Archives of Bone and Joint Surgery
Volume:8 Issue: 6, Nov 2020

Total hip replacement (THR) has proved to be a reliable treatment for the end stage of hip osteoarthritis. It is acommon orthopaedic procedure with excellent results, but is associated with significant blood loss and high ratesof allogeneic blood transfusion (ABT). The potential complications and adverse events after ABT, combined with theongoing research, have resulted in multimodel, multidisciplinary blood management strategies adoption, aiming toreduce the blood loss and transfusion rates. Many reviews and meta-analyses have tried to demonstrate the bestblood management strategies. The purpose of this study is to review any evidence-based blood conserving technique,dividing them in three stages: preoperative, intraoperative and postoperative.Level of evidence: III

The primary goals of total shoulder arthroplasty (TSA) are to relieve pain, improve range of motion,and restore function. Physical therapy is commonly used to help achieve these goals. Recent evidence has pointedto the success and safety of a purely physician-guided, home-based or internet-based, program versus the traditionaltherapist guided program.The purpose of this study was to evaluate outcomes of TSA in patients using a web-based, home therapy program.

A retrospective review was performed of TSA patients who were given the option of using a web-based,home therapy program. Functional outcomes were collected preoperatively, 6-month, and 12-month post-operativeexaminations. Physical examination parameters were recorded at preoperative, 3-month, 6-month, and 12-month timepoints.

Forty-seven patients used the web-based, home therapy program and had complete follow-up data at alltime intervals. All mean range of motion parameters and functional scores improved significantly from preoperatively topostoperatively. There was one reported complication in a patient who sustained a subscapularis rupture and underwentsubsequent open repair at 10 months postoperatively.

This study demonstrates successful improvements in range of motion and functional outcomes in asubset of patients who utilized an online therapy program after TSA. Future study will be necessary to directly compareresults in patients enrolled in formal, outpatient therapy programs and to determine barriers to utilization of web-basedtherapy programs.Level of evidence: IV

Remote video consultations on musculoskeletal illness are relatively convenient and accessible,and use fewer resources. However, there are concerns about technological and privacy issues, the possibility ofmissing something important, and equal access to all patients. We measured patient characteristics associated withwillingness to conduct a remote video musculoskeletal upper extremity consultation.

One hundred and five patients seeking specialty musculoskeletal care completed questionnairesaddressing (1) demographics, (2) access to a device, internet, and space to conduct a remote video consultation,(3) health literacy, (4) pain intensity, (5) magnitude of limitations of the upper extremity, (6) self-efficacy, and (7)rated willingness to conduct a remote video musculoskeletal consultation (11-point ordinal scale). A multivariablelinear regression analysis sought factors independently associated with patient willingness to conduct remote videomusculoskeletal upper extremity consultations.

Patient education level (4 years of college) and accessibility to a space suitable for remote video consultationswere independently associated with interest in remote video consultations. Sociodemographic factors, health literacy,accessibility to a device or internet, and amount of perceived pain and disability were not.

We speculate that education level and suitable space might be surrogates for trust and privacy concerns.Future research might measure the ability of interventions to gain trust and ensure privacy to increase willingness toengage in remote video musculoskeletal consultations.Level of evidence: II

The optimal surgical indications for humeral shaft fractures in the working population remain uncertain.This study investigates the impact of surgical fixation on return to duty, union, and complications in workers’ compensationpatients with humeral shaft fractures. All workers’ compensation patients with humeral shaft fractures managed at a single institution between2007 and 2017 were identified. Manual chart and radiographic review was performed to identify etiology of injury, typeof work, time until return to duty, length of physical therapy, complications, and time to fracture union. There were 39 humeral shaft fractures in workers’ compensation patients managed at our institution (25surgical; 64.1%). There was no difference in the return to light (106.1 versus 60.4 days; P=0.20) or full (140.1 vs.139.9 days; P=0.99) duty for surgical versus nonsurgical treatment, respectively. There was no difference in thelength of physical therapy (132.6 versus 106.3 days; P=0.15) or time to maximum medical improvement (174.3 vs.198.8 days; P=0.25) for surgical versus nonsurgical treatment, respectively. Three patients returned to the operatingroom in the surgical group. Nonunion was observed in two surgical cases (8.0%) and one case (7.1%) of nonsurgicalmanagement. This study did not identify an advantage for faster return to work after surgical management of humeralshaft fractures in workers’ compensation patients. Though one of the perceived advantages of surgical fixation is aquicker return to physical activity, there may be other variables in this patient population that influence the timing ofreturn to work.Level of evidence: III

