فهرست مطالب

Archives of Bone and Joint Surgery  - Volume:7 Issue:4, 2019
  • Volume:7 Issue:4, 2019
  • تاریخ انتشار: 1398/04/10
  • تعداد عناوین: 14
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  • Casey M. O’Connor, David Ring * Pages 303-306
    Background
    The Single Assessment Numeric Evaluation (SANE) is a simple, one-question patient-reported outcomemeasure (PROM). We systematically reviewed correlations between SANE and more extensive PROMs.
    Methods
    We identified studies with correlation coefficients between SANE and other shoulder, knee, and anklespecificPROMs. We calculated mean, median and range across studies and time points of data collection.
    Results
    Eleven studies provided 14 correlations, six shoulder-specific PROMs in four studies, six knee-specific PROMsin six studies and two ankle specific PROMs in one study. The mean correlation comparing SANE and knee-specificPROMs was 0.60 (SD 0.24), median 0.66, and range 0.12 to 0.88. Among studies comparing SANE and shoulderspecificPROMs mean correlation was 0.59 (SD 0.20), median 0.62 and range 0.20 to 0.89. The mean correlationbetween SANE and ankle-specific PROMs was 0.69 (SD 0.17), median 0.69 and range 0.75 to 0.81.
    Conclusion
    There seems to be moderate correlation amongst PROMs, even those that are a single question. Futureresearch might address whether patient reported outcome measure a common underlying construct even when theyconsist of a single question.Level of evidence: V
    Keywords: Patient-reported outcome measures, PROMs, SANE, Single Assessment Numeric Evaluation
  • Jia, Wei Kevin Ko, Usman Ali Syed, Jonathan D. Barlow, Scott Paxton, Bryan J. Loeffler, Ocean Thakar, Grant Jamgochian, Joseph Abboud *, Charles L. Getz, Gerald R. Williams Pages 307-313
    Background
    Managing posterior glenoid wear and retroversion remains a challenge in shoulder arthroplasty.Correcting glenoid version through asymmetric reaming (AR) with placement of a standard glenoid component and theuse of posteriorly augmented glenoid (PAG) components are two methods used to address this problem. Our objectiveis to report the radiographic outcomes of patients with posterior glenoid wear and/or retroversion treated with eitherapproach.
    Methods
    Patients with posterior glenoid wear and a minimum of 15 degrees of retroversion, treated with AR andstandard glenoid component or with a PAG component (3 mm, 5 mm, or 7 mm posterior augmentation), wereconsecutively identified through retrospective chart review. Pre-operative axillary views were evaluated for version,humeral head subluxation in relation to scapular axis and to mid-glenoid face. Post-operative axillary views werereviewed to measure corrected inversion and humeral head subluxation.
    Results
    There were 48 patients in the AR group and 49 patients in the PAG group. Version improved 6.8 degrees in theAR group. In the PAG group, version improved 8.8 degrees with 3 mm augment, 13.4 degrees with 5 mm augment, and12.8 with 7 mm augments. There were significantly more central peg perforations in the 5 mm PAG group comparedto other groups. The humeral head was re-centered within 6.1% of normal in all groups except 7 mm augments.
    Conclusion
    This study demonstrates that AR and PAGs have the ability to re-center the humeral head when utilizedin patients with retroversion and posterior wear. Use of a PAG component may allow for greater correction of glenoidretroversion, however, there is an increased risk for central peg perforation with the specific implant utilized in this study.Long-term follow-up is ongoing and needed to understand the clinical implications of these findings.Level of evidence: IV
    Keywords: Augmented Glenoid, Glenoid Reaming, Shoulder Arthritis, Total Shoulder Arthoplasty
  • Anuwat Pongkunakorn *, Patanapong Palawong, Swist Chatmaitri, Nawakun Phetpangnga Pages 314-320
    Background
    Femoral stem anteversion during hip arthroplasty is generally estimated by eye intraoperatively and hasproven to be different from targeted values. This study aims to determine the accuracy of a novel technique using adigital protractor and a spirit level to improve surgeons’ estimation of stem anteversion.
