Archives of Bone and Joint Surgery
Year:2023 | Volume:11 | Issue:10|Papers Count:9

Objectives: Intertrochanteric hip fractures are a common orthopaedic injury in the United States. Complications of surgical treatment include nonunion, lag screw cutout, implant failure, post-operative pain, risk of refracture or reoperation, and infection. The purpose of this study was to compare the rate of complications of sliding hip screw fixation (SHS) compared to cephalomedullary nailing (CMN) for the treatment of closed intertrochanteric femur fractures in adult patients. Methods: PubMed, CINAHL, and Cochrane Library databases were searched for studies comparing SHS to CMN in the treatment of closed intertrochanteric femur fractures in adults. Data were compiled to observe the rate of nonunion, cutout failure, infection, refracture, perioperative blood loss, reoperation, postoperative pain, pulmonary embolism/deep venous thrombosis (DVT), length of hospital stay, and mortality. Results: Seventeen studies were included comprising 1, 500 patients treated with SHS and 1, 890 patients treated with CMN. Treatment of intertrochanteric femur fractures with SHS demonstrated significantly fewer refractures and reoperations. There was no significant difference in other variables between SHS and CMN treated groups. Conclusion: This meta-analysis shows that the only notable difference in outcomes is patients treated with CMN have a higher rate of refracture and reoperation. With new advances in the development of both CMNs and SHS, further studies will be required to see if these differences persist in the coming years. Level of evidence: II

The potential for many of the commonly used surgical site wound adhesives, skin antiseptic solutions, topical antibiotics, and suture materials to sensitize and subsequently result in allergic contact dermatitis (ACD) has become increasingly recognized within orthopedic surgery. Particularly with subsequent exposure to the offending allergen, the cutaneous allergic reaction may present in a similar fashion to cellulitis, thus making early differentiation between the two etiologies to initiate the appropriate and timely treatment crucial. Recognition of the characteristic appearance and severity of ACD surrounding a surgical wound often drives the initial management. This typically consists of anti-histamines, topical corticosteroids, and possible removal of the offending allergen for low grade findings and oral steroids and prophylactic oral antibiotics for the more severe reactions. Multidisciplinary care, including the expertise of a dermatologist or wound care specialist when faced with this challenging clinical scenario is critical and elective patch testing may be indicated to ascertain the exact allergen involved, particularly in patients with a prior history of wound issues. Finally, any clinical cases of ACD following an orthopedic procedure should be documented in the patient’s chart so that exposure can be avoided with any future surgery. Level of evidence: III

Objectives: In order to treat a rat model of rotator cuff rupture, this work concentrated on the expression of TNMD and RUNX2, followed by rotator cuff repair and secretome-hMSCs. Methods: A total of thirty 10-weeks-old male Sprague–Dawley rats were separated into five groups randomly, RC on week 0, lesion treated with a rotator cuff repair and saline (RC + NaCl group, n = 6) for 2 and 8 weeks, and lesion treated with a rotator cuff repair and secretome-hMSCs (RC + secretome-hMSC group, n = 6) for 2 and 8 weeks. The supraspinatus and infraspinatus muscle–tendon units were obtained for histological and biomechanical investigation at 0, 2 and 8 weeks following injury. Results: The findings showed that, in comparison with the RC + NaCl group, secretome-hMSCs significantly improved tendon repair by upregulating TNMD and RUNX2 expression and histology score. Conclusion: Combining Secretome-hypoxia MSCs with RC healing may help rats with rotator cuff tears. Level of evidence: IV

Objectives: Impaired proprioception and muscle weakness may not only be a consequence of knee osteoarthritis (OA) but also part of its pathogenesis. Thus, the enhancement of quadriceps strength and proprioceptive accuracy can play a pivotal role in the management of knee OA. This study aimed to investigate the effects of Kinesio tape and flexible knee orthosis in terms of clinical and neuromuscular outcomes in patients with knee OA. Methods: This clinical trial was conducted on 56 patients with knee OA, randomly allocated to two groups: knee orthosis or Kinesio tape. The knee orthosis group wore a neoprene knee support for 4 weeks. For participants in the Kinesio tape group, tape was applied once a week, for 4 weeks. The primary outcomes were pain intensity and physical function evaluated through the visual analog scale and the Western Ontario and McMaster OA index. The secondary outcomes were concentric and isometric quadriceps strength, Joint Position Sense (JPS), Threshold to Detect Passive Motion (TTDPM), and force sense (FS), all measured by isokinetic dynamometry. Results: All outcome measures were significantly improved in the orthosis group. The Kinesio tape group also demonstrated significant changes in all outcome measures except three proprioception components namely JPS (70° target), FS, and TTDPM. At the end of the fourth week, there were no significant between-group differences for measured parameters. Conclusion: Wearing a flexible knee orthosis and/or Kinesio tape for 4 weeks significantly improved knee pain, physical function, and quadriceps strength. Although knee orthosis showed significant beneficial effects on various components of proprioception, there were no significant differences between the two groups at the end of the 4-week intervention. Level of evidence: II