Osteoporosis represents the most common bone disease and has to be respected in planning total hip replacement, especially against the background of increasing uncemented total hip replacement. In this context, theradiographic geometry of the proximal femur got into focus and is controversially discussed.The aim of the presented study was to find any difference regarding known indices for proximal femur bone geometrybetween patients with high-grade osteoarthritis and patients suffering from a femoral neck fracture caused by lowimpact trauma. Retrospective matched-paired analysis of 100 plane pelvic radiographs from 50 patients who suffered fromhigh-grade hip osteoarthritis and 50 patients who suffered from femoral neck fracture was performed. Measurement ofCanal-Bone Ratio (CBR), Canal-Calcar Ratio (CCR), Mineral Cortical Index (MCI) and Canal Flare Index (CFI) wereperformed. CBR was significantly higher in the fracture-group (0.45 +/- 0.06 vs. 0.41 +/- 0.08) (P-value= 0.008). Moreover,the femoral thickness 10 cm below the trochanter minor [F] was significantly higher in the osteoarthritis-group (34.68+/- 4.14 vs 32.11 +/- 3.43) (P-value 0.001). In conclusion, patients with a femoral neck fracture demonstrated a higher CBR, which indicates a poorerbone quality. In case of planning a THA, the CBR is an index which can easily be measured and can be seen as onedecision criterion in THA regarding fixation technique.Level of evidence: III

The vertebral column is the second most common fracture site in individuals with high-grade osteoporosis(30–50%). Most of these fractures are caused by falls. This information reveals the importance of considering impactloading conditions of spinal motion segments, while no commercial apparatus is available for this purpose. Therefore,the goal was set to fabricate an impact testing device for the measurement of impact behavior of the biological tissues. In the present study, first, a drop-weight impact testing apparatus was designed and fabricated to record bothforce and displacement at a sample rate of 100 kHz. A load cell was placed under the sample, and an accelerometerwas located on the impactor. Previous devices have mostly measured the force and not the deformation. Thereafter,the effect of high axial compression load was investigated on a biological sample, i.e., the lumbar motion segment, wasinvestigated. To this end, nine ovine segments subjected to vertical impact load were examined using the fabricateddevice, and the mechanical properties of the lumbar segments were extracted and later compared with quasi-staticloading results. The results indicated that the specimen stiffness and failure energy in impact loading were higher than thosein the quasi-static loading. In terms of the damage site, fracture mainly occurred in the body of the vertebra duringimpact loading; although, during quasi-static loading, the fracture took place in the endplates. The present study introduces an inexpensive drop-test device capable of recording both the force andthe deformation of the biological specimens when subjected to high-speed impacts. The mechanical properties of thespinal segments have also been extracted and compared with quasi-static loading results.Level of evidence: V

Rotator cuff disorders are a leading cause of shoulder symptoms. Accurate imaging, detecting the typeof the involved muscle, and severity of the injury have important effects on the choice of treatment. Accordingly, thecurrent study was conducted to evaluate the diagnostic accuracy of ultrasound for rotator cuff disorders in patientssuffering from shoulder pain and to explore the precision of ultrasound in determining the exact dimensions of a tear incomparison with magnetic resonance imaging (MRI). This prospective research was performed on patients clinically suspected of rotator cuff tendinopathy. Anultrasound of the shoulder was initially performed for the candidates. In this study, MRI was regarded as the modalityof choice for examining the images of shoulder disorders. The European Society of Musculoskeletal Radiology (ESSR)guidelines were used to design the protocols and implement imaging measures. Based on the reference standard ofMRI, the specificity and sensitivity as well as positive and negative predictive values of ultrasound in detection of rotatorcuff disorders were calculated. A total of48 patients (22 women, 23 dominant right hands) with an average age of 51.6±8.3 years wereenrolled in this study. Based on MRI findings, rotator cuff disorders were detected in 43 patients (89.5%). The mostcommonly observed disorders were partial-thickness rotator cuff tear (n=17, 35.4%), full-thickness rotator cuff tear(n=16, 33.3%), and tendinopathy (n=10, 20.8%). Among rotator cuff disorders, the highest sensitivity of ultrasound wasobserved in the detection of full-thickness tear (93.7%) and rotator cuff tendinopathy (90%). The highest specificity wasfound in the detection of full-thickness rotator cuff tear (100%) and partial-thickness rotator cuff tear (96.7%). Based on our findings, ultrasound could be considered as a high-quality diagnostic tool to rule in partialand full-thickness rotator cuff tears and rule out the rotator cuff pathologies.Level of evidence: I

Serial casting under general anesthesia, which is considered as a gold standard of treatment for patientswith infantile idiopathic scoliosis (IIS), can lead to significant negative neurodevelopmental effects. Therefore, theappropriateness of this type of treatment is controversial. Brace treatment is one alternative method of treatment for IISpatients. However, long-term studies have not yet verified its effectiveness. Thus, the present study aimed to evaluatethe effectiveness of brace treatment in patients with IIS until skeletal maturity or spinal fusion.

