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Archives of Bone and Joint Surgery - Volume:7 Issue: 3, 2019
  • Volume:7 Issue: 3, 2019
  • تاریخ انتشار: 1398/02/11
  • تعداد عناوین: 15
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  • Vishavpreet Singh *, Ali Oliashirazi, Timothy Tan, Azzam Fayyad, Alisina Shahi Pages 211-219
    Knee osteoarthritis (OA) affects the joint beyond just the articular cartilage. Specifically, magnetic resonance imagingidentifiedbone marrow lesions (BML) in the subchondral bone have both clinical and pathophysiological significance.Compared to joint space narrowing on traditional radiographs, the presence of BMLs has been better correlated withseverity of clinical symptoms as well as clinical deterioration. Presence of a BML increases the likelihood for progressionto a total knee arthroplasty by up to nine fold. Histochemical analysis of BMLs has shown increased levels of tumornecrosis factor-alpha, matrix metalloproteinases and substance P, thought to stimulate pain receptors in osteoarthritis.
    Keywords: Bone Marrow Lesions (BML), Knee Osteoarthritis, Magnetic Resonance Imaging (MRI)
  • Zahra Rezaieyazdi, Maryam Sahebari, Mandana Khodashahi * Pages 220-228
    The preoperative care of patients undergoing orthopedic surgery and treated with biologic agents is of great significance.Perioperative use of biologic agents could lead to such complications as infection and delayed postoperative woundhealing. This narrative review aimed to evaluate the current information on the use of biologic agents in patientsundergoing orthopedic surgery, determine the rate of associated postoperative complications, and identify theappropriate time for the continuation or discontinuation of biologic therapy in these patients. It can be stated thatall biologic agents increase the risk of infections depending on their half-lives. Biologic agents are suggested to bewithheld for at least twice their half-lives before major surgeries. However, in case of minor operations, they can becontinued given the low risk of infection and impaired wound healing in these cases.Level of evidence: I
    Keywords: B cell inhibitor, Biologic therapy, Preoperative care, T cell inhibitor, TNF-? inhibitor
  • David Ross, Omer Erkocak, Mohammad R. Rasouli, Javad Parvizi * Pages 229-234
    Background
    Allogeneic blood transfusion in patients undergoing total joint arthroplasty (TJA) has been shown tonegatively affect patient outcomes. This study aimed to examine if there is a correlation between operative time and theneed for allogeneic blood transfusions during TJA.
    Methods
    We performed a retrospective review of 866 patients who underwent primary TJA during a one-year periodat our institution. Logistic regression was performed to identify the association between operative time and need forallogeneic blood transfusion, controlling for other patient and surgical factors. Multiple linear regression analysis wasalso performed to see how the same factors affected CBL.
    Results
    Of the 866 cases, 13%(115) were simultaneous bilateral. 52%(449) of patients received preoperativeautologous blood donation. The average operative time for unilateral and bilateral patients was 74.1±(33.9) and132.6±(36.0) minutes, respectively. Average CBL for unilateral patients was 2120mL±(1208) and 4051mL±(1311) forbilateral cases. The average number of allogeneic transfusions was also higher within the bilateral group (0.49 vs 1.15units). Multivariate analysis indicated that duration of surgery (odds ratio [OR]:1.35 per 15 minutes) and bilateral TJA(OR: 2.97) increase the risk of allogeneic blood transfusion, while patients having total knee arthroplasty are less likelyto receive allogeneic blood transfusion (OR: 0.50). CBL also increased significantly with surgical duration (211.5 mLper 15 minutes).
    Conclusion
    A subgroup analysis confirmed that there was a correlation between operative time and need forallogeneic transfusion following unilateral TJA. Expeditious surgery can minimize blood loss and subsequent need forblood transfusion and its associated adverse consequences.
    Keywords: Arthroplasty, Hip, knee, operative time, outcomes, Transfusion
  • Kevin Lutsky *, Charles Leinberry, Greg Gallant, Robert Takei, Moody Kwok, Pedro Beredjiklian Pages 235-238
    Background
    Distribution of radiographic images in the outpatient setting on compact discs-recordable (CD-R) iscommonplace. Opening, manipulating and interpreting these can be challenging. This study evaluated the availabilityand ease of use of CD-R to evaluate digital images in an outpatient orthopedic setting.
