Showing papers in "The Open Orthopaedics Journal in 2020"
TL;DR: The clinical findings suggest that this treatment approach may be used as a conservative, non-invasive treatment option for patients with knee osteoarthritis and may benefit from improved localized delivery.
Abstract: Background Sustained Acoustic Medicine (SAM) is an emerging, non-invasive, non-narcotic, home-use ultrasound therapy for the daily treatment of joint pain. The aim of this multi-site clinical study was to examine the efficacy of long-duration continuous ultrasound combined with a 1% diclofenac ultrasound gel patch in treating pain and improving function in patients with knee osteoarthritis. Methods The Consolidated Standards of Reporting Trials (CONSORT) were followed. Thirty-two (32) patients (18-males, 14-females) 54 years of average age with moderate to severe knee pain and radiographically confirmed knee osteoarthritis (Kellgren-Lawrence (KL) grade II/III) were enrolled for treatment with the SAM device and diclofenac patch applied daily to the treated knee. SAM ultrasound (3 MHz, 0.132 W/cm2, 1.3 W) and 6 grams of 1% diclofenac were applied with a wearable device for 4 hours daily for 1 week, delivering 18,720 Joules of ultrasound energy per treatment. The primary outcome was the daily change in pain intensity using a numeric rating scale (NRS 0-10), which was assessed prior to intervention (baseline, day 1), before and after each daily treatment, and after 1 week of daily treatment (day 7). Rapid responders were classified as those patients exhibiting greater than a 1-point reduction in pain following the first treatment. Change in Western Ontario McMaster Osteoarthritis Questionnaire (WOMAC) score from baseline to day 7 was the secondary functional outcome measure. Additionally, a series of daily usability and user experience questions related to devising ease of use, functionality, safety, and effectiveness, were collected. Data were analyzed using t-tests and repeated measure ANOVAs. Results The study had a 94% retention rate, and there were no adverse events or study-related complaints across 224 unique treatment sessions. Rapid responders included 75% of the study population. Patients exhibited a significant mean NRS pain reduction over the 7-day study of 2.06-points (50%) for all subjects (n=32, p<0.001) and 2.96-points (70%) for rapid responders (n=24, p<0.001). The WOMAC functional score significantly improved by 351 points for all subjects (n=32, p<0.001), and 510 points for rapid responders (n=24, p<0.001). Over 95% of patients found the device safe, effective and easy to use, and would continue treatment for their knee OA symptoms. Conclusion Sustained Acoustic Medicine combined with 1% topical diclofenac rapidly reduced pain and improved function in patients with moderate to severe osteoarthritis-related knee pain. The clinical findings suggest that this treatment approach may be used as a conservative, non-invasive treatment option for patients with knee osteoarthritis. Additional research is warranted on non-weight bearing joints of the musculoskeletal system as well as different topical drugs that could benefit from improved localized delivery.Clinical Trial Registry Number: (NCT04391842).
10 citations
TL;DR: Thirty-three cases with displaced acromioclavicular joint dislocation were retrospectively evaluated and clinical and radiographic results were evaluated and compared between the two groups.
Abstract: Thirty-three cases with displaced acromioclavicular joint dislocation were retrospectively evaluated. In the first 14 cases, the wires temporarily penetrated the joint for an average of 7 weeks (trans-articular group), while the acromioclavicular joint was temporarily stabilized by wires passing under the acromion that were inserted into the distal clavicle for an average of 13 weeks in the latter 19 cases (subacromial group). Clinical and radiographic results were evaluated and compared between the two groups.
5 citations
TL;DR: PNBs provide effective analgesia after TKA and adductor Canal Blocks have shown excellent results in reducing post-operative pain while minimizing motor blockade.
