Introduction: Airborne Biologic Particles (ABPs) are a potential risk factor for infection following total joint arthroplasty. Factors such as temperature and humidity may affect the number of ABPs which can increase the risk of infection. Comparisons of ABP count between Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) have yet to be made. Our study examines the differences in ABP count between primary THA and TKA procedures. Methods: We analyzed all primary TJA procedures done within the same OR at an academic institution from April 2019 to June 2020. All procedures between the dates of March 15, 2020 – May 4, 2020 were excluded to avoid COVID-related confounding. Intraoperative measurements of temperature, humidity, and ABP count per minute were recorded. A report containing surgical data from the same time was generated using the institution’s Electronic Health Records (EHR) system and cross-referenced to the intraoperative measurements using procedure start and end times. ABP was calculated as an average ABP count per minute. Descriptive statistics were used to evaluate differences in variables of interest. P-values were calculated using t-test for continuous variables and chi square for categorical values. Results: A total of 168 cases were included in the study, comprised of 98 (58.3%) primary THA and 70 (41.7%) primary TKA. No significant differences in room temperature or particle counts across all particle sizes were found between THA and TKA groups. Similarly, time spent in the room was not significantly different between THA and TKA. The only variable that was significantly different between the two groups was average relative humidity, with higher humidity in the THA group (46.9% + 7.56 vs 44.4% + 8.02, p=0.008). Conclusion: There were no significant differences in temperature or particle count between primary THA and primary TKA procedures, suggesting OR air quality was similar between the two procedure types. Further investigation including additional variables such as OR size, airflow patterns, and different procedure types should be performed to better characterize the role of ABPs in air quality and infection risk.
简介:空气中的生物颗粒(ABPs)是全关节置换术后感染的潜在危险因素。温度和湿度等因素可能会影响ABPs的数量，从而增加感染的风险。全髋关节置换术(THA)和全膝关节置换术(TKA)之间ABP计数的比较尚未进行。我们的研究检查了原发性THA和TKA手术中ABP计数的差异。方法:我们分析了2019年4月至2020年6月在同一学术机构的同一手术室进行的所有初级TJA手术。排除2020年3月15日至2020年5月4日之间的所有手术，以避免与covid相关的混淆。记录术中温度、湿度和每分钟ABP计数。使用该机构的电子健康记录(EHR)系统生成包含同一时间手术数据的报告，并使用手术开始和结束时间交叉引用术中测量结果。ABP以每分钟平均ABP计数计算。描述性统计用于评估感兴趣变量的差异。对连续变量采用t检验，对分类值采用卡方法计算p值。结果:本研究共纳入168例，其中原发性THA 98例(58.3%)，原发性TKA 70例(41.7%)。在THA组和TKA组之间，室温和所有颗粒大小的颗粒数没有显着差异。同样，在房间里花费的时间在THA和TKA之间没有显着差异。两组间唯一有显著差异的变量是平均相对湿度，THA组的平均相对湿度更高(46.9% + 7.56 vs 44.4% + 8.02, p=0.008)。结论:原发性全髋关节置换术和原发性全髋关节置换术在温度和颗粒计数方面没有显著差异，表明两种手术类型的手术室空气质量相似。进一步的调查应包括其他变量，如手术室大小、气流模式和不同的手术类型，以更好地表征ABPs在空气质量和感染风险中的作用。
{"title":"How Sterile Are Our Operating Rooms? A Comparison of Air Quality During Primary TKA and THA","authors":"Gennaro DelliCarpini","doi":"10.46889/josr.2023.4202","DOIUrl":"https://doi.org/10.46889/josr.2023.4202","url":null,"abstract":"Introduction: Airborne Biologic Particles (ABPs) are a potential risk factor for infection following total joint arthroplasty. Factors such as temperature and humidity may affect the number of ABPs which can increase the risk of infection. Comparisons of ABP count between Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) have yet to be made. Our study examines the differences in ABP count between primary THA and TKA procedures.\u0000\u0000Methods: We analyzed all primary TJA procedures done within the same OR at an academic institution from April 2019 to June 2020. All procedures between the dates of March 15, 2020 – May 4, 2020 were excluded to avoid COVID-related confounding. Intraoperative measurements of temperature, humidity, and ABP count per minute were recorded. A report containing surgical data from the same time was generated using the institution’s Electronic Health Records (EHR) system and cross-referenced to the intraoperative measurements using procedure start and end times. ABP was calculated as an average ABP count per minute. Descriptive statistics were used to evaluate differences in variables of interest. P-values were calculated using t-test for continuous variables and chi square for categorical values.\u0000\u0000Results: A total of 168 cases were included in the study, comprised of 98 (58.3%) primary THA and 70 (41.7%) primary TKA. No significant differences in room temperature or particle counts across all particle sizes were found between THA and TKA groups. Similarly, time spent in the room was not significantly different between THA and TKA. The only variable that was significantly different between the two groups was average relative humidity, with higher humidity in the THA group (46.9% + 7.56 vs 44.4% + 8.02, p=0.008). \u0000\u0000Conclusion: There were no significant differences in temperature or particle count between primary THA and primary TKA procedures, suggesting OR air quality was similar between the two procedure types. Further investigation including additional variables such as OR size, airflow patterns, and different procedure types should be performed to better characterize the role of ABPs in air quality and infection risk.","PeriodicalId":382112,"journal":{"name":"Journal of Orthopaedic Science and Research","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132747735","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}