    Methods
    A prospective non-randomized study was conducted among 93 patients with femoral neck fracture whounderwent cemented hemiarthroplasty via posterolateral approach. In the control group (N=62), five experiencedsurgeons assessed stem anteversion related to the posterior femoral condylar plane using visual estimation with atarget angle of 15°-25°. In the study group (N=31), another two surgeons assessed stem anteversion with the sametarget angle by placing a digital protractor on the femoral stem inserter handle while the assistant held the leg in the trulyvertical position, verified by a spirit level that was attached to the shin with cable ties. Stem anteversion was measuredblind, postoperatively, on 2D-CT and compared with the intraoperative results.
    Results
    The mean postoperative anteversion was 22.4° (-4.2° to 51.3°, SD 11.1°) in the control group and 23.0° (16.0°to 29.9°, SD 3.6°) in the study group (P=0.810). The study group had more stems positioned in 15°-25° anteversion(71.0% vs 32.3%, P=0.001) and the mean absolute value of surgeon error was -0.2° (-5.4° to 7.0°, SD 3.0°). Twentyeightstems of the study group (90.3%) had an error within 5°. Surgeon overestimation >5° was found in 1 hip (3.2%)and underestimation >5° was found in 2 hips (6.4%).
    Conclusion
    Using a digital protractor and a spirit level was reliable with high accuracy and precision to improve theintraoperative estimation of cemented stem anteversion.Level of evidence: II
    Keywords: digital protractor, Femoral stem anteversion, hip arthroplasty, spirit level
  • Babak Ganjeifar, Ehsan Keykhosravi, Gholamreza Bahadorkhan, Hossein Mashhadinezhad, Mohammad R. Ehsaei, Fariborz Samini, Masoud Pishjoo, Abdolreza Mahmoodi, Hamid Rezaei * Pages 321-324
    Background
    Thoracolumbar spinal fractures include a range of injuries of various severities from simple apophysealfractures to neurological injury and complex fractures associated with vertebral dislocation. The treatment ofthoracolumbar fractures is challenging, especially due to the difficulty of evaluating the posterior ligamentous complex(PLC). The purpose of this study was to evaluate the diagnostic value of computed tomography (CT) scan in predictingPLC injuries in the patients with thoracolumbar spinal fractures referring to the referral center of spinal trauma in theeast north of Iran in 2016.
    Methods
    This retrospective study was conducted on patients with thoracolumbar injuries referring to Shahid KamyabHospital in Mashhad, east north of Iran, in 2016. The data were collected by entering the data of medical records intospecial forms. The classification of spinal fractures was accomplished using the AO Spine Classification System.
    Results
    According to the results, 71 (71.7%) patients were male, and the subjects had a mean age of 44.6±17.7 years.The PLC injury was observed in 28 (28.3%) patients. The PLC injury showed a significant relationship with facet jointwidening, increased interspinous process distance, and spinous process avulsion fracture (P<0.05).
    Conclusion
    As the findings of this study indicated, the diagnostic results of PLC injury by means of CT scan wassimilar to those obtained by magnetic resonance imaging in patients with thoracolumbar spinal fractures.Level of evidence: III
    Keywords: CT Scan, MRI, Posterior Ligamentous Complex (PLC), Thoracolumbar spinal injury Trauma
  • Saeed Kokly *, Alessandro Castagna, Mohammadreza Guiti Pages 325-330
    Background
    Distal humeral fractures accounts for approximately 2% of all fractures and nearly one-third of humeralfractures in adults. In this regard, Modified Tension Bind Wiring (MTBW) technique was used for the fixation of the distalhumeral fractures type A2 and C1 (AO) to evaluate the early movement and complications of the patients.
    Methods
    This study was conducted on 25 patients, who were subjected to open reduction and internal fixation usingMTBW techniques, to evaluate the incidence of complications.
    Results
    The mean age of the participants was 53.7 years. Out of 25 patients, 16 cases had C1 and 6 individualssuffered from A2. The mean tourniquet time was 43 min. The mean union time was 12.24 weeks and the mean durationof the follow-ups was 13.72 months. The mean values for the lack of extension, flexion, and range of motion were 18o,124o, and 106o, respectively. Wound haematoma and dehiscence were observed in two cases, who were treated afterconservative treatment. During 15-90 days, there were no signs of neurapraxia injuries. The non-union of olecranonosteotomy site was seen in one case, who was treated by the MTBW technique. Since the range of motion was lessthan 100o in 4 patients, device removal was performed 6 months after the surgery when the range of motion wasincreased by nearly 12o. Moreover, patients were diagnozed with no serious complications, such as the nonunion offracture site, malunions, and deep infection. The radiological examination of the patients revealed the success of theirtreatment.
