Journal of Orthopedic and Spine Trauma
Volume:9 Issue: 2, Jun 2023

Arthroscopy procedures for the knee are excellent and tend to be outpatient procedures. Pain control after arthroscopic surgery is an important aspect of patient satisfaction and quicker return to daily activities following surgery. The objective of this article was to review the current literature regarding pain management after knee arthroscopy using intra-articular (IA) injections. Our goal in this article is to review the drugs that have been suggested in various articles for IA injections following knee arthroscopy to control pain. In conclusion, the current evidence suggests that combining IA lidocaine and morphine with tranexamic acid (TXA), in addition to ketorolac, is effective for pain relief after arthroscopic knee surgery.

Artificial intelligence (AI) is the high-tech discipline of employing computers to perform or potentially outperform human intelligence. With the deployment of AI systems, the traditional medical environment has already changed. For recent AI developments that have not yet been applied to medicine, as well as potential future developments, to be implementable in medicine, numerous considerations must be taken into account. In this article, we introduce fundamental AI-related concepts for researchers and administrators of healthcare systems. This article also discusses challenges with applications of AI in medicine, potential futures, and preparation strategies for the future of AI-enhanced medicine. In addition, a list of applications of AI in medicine is provided with a categorization that could help medical professionals to understand potential applications of AI systems in their fields of work.

Intertrochanteric (IT) fractures are responsible for almost half of the fractures in the elderly. The financial burdens of IT fractures are considerable, not only because of their influence on morbidity and mortality but also because they might lead to functional limitation, alleviated quality of life, and a limited possibility to work. There are several methods of fixations for IT fractures, such as cephalomedullary nailing, dynamic hip screw (DHS), proximal femur plate, and external fixator. Most of the patients with this fracture were unsuitable for anesthesia and surgical procedure. The external fixator is a fast, non-invasive, and bloodless method for fixation which would be performed with light sedation. In the present study, we reviewed recent literature regarding external fixators for IT fractures.

Complex regional pain syndrome (CRPS) is an important common complication after surgical treatment for distal radius fracture. Recognition of the related factors is important to reduce the burden of the problem. Herein, the contributing factors for CRPS after distal radius fracture surgery are studied.

In this cross-sectional comparative study, 250 patients admitted to the orthopedics ward in Sina Hospital in Tehran, Iran, from 2017 to 2020, were enrolled. The contributing factors for CRPS after distal radius fracture surgery were determined in them.

The CRPS was seen in 17 cases (6.8%). 9 percent of male and 1.9 percent of female patients were diagnosed with CRPS. This showed a significant difference in the Fisher test (P = 0.028). The mean pain severity by Visual Analogue Scale (VAS) was higher in CRPS cases, that showed a significant difference by the Mann-Whitney test (P = 0.001).

According to the obtained results, it may be concluded that CRPS was seen in seven percent of patients under surgery for distal radius fracture and was related to the male gender and higher pain severity.

Rotator cuff tears present in about 20% of the population. This has prompted surgeons to look for techniques to augment the rotator cuff tear repair. This study aimed to assess the results of Ultrapro mesh augmentation in patients with massive and large rotator cuff tears as a clinical trial.

The study was a single-blind randomized controlled trial in which patients were randomly divided into two groups. Both groups underwent surgery. In one, Ultrapro mesh was used to augment the repair. Therapeutic outcome was assessed by using a joint range of motion, Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), and visual analogue scale (VAS).

60 patients were included, of whom 47 were men. Forward flexion (FF), abduction, external rotation (ER), and internal rotation (IR) degree increased significantly in both groups (P < 0.01), but no significant difference was found between the two groups in terms of changes in these angles (P > 0.05). During the study period and in both groups, the OSS score decreased, and the SST score increased. The pain in both groups decreased until the sixth month and increased after that up to the twelfth month.

Although the use of Ultrapro mesh augmentation in the rotator cuff tear has been associated with better long-term results in the abduction and ER of patients, the effect on the patients’ clinical results is not significant. Further studies are needed to make a more accurate judgment.

Patellofemoral pain syndrome (PFPS) is the most prevalent disease of the knee. The purpose of this study was to compare the acute effects of various warm-up methods on several performance measures and pain intensity in athletes with and without PFPS.

