Pub Date : 2023-05-03DOI: 10.18502/jost.v9i2.12624
M. Guity, Nima Bagheri, A. Heydari
Background: Rotator cuff tears present in about 20% of the population. This has prompted surgeons to look for techniques to augment the rotator cuff tear repair. This study aimed to assess the results of Ultrapro mesh augmentation in patients with massive and large rotator cuff tears as a clinical trial. Methods: The study was a single-blind randomized controlled trial in which patients were randomly divided into two groups. Both groups underwent surgery. In one, Ultrapro mesh was used to augment the repair. Therapeutic outcome was assessed by using a joint range of motion, Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), and visual analogue scale (VAS). Results: 60 patients were included, of whom 47 were men. Forward flexion (FF), abduction, external rotation (ER), and internal rotation (IR) degree increased significantly in both groups (P < 0.01), but no significant difference was found between the two groups in terms of changes in these angles (P > 0.05). During the study period and in both groups, the OSS score decreased, and the SST score increased. The pain in both groups decreased until the sixth month and increased after that up to the twelfth month. Conclusion: Although the use of Ultrapro mesh augmentation in the rotator cuff tear has been associated with better long-term results in the abduction and ER of patients, the effect on the patients’ clinical results is not significant. Further studies are needed to make a more accurate judgment.
{"title":"Pro ultra-Mesh Augmentation in the Rotator Cuff Repair: A Randomized, Single-Blind, Controlled Trial","authors":"M. Guity, Nima Bagheri, A. Heydari","doi":"10.18502/jost.v9i2.12624","DOIUrl":"https://doi.org/10.18502/jost.v9i2.12624","url":null,"abstract":"Background: Rotator cuff tears present in about 20% of the population. This has prompted surgeons to look for techniques to augment the rotator cuff tear repair. This study aimed to assess the results of Ultrapro mesh augmentation in patients with massive and large rotator cuff tears as a clinical trial. \u0000Methods: The study was a single-blind randomized controlled trial in which patients were randomly divided into two groups. Both groups underwent surgery. In one, Ultrapro mesh was used to augment the repair. Therapeutic outcome was assessed by using a joint range of motion, Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), and visual analogue scale (VAS). \u0000Results: 60 patients were included, of whom 47 were men. Forward flexion (FF), abduction, external rotation (ER), and internal rotation (IR) degree increased significantly in both groups (P < 0.01), but no significant difference was found between the two groups in terms of changes in these angles (P > 0.05). During the study period and in both groups, the OSS score decreased, and the SST score increased. The pain in both groups decreased until the sixth month and increased after that up to the twelfth month. \u0000Conclusion: Although the use of Ultrapro mesh augmentation in the rotator cuff tear has been associated with better long-term results in the abduction and ER of patients, the effect on the patients’ clinical results is not significant. Further studies are needed to make a more accurate judgment.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49277401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-29DOI: 10.18502/jost.v9i1.12563
S. Tan, M.S-C Kuo, Yu-Cheng Yeh, Meng-Yin Ho, F. Tsuang
here are several surgical strategies which have been proposed to treat the osteoporotic patient with vertebral fracture, ranging from vertebral body cement augmentation, percutaneous/mini-open short segment pedicle screw fixation, and cortical bone trajectory screw to kyphotic deformity correction surgery. Minimally invasive spine surgery has the potential benefits of faster recovery, reduced blood loss, less postoperative wound pain, lower infection risk, and shorter length of hospital stay. Novel surgical techniques such as percutaneous instrumentation fixation, cortical bone trajectory technique, screw cement augmentation, and vertebral body augmentation are developed. However, various complications have been reported, including pedicle fracture, instrumentation loosening, adjacent-level disc degeneration with herniation, and progressive junctional kyphosis. The purpose of this review was to outline various advancements in minimally invasive spinal surgery for patients with osteoporosis. Minimally invasive surgical techniques for fixation including percutaneous instrumentation, cortical bone trajectory technique, screw cement augmentation, and vertebral body augmentation have benefited patient with osteoporosis. Studies and discussions about short-segment pedicle screw fixation (one level above and below the fracture level) have shown that it provides enough stability for thoracolumbar burst fractures. There are also complications, including cement embolism, adjacent vertebral fracture, neuraxial anesthesia, and infection, which have been observed with the above technique. With the advancement of instrument and technique, the complication rate decreased in recent studies. Minimally invasive fixation still has many advantages for patients with osteoporosis. Many of these studies and strategies only have evidence from biomechanical and cadaveric studies and require further clinical trials to establish their clinical efficacy.
