Archives of Bone and Joint Surgery
Year:2018 | Volume:6 | Issue:4|Papers Count:15

Background: Industrialization could bring risk of Technological Disaster (TD) such as happened in Chernobyl, Bhopal and Fukushima crisis. Little has been discussed about its related ethical issues. In this study, we aimed to investigate ethical issues have been stated for technological disasters. Methods: A systematic search was conducted on the main international literature databases including Pubmed, Embase, Scopus and ISI (Jan 1, 2000 to Jan 1, 2018). From 64articles were eligible for investigation of ethical issues in Natural disaster, 6 was related to Technological Disaster. The articles were in English language. Results: Our result show that there are seven articles discussing ethical issues during Technological disaster. All of them are related to nuclear crisis in Fukushima resulting from Japan tsunami 2011. These articles discussed mainly three ethical issues in providing medical care to victims of Technological Disasters as follow: 1-Duty of care 2-Mandatory evacuationand3-Resource Allocation. Conclusion: Victim health is the main factor for making decision and implementation of any programs during response to disasters. Mandatory Evacuation for reasons other than providing health to people (such as: maintain public order) and if bring health risk to people will be unjustified. Duty of health workers for providing care is based on General beneficence meanwhile it is necessary to provide facilities to protect them from dangers that treat them in the field. For act ethically, Health workers must have adequate preparedness for response to T-D meanwhile it is necessary to provide guidelines for individuals that participation in relief operation. It is necessary to discuss more about Technological Disaster Ethics especially in industrial countries and where there is especial industrial with potential of huge crises.

The right to health accepted as an essential human right and the world health organization (WHO) emphasizes to settle a right-based approach to health (1). The US administration’ s withdrawal from the Iran nuclear deal in May 2018 requires imminent attention to the impact of sanctions on health of more than 80 million Iranians. In Iran, public health-care system plays a central role in providing health care and treatment services (2). The sanctions before 2015 indirectly targeted Iran public health system (3). New sanctions will have devastating effects on the health of many Iranians, notably patients suffered from cancer. Cancers are the third cause of death in Iran (4).

Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony root avulsion. This injury is biomechanically comparable to a total meniscectomy, leading to compromised hoop stresses resulting in decreased tibiofemoral contact area and increased contact pressures in the involved compartment. These changes are detrimental to the articular cartilage and ultimately lead to the development of early osteoarthritis. Surgical repair is the treatment of choice in patients without significant osteoarthritis (Outerbridge grades 3 or 4). Root repairs have been reported to improve clinical outcomes, decrease meniscal extrusion and slow the onset of degenerative changes. Here we describe the anatomy, biomechanics, clinical evaluation, treatment methods, outcomes, and post-operative rehabilitation for posterior meniscal root tears.

Background: The ” July effect” is a colloquialism asserting an increased rate of errors at the start of the academic year in teaching hospitals. This retrospective population-based study evaluated for the presence of the July effect in performing shoulder arthroplasty. Methods: Using the Nationwide Inpatient Sample for 2002 through 2011, a total of 178, 590 patients undergoing shoulder arthroplasty at academic medical centers were identified and separated into 2 groups: 1) patients admitted during July and 2) patients admitted between August and June. Multivariable logistic regression was used to identify associations with inpatient mortality and adverse events, blood transfusion, prolonged length of stay (>75th percentile) and non-routine discharge. Results: After adjusting for patient, procedure, and hospital characteristics in multivariable modeling, admission in July was not associated with increased risk for inpatient mortality (OR 1. 6) aggregate morbidity, blood transfusion, prolonged length of stay, and non-routine discharge. Conclusion: This nationwide database analysis shows that shoulder arthroplasty at academic medical centers is not associated with increased perioperative morbidity and resource utilization during the month of July.