Introduction: The recent emphasis on tissue preservation and minimally invasive outpatient joint replacements has resulted in a significant increase in the use of Direct Anterior Approach (DAA) total hip arthroplasty. It has gained interest recently because of its faster short-term recovery, despite concerns about increased complications and operative time, especially during the learning curve period. The primary objective of this study was to determine whether complications of transitioning to a direct anterior approach for primary total hip arthroplasty may impair patient safety. Methods: A total of 51 primary hip arthroplasties were performed in 44 patients with the direct anterior approach technique: 37 unilateral arthroplasties and 7 bilateral arthroplasties, during the first 3 years of the learning curve of this technique and their complications were analyzed. Results: No patient had severe complications or surgical reinterventions associated to transoperative complications. Tearing of the tensor fascia lata muscle was on average the most frequent complication (19.6%), followed by skin lesions (17.6%), difficulty in implant reduction (9.8%) and fractures of the greater trochanter (7.8%). No severe complications occurred. Conclusion: This study demonstrates that the transition to the direct anterior approach can be done safely without a significant complication rate. These complications are usually associated with the use of inadequate special instruments, inadequate patient selection and the knowledge of maneuvers of the surgeon and his team acquired during the experience and development of the technique. Even so, they do not require additional treatment, which allows us to conclude that this technique is reproducible and can be safely transitioned.
{"title":"Transition to Anterior Approach in Primary Total Hip Arthroplasty - Learning Curve Complications","authors":"Leopoldo J Maizo","doi":"10.46889/josr.2023.4201","DOIUrl":"https://doi.org/10.46889/josr.2023.4201","url":null,"abstract":"Introduction: The recent emphasis on tissue preservation and minimally invasive outpatient joint replacements has resulted in a significant increase in the use of Direct Anterior Approach (DAA) total hip arthroplasty. It has gained interest recently because of its faster short-term recovery, despite concerns about increased complications and operative time, especially during the learning curve period. The primary objective of this study was to determine whether complications of transitioning to a direct anterior approach for primary total hip arthroplasty may impair patient safety.\u0000\u0000Methods: A total of 51 primary hip arthroplasties were performed in 44 patients with the direct anterior approach technique: 37 unilateral arthroplasties and 7 bilateral arthroplasties, during the first 3 years of the learning curve of this technique and their complications were analyzed.\u0000\u0000Results: No patient had severe complications or surgical reinterventions associated to transoperative complications. Tearing of the tensor fascia lata muscle was on average the most frequent complication (19.6%), followed by skin lesions (17.6%), difficulty in implant reduction (9.8%) and fractures of the greater trochanter (7.8%). No severe complications occurred.\u0000\u0000Conclusion: This study demonstrates that the transition to the direct anterior approach can be done safely without a significant complication rate. These complications are usually associated with the use of inadequate special instruments, inadequate patient selection and the knowledge of maneuvers of the surgeon and his team acquired during the experience and development of the technique. Even so, they do not require additional treatment, which allows us to conclude that this technique is reproducible and can be safely transitioned.","PeriodicalId":382112,"journal":{"name":"Journal of Orthopaedic Science and Research","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126417433","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}
Background: The most common cause of discomfort in old age is osteoarthritis. The age range between 55 and 64 years old has the largest annual incidence of knee osteoarthritis. 65 and younger make up more than half of those with symptomatic knee OA. Women make up 62% of those with osteoarthritis. Aim: The current study’s objective is to determine the effect of osteoarthritis pain in the knees of older women on their ability to carry out everyday activities in Northern Upper Egypt. Setting: The investigation was conducted in the orthopaedics outpatient clinic and the physiotherapy unit at Beni-Suef University Hospital. Subjects: In the current study, 300 studied women were recruited using a non-probability consecutive sampling technique. Tools: Katz scale, interview questionnaire, and Visual Analog Scale (VAS). Results: showed that more than one-third (40%) of the elderly women in the study had knee joint problems from less than five years ago and 70% of them experienced severe pain. Additionally, 30% of the women in the study required supervision, guidance, personal assistance, or complete care when getting dressed, and 90% reported fatigue, 71.3% anxiety, and 70% limited social participation. Conclusion: The pain of osteoarthritis in older women has an impact on their social, psychological, and physical health. Recommendations: Through targeted programs to people in the community, raise public awareness of osteoarthritis pain and complications.
