Journal of Orthopedic and Spine Trauma

Total Knee Arthroplasty in Patients with Concomitant Low Back Pain, Its Effects on Pain, Functional Outcomes and Satisfaction, a Narrative Review

Alireza Moharrami — 2024-06-30

The request for total knee arthroplasties (TKA) is increasingly being raised and imposes an enormous burden on the healthcare system. Most subjects represent symptomatic concomitant low back pain (LBP) at baseline, interfering with functional outcomes with little or no improvement in mental health following TKA. Orthopedics should notify the patients suffering from concomitant LBP about the like hood of unfavorable recovery. The authors describe the functional outcomes and satisfaction following TKA in patients suffering from concomitant LBP.

The Role of Extracorporeal Shockwave Therapy (ESWT) in Treating Low Back Pain; Current Concept Review

Mir Mansour Moazen Jamshidi — 2024-06-30

The current study aims to evaluate the potential role of extracorporeal shock wave therapy (ESWT) on functional status, physical disability, and pain in patients suffering from low back pain (LBP). ESWT may provide superior therapeutic outcomes in reducing pain and ameliorating the patient's functional status regarding LBP.

Do Psychological and Social factors Correspond with Health Care Utilization?

Sina Ramtin — 2024-06-30

Objective

Whitin 6 weeks prior to an in-person musculoskeletal specialty care visit, 1) Is the number of self-reported in-person contacts associated with psychological and social factors? and 2) Is the number of remote and total contacts associated with psychological and social factors?

Methods

We enrolled 148 adult patients in a cross-sectional study of people visiting a musculoskeletal specialist for a new or return visit. Patients completed a survey of social health, indicated the number of self-reported remote and in-person care episodes, and completed measures of unhelpful thoughts regarding symptoms, general distress, and demographics.

Results

Accounting for potential confounding in multivariable analysis, more self-reported in-person care episodes were independently associated with more unhelpful thoughts about symptoms (higher score on NPTQ; RC 0.05; 95% CI: 0.02 to 0.09; P < 0.05) and household income between $15,000 and $29,999 or $30,000 and $49,999. No factors were associated with total remote and in-person care contacts.

Conclusions

The observation that patients with greater unhelpful thinking seek out more in-person care episodes for musculoskeletal symptoms supports the concept that comprehensive care strategies attentive to common unhelpful thoughts regarding symptoms could limit unhelpful resource utilization.

Functional Outcome of Arthroscopic Bankart Repair with Knotless Suture Anchor: A Retrospective Observational Study

Ravindra Chauhan — 2024-06-30

Background: Soft tissue in the shoulder contributes to anterior shoulder instability that results in humeral head displacement from the glenoid fossa. Repair of Arthroscopic Bankart is considered as a broadly accepted method for restoring labrum to the glenoid rim. Our study's objective is to assess the clinical outcomes of Bankart repair by knotless suture anchors at medium-term follow-up.

Aim: To study the functional outcomes of using knotless suture anchor for recurrent instability of anterior glenohumeral and perform the clinical assessment using Rowe score in patients at 6-week, 3-month, and 6-month intervals.

Materials and Methods: In this prospective trial, patients undergoing arthroscopic Bankart repair with 2.8 mm knotless suture anchor (MINI-VIM PK^®) were enrolled in the study. Patients were assessed for stability, movement, and function of shoulders using the Rowe scale at the baseline, 6-week, 3-month, and 6-month follow-up period planned for early efficacy measures.

Results: The mean age of the subjects was 28.10±6.14. In this trial, the patients have been diagnosed with recurrent shoulder dislocation on the left side in 51(69.86%) patients and right side in 22(30.14%) patients. The Rowe score shows significant (p<0.0001) improvement from 44.73±1.64 to 95.62±18.33 at the 6-month follow-up period. Thus, provided better clinical outcomes and less movement of recurrent instability with knotless suture anchor.

Conclusions: The knotless suture anchor showed reduced recurrence rates, improved post-operative shoulder motion, and increased stability without adding complexity to the procedure.

Comparison of different Ketofol procedural sedation and analgesic doses during orthopedic procedures in patients referred to the Emergency Department; A double-blinded randomized clinical trial

saeed abbasi — 2024-06-30

Background

Orthopedic procedures are one of the most common medical procedures in the Emergency Department

(ED) and are also among the painful procedures performed on the conscious patient.

Objectives

The aim of this study was to compare different doses of Ketofol in procedural sedation and analgesia in

patients referred to the EDs.