{"title":"Minimally Invasive Fixation in Osteoporotic Vertebral Fractures: A Review Article","authors":"S. Tan, M.S-C Kuo, Yu-Cheng Yeh, Meng-Yin Ho, F. Tsuang","doi":"10.18502/jost.v9i1.12563","DOIUrl":"https://doi.org/10.18502/jost.v9i1.12563","url":null,"abstract":"here are several surgical strategies which have been proposed to treat the osteoporotic patient with vertebral fracture, ranging from vertebral body cement augmentation, percutaneous/mini-open short segment pedicle screw fixation, and cortical bone trajectory screw to kyphotic deformity correction surgery. Minimally invasive spine surgery has the potential benefits of faster recovery, reduced blood loss, less postoperative wound pain, lower infection risk, and shorter length of hospital stay. Novel surgical techniques such as percutaneous instrumentation fixation, cortical bone trajectory technique, screw cement augmentation, and vertebral body augmentation are developed. However, various complications have been reported, including pedicle fracture, instrumentation loosening, adjacent-level disc degeneration with herniation, and progressive junctional kyphosis. The purpose of this review was to outline various advancements in minimally invasive spinal surgery for patients with osteoporosis. Minimally invasive surgical techniques for fixation including percutaneous instrumentation, cortical bone trajectory technique, screw cement augmentation, and vertebral body augmentation have benefited patient with osteoporosis. Studies and discussions about short-segment pedicle screw fixation (one level above and below the fracture level) have shown that it provides enough stability for thoracolumbar burst fractures. There are also complications, including cement embolism, adjacent vertebral fracture, neuraxial anesthesia, and infection, which have been observed with the above technique. With the advancement of instrument and technique, the complication rate decreased in recent studies. Minimally invasive fixation still has many advantages for patients with osteoporosis. Many of these studies and strategies only have evidence from biomechanical and cadaveric studies and require further clinical trials to establish their clinical efficacy.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49256776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-29DOI: 10.18502/jost.v9i1.12569
Aidin Arabzadeh, Hosein Hamdilahzadeh, Kian Zohrabi, M. Farzan, Omid Salkhori
Background: Rice bodies can be found in rheumatic diseases, infectious diseases, and osteoarthritic joints. Rice bodies' most common locations include the subacromial bursa of the shoulder and the knee, while rice body synovitis of the wrist extensor tendons is uncommon. We have presented the case of tuberculous tenosynovitis with rice body formation in the extensor tendon sheaths of the hand and wrist. Case Report: A 51-year-old man presented with swelling and mild pain in the dorsal side of left wrist, hand, and proximal phalanx of the second finger. He stated a history of traumatic injury to the proximal phalanx of the index finger. Radiographs showed a softtissue mass shadow, and magnetic resonance imaging (MRI) showed edema and soft tissue swelling around extensor tendons extending into the distal forearm and ulnar side of the second finger in favor of tenosynovitis. Laboratory test results were normal. The patient had a negative Mantoux test result and no history of mycobacterial exposure. Surgical exploration of the lesion revealed rice bodies in the synovial sheath of extensor tendons in the wrist, extending distally to the dorsal aspect of the hand, especially the radial side. Removal of the rice bodies and complete excision of the sheath and tenosynovectomy was performed. Conclusion: As in our case, even in the absence of past tuberculosis (TB) infection or exposure, Mycobacterium TB (MTB) should be considered in the differential diagnosis of long-standing extensor tenosynovitis in the hand and wrist.