Abstract: PNBs provide effective analgesia after TKA. Historically, femoral nerve blocks (FNB) have been commonly employed. FNBs, however, lead to the significant motor blockade to the quadriceps musculature, which can dampen early rehabilitation efforts and increase the risk of post-operative falls. Adductor Canal Blocks (ACB) have shown excellent results in reducing post-operative pain while minimizing motor blockade. Periarticular injections (PAI), and infiltration between the popliteal Artery and Capsule of the Knee (IPACK) have similarly helped in reducing patient discomfort after TKA and providing analgesia to the posterior capsular region of the knee.
4 citations
TL;DR: The aim of this article is to concisely describe the anatomy and biomechanics of the elbow joint relevant to the practice of trauma and orthopedic surgeons.
Abstract: A sound knowledge of the elbow anatomy and biomechanics is critical to understanding the pathology of various elbow disorders and instigating appropriate management. The elbow joint is a trochoginglymoid joint: that is, it has flexion-extension [ginglymoid] motion at the ulnohumeral and radiocapitellar articulations and pronation and supination [trochoid] motion at the proximal radioulnar joint. Stability of the elbow joint is achieved through static and dynamic components. The aim of this article is to concisely describe the anatomy and biomechanics of the elbow joint relevant to the practice of trauma and orthopaedic surgeons.
3 citations
TL;DR: The purpose of this review is to highlight the most important clinical features, work-up, and medical management of the different subtypes of JIA.
Abstract: Joint pain is a common symptom in children and adolescents. While there are many causes of joint pain in children, most of these are acute or not related to underlying joint inflammation. Chronic arthritis, however, can be one of the reasons behind the joint pain. The most common causes of chronic arthritis in children are categorized under juvenile idiopathic arthritis (JIA). The purpose of this review is to highlight the most important clinical features, work-up, and medical management of the different subtypes of JIA.
3 citations
TL;DR: Calcar-guided short-stem Total Hip Arthroplasty resulted in excellent clinical outcomes after two years of follow-up, and the radiographs revealed few signs of stress shielding, and calcar- guided short- stem THA is regarded as a safe and effective treatment alternative in daily clinical practice.
Abstract:
Calcar-guided short-stem Total Hip Arthroplasty (THA) is increasingly being used to preserve proximal femoral bone stock for potential later revision surgery.
In this study, we aimed to expand the clinical evidence on calcar-guided short-stem THA used in daily clinical practice, focusing on clinical outcomes as well as radiographic signs of stress shielding and femoral bone loss.
In a prospective multicentre study, we enrolled 213 patients with a total of 224 THAs for mainly degenerative indications. The patients were examined clinically and radiographically 6 to 12 weeks, 12 months, and 24 months postoperatively.
All clinical outcomes improved significantly over the first 6 to 12 weeks compared to preoperative values (P < 0.001). At 24 months, the mean Harris hip score was 95.3 ± 6.7, and the mean visual analogue scale for pain was 1.0 ± 1.7 under load and 0.5 ± 1.3 at rest. We observed early distal stem migration in six patients and late migration in one patient. Additionally, we found 16 cases of radiographic signs indicative of stress shielding. Four patients required stem revision surgery: two for stem migration, one for periprosthetic fracture, and one for deep infection.
Overall, calcar-guided short-stem THA resulted in excellent clinical outcomes after two years of follow-up, and the radiographs revealed few signs of stress shielding. We, therefore, regard calcar-guided short-stem THA as a safe and effective treatment alternative in daily clinical practice.
2 citations
TL;DR: CKD has been associated with certain factors, including extrinsic factors such as intrauterine packaging disorders, breech presentations, and intrinsic factors like genetic malformation, but most of the cases are sporadic.
Abstract: Congenital knee dislocation (CKD) was first reported by a Swiss physician Chatelaine, in the year 1822 [1], but even after the passage of two centuries, the exact treatment protocol is still debatable. CKD is a hyperextension deformity of the knee with anterior tibia displacement, present at birth. It may be idiopathic or syndromic (Larsen’s syndrome, arthrogryposis multiplex congenita, myelomeningocele) [2 4]. The incidence of CDK is 1/100,000 in live births [5, 6]. To make it simple, it is 1% of the incidence of congenital hip dislocation [7, 8]. The exact etiology remains unknown. CDK manifests in the second half of pregnancy [9]. It has been associated with certain factors, including extrinsic factors such as intrauterine packaging disorders, breech presentations, and intrinsic factors like genetic malformation, but most of the cases are sporadic.
