Archives of Bone and Joint Surgery
Volume:1 Issue: 1, Jan 2013

The clinical use of PRP therapy in the practical setting of orthopaedic fields is increasing partly because of the accessibility of devices that are used in outpatient preparation and delivery. Another reason is the strong advertisement of PRP procedures as the ultimate treatment and novel technology for knee problems by a few orthopaedic surgeons based on claims of abundant scientific evidence. Hence, PubMed articles related to the clinical use of PRP in knee osteoarthritis were searched using the key words: PRP, knee and osteoarthritis in order to study these claims. A total of 20 reports were found directly related to the topic. The aforementioned clinical studies suggest that intraarticular injections of PRP could have preventive effects against osteoarthritis progression. However, presently there is no clear evidence from well-designed clinical trials that intraarticular injections of PRP are efficacious in osteoarthritis. Therefore, at this time the efficacy of PRP requires more investigation, wherein better scientific studies should be performed that include high powered randomized controlled trials.

Osteoporotic compression vertebral fractures are common clinical problems. In those with refractory fractures, percutaneous cement augmentation has been suggested. The aim of this study was to evaluate the functional outcome of percutaneous vertebroplasty in Iranian patients with refractory osteoporotic fractures. We retrospectively studied 37 osteoporotic fractures in 28 patients (6 men and 22 women), who had been treated with vertebroplasty from August 2009 to June 2012. The mean follow-up period was 12.1±3.6 (range: 6-42 months). The patients’ states were assessed by the visual analogue scale and short form-36 questionnaire. Student t test was used to analyze the pre- and postoperative data. The mean age of the patients was 71.6±6.1 (range: 50 to 91 years) and the most common fractured vertebrae were L1 and T12. There were five patients with two levels of vertebral fractures and two with three levels. Vertebroplasty could improve the scores for pain and quality of life from preoperative 7.6 ± 1.4 and 44.8 ± 7.6 to 1.8 ± 0.4 and 74.1 ± 5.3 at four weeks after surgery. At the last follow-up visit, this improvement continued with no significant decline. The most common complication was cement leakage (32.4% per vertebra), wherein all of of the patients were clinically asymptomatic. Adjacent vertebral fracture occurred in six cases. By understanding the risks, we propose vertebroplasty in Iranian patients with refractory osteoporotic vertebral fracture. If correctly performed, this procedure can significantly improve the pain and quality of life in these elderly osteoporotic patients.

At present, there is no consensus on an appropriate treatment modality for intertrochanteric fractures in the elderly with background diseases. The aim of the present study was to compare treatment outcomes of intertrochanteric fractures reduced with dynamic hip screws (DHS) and bipolar hemiarthroplasty in elderly patients with background medical conditions. In this randomized clinical trial, 60 patients with intertrochanteric fractures, who were 45-60 years old, were randomly divided into DHS and bipolar groups. After treatment, the two groups were compared in relation to complications and mortality rates, functional status using the Harris Hip Score (HHS), range of movement and severity of pain using the visual analogue score (VAS). HHS (86±9 vs. 75±7.6), range of flexion (105±11 degrees vs. 90±17 degrees) and external rotation (35±7 degrees vs. 20±7 degrees) were significantly higher in the bipolar group compared to the DHS group (P<0.05). However, there were no significant differences in pain severity between the two groups. Reduction of intertrochanteric fractures in elderly patients with background medical conditions is more effective and less problematic with the bipolar technique compared to DHS and is better tolerated by patients, because this technique is associated with improvements in functional status and hip joint movement range.

Acute pain is common after arthroscopic surgeries and it is one of the most important causes of patient dissatisfaction, admission time and increased morbidity. Gabapentin with anti-hyperalgesic effects can play a critical role in pre-emptive analgesia methods. The aim of this study was to assess the efficacy of gabapentin in pain management after surgery and the rate of drug consumption in patients who are candidate for anterior cruciate ligament (ACL) reconstruction arthroscopic surgery. In this randomized, triple blind clinical trial, 114 patients who were candidate for arthroscopic ACL reconstruction were divided into two groups of gabapentin (G) and placebo (p), with 57 patients in each group. The intervention group received gabapentin 600 mg and a placebo was administered in control group. Patients received on-demand pethedine for pain management. The primary outcome was pain intensity according to the visual analogue scale (VAS) and the secondary outcome was the amount of opioid consumption and incidence of side effects (including: dizziness, sedation, nausea and vomiting) at 6 and 24 h visits. The mean pain intensity in G group at both the 6 and 24 hour visits was significantly lower than the control group (Both p <0.0001). Also, patients in the gabapentin group consumed less opioid at both visits in comparison to the placebo group (p <0.001, p =0.032). The incidence rate of sedation, dizziness, nausea and vomiting was similar in both groups. In arthroscopic ACL reconstruction, administering a preoperative single dose of 600mg gabapentin may decrease both pain intensity and opioid consumption.