    Conclusion
    Based on the obtained results, it can be concluded that MTBW is an effective technique in fracturefixation, which allows gentle early motion. Moreover, this cost-effective technique decreased the surgery duration,tourniquet time, and damage caused by soft tissue stripping.Level of evidence: IV
    Keywords: AO, Distal humerus, Fracture, Periosteal stripping, Tension band wiring
  • Mohsen Karami, Alireza Radyn Majd, Mohammad A. Tahririan *, Sajad Badiei, Amin Karimi Pages 331-338
    Background
    Iliac osteotomies in adolescent patients may accompany graft related difficulties such as graft absorptionand delayed union. A new modification of iliac osteotomies has been proposed to address these difficulties.
    Methods
    A total of 24 consecutive hip joints in 21 juvenile or adolescent patients who were candidate for salter ortriple pelvic osteotomy were included. A modification was performed to harvest a wedged bone graft based on a musclepedicle of Tensor Fascia Lata and inserted at pelvic osteotomy site instead of a traditional graft technique. The hipswere randomized into two groups. The traditional wedge graft was used in group 1, while the new modification wasperformed in group 2. The primary outcome of this study was duration of union. The secondary outcomes were CenterEdge Angle (CE) Angle on pre-operation, immediately post-operation and at the end of follow-up.
    Results
    Both groups were similar statistically regarding their age, gender , estimated blood loss and the duration offollow-up. However, significant differences were found in the time to complete union between the two groups (P=0.03).CE angle decreased in both groups when comparing its last follow-up to its right postoperative values, but the decreasewas significant only in group 1(P=0.03). The type of surgery (Salter or TPO) had no significant effect on the averagetime to union. That shows faster union in pedicle graft group and less coverage loss during follow-up period thanconventional graft patients.
    Conclusion
    With the modification proposed , the healing at the osteotomy site was faster and the loss of correction,owing to the graft resorption, decreased. Using this pedicle wedge graft technique may improve the results of pelvicosteotomies in adolescent.Level of evidence: II
    Keywords: complication, pelvic osteotomy, surgical technique
  • Elham Karimi, Reza Zandi, Mohsen Norouzian, Ali Birjandinejad * Pages 339-345
    of the Caucasian population. The purpose of this study was to investigate the morphometry of the proximal tibia in thestandard resected surface of total knee arthroplasty (TKA).
    Methods
    In this descriptive study, the anthropometric data of the proximal tibia were measured in 132 knees (80 malesand 52 females) using magnetic resonance imaging in 2015. The collected data included anteroposterior (AP) length,mediolateral (ML) width, medial AP, lateral AP, and aspect ratio (ML/AP). The medial and lateral AP distance to bonecenter was calculated for symmetry analysis. The morphometric data were also compared with the same dimensionsof four current tibial implants.
    Results
    The mean age of the subjects was 38.26±11.45 year (age range: 20-60 years). The mean AP length andmean ML width in the resected surface of the bone, as well as the mean aspect ratio (ML/AP) of tibial bone in all thesubjects, were 46.53±4.05 mm, 73.36±6.86 mm, and 1.58±0.11, respectively. The mean values of medial and lateralAP distance up to bone center were 13.40±6.17 and 17.09±6.83 mm, respectively, indicating asymmetric proximal tibiain the study population.
    Conclusion
    The measurements of anatomic shapes and dimensions of the proximal tibia revealed that women havesmaller dimensions than their male counterparts. Prostheses with smaller AP size tended to be undersized and largerAP size had a tendency towards overhang in the mediolateral dimension. The data and obtained results of this studycan be used as guidance on designing tibial implant components suitable for TKA in the Iranian population.Level of evidence: IV
    Keywords: Implant, knee, Morphometry, MRI, Proximal Tibia
  • Abolfazl Bagherifard, Mahmoud Jabalameli, Salman Ghaffari, Jafar Rezazadeh, Majid Abedi, Masoud Mirkazemi, Javad Aghamohamadi, Afshin Hesabi, Mehdi Mohammadpour * Pages 346-353
    Background
    Multiligament knee injury (MLKI) is a complex orthopedic injury leading to the tear of at least two ofthe major knee ligaments. However, there is no consensus on the optimal management of this debilitating condition.Regarding this, the present study was performed to evaluate the outcomes of single-stage multiligament reconstructionsurgery in patients with MLKI.
