Journal of Research in Orthopedic Science
Volume:8 Issue: 3, Aug 2020

Proximal tibia is the second most common site for cancellous bone harvest after iliac crest. It is an excellent bone graft donor site especially when the same limb is undergoing the primary operation. The amount of graft and the quality probably are comparable to that taken from iliac crest and complications are by far less common and less serious. It seems that proximal tibia is a suitable donor site for bone graft harvest and orthopedic surgeons must keep this site in mind when this surgery is necessary.

The present study provides an analysis of methods in assessment and measurement of knee arthrokinematic movements.

in this study, an exhaustive review of the methods for assessment of knee joint arthrokinematics is provided. For this, some known databases including Science Direct, PubMed, EMBASE, CINAHL, and Google Scholar, for the period 1985 to February 2020 are explored.

After the assessment steps, 14 articles were chosen based on the criteria and objectives of the research; 13 articles in entirety and one as a summary. Through a review of the studies, it was observed that various methods were used in assessment and measurement of the knee joint arthrokinematic movements. In the beginning, focus was on transitional motion in which knee arthrokinematic movements were studied in static state; but with time, knee transitional movement was studied in dynamic state as well. More recent studies scrutinized three main types of arthrokinematics: motion rolling, gliding and spinning. There were also studies that tried to implement tools which required minimum cost and scrutinized the knee arthrokinematic movements without complicated state-of-the-art equipment. All the said equipment were designed with the aim of diagnosis of how the arthrokinematic movements of an injured knee compared to a healthy one.

Results of our analysis show that the literature is rich with a variety of instruments for measuring knee arthrokinematic movements. By classifying the instruments, it was found that studies of four different measurement methods including static, dynamic, functional and qualitative have examined the arthrokinematic movements of the knee.

Spondylolysis is a defect in the pars interarticularis of the vertebra. The defect changes the biomechanical stresses and probably causes the degenerative process in the adjacent facet joints. 

In this study, we aimed to assess the effect of L5 spondylolysis on the osteoarthritis process of adjacent L5-S1 facet joints. 

In this cross-sectional cohort study, we assessed 157 cases with a history of low back pain who underwent lumbar computerized tomography scanning of two lower lumbar vertebrae for any reason. The patients with a medical history of vertebral fracture, previous surgery, or infection were excluded. The samples were placed into two groups; 1 (with L5 spondylolysis; 80 cases) and 2 (without spondylolysis; 77 cases). Then, their facet joints osteoarticular severity changes were scored and compared on imaging scans based on observing narrowing, sclerosis, osteophyte formation, and bone cyst. 

The difference regarding the frequency of sex was not significant between the two groups. The prevalence rates of narrowing (P<0.001), sclerosis (P=0.032), and osteophyte (P=0.023) were significantly higher in group 1; however, bone cyst showed no significant difference (P=0.365). Data analysis by logistic regression showed that the aging process was more implicated than spondylolysis in increasing the prevalence of arthritic changes, but bone cysts were not associated with degenerative changes (P=0.216). 

Facet joint degenerative changes (including joint space narrowing, osteophyte, subchondral sclerosis, and cyst) in cases with L5 spondylolysis were not significantly different from those without it. These changes were more affected by the aging process than the spondylolysis itself.

Optimization of the corrective osteotomy for the treatment of distal radius extra-articular ‎ ‎malunion is an ‎ongoing project‎‏.

In this study, ‏we aimed to evaluate the outcome of corrective osteotomy ‎with K-wire fixation in the treatment of patients with symptomatic distal radius extra-articular malunion.‎

Twenty-three patients with symptomatic distal radius extra-articular malunion, mean ‎age of ‎38.3±7.6‎‏ years‎, ‎and a mean follow‎-‎up of ‏‎34.4±11.3 months‎‏ were included‎. ‎Corrective osteotomy ‏was performed through a dorsal approach and using K‎-‎wire instead of the plate for the fixation ‏of the osteotomy site‎. ‎The outcome was assessed with radiographic measures including ‏ulnar ‎variance, radial tilt, radial inclination angle, radial height, and clinical measures including ‎wrist range of motion, the short form of Disabilities of the Arm, Shoulder, and ‎Hand (Quick-‎DASH), and the Modified Mayo Wrist Score (MMWS).‎

Radiographic measures and wrist range of motion in all directions were significantly improved at the last follow-up. The mean final Quick-DASH score of the patients was 16.3±8. The mean final MMWS was 92.2±13.5. According to the MMWS, 9 (39.1%) patients had an excellent function, 13 (56.5%) patients had a good function, and one (4.4%) patient had a fair function. Radiographic union was observed in all wrists within an average period of 10.2±4 weeks. No postoperative complication was recorded.

Since K-wire fixation is less expensive, requires smaller incision, and provides acceptable radiologic and clinical outcomes, it could be regarded as a good alternative for plate fixation in corrective osteotomy for distal radius extra-articular malunion.

Anatomic distal femoral plates locking compression plate (LCP) are generally used for the fixation of distal femoral fractures. However, they are not suitable for periprosthetic femoral fracture after total knee arthroplasty (TKA), mainly owing to the impingement with prosthesis.