{"title":"Impact of Elderly Women's Knee Osteoarthritis Pain on Daily Living Activity at Northern Upper Egypt","authors":"H. Hassan","doi":"10.46889/josr.2023.4108","DOIUrl":"https://doi.org/10.46889/josr.2023.4108","url":null,"abstract":"Background: The most common cause of discomfort in old age is osteoarthritis. The age range between 55 and 64 years old has the largest annual incidence of knee osteoarthritis. 65 and younger make up more than half of those with symptomatic knee OA. Women make up 62% of those with osteoarthritis. Aim: The current study’s objective is to determine the effect of osteoarthritis pain in the knees of older women on their ability to carry out everyday activities in Northern Upper Egypt. Setting: The investigation was conducted in the orthopaedics outpatient clinic and the physiotherapy unit at Beni-Suef University Hospital. Subjects: In the current study, 300 studied women were recruited using a non-probability consecutive sampling technique. Tools: Katz scale, interview questionnaire, and Visual Analog Scale (VAS). Results: showed that more than one-third (40%) of the elderly women in the study had knee joint problems from less than five years ago and 70% of them experienced severe pain. Additionally, 30% of the women in the study required supervision, guidance, personal assistance, or complete care when getting dressed, and 90% reported fatigue, 71.3% anxiety, and 70% limited social participation. Conclusion: The pain of osteoarthritis in older women has an impact on their social, psychological, and physical health. Recommendations: Through targeted programs to people in the community, raise public awareness of osteoarthritis pain and complications.","PeriodicalId":382112,"journal":{"name":"Journal of Orthopaedic Science and Research","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124645938","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}
Background: Given that optimization of management of the subscapularis is essential to ensuring an optimal outcome after shoulder arthroplasty, this review will focus on the ideal method of Lesser Tuberosity Osteotomy (LTO) repair and the methods by which this is assessed. Specifically, we will review the existing literature to determine how suture configuration, number of sutures, type of sutures, and osteotomy size all influence the biomechanics of an LTO repair. Methods: A systematic review was performed in which one reviewer searched PubMed to find studies analyzing biomechanical strength of lesser tuberosity osteotomy repairs after a total shoulder arthroplasty. The following keywords were used to retrieve articles: (biomechanical) and (Lesser Tuberosity Osteotomy) or (LTO) or (subscapularis repair) and (total shoulder). Results: Nine studies met inclusion criteria. LTO was the strongest, most durable repair in most biomechanical studies. However, the biomechanical testing protocols and repair techniques widely varied throughout the literature. Dual row repair with sutures wrapped around the stem as well thin LTO fragments showed superior biomechanical outcomes. There has been minimal literature focusing on how the number, size and type of suture utilized in a repair affect biomechanical outcomes. Discussion: While the LTO repair technique has been demonstrated in multiple studies to be a biomechanically superior method of subscapularis repair in the setting of TSA, there has not been a single study which has analyzed the effects of repair technique, osteotomy size, as well as suture number/type/size using a standardized biomechanical testing protocol.