Methods

In this double-blinded clinical trial, 296 patients aged 18 years or over presented with need of orthopedic

procedures in the three academic EDs in 2020 were studied. After completing the written consent, the

patients were randomly assigned into four treatment groups. Demographic information, underlying

diseases, patients' physical condition, type of orthopedic injuries requiring intervention, patients' vital

signs were recorded in a checklist for each patient.

Results

In this study, the mean age, gender, level of education, addiction, patients' physical condition, type of

procedures performed, apnea, hypoventilation, bradycardia, hypotension and agitation in all four

treatment groups were not statistically different, but hallucination and hypoxia in group C (1: 3) were

much less than other groups thus oxygen administration was more common in other groups.

Conclusion

By testing different doses of ketamine, we came to the conclusion that doses of 1 mg and 0.5 mg were

associated with more side effects. Dose of 0.33 mg of ketamine, has fewer side effects while causing

analgesia and sedation as in the above doses. Dose of 0.25 mg ketamine increases the likelihood of

requiring subsequent doses. Therefore, it seems that 0.33 mg of ketamine is the best dose of choice.

Open soft tissue degloving injuries of lower limbs managed by a staged protocol using preserved autologous skin graft.

John Mohd — 2024-06-30

Objectives: The study aimed to assess the outcome of open circumferential soft tissue degloving injuries of lower limbs using a staged protocol by utilizing the stored skin graft harvested from degloved skin flaps.

Materials and Methods: This retrospective study included 12 patients with open circumferential lower limb degloving injuries (Arnez types 3 and 4), with a minimum final, follow-up of two years. All the patients were treated using a staged protocol which included harvesting skin graft from the degloved skin followed by refrigerator storage of the graft and stay sutures for the flap. The refrigerator-stored graft was then used to cover the raw areas left after secondary debridement.

Results: The mean area of the wound per patient that required skin grafting in the present study was 1082.9±679 cm² and the mean area of the wound covered by refrigerator-preserved, meshed skin graft per patient was 798.75±350 cm². One patient needed a latissimus dorsi flap and three patients with whole limb degloving had to undergo skin grafting for the remnant raw area which was harvested from the contralateral thigh. None of the patients landed up with amputation. All the patients had complete graft uptake and healing at the final follow-up. All the patients were satisfied with the final functional outcome and were able to return to their pre-injury working status. The mean hospital stay per patient in the present study was 15.16±4.9 days.

Conclusion: Despite being rare, open STDIs are very complex injuries with no definitive guidelines for management, especially Arnez type 3 and 4 injuries. The staged protocol presented in the present series provides a potential answer to the dilemma. However, larger multi-centric trials are needed to compare the various methods of treatment and the outcomes thereof.

Study of the Healing of Tibial Fractures Treated with Dynamic Intramedullary Nailing

Afshin Sahebjamei — 2024-06-30

Introduction and Aims: Dynamic nailing (IMN) by placing only one screw on one side of the nail, shortens the surgical time and reduces the complications during surgery and secondary dynamization, so we decided to investigate the healing of dynamic IMN of tibial fractures.

Material and Methods: This cross sectional study was done on 67 patients with dynamic IMN in Fifth Azar Hospital, Gorgan in 2015-2018. Complications, union time, RUST score and Johner-Wruhs criteria were analyzed based on their grouping in AO classification.

Results: The average age of the patients was 33.2±13 years. Most of the fractures were closed type (71.6%), type C (43.4%). The mean healing time was 14.62±4.38 weeks and RUST score was 8.9±1.26. There was no significant difference between locations of fracture and the healing time or RUST score (P> 0.05). The healing time in the comminuted fractures (e.g, type C) and open tibial fractures were statistically longer than the simpler type (e.g, type A or B) and the mean radiological score in type C fractures was significantly lower (P<0.05). The mean Johner-Wruhs Criteria score of fractures was 46.31±4.49, so that 61 patients had excellent results, four patients had good results, and two patients had fair results.

Conclusion: Dynamic IMN of closed and middle third tibial fractures and simpler types of fractures (e.g, type A or B) have faster healing. Anyway, it is better to be more cautious for fixation of open or comminuted fracture (e.g, type C).

