Time to Look for Ergonomically Viable Designs of Radiation Protection Aprons and Thyroid Shields in Orthopedic Surgery: A Survey of 416 Orthopedic Surgeons.

Introduction The advent of minimally invasive surgery has increased the use of C-arm among orthopedic surgeons. Their views on the ergonomicity of radiation protection aprons and thyroid shields need elucidation. To investigate, we deliberated a question-based survey. The primary aim of the survey was to find out the percentage of those not using these devices, the prevalence of back pain, and its relationship with the type of radiation protection aprons. Materials and methods This was a cross-sectional survey. A five-section Google Forms survey (Google, Inc., Mountain View, CA) was filled out, and responses from 416 orthopedic surgeons were included. Analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 14.0 (SPSS Inc., Chicago, IL). Results Of the total number of orthopedic surgeons, 36.8% felt that apart from radiation exposure, wearing a radiation protection apron was the biggest problem in C-arm usage. Furthermore, 20.4% wore thyroid shields the majority of the time. The 31-40 years age group was the most comfortable wearing these devices, wore them more often, and suffered more often from back pain (all p<0.01). Conclusion The study concluded that the majority of orthopedic surgeons were not comfortable with the current designs of radiation protection aprons and thyroid shields. Thyroid shields are worn less than aprons. Lead apron weight and thyroid shield ergonomicity were the number one reason for being bare-bodied. Among those who regularly wore aprons, a large proportion suffered from back pain.

Metaphyseal sleeves in revision total knee arthroplasty: Minimum seven-year follow-up study.

BACKGROUND: Metal metaphyseal sleeves are an option for reconstruction as well as enhancing fixation in managing challenging bone defects in revision knee replacement. We report our results of revision knee replacement using metaphyseal sleeves with a minimum of seven years of follow-up. METHODS: The records of 103 patients (104 knees) who underwent revision knee replacement using metaphyseal sleeves in our centre were evaluated. The follow-up included clinical assessment, functional scores and radiologic assessment. RESULTS: The mean age of patients was 74.7 (tange 58-92) years. Mean follow-up was 95.7 (range, 88-115) months. From the original cohort, 15 (14%) patients had died from unrelated causes. During the follow-up period, there were 23 (22.1%) re-revisions. Indications for re-revision was aseptic loosening in seven (6.7%), stiffness in four (3.8%), infection in five (4.8%), instability in three (2.8%) and persistent pain in two (1.9%) patients. For aseptic loosening, the average time for re-revisions was 56.6 months (range 25 to 84). Radiographically, all unrevised sleeves were well-fixed, without any evidence of loosening. Oxford knee score in patients without re-revisions was 28.5 (range four to 48). CONCLUSION: At mid-term follow-up, metaphyseal sleeves demonstrate durable clinical results and radiographic fixation.

The chondral print sign: what does it really mean?

BACKGROUND: The chondral print (CP) sign is a chondral change on the humeral head underneath the long head of the biceps (LHB) tendon. Several suggested causative links have been described, but the pathologic mechanism remains unclear. METHODS: We designed this prospective cohort association study of 102 consecutive shoulder arthroscopies to investigate proposed associations of CP with LHB, rotator cuff, labral pathology, and other chondral lesions. Data collection was by a specifically designed pro forma, and statistical analysis was performed. RESULTS: We identified 24 patients (23.5%) with the CP sign. Patients were a mean age of 58 years. Shoulders with positive CP sign had associated pathologies: 16 superior labral anteroposterior (SLAP) tears, 4 LHB instabilities, and 11 other LHB lesions. We also recorded other chondral lesions, 10 humeral head and 12 on the glenoid surface. The overall arthroscopic appearance of CP signs could be classified into 3 different types. Statistical analysis revealed that the CP sign is not statistically associated with LHB instability, any other LHB pathologies, rotator cuff tears, or instability. The CP sign was statistically positively associated with SLAP lesions (but only if type 1 were included). There was a weak association of CP sign with age and a positive association of SLAP lesions with other (non-CP) humeral chondral lesions. CONCLUSIONS: Our prospective association study cannot determine the cause of the CP sign. It does not seem to be a reliable sign of LHB instability or of other LHB pathology. There is an association with age and degenerative SLAP lesions.

Comparative study of single lateral locked plating versus double plating in type C bicondylar tibial plateau fractures.

