Journal of Research in Orthopedic Science
Volume:7 Issue: 4, Nov 2020

The anterior cruciate ligament surgery commonly uses a hamstring tendon. The hamstring grafts are usually prepared by wrapping in a wet gauze under tension. 

The placement of a hamstring tendon in a dry gauze affects the size of the graft, without any change in its collagen volume. The present study aimed to prove that the preparation method could affect the hamstring graft width.

A total number of 32 patients who had undergone the anterior cruciate ligament reconstruction were enrolled in this analytical descriptive study. Initially, the width of the 4-layered extracted graft was measured using the sizer system, after placement under traction. Then, 16 patients were operated on, based on the dry gauze preparation method, and the other 16, based on the wet gauze preparation method. The grafts were remeasured after traction. Six months after the surgery, all patients received a clinical evaluation, in which the integrity of the graft was evaluated based on clinical criteria. 

The Mean±SD width of the 4-layered extracted grafts was 7.44±0.54 mm and 7.41±0.33 mm in the dry gauze and wet gauze groups, respectively. However, these values did not significantly differ (P=0.96). After traction, the Mean±SD graft width of the dry gauze group was reduced to 6.97±0.62 mm. The traction led to no change in the graft width of the wet gauze group. The changes in the graft size significantly differed between the two groups (P=0.032). Moreover, 4 patients (25%) exhibited no certain endpoint in the Lachman test, also, the pivot shift-test was positive in 5 patients (31.2%).

The hamstring graft preparation technique affects the tunnel graft size. Besides, the use of dry gauzes procures the need for a narrower tunnel in the tibia and femur.

There is no consensus regarding the clinical benefit of interbody fusion cage in the treatment of Spondylolisthesis (SL). This study aimed to evaluate the effect of posterolateral fusion combined with interbody fusion cage on the spinopelvic parameters and the pain level of the patients. 

Role of interbody fusion in the treatment of spondylolisthesis 

This prospective study included 40 SL patients who underwent surgery following the failure of conservative management. The Meyerding classification was used to grade SL. Also, the visual analog scale was used to measure the level of pain, before and after the operation. Spinopelvic parameters included total kyphosis, sagittal vertebral axis, pelvic tilt, pelvic incidence, and lumbar lordosis.

The Mean±SD age of the patients was of 53.4±11.6 years. In four patients (10%), SL occurred at two levels. Besides, the etiology was degenerative in 21 cases (52.5%) and isthmic in 19 cases (47.5%). The grade I, II, and III of SL were detected respectively in 17, 17, and 6 cases (42.5%, 42.5%, and 15%, respectively). The Mean±SD preoperative value of the sagittal vertebral axis was 43.1±33.1 mm, which improved to 24.8±22.3 mm after the surgery (P<0.001). Also, the Mean±SD preoperative value of the pelvic tilt significantly improved from 19.2±10º to 17±9.1º (P=0.049). Moreover, the Mean±SD score of the visual analog scale improved from 9.1±0.8 to 2.8±1.2 (P<0.001). The clinical and spinopelvic parameters greatly improved in patients with degenerative SLs, single-level SLs, and the lower grades of SL.

Posterolateral fusion combined with interbody fusion cage improves both the clinical and spinopelvic parameters of SL patients and could be suggested as the treatment of choice for these patients.

The most clinical manifestation of hemophilia, as a congenital bleeding disorder, is the Intra-articular hemorrhage. The treatment of acute hemarthrosis with a sufficient amount of factor replacement will return the joint to the normal status.

This study aimed to evaluate the efficacy of platelet-rich plasma in the treatment of hemophilic arthropathy patients to reduce and improve their pain and physical function.

Consecutive patients with hemophilic arthropathy were included in a self-control open-label trial in Mofid Children’s Hospital, Tehran, Iran. All participants received three platelet-rich plasma injections given two weeks apart. Also, the seriate self-reported and objective clinical outcomes were evaluated before and three months after the treatment. 

A total of 11 patients with hemophilic arthropathy involving 14 joints received three injections of platelet-rich plasma at 2-week intervals, at our center. All patients were evaluated with a visual analog scale, the hemophilia joint health score, and the range of motion, and bleeding events, before and after the treatment. Finally, 9 boys (81.8%) and 2 girls (18.2%) completed the study. The mean age of the participants was 14.7 years (range, 9-19 years). In all patients, statistically significant improvements were noted on all evaluated measures.

Platelet-rich plasma therapy is a reasonable and minimally invasive procedure that includes beneficial chondro-regenerative properties.