    Methods
    This retrospective study was conducted on 41 consecutive MLKI patients who underwent surgicalreconstruction. Objective evaluation of the outcome included active extension and flexion. Furthermore, the subjectiveevaluation of the outcome was accomplished using the Lysholm scoring scale and International Knee DocumentationCommittee (IKDC) form in Persian. Postoperative complications were also recorded for all patients.
    Results
    The mean age of the participants was 31.95±7.82 years. In addition, the mean follow-up period and themean time interval between the injury and surgery were recorded as 36.9±17.8 and 11.5±8.9 months, respectively. Themean Lysholm and IKDC scores were obtained as 86.9±11.5 and 70±18.7, respectively. The mean Lysholm and IKDCscores were not statistically different between the patients who underwent surgery less than 6 months after the injuryand those subjected to reconstruction 6 months postinjury (P=0.07 and P=0.3, respectively). Seven patients showedpostoperative restricted range of motion, which was resolved with physiotherapy. The only surgical complication waspopliteal artery injury.
    Conclusion
    As the findings indicated, the single-stage reconstruction of MLKI provided an acceptable outcome.However, several aspects of this reconstruction, such as the timing of the surgery, still remain to be resolved in futureinvestigations.Level of evidence: IV
    Keywords: complication, Multiligament knee injury, Outcome, reconstruction surgery
  • Mohamad Qoreishi *, Mohammadreza Abbasian, Farshad Safdari Pages 354-359
    Background
    The prevention of surgical site infection is one of the most concerning issues in operating rooms. Surgicalgowns are worn as one of the intraoperative strategies for infection prevention. The present study investigated whetherthe gowns remained sterile during the surgical procedure. Furthermore, this study examined which parts of the surgicalgown were more prone to contamination.
    Methods
    The sterility of the gowns was investigated during eight total joint arthroplasties all of which were performedby four surgeons. The samples were taken from the arms and frontal part of the sterile gowns pre- and postoperatively.In the anterior surface of the gown, the sampling was initiated at a strip with 50 cm height from the ground followedby the strips with 15 cm distances from caudal to cephalad. Furthermore, the frontal part of the gown was dividedinto three parts in relation to the operating room table. Finally, the contamination rate was evaluated in each part. Asemiquantitative method was used for the analysis of bacterial culture.
    Results
    Before the operation, there were four samples tested positive for bacterial culture (1.06%). All of these sampleswere taken from the most proximal strip near the neckline. After the surgery, the rate of contamination in the strips onthe frontal part of the gown was reported as 3.1% to 53%. Based on the operating table, the contamination rate was35.9%, 8.9%, and 47.3% in the distal, middle, and proximal parts of the gown, respectively. The contamination rate atthe elbow crease was 23%, and at 5 and 10 cm above the creases were 24% and 36%, respectively.
    Conclusion
    The high rate of gown contamination during the operation is concerning. However, part of the gown thatwas in contact with the operating room table remained clean most of the time. More safe strategies should be used forinfection prevention in operating rooms.Level of evidence: IV
    Keywords: Contamination, Infection, Operating room, Sterility, surgical gown
  • Fatemeh Azadinia, Ismail Ebrahimi, Takamjani *, Mojtaba Kamyab, Morteza Asgari, Mohamad Parnianpour Pages 360-366
    Background
    Lumbosacral orthosis (LSO) is commonly used for the treatment of back pain. The clinical andmechanical effectiveness of this device has been repeatedly investigated in several studies; however, its sensorimotoreffectiveness has been rarely considered. Regarding this, the aim of the current study was to investigate the effect ofa non-extensible LSO on postural stability (as a construct of sensorimotor function) in patients with nonspecific chroniclow back pain (LBP).