2 citations
TL;DR: It is suggested that pre-menarcheal, skeletally immature patients with mild idiopathic scoliosis, and low vitamin D, BMD, and BMI should be treated, and asymmetric foot biomechanics should be addressed, although nutrition and foot orthoses are regarded to have no role in the management of idiopATHicScoliosis.
Abstract:
Observation is the treatment of choice for idiopathic scoliosis with Cobb angles between 15 degrees - 20 degrees in growing children. This passive approach does not address the anxiety of the patient and the stress of the parents. In this paper, we attempt to identify skeletally immature patients with mild scoliosis curvatures that are more at risk of progression and propose possible intervention for this group of subjects.
The literature was searched in Pubmed, and additional references were searched manually in the literature.
Many studies have shown that low serum 25[OH]D level, bone mineral density (BMD), and body mass index (BMI) are related to the curve severity or progression of the curve.
We suggest that skeletally immature patients (< Risser 2) with mild curves be divided into two groups, viz. Group O (observation) with a lower risk of progression, and Group I (intervention) with a higher risk of curvature progression. We propose early intervention for the latter group.
It is suggested that pre-menarcheal, skeletally immature patients with mild idiopathic scoliosis, and low vitamin D, BMD, and BMI should be treated. Also, asymmetric foot biomechanics should be addressed, although nutrition and foot orthoses are regarded to have no role in the management of idiopathic scoliosis. The outcome of early intervention may be utterly different from late treatment when the curvature becomes more structural, and the patient more skeletally mature.
Research is required to prove if the intervention is clinically indicated.
2 citations
TL;DR: The study included 10 healthy young men, and measurements were performed on their dominant arms to record the elements during shoulder flexion and reaching elevation: the angles of glenohumeral joint elevation and scapular upward rotation, scapulohumseral rhythm, and external rotation of the humerus.
Abstract: The study included 10 healthy young men. (average age, 21.5 ± 3.4 years), and measurements were performed on their dominant arms. A threedimensional motion analyzer was used to record the following elements during shoulder flexion and reaching elevation: the angles of glenohumeral joint elevation and scapular upward rotation, scapulohumeral rhythm, external rotation of the humerus, and glenohumeral plane shifting from the coronal plane. The EMG activities in the supraspinatus, infraspinatus, subscapularis, and teres minor were recorded simultaneously.
2 citations
TL;DR: Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Japan Department of Orthoplastic Surgery, Tohoku University School of Medicine, Sendae, Japan department of Orthopedics Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
Abstract: Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Japan Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan Department of Orthopaedic Surgery, Iwate Prefectural Central Hospital, Morioka, Japan Department of Orthopaedic Surgery, East Japan Railway Company Sendai Hospital, Sendai, Japan Department of Orthopaedic Surgery, South Miyagi Medical Center, Shibatagun, Japan
2 citations
TL;DR: Meniscal repair is a successful procedure in conjunction with ACL reconstruction, however, when knee instability after ACL reconstruction remains, the choice of meniscal repair implants may lead to potential complications even after long-term clinical follow-up.
Abstract: Complications after arthroscopic meniscal suture repair have been reported. Migration of a meniscal repair implant mimicking meniscal injury is rare. A 28-year-old female had undergone Anterior Cruciate Ligament (ACL) reconstruction at another hospital 12 years ago . The remaining instability after ACL reconstruction resulted in medial meniscal damage, wear and narrowing in the posterior third. The H-fix that was used in the meniscal repair became detached, exposing the inside of the knee joint. Meniscal repair is a successful procedure in conjunction with ACL reconstruction. However, when knee instability after ACL reconstruction remains, the choice of meniscal repair implants may lead to potential complications even after long-term clinical follow-up.