    Methods
    118 CD-R containing diagnostic studies were evaluated by seven board certified orthopaedic surgeons.Surgeon age and self-perceived “tech savvy” scores were tabulated using a visual analog scale (VAS). Surgeonsevaluated: ability and number of computers to open, autorun, and specific reader software. Time to load was recordedin seconds, type of study, presence of “not for diagnostic use”, and if the disc required additional software. Studies weregraded using a VAS for ease of opening, ability to move from image to image and/or between series, to manipulatethe image, and to zoom and pan.
    Results
    There were 79 radiographs, 29 MRI’s, and 10 CT scans. Seven (6%) had to be manually opened andfour (3%) required software installation. Thirteen (11%) contained a warning that the studies should not be used fordiagnostic purposes. Six (5%) of the studies could not be opened. For the opened studies, average time from diskinsertion to image was 43.7 seconds overall (range 3-350), 65.3 seconds (range 21-191) for MRI and CT, and 35.2seconds (range 5-177) for radiographs.
    Conclusion
    The present digital imaging systems include different software types and a variety of interfaces.Improving this would decrease time and effort necessary to open and evaluate these studies, and improveefficiency.Level of evidence: III
    Keywords: CD-R, Outpatient imaging
  • Brian K. Lee, Grant C. Jamgochian, Usman Ali M. Syed, Charles L. Getz, Christopher C. Dodson, Surena Namdari, Matthew L. Ramsey, Gerald R. Williams, Joseph A. Abboud *, Mark D. Lazarus Pages 239-245
    Background
    Reconstructions of acute acromioclavicular (AC) dislocations have been thought to result in superioroutcomes than chronic dislocations. The use of tendon graft in reconstructions has demonstrated favorablebiomechanical properties. To determine whether utilizing tendon graft during repair of acute AC dislocations results insuperior outcomes and lower complication rate.
    Methods
    A retrospective review of AC reconstructions was conducted. Reconstructions performed within 3 weeks ofinjury were included. Inclusion criteria included age over 18, grade 3-5 AC joint separation, and no previous ipsilateralshoulder injury. Primary outcome measure was radiographic loss of reduction. Secondary outcomes included ASESand SANE scores.
    Results
    Of 47 reconstructions of acute AC joint separations, 35 utilized fixation without a tendon graft, while 12underwent an anatomic reconstruction with tendon graft. Repairs without the use of graft resulted in 8 (23%) casesof loss of reduction, while tendon graft augmented repairs resulted in 5 (42%). This difference was not statisticallysignificant (P = 0.22). No patients required reoperation. There was no statistical difference in the ASES and SANEscores between the two groups. Furthermore, we found no significant difference in ASES or SANE scores in patientswho maintained reduction postoperatively versus those that lost reduction.
    Conclusion
    A greater but not statistically significant rate of loss of reduction was observed in the group reconstructedwith the use of a tendon graft. Further research is needed to determine whether the use of tendon graft is beneficial inthe treatment of acute AC joint separations.Level of evidence: IV
    Keywords: Acromioclavicular, AC reconstruction, CC reconstruction, coracoclavicular
  • Kwan Jun Park, Brandon Anthony Romero, Shahryar Ahmadi * Pages 246-250
    Background
    Several studies have identified the radial nerve in arm using different anatomic landmarks, however, acontroversy remains. Deltoid tuberosity (DT) and brachioradialis (BR) are reproducible landmarks that can be used toidentify the radial nerve (RN) during fracture surgery.
    Methods
    Dissection of RN was carried out in 17 fresh frozen adult cadavers. Using a calibrated caliper, we measuredthe distance between DT and the origin of BR. The distance between DT and where RN becomes lateral in its relationshipwith the humerus (DT-RN) and the distance between RN and BR (RN-BR) were subsequently measured. The ratio ofDT-RN to DT-BR was calculated to see where the nerve lies in relationship to DT-BR.
    Results
    Average DT-BR was 81.8 (±14.86) mm, average DT-RN was 48.9 (± 7.83) mm, and average RN-BR was 33.0(± 10.16) mm. RN was always found posterior to DT and was never found in the proximal third of DT-BR. The nervewas found in the middle third of DT-BR in 14 of 17 cadavers (82.4 %) and in the distal third in 3 out of 17 cadavers(17.6%). 16 of 17 cadavers (94%) had radial nerve in the distal half of DT-BR.