{"title":"Coping Strategies among Elderly Women with Knee Osteoarthritis Pain at Beni-Suef City: Impact of Socio-demographic Characteristics","authors":"Trevor D. Ottofaro","doi":"10.46889/josr.2023.4107","DOIUrl":"https://doi.org/10.46889/josr.2023.4107","url":null,"abstract":"Background: Given that optimization of management of the subscapularis is essential to ensuring an optimal outcome after shoulder arthroplasty, this review will focus on the ideal method of Lesser Tuberosity Osteotomy (LTO) repair and the methods by which this is assessed. Specifically, we will review the existing literature to determine how suture configuration, number of sutures, type of sutures, and osteotomy size all influence the biomechanics of an LTO repair.\u0000\u0000Methods: A systematic review was performed in which one reviewer searched PubMed to find studies analyzing biomechanical strength of lesser tuberosity osteotomy repairs after a total shoulder arthroplasty. The following keywords were used to retrieve articles: (biomechanical) and (Lesser Tuberosity Osteotomy) or (LTO) or (subscapularis repair) and (total shoulder).\u0000\u0000Results: Nine studies met inclusion criteria. LTO was the strongest, most durable repair in most biomechanical studies. However, the biomechanical testing protocols and repair techniques widely varied throughout the literature. Dual row repair with sutures wrapped around the stem as well thin LTO fragments showed superior biomechanical outcomes. There has been minimal literature focusing on how the number, size and type of suture utilized in a repair affect biomechanical outcomes.\u0000\u0000Discussion: While the LTO repair technique has been demonstrated in multiple studies to be a biomechanically superior method of subscapularis repair in the setting of TSA, there has not been a single study which has analyzed the effects of repair technique, osteotomy size, as well as suture number/type/size using a standardized biomechanical testing protocol.","PeriodicalId":382112,"journal":{"name":"Journal of Orthopaedic Science and Research","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122145148","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}
Background: The leading cause of pain and incapacity in elderly women is Osteoarthritis (OA). It affects females more frequently than males. The quantity and quality of coping resources that a person may have at their disposal affect the coping style they ultimately choose. The purpose of this study was to examine how the socio-demographic features of older women in Beni-Suef city who were experiencing knee Osteoarthritis (OA) pain affected their coping mechanisms. Design: The current study used a descriptive cross-sectional research design. The investigation was conducted in the orthopaedics outpatient clinic and the physiotherapy unit at Beni-Suef University Hospital. Subjects: In the current study, 300 studied women were recruited using a non-probability consecutive sampling technique. Tools: Pain Coping Inventory (PCI), Visual Analog Scale (VAS) and Interview Questionnaire Results: Based on the visual analogue scale for measuring pain intensity. It demonstrates that 50% of the older women in the study had low coping skills, 49.3% experienced moderate pain, 50.3% had moderate and 50.3% had severe pain. Younger (65-70 years old), women with intermediate education (38.5% and 32.7%), women who were retired and unemployed (48.1% and 32.7%), married (92.3%), women who lived in rural areas (53.8%) and elderly adult women with an adequate family income (92.3%) were more likely to use high levels of coping strategies. There was a positive association between pain level and activities of daily life (r= 0.109 and p= 0.05) and a severe negative link between the overall pain coping inventory and degree of pain (r= -0.280 and p= 0.000). Conclusion: Age, educational attainment, employment position and marital status all significantly influenced how well older women coped with pain. Even Nevertheless, there was a statistically significant correlation between the ability of older women to cope with pain and their monthly income and area of residence. The overall pain coping inventory and the visual analogue scale were shown to have a substantial negative connection. While the Katz scale for ADL and the pain coping inventory showed a positive association.
{"title":"Systematic Review of Lesser Tuberosity Osteotomy Techniques, Outcomes and Biomechanical Testing Parameters: A Critical Appraisal","authors":"H. Hassan","doi":"10.46889/josr.2023.4106","DOIUrl":"https://doi.org/10.46889/josr.2023.4106","url":null,"abstract":"Background: The leading cause of pain and incapacity in elderly women is Osteoarthritis (OA). It affects females more frequently than males. The quantity and quality of coping resources that a person may have at their disposal affect the coping style they ultimately choose. The purpose of this study was to examine how the socio-demographic features of older women in Beni-Suef city who were experiencing knee Osteoarthritis (OA) pain affected their coping mechanisms.\u0000\u0000Design: The current study used a descriptive cross-sectional research design. The investigation was conducted in the orthopaedics outpatient clinic and the physiotherapy unit at Beni-Suef University Hospital.\u0000\u0000Subjects: In the current study, 300 studied women were recruited using a non-probability consecutive sampling technique.\u0000\u0000Tools: Pain Coping Inventory (PCI), Visual Analog Scale (VAS) and Interview Questionnaire\u0000\u0000Results: Based on the visual analogue scale for measuring pain intensity. It demonstrates that 50% of the older women in the study had low coping skills, 49.3% experienced moderate pain, 50.3% had moderate and 50.3% had severe pain. Younger (65-70 years old), women with intermediate education (38.5% and 32.7%), women who were retired and unemployed (48.1% and 32.7%), married (92.3%), women who lived in rural areas (53.8%) and elderly adult women with an adequate family income (92.3%) were more likely to use high levels of coping strategies. There was a positive association between pain level and activities of daily life (r= 0.109 and p= 0.05) and a severe negative link between the overall pain coping inventory and degree of pain (r= -0.280 and p= 0.000).