TL;DR: The correlation between ultrasonographic and radiographic assessments was investigated and the usefulness of these assessments for the diagnosis of UCL injury was evaluated.
Abstract: Thirty-two high school baseball players participated in this study. Fourteen players (44%) were diagnosed with Ulnar Collateral Ligament (UCL) injury. Valgus stress was applied to the elbow by gravity during ultrasonographic and radiographic assessments, and the MJS was measured. The MJS of the throwing side was compared with that of the non-throwing side, and the increase in the MJS of the throwing side was determined. The correlation between ultrasonographic and radiographic assessments was investigated and the usefulness of these assessments for the diagnosis of UCL injury was evaluated.
TL;DR: The key factors of appropriate surgical management in JIA patients are to decrease pain, restore function and avoid loss of ambulation at a young age.
Abstract: Surgical management of Juvenile Inflammatory Arthritis (JIA) presents many challenges for the patient, healthcare team and especially the orthopedic surgeon. Collaborative care efforts must be endorsed early on in order to facilitate maximal postoperative functional ability. Developmental levels, both physically and emotionally must be established preoperatively. It is important to determine bone age and growth plate closure to establish the best surgical intervention and avoid leg-length discrepancies later in life. Emotional maturity may impede the ability of the patient to manage pain or follow directions throughout the recuperative process. Surgical challenges require a team approach that includes rheumatologists who can manage disease modifying agents and the effects of discontinuing medications or planning surgery around dosing regimens in order to decrease immunosuppression. Managing multiple joint issues will require an expert team of occupational and physical therapists to prepare adaptive devices and rehabilitate patients who have significant functional limitations and decreased muscular strength. Because of an anticipated longer and more difficult recovery for JIA patients, case managers must engage in support systems and plan for postoperative care prior to surgery. Implant specific devices need to accommodate small bone structure, bone loss and complex deformities along with diaphyseal or epiphyseal dysplasia. Neurologic assessments will avoid cervical spine compromise during anesthesia administration. Bilateral procedures in the lower extremities should be considered whenever flexion contractures are present and should take place prior to upper extremity joint replacements. Restoring function to the hand and wrist takes priority over elbow and shoulder replacement, respectively. The key factors of appropriate surgical management in JIA patients are to decrease pain, restore function and avoid loss of ambulation at a young age. Extensive preoperative planning and communication with the patient, support system and healthcare team are warranted to address the complexities in this patient population.
TL;DR: Patients’ WBS scores and requests for analgesics showed a moderately strong, positive correlation, but only at 24 h following the second TKA, and patients required a median of 1 day to resume walking after both TKAs.
Abstract: Comparing the postoperative period following the first and second TKA, there were no significant differences in WBS 24, 48, and 72 h postoperatively. The frequency of requests, and the total number of requests for analgesics did not differ when comparing the first and second TKA, at any time point. The total number of analgesic requests exhibited a moderately strong, positive correlation between the first and second TKA (p < 0.001, r = 0.623). Patients’ WBS scores and requests for analgesics showed a moderately strong, positive correlation, but only at 24 h following the second TKA (p = 0.002, r = 0.567). After both TKAs, patients required a median of 1 day to resume walking.
TL;DR: This study showed significant positive clinical and radiographic outcomes for patients who underwent MIS LLIF using titanium expandable interbody spacers with adjustable lordosis based on significant changes in VAS back pain scores, ODI scores, and radiography parameters at 12month follow-up.