    Conclusion
    Using the anatomic relationships between RN, DT, and the origin of BR, identification of RN is easilyreproducible. These two structures can serve as the stationary landmarks during fracture surgery to find the radialnerve, which can be found in the distal 2/3 of the distance between the deltoid tuberosity and the origin of brachioradialis.Level of evidence: V
    Keywords: Arm, brachioradialis, deltoid tuberosity, humerus, Radial nerve
  • Abhiram R. Bhashyam *, Jesse B. Jupiter Pages 251-257
    Background
    The purpose of this retrospective study was to analyze the long-term results of revision ORIF, jointcontracture release, and autogenous bone-grafting in the treatment of distal humerus frac-ture nonunions in older agedpatients with poor bone quality or bone loss who would have been candidates for total elbow arthroplasty.
    Methods
    Seven patients (average age at index procedure: 53.3 years, range: 41-75) with a distal humerus fracturenonunion treated with revision ORIF, joint contracture release and autogenous bone grafting between 1989-2000 wereavailable for follow-up. Radiographic union and arthrosis were assessed using the most recent radiograph. Pain-relatedoutcomes were measured using PROMIS Pain Interference scores. Functional outcomes were evaluated using theMayo Elbow Perfor-mance Index (MEPI).
    Results
    After an average follow-up of 22 years (range: 19-27 years), all nonunions were healed after the indexprocedure and had an average arc of ulnohumeral motion of 80°, flexion of 112°, and flex-ion contracture of 32°.Average arthrosis grade was moderate joint-space narrowing with osteo-phyte formation. One patient had exertionaldiscomfort but none required chronic pain medica-tions. PROMIS-Pain Interference scores were no different than thegeneral population (mean [95%CI] = 49.2 [41.8, 56.6], P=0.83). Per the MEPI, the functional result was excellent in fivepatients, good in one, and poor in one.
    Conclusion
    Despite older age and worse bone quality, distal humerus fracture nonunions can be treated using revisionORIF, joint contracture release and autogenous bone-grafting with acceptable long-term outcomes.Level of evidence: IV
    Keywords: Humeral fractures, Osteoporotic fractures, Ununited Fracture
  • Masoud Yavari, Seyed Esmaeil Hassanpour, Hamidreza Alizadeh Otaghvar, Hossein A. Abdolrazaghi, Amir R. Farhoud * Pages 258-262
    Background
    The purpose of this study was to assess the incidence and importance of bony bridge that covers thesupra scapular notch during posterior approach to transfer accessory nerve to suprascapular nerve.
    Methods
    Between 2010 and 2015, the frequency and importance of suprascapular bony bridge instead of transverseligament was assessed among patients with brachial plexus injury candidate to shoulder function restoration byaccessory to suprascapular nerve transfer through posterior approach.
    Results
    Forty three patients, 41 male and 2 female, (mean age: 32.5 years, range 14 to 36) were included in thisstudy. Five male patients (11.6%) had a complete bony rim on the superior scapular notch. Suprascapular nerverelease needed osteotomy of the bony bridge and related equipment.
    Conclusion
    Although all previous cadaveric studies among different ethnic groups had reported the prevalencebetween 0.3 to 30% of suprascapular canal, this in vivo study showed the incidence of 11.6%. Preoperative alertnessabout this variation could make the exploration and release of the suprascapular nerve easier and reduce the risk ofnerve injury or failing to anatomize it.
    Keywords: Brachial Plexus, Nerve Transfer, Superior Transverse Scapular Ligament, Suprascapular Notch
  • Fateme Mirzaee, Mohammad A. Aslani, Zohreh Zafarani, Hamidreza Aslani * Pages 263-268
    Background
    The alternative surgery for massive and irreparable shoulder rotator cuff tears in older patients is thedebridement of subacromial bursa, biceps tenotomy, and tuberoplasty (reverse acromioplasty). This study aimed toreport the effectiveness of such a treatment performed arthroscopically in a small group of patients for a short periodof time.
    Methods
    This prospective study was conducted on 12 patients with massive irreparable rotator cuff tear during 2014-2017. Participants with the mean age of 65 were subjected to arthroscopic debridement of subacromial bursa, necroticrotator cuff tendon remnants, and tuberoplasty without coracoacromial ligament excision. The sign and symptoms ofpatients before and after the surgery were evaluated based on Modified-University of California at Los Angeles (UCLA)Shoulder Score.
    Results
    With the mean follow-up of 18 months (12-24 months), the mean of the modified UCLA score improved from9.2 to 27.5. The obtained results of the study revealed that the pain and range of motion improved to near normal in theparticipants. The functional outcome was good although there were a decrease of acromiohumeral distance from 5 to4 mm and a slight increase in degenerative changes.
