Multimodal Therapeutic Glove in Patients with Hand Osteoarthritis: A Phase I-II Pilot Study

Background: Hand Osteoarthritis (HOA) is a prevalent form of osteoarthritis that leads to significant morbidity. The management of HOA typically involves a combination of nonpharmacological and pharmacological interventions, with a focus on safest therapies. Nonpharmacological interventions, such as splints or topical heat application, have shown potential benefits in reducing pain and improving grip strength. Obj...

Immunomodulation Enhancing Bone Synthesis: A Concept Emerging From a Clinical Case

From the late decades of the previous century and progressively into the 21st century, the science of fracture repair has significantly changed. It moved from a simple metabolic/hormonal concept of bone regeneration to an inflammatory concept, to a more complicated immunological description. It was age dependant and related to diabetes, nutrition, hormone connection, autoimmune diseases, rheumatic arthritis, and n...

Beyond Protocols: Physiotherapy in Practice

Objectives: The primary aim was to evaluate post-operative physiotherapy delivery, and to assess average treatment session numbers and duration for a range of shoulder surgeries. Metrics to develop and implement a standardised physiotherapy process protocol were identified. This was a retrospective review in Secondary Care MSK Physiotherapy Departments, within a single NHS Trust. Methods: 807 of 946 patients refer...

Long-Term Follow-Up of the Monteggia Lesions recent in Children: An 11-Year Experience

Introduction: Monteggia’ lesions account for 1.5 to 3% of elbow fractures in children. The aim of this study was to describe the management and evolution of recent Monteggia’ lesions in children, based on 11 years of experience. Patients and Method: This was a descriptive and retrospective study over 11 years covering the children admitted and managed for a recent Monteggia’ lesion. We collected and analysed the c...

Impact of the Needle Size on the Dynamic Viscosity of Hanox-M-Xl, A Cross-Linked Hyaluronic Acid Viscosupplement

Rationale: Viscosupplementation (VS) by intra-articular (IA) injections of hyaluronic acid (HA) is widely used for treating osteoarthritis (OA) of the knee, hip, ankle, shoulder and trapezio-metacarpal joints. Thus, the needle size (diameter and length) has to be adapted to the joint in which HA is injected. HA being a fragile macromolecule, it might be structurally altered according to the needle size during IA i...

Virtual Outpatient Clinics help Address Inequities in Healthcare Access

Background: Common orthopaedic fractures require outpatient clinic follow-up. Inperson clinic demand traditionally tends to exceed capacity, the impact of which falls most heavily on communities of low Socioeconomic Status (SES); especially Māori and Pacific Island communities. The Virtual Fracture Clinic (VFC) is a form of telemedicine that has been successfully adopted internationally. The utility of the VFC mod...

Evaluating Clinical Outcomes of the New Femoral Neck System (Depuy Synthes) for Femoral Neck Fractures

ABSTRACT Introduction: The recently introduced Femoral Neck System (FNS) (DePuy Synthes, Zuchwil, Switzerland) is developed for dynamic fixation with rotational stability of a fracture of the femoral neck (FNF). The aim of this study is to evaluate early implant outcomes and the rate of implant failure within 6 months of follow up. Methods: For this cohort study data was extracted from a prospective hip fracture d...

A Surgical Case Report: Scaphoid Bony Irregularity Leading to Tendon Entrapment and Attrition

The complex bony structure of the wrist and associated soft tissue attachments allows a unique combination of mobility and strength, but also renders the wrist vulnerable to injury. The scaphoid is the most commonly injured carpal bone, accounting for more than 80% of carpal fractures. Scaphoid fractures and their sequelae are frequently discussed in hand surgery literature. Flexor Carpi-Radialis (FCR) tendinitis...

Unusual Tibial Ganglion Cyst Formation Due to Bioabsorbable Screw 13 Years After Anterior Cruciate Ligament Reconstruction: A Case Report

Bioabsorbable screws are widely used as interference screws in anterior cruciate ligament reconstruction. Despite many advantages, they have certain complications associated with their usage. Pretibial and/or tibial cysts formation is a rare complication seen generally in the first few years of the operation. We reported a patient with a painful tibial ganglion cyst, which presented 13 years after ligament reconst...

Bilateral Patellar Tendon Rupture in an Adolescent Patient with the Presence of OsgoodSchlatter Disease: A Case Report and Review of the Literature

Background: Bilateral patellar tendon rupture is an extremely rare injury in children and adolescents. Predisposing factors include repetitive microtrauma, systemic metabolic or rheumatic diseases, and corticosteroid or fluoroquinolone usage. The coexistence of Osgood-Schlatter disease and patellar tendon rupture has been described very rarely in the literature. Case Report: We presented a 14-year-old male patient...