\u0000\u0000Conclusion: Age, educational attainment, employment position and marital status all significantly influenced how well older women coped with pain. Even Nevertheless, there was a statistically significant correlation between the ability of older women to cope with pain and their monthly income and area of residence. The overall pain coping inventory and the visual analogue scale were shown to have a substantial negative connection. While the Katz scale for ADL and the pain coping inventory showed a positive association.","PeriodicalId":382112,"journal":{"name":"Journal of Orthopaedic Science and Research","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123226842","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}
Background: Hip osteoarthritis, a highly disabling disease with no distinct cause, and a disease associated with high degrees of pain, stiffness, and disability continues to affect the lives of many adults of all ages highly adversely and may be influenced adversely by some forms of muscle dysfunction, such as hip muscle atrophy. Aim: To examine the prevailing research support for a mediating or causative role of muscle atrophy in hip osteoarthritis. Methods: An in-depth literature review focusing on hip osteoarthritis muscle atrophy associations was conducted. Results: A fair number of past and recent research reports indicate efforts to examine and intervene to minimize one or more attributes of hip muscle atrophy appears promising in the context of efforts to foster improved outcomes of hip joint osteoarthritis, regardless of the application of high-tech surgery. Conclusion: Future research efforts are strongly indicated.
{"title":"Hip Muscle Atrophy and Hip Osteoarthritis-Evidence and Continuing Challenges","authors":"R. Marks","doi":"10.46889/josr.2023.4105","DOIUrl":"https://doi.org/10.46889/josr.2023.4105","url":null,"abstract":"Background: Hip osteoarthritis, a highly disabling disease with no distinct cause, and a disease associated with high degrees of pain, stiffness, and disability continues to affect the lives of many adults of all ages highly adversely and may be influenced adversely by some forms of muscle dysfunction, such as hip muscle atrophy.\u0000\u0000Aim: To examine the prevailing research support for a mediating or causative role of muscle atrophy in hip osteoarthritis.\u0000\u0000Methods: An in-depth literature review focusing on hip osteoarthritis muscle atrophy associations was conducted.\u0000\u0000Results: A fair number of past and recent research reports indicate efforts to examine and intervene to minimize one or more attributes of hip muscle atrophy appears promising in the context of efforts to foster improved outcomes of hip joint osteoarthritis, regardless of the application of high-tech surgery.\u0000\u0000Conclusion: Future research efforts are strongly indicated.","PeriodicalId":382112,"journal":{"name":"Journal of Orthopaedic Science and Research","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121655235","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}
Background: Abnormal craniofacial contour and deformities of the appendicular skeleton of the lower limbs can occur in connection with a long list of skeletal dysplasia. The natural history of chronic/unusual disorders can be a precise key factor towards a successful diagnostic process. Material and Methods: Three unrelated children aged 18-months, 2 and 7 year (two boys and one girl) presented with generalised skeletal mal-development compatible with multiple epiphyseal dysplasia. However, in the early months of life these children have been diagnosed with early infancy insulin dependent diabetes. Strikingly, all manifested Wormian bones over the lambdoid sutures. In addition to Progressive malalignment of the lower limbs and thoracic kyphosis associated with significant growth deficiency were the major skeletal abnormalities. Endochondral ossification was diffusely affected associated with multiple epiphyseal dysplasia and appearance of irregular and fragmented epiphyses. Results: Based on early permanent neonatal or early-infancy insulin-dependent diabetes, associated with the clinical and radiological phenotypic characterizations of multiple epiphyseal dysplasia and growth retardation as the major abnormalities in these children. Wolcott-Rallison syndrome was the highly likely diagnosis. The most interesting findings in this study; The Wormian bones, not only involved the lambdoid sutures, but also extended to involve the occipitomastoid suture. We confirmed our diagnosis via sequence analysis which revealed a homozygous nonsense gene mutation (EIF2AK3) resulting in a premature stop codon (c.2707 C>T, p.R903X). Parents in two families were identified as heterozygous carriers of this mutation. Conclusion: The significance of this study is to point out the importance of analysing the skull bones in children with skeletal dysplasia. Interestingly, for the first time we detected the downward bulging of the occiput because of the abundancy of the Wormian bones (sites of maximal skull bone fragility) along the lambdoid and the occipito-mastoid sutures is by itself a highly alarming sign of progressive weakness of the weight-bearing zone (which is represented by the lambdoid and the occipitomastoid sutures). The exerting load of the cerebrum on these vulnerable and soft sutures can lead to brain swelling (a serious condition). Despite that lower limb defects in children are the most frequent deformities encountered in the departments of paediatric orthopaedics, because of the real or apparent detrimental effect that they have on gait and upright activity, and it draw immediate and alarming attention to parents. But, nevertheless, it is the responsibility of physicians to pay prompt attention for the necessity to scrutinize the skulls and the craniocervical junction in patients with long term bone disorders.