Abstract: Aims: This study aims to understand the clinical and radiographic outcomes between patients treated with static and expandable interbody spacers with adjustable lordosis for minimally invasive (MIS) lateral lumbar interbody fusion (LLIF). Background: The use of large interbody spacers in MIS LLIF offers favorable clinical and radiographic results. Static interbody spacers may cause iatrogenic endplate damage and implant subsidence due to forceful impaction and excessive trialing. Expandable interbody spacers with adjustable lordosis offer in situ expansion that may optimize endplate contact and maximize and maintain sagittal alignment correction until fusion occurs. Objective: The objective of this study is to compare the clinical and radiographic outcomes between patients treated with static and expandable interbody spacers with adjustable lordosis for MIS LLIF. Methods: This is a multi-surgeon, retrospective, Institutional Review Board-exempt chart review of consecutive patients who underwent MIS LLIF at 1-2 contiguous level(s) using either a polyetheretherketone (PEEK) static (32 patients) or a titanium expandable spacer with adjustable lordosis (57 patients). The mean differences of radiographic and clinical functional outcomes were collected and compared from preoperative up to 12-month postoperative follow-up. Statistical results were significant if P<0.05. Results: The mean improvement of VAS back pain scores from preoperative to 6 and 12 months was significantly higher in the expandable group compared to the static group (P<0.05). Mean improvement of Oswestry Disability Index (ODI) scores from preoperative to 3, 6, and 12 months were significantly higher in the expandable group compared to the static group (P<0.001). The expandable group had a significantly greater mean improvement in segmental lordosis from preoperative to 6 weeks, 3, 6, and 12 months (P<0.001). For disc height, the mean improvement from preoperative to 6 weeks and 3 months was more significant in the expandable group compared to the static group (P<0.05). In the expandable group, the mean improvement from preoperative to 6 weeks, 3, and 6 months was significantly greater compared to the static group for neuroforaminal height (P<0.001). Subsidence was 0% in the expandable group and 32.4% (12/37) in the static group. Conclusion: This study showed significant positive clinical and radiographic outcomes for patients who underwent MIS LLIF using titanium expandable interbody spacers with adjustable lordosis based on significant changes in VAS back pain scores, ODI scores, and radiographic parameters at 12month follow-up. There was a 0% subsidence rate in the expandable group, compared to a 32% subsidence rate in the static group.
TL;DR: Pre, peri and postoperative management is reviewed as careful attention to irregular bony dimensions and dysmorphic anatomy precludes the use of standard implants, and various methods for performing joint replacement of the shoulder and elbow in the JIA population are discussed.
Abstract: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory arthropathy that manifests itself prior to the age of sixteen years with symptoms lasting six weeks or longer. As JIA frequently effects the upper extremities, activities of daily living become compromised during the stages of development when young adults are striving for independence. Symptomatology includes ankylosing, pain and early growth plate closure. Patients with joint involvement prior to growth plate closure have the most destruction in terms of joint abnormality and surgical complexity.Medical management of JIA has allowed for better non-surgical management, yet, there is a continued need to understand the appropriate surgical intervention and order for the greatest functional gains. Comparative studies have shown that varied results as to whether the shoulder replacement should supersede the elbow replacement or should that be reversed or both joint replacements done simultaneously. Our experience found a more significant functional improvement after total elbow replacement due to the unpredictable nature from the shoulder replacement outcomes and an inability for patients to do simple tasks such as bringing a cup to their mouths or handling a toothbrush. The exception to this occurs if the ipsilateral shoulder joint is severely limited to the point that the stressors placed on the elbow due to compensation will lead to early loosening or failure of the elbow joint replacement.Various methods for performing joint replacement of the shoulder and elbow in the JIA population will be discussed. Soft tissue integrity including the functional status of the rotator cuff will be a consideration for which surgical procedure should be considered. Surgical approaches for the elbow present fewer options for improving pain and function in this patient population. Pre, peri and postoperative management is reviewed as careful attention to irregular bony dimensions and dysmorphic anatomy precludes the use of standard implants.Total shoulder and total elbow arthroplasty should be considered in the JIA population where pain and significant functional compromise are present. The order of procedures is dependent on multiple factors and expected outcomes. Educating patients on postoperative expectations over the lifespan is an important part of surgical management for patients with JIA.
TL;DR: Total joint arthroplasty (THA) is successful in relieving pain, and improving function, ambulation and range of motion in end-stage degenerative arthritis, and it is hoped that the longevity of THA will facilitate a more normal and enduring lifestyle.
