Journal of Orthopedic and Spine Trauma
Volume:9 Issue: 4, Dec 2023

Kienbock disease (KD) was described by Robert Kienbock in 1910 as osteomalacia of the lunate. A century has passed since the first description of KD, and numerous theories, classifications, and treatments have been published for achieving the best outcomes for this disease, but the treatments remain controversial among surgeons. Various classifications have been proposed for KD based on radiography, MRI, arthroscopy, and morphology from 1947 to 2017. Recently, the pioneers of KD (Lichtman and Bain) proposed a new classification based on all the previous classification (radiographic, MRI, and Arthroscopy). This classification seems to be the best evaluation method and treatment for KD. We recommend using this new classification for assessment of Kienbock disease.

Knee osteoarthritis and low back pain (LBP) are common and occur at the same time in elderly. The LBP in patients who are candidates for knee arthroplasty affect the outcome and prognosis after surgery. In this study, we investigated the LBP in patients with simultaneous osteoarthritis of the knee and lumbar spine after total knee arthroplasty.

In this cross-sectional study, 41 candidates for knee arthroplasty suffering from LBP were included in the study. Demographic and VAS questionnaires for LBP and WOMAC questionnaire for knee pain and function were completed by patients before surgery. Patients are graded according to the JAS index. Patients were followed up for at least 6 months to2 years.

Of41 patients, The mean age of patients was64.3 years. The mean of preoperative VAS index was5.15, while postoperative had decreased to 4.34(P= 0.024). Of the total number of patients in preoperative evaluation, 24.4% were in low grade based on the JAS index, followed by moderate(41.5%) and severe(34.1%) grade. The greatest improvement in the VAS index was related to those who were in the mild and moderate grade before surgery. The mean preoperative WOMAC index was found to be 55.1, while it was postoperatively reduced to 42.9(P= 0.000). Postoperative WOMAC was found to be correlated with postoperative VAS(P = 0.004).

In patients with mild to moderate LBP and knee osteoarthritis, their back pain would improve if they had knee arthroplasty. However, in patients with severe LBP and knee osteoarthritis, the spine should be examined further.

Oxygen ozone gas mixture as a newly prescribed substance became popular among clinicians to relieve low back pain in discogenic patients as an alternative method rather than surgery. It is believed multiple metabolic pathways intervein within its site of action with nucleus pulposus. We developed this study to uncover whether this combination could be helpful in the middle Eastern population or not.

 In the present randomized clinical trial study, we included 40 patients with L1 to S1 disc herniation based on MRI verification within years 2018-2019 who did not respond to 6 weeks of physiotherapy. All patients were followed with a mean time of 12 weeks after injection, and pain VAS score and SF-36 score were performed for all patients. The severity of disc herniations was evaluated by a spine surgeon within the Michigan State University (MSU) classification frame.

Nine out of 40 patients were unexpectedly excluded during our study due to their absence for follow-up. The present study showed that the mean distribution of the patient’s sex, age, BMI, smoking was not contrasting between the two groups (p>0.05). The current study represented two groups were identical regarding Lumbosacral segment involvement during 12 weeks of our survey (p>0.05). SF-36 score graphical inclination was equivalent in both intervention and control groups. The mean VAS score was primarily decreased after two weeks in the intervention group in comparison with the control group, but it failed to thrive in the following weeks and was raised afterward. On the other hand mean VAS score for the control group (6.1; 95% CI: 5.4-6.8) proceeded with a steady slope notably lower than the intervention group (7.5; 95% CI: 6.9-8.2; P<0.001).

In conclusion, referring to statistical outcomes inferred from our study, we understood oxygen-ozone mixture injection is not beneficial in patients with low back pain.

Determining the exact details of complex traumatic injuries such as knee ligament rupture will be a crucial point in planning the surgical approach, which is determined through accurate imaging techniques such as magnetic resonance imaging (MRI). We aimed to evaluate the pattern of MCL rupture in patients who presented with simultaneous rupture of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL).

We evaluated knee MRI in 44 patients (25 females and 19 males; mean age 38.6±5.4 years, range 21 to 64 years) who suffered from clinically acute simultaneous ACL and MCL injuries. Meniscus status, MCL rupture patterns, and pivot bone bruise were analysed.

Concerning ACL rupture, 38.6% had a partial ACL rupture, and 61.4% had a complete rupture. The meniscus ruptured in 61.4%. The most common site of the meniscus rupture was related to the medial posterior horn (37.0%). The vertical type rupture was the most common (37%), followed by horizontal rupture (29.6%). MCL rupture was present in all patients with grade 2 of rupture revealed in 52.3%. Regarding the location of MCL ligament rupture, the highest ratio found in the femoral site (65.9%). Semimembranosus rupture was observed at 2.3%. Pivot Bone Bruise was positive in 34.1%. Medial patellofemoral ligament rupture was also revealed in 68.2%. There was a significant relationship between the grade of rupture in the MCL ligament and the presence of Pivot bone bruise (p < 0.001).

Femoral detachment of MCL and posterior horn of medial meniscus are the most common site of MCL injury and meniscus rupture in context of ACL rupture. Besides, our results show a relevant influence of the extent of bone bruise on the grade of MCL rupture.

Lower back pain is a common cause of disability that affects mobility and quality of life in both adult and elderly patients. Initial management of lower back pain includes anti-inflammatory drugs, physiotherapy, analgesics, and epidural steroid infiltration. Surgery is indicated only for those patients who develop refractory back pain radiculopathy with or without weakness, and when multiple trials of conservative management failed. The two main approaches to surgical intervention include decompression (laminectomy) and decompression with fusion (TLIF).