BACKGROUND: Bicondylar tibial plateau fractures are complex injuries and treatment is challenging. Ideal method is still controversial with risk of unsatisfactory results if not treated properly. Many different techniques of internal and external fixation are used. This study compares the clinical results in single locked plating versus dual plating (DP) using two incision approaches. Our hypothesis was that DP leads to less collapse and change in alignment at final followup compared with single plating. MATERIALS AND METHODS: 61 cases of Type C tibial plateau fractures operated between January 2007 and June 2011 were included in this prospective study. All cases were operated either by single lateral locked plate by anterolateral approach or double plating through double incision. All cases were followed for a minimum of 24 months radiologically and clinically. The statistical analysis was performed using software SPSS 10.0 to analyze the data. RESULTS: Twenty nine patients in a single lateral locked plate and 32 patients in a double plating group were followed for minimum 2 years. All fractures healed, however there was a significant incidence of malalignment in the single lateral plating group. Though there was a significant increase in soft tissue issues with the double plating group; however, there was only 3.12% incidence of deep infection. There was no significant difference in Hospital for special surgery score at 2 years followup. CONCLUSION: Double plating through two incisions resulted in a better limb alignment and joint reduction with an acceptable soft tissue complication rate.

Impact of patellar height on unicompartment knee arthroplasty: does patella baja lead to an inferior outcome?

BACKGROUND: Though a number of series with long-term results have been published, there is still a paucity of literature on the role of patellar height after unicompartment knee arthroplasty (UKA). The present study was conducted with a hypothesis that patella baja may lead to a poor outcome at follow-up. MATERIALS AND METHODS: A retrospective review of 134 knees was performed and patellar height calculated before and after UKA by Blackburne-Peel index (BPI) and the Insall-Salvati ratio (ISR) on true lateral radiographs of the patients in 30° of flexion taken pre-operatively and at 1 year, 2 years and final follow-up (minimum 5 years). Statistical analysis was performed to evaluate the outcomes. RESULTS: There was a decrease in ISR in 14.18 % and in BPI in 19.4 % at final follow-up. There was a significant decrease in BPI values while the decrease was not significant for ISR. After eliminating the pre-operative patella baja, 7.3 % developed post-operative patella baja, according to ISR, while 11.5 % developed patella baja as per BPI. At final follow-up there was a statistically significant decrease in stair climbing scores in patients with patella baja when compared to patients with normal ISR. CONCLUSION: Patients with a decrease in patellar height as per ISR have a decrease in stair climbing score at mid-term follow-up while the overall KSS, and pain scores are not affected by a change in patellar height and neither is there a significant progress in patellofemoral osteoarthritis among patients with patella baja compared to normal patella.

Role of nonoperative treatment in managing degenerative tears of the medial meniscus posterior root.

BACKGROUND: Tears of the medial meniscus posterior root can lead to progressive arthritis, and its management has no consensus. The aim of our study was to evaluate the effect of supervised exercise therapy on patients with medial meniscus posterior root tears. MATERIALS AND METHODS: Between January 2005 and May 2007, 37 patients with this tear verified by magnetic resonance imaging (MRI) and osteoarthritis grade 1-2 by radiographic examination were treated by a short course of analgesics daily for up to 6 weeks and then as required during follow-up, as well as a 12-week supervised exercise program followed by a home exercise program. Final analysis was performed for 33 patients, average age 55.8 (range 50-62) years and average follow-up of 35 (range 26-49) months. Patients were followed up at 3, 6, and 12 months and yearly thereafter using the Lysholm Knee Scoring Scale, Tegner Activity Scale (TAS), and visual analog scale (VAS). The analysis was performed using one-way analysis of variance (ANOVA) and Pearson's correlation coefficient to determine the relationship between Lysholm score and body mass index (BMI). RESULTS: Patients showed an improvement in Lysholm score, TAS, and VAS, which reached maximum in 6 months and later was accompanied by a decline. However, scores at the final follow-up were significantly better than the pretherapy scores. There was also a progression in arthritis as per Kellgren and Lawrence radiographic classification from median 1 preintervention to median 2 at the final follow-up. A correlation between BMI and Lysholm scores was seen (r = 0.47). CONCLUSION: Supervised physical therapy with a short course of analgesics followed by a home-based program results in symptomatic and functional improvement over a short-term follow-up; however, osteoarthritis progression continues and is related to BMI.