Keywords: leg, tibia fracture, healing, Dynamic, intramedullary nail

A Study of Titanium Elastic Nailing in Forearm Fractures in Elderly Patients

Ashok Sharma — 2024-06-30

Introduction:

As operative techniques and the quality of implants are improving, surgical management of diaphyseal fractures of forearm bones in elderly patients is gaining widespread acceptance. A combination of a better understanding of the fractures, preoperative antibiotics, properly designed newer implants, minimal soft tissue handling techniques, and C-Arm guidance have made surgical fixation practical and safe while treating these fractures. Titanium elastic nailing system (TENS) provides flexural, axial, translational, and adequate amounts of rotational stability.

Aim and objectives:

The treatment of diaphyseal forearm bone fracture with TENS nail aims to regain length, axial, and adequate rotational stability without extensive soft tissue injury, neurovascular compromise, and periosteal stripping. Objective of this study is to analyze the demographic distribution, union rates, functional outcomes, cosmetic outcomes, complications, and functional rehabilitation of the upper limb.

Methods:

Elderly patients admitted to the Department of Orthopedics at SRG Hospital and Medical College, Jhalawar with BBFA diaphyseal fractures during the period from JUNE 2019 TO MAY 2023 were selected and evaluated clinically and radiologically. We followed all those patients for an average of 6 months. The outcome was assessed using the Grace-Eversmann scoring system. We followed up with all 25 patients and evaluated them every 2 weeks until the fracture unites.

Results:

Our study consisted of 25 patients, 14 males, and 11 females. The mean age of distribution was 65 years. The average time to bone union was 12 (8–20) weeks, and the average surgery time was 35 (15–60) minutes. There was a superficial infection in 1 case. No one had a deep infection, mal-union, non-union, fracture, nail migration, compartment syndrome, nerve palsy, synostosis, or rupture of any tendon. Most patients had a full range of Elbow and Wrist Movements after the union.

Conclusion:

Based on our experience and results, we conclude that the titanium elastic nailing technique is a better method for the treatment of displaced BBFA diaphyseal fractures in elderly patients also. It is easy, cheap, convenient, and gives elastic mobility promoting a rapid union of fractures and stability which is ideal for early mobilization. It provides a lower complication rate, shorter surgery time, good cosmetic outcome, and easy implant removal when compared to other methods of treatment.

Subtrochanteric Fracture in Adolescents Treated with Adult Proximal Humerus Locking Plate

reza zandi — 2024-06-30

We report four cases of subtrochanteric fracture in school-aged pediatrics, treated with an adult proximal humerus locking plate. The clinical outcomes were excellent. The advantage of this plate is that many screws can be inserted at appropriate positions and angles without damaging the physis. This approach is considered useful for pediatric subtrochanteric fractures.

MIPO for Pilon Fractures: Educational Corner

Omid Salkhori — 2024-07-01

no abstract

Bilateral asymmetrical hip dislocation after falling from height: a case report

Mohammad Sajjad Mirhoseini — 2024-06-30

We are reporting a case of asymmetrical bilateral dislocation of hip in a 60 years old man after falling from 6 meters height. 4 hours after injury the patient was transferred to OR and a closed reduction of hip was done for him which was successful. The time interval between injury and reduction is crucial for these patients.

A literature review to compared sexual distribution, mechanism of dislocation, and associated fractures between patients with asymmetrical bilateral dislocation of hip (n=103) and unilateral dislocation of hip (n=105) revealed that female to male ratio is almost similar in both groups but most patients were male in our population (81%). Traffic accidents are the most common cause of dislocation. But the odds of this mechanism is about 2 times larger in unilateral patients (OR=0.46). Fractures were more common among patients with asymmetrical bilateral dislocation and the most common associated fractures included: Acetabulum (52.8%), posterior edge (21.3%), femur neck (18.5%), femur head (3.7%) and pelvis (3.7%).

Bilateral Radial Head and Neck Nondisplaced Fracture, A Challenge for treatment; A Case Report

Omid Salkhori — 2024-06-30

Background: Radial head and neck fractures are one of the common fractures of the elbow in adult patients. There are controversial in treatment of nondisplaced head and neck fracture. However, nonoperative treatment remain as a choice treatment of nondisplaced radial head fracture without motion block.

Case Report: we presented a 23 years-old patient who had bilateral nondisplaced radial head fracture. The Patients was managed with conservative treatment and early elbow range of motion. Finally, the patient had full range of motion without any pain in his both elbows.

Conclusion: Nonoperative treatment with early range of motion remain as a treatment for bilateral nondisplaced radial head fracture with acceptable outcome.