Isolated pisiform dislocation after a seizure episode.

A 31-year-old woman had a seizure episode three weeks before, leading to a fall on her left hand. Following the accident, she had discomfort on the ulnar side of her left wrist. She decided to seek treatment from a local bone setter; however, her hand discomfort continued and she then came to us for treatment. The radiography and computed tomography scan demonstrated a pisiform dislocation. The pisiform bone was surgically removed. The pisiform dislocation should be considered in the differential diagnosis of the ulnar side wrist discomfort following wrist trauma.

Plastic and elastic biomechanical properties of anterior cruciate ligament autografts.

BACKGROUND: Anterior cruciate ligament (ACL) rupture is a common orthopedic injury, occurring in roughly 68.6 per 100,000 persons annually, with the primary treatment option being ACL reconstruction. However, debate remains about the appropriate graft type for restoring the native biomechanical properties of the knee. Furthermore, plastic graft elongation may promote increased knee laxity and instability without rupture. This study aims to investigate the plastic properties of common ACL-R graft options. METHODS: Patellar tendon (PT), hamstring tendon (HT), and quadriceps tendon (QT) grafts were harvested from 11 cadaveric knees (6 male and 5 female) with a mean age of 71(range 55-81). All grafts were mechanically tested under uniaxial tension until failure to determine each graft's elastic and plastic biomechanical properties. RESULTS: Mechanically, the QT graft was the weakest, exhibiting the lowest failure force and the lowest failure stress (QT < HT, p = 0.032). The PT was the stiffest of the grafts, having a significantly higher stiffness (PT > QT, p = 0.0002) and Young's modulus (PT > QT, p = 0.001; PT > HT, p = 0.041). The HT graft had the highest plastic elongation at 4.01 ± 1.32 mm (HT > PT, p = 0.002). The post-yield behavior of the HT tendon shows increased energy storage capabilities with the highest plastic energy storage (HT > QT, p = 0.012) and the highest toughness (HT > QT, p = 0.032). CONCLUSION: Our study agrees with prior studies indicating that the failure load of all grafts is above the requirements for everyday activities. However, grafts may be susceptible to yielding before failure during daily activities. This may result in the eventual loss of functionality for the neo-ACL, resulting in increased knee laxity and instability.

Antibiotic prophylaxis following low-velocity gunshot fractures: an updated review.

PURPOSE: Low-velocity gunshot fractures (LVGFs) are a common type of gunshot-induced trauma with the potential for complications such as infection and osteomyelitis. The effectiveness of antibiotic therapy in LVGFs remains uncertain, leading to ongoing debate about the appropriate treatment. In this review, we evaluate recent updates on the current understanding of antibiotic therapy in LVGFs, how previous studies have investigated the use of antibiotics in LVGFs, and the current state of institutional policies and protocols for treating LVGFs with antibiotics. METHODS: We conducted a review of PubMed, Embase, and Web of Science databases to identify studies that investigated the use of antibiotics in LVGFs after the last review in 2013. Due to the lack of quantitative clinical trial studies, we employed a narrative synthesis approach to analyze and present the findings from the included primary studies. We categorized the outcomes based on the anatomical location of the LVGFs. RESULTS: After evaluating 67 publications with the necessary qualifications out of 578 abstracts, 17 articles were included. The sample size of the studies ranged from 22 to 252 patients. The antibiotics used in the studies varied, and the follow-up period ranged from three months to ten years. The included studies investigated the use of antibiotics in treating LVGFs at various anatomic locations, including the humerus, forearm, hand and wrist, hip, femur, tibia, and foot and ankle. CONCLUSION: Our study provides updated evidence for the use of antibiotics in LVGFs and highlights the need for further research to establish evidence-based guidelines. We also highlight the lack of institutional policies for treating LVGFs and the heterogeneity in treatments among institutions with established protocols. A single-dose antibiotic approach could be cost-effective for patients with non-operatively treated LVGFs. We suggest that a national or international registry for gunshot injuries, antibiotics, and infections could serve as a valuable resource for collecting and analyzing data related to these important healthcare issues.