{"title":"Wrist Extensor Tenosynovitides: A Case Report","authors":"Aidin Arabzadeh, Hosein Hamdilahzadeh, Kian Zohrabi, M. Farzan, Omid Salkhori","doi":"10.18502/jost.v9i1.12569","DOIUrl":"https://doi.org/10.18502/jost.v9i1.12569","url":null,"abstract":"Background: Rice bodies can be found in rheumatic diseases, infectious diseases, and osteoarthritic joints. Rice bodies' most common locations include the subacromial bursa of the shoulder and the knee, while rice body synovitis of the wrist extensor tendons is uncommon. We have presented the case of tuberculous tenosynovitis with rice body formation in the extensor tendon sheaths of the hand and wrist. \u0000Case Report: A 51-year-old man presented with swelling and mild pain in the dorsal side of left wrist, hand, and proximal phalanx of the second finger. He stated a history of traumatic injury to the proximal phalanx of the index finger. Radiographs showed a softtissue mass shadow, and magnetic resonance imaging (MRI) showed edema and soft tissue swelling around extensor tendons extending into the distal forearm and ulnar side of the second finger in favor of tenosynovitis. Laboratory test results were normal. The patient had a negative Mantoux test result and no history of mycobacterial exposure. Surgical exploration of the lesion revealed rice bodies in the synovial sheath of extensor tendons in the wrist, extending distally to the dorsal aspect of the hand, especially the radial side. Removal of the rice bodies and complete excision of the sheath and tenosynovectomy was performed. \u0000Conclusion: As in our case, even in the absence of past tuberculosis (TB) infection or exposure, Mycobacterium TB (MTB) should be considered in the differential diagnosis of long-standing extensor tenosynovitis in the hand and wrist.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43656112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-29DOI: 10.18502/jost.v9i1.12571
Abbas Abdoli, A. Salmani
Background: Trochlea fracture usually happens with other fractures such as capitellum fracture or medial or lateral condyle fracture and isolated trochlea fracture is very rare because of its location and there are only a few cases of isolated trochlea fracture that have been reported. Case Report: We pElbow; Ulna; Humeral Fracturesresent here a 40-year-old man who suffered from an isolated trochlea fracture due to falling from three meters height on his flexed left elbow. After examination, imaging, and setting up a plan for surgery, the patient's fragment was fixed with two Herbert screws through anterior approach and after five years of follow-up which was the longest follow-up that had been reported, the patient’s elbow range of motion was 5° to full flexion with Mayo Elbow Performance Index (MEPI) of 85/100 and Disabilities of Arm, Shoulder, and Hand (DASH) score of 13.6/100. Conclusion: Isolated trochlea fracture is very rare, and it is best treated with open reduction and secure internal fixation using anterior or medial approaches
{"title":"Isolated Trochlea Fracture: A Rare Case Report","authors":"Abbas Abdoli, A. Salmani","doi":"10.18502/jost.v9i1.12571","DOIUrl":"https://doi.org/10.18502/jost.v9i1.12571","url":null,"abstract":"Background: Trochlea fracture usually happens with other fractures such as capitellum fracture or medial or lateral condyle fracture and isolated trochlea fracture is very rare because of its location and there are only a few cases of isolated trochlea fracture that have been reported. \u0000Case Report: We pElbow; Ulna; Humeral Fracturesresent here a 40-year-old man who suffered from an isolated trochlea fracture due to falling from three meters height on his flexed left elbow. After examination, imaging, and setting up a plan for surgery, the patient's fragment was fixed with two Herbert screws through anterior approach and after five years of follow-up which was the longest follow-up that had been reported, the patient’s elbow range of motion was 5° to full flexion with Mayo Elbow Performance Index (MEPI) of 85/100 and Disabilities of Arm, Shoulder, and Hand (DASH) score of 13.6/100. \u0000Conclusion: Isolated trochlea fracture is very rare, and it is best treated with open reduction and secure internal fixation using anterior or medial approaches","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44203544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-29DOI: 10.18502/jost.v9i1.12561
O. Farouk, A. Khalifa
Segmental tibial bone defects (STBD) represent a dilemma for the trauma surgeon; these defects could result from trauma, after debridement for infection, or after tumor resection. We aimed in this review to shed some light on the various reconstruction options without the need to use a circular fixator. Reconstruction options rely on various factors related to the patient, the surgeon, and the nature of the defect (location and size). Various reconstruction techniques include simple bone grafting (autograft or allografts), bone transport [distraction osteogenesis (DO)], induced membrane technique, and vascularized fibular graft. Fixation could be performed using either internal or external fixators; the latter could be a circular or a unilateral frame. Although circular frames (Ilizarov) fixators reported good results, they are still considered cumbersome, need special attention, carry pin tract infection risk, and could not be tolerated by patients. Hence, various other options were introduced, such as bone transport over an intramedullary nail (IMN), rail monolateral external fixator, and tibialisation of the ipsilateral fibula.
