55 (±1.94) Kg/m2. The mean HKAA and JLCA were significantly different between double and single leg weight-bearing radiographs. Intraclass correlation coefficient (ICC) test showed high (0.99) inter-reproducibility between three observers in all cases, except one (ICC=0.92). Intra-observer reproducibility indicated a strong correlation between the observer’s measurements at different times (ICC > 0.99).
    Conclusion
    HKAA and JLCA were affected by the patient’s position. Observer and time interval had no effect on either of HKAA, MPTA, LDFA, and JLCA. Also the measurement of knee alignment parameters was not dependent on observer’s experience. In conclusion single leg weight-bearing radiography is more representative of knee alignment and is inter and intra-observer reproducible.
    Keywords: Knee Alignment, Osteoarthritis, Radiography, Reliability
  • The Effect of Dynamic Hyperextension Brace on Osteoporosis and Hyperkyphosis Reduction in Postmenopausal Osteoporotic Women
    Hooman Shariatzadeh, Bagher Saeed Modaghegh, Alireza Mirzaei * Pages 181-185
    Background
    Osteoporosis and hyperkyphosis could impose a considerable financial and therapeutic burden on the affected society. Thus, new strategies to prevent or manage such complications are of significant importance. Here we evaluate the effect of ‘Dynamic Hyperextension Brace’ (DHB) on bone density, and hyperkyphosis correction.
    Methods
    Sixty postmenopausal women were randomly assigned to the case and control groups and followed for one year. DHB was applied in the case group according to the pre-designed protocol and the patients’ clinical and paraclinical parameters, including bone mineral density (BMD), kyphosis angle, osteoporotic fracture, and serum alkaline phosphatase (ALP) were evaluated in two groups.
    Results
    Despite no significant difference in basic BMD and kyphosis between the case and control groups, BMD and kyphosis were significantly improved in the DHB treated group, at the end of the study (P=0.003 and P=0.001, respectively). Serum ALP level was significantly higher in cases compared to the controls (P=0.48). The vertebral fracture rate was also lower in the case group compared to the controls.
    Conclusion
    The efficacy of bracing in osteoporosis and kyphosis management should be more emphasized. However, more detailed and controlled studies with more patients and a longer follow-up period is needed to adequately evaluate the long-term results of braces, including DHB.
    Keywords: Dynamic Hyperextension Brace, Kyphosis, osteoporosis
  • Epidemiological Profile of Extremity Fractures and Dislocations in Road Traffic Accidents in Kashan, Iran:a Glance at the Related Disabilities
    Mehrdad Mahdian, Mohammad R. Fazel *, Mojtaba Sehat, Gholamreza Khosravi, Mahdi Mohammadzadeh Pages 186-192
    Background
    Apart from the mortality, road traffic injuries are associated with significant morbidities. This study has aimed to examine the pattern of traffic accident-related extremity fractures/dislocations and their related disabilities.
    Methods
    A retrospective hospital-based study was conducted to assess the characteristics of limb fractures/dislocations among road traffic accident victims registered in Trauma Research Center registry of Kashan University of Medical Sciences, Kashan, Iran, during 2012-2013. Age and sex distribution, cause of injury, and site of fractures/dislocations were recorded. Years lived with disability (YLD) was calculated as a scale to measure the disability. One-way ANOVA and chi-square tests were used for data analysis.
    Results
    From a total of 962 subjects, 812 (84.4%) were males (the male/female sex ratio: 5.4:1). The mean age of victims was 32.7±17.9. Leg (37%) and forearm (19%) fractures were the most frequent fractures. Shoulder dislocations were among the most affected joints accounting for 36.6% of the cases. The total calculated YLD was 135.6 (34.4 for temporal and 101.2 for lifelong disabilities, and totally 117.3 and 18.3 for males and females, respectively). The highest YLD was for motorcyclists (104) and while the most YLD was for 15-29 years (68.2).
    Conclusion
    Young men motorcyclist accidents are a major problem in Kashan region. Generally, they have been accounted for the highest YLD due to fractures/dislocations, especially in lower extremity. Although the calculated YLD will be decreased with increasing age, the elder people also had the high rate of traffic-related limb injuries.
    Keywords: Dislocation, fracture, Road traffic accident, years lived with disability
  • Nail Psoriasis Triggered by the Reconstruction of Syndactyly
    Ahmadreza Afshar, Ali Tabrizi * Pages 193-195
    Koebner phenomenon is observed in a number of inflammatory skin diseases. Psoriasis is one of the most common skin diseases associated with Koebner phenomenon. Nail psoriasis may be developed independently from inflammatory arthritis and skin psoriasis. This study reports on the reconstruction of third web of a 30-year-old woman, which performed on her right, due to congenital syndactyly. Four months postoperatively, she developed nail dystrophy, onycholysis and onychorrhexis of the middle, ring and little fingernails. The clinical and histopathology findings were compatible with diagnosis of isolated nail psoriasis.
    Keywords: Koebner phenomenon, nail dystrophy, nail psoriasis, onycholysis, syndactyly
  • Chronic Recurrent Multifocal Osteomyelitis in a 9-year-old Boy
    Abdolreza Malek, Mohammadhassan Aelami, Narges Afzali, Ali Parsa, Havva Jalalinia * Pages 196-200
    Chronic recurrent multifocal osteomyelitis (CRMO) is a rare aseptic, auto-inflammatory bone disorder. CRMO presents with bone pain with or without fever. The diagnosis of CRMO is a diagnosis of exclusion and should be included in the differential diagnosis of chronic inflammatory bone lesions in children. Cultures of the bone are typically sterile, antibiotic therapy does not result in clinical improvement whereas anti-inflammatory drugs improve the condition. Furthermore, biopsy should be considered in chronic and relapsing bone pain and swelling unresponsive to treatment. Herein, we present a nine-year-old boy complaining of recurrent pain in his upper and lower extremities. On examination he had mild fever and cervical lymphadenopathy. He also had experienced bone pain and weight loss in the recent month. Based on biopsy and bone scan he was finally diagnosed with CRMO. Naproxen and Pamidronate was prescribed and he was getting better and returned to normal life and activity without need to corticosteroids.
    Keywords: Bone pain, Children, Chronic multifocal osteomyelitis (CRMO)
  • Anatomic Spring Ligament and Posterior Tibial Tendon Reconstruction: New Concept of Double Bundle PTT and a Novel Technique for Spring Ligament
    Alireza Mousavian *, Jakrapong Orapin, Apisan Chinanuvathana, Lew C. Schon Pages 201-205
    A new technique in spring ligament reconstruction using medial half of posterior tibial tendon is demonstrated as a means of supporting the arch. In addition a new concept of double bundle PTT reconstruction based on anatomical attachments of original PTT is presented with the goal of obtaining the full function of PTT.
    Keywords: Anatomic, Posterior tibial tendon reconstruction, Spring ligament, Technique