Trapezium Tunnel Syndrome.

The trapezium tunnel is situated on the lateral side of the carpal tunnel, lined with synovial tissue, and accommodates the flexor carpi radialis tendon. Trapezium tunnel syndrome is characterized by flexor carpi radialis tendinitis/peritendinitis and may lead to complicated clinical scenarios, such as flexor carpi radialis tendon rupture and the formation of primary or recurrent ganglion cysts on the volar radial side of the wrist and thenar area. Notably, the simultaneous presence of trapezium tunnel syndrome might contribute to unsuccessful outcomes in carpal tunnel surgeries. Trapezium tunnel syndrome may arise from either intrinsic or extrinsic factors. The entity of trapezium tunnel syndrome has attracted a low index of clinical suspicion because the other causes of radial side wrist pain that are more prevalent and frequent. We present a narrative review of this condition in an endeavor to heighten awareness and clinical suspicion of trapezium tunnel syndrome.

Sliding Plate System: A Novel Method and Device for Shortening Osteotomy.

We report a novel sliding plate system (SPS) and its application for radial shortening osteotomy. We conceptualised, designed and introduced the SPS, which helps with precise shortening osteotomy in both radius and ulna. We implanted the SPS in a patient with Kienböck disease following a radius shortening osteotomy. The SPS was safe and efficient, and the surgical technique eliminated extra steps. The SPS affords precise shortening, optimum compression and anatomic alignment after radius shortening osteotomy. Level of Evidence: Level V (Therapeutic).

Black discoloration of the knee articular cartilage in a patient with pigmented villonodular synovitis: A case report.

In this case report, total knee arthroplasty was performed in a patient with pigmented villonodular synovitis. During surgery, severe black discoloration of the articular cartilage and menisci was observed in the patient. According to literatures, this is the first case report of severe articular cartilage pigmentation in a patient with pigmented villonodular synovitis.

Assessment of Bone Healing: Opportunities to Improve the Standard of Care.

➤ Bone healing is commonly evaluated by clinical examination and serial radiographic evaluation. Physicians should be mindful that personal and cultural differences in pain perception may affect the clinical examination. Radiographic assessment, even with the Radiographic Union Score, is qualitative, with limited interobserver agreement.➤ Physicians may use serial clinical and radiographical examinations to assess bone healing in most patients, but in ambiguous and complicated cases, they may require other methods to provide assistance in decision-making.➤ In complicated instances, clinically available biomarkers, ultrasound, and magnetic resonance imaging may determine initial callus development. Quantitative computed tomography and finite element analysis can estimate bone strength in later callus consolidation phases.➤ As a future direction, quantitative rigidity assessments for bone healing may help patients to return to function earlier by increasing a clinician's confidence in successful progressive healing.

Persian Fixation - A Novel Surgical Method for Intra-articular Distal Radius Fractures.

Background: Intra-articular distal radius fracture treatment options include Kirschner wires (K-wire) fixation, external fixation and plate fixation, however, fixation of small bone fragments in distal radius fractures in a secure and anatomical manner was a challenging issue with several limitations. In this study, we present a novel surgical method that we have called the Persian Fixation for intra-articular distal radius fracture and describe a short-term clinical result. Methods: We described the surgical procedure and clinical result of 15 patients between 2019 and 2020 in whom the Persian Fixation technique was utilised. Through clinical examination and questionnaires, objective and subjective clinical results were determined. Results: At the final follow-up, the mean Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score for our patients was 17.6 ± 12.1, the mean WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP) score was 20.7 ± 4.4 and the mean Visual Analogue Scale (VAS) score was 27.8 ± 16.5, indicating a good to excellent clinical result. Conclusions: We recommended the Persian Fixation technique for intra-articular distal radius fractures, which is a low-cost and readily accessible procedure that provides stable fixation of a tiny bone piece. Level of Evidence: Level IV (Therapeutic).

