Primary Results of Hook Plate Fixation Technique for Ulnar Collateral Ligament Fracture-Avulsion: A Case Study.

Background: Ulnar collateral ligament(UCL) fracture-avulsion of the thumb which involves small osseous fragments is among common injuries to the thumb metacarpophalangeal (MCP) joint. Methods: This case series was conducted on 11 patients (9 males and 2 females) with a mean age of 25.4±4.8 years with acute traumatic UCL fracture-avulsion with instability and Stener Lesion. A low-profile 2-mm stainless steel hook plate with a 2-mm screw was used for the internal fixation. Immobilization was performed for 10 days. Range of motion movements (ROM), grip power, and pinch strength were measured after three months. At the end of the follow-up period, functional outcomes were determined by the visual analog scale (VAS), and Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH). Results: The mean follow-up period was reported as 12.4±2.3 months. the union of avulsed small osseous fragments occurred at the end of the three-month follow-up. A number of 10 patients were treated by one hole 2-mm plate with a screw and a mean VAS score of 22.5±2.4, while a female patient had more severe pain with a mean score of 45. This patient complained about the irritation of the plate, especially in the thumb grip. The mean Quick DASH score was 9.6±1.4. The postoperative ROM was similar to that of the other side. Grip power and pinch strength were lower in the treated thumb, as compared to that in the opposite side; nonetheless, the difference was not statistically significant. Conclusion: As evidenced by the obtained results, it can be concluded that the hook plate technique is a strong fixation method for thumb UCL fracture-avulsion, raising the possibility of earlier joint movements and rapid recovery; nevertheless, in some cases, it can reduce efficiency and induce painful grip.

Palmar approach for fixation of metacarpal fractures.

Between 2018 and 2020, 14 patients with closed metacarpal fractures requiring open reduction were operated on via a palmar approach. Reduction and fixation were done with screws or plates. We assessed range of motion, grip strength, Mayo score, possible nerve damage and cosmesis. The range of motion and grip strength were fully restored by 6 months after operation. Transient paraesthesiae in the digital nerve territory occurred in two patients and had resolved by 3 months. In selected patients the palmar approach for metacarpal shaft fractures can provide satisfactory cosmesis and function of the hand. This method can be useful in patients with history of hypertrophic scarring or in patients who would prefer to avoid a visible scar on the dorsum of the hand.Level of evidence: IV.

Is Standing Coronal Long-Leg Alignment View Effective in Predicting the Extent of Medial Soft Tissue Release in Varus Deformity during Total Knee Arthroplasty?

The aim of this study was to assess the predictive value of the femoral intermechanical-anatomical angle (IMA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), femorotibial or varus angle (VA), and joint line convergence angle (CA) in predicting the stage of the medial collateral ligament (MCL) during total knee arthroplasty (TKA) of varus knee. We evaluated 229 patients with osteoarthritic varus knee who underwent primary TKA, prospectively. They were categorized in three groups based on the extent of medial soft tissue release that performed during TKA Group 1, osteophytes removal and release of the deep MCL and posteromedial capsule (stage 1); Group 2, the release of the semimembranosus (stage 2); and Group 3, release of the superficial MCL (stage 3) and/or the pes anserinus (stage 4). We evaluated the preoperative standing coronal hip-knee-ankle alignment view to assessing the possible correlations between the knee angles and extent of soft tissue release. A significant difference was observed between the three groups in terms of preoperative VA, CA, and MPTA by using the Kruskal-Wallis test. The extent of medial release increased with increasing VA and CA as well as decreasing MPTA in preoperative long-leg standing radiographs. Finally, a patient with a preoperative VA larger than 19, CA larger than 6, or MPTA smaller than 81 would need a stage 3 or 4 of MCL release. The overall results showed that the VA and MPTA could be useful in predicting the extent of medial soft tissue release during TKA of varus knee.

Value of D-Dimer as a Diagnostic Marker of Infection Associated with Orthopedic Implants.

BACKGROUND: Recently, the D-dimer biomarker has gained the researchers' attention for predicting infections. We aimed to determine the relationship between this marker and other inflammatory markers involved in orthopedic implant-associated infections. MATERIALS AND METHODS: In this study, all patients diagnosed with an orthopedic implant-associated infection were investigated in 3 years. The serum level of D-dimer, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) was measured. Infection was diagnosed based on the clinical and culture results of biopsy samples. RESULTS: The cultured microorganisms, detected in 26 patients with infections, included Staphylococcus aureus (n = 13, 50%), Staphylococcus epidermidis (n = 2, 7.7%), Klebsiella aerogenes (n = 8, 30.8%), and Pseudomonas aeruginosa (n = 3, 11. 5%). Based on laboratory findings, there was a significant difference in the CRP level and ESR (P = 0.001). Although the level of D-dimer was higher in infected patients, compared to the controls (992.6 ± 667.2 vs. 690.1 ± 250.2 ng/mL), the difference was not statistically significant. There was no significant correlation between the elevated D-dimer level and CRP level, whereas ESR had a positive correlation with the elevated D-dimer level (r = 0.6, P = 0.03). The sensitivity, specificity, and positive predictive value (PPV) of D-dimer in the prediction of infection were 65%, 57%, and 45%, respectively. Furthermore, the sensitivity, specificity, and PPV of CRP were 100%, 92.3%, and 95%, respectively, whereas the corresponding values for ESR were 85%, 69.2%, and 62%, respectively. CONCLUSION: Measurement of the serum D-dimer level is not efficient for the diagnosis of orthopedic implant-associated infections due to its low predictive value. Furthermore, there was no significant correlation between the serum D-dimer level and CRP.

