Journal of Research in Orthopedic Science
Volume:6 Issue: 3, Aug 2019

As a minimally invasive operation, kyphoplasty has become popular in the treatment of osteoporotic vertebral compression fracture (OVCF).

This study aimed to evaluate how the timing of kyphoplasty affects the parameters of sagittal alignment in OVCF.

In this prospective study, the patients with OVCF, who underwent kyphoplasty at our center, were recruited. Pre- and post-operative vertebral height, local and total kyphosis, coronal axis, sagittal vertebral axis, pelvic tilt, lumbar lordosis, sacral slope, and spino-cranial angle were evaluated and compared between acute OVCF (kyphoplasty performed within 1 month after injury) and chronic OVCF (kyphoplasty performed after 1 month from injury) patients.‎

Kyphoplasty was done for 18 acute and 28 chronic OVCF patients. All of the evaluated parameters, except spino-cranial angle, were significantly improved after the kyphoplasty. A significant difference was observed between the mean lumbar lordosis improvement of the two groups (P=0.026). In particular, the Mean±SD lumbar lordosis improved 6.1±6.6º in the acute patients and 0.92±7.86º in the chronic group. No other significant difference was observed between the improvement of the spinopelvic parameters in the two groups.

The timing of kyphoplasty impacts the improvement of spinopelvic parameters, ‎as well as the reduction of pain and restoration of vertebral height.

The appropriate monitoring of union following the treatment of scaphoid nonunion is essential. However, there is no consensus regarding the optimal imaging modality for this evaluation. 

Here, we compared the reliability of plain radiographs with computed tomography (CT) scanning in determining the union of scaphoid following the scaphoid nonunion.

In this retrospective study, 25 patients, who underwent the surgical treatment of scaphoid nonunion and had both plain radiographs and CT images, were included. The surgical procedure included open reduction, illiac crest bone graft, and K-wire fixation. Two different observers assessed the healing of scaphoid nonunion by both imaging modalities and graded as healed or non-healed.

The mean±SD age of the patients was 29.1±6.8 years. The mean±SD time interval from the operation to imaging was 6.5±2.5 months. Based on the plain radiographs, all patients achieved the scaphoid union. However, in the CT evaluation, 23(92%) patients showed the scaphoid union. Accordingly, CT images and plain radiographs agreed in 23 cases and disagreed in two cases. This difference was not statistically significant (P=0.5).

In a subset of patients, who underwent the operation for the treatment of scaphoid nonunion, plain radiographs might falsely confirm a scaphoid union. In these patients, a complementary CT evaluation might be helpful in the accurate assessment of scaphoid healing.

Post-traumatic Pseudoaneurysm (PTP) is a rare condition. Because of its clinical course and presentation like a tumor lesion, its early diagnosis and appropriate treatment is necessary.

In this study, we present a case of PTP in the left peroneal artery two years after trauma that presented with calf mass.
Conclousion:  Magnetic resonance imaging and magnetic resonance angiography were used for the diagnosis, and the patient was successfully managed with endovascular stenting.

Trigger wrist is a relatively rare hand disorder that refers to the painful snapping and clicking or triggering at the wrist level during finger or wrist movements. 

In this study, we aimed at reporting a series of trigger wrist and discussing their etiology, as well as their clinical manifestation and outcomes.

In this retrospective study, the patients with the definitive diagnosis of trigger wrist were reviewed. Their demographics and clinical symptoms were extracted from their medical records. The symptoms of median neuropathy, including weakness or atrophy of the thenar muscles, ‎persistent numbness, and paresthesia were recorded to investigate the association with carpal tunnel syndrome (CTS).

A total of seven patients with the mean±SD age of 35.5±10.3 years were included in the study. A benign mass was the etiology of trigger wrist in all cases, with giant cell tumor of flexor tendon sheet as the most common etiology (57.1%). Trigger wrist was associated with CTS in three cases (42.8%), in all of whom the tumor size was larger than the average. Pain and snapping with or without palpable mass were the main clinical symptoms of the patients that completely disappeared by surgical removal of the lesion. A mean 40.3 months follow-up of the patients was uneventful.

Benign neoplasms could be considered as the most common etiology of trigger wrist. Since many patients with trigger wrist might have CTS, too, the careful differentiation of these entities is necessary. Once accurately diagnosed, surgical intervention is entirely curative.

Ankle dislocations are a group of injuries requiring immediate orthopedic interventions to avoid subsequent neurovascular complications and impairments. In most cases, they are associated with a malleolar fracture in the ankle. However, in the sporadic cases, especially the ones due to high-energy traumas, ankle dislocations are not associated with malleolar fractures and are referred to as "pure ankle dislocations".

Here, we report a rare case of pure ankle dislocation in a 38-year-old female athlete with no previously established predisposing risk factors. The patient was referred to our emergency department following a catastrophic fall down during exercise, resulting in severe ankle pain and deformity. The patient was treated with urgent reduction of the displacement and 6 weeks of immobilization by casting followed by intensive physiotherapy.

At the end of the 3-month follow-up, no symptoms of instability were observed, and the patient could walk normally; at the 6-month follow-up, the patient could perform her sport activates similar to the initial level.

Pseudoaneurysm, accompanied by penetrating trauma in the forearm, is rarely reported. Considering that clinical examination is not standard in these cases, clinical suspicion and application of suitable diagnostic modalities would be promising and helpful. Most of these patients were referred to the emergency units but were not correctly diagnosed. 

In this report, we present a 22-year-old patient with increasing pain because of a stab wound to forearm 10 days after the first referral to the emergency unit. A pseudoaneurysm was suspected in posterior interosseous of the radial artery because of the persistent pain and palpation of mass. 

The results of bedside ultrasound in the emergency unit and CT angiography revealed pseudoaneurysm in posterior interosseous of the radial artery. The surgical treatment was the resection of the lesion and posterior interosseous ligature. All symptoms of the patient were resolved in a 2-months follow-up. Post-traumatic upper extremity pseudoaneurysm can show its signs and symptoms after a long time.

Osteoid osteoma is the third most common benign tumor of bone. The incidence of osteoid osteoma in the spine, particularly in the patients younger than five years, is low.

Here, we report a case of osteoid osteoma located in the lumbar spine (L5) occurred in a 3.5-year-old boy. The patient was referred with a chief complaint of back pain for six months that was aggravated at nights. Furthermore, no apparent spinal deformity existed. Based on the clinical and imaging findings, the diagnosis of osteoid osteoma was made, and the surgical excision of the lesion was performed. The histologic examination of the extracted tissue confirmed the diagnosis of osteoid osteoma. 

The back pain alleviated the day after the operation, and he was event-free over 6-month follow-up visits. This report highlights the importance of osteoid osteoma in the differential diagnosis of spinal pain presented at any age.

Gorham’s disease is a rare enigmatic bone disorder associated with obscure osteolysis pattern, challenging diagnosis and treatment. Particularly, there is a high level of controversy regarding the diagnosis and strategy of treatment in the spinal involvement of Gorham’s disease that is generally presented with a kind of spinal deformity.

Here, we report a case of Gorham’s disease of the spine manifested with spinal cord complications and lacking any spinal deformity. The patient was managed through a two-stage spinal cord decompression technique. The symptoms were resolved afterward and five-year visits did not demonstrate any significant complication. 

This case reveals that the Gorham’s disease of the spine could be presented with spinal cord complication alone. Accordingly, the strategy of treatment should be established based on the occurrence of spinal cord complications or magnitude of spinal deformity.