Biomechanical study of the abductor pollicis longus & extensor pollicis brevis after release and reconstruction of the first dorsal compartment of the wrist.

BACKGROUND: The purpose of this study was to determine the biomechanical changes after first dorsal compartment release and after Z-plasty of the first dorsal compartment with respect to the excursion and displacement of the abductor pollicis longus and extensor pollicis brevis tendons. MATERIALS AND METHODS: Six fresh frozen cadaveric hand and forearms were obtained and the tendons of the abductor were exposed and separated from surrounding tissues through a palmar incision and tenotomized at the musculotendinous junction. The excursion and displacement of the abductor pollicis brevis and flexor pollicis brevis tendons were measured for all six cadaveric hands. RESULTS: Increases in tendon excursion were observed in both the abductor pollicis longus (29%) and extensor pollicis brevis (30%) while these observations after Z-plasty were 0.04% for abductor pollicis longus and 0.07% for extensor pollicis brevis. With the use of the modified Elftman curve for the Lengths, tension relationship and Brand's data for resting fiber length we found that 1 cm increase of The excursion of the APL and EPB will decrease tension %65 and %80 respectively. There was also a 12.2-mm displacement of the tendons after release and 4.8 mm displacement after z-plasty of the compartment. CONCLUSION: It seems that Procedures such as enlargement plasty of Kapandji or Z-plasty will increase the size of the compartment but will not change the biomechanical behaviors of the tendons significantly.

Results of surgical treatment for Sprengle's deformity with vertical corrective scapular osteotomy.

INTRODUCTION: Sprengle deformity is the most common congential anomaly of shoulder complex that is the result of scapular placement in cephalad abnormal position. The purpose of this study is the evaluation of clinical and radiological results of vertical corrective scapular osteotomy and comparision of these results with previous studies. METHODS: We retrospectively reviewed the results of the vertical corrective scapular osteotomy (VSO) with or without clavicular osteotomy and wake-up test in 31 consecutive patients at an average duration of follow up of 30 month (6 month-15 years). 22 patients were girls and 9 were boys. The average age of the patients was 7.3 years (3-13) at the time of surgery. We evaluated the clinical and radiological results of this method in last fallow-up. No funding was used for this study and there are no conflicts of interest. RESULTS: 31 surgical procedures were performed. All osteotomies were healed. No neurovascular complication. Postoperative the mean shoulder flexion and abduction were improved 30 and 36° respectively (p < 0.001). The mean improvement of superior scapular angle (S.S.A) and inferior scapular angle (I.S.A) were 16 and 21° respectively (p < 0.001). CONCLUSION: It is intuitive that more cosmetic scapular lowering with little chance of neurovascular problems can be achieved after VSO. In addition, scapular rotation can be corrected using this technique, which should be considered as one of the advantages of this technique.We believe that a properly applied VSO procedure in severe deformities is safe with predictable outcomes in the treatment of a complex deformity that provides favorable functional and cosmetic outcomes in the longer term.

Osteochondral autograft transfer (mosaicplasty) for treatment of patients with osteochondral lesions of talus.

PURPOSE: Osteochondral lesion of talus (OLT) is one of the common causes of ankle pain. This disorder is common in young athletes after ankle injury. There are various therapeutic options. One of the options is mosaic plasticizer. The purpose of this study was to investigate the effect of mosaicplasty on improvement of symptoms of patients with osteochondral lesions of talus. METHODS: Nineteen patients with osteochondral lesions of talus participated in this study, who were treated with mosaicplasty. Before and after treatment, pain (visual analogue scale), function (American Orthopaedic Foot and Ankle Society), range of motion and radiographic signs were evaluated. RESULTS: The results of this study showed that mosaicplasty could significantly reduce pain, increase function and improve radiographic symptoms. The range of motion increased after treatment, which was not significant. CONCLUSION: We can confirm the effect of mosaicplasty on the improvement of patients with osteochondral lesions of the ankle, suggesting it as a treatment option.

Clinical and functional results of radial club hand with centralization and pollicization using the second metacarpus: A clinical case series.

INTRODUCTION: Radial club hand (RCH) is a rare congenital deformity leading in several functional and psychological problems. However, our knowledge about the long-term functional outcomes of treating RCH is limited. In current study, we investigated the outcomes of centralization and pollicization using second or third metacarpal bone in RCH patients. METHODS: There were 15 hands (13 patients) with RCH underwent centralization and pollicization using second or third metacarpal bone or tendon transfer. The patients aged 1.2 ±â€¯1 years at the time of the surgery. On early postoperative x-rays, the forearm-hand angle was measured. The patients were followed for 6.2 ±â€¯2.3 years. At the final visit, disabilities of arm, shoulder and hand (DASH) score was completed. Furthermore, forearm-hand angle and range of motion of both wrists in sagittal and coronal planes were measured. RESULTS: The mean of forearm-hand angle increased significantly. In 11 wrists, forearm-hand angle increased only 10 degrees of less. The range of operated wrist was improved in sagittal and coronal planes. The relative range of wrist motion in patients with unilateral deformity in sagittal and coronal planes was 83 ±â€¯11 percent and 61 ±â€¯12 percent. Three patients developed skin necrosis. CONCLUSION: Early centralization and pollicization using second or third metacarpal bone can significantly restore the range of motion and function in patients with RCH.

Treatment of Massive Irreparable Rotator Cuff Tear with Arthroscopic Subacromial Bursectomy, Biceps tenotomy, and Tuberoplasty.