Background: The purpose of this study was to determine patient-specific risk factors and clinical intervention rates for abnormal postoperative Chem-7 panels in shoulder arthroplasty patients. Methods: Retrospectively, all primary anatomic total (aTSA) and reverse shoulder (RTSA) arthroplasties (between 2007-2013) performed at a single institution were identified. All patients underwent routine preoperative and postoperative day one (POD1) chemistry panels. Each clinically significant component of the Chem-7 panel was independently evaluated using a multivariate analysis to identify risk factors for abnormal results. Associated clinical intervention rates were also calculated. Results: Data from 1, 012 patients (248 RTSA; 764 aTSA) was analyzed. 5. 4% of patients had at least one preoperative abnormal chemistry result. On multivariate analysis, patients with abnormal preoperative Chem-7 labs and a history of renal disease had significantly increased risk for abnormal POD1 labs (P<0. 001). Although 25. 6% (259/1, 012) of patients had at least one abnormal POD1 lab result, the total postoperative clinical intervention rate was 15. 1% (39/259). Conclusion: Renal disease and a preoperative abnormal chemistry result are important risk factors for abnormal postoperative Chem-7. Optimizing renal status and correcting abnormal blood chemistry results preoperatively may reduce the incidence of abnormal postoperative chemistry results.

Background: The valgus cut angle (VCA) of the distal femur in Total Knee Arthroplasty (TKA) is measured preoperatively on three-joint alignment radiographs. The anatomical axis of the femur can be described as the anatomical axis of the full length of the femur or as the anatomical axis of the distal half of the femur, which may result in different angles in some cases. During TKA, the anatomical axis of the femur is determined by intramedullary femoral guides, which may follow the distal half or near full anatomical axis, based on the length of the femoral guide. The aim of this study was to compare using the anatomical axis of the full length of the femur versus the anatomical axis of the distal half of the femur for measuring VCA, in normal and varus aligned femurs. We hypothesized that the VCA would be different based upon these two definitions of the anatomical axis of the femur. Methods: Full-length weight bearing radiographs were used to determine three-joint alignment in normal aligned (Lateral Distal Femoral Angle; LDFA = 87º ± 2º ) and varus aligned (LDFA >89º ) femurs. Full-length anatomical axismechanical axis angle (angle 1) and distal half anatomical axis-mechanical axis angle (angle 2) were measured in all subjects by two independent orthopedic surgeons using a DICOM viewer software (PACS). Angles 1 and 2 were compared in normal and varus aligned subjects to determine whether there was a significant difference. Results: Ninety-seven consecutive subjects with normally aligned femurs and 97 consecutive subjects with varus aligned femurs were included in this study. In normally aligned femurs, the mean value of angle 1 was 5. 05° ± 0. 76° and for angle 2 was 3. 62° ± 1. 19° , which were statistically different (P= 0. 0001). In varus aligned femurs, the mean value of angle 1 was 5. 42° ± 0. 85° and for angle 2 was 4. 23° ± 1. 27° , which were also statistically different (P= 0. 0047). Conclusion: The two different methods of outlining the anatomical axis of the femur lead to different results in both normal and varus-aligned femurs. This should be considered in determination of the valgus cut angle on preoperative radiographs and be adjusted according to the length of the intramedullary guide.

Background: Although it has been shown that perioperative protocols enhance arthroplasty care and safety, it is not known how prevalent their use is in safety net hospitals, which operate with a mandate to treat the poor and underserved. Understanding the elements currently included in standard perioperative arthroplasty protocols at various institutions may help guide future interventions and policy aimed at improving underserved patients’ outcomes. Methods: In this cross-sectional study, safety net hospitals were asked to complete a survey over the phone, via email or in person regarding existence and elements of perioperative management protocols for total hip arthroplasty (THA) and total knee arthroplasty (TKA). Implementation barriers were also addressed. Specifically, survey questions sought to determine the total yearly number of arthroplasty procedures performed at each institution and better understand, among other elements, the following: presence of preoperative pain management protocols, inpatient care pathways, use of social workers and involvement of physical therapy services. Descriptive statistics were calculated and reported. Results: Over 90% of safety net hospitals performing arthroplasty utilized regional anesthetic techniques, inpatient clinical care pathways and inpatient physical therapy. However, 16. 7%, 20. 0%, 23. 3% and 73% lacked social services, anesthesia preoperative clinics, inpatient pain management protocols and preoperative sobriety pathways, respectively. Conclusion: Barriers to receiving arthroplasty care included lack of qualified surgical personnel and concerns about surgical risk in vulnerable patient populations. These findings suggest that further effort is warranted to expand and improve arthroplasty care for the underserved to ensure safety and high quality outcomes.