Abstract: The hip joint is commonly affected in Juvenile Idiopathic Arthritis (JIA), especially in cases of systemic polyarticular disease. Chronic synovitis of the hip leads to joint destruction, therefore, systemic and local control of the disease is of paramount importance. Non-steroidal antiinflammatory drugs, Disease Modifying Anti-Rheumatic Drugs (DMARDs), biologics, intra-articular corticosteroid injections, and physical therapy are the mainstay for controlling ongoing inflammation and hip joint contractures. Synovectomy with soft tissue releases is useful in the early stages of the disease, when the joint cartilage is largely preserved. Total joint arthroplasty (THA) is successful in relieving pain, and improving function, ambulation and range of motion in end-stage degenerative arthritis. With improved designs of smaller prostheses and modern bearing couples, it is hoped that the longevity of THA will facilitate a more normal and enduring lifestyle.
TL;DR: Factors Affecting Stability of the Reverse Total Shoulder Arthroplasty: A Cadaveric Biomechanical Study are studied.
Abstract: RESEARCH ARTICLE Factors Affecting Stability of the Reverse Total Shoulder Arthroplasty: A Cadaveric Biomechanical Study Ryan Bicknell, Michael Furlan, Alexander Bertelsen and Frederick Matsen Department of Surgery, Queen's University, Kingston, Canada Department of Physics, Queen's University, Engineering Physics and Astronomy, Kingston, Canada Department of Orthopaedics and Sports Medicine, University of Washingston, Seattle, Washington, USA
TL;DR: A unique case of Langerhans Cell Histiocytosis arising in the scapula of a 2-year old male child masquerading as an aneurysmal bone cyst (ABC) at clinical presentation and on imaging is described.
Abstract: We describe a unique case of Langerhans Cell Histiocytosis (LCH) arising in the scapula of a 2-year old male child masquerading as an aneurysmal bone cyst (ABC) at clinical presentation and on imaging. Scapular involvement is only occasionally noted in LCH cases. Solitary bone involvement in our patient’s age group is uncommon in LCH without multi-organ involvement. Careful pathologic examination and immunohistochemistry was crucial in establishing this diagnosis due to the presence of a solitary lesion with fluid-fluid levels.
TL;DR: A 40-year-old female underwent opening-wedge high tibial osteotomy and osteochondral grafting for osteonecrosis of the femoral medial condyle and osteoarthritis of the knee caused by leg length discrepancy after a traffic accident.
Abstract: Untreated leg length discrepancy can cause spontaneous osteonecrosis of the knee, which is associated with subchondral insufficiency fractures of the knee and progression or onset of osteoarthritis of the knee. Spontaneous osteonecrosis of the knee can be secondary to cartilage loss or additional subchondral changes. A 40-year-old female underwent opening-wedge high tibial osteotomy and osteochondral grafting for osteonecrosis of the femoral medial condyle and osteoarthritis of the knee caused by leg length discrepancy after a traffic accident. High tibial osteotomy and cartilage restoration are often considered for the treatment of knee osteonecrosis with cartilage damage in younger patients.
TL;DR: Hill-Sachs lesions were created in all fourteen ex vivo ovine shoulders, corresponding to a 30% defect of the axial diameter of the humeral head (significant lesion according to literature), and independent nonparametric tests were used for the statistical analysis.
Abstract: Hill-Sachs lesions were created in all fourteen ex vivo ovine shoulders, corresponding to a 30% defect of the axial diameter of the humeral head (significant lesion according to literature). The defects were repaired using the remplissage technique applying one of the two randomly chosen suture configurations: two independent mattress sutures or a double-pulley. The contact pressure and contact surface area, as well as percent defect coverage, were recorded using a film sensitive to these parameters. Independent nonparametric tests (Mann-Whitney) were used for the statistical analysis.
TL;DR: Anxiety, a potentially remediable state of mental distress found linked to chronically disabling forms of arthritis, in various imperceptible ways, and which may have an immense bearing on the outcomes of osteoarthritis, has not received as much attention in the related literature as other topics, such as surgery.