The study was done under the department of orthopedics at SRG hospital Jhalawar (Rajasthan, IN) between May 2019 and November 2022. In our study, we compared the clinical outcome of TLIF and laminectomy for single-level lumbar canal stenosis with grade 1&2 spondylolisthesis. 40 patients with Single-Level Lumbar Canal Stenosis with Grade 1&2 Spondylolisthesis were divided into 2 equal groups. Patients in both groups were followed up for 2 years.

The ODI scores improved significantly postoperatively. Modified Macnab criteria, suggest the outcomes rated as excellent/good rate of 90% in TLIF and 85% in laminectomy.

We evaluated that TLIF procedures are associated with slightly more significant improvement in clinical outcomes in all of the scoring systems that were applied, TLIF provides early ambulation but higher cost of treatment and longer hospital stay in comparison to laminectomy. Laminectomy procedures are associated with less economic burden, lesser hospital stays, less blood loss, and less surgical duration than TLIF.

Various fixation techniques have been described for osteotomy for correction of cubitus varus. Kirschner-wiring (K-wiring) was used in the past for fixation; however, rates of fixation failure and pin-track infection were high. Fixation with two screws and a figure-of-eight wiring provides a stable fixation in children younger than 15 years. Herein, we used a modified lateral approach and a figure-of-eight construct with two screws and evaluated the outcome.

A case series comprising 35 patients out of the total of 54 patients who underwent modified French osteotomy between January 2013 to December 2021 was conducted retrospectively. Functional outcomes were assessed using the modified Mayo Elbow Performance Scoring (MEPS) system.

There were 22 male and 13 female subjects in the study group. We had excellent results in 16 cases, good outcomes in 13 cases, and fair outcomes in 6 cases. Superficial infection was seen in three patients and four patients had occasional negligible pain. In addition, there was no loss of correction or fixation failures in our study.

Modified French osteotomy using two screws and figure-of-eight wiring is a simple and safe procedure that yields satisfactory outcomes. A careful preoperative planning, sufficient surgical technique, and stable fixation are key to achieving satisfactory functional outcomes.

Dystonia is a common movement disorder with a wide range of aetiologies. Delays in the identification and initiation of effective treatments should be minimized to improve patient pain and optimize outcomes. This case report aims to underscore the successful treatment of chronic dystonia with the use of mood-modifying serotonin and norepinephrine reuptake inhibitors (SNRI), and encourage clinicians to consider a diagnosis of functional (psychogenic) movement disorder in patients with dystonia that is refractory to usual treatment.

Case Report: 

This case report describes a 40-year-old woman who presented to a chronic pain clinic for pain related to cervical dystonia with associated head tremor. Her symptoms were refractory to nearly a decade of quarterly botulinum toxin injections. Based on careful evaluation of the patient’s history, a normal neurological examination, increased Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Injustice Experiences Questionnaire (IEQ) scores, and unsuccessful symptom management with botulinum toxin A, a diagnosis of functional movement disorder (FMD) was made. Low-dose Cymbalta was initiated. The patient achieved near complete symptom remission and resolution of her chronic pain within 2 months and achieved near complete resolution in 2 years.

A diagnosis of FMD should be considered in all patients with dystonia, but especially in patients who respond inadequately to botulinum toxin injections or other rehabilitation therapies. The treatment of comorbid psychiatric conditions can result in substantial benefits and remission from dystonia due to FMD.

Giant cell tumor (GCT) is a benign aggressive bone tumor that occurs mostly in young adult patients after puberty. The most common location is around the knee joint. Occurrence in pre-puberty pediatric patients is very rare and accounts for 1.8% to 10% of all known GCTs.

Case Report: 

Here, we report an eight-year-old boy who complained of pain and loss of range of motion (ROM) in the right hip. Radiological and pathological studies revealed GCT of the femoral head with joint expansion. We treated the patient by wide resection and osteochondral allograft reconstruction.

We believe this is the first reported case of GCT in the proximal femoral bone of pediatric patients, which is proven by pathology. Studying the current case may help tumor surgeons to become aware of this possibility.

Tenosynovial giant cell tumor (TGCT) is a rare hyperplastic disease of the synovial membrane of the joint with a high recurrence rate and tumor-like features, affecting large joints such as the hip, knee, and ankle. Dull and chronic pain is common, as is swelling of the joint, which can make definitive diagnosis difficult. The gold standard of treatment is complete resection of the lesion. In this case report, we present a TGCT at the knee joint of an adult patient with nonspecific clinical presentation.

Case Report:

 We present a 33-year-old male patient who presented with chronic swelling, warm sensation, and limited range of motion (ROM) in the knee. He had no history of trauma and infectious disease had been ruled out. After several nonspecific orthopedic procedures and inadequate treatment of signs and symptoms, he was finally diagnosed with local TGCT.

To make the correct diagnosis, the unusual and somehow deceptive clinical presentation of TGCT must be considered.

Pigmented villonodular synovitis (PVNS) is a very rare pathology of the synovial membrane and even less common in the pediatric group. Rarity leads to misdiagnosis in pre-puberty cases, which may waste significant time for the patient before definite treatment. Reviewing such cases is useful for every pediatrician or orthopedic surgeon to avoid misdiagnosing possible cases.

Case Report: 

We report a 15-month-old boy who suffered pain and swelling in his knee for about two years before he was eventually diagnosed with PVNS and underwent surgery. Keeping this diagnosis in mind may have saved him and his family from two years of pain, several admissions, and unnecessary prescriptions.

PVNS in pediatrics is rare, but it can occur and be misdiagnosed for diseases such as juvenile rheumatoid arthritis (JRA) and septic arthritis which elongates the pain period. PVNS responds well to subtotal synovectomy, and symptoms are relieved after the surgery if well performed.