This clinical trial study included 18 to 24-year-old professional female athletes with or without PFPS. Both groups performed warm-up protocols, including general stretching, foam rolling, and Federation Internationale de Football Association (FIFA) 11+ warm-up exercises in three test sessions simultaneously. The data collection procedure was implemented on three separate days in one week. Pain intensity was measured using the Visual Analogue Scale (VAS). Countermovement jump (CMJ) and squat jump (SJ) to measure the stretch-shortening cycle (SSC) and Landing Error Scoring System (LESS) were examined before and after each session.

No significant difference was observed between the effect of different warm-ups in groups with and without PFPS regarding the use of the SSC (P = 0.185), while there were significant differences in the effect of various warm-up protocols on LESS (P < 0.001) and pain scores (P < 0.001).

Using the foam roller as a warm-up method can decrease the pain intensity in athletes with PFPS but may increase their LESS score. In addition, there was no difference in the effect of various warm-up methods on the SSC between athletes with and without PFPS. Finally, it seems that foam rolling should be used with more caution as a part of warming up in athletes with PFPS.

Uncertainties remain as to which type of plate [locking compression plate (LCP) or dynamic compression plate (DCP)] is more efficient and cost-effective in fixing and stabilizing the fractures. We aimed to compare the clinical utility of the two types of plates including LCPs and 3.5-mm DCPs in the treatment of low distal fibula fracture (distal lateral malleolus fractures).

This randomized single-blinded clinical trial was performed on 54 patients with distal fibula fractures who were candidates for surgical treatment using compression plate fixation. The patients were randomly assigned into two groups scheduled for treatment with fixation of LCPs or with 3.5-mm T-plates (DCPs). The patients were finally followed-up for two years to assess the clinical outcome of the procedures.

No difference was revealed between the two groups in the prevalence of postoperative infection, nonunion, wound dehiscence, skin reactions, and local surgical pain. The mean functional score [Olerud-Molander Ankle Score (OMAS)] in the DCP and LCP groups was 85.33 ± 4.92 and 84.85 ± 5.12, respectively, indicating no difference between the groups (P = 0.726).

In the treatment of low distal fibula fractures, the use of LCPs and 3.5mm DCPs can similarly result in improving functional status with minimal postoperative complications. Due to the similarity of the consequences of using both plates and the fact that the DCP type is more cost-effective and available in remote and deprived areas, this type seems to be preferred.

This study was done to know whether patients with hip injury have pre-existing osteoporosis due to which, the patient sustained the fracture, subsequent fracture of the contralateral hip, any osteoarthritic changes of the contralateral hip at the time of index fracture, and ten-year probability of a major osteoporotic fracture by calculating fracture risk assessment percentage (FRAX%).

34 patients were evaluated for age, gender, body mass index (BMI), fracture type, Singh index, bone mineral density (BMD), T-scores using dual-energy X-ray absorptiometry (DEXA) scan, and ten-year probability of fracture using FRAX%.

Average age of the patients with hip fractures was 72.1 years. About 85% of patients were women. 67.6% of the patients were with BMI of 18.5-25 kg/m2. The Singh index for osteoporosis fell in grades 2 and 3 in most patients. The mean interval between index fracture and contralateral hip injury was 4.25 years. Osteoarthritis of the contralateral hip was seen in 9%. The probability in ten years of hip fracture in 30 indexed patients using the FRAX% tool was 15%, and for 4 patients who were having bilateral hip fractures was 22.75%. There was a significant relationship between FRAX% with the Singh index and osteoarthritis of the contralateral hip. FRAX% was high in female patients.

Contralateral hip fracture in patients with osteoporosis was high in women and patients with low and high BMI. Fractures were also high in patients with low Singh index and T-scores. FRAX% increased with an increase in age and increased with a decrease in T-score.

Despite the high prevalence of proximal humeral fracture, one of the most prevalent osteoporotic fractures, its treatment has always been challenging. Here we are going to determine the factors that affect the outcomes of such fractures.

The present retrograde cohort study was conducted in a tertiary trauma center during 2015-2020. The Neer classification was used to classify fracture severity. Patients’ functional status was measured using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and Constant-Murley Score (CMS). Patients were selected thorough purposive sampling method.