{"title":"Distinctive Cranial Abnormalities in Children with Early Infancy Insulin Dependent Diabetes in Connection with Wolcott-Rallison Syndrome","authors":"A. Kaissi","doi":"10.46889/josr.2023.4104","DOIUrl":"https://doi.org/10.46889/josr.2023.4104","url":null,"abstract":"Background: Abnormal craniofacial contour and deformities of the appendicular skeleton of the lower limbs can occur in connection with a long list of skeletal dysplasia. The natural history of chronic/unusual disorders can be a precise key factor towards a successful diagnostic process. \u0000\u0000Material and Methods: Three unrelated children aged 18-months, 2 and 7 year (two boys and one girl) presented with generalised skeletal mal-development compatible with multiple epiphyseal dysplasia. However, in the early months of life these children have been diagnosed with early infancy insulin dependent diabetes. Strikingly, all manifested Wormian bones over the lambdoid sutures. In addition to Progressive malalignment of the lower limbs and thoracic kyphosis associated with significant growth deficiency were the major skeletal abnormalities. Endochondral ossification was diffusely affected associated with multiple epiphyseal dysplasia and appearance of irregular and fragmented epiphyses. \u0000\u0000Results: Based on early permanent neonatal or early-infancy insulin-dependent diabetes, associated with the clinical and radiological phenotypic characterizations of multiple epiphyseal dysplasia and growth retardation as the major abnormalities in these children. Wolcott-Rallison syndrome was the highly likely diagnosis. The most interesting findings in this study; The Wormian bones, not only involved the lambdoid sutures, but also extended to involve the occipitomastoid suture. We confirmed our diagnosis via sequence analysis which revealed a homozygous nonsense gene mutation (EIF2AK3) resulting in a premature stop codon (c.2707 C>T, p.R903X). Parents in two families were identified as heterozygous carriers of this mutation.\u0000\u0000Conclusion: The significance of this study is to point out the importance of analysing the skull bones in children with skeletal dysplasia. Interestingly, for the first time we detected the downward bulging of the occiput because of the abundancy of the Wormian bones (sites of maximal skull bone fragility) along the lambdoid and the occipito-mastoid sutures is by itself a highly alarming sign of progressive weakness of the weight-bearing zone (which is represented by the lambdoid and the occipitomastoid sutures). The exerting load of the cerebrum on these vulnerable and soft sutures can lead to brain swelling (a serious condition). Despite that lower limb defects in children are the most frequent deformities encountered in the departments of paediatric orthopaedics, because of the real or apparent detrimental effect that they have on gait and upright activity, and it draw immediate and alarming attention to parents. But, nevertheless, it is the responsibility of physicians to pay prompt attention for the necessity to scrutinize the skulls and the craniocervical junction in patients with long term bone disorders.","PeriodicalId":382112,"journal":{"name":"Journal of Orthopaedic Science and Research","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130135019","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}
In the article we present one of two main etiopathological groups of pathology of locomotor system. The health of the adults very often depends on the effectiveness of prophylaxis and proper treatment of disorders in the childhood. The treatment of children often can be easy and give good results, what is important for all years of life of everybody. In our experience, the abnormalities described in article are very frequent, due to various reasons. In the article we present one of the causes of pathology.