BACKGROUND: The alternative surgery for massive and irreparable shoulder rotator cuff tears in older patients is the debridement of subacromial bursa, biceps tenotomy, and tuberoplasty (reverse acromioplasty). This study aimed to report the effectiveness of such a treatment performed arthroscopically in a small group of patients for a short period of time. METHODS: This prospective study was conducted on 12 patients with massive irreparable rotator cuff tear during 2014-2017. Participants with the mean age of 65 were subjected to arthroscopic debridement of subacromial bursa, necrotic rotator cuff tendon remnants, and tuberoplasty without coracoacromial ligament excision. The sign and symptoms of patients before and after the surgery were evaluated based on Modified-University of California at Los Angeles (UCLA) Shoulder Score. RESULTS: With the mean follow-up of 18 months (12-24 months), the mean of the modified UCLA score improved from 9.2 to 27.5. The obtained results of the study revealed that the pain and range of motion improved to near normal in the participants. The functional outcome was good although there were a decrease of acromiohumeral distance from 5 to 4 mm and a slight increase in degenerative changes. CONCLUSION: This simple arthroscopic procedure is recommended for massive irreparable rotator cuff tear, especially in elderly patients. LEVEL OF EVIDENCE: IV.

Modified Internal Fixation Technique for Acromio-Clavicular (AC) joint dislocation: The "Hidden Knot Technique".

Acromioclavicular (AC) joint injuries are common and often seen in contact athletes, resulting from a fall on the shoulder tip with adducted arm. This joint is stabilized by both static and dynamic structures including the coracoclavicular (CC) ligament. Most reconstruction techniques focus on CC ligament augmentation as the primary stabilizer of the AC joint. The best surgical technique for some AC joint dislocations is still controversial. In this study, we explained a modification of the CC ligament reconstruction technique described by Wellmann. The method is based on minimally invasive CC ligament augmentation with a flip button/polydioxanone (PDS) repair, typically used for extracortical ACL graft fixation. Patients commonly complain that heavy sutures under the skin in subcutaneous tissue irritate the skin and sometimes require reoperation for suture removal. We present an augmentation technique that resolves this issue by changing the suture knot location to the sub-clavicular position. Level of evidence: II.

Repair of Massive and Irreparable Rotator Cuff Tear Using Arthroscopic Method.

Rotator cuff tear stands as one of the major origins of shoulder discomfort and disability, especially in elderly patients over 60 years. Improvement of performance and reduction of pain hardly occur in patients with contracted rotator cuff tear. Despite therapeutic advances, yet there are many discussions over choosing the best type of treatment for major rotator cuff tear. Complete care of massive rotator cuff tear continues to be a challenge in shoulder surgery. Treatment options have changed in comparison with traditional treatment methods in open or arthroscopic debridement surgery with or without decompression. Recently, many treatments have been introduced, including a range of non-surgical treatments, acromioplasty by debridement, minor repair biceps tenotomy, tuberoplasty by biceps tenotomy, minor repair, mini-open rotator cuff repair, arthroscopic rotator cuff, muscle movement, reverse shoulder arthroscopy, soft tissue reinforcement and hemiarthroplasty. Non-surgical massive rotator cuff control is typically assigned for patients with insignificant pain. This therapy functions by changing activities, proper use of steroid injections and physical therapy with an emphasis on the anterior deltoid exercises. But the main problem is the selection of the best treatment and making the final decision. In general, in the arthroscopic, morbidity, postoperative pain along with hospital stay are less and the operation has better cosmetic results. So this information and our results have prompted us to study a variety of rotator cuff treatment methods with a focus on the arthroscopic treatment.

Clinical Results of Platelet-Rich Plasma for Partial Thickness Rotator Cuff Tears: A Case Series.

Partial thickness rotator cuff tears (PTRCTs) are a common pathology among shoulder disorders in people over 50 years. Treatment of PTRCTs remains controversial. Most studies on the treatment of PTRCTs have explained surgical techniques or outcomes; few studies have centralized on the conservative and new management of PTRCTs, like treatment with Platelet-rich plasma (PRP). These case series study have been conducted on Platelet-rich plasma (PRP) injection, as a concentrated source of cytokines that can stimulate healing of soft tissue. PRP injection showed positive effect on improving PTRCTs complains. This method improved pain, function, DASH score and shoulder joint range motion in. Because of PRP products are safe and easy to prepare and apply, and also according to improving patient's condition, this method can be used to treat PTRCTs.

Wound dehiscence after total knee arthroplasty.

INTRODUCTION: Wound dehiscence is one of the most common complications of surgical ulcer, involving the breaking open of the surgical incision along the stitch. This condition is a severe complication of total knee arthroplasty. PRESENTATION OF CASE: We report a case of a 59-year-old female patient with diabetes who underwent a total knee arthroplasty in which all layers of wounds were dehiscence and prosthetic was exposed. DISCUSSION: Wound dehiscence is a complication after total knee arthroplasty especially in diabetic patient. So, patients with diabetes more susceptible to development of wound dehiscence following total knee arthroplasty and should be followed particularly postoperatively care. CONCLUSION: Postoperative care after knee replacement should be more considered in diabetic patients. Finally the patient was successfully treated with irrigation and debridement (I&D) and polyethylene insert exchange.

Loosening of Total Knee Arthroplasty after Brucellosis Infection: A Case Report.

In this report we describe a 78-year-old man whose total knee arthroplasty showed the symptoms of infection with brucella with radiographic signs of loosening 5 years after the index surgery. The patient was treated successfully after a 2-stage revision arthroplasty surgery along with using rifampicin and doxycycline for 8 weeks.