{"title":"Tibial Bone Loss: How to Treat without Circular Fixation?","authors":"O. Farouk, A. Khalifa","doi":"10.18502/jost.v9i1.12561","DOIUrl":"https://doi.org/10.18502/jost.v9i1.12561","url":null,"abstract":"Segmental tibial bone defects (STBD) represent a dilemma for the trauma surgeon; these defects could result from trauma, after debridement for infection, or after tumor resection. We aimed in this review to shed some light on the various reconstruction options without the need to use a circular fixator. Reconstruction options rely on various factors related to the patient, the surgeon, and the nature of the defect (location and size). Various reconstruction techniques include simple bone grafting (autograft or allografts), bone transport [distraction osteogenesis (DO)], induced membrane technique, and vascularized fibular graft. Fixation could be performed using either internal or external fixators; the latter could be a circular or a unilateral frame. Although circular frames (Ilizarov) fixators reported good results, they are still considered cumbersome, need special attention, carry pin tract infection risk, and could not be tolerated by patients. Hence, various other options were introduced, such as bone transport over an intramedullary nail (IMN), rail monolateral external fixator, and tibialisation of the ipsilateral fibula.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47565288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-29DOI: 10.18502/jost.v9i1.12568
M. Sadeghian, M. Golbakhsh, Abbas Rahimian, Parham Talebiyan, Mohammad Javad Dehghani Firoozabadi
“Sagittal balance” is defined by the anatomic relationship between the pelvis and the spine in the sagittal plane to keep the center of gravity over the feet. It is important to calculate the anatomical parameters of cervical, thoracic, lumbar, and spinopelvic regions and how any static and dynamic changes could affect the sagittal balance to understand the conditions necessary for such a balance. One of the effective changes in sagittal balance is aging, which leads to changes in spine parameters and further activation of compensatory mechanisms. Understanding the relationships between these parameters, especially in pathological cases, helps correct spine sagittal imbalance.
{"title":"Sagittal Balance Concept and Spinopelvic Parameters","authors":"M. Sadeghian, M. Golbakhsh, Abbas Rahimian, Parham Talebiyan, Mohammad Javad Dehghani Firoozabadi","doi":"10.18502/jost.v9i1.12568","DOIUrl":"https://doi.org/10.18502/jost.v9i1.12568","url":null,"abstract":"“Sagittal balance” is defined by the anatomic relationship between the pelvis and the spine in the sagittal plane to keep the center of gravity over the feet. It is important to calculate the anatomical parameters of cervical, thoracic, lumbar, and spinopelvic regions and how any static and dynamic changes could affect the sagittal balance to understand the conditions necessary for such a balance. One of the effective changes in sagittal balance is aging, which leads to changes in spine parameters and further activation of compensatory mechanisms. Understanding the relationships between these parameters, especially in pathological cases, helps correct spine sagittal imbalance.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46834689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-29DOI: 10.18502/jost.v9i1.12564
T. Apivatthakakul
Displaced femoral neck fractures in the young are difficult to treat. The complexity of the fractures for closed or open reduction requires careful surgical planning and experience. Acceptable reduction criteria in this fracture is crucial and should be followed strictly in order to get the favorable outcomes. Various reduction techniques have been described ranging from closed reduction by traction table or closed reduction with minimal direct manipulation with instruments to direct open reduction. This manuscript describes the mini open reduction, Watson-Jones and Smith-Petersen approaches, and some modifications in terms of indications, advantages, and disadvantages of each approach for the decision-making in these complex fractures.
{"title":"Surgical Approaches for Femoral Neck Fractures: A Review Article","authors":"T. Apivatthakakul","doi":"10.18502/jost.v9i1.12564","DOIUrl":"https://doi.org/10.18502/jost.v9i1.12564","url":null,"abstract":"Displaced femoral neck fractures in the young are difficult to treat. The complexity of the fractures for closed or open reduction requires careful surgical planning and experience. Acceptable reduction criteria in this fracture is crucial and should be followed strictly in order to get the favorable outcomes. Various reduction techniques have been described ranging from closed reduction by traction table or closed reduction with minimal direct manipulation with instruments to direct open reduction. This manuscript describes the mini open reduction, Watson-Jones and Smith-Petersen approaches, and some modifications in terms of indications, advantages, and disadvantages of each approach for the decision-making in these complex fractures.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44458224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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