Abstract: Osteoarthritis, a widespread highly painful often incapacitating joint disease continues to impose immense personal and societal challenges among adults of all ages, especially among older adults. In the absence of any effective cure or treatment, it has become essential to explore all correlates of this chronic disabling disease, especially those that might be preventable or modifiable. Anxiety, a potentially remediable state of mental distress found linked to chronically disabling forms of arthritis, in various imperceptible ways, and which may have an immense bearing on the outcomes of osteoarthritis, has not received as much attention in the related literature as other topics, such as surgery.
TL;DR: A growing body of research is finding a correlation between primary TKA failure and metal hypersensitivity, most commonly with nickel and cobalt, and knee prosthetics are being made from hypoallergenic metals to minimize the number of failures due to metal allergy.
Abstract: Background: Patients can experience multiple issues following a primary Total Knee Arthroplasty (TKA). A growing body of research is finding a correlation between primary TKA failure and metal hypersensitivity, most commonly with nickel and cobalt. Because of this, knee prosthetics are being made from hypoallergenic metals, such as zirconium nitride (ZrN), to minimize the number of failures due to metal allergy. Given the relatively new development of the hypoallergenic prostheses, there is sparse data about their overall success.
TL;DR: Different aspects of perioperative management of patients with Juvenile Idiopathic Arthritis are reviewed, including the risks and difficulties secondary to articular damage, and also pharmacologic treatment strategies interfering with the anesthetic plan.
Abstract: Juvenile Idiopathic Arthritis is one of the most common chronic diseases in children. The disease affects one or multiple joints. Additionally, systemic involvement can be present either due to the condition itself or due to pharmacologic side effects resulting from treatment. This article reviews different aspects of perioperative management of patients with Juvenile Idiopathic Arthritis. It outlines the risks and difficulties secondary to articular damage, and also pharmacologic treatment strategies interfering with the anesthetic plan.
TL;DR: A 13-year-old boy complained of shortness of his left arm with the desire for lengthening and lengthening was performed using the fully inserted magnetic driven Precice nail, resulting in enchondromatous changes.
Abstract: A 13-year-old boy complained of shortness of his left arm with the desire for lengthening. The X-Ray showed the enlarged ellipsoid shaped humeral epiphysis in varus position and irregular joint surface. The MRI documented a distorted bone structure involving the complete epiphysis, overgrowth of the tuberosities and partial closure of the physis. MR-angiography revealed normally appearing vessel formation; however, a biopsy was recommended to rule out a vascular malformation. A tru-cut needle biopsy confirmed the diagnosis of enchondromatous changes. As the patient felt strongly disturbed by the shortness of his arm, lengthening was performed using the fully inserted magnetic driven Precice nail.
TL;DR: Radiographic and intraoperative findings suggested Osgood-Schlatter disease, which might cause avulsion of the tibial tuberosity, which was also present to a milder degree in the left knee.
Abstract: A 38-year-old man presented to our clinic with severe right knee pain after falling down the stairs and abruptly bending the right knee. Plain radiographs of this knee showed tibial avulsion and a high riding patella, suggesting underlying Osgood-Schlatter disease, which was also present to a milder degree in the left knee. Magnetic resonance imaging confirmed an avulsion of the tibial tuberosity and showed concomitant avulsion of the patellar tendon without bone marrow edema. Computed tomography showed that the fragment of the tibial tuberosity had a dull-edged margin, and cortical bones were partially exposed. During surgery, the patellar tendon was divided into superficial and deep layers. The superficial layer was peeled from an attachment at the patella, while the deep layer was from the tibia and contained the fragment of the tibial tuberosity. The detached side of the fragment and tibia were coated with dense, fibrous tissue. Surgical repair was performed, with excellent outcomes. Radiographic and intraoperative findings suggested Osgood-Schlatter disease, which might cause avulsion of the tibial tuberosity.