    Methods
    This preliminary study was conducted on 17 patients with nonspecific chronic LBP using a single-groupquasi-experimental design. Postural stability was measured while the participants were placed in a quiet standingposition, under the combined conditions of base of support (rigid and foam surface), visual input (open eyes and closedeyes), and LSO (with and without orthosis).
    Results
    The findings demonstrated that wearing orthosis during the most challenging postural task (i.e., blindfoldedwhile standing on a foam surface) significantly reduced postural sway parameters related to the position anddisplacement of the center of pressure (COP; the sway area and sway amplitude in the anteroposterior direction;P<0.001). However, the use of this device had no significant effect on COP velocity.
    Conclusion
    As the findings of the present study indicated, the use of a non-extensible LSO decreased the COPdisplacement; however, it did not affect the COP velocity. Therefore, our data could not utterly support the effectivenessof non-extensible LSO on postural stability as a construct of sensorimotor function. Postural control is an appropriateindicator for assessing the global functioning of the sensorimotor system due to its dependence upon the interactionbetween the neural and musculoskeletal systems. Consequently, further studies are needed to elucidate the positiveeffects of LSO on the aspects of sensorimotor function.Level of evidence: III
    Keywords: LBP, orthotic device, Postural balance
  • Sayyed Hadi Sayyed Hoseinian, Mohammad H. Ebrahimzadeh, Mohammad T. Peivandi, Farshid Bagheri, Jalil Hasani, Sogol Golshan, Ali Birjandinejad * Pages 367-372
    Background
    Motorcyclists are among the most vulnerable groups of road accident victims, who are prone to a growingmortality rate due to the constant rise in the number of accidents. This study was performed to investigate the injurypatterns among motorcyclist trauma patients admitted to Kamyab Hospital, the largest trauma center affiliated withMashhad Univercity of Medical Sciences, Mashhad, Iran, due to an accident.
    Methods
    This cross-sectional study was conducted on motorcyclists referred to our hospital due to accidents fromAugust 23, 2014 to August 22, 2016 to receive treatment. After the accurate examination of the collected data andcorrection of the potential errors, they were subjected to analysis. The gathered data included the demographicvariables, injury pattern, accident time, and accident type. Data analysis was performed in Stata Software, version 12.
    Results
    A total of 4,205 motorcycle accident cases were hospitalized (14% of all cases were hospitalized during thetwo-year study period). The mean age of the patients was 30 years, and 88% of them were male (a male to female ratioof 7.3). Car- and pedestrian-motorcycle collisions were the most common causes of injury that accounted for 68% and22% of the cases, respectively. The head was the most commonly injured site of the body; in this regard, 59.7% of theadmitted patients and 85.4% of total death cases had a head injury. In addition, 67% of the target population receivedtrauma in more than two parts of their body. The elbow, arm, and hip were the least regions involved.
    Conclusion
    Motorcycle accidents cause severe physical injuries to the patients’ body. Head injury was the mostcommon type of trauma, leading to a wide range of disabilities. Therefore, the use of crash helmets and avoidance ofdangerous driving behaviors will remarkably decrease such trauma.Level of evidence: IV
    Keywords: Injury, motorcyclist, Trauma
  • Javad Khaje Mozafari, Karim Pisoudeh *, Kaveh Gharanizadeh, Mansour Abolghasemian Pages 373-378
    Background
    Open hamstring lengthening (oHSL) is commonly performed to decrease knee contracture and improvegait and posture for children with spastic diplegia. Furthermore, percutaneous hamstring lengthening (pHSL) is alsogaining popularity as an alternative to the open approach. This study aimed to compare the results of pHSL versusoHSL and to determine the efficacy and safety of the percutaneous approach.
    Methods
    This retrospective included 54 patients (108 knees) with spastic diplegia operated for flexed knee gait witheither open or percutaneous HSL. The mean age of the participants at the time of surgery was 10.3±1.7 years (agerange: 5-25 years) for the open and 8.5±1.5 years (age range: 7-23 years) for the percutaneous group. Overall, 29 and25 children were subjected to oHSL and pHSL, respectively.