Validity and Reliability of the Persian Version of WOrk-Related Questionnaire for UPper Extremity Disorders (WORQ-UP).

Background: We aimed to evaluate the validity and reliability of the Persian version of the WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP) questionnaire in a working population with upper extremity musculoskeletal disorders. Methods: We enrolled 181 patients with upper extremity conditions to complete the Persian WORQ-UP. A total of 35 patients returned after 1 week to complete the questionnaire again. To test the construct validity, patients responded to the Persian Quick Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH) at the first visit. The correlation between Quick-DASH and the WORQ-UP was assessed using Spearman correlation coefficient. Internal consistency (IC) was tested using Cronbach's alpha, and test-retest reliability was measured using the intraclass correlation coefficient (ICC). Results: Spearman correlation coefficient was 0.630 (p < 0.001), indicating a strong correlation between Quick-DASH and WORQ-UP. Cronbach's alpha was 0.970, which is considered excellent. ICC for the total score of the Persian WORQ-UP was 0.852 (0.691-0.927), indicating good to excellent reliability. Conclusions: Our study demonstrated that the Persian version of the WORQ-UP questionnaire has excellent reliability and IC. Construct validity showed a moderate to strong correlation between WORQ-UP and Quick-DASH, which provides a platform for the workers' population to assess the extent of disability and follow the progress along the treatment course. Level of Evidence: Level IV (Diagnostic).

Concomitant Avascular Necrosis of the Lunate and Proximal Pole of the Scaphoid in a Thalassemia Minor Patient.

Avascular necrosis (AVN) of multiple carpal bones is a very rare condition. This case report presents a patient with concomitant AVN of the lunate and proximal pole of the scaphoid that had led to severe joint space narrowing and degenerative arthritis in the radiocarpal and distal radioulnar joints (DRUJs). She was known to have thalassemia minor hemoglobinopathy. Wrist arthrodesis and distal ulna hemiresection-interposition arthroplasty (Bowers technique) for a DRUJ were offered and performed. The patient was satisfied with the clinical outcomes.

Perceived Pain Severity and Disability After the Recurrence of Tennis Elbow Following a Local Corticosteroid Injection.

Background: We hypothesized that there is no difference in the perceived pain and disability when the tennis elbow symptoms recur after a corticosteroid injection (CSI). Consequently, we secondarily aimed to assess the approximate time from CSI until symptom recurrence. Moreover, we aimed to evaluate factors associated with the time to recurrence. Methods: This cross-sectional study was performed during 2018-2019. We enrolled 50 consecutive patients who presented with the recurrence of tennis elbow symptoms and had a history of a single CSI for this condition. We asked the patients to rate the perceived pain and disability by filling the QuickDASH twice, including one by recalling pain and function before the CSI and one for the recent recurrent symptoms to assess the patient's perceived pain and disability at the two-time points. Results: There was a significant difference in perceived pain VAS and disability QuickDASH between pre-injection and recurrence, showing that the patient's perceived pain and disability were greater when recurred (P<0.001). The mean time between CSI and recurrence of symptoms was 6 (4-7) months, which is shorter than the expected spontaneous resolution of tennis elbow (> 1 year) to offer other invasive treatments. Time to recurrence had no significant association with sex, age, side, education, occupation, pre-injection VAS score, pre-injection QuickDASH, or symptom duration using a linear regression model. Conclusion: Although CSI seems to relieve or mask the pain in the short term, there is a considerable chance of recurrence, and patients may perceive more significant pain and disability that may lead to subsequent injection or precocious surgery. Time is an effective treatment for this illness. Shared decision-making is paramount, and patients have to be counseled regarding the natural history and expected prognosis of different treatments.