In this case series, we report the outcome of proximal tibial LCP fixation in the treatment of periprosthetic femoral fracture after TKA.

Twelve patients with a periprosthetic femoral fracture who underwent surgical treatment were included. According to Su et al. classification, all fractures were type II, originating from the femoral component with proximal extending. Fractures were managed with open reduction and plate fixation. The plate choice was either a long low-profile proximal tibial LCP (n=9) or a short anatomic distal femoral LCP (n=3).

The study population included one male and 11 females with a mean age of 74.5±9.3 years and a mean follow-up of 2.8±1.3 years. Union of fracture was observed in all fractures that were fixed with a long locking plate during a mean period of 3.1±2.1 months. Fixation failed in all three patients who were managed with a short plate. These patients underwent revision surgery with a long low-profile proximal tibial LCP. In one of them, the fixation failed again and finally fixed with tumor prosthesis. The other two fractures were united with no complications.

Long low-profile proximal tibial LCP omits the problem of impingement by prosthesis, which is caused by short anatomic distal femoral LCP in the treatment of periprosthetic femoral fractures above the prosthesis. However, future large-scale comparative studies are required before we can recommend it for routine implications in these fractures.

There are several methods like Kirschner wire, suture fixation, different plaque and etc. for surgical treatment of Neer’s type-II fractures of distal end of clavicle.

Due to lack of gold standard in treatment of fractures of distal end of clavicle, this study was conducted to compare therapeutic outcomes of tension band wire (TBW) and suture fixation (SF) in treatment of this type of fractures.

This retrospective cross sectional-analytic study was performed on patient with confirmed unilateral unstable Neer’s type-II fracture of distal end of clavicle. Based on surgeon preferred protocol for fixation of fractures, for patients from 21 September 2010 to 20 March 2013 pin and wire were used (TBW group) and patients from 21 March 2013 to 23 September 2015, were enrolled as SF group. Demographic information were recorded separately for both groups. All patients were evaluated and scored based on constant score, VAS, symptomatic hardware, loss of reduction in 3 and 6 months  and final visit after surgery.

Among 85 patients, 41 and 44 patients were allocated in TBW and SF groups respectively. Mean of follow-up time was 36.7 months. Our findings showed that both groups in three follow-up periods were similar with regard to shoulder function based on constant score, VAS score, loss of reduction, and nonunion. But SF group had lesser symptomatic hardware rather than TBW group (P=0.001).

Although the results of pain intensity and function were similar in two groups, existence of symptomatic hardware and need of hardware removal in TBW method are weak points which should be considered.

Carpal malalignment following the treatment of scaphoid nonunion increases the risk of Dorsal Intercalated Segment Instability (DISI) and progressive radiocarpal arthrosis. 

In this study, we aimed to investigate the outcome of interpositional bone grafting without preplanning to correct carpal malalignment in treating scaphoid nonunion. 

In a retrospective study, 96 patients who underwent surgery to treat scaphoid nonunion (interpositional bone grafting without correction of carpal malalignment) were included. Indices of carpal malalignment, including the lunocapitate and scapholunate angles, were assessed before and one year after the surgery. A lunocapitate angle of more than15º and a scapholunate angle of more than 60º were considered a sign of DISI.

The study population included 93 men (96.9%) and three women (3.1%) with a Mean±SD age of 26.1±3.1 years. The mean±SD time from fracture to nonunion surgery was 8.6±4.2 months. The Mean±SD lunocapitate angle was 15.2±13.1º before and 14.4±11º one year after the surgery (P=0.48). The Mean±SD scapholunate angle was 63.9±15.2º before and 64.5±14.6º after the surgery (P=0.69). DISI was present in 67 patients (69.8%) before and 66 (68.8%) after the surgery. This difference was not statistically significant, too (P=0.89).

Correction of carpal malalignment should be preoperatively planned to treat scaphoid nonunion to reduce the risk of postoperative DISI and subsequent radiocarpal arthrosis.

Inhibitor development is the main treatment-related complication in patients with hemophilia. Degenerative joint lesions caused by repeated bleeding episodes are more common in patients with inhibitors than in those without inhibitors. We introduced Platelet-rich Plasma (PRP) treatment to reduce joint damage and provide symptomatic relief. 

The aim of this study was to compare PRP treatment outcomes in two groups of patients with hemophilia presenting synovitis, with or without inhibitors, at 3- and 6-month follow-ups. 

We treated 87 patients with 143 affected joints divided into two groups: 78 patients without inhibitors with 129 affected joints and a mean age of 25.8 years, and 9 patients with inhibitors with 14 affected joints and a mean age of 16.3 years. 

The difference in mean age between the two groups was statistically significant (P=0.007). The number of bleeding episodes, Visual Analogue Scale (VAS), and Hemophilia Joint Health Score (HJHS) before treatment and after three and six months showed no statistically significant differences between groups. We demonstrated that PRP treatment decreased the number of bleeding episodes, pain levels, and HJHS in the whole study population (P<0.001). No differences were found between patients with and without inhibitors. 

PRP was proved to be effective for synovitis treatment in patients with hemophilia with and without inhibitors.