Background: Oxford medial unicompartmental knee replacement (UKR) is indicated in patients with anteromedial osteoarthritis (AMOA) of the knee. Microplasty (MP) instrumentation was introduced in 2012 as an improvement over phase 3 instrumentation. Advantages of this instrumentation include conservative tibial cut, decreased tibial re-cut rate and improved component alignment. We report the results of UKR with the new instrumentation in a consecutive series with a minimum follow-up of 2 years. Methods: A prospective study of 115 cemented medial Oxford UKRs implanted in 89 patients was done. Postoperative alignment of the tibial and femoral components was analysed. Patient reported outcome measures were recorded using Oxford Knee Score (OKS) and the American Knee Society Score (KSS). Tegner Activity Scale (TAS) was used to record the activity level. Results: 115 consecutive medial Oxford UKRs were studied. All patients were followed up annually in this prospective ethically approved study. The mean follow-up was 36 months and the minimum follow-up was 25 months. No patient died and none were lost to follow-up. At the final follow-up, the average OKS of the cohort was 39. 5 (SD: 5. 7). 91. 2 % of the patients had good or excellent OKS with only 3. 5 % reporting poor OKS. The overall limb alignment was 4. 80 varus (0 – 140 varus). Tibia was recut in 5. 2 % of cases. Median bearing size was 3 (range: 3 to 6). There was one case of bearing dislocation and one case of aseptic tibial loosening. Conclusion: This is the first study to report results of MP instrumentation at a minimum follow-up of 2 years. Our study indicates that the new instrumentation results in reliable and accurate implantation of femoral and tibial components in majority of the cases, with a decrease in number of alignment outliers, and also a reduced rate of bearing dislocation.

Background: Anesthesia is performed in two major methods including regional and general. The aim of this study was to compare the effect of anesthesia method (spinal and general) on oxidative stress in diabetic patients underwent diabetic amputation surgery. Methods: In this randomized control trial, 40 patients with diabetic foot who were candidate for foot amputation surgery at our academic hospital in 2013, were selected and divided into two groups based on anesthesia method. Lipid peroxide level and serum total antioxidant capacity (TAC) were measured before anesthesia induction and one hour after surgery. As the normal range, the findings obtained from 23 healthy volunteers were utilized. Results: Mean age was 54. 9± 11. 21 and 52. 4± 11. 23 years in the spinal anesthesia (SA) and the general anesthesia (GA) group, respectively (P=0. 49). Serum TAC in GA group increased from 1. 03± 0. 04 mM to 2. 98± 0. 7 mM. In SA group, the increase of serum TAC from 1. 22± 0. 11 mM to 3. 42± 0. 5 mM was observed that indicated the increase of serum TAC in both groups was not significantly different (P=0. 21). Serum Malondialdehyde (MDA) in GA and SA groups did not show a significant difference before surgery (31. 14± 3. 9 mM vs. 29. 06± 2. 49 mM in GA and SA groups, respectively) (P=0. 31), while it was significantly different after surgery (23. 14± 2. 6 mM and 19. 24± 2. 7 mM in GA and SA groups, respectively) (P=0. 03). Conclusion: lower limb amputation can help to control oxidative stress in diabetic patients; and considering serum MDA as a marker of oxidative stress, SA seems to be more effective to control this problem.

Background: Developmental dysplasia of the hip (DDH) is one of the most important and challenging conditions in the field of pediatric orthopedics; if not diagnosed and treated in time, it would lead to remarkable morbidity. Methods of treatment based on the patient’ s age can vary. The aim of this study is to compare the outcomes of Salter osteotomy surgery in two groups of patients under and over three years old. Methods: In this retrospective study, medical records of patients who had undergone innominate Salter osteotomy, within the past ten years, due to non-pathological DDH were collected. Mean follow up of all patients is 70. 28 months (min=25, max=118). Results: Seventy patients were selected including 85 operated hips. Radiological satisfaction based on modified Severin score system rate was 86% and 85% for lower three years old group and second group, respectively. In clinical assessment, it was found that results in 82% of the patients under 3 years old and 82. 9% of patients older than three years old were satisfactory. There was no statistically significant difference between the two groups based on Modified MacKay criterion. Conclusion: Results in both groups of patients under and over 3 years old were found satisfactory. Difference in patient satisfaction rates based on clinical and radiological outcomes was not statistically significant between the two groups. It should also be noted that complications such as redislocation and deep wound infection would cause poor clinical and radiological outcomes.