The study participants included 70 patients with a mean age of 50.47 ± 16.73 years. The 3 treatment options of open reduction and internal fixation (ORIF) (39 cases; 52%), hemiarthroplasty (3 cases; 4%), and conservative treatment (33 patients; 44%) were considered. Malunion was the most prevalent complication in the study population (9 cases; 12%). The mean DASH score of the participants was 29.91 ± 20.43. The mean DASH score in patients of over 65 years of age was higher than in those under 65 years (36.97 vs. 28.14; P = 0.136). The score in patients underwent surgery (ORIF and hemiarthroplasty) showed a significant difference compared to the patients who were treated non-surgically (P = 0.050). The mean CMS of participants was 64.09 ± 22.71. The mean age of patients classified as “poor” was significantly higher than the “excellent” group (P = 0.041). The mean visual analogue scale (VAS) score of the participants was 2.80 ± 2.49. The VAS score was significantly higher in patients with more severe fracture based on the Neer classification (P = 0.050).

The present study results showed the significant effect of age, fracture severity, and underlying disease on the proximal humeral fracture outcome. A longer follow-up period was observed in patients who had better functional outcomes. However, more studies with larger sample size are required to evaluate proximal humeral fracture outcomes in order to help us to improve outcomes and reduce complications.

Dehiscence of the wound is an infrequent complication following total knee arthroplasty (TKA); numerous risk factors are responsible for this. This study aims to represent a case who underwent TKA, was infected with coronavirus disease-2019 (COVID-19) soon afterward, took corticosteroid as an immunosuppressive agent to resolve COVID-19 symptoms, and presented with wound dehiscence with minor trauma in early postoperative follow-ups.

Case Report: 

A 62-year-old man underwent TKA, and soon after discharge from the hospital, he was hospitalized with COVID-19. A corticosteroid was started for the patient, and a traumatic impaction occurred on his operated knee after he fell in the hospital. As a result, wound dehiscence was performed on the operated knee.

Numerous risk factors such as diabetes mellitus and corticosteroid consumption are implicated as known risk factors for wound dehiscence after TKA, which must be followed precisely to prevent the unfortunate development of such complications. Postoperative care must be considered in patients at risk for wound dehiscence. In the presented case, wound management was fulfilled with proper timing of irrigation and debridement without any prosthesis component exchange.

The occurrence of radioulnar shaft fracture and elbow dislocation simultaneously is not a usual event, and it has only been reported in a few studies. This study aimed to report a case with posterior ulno-humeral joint dislocation and concomitant radioulnar shaft fracture. Furthermore, in a literature review, we summarized other studies that reported this kind of fracture-dislocation and the treatment chosen in each study.

Case Report: 

A 12-year-old boy was admitted to the emergency department due to high-energy trauma following a car accident while cycling. Open fracture of the left radioulnar shaft and posterior dislocation of the left elbow were detected.

More studies are required to advance our knowledge about this kind of fracture-dislocation, especially its mechanism of injury. Subsequent examinations can help us design an efficient classification system and determine the best treatment option for radioulnar shaft fracture with elbow dislocation.

Polymethylmethacrylate (PMMA) has been extensively used as bone cement in orthopedic procedures. Pulmonary cement embolisms (PCEs) are supposed to originate from cement extravasation into the basivertebral veins before draining into the inferior vena cava and eventually becoming lodged in the pulmonary capillaries. Few cases of bone cement embolism have been reported. This study reported a case of pulmonary embolism (PE) after thoracolumbar fixation and kyphoplasty and reviewed the current literature.

Case Report: 

We presented an 81-year-old woman who had undergone thoracolumbar vertebroplasty three months before admission and became symptomatic due to PE after total knee arthroplasty (TKA).

This case illustrates that clinicians must be aware of the probable occurrence of respiratory distress syndrome in patients with a history of vertebroplasty.

Hemicorporectomy is a life-saving operation to maintain the survival of patients with severe and irreversible pelvis and lower extremities injuries. In the typical procedure, removing lower extremities and pelvic viscera in the two stages might result in hemodynamic instability, intraoperative and postoperative morbidities, and more deficient patients' survival. In this study, we aim to describe our experience with a new technique for one-stage hemicorporectomy, which minimizes surgical time and intraoperative bleeding.

Case Report: 

A 77-year-old male patient with lower limb gangrene after previous vascular surgery for an abdominal aortic aneurysm in an unstable situation underwent hemicorporectomy in one step.

We believe that achieving a one-step procedure, especially in non-malignant cases or in the absence of severe trauma lesions, may be a viable option in emergency surgery cases or hemodynamic instability. However, there is still a need to modify the single-stage surgical technique in later experiments.