Hip Fracture Incidence – Using the National Hip Fracture Database (NHFD) to Examine Trends in Women and Men in the UK

SUMMARY We compare the numbers of hip fractures presenting in England, Wales and Northern Ireland in 2012 and 2018. Between these years the age-adjusted annual incidence of hip fracture fell by 4.7% in women, but in increased by1.9% in men. This may reflect the success of fracture prevention in women, but highlights the need for strategies focused on men. ABSTRACT Purpose: We set out to examine temporal trends in...

Fracture Risk in Obese Middle-Age Women with Autoimmune Thyroid Disease: Serbian Experience

Introduction: The association between obesity, thyroid autoimmunity and bone health is still unclear. Autoimmune thyroid disease with or without thyroid dysfunction has a significant impact on the quality of life and bone quality. It is known that menopause is u turning point at which bone density is reduced, and in this period the prevalence of thyroid disease and obesity is higher. The aim of the study was to in...

Heterotopic Ossification: Prevalence and Clinical Characteristics in Spinal Cord Injured Patients Treated at CIREN

Introduction: Neurogenic heterotopic ossification is the abnormal formation of bone in soft tissues or muscles that occurs after a neurological injury, its cause is still unknown. In the spinal cord injured patient, it has a variable prevalence, which is not known in our country and some relevant aspect of treatment. Objective: To define the prevalence of heterotopic ossification in the spinal cord injured patient...

Total Hip Arthroplasty and Immediate Weight Bearing for Osteoporotic Acetabular Fractures

Background: The treatment of osteoporotic acetabular fractures is complex since techniques of osteosynthesis have poor outcomes in this patient population. There is a trend towards treating patients acutely with a total Hip Arthroplasty (THA). We present a clinical series of osteoporotic acetabular fractures treated acutely with THA and weight bearing as tolerated. Methods: From 2008-2012, 8 patients (3 women, 4 m...

Treatment of Spinal Deformities: Don’t be « Glued » by the COBB Angle

Despite the evaluation of any spinal deformity must be always done on Morphology, Pain, Function, Self- Image, Psychology, Quality of life…The evaluation of the Cobb angle is considered as the basis of such evaluation pre and post any eventual treatment. Despite its simplicity to use It really measure very incompletely only in 2D, the morphology of the spinal deformities because essentially the horizontal plane da...

About the Correction of the Spinal Deformities

No matter, neither the etiology neither the ways of treatment not surgical or surgical, the correction of the spinal deformities is appreciated mainly on radiological purely angular measurements as well as morphological as functional on SF36 or Oswestry or other scores. The spinal community is quite addicted on these angular measurements coming from Cobb Angle AP and sagittal projections, ignoring most of the time...

Arthroscopic Management of an Intraosseous Ganglion Cyst in the Proximal Tibia

We report a case of an intraosseous ganglion in the upper end of the tibia which was managed arthroscopically. A sixty-five years old gentleman presented with left sided knee pain, plain radiographs demonstrated a small well circumscribed radiolucent lesion with thin sclerotic margins in the subchondral region of the proximal tibia. An MRI examination revealed the lesion measuring 1x1 centimetre in diameter and wa...

A Current Concept of Scapular Dyskinesia and Scapular Algorithm

The shoulder is the ultimate movable joint in the human body its anatomical construction permits a broad range of motion in multi directions. On the other hand, leads to an insubstantial balance between stability and mobility. Therefore, shoulder pain is a very common complaint in clinical practice and there are numerous conservative treatments suggested however, this condition can be overlapped by various other c...

Bones and Art Narrate the History of Dwarfs in Ancient Egypt

The existence of dwarfs is amply documented throughout ancient Egypt, in particular during Predynastic/early Dynastic Times, before the pyramids were built. Evidence includes complete and partial skeletons, artistic representations, and written texts. There were two dwarf gods, Bes and Ptah, who were widely worshiped. The artistic representations are abundant in the form of statues, amulets, as well as drawings on...

Plate Fixation of Posterior Malleolar Fractures through Posterolateral Approach

Background: Posterior malleolar fractures are intra-articular, andcan jeopardize the strength of the syndesmotic ligaments, with most of the literature noting the need for fixation when fragments are larger than 20%, however, there is no agreement on the best method for fixation. The purpose is to evaluate the clinical, functional, and radiological outcome of plate fixation of posterior malleolus using posterolate...