Femur originated genu varum in a patient with symptomatic ACL deficiency: a case report and review of literature.

BACKGROUND: Anterior cruciate ligament (ACL) injury may be associated with genu varum. There are a few indications in which the varus deformity can be corrected at the time of ACL reconstruction. However, as the genu varum originates mostly from the tibia and the simultaneous presence of ACL deficiency and femur originated genu varum is uncommon, only a few papers have described their management for ACL deficient patients with femur originated genu varum. CASE PRESENTATION: A young patient visited our clinic with a complaint of right knee pain and giving way. Further work up revealed a full mid substance ACL tear, mild medial knee osteoarthritis and femur originated genu varum of his right knee. He was managed with simultaneous ACL reconstruction and distal femoral valgus osteotomy. CONCLUSIONS: Any corrective osteotomy for genu varum should be performed at center of rotation angle. Isolated ACL reconstruction in patients with simultaneous ACL deficiency and genu varum may hasten the knee degeneration. LEVEL OF EVIDENCE: IV.

Association of New Coronavirus Disease with Fragility Hip and Lower Limb Fractures in Elderly Patients.

The novel coronavirus-induced infection (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. Iran is one of the countries with a high incidence of COVID-19 infection. Data on three patients with fragility hip fracture and COVID-19 infection were collected from one hospital located in Badrud, Isfahan, Iran, from March 1, 2010, to March 30, 2020. All patients were elderly and had fracture induced by fall from standing height. All patients (n=3) were admitted with fragility hip fracture due to low energy trauma. The most common symptoms were weakness and fatigue. Positive C-reactive protein (CRP) and Leukopenia were the most common abnormal laboratory evaluations. According to the results, two patients underwent surgical treatment, and one patient had negative reverse transcription-CRP; however, all of them underwent medical treatment for COVID-19 infection. There is a possible relationship between COVID-19 infection and fragility hip fracture in elderly patients. It could be induced by fatigue and weakness due to COVID-19 disease. COVOID-19 infection should be considered in elderly patients with fragility hip fracture during the coronavirus pandemic.

Isolated Metastatic Carcinoma to the Hamate Bone: The First Manifestation of an Occult Malignancy.

A 60-year-old man presented with swelling, pain, and tenderness at the ulnar side of his left wrist. Imaging studies demonstrated an osseous lesion in the left hamate bone. Histopathology study of the lesion revealed that the lesion was an isolated osseous metastatic carcinoma. The metastasis was the first presentation of this occult malignancy. The patient was treated with radiotherapy and chemotherapy; however, he expired 20 months after the diagnosis. This is a level IV study.

Biomechanical Study of Meniscal Repair Using Horizontal Sutures and Vertical Loop Techniques.

BACKGROUND: Meniscus plays an important role in weight-bearing and energy absorption. Moreover, its function is optimal to maintain joint stability and congruous. Treatments for meniscus damage or meniscus tear include open or arthroscopic repair and meniscectomy. One of the most important factors that influence patients' recovery outcome is restoration technique. The purpose of this study was to compare the strength of recently new method of meniscus repair, submeniscal horizontal sutures, and single vertical loop suturing techniques in meniscus repair. MATERIALS AND METHODS: An experimental study was conducted to study 12 ruptured medial meniscuses of bulls, which were divided into two groups of six meniscuses equally. In this study, submeniscal horizontal and vertical loop suturing techniques were compared based on their resistance to tensile forces and the stability of repaired gaps. RESULTS: In this study, submeniscal horizontal and vertical loop knots were 104.3 ± 12.5 N and 110.7 ± 16.4 N, respectively. No significant difference was found between the two groups. To measure the stability of the gap, 95.4 ± 8.7 N tensile force was applied to submeniscal and 124.6 ± 11.7 N to vertical loop techniques. There was significantly different in gap stability between horizontal and vertical loop techniques in meniscal repair (P = 