Several pelvic osteotomy techniques are introduced for the treatment of Developmental Dysplasia of the Hip (DDH). However, there is no agreement on the optimal pelvic osteotomy in DDH. Thus, this study aimed to compare the outcomes of Pemberton Osteotomy (PO) and the Kalamchi Modification of Salter Osteotomy (KMSO).

Comparison of pemberton osteotomy and kalamchi modification of salter osteotomy in the treatment of developmental dysplasia of the hip.

In a retrospective study, radiographic and clinical outcomes as well as surgical complications were compared between the patients who underwent unilateral DDH surgery using either KMSO or PO. The radiographic measures included the assessment of the acetabular index and the Shenton line. The clinical results of the osteotomies were evaluated by McKay’s criteria modified by Berkeley et al. Also, Kalamchi and MacEwen’s classification was used for the assessment of avascular necrosis.

The characteristic features of the patients, such as age and follow-up time, were statistically comparable between the two study groups. One year after the surgery, the Shenton line was intact in 55 patients (84.6%) of the KMSO group and 40 patients (88.9%) of the PO group (P=0.52). The Mean±SD value of the acetabular index was 21.1±5.1 and 20.7±3.9 in the KMSO and PO groups, respectively (P=0.13). Besides, the McKay’s clinical criteria were respectively excellent, good, and fair in 44, 16, and 5 patients (67.7%, 24.6%, and 7.7%, respectively) of the KMSO group, and 31, 12, and 2 patients (70%, 26.6%, and 4.4%, respectively) of the PO group (P=0.4). Moreover, the number of postoperative avascular necrosis did not significantly differ between the two study groups.

The PO and KMSO techniques are equally safe and effective osteotomies in the treatment of DDH and can be used interchangeably.

Type III Monteggia equivalent fracture is a rare injury, and its optimal diagnosis and management are still unclear. Reporting two cases of type III Monteggia equivalent fracture in two boys who were surgically treated the day after the presentation.This study presents two cases of type III Monteggia equivalent fracture in two boys who were surgically treated the day after the presentation. These observations suggest that the timely surgical treatment of type III Monteggia equivalent fracture results in acceptable outcomes. However, the lack of a universal classification system limits the generalization of the results

Infantile fibrosarcoma is a rare soft-tissue neoplasm, which may render a diagnostic challenge leading to misdiagnosis and consequently an inappropriate treatment of patients. This study reports a case of infantile fibrosarcoma that mimicked a hemangioma in an 11-month-old girl. As the lesion signal in the MRI was not consistent with the diagnosis of hemangiomas, we performed a core needle biopsy, which its result was consistent with the diagnosis of infantile fibrosarcoma. The lesion was initially treated with surgical resection. However, the lesion recurred one year after the surgery. The recurrence was managed with debulking surgery. The fifth finger was necrotized during the hospitalization after the relapse surgery. Finally, the necrotic finger was amputated. Also, adjuvant chemotherapy was used to prevent further relapses. The 1-year follow-up of the patient was recurrence-free. These findings highlight the importance of considering infantile fibrosarcoma when an infant presents with a lesion that clinically mimics a vascular lesion.

Occult ipsilateral femoral neck fractures associated with femoral shaft fractures are frequently missed. They may lead to adverse outcomes, such as fracture displacement and delayed treatment followed by poor outcomes, including delayed union, malunion, nonunion, and osteonecrosis, which may lead to early arthroplasty. These adverse effects can be prevented by the awareness of this combined injury pattern, the adequate preoperative and intraoperative imaging of the femoral neck, and proper treatment. A 27-year-old man was admitted with a displaced fracture of the right femur. Fluoroscopic evaluation was performed after the intramedullary nailing of the shaft fracture. The evaluation revealed an ipsilateral displaced femoral neck fracture, which was fixed with two cannulated screw inserted anterior to the nail. Between 2% and 9% of all femoral shaft fractures are associated with ipsilateral femoral shaft fractures. This case report necessitates the increase of awareness for the presence of associated femoral shaft and neck fractures in patients undergoing antegrade femoral nailing. Also, we recommend appropriate preoperative, intraoperative, and postoperative imaging.

Chondroblastomas are rare benign neoplasms and scarcely present in the acromion. We reported a case of chondroblastoma presented in the right acromion of a 36-year-old male. The patient had pain and restricted abduction. Moreover, the histological analysis of the biopsy sample was consistent with the diagnosis of chondroblastoma. The patient was treated with extended curettage and bone grafting. Besides, the 2-year follow-up of the patient was event-free. This case reveals that the chondroblastoma of acromion can be adequately treated by extended curettage. It also highlights the importance of acromion chondroblastoma in the differential diagnosis of shoulder pain to avoid the undertreatment of the patients.