The medical records of all IIS patients with the referral age of 0-3 years who received brace treatment fromJune 1986 to November 2013 were reviewed. Those patients with pre-brace Cobb angle > 20° were included andfollowed up to skeletal maturity or the time of spinal fusion. The Cobb angle was recorded at the time of diagnosisbefore the initiation of bracing, weaning time, brace discontinuation, and final follow-up. In addition, the maximum inbracecurve correction was measured.

Out of 87 patients with IIS, a total of 29 cases (19 males and 10 females) with the average curve magnitudeof 35.62° at the time of diagnosis were included in the study. The average best in-brace correction was 57.32% forsuccessfully treated patients and 36.97% for progression/surgery patients. Based on the results, brace treatment failedfor a total of 20 patients (69%), with a scoliosis curvature progress ≥ 45°. Of these patients, 12 cases (60%) reachedspinal fusion. Finally, four patients (13%) in the surgery-treated group underwent surgery before the age of 10.

The results revealed that bracing was successful for more than two-thirds of patients with IIS curves,preventing surgery before the age of 10.Level of evidence: IV

Different surgical procedures have been proposed for the treatment of Distal Radioulnar Joint (DRUJ)arthrosis and other conditions. This study aimed to introduce a new design of DRUJ prosthesis based on the Sauvé-Kapandji procedure followed by the evaluation of its short-term results. Darrach and Sauvé-Kapandji techniques aretwo well-known salvage procedures. Various implant designs have been proposed for DRUJ substitution to avoid thedisadvantages of these procedures.

Before and after the insertion of the intraosseous DRUJ prosthesis in five patients, indices, such as therange of motion, as well as grip and pinch strengths were measured and recorded. Moreover, the patients were askedto complete three questionnaires (i.e., Quick-Disabilities of the Arm, Shoulder and Hand; Visual Analogue Scale-Pain;and Patient-Rated Wrist Evaluation).

The patients were followed up for 27.6 months. It is worth mentioning that all patients completed the followup period with no complication, except for one case who came with dislocation secondary to forearm malunion andproximal forearm impingement. According to the results, there were improvements in all indices, compared to preoperation.

The intraosseous distal radioulnar prosthesis can be an alternative option for the replacement of DRUJ.Level of evidence: IV

Several devices have been described for fixation of displaced medial malleolar fractures. Fullythreaded cancellous screws engaging the bone may provide advantages compared to partially threaded screws.This study was designed to compare the clinical results of fully and partially threaded 4 millimeter cancellousscrews in fixation of medial malleolar fractures.

In a randomized clinical trial study 44 patients with displaced closed medial malleolar fractures wererandomly divided into two groups. Two fully threaded four millimeter cancellous screws were used for fracturestabilization (FT group) in the first group, while, the second group was operated by use of two partially threaded fourmillimeter cancellous screws (PT group). The clinical outcomes and complications were compared in two groups atone year follow up.

Nineteen patients in FT group and 21 in PT group were present at final follow up. Nonunion was notdeveloped in either group but two cases (9%) of delayed union occurred in PT group. The rate of postoperativeinfection and symptomatic hardware were not statistically different. Functional assessment using AOFAS, MOXFQand VAS scores showed no significant difference between the two groups.

Both fully and partially threaded 4 mm cancellous screws can be considered as acceptable devices forthe fixation of medial malleolar fractures with good and comparable clinical results.Level of evidence: I

Injury is one of the leading causes of death and disability worldwide. Lower extremity injuries put a heavyburden on communities. The aim of this study is to assess the prevalence of lower extremity injuries in Mashhad, Iran.

The data from 57430 patients with lower extremity injuries from all traumatology hospitals in Mashhad wereanalyzed in this retrospective descriptive cross-sectional study to determine the prevalence of lower extremity injuriesin Mashhad, Iran, between March 2011 and March 2015.

The prevalence of lower extremity injury in the general population of Mashhad was 0.34%. The mean ageof the casualties was 33.7±19.8 years, and 77.9% were male. Knee and lower leg injuries had the highest frequency(61%). The mean hospitalization period was 7.7±12.6 days. The highest mortality rate (MR) (2%) and discharge againstmedical advice (DAMA) (11%) were observed in hip and thigh injuries. DAMA (8.8% vs. 6.7%, p <0.001) and MR (1.7%vs. 1.5%, P=0.005) was higher in females. However, males had a longer hospitalization period (8±13) compared tofemales (6.8±10.1 days) (p <0.001). The prevalence rate was declining during the study period.