Carpal tunnel syndrome (CTS) is a compression neuropathy that causes paresthesia, pain or numbness in the territory of median nerve. The aim of this study is to compare the open surgery outcome and patients` satisfaction in carpal tunnel syndrome among diabetic and non-diabetic patients. In a retrospective cohort study from April 2011 to June 2012, patients suffered from carpal tunnel syndrome at least 6 months, without response to conservative treatment, who had the inclusion and exclusion criteria, were evaluated by the usage of MHQ and WHOQOL-BREEF tests, one month before surgery and three months after that. Carpal tunnel decompression surgery was performed by two surgeons, experienced in hand surgery, which used the same surgical method. Statistical analysis was performed by SPSS 19.0. 24 of patient (34.2%) were male and 46 (65.8%) were female and there was no significant difference between two groups (P>0.05). MHQ total score before and after surgery was respectively 50.22±7.13 and 63.49±11.28 and this difference was significant (P<0.05). In WHOQOF-BREEF parameters, physical parameters (36.81±19.8 vs. 55.30±24.36) and psychological parameters (41.64±14.77 vs. 61.24±19.9) improved significantly after surgery. The outcome of carpal tunnel syndrome open surgery is good in both men and women, but diabetes has a negative impact on surgery outcome in short term.

Peritendinous adhesions after repairing an injury to the digital flexor tendons are a major problem in hand surgery. Non-steroidal anti-inflammatory drug therapy may affect tendon healing and the development of peritendinous adhesions. The aim of this study was to evaluate ibuprofen effect in patients function after flexor tendon surgical repair. Thirty-five patients, who had sharp-edge lacerations of hand-zone II requiring flexor tendons repair, participated in this randomized double-blind clinical trial study. The patients were randomly classified into two parallel and matched groups (21 patients in the intervention group and 14 patients in the control group). The groups were matched considering age, gender, and laceration size. The control group received a placebo with the same appearance and dosage. In the intervention group, ibuprofen was prescribed at a high dosage (2400 mg/day). The range of motion improvement rate of the involved fingers and the patients’ performance after their follow-up period were compared. There was a statistically significant difference between the two groups for range of motion of the involved finger joints (P=0.03). According to the DASH score, there was a statistically significant difference between the final performance of the patients, such that it was 11±2.4 and 18.4±6.3 in the intervention and control groups, respectively (P=0.01). There was not any case of re-tear or need to re-operate in the intervention and control groups. Our findings reveal that ibuprofen with an anti-inflammatory dose was effective in improving the range of motion of the involved fingers joints after flexor tendon injury.

The prevalence of hip dysplasia is 1 in 1000. Several pelvic osteotomy methods have been developed to prevent early osteoarthritis, such as triple osteotomy. In this study we are going to introduce our new technique that was done on 4 patients with favorable short-term results. Four patients underwent triple osteotomy and fixation using a reconstruction plate and early weight bearing was started. The Harris Hip Score, limb length, center-edge angle, and acetabular inclination showed improvement. This modified technique is suggested for corrective surgery on adult dysplastic hips.

This report is on a migration of a Steinman pin into the posterior com Department of the calf. It was used to fix a greater trochanteric osteotomy in a total hip arthroplasty. The puzzling note is how this metal piece passed through the anterolateral compartment of the thigh to the posterior compartment of the calf. Accord ing to our literature review, migration of fixation pins through the knee joint is an extremely rare occurrence and could be missed by an inattentive physician.

Osteoid osteoma is a benign bone tumor that rarely involves joints. Although there are several reports of arthroscopic osteoid osteoma excisions, to our knowledge, there are no reports of this type of treatment for osteoid osteoma in carpal bones. We report two cases of arthroscopic (a person who had a pain in the left wrist and the other one with carpal tunnel syndrome) with excision of osteoid osteoma in the carpal bones. We think arthroscopic excision is the best choice for treatment as long as the tumor is accessible for arthroscopic surgery, when osteoid osteoma has classic clinical and imaging findings and is near an articular surface. However, when the tumor is far from the joint surfaces, when we need pathologic confirmation or when the tumor is easily accessible using a non-articular approach, arthroscopic excision may not be the most appropriate technique.

Retained gauze after surgery is an uncommon error and it may be associated with many complications. We are reporting our case to call attention to the fact that retained gauze may become symptomatic even after a very long interval. Herein we report on a patient who developed infection and fistula with discharge from this error 35 years after a surgery for femur fracture and insertion of a IM nail. The diagnosis was easily made because of a marker in the gauze. Removal of the gauze and irrigation and debridement of the wound in two stages led to complete recovery of the patient as was shown in the 1 year follow up. Retained gauze after surgery is a preventable complication and may be asymptomatic for a very long period, but can become a complication post-operatively at any time. Hence, if diagnosed immediately after the surgery or at any other time, the gauze should be removed.