{"title":"Syndrome of Contractures and Deformities (SofCD): Dysplasia of Hips, Varus Deformity of Shanks, Wry Neck, So-Called Idiopathic Scoliosis Causes Clinic Prophylaxis Therapy","authors":"T. Karski","doi":"10.46889/josr.2023.4103","DOIUrl":"https://doi.org/10.46889/josr.2023.4103","url":null,"abstract":"In the article we present one of two main etiopathological groups of pathology of locomotor system. The health of the adults very often depends on the effectiveness of prophylaxis and proper treatment of disorders in the childhood.\u0000\u0000The treatment of children often can be easy and give good results, what is important for all years of life of everybody. In our experience, the abnormalities described in article are very frequent, due to various reasons. In the article we present one of the causes of pathology.","PeriodicalId":382112,"journal":{"name":"Journal of Orthopaedic Science and Research","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122996188","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}
Background: Tibial plateau fractures comprise a heterogenic group of patients, involving several mechanisms and variability in demographic characteristics. Although short term peri-operative clinical and radiologic outcomes are well described in the literature, long-term prognosis reports are scarce. Hypothesis: Long-term prognosis of Tibial plateau fractures may be correlated with secondary Osteoarthritis (OA) and the need for total knee arthroplasty in rates greater than reported in the current literature, which focuses on short and mid-term prognosis. Methods: 310 patients treated for Tibial plateau fractures, with a follow up period of 10-30 years were attempted contact by mail. They were questioned about their knee function and subsequent surgeries following the index operation. Total knee arthroplasty was defined as the primary endpoint. Results:70 patients had responded. 61 patients were treated surgically primarily with an ORIF, and nine were treated conservatively. The median follow-up period was 211 months (range 121-368). The median Tegner-Lysholm knee function score was 74.5 (IQR 43). 25 patients underwent additional surgery in the injured knee, and 15 patients with inferior Tegner-Lysholm score had TKA. Several distinguished characteristics were found and discussed. Conclusions: Tibial plateau fractures are a heterogenic group of injuries, with a sub-optimal functional outcome and a high prevalence of additional surgeries, in specific, knee arthroplasty.
{"title":"Morbidity and Total Knee Arthroplasty as a Long-Term Sequela of Tibial Plateau Fractures","authors":"Eran Keltz","doi":"10.46889/josr.2023.4102","DOIUrl":"https://doi.org/10.46889/josr.2023.4102","url":null,"abstract":"Background: Tibial plateau fractures comprise a heterogenic group of patients, involving several mechanisms and variability in demographic characteristics. Although short term peri-operative clinical and radiologic outcomes are well described in the literature, long-term prognosis reports are scarce.\u0000\u0000Hypothesis: Long-term prognosis of Tibial plateau fractures may be correlated with secondary Osteoarthritis (OA) and the need for total knee arthroplasty in rates greater than reported in the current literature, which focuses on short and mid-term prognosis.\u0000\u0000Methods: 310 patients treated for Tibial plateau fractures, with a follow up period of 10-30 years were attempted contact by mail. They were questioned about their knee function and subsequent surgeries following the index operation. Total knee arthroplasty was defined as the primary endpoint.\u0000\u0000Results:70 patients had responded. 61 patients were treated surgically primarily with an ORIF, and nine were treated conservatively. The median follow-up period was 211 months (range 121-368). The median Tegner-Lysholm knee function score was 74.5 (IQR 43). 25 patients underwent additional surgery in the injured knee, and 15 patients with inferior Tegner-Lysholm score had TKA. Several distinguished characteristics were found and discussed.\u0000\u0000Conclusions: Tibial plateau fractures are a heterogenic group of injuries, with a sub-optimal functional outcome and a high prevalence of additional surgeries, in specific, knee arthroplasty.","PeriodicalId":382112,"journal":{"name":"Journal of Orthopaedic Science and Research","volume":" 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113950597","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}
Background: Arthralgia in connection with patellar instability have been studied thoroughly in a number of pediatric and adult patients. Small and dysplastic patellae accompanied by hypoplasia of the lateral femoral condyle may results in recurrent subluxation or dislocation of the patellae, knee discomfort and pain. We aimed to detect the underlying etiology of every single patient. Patients and Methods: A total of seven children presented with long term painful knee joints have been refered from the departments of rheumatology. We added adult female patient of a-35-years-old. She was a chronic client of rheumatology clinics since her postadulthood. In addition to her early life knee pain. Recently she experienced additional chronic pain of the groin (located at the posterior buttocks). All our patients showed episodes of knee pain with variable intensity as a constant complaint and all received antirheumatic treatments for years despite the negative results of the implemented tests. In