The downward trend of lower extremity injuries is promising; however, the higher mortality rate in femalesneeds more attention. These findings can be used for better management of traumatic patients.Level of evidence: III

Myoelectric control is a method of decoding the motor intent from the electromyogram (EMG) data andusing the estimated intent to control prostheses and robots. This work investigates estimation of the wrist kinematicsfrom EMG signals using polynomial models. Due to their low complexity, polynomial models are potentially the perfectchoice for EMG-kinematics modeling. Ten ablebodied individuals participated in this study, where the EMG signals from the forearm and thewrist kinematics from the contralateral wrist were measured during mirrored contractions. Two sets of EMG featureswere employed including the time domain (TD) set, and TD features along with autoregressive coefficients (TDAR).Polynomial models of order 1 to 4 were applied to map the EMG signals to the wrist motions. The performance wasdirectly compared to that of a multilayer perceptron (MLP) neural network. The estimation accuracy of the wrist kinematics improved with increasing the order of the model, but saturatedat the 4th order. When using the TD set, the MLP significantly outperformed all polynomial models. However, whenusing the TDAR set, the polynomial models’ performance improved so that the 4th order model performance was notsignificantly different than that of the MLP in two DoFs, although it was lower than MLP in one DoF. These results indicate that polynomial models are not as effective as more complex models such asneural networks, in learning the highly nonlinear mapping between the EMG data and motion intent. However, using asufficiently high number of various EMG features, would reduce the mapping nonlinearities, and thereby may increasethe polynomial models’ performance to levels similar to those of complex black box models.Level of evidence: I

Posterior shoulder dislocation, whilst uncommon, is frequently missed and often associated with a significant defect onthe antero-medial aspect of the humeral head (the reverse Hill-Sachs lesion). Several techniques for stabilisation havebeen described, depending on the size of the lesion. We describe an additional technique for stabilising the shoulderfollowing posterior dislocation by augmenting the reverse Hill-Sachs lesion with layers of extracellular matrix, thusfurther filling the defect.Level of evidence: V

Acetabular cup optimum position is paramount for total hip arthroplasty (THA) good outcomes. Although controversial,Lewinnek proposed safe zone for cup placement still the most widely accepted target. Cup placement can be improvedusing specific anatomical landmarks, computer navigation system and handheld navigation devices. As using asmartphone on daily bases became popular among orthopedic surgeons, in this technical note, we describe how to usesmartphone specific applications intraoperatively during total hip arthroplasty to adjust cup inclination angle, which webelieve to be easy, cheap and beneficial for young less experienced surgeons.Level of evidence: IV

Proximal interphalangeal (PIP) fracture-dislocation is a relatively common injury that results from “jamming” a finger.Treatment hinges on the degree of articular surface involvement, which determines stability of the joint. For unstableinjuries, a variety of surgical interventions have been described including extension block pinning, open reduction internalfixation, volar plate arthroplasty, static or dynamic external fixation, and hemi-hamate reconstruction. We present thecase of an unstable, subacute ring finger PIP dorsal fracture dislocation for which the above options were not possible ordesirable to the patient.We performed temporary bridge plate fixation of the joint, based on the success of a similar procedure used to treatcomminuted and unstable distal radius fractures.The procedure allowed immediate return to work, which was the patients’ primary goal, and resulted in a reasonable shorttermoutcome, similar to other mentioned procedures.Temporary bridge plate fixation can be considered among treatment choices for PIP fracture dislocation when other, moreestablished options are not possible or desirable.Level of evidence: IV

The purpose of this case report is to present and to assess a new exercise therapy using an intelligent robotic system endowed by the functional electrical stimulation (FES) for gait improvement in a person with foot drop due to stroke. The subject was a 30-year-old man who had suffered a hemorrhagic stroke patient 8 years ago. He had gotten all proper conventional physical therapies, yet suffered from right foot drop which affected significantly on the gait quality. The patient wore the FES-robotic system on his impaired ankle and walked about 50 strides in each therapy session. During each gait cycle, the subject voluntarily determined the starting times of the dorsiflexion and plantarflexion of the affected ankle through toughing a sensor. Three clinical tests including Functional Ambulation Category (FAC), Fugl-Meyer Assessment (FMA), and Mini Balance Evaluation System Test (Mini-BESTest) were conducted. All related quantitative indexes increased after four-month exercise therapy. It proves the improvement of the gait quality in the patient after getting the proposed exercise therapy using the implemented FES-robotic system.

We have to indicate that the number of 100 was arbitrary. Collecting a large number of citations dose not necessary indicates that the study is the best and has a high level of evidence. This study by no means negate high quality important articles that have been published recently and had not enough time to increase their citations yet. Findings on COVID-19 Characteristics are rapidly changing and subject to selection bias. The current study was a cross-sectional study on August 6, 2020; therefore, our findings will be changed overtime.

Subungual exostosis is a benign osteo-chondral overgrowth occurring on the distal phalanx beneath the nail plate. Dermatoscopic features of subungual exostosis have been described in a few studies, however, intraoperative dermatoscopic findings of the entity has not been described yet. Here we report intraoperative dermatoscopy of subungual exostosis in a young female patient.