    Results
    The mean durations of follow-up were 19.1 months (range: 12-49 months) and 18.3 months (range: 14-45 months) for oHSL and pHSL groups, respectively. In the open group, the mean of preoperative popliteal angledecreased from 64.3±3.6 to 28.4±4.3 (P<0.001), and in the percutaneous group from 63.8±2.7 to 29.5±2.3 (P<0.001).The obtained results revealed no significant differences between the two approaches leading to a similar improvementamong the investigated patients (P=0.83).Although the Gross Motor Function Class Score improved significantly within each group (P<0.001); this improvementwas insignificant between the groups (P=0.88). The mean of hospital stay for the percutaneous group was 1.6 days(range:1-3 days) compared to 3.6 days (range: 2-6 days) for the open group, which indicated a significant difference(P=0.001). The mean values of total cost were $333 and $473 in the percutaneous group and open group (P=0.001),respectively. There was no significant difference between the groups regarding the complication rate (P=0.85).
    Conclusion
    Percutaneous HSL is a safe, easy, rapid, and brief procedure that is as effective as the open technique forchildren with spastic diplegia in a short period of time. However, it is essential to examine the effects of this approachduring longer follow-ups to generalize the findings of the current study.Level of evidence: III
    Keywords: Cerebral palsy, Diplegia, Hamstring Lengthening, Percutaneous, Popliteal Angle
  • Deepak Gautam, Ashish Pande, Rajesh Malhotra * Pages 379-383
    Ceramic bearing surfaces are being increasingly used in young patients undergoing total hip arthroplasty. However,failures have been reported including fractures even with the newer third generation ceramics. The recommendedtreatment for fracture of ceramic bearing surfaces is complete synovectomy and revision total hip arthroplasty.However, disappointing results have also been reported with this approach. The residual ceramic particles may leadto complications. We report a fatal case of cobalt toxicity leading to cardiomyopathy secondary to the catastrophicfailure of a Cobalt-Chrome femoral head, which followed the revision of a fractured ceramic-on-ceramic total hiparthroplasty.Level of evidence: IV
    Keywords: Ceramic head fracture, Cobalt Toxicity, Fatal cardiomyopathy, Metal on Polyethylene, Revision hip arthroplasty
  • Hangama C. Fayaz *, Raymond M. Smith, Mohammad H. Ebrahimzadeh, Hans, Christoph Pape, Javad Parvizi, Khaled J. Saleh, Jens, Peter Stahl, Johannes Zeichen, James F. Kellam, SM Mortazavi, Ashok Rajgopal, Vivek Dahiya, Wolfgang Zinser, Leonid Reznik, Igor Shubnyakov, Marco Pecina, Jupiter B. Jesse Pages 384-396
    Background
    To date, little has been published comparing the structure and requirements of orthopedic training programsacross multiple countries. The goal of this study was to summarize and compare the characteristics of orthopedic trainingprograms in the U.S.A., U.K., Canada, Australia, Germany, India, China, Saudi Arabia, Russia and Iran.
    Methods
    We communicated with responders using a predetermined questionnaire regarding the national orthopedictraining program requirements in each respondent’s home country. Specific items of interest included the following: thestructure of the residency program, the time required to become an orthopedic surgeon, whether there is a log book,whether there is a final examination prior to becoming an orthopedic surgeon, the type and extent of faculty supervision,and the nature of national in-training written exams and assessment methods. Questionnaire data were augmented byreviewing each country’s publicly accessible residency training documents that are available on the web and visitingthe official website of the main orthopedic association of each country.
    Results
    The syllabi consist of three elements: applied clinical knowledge, applied clinical skills, and professional andmanagement skills. The application of simulation techniques for both teaching and assessment are fundamental tomodern surgical education. The skill of today’s trainees predicts the quality of future orthopedic surgeons. The EuropeanBoard of Orthopaedics and Traumatology (EBOT) exam throughout the European Union countries should function asthe European board examination in orthopedics. We must standardize many educational procedures worldwide in thesame way we standardized patient safety.
    Conclusion
    Considering the world’s cultural and political diversity, the world is nearly unified in regards to orthopedics.The procedures (structure of the residency programs, duration of the residency programs, selection procedures, using a logbook, continuous assessment and final examination) must be standardized worldwide, as implemented for patient safety.To achieve this goal, we must access and evaluate more information on the residency programs in different countries andtheir needs by questioning them regarding what they need and what we can do for them to make a difference.Level of evidence: III
    Keywords: Cultural Competences, Educational Procedures, Politics, residency programs, Women in orthopedics