Closed K-wire Fixation for the Treatment of Perilunate Dislocation and Trans-Scaphoid Perilunate Fracture Dislocations without Ligamentous Repair: Short Term Follow-Up.

BACKGROUND: The purpose of this study was to evaluate the treatment outcomes of perilunate dislocations (PLDs) and transscaphoid perilunate fracture dislocations (TSPLDs) treated with operative volar approach without ligament repair or reconstruction. METHODS: A total of seven patients (10 hands) were studied during 2017-2018. We fixed scaphoid fractures thorough a volar approach and 3 k-wires were inserted to stabilize the scaphoid to the adjacent bones. We evaluated patients' range of motion by VAS and grip strength, sensitivity assessment, and radiographs. Mayo and DASH scores were also recorded for wrist evaluation. RESULTS: All fractures united well. The mean Mayo wrist score was 81.5. Five patients scored good and excellent results (90-100). Excellent DASH scores (˂20) were observed in 4 patients and there was no poor DASH score (˃50). CONCLUSION: Treatment of PLDs and TSPLDs with k-wire and screw fixation using a volar approach and without any ligament repair or reconstruction results in minimal manipulation and has favorable short-term outcomes.

Effects of dry needling on tendon-pulley architecture, pain and hand function in patients with trigger finger: a randomized controlled trial study.

[Purpose] The purpose of this study was to determine the effect of dry needling on tendon-pulley architecture, pain and hand function in patients with trigger finger. [Participants and Methods] A randomized controlled trial was conducted. Fifty eight patients having trigger finger were randomly assigned as either an experimental group that received a single session of dry needling over pulleyA1 and flexor tendon or a control group that received no intervention. Thickness of tendon-pulley, and pain-hand function (by disability arm-shoulder questionnaire score and pinch grip strength) were measured by a blinded assessor before and one week after intervention. [Results] The two way mixed ANOVA in the experimental group showed that the thickness of pulley-tendon decreased, pinch grip power increased and DASH questionnaire score was decreased in comparison to the control group. [Conclusion] This study results suggest that a single session of Dry Needling (DN) was effective in decreasing pain, DASH score, pulley-tendon thickness and improving pinch grip power in patients with trigger finger.

Studying the effects of primary arthroplasty on post-treatment results among elderly patients with pertrochanteric fracture.

Various therapeutic methods are available to treat patients with intertrochantric fracture, which is usually caused by falling down. This complication is usually observed among the elderly, particularly old women. The choice of the proper therapeutic method depends on many factors including patient's condition, type of fracture, and the amount of movement. Hip arthroplasty is one of these therapeutic methods, which have certain advantages and disadvantages. Immediate resumption of walking with the ability of weight toleration and absence of complications such as aseptic necrosis are some advantages of this method. Sixtyeight elderly patients with pertrochanteric fracture who had resorted to Iranian Army's hospitals and had undergone arthroplasty. These cases were examined with due comparison with historical and external controls. Variables such a type of operation, age, post-operation pain, the pace of resuming walking ability, embolism, surgical site infection, bedsore and DVT were studied and compared against standard operation. The results achieved through assessment of variables showed a significant difference with standard operation in terms of variables such as post-operative movement ability, pain scale in various times, surgical complications, embolism, surgical site infection, bedsore, and DVT. Post-operative pain within the first 3 months following it are some complications with not much attention is paid to them, but they are important complications which can cause many negative and influential effects on patients. Arthroplasty is more expensive than standard operation and the patient may initially feel more pain.

Comparative investigation of percutaneous plating and intramedullary nailing effects on IL-6 production in patients with tibia shaft fracture.

OBJECTIVE: The aim of this study was to analyze the effect of intramedullary nailing (IMN), open plating and percutaneous plating on the induction of IL-6 in patients with tibia fractures. METHODS: A total of 30 patients with tibia shaft fracture underwent either intramedullary nailing (IMN, n = 15; 14 males and 1 female; mean age: 32.1 ± 15.6), ORIF plating (n = 8; 5 males and 3 females; mean age: 60.0 ± 17.8), or percutaneous plating (n = 7; 6 males and 1 female; mean age: 43.1 ± 21.4). Serum IL-6 cytokine levels were measured prior to, and 6 and 24 h after the surgery, using a special ELISA kit. RESULTS: The IL-6 concentration increased to peak levels at 6 h in both IMN and percutaneous plating groups, and at 24 h in ORIF plating group (p < 0.001). The mean IL-6 concentration of percutaneous plating group was significantly lower than that of the IMN group at 6 h following the surgery (p = 0.022). In addition, the mean IL-6 concentration of ORIF plating group was significantly higher than that of the percutaneous plating group at 24 h post operation (p = 0.009). CONCLUSION: Our results suggest that percutaneous plating compared to the IMN has lower effects on IL-6 production in patients with tibia fracture. LEVEL OF EVIDENCE: Level III, therapeutic study.

Osteochondritis Dissecans of the Humeral Head: A Case Report and Review of the Literature.

Osteochondritis dissecans (OCD) is a common joint disorder in knee, ankle and elbow, however it can be rarely found in glenohumeral joint. In this study, we report an asymptomatic case of humeral head OCD, which was detected incidentally following a trauma. X-rays showed an area of lucency around an oval bony fragment measuring about 1 cm on the superior aspect of the humeral head. However, the patient was pain-free and the shoulder range of motion was normal.