Background: Sagittal imbalance is known as the main radiographic driver of disability in adult spinal deformity (ASD). In this study, the association of radiological spinopelvic parameters and clinical outcomes was evaluated following the corrective surgery of sagittal imbalance, in order to explore the predictive ability of each parameter. Methods: A total of 23 patients, who underwent corrective osteotomy for restoration of sagittal balance, were included in this study. The mean follow-up period of the patients was 15. 5± 2. 1, ranging from 12 to 18 months. Pre-and postoperative radiological parameters including pelvic tilt (PT), sagittal vertical axis (SVA) and pelvic incidence minus lumbar lordosis (PI-LL) were assessed for each patient. Clinical outcomes were evaluated using Oswestry disability Index (ODI). Results: The mean ODI improved 32% following the corrective osteotomy of sagittal imbalance. Postoperative ODI was significantly correlated with all preoperative radiological parameters (r=0. 608, P=0. 002 for PI-LL; r=0. 483, P=0. 01 for PT; and r=0. 464, P=0. 02 for SVA). ODI improvement was significantly correlated with PI-LL and SVA change (r=536, P=0. 008 and r=416, P=0. 04, respectively), but not with PT change (r=247, P=0. 25). The outcome was better in pedicle subtraction osteotomy (PSO) compared to Smith-Petersen Osteotomy (SPO). Conclusion: Surgical correction of sagittal imbalance could limit the amount of disability caused by this misalignment. According to our results, while all the spinopelvic parameters could be used in the prediction of the outcomes of corrective surgery of sagittal imbalance, PI-LL was the most informative parameter and more attention should be devoted to this parameter.

Limb lengthening by Ilizarov lengthens not just the long bone, but also the soft tissues too. Damage of the muscles during corticotomy and their stretching during distraction play a crucial role in occurrence of complications and final limb function. We present here a systematic codified nomenclature system of each muscle summarising all the influence that corticotomy and distraction have the particular muscle and demonstrate the same in the setting of tibial lengthening. This scheme helps the surgeon easily recollect what all muscles are involved in what all ways in each level of corticotomy thus enabling him to watch out for complications thereof and monitor and accordingly modify the limb lengthening process.

Dear Editor: Total knee arthroplasty (TKA) is one of the most successful procedures in modern orthopedic surgery, providing high patient satisfaction rate. As a result, the number of patients undergoing TKA is increasing in number every year and more patients would be inclined to have the operation in near future. The demand for TKA is expected to grow 673% between 2005 and 2030. Knee surgeons are using more advanced techniques of arthroplasty and apply their experience to improve the outcome of the operation and achieving better results (1-3)...

Dear Editor If we are honest in our profession, we might ask ourselves how many percent of patients with spinal surgery are satisfied with our treatments: 50%, 70%, or 90%. How many percent of our spinal surgeries can restore normal anatomy to the patient? Is it enough to have academic credentials for carrying out spinal surgeries? Does having a gun means having the right to shoot at everyone freely? “ Conflict of interest” is a term commonly used in scientific articles. This phrase implies the simultaneous existence of two or more benefits from a research activity that one of these benefits may not be oriented in a same direction of others. This secondary interest may interfere with the primary interest of an honest professional activity and should be clearly explained before the manuscript could be published and put into the widespread use (1, 2)...

Recent studies suggest that Denosumab reduces tumor size, therefore, makes the surgery easier with lower morbidity. However, some studies have reported several complications for this drug. So, this systematic review was performed to determine the effectiveness and safety of Denosumab in reducing bone destructions activity of giant cell tumor and skeletal-related events (SRE) in affected patients with giant cell tumor of bone (GCTB) and its recurrence. We explored studies in PubMed, and Cochrane Library. For this purpose, articles of various levels were retrieved until October 22, 2016. Two reviewers assessed the articles independently based on predefined criteria to extract the relevant data. Primary outcomes associated with skeletal-related event, overall survival, and secondary outcomes such as pain, quality of life and adverse events were evaluated and analyzed. The total population of this meta-analysis consisted of 686 patients. Of this population, 55% had primary GCTB and 45% had giant cell tumor recurrence, with 2% experiencing secondary recurrence. The results showed the effectiveness of Denosumab in reducing the tumor size due to inhibiting the Osteoclastogenesis. Denosumab didnot show any effect on reducing tumor recurrence, but, in cases where complete tumor surgery is not possible and tumor residuals may remain, Denosumab can be helpful. Also, the clinicians should consider the risk benefit of Denosumab.