    Conclusion
    This simple arthroscopic procedure is recommended for massive irreparable rotator cuff tear, especiallyin elderly patients.Level of evidence: IV
    Keywords: Arthroscopy, Biceps tenotomy, Rotator cuff tear, Tuberoplasty
  • Hamid Namazi, Mohammad J. Emami, Fatemeh Dehghani Nazhvani *, Ali Dehghani Nazhvani, Zeinab Kargarshouroki Pages 269-277
    Background
    One of the major challenges in orthopedic surgery is the prevention of arthrofibrosis, which can besuccessfully alleviated in its early stages. Many studies suggest the administration of methylene blue (MB) as anaccessible and effective agent for the prevention of post-operation adhesions. The purpose of this study was to evaluatethe efficacy of MB in the prevention of arthrofibrosis.
    Methods
    This study was conducted on 18 New Zealand white female mature rabbits. The anterior cruciate ligamentof the left stifle joint of each animal was cut during aseptic surgery. In the next step, the rabbits were divided into threegroups based on their treatments. The rabbits in the first, second, and third groups were subjected to the injection ofnormal saline, 1% MB solution, and 2% MB solution into their synovial space, respectively. The postoperative stiflerange of motion was measured every week. After 4 weeks, the animals were euthanized and all joints were dissectedfor histopathology.
    Results
    The histopathological evaluation of tissues indicated the presence of fibrotic connective tissue as a sign offibrosis in all groups. The fibrosis rate, inflammatory rate, tissue disarrangement, fibroblastic cellularity, and granulationtissue formation were at their highest levels in the 1% MB group. The integrity of articular cartilage in the 2% MB groupwas lower than the other groups. The level of bone degeneration was similar in both MB groups; however, it was morethan the control saline group. The range of motion was reduced during the first week, then increased in the second andthird weeks, and finally decreased in the fourth week.
    Conclusion
    The MB was not an effective method regarding the prevention or treatment of arthofibrosis and thesubsequent osteoarthritis. In contrast with previous studies, fibrosis was lower in the high dose MB group, comparedto the low dose MB group. The alterations in the range of motion were related to the reduced movement caused by thepain and stiffness of the operated joints. The current study can be considered as the first report addressing the adverseeffect of MB on synovial components.
    Keywords: anterior cruciate ligament, Arthrofibrosis, Fibrosis, Methylene blue, Stifle
  • Hosseinali Hadi, Abolfazl Bagherifar, Fereshte Tayebi, Majid Ansari, Ali Shahsavaripour, Iman Qomashi *, Mahmoud Jabalameli Pages 278-283
    Background
    Hamstring tendons are secondary hip extensors. Their harvest for graft in anterior cruciate ligament(ACL) reconstruction may create deleterious effect on hip extension strength. This is of particular importance in sportsthat need powerful hip extension force like climbing and sprinting. Due to scarcity of a comprehensive study in thisarea, we designed this prospective study to evaluate hip extension strength following ACL reconstruction using differenttypes of grafts.
    Methods
    Fifty eight patients were enrolled in this prospective non-randomized case control study to compareisokinetic hip extension strength following ACL reconstruction with different graft types. Twenty patients in groupA (both Semitendinosus and Gracilis tendons autograft (ST-G)), 14 patients in group B (Tibialis Posterior tendonallograft (Allograft)), 12 patients in group C (bone-patellar tendon-bone autograft (BPTB)) and 12 patients in group D(only semitendinosus autograft (ST)) were studied. Hip extension strength was tested post-operatively at three- andsix-month periods using a Biodex isokinetic testing machine at a speed of 30 degree per second in operated (cases)and non-operated (controls) limbs.
    Results
    There was a significant increase in hip extension force between three and six month intervals in all fourgroups and in both operated (case) and non-operated (control) limbs (P<0.05, 95% CI). However, there was moreincrease in case limbs in comparison to control limbs. There was no significant difference in hip extension strengthamong all four groups (both in case and control limbs) in the third- and the sixth-month post-operative tests.