Objectives: Effective postoperative pain control in microdiscectomy surgery is crucial to managing the disease and improving the patient's quality of life. Therefore, this study aimed to assess the potential effectiveness of 2% lidocaine in reducing pain immediately after discectomy surgery. Methods: A total of 60 patients who underwent microdiscectomy surgery were enrolled in this randomized clinical trial study. They were randomly assigned to three groups: one group received lidocaine just before the incision, another group received lidocaine just before closing the incision, and the third group served as the control. Pain scores were measured at 1, 2, 3, 4, 8, and 12 h after the surgery using a Visual Analogue Scale. Results: The demographic and clinical characteristics of the study population, including age, weight, length of surgery, gender, and history of diabetes, hypertension, and previous surgery, were comparable across all three groups (P>0. 05). There was a significant reduction in pain scores over time in the groups that received lidocaine before (P<0. 001) and during surgery (P=0. 002). Moreover, there were significant differences in pain scores at all time points among the three groups. Both groups receiving lidocaine showed significantly lower pain scores than the control group (Pbefore surgery=0. 005 and Pduring surgery<0. 001). However, no significant difference was observed between the groups receiving lidocaine (P=0. 080). Conclusion: These findings highlight the effectiveness of a local injection of 2% lidocaine either before or during the surgery in managing post-incisional surgical pain after discectomy. Level of evidence: II

Objectives: The study aimed to evaluate the clinical and radiological results after endoscopic repair of gluteus medius muscle injuries and proposed an anatomical classification for the different injury classes. Methods: A retrospective case series, including patients who had undergone endoscopic repair of the hip abductor tendon. The surgical procedure was standardized. Magnetic resonance imaging (MRI) studies were analyzed, and the injuries were classified into three types: nontransfixing partial-extension (nTPE) tear, transfixing partial-extension (TPE) tear, and transfixing full-extension (TFE) tear. TPE and TFE were considered high-grade tears. The postoperative outcomes were as follows: duration of walking aid requirement, duration of physical therapy, time to return to daily activities, modified Harris Hip score (mHHS) and Nonarthritic Hip Score (NAHS) functional scores, pain visual analog scale (VAS), satisfaction, claudication, Trendelenburg test, and reoperation. Results: Sixteen patients were included (94% women,mean age 65 years), with a mean follow-up of 42 months (12-131, range). Out of the cases with preoperative exams available for analysis, four cases (31%) were nTPE, three (23%) TPE, and six (46%) TFE tears. Thus, 69% of the patients had high-grade injuries. These patients had a higher degree of fat infiltration (P = 0. 034), but this was not correlated with inferior postoperative clinical or radiological results. One patient required reoperation due to a recurrent injury. Conclusion: Isolated extra-articular injuries to the tendons of the gluteus medius and minimus evolved satisfactorily after endoscopic repair. Due to the small number of cases, it was not possible to observe differences in outcomes between high-and low-grade injuries. Level of evidence: IV

Objectives: The epidemiology of osteosarcoma (OS), the most common primary bone sarcoma, was not evaluated in the Middle East. Therefore, this study aimed to examine the incidence, demographic characteristics, epidemiology, and survival rate of patients with different subtypes of OS, based on data derived from the Iran National Cancer Registry (INCR) to evaluate the influence of ethnicity and race. Methods: All OS patients registered in the INCR between March 20, 2008, and March 20, 2014, were enrolled in this study, and information such as age, gender, cancer location, OS subtype, and survival time were evaluated statistically. Results: The Age-Standardized Incidence Rate (ASIR) for OS was 3. 02 per million person-years, with a mean age of 25. 6 years and a male-female ratio of 1. 54: 1. Not Otherwise Specified (NOS) OS, chondroblastic OS, and central OS had the highest frequencies among the subtypes of OS. The overall one-, three-, and five-year survival rates were 87%, 61%, and 49%, respectively, with a mean duration of 6. 16 years. Conclusion: The ASIR of OS in our country was similar to that in the US and higher than that in China. The peak frequency was between 15-19 years old. The male-female ratio in our patients was higher than the OS gender ratio in most series. Although it was not statistically significant, older age at the time of diagnosis, axial location, and male gender were the poorest prognosis factors. Level of evidence: III

An obese 57-year-old woman with known hypertension and diabetes mellitus sustained multiple injuries during an accident, which caused anterior-posterior fracture-dislocation of the pelvic ring. Due to the drawbacks of conventional stabilizing methods for anterior-posterior fracture-dislocations of the hip in this setting, such as the inability to visualize anatomical landmarks fluoroscopically for the iliosacral screw technique and the compromised L5 pedicle preventing lumbopelvic fixation, the patient underwent an innovative Hula Hoop technique described here. Using the Hula Hoop technique, a technique that has rarely been studied in humans, we avoided an invasive open procedure, decreased anesthesia time, reduced the size and number of incisions, and minim ized bleeding. After three months of routine physiotherapy and occupational therapy, the patient was able to walk with a walker and an ankle-foot orthosis. Level of evidence: V

Studies that compare routine immediate operative treatment of fractures with selective later reconstructive surgery for malunion or nonunion may be misleading because it discounts the people who did well with nonoperative treatment. We identified 20 studies comparing routine operative fracture treatment and later reconstruction in the hip, clavicle, proximal humerus, elbow, and distal radius. Fifteen of 20 studies favored immediate operative treatment on the basis of lower reoperation rates, fewer complications, better patient reported outcome scores, and higher satisfaction. Five studies were neutral, and none favored delayed reconstruction for malunion or nonunion. These findings emphasize the potential benefits of routine early surgery and raise questions about the validity of studies comparing different timings of fracture treatment. Level of evidence: N/A