TL;DR: Recent series of arthroplasty implants have consistently shown good outcomes and trapezio-metacarpal joint replacement has been observed to provide excellent long-term function in the fit and active patient and is recommended for use in active patients with well-preserved scapho-trapezio -trapezoid (STT) joints.
Abstract:
Trapezio-Metacarpal Joint (TMJ) arthritis is a common cause of radial sided wrist pain. After conservative measures have been exhausted, the current mainstay of surgical treatment is trapeziectomy. Some surgeons combine this with additional ligament reconstruction and tendon or capsular interposition techniques to provide a more stable base for the thumb metacarpal.
In modern Orthopaedic practice, arthroplasty is the procedure of choice for many end-stage arthritic joints. However, due to the reliable and reproducible outcomes of trapeziectomy, this has yet to be widely adopted by hand surgeons in the management of TMJ arthritis. Recent series of arthroplasty implants have consistently shown good outcomes and trapezio-metacarpal joint replacement has been observed to provide excellent long-term function in the fit and active patient.
We have performed a total of 52 TMJ arthroplasties in 46 patients in our institution for over 5 years (2011 to 2016). After excluding 3 cases, 43 available patients (49 implants) were subsequently asked to submit QuickDASH scores and a patient satisfaction survey.
Average QuickDASH score was 16.6, with high patient satisfaction postoperatively at 1 year. Complications included one intraoperative fracture, and five cases of post-operative instability/ dislocation. Dislocations were treated successfully with open reduction and revision.
TMJ arthroplasty has shown good outcomes and patient satisfaction with a low revision rate and we recommend its use in active patients with well-preserved scapho-trapezio-trapezoid (STT) joints.
TL;DR: The objective of this retrospective study was to compare surgical procedures with regard to weight bearing, length of hospital stay, the occurrence of complications, and the necessity of surgical revisions.
Abstract: Objective: The number of subtrochanteric femoral fractures will continue to grow on account of demographic developments. The treatment of choice is reduction and surgical stabilisation. Intramedullary (IO) and extramedullary (EO) techniques are available for this purpose. A final assessment has not been made of which technique is superior with regard to treatment outcome, complication rates, and revision rates. The objective of this retrospective study was to compare surgical procedures with regard to weight bearing, length of hospital stay, the occurrence of complications, and the necessity of surgical revisions.
TL;DR: Intraoperative use of ultrasound during arthroscopic tuberoplasty offers advantages over fluoroscopic guidance concerning control of the amount of bone resection and dynamic evaluation between the GT and the acromion in addition to the problems of radiation and space-occupying devices.
Abstract:
Greater Tuberosity (GT) malunion can lead to impingement against the acromion, resulting in pain, stiffness, and weakness of the rotator cuff. For patients with lesser degrees of displacement, partial removal of the GT with rotator cuff repair (tuberoplasty) under fluoroscopic guidance is considered.
A sixty-five year old female fell from a standing height and suffered a minimally displaced isolated GT fracture. She was conservatively managed for four months and referred to our institution due to persisting pain and stiffness. The shoulder motion was severely restricted (anterior elevation: 90°, lateral elevation: 45°, external rotation with the arm at side: 25°, hand behind back: 4th lumber vertebrae) and pain aggravated especially when laterally elevated. Plain radiography and computed tomography showed small superiorly malunited GT and magnetic resonance imaging showed no rotator cuff pathology. Ultrasound images showed impingement of the GT against the acromion when laterally elevated. Arthroscopic excision of the malunited GT and rotator cuff repair along with capsular release and acromioplasty was performed under ultrasound guidance. The ultrasound images were simultaneously delineated to the arthroscopic monitor. Dynamic evaluation of the reshaped GT passing under the acromion was possible.
Intraoperative use of ultrasound during arthroscopic tuberoplasty offers advantages over fluoroscopic guidance concerning control of the amount of bone resection and dynamic evaluation between the GT and the acromion in addition to the problems of radiation and space-occupying devices.