    Conclusion
    Graft type had no effect on hip extension strength following ACL reconstruction, and the harvest of one orboth hamstrings had no deleterious effect on hip extension force.Level of evidence: III
    Keywords: anterior cruciate ligament, hip extension, isokinetic testing
  • Mohammad Qoreishi, Hamid R. Seyyed Hosseinzadeh *, Farshad Safdari Pages 284-290
    Background
    The pelvic ring fractures (PRF) and acetabular fractures (AF) are among the major orthopedic injuriesassociated with high rates of morbidity and mortality. Open surgical stabilization is the standard treatment for themajority of these complications. Percutaneous minimally invasive surgical stabilization of the fractures has become anaccepted treatment method for the past several years. This study investigated the outcomes of percutaneous fixationof pelvic and acetabular fractures.
    Methods
    Totally, 143 patients with PRF or AF of whom 95 cases were males underwent percutaneous fixation betweenFebruary 2015 and September 2016. All the operations were performed by a single surgeon in a supine position andunder C-arm fluoroscopy visualization. The patients were followed up for one year.
    Results
    All the fractures healed in all of the patients within the first postoperative three months. The patients couldbear weight completely on both lower limbs. Out of 143 patients, 133 cases could get back to their preoperative work(93%). The mean amount of intraoperative blood loss was 29±19 cc. Of the total patients, seven cases required oralanalgesics because of moderate pain (4.9%). The means of operation time and length of incision were 32±8 min and3.2±2.4 cm, respectively. There was one screw back out and one deep infection. No neurovascular injury was reportedin this study.
    Conclusion
    Closed reduction and percutaneous minimally invasive screw fixation for a pelvic ring or acetabularfractures is a useful surgical treatment option with low complication rates.Level of evidence: IV
    Keywords: Acetabulum, Fracture, Internal Fixation, Minimally invasive surgery, Pelvis, percutaneous screw fixation
  • Alireza Mousavian, Sayyed Hadi Sayyed Hosseinian, Omid Shahpari, Ali Mohammadi, Nafiseh Elahpour, Arezoo Orooji, Mohammad Hosein Ebrahimzadeh, Ali Moradi * Pages 291-296
    Background
    Foot function index (FFI) is a worthy subjective patient reported outcome measures (PROM) tool forevaluation of the outcomes of medical interventions on foot and ankle. This study was conducted to assess the validityof the Persian version of the foot function index (FFI).
    Methods
    After translating the original FFI into Persian, back-translation was performed on the agreed Persian versionand the final version was established. A total of 113 Persian-speaking patients with foot and ankle problems wereenrolled in this study and were asked to fill in the FFI.
    Results
    The Cronbach’s alpha for subsections of FFI and MOXFQ was above 0.8 and 0.7, respectively, while it was0.95 and 0.93 for total FFI and MOXFQ, respectively. The ICC for all subsections of MOXFQ and FFI was above 0.7.The Pearson’s correlation coefficient for all subsections of FFI and MOXFQ was significant (P<0.01).
    Conclusion
    The Persian version of FFI is valid and reproducible in Persian speaking population.Level of evidence: IV
    Keywords: Foot function index, Persian version, Validation, Foot, ankle
  • E. Carlos RODRIGUEZ MERCHAN * Pages 297-300
    Background
    Anterior cruciate ligament (ACL) reconstruction using tendon or ligament autograft is the current goldstandard surgical technique for acute ACL ruptures. However, ACL repair surgical procedures are reappearing as anoptimistic treatment alternative for acute proximal ruptures. The purpose of this annotation is to review the current roleof primary repair of the ACL.
    Methods
    A Cochrane Library and PubMed (MEDLINE) search related to the role of ACL repair in acute ACL rupturewas analyzed.
    Results
    Arthroscopic ACL repair can accomplish good short-run outcomes with knee stability and resumption of sportactivity in children, with proximal ACL avulsion tear. Reported results of open primary repair in adult patients with proximaltears are excellent, which ratifies there may be a possible role for primary repair as management for proximal ACL tears.
    Conclusion
    Recent reports suggest that refixation of the ACL is a possible treatment alternative in selected patients.Only time will tell whether the long-run results are similar to those obtained following ACL reconstruction.Level of evidence: III
    Keywords: ACL, adults, Children, repair
  • Ali Tabrizi * Pages 301-302
    In developing countries, similar to other parts of the world, smartphones and social networks are highly popular. there are many challenges in use of social networks by the health system staff. Clinical photography plays an important role in the medical practice to determine the state, treatment and progression of a patient’s condition. ethical education is needed on how to take and share clinical photography and radiographies in the social media during residency program or medical education system.
    Keywords: Clinical Photography, Ethics, Social Media