order to commence the diagnostic process, clinical and radiological phenotypic characterization were the main core of our stratregy followed by molecular genetic confirmation. Results: Seven unrelated children (aged from 8-17 years old) were consistent with the diagnosis of Nail- Patella syndrome. The adult female patient of a-35-years-old- manifested patellar instability since her early childhood. Her clinical phenotype was totally compatible with the diagnosis of Nail-Patella syndrome. Surprisingly, the clinical examination of the female patient and the standing AP pelvis radiograph revealed massive encroachment of the medial aspect of the femoral neck and the lesser trochanters onto the ischium. The latter resulted in the diagnosis of Ischiofemoral Impingement (IFI) syndrome. Her genetic tests showed heterozygous mutation in the LIM-homeodomain protein LMX1B on chromosome 9q33. Conclusion: Arthralgia associated with abnormal gait (mostly antalgic gait and waddling gait) was the paramount clinical presentation in all our patients. Dysplasia of the nails and patellar instability were the characteristic clinical findings in our patients with the definite diagnosis of osteo-onychodysplasia syndrome. We approached to the diagnosis from the first session of clinical examination. Interestingly, the constant groin pain in the adult female patient which has been totally overlooked by other instutions, were in favor of the diagnosis of Ischiofemoral Impingement (IFI) syndrome. As well as the existing abnormality of the elbows associated with defective pronation and supination as due to impingement of the olecranon. The task of establishing the diagnostic process in complex clinical conditions is the most challenging. Sadly speaking, none of the aforemnetioned dignostic criteria attracted the attention of dozens of clinicians. Admistering medications to overcome knee pain through dozens of useless laboratory tests were the main false issue. Clinicians who are actively
{"title":"Chronic Knee Pain is the Paramount Presentation in Patients with Nail-Patella Syndrome","authors":"A. Kaissi","doi":"10.46889/josr.2022.4101","DOIUrl":"https://doi.org/10.46889/josr.2022.4101","url":null,"abstract":"Background: Arthralgia in connection with patellar instability have been studied thoroughly in a number of pediatric and adult patients. Small and dysplastic patellae accompanied by hypoplasia of the lateral femoral condyle may results in recurrent subluxation or dislocation of the patellae, knee discomfort and pain. We aimed to detect the underlying etiology of every single patient.\u0000\u0000Patients and Methods: A total of seven children presented with long term painful knee joints have been refered from the departments of rheumatology. We added adult female patient of a-35-years-old. She was a chronic client of rheumatology clinics since her postadulthood. In addition to her early life knee pain. Recently she experienced additional chronic pain of the groin (located at the posterior buttocks). All our patients showed episodes of knee pain with variable intensity as a constant complaint and all received antirheumatic treatments for years despite the negative results of the implemented tests. In order to commence the diagnostic process, clinical and radiological phenotypic characterization were the main core of our stratregy followed by molecular genetic confirmation.\u0000\u0000Results: Seven unrelated children (aged from 8-17 years old) were consistent with the diagnosis of Nail- Patella syndrome. The adult female patient of a-35-years-old- manifested patellar instability since her early childhood. Her clinical phenotype was totally compatible with the diagnosis of Nail-Patella syndrome. Surprisingly, the clinical examination of the female patient and the standing AP pelvis radiograph revealed massive encroachment of the medial aspect of the femoral neck and the lesser trochanters onto the ischium. The latter resulted in the diagnosis of Ischiofemoral Impingement (IFI) syndrome. Her genetic tests showed heterozygous mutation in the LIM-homeodomain protein LMX1B on chromosome 9q33.\u0000\u0000Conclusion: Arthralgia associated with abnormal gait (mostly antalgic gait and waddling gait) was the paramount clinical presentation in all our patients. Dysplasia of the nails and patellar instability were the characteristic clinical findings in our patients with the definite diagnosis of osteo-onychodysplasia syndrome. We approached to the diagnosis from the first session of clinical examination. Interestingly, the constant groin pain in the adult female patient which has been totally overlooked by other instutions, were in favor of the diagnosis of Ischiofemoral Impingement (IFI) syndrome. As well as the existing abnormality of the elbows associated with defective pronation and supination as due to impingement of the olecranon. The task of establishing the diagnostic process in complex clinical conditions is the most challenging. Sadly speaking, none of the aforemnetioned dignostic criteria attracted the attention of dozens of clinicians. Admistering medications to overcome knee pain through dozens of useless laboratory tests were the main false issue. Clinicians who are actively","PeriodicalId":382112,"journal":{"name":"Journal of Orthopaedic Science and Research","volume":"209 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132131654","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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