Skeletal muscle tuberculosis simultaneously involving multiple sites.

Tuberculosis (TB) continues to be a public health problem in both developing and industrialized countries. TB of the skeletal muscle is very rare. We present a case of the simultaneous involvement of skeletal muscles in multiple sites in an 11-year-old immune-competent female patient. All physicians should have adequate knowledge of TB and awareness of its atypical presentations to ensure the proper management of such patients.

Irreducible dislocation of all the lesser metatarsophalangeal joints of the foot: a case report.

We report a case of irreducible dorsal dislocation of all the lesser metatarsophalangeal joints of the foot following injury at sport. Plantar plate prevented reduction at all the joints, which necessitated an open reduction and stabilization with K-wire. This report highlights the necessity of prompt open reduction and reviews the mechanism of injury and complex anatomy at metatarsophalangeal joint.

Tubercular osteomyelitis of distal ulna presenting as epiphyseal injury.

Tuberculosis (TB) continues to be a public health problem in both developing and industrialized countries. T.B can involve any bone theoretically but involvement of distal metaphysis and epiphysis is a rare presentation. We present a case of 11yr old female child who presented to us with pain and swelling in distal forearm and radiograph revealing an osteolytic lesion in distal ulnar metaphysic and volar displacement of epiphysis. Histopathology and BACTEC culture led us to a diagnosis. Awareness of atypical presentations of TB is most important in endemic areas to ensure proper management of such patients.

Ipsilateral femoral neck and trochanter fracture.

Ipsilateral fractures in the neck and trochanteric region of the femur are very rare and seen in elderly osteoporotic patients. We present a case of a young man who presented with ipsilateral fracture of the femoral neck and a reverse oblique fracture in the trochanteric region following a motor vehicle accident. A possible mechanism, diagnostic challenge, and awareness required for identifying this injury are discussed.

IIlizarov external fixator for bilateral severe flexion deformity of the knee in haemophilia: case report.

INTRODUCTION: Deformity correction by Illizarov method in haemophilic patients is a rare phenomenon. AIM: To correct the bilateral knee deformity by Illizarov in one sitting. MATERIALS AND METHODS: Patient had fixed flexion deformity (100 degrees ) of both knees; posterior skin webs, posterior subluxation, wasting of quadriceps and <1% level of factor IX. Patient was managed with optimisation of factor IX level in perioperative period by factor IX supplementations. Deformities were corrected by Illizarov's fixator on both lower limbs at 3 months and fixator was removed at 4 months. At 3 months, patient developed bilateral equinus deformity which was corrected by a dynamic foot sling and gentle tendoachillis stretching exercises. RESULT: Patient had superficial pin tract infection at three sites. There were no episodes of bleeding from pin tracts or in knee joint during distraction period. Patient had bilateral knees flexion up to 120 degrees with 5 degrees extensor lag on the right side. Patient is going to college and walks with intermittent use of a hinge knee brace at 3 years follow-up. CONCLUSION: Illizarov method is a safe, less invasive, effective, economical and truly biological method for correction of severe flexion deformities of knee in haemophilic patients.

Total hip arthroplasty in patients with active tuberculosis of the hip with advanced arthritis.

UNLABELLED: Osteoarticular tuberculosis (TB) in the hip and other joints is increasing and patients in developing countries commonly present with advanced joint destruction. We asked whether TB is reactivated after THA in these patients. We retrospectively reviewed 12 patients with an average age of 45 years who had advanced stages of hip destruction secondary to mycobacterium TB and who were treated with primary THA and prescribed perioperative antituberculous medication for 12 to 18 months postoperatively. Diagnosis in all these patients was confirmed by histopathology and culture. The minimum followup was 25 months (average, 41 months; range, 25-58 months). We observed no reactivation of TB in 11 patients who had Harris hip scores ranging from 86 to 97. One patient who postoperatively did not comply with the antituberculous chemotherapy had reactivation and superimposed infection through a nonhealing sinus tract; that patient underwent component removal and resection arthroplasty. When the infected tissue can be débrided and adequate antituberculous therapy is instituted the outcome of joint arthroplasty may not be adversely affected. THA in the tuberculous hip has a low risk of reactivation and produces good functional results. LEVEL OF EVIDENCE: Level IV, therapeutic case series (no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.