Drug-Induced Gout with Neprilysin Inhibitors

A number of pharmacological drugs can induce hyperuricemia, and sometimes gout, usually by interfering with the renal tubular excretion of urate but also by increasing the formation of uric acid. We report the case of a 74-year-old patient hospitalized for refractory gout-related polyarthritis despite treatment by allopurinol at maximum dose concomitant with the introduction of Entresto, which is an association o...

The Current State of Fracture-Dislocations of the Knee

Fracture-dislocations of the knee are rare and devastating injuries. They are frequently missed because they are uncommon and often occur in the polytrauma patient with distracting and life-threatening injuries. Because of their ability to cause significant morbidity if not identified and addressed acutely, they are an important topic to explore and understand in more detail. These injuries were initially classifi...

The Role of Vitamin D Levels in Geriatric Patients with Hip Fractures

Background: Vitamin D deficiency is common amongst the geriatric population. Severe vitamin D deficiency causes rickets or osteomalacia. Less severe vitamin D deficiency causes an increase of serum Parathormone (PTH) leading to bone resorption, osteoporosis and fractures. Objectives: In this study our aim was to determine, whether levels of vitamin D in geriatric patients are associated with postoperative rehabili...

The Role of Ultrasound in Shoulder Impingement Syndrome and Rotator Cuff Tear

Objective: To evaluate the role of ultrasound in shoulder impingement syndrome and rotator cuff tear in patients of primary and secondary health care settings. Methods: Google scholar, PubMed, Medline, Medscape, Wikipedia and NCBI were searched in June 2017 including all original researches and review articles to identify the relevant study. Two reviewers selected the articles independently for evaluation of the d...

Chronic Refractory Osteomyelitis Treated with Hyperbaric Oxygen Therapy

We present a case of 30 years of chronic osteomyelitis of the femur with a draining sinus, refractory to multiple surgeries and multiple courses of antibiotics. Three orthopedic surgeons were consulted regarding operative management, but could only offer curative leg amputation which was not acceptable to the patient. We added hyperbaric oxygen to the patient’s regimen. At the time of treatment initiation, patient...

The Arthroscopic-Assisted Reduction of Wrist Fracture is Worth the Reward? Single Centre Experience

Objectives/Interrogation: The goal of wrist fractures remains anatomic reduction. In literature is reported a considerable number of injuries of inter-carpal ligaments and Triangular Fibro Cartilage Complex associated (TFCC) to wrist fractures that were not detected or were underestimated using only intraoperative fluoroscopy. We proposed a retrospective study of single centre experience on arthroscopic-assisted t...

Entrapment Neuropathies of the Upper and Lower Extremities: Utility of Electrodiagnostic Studies

Entrapment neuropathies of the upper and lower extremities are commonly seen in Orthopedics consultations. In these evaluations, it is important to understand the usefulness of electrodiagnostic (EMG/NCS) studies for supporting these diagnoses. This is a review of the most common nerve entrapments of the upper and lower extremities and the critical EMG/NCS data. This summary identifies locations, signs and symptom...

Surgical Treatment of severe Thoracic Lordoscoliosis in an Adult with Freeman– Sheldon Syndrome and Respiratory Dysfunction: A 2-year Postoperative Follow-Up

Purpose: We present data of 2-year postoperative follow-up of surgical treatment for severe lordoscoliosis and respiratory dysfunction in a male patient with Freeman–Sheldon Syndrome (FSS). Methods: He was diagnosed with FSS at birth. He presented to our institution at the age of 28 years for significant spinal deformity and associated respiratory distress. Physical examination revealed joint contractures of all f...

Neurofilament Expression in a Dermatofibroma

Dermatofibroma is a benign tumor of dermal fibroblasts frequently observed in limbs. A case of dermatofibroma in the forearm is presented, with a strong and diffuse expression of vimentin and neurofilament. No neural, schwannian, endoneurial or perineurial elements were demonstrated with immunohisto chemistry. The case has positive and negative internal control. The co-expression of both intermediate filaments was...

Potentially Fatal Complication of Luxatio Erecta: Case Report and Evidence Based Literature Review

Inferior shoulder dislocation or luxatio erecta is one of the less usual forms of shoulder dislocation. Musculoskeletal and neurovascular injuries are frequently associated. Injury of the axillary artery causing pseudoaneurysm is a very rare occurrence but it is a serious surgical emergency and a surgical intervention is indicated. Misdiagnosis or delayed diagnosis of axillary pseudoaneurysm may result in upper li...

Cervical Esophageal Perforation Caused by a Fifteen-Centimeter Foreign Body: Diagnostic and Therapeutic Approach

Cervical esophageal perforation of traumatic origin is a rare condition that entails a vital risk for the patient. Early management by the emergency team is crucial to reduce the high morbidity and mortality that is usually associated with this pathology. 2. Methods We describe a rare case of cervical esophageal perforation caused by a large foreign body and review the diagnostic and therapeutic approach of this c...

A Case Series of LIPUS Stimulation in Unstable Forearm Fractures in Children to Facilitate Bone Union

This is an open labeled and retrospective cohort study which compared the efficacy of Low-intensity pulsed ultrasound (LIPUS) stimulation to facilitate unstable forearm fracture healing in children.Twenty five children with both radius and ulna diaphysis fractures were treated with intramedullary nailing (mean age 9.2±2.6 years) using K-wires. LIPUS stimulation was applied to 15 patients and not applied to 10 pati...

A Network Meta-Analysis Evaluating Different Bone Stimulation Technologies on Fracture Healing Outcomes

Background: Low Intensity Pulsed Ultrasonography (LIPUS) and Electrical Stimulation (ESTIM) are two commonly prescribed non-invasive techniques for the treatment of fresh fractures and fracture non unions. To date, no Randomized Controlled Trials (RCTs) have directly compared the efficacy of LIPUS versus ESTIM on fracture healing. Methods: We conducted a network meta-analysis that indirectly compared LIPUS with ES...

Foot and Ankle Joints Intra Articular Injection Accuracy; without Image Guidance

Introduction: Intra-articular injections form an integral part of diagnostic and therapeutic tools in Orthopaedics. Intra-articular injections have traditionally been performed without any imaging support, guided only by anatomic landmarks. This study was performed to assess the accuracy of intra-articular foot and ankle injections without fluoroscopy guidance. Aim and objectives: To measure the accuracy of foot a...

The Current Role of Minimal Invasive Surgery in Orthopaedics – A General Overview

The goal of Minimal Invasive Surgery (MIS) is to reduce surgical trauma and shorten recovery. The scope of MIS in orthopaedics and traumatology is very wide. The current article is a brief overview of the status of MIS in fracture repair, spine surgery, joint replacement surgery, sport and arthroscopic surgery. Such goal is not always achieved in all clinical scenarios. The use of modern intramedullary nails and s...

Tips, Trics and Long-Term Results of the Treatment of Trapezometacarpal Joint Osteoarthritis with Total Arthroplasty

Until a few years ago it was not given any definitive therapeutic solution to the Trapezio-methacarpal joint osteoarthritis (TMCJ OA). The first surgical solutions were simple and consisted of removal of the trapeze (trapezectomy). Afterwards, it came some procedures based in ligamentents reconstruction and tendon interposition (LRTI); these, use different neighbourhood tendons trying to improve the length and str...

Multifocal Neonatal Osteomyelitis by Acinetobacter Baumanni: Case Report and Review of Literature

Acinetobacter baumannii has emerged as a major nosocomial pathogen over the last few years, especially in immune compromised patients and in ICU settings. However reports of multifocal osteomyelitis due to haematogenous spread of ‘Extremely Drug Resistant’ (XDR) Acinetobacter baumannii in neonates is rare and that too involving the clavicle is the first of its kind. Inspite of the rarity of the condition early dia...

Ankylosis of the Major Joints and Jaw in Patients with Fibrodysplasia Ossificans Progressiva: A Report of Two Cases

Fibrodysplasia Ossificans Progressiva (FOP) is an extremely rare genetic condition characterized by congenital malformation and progressive heterotopic ossification (HO) caused by a recurrent single-nucleotide substitution at position 617 in the ACVR1 gene. As the condition progresses, HO leads to joint ankylosis, breathing difficulties, and mouth opening restriction. Here, we describe 2 cases of FOP confirmed by...

Nerve Transfers for Restoration of Elbow Flexion following Adult Brachial Plexus Injury

Restoration of elbow flexion is a fundamental functional requirement following adult brachial plexus injury. Nerve transfer offers advantages over grafting and has shown better motor recovery. Contemporary literature regarding elbow flexion reconstruction is reviewed and compared. Intraplexal expendable nerve donors for C5, C6, C7 injuries allow nerve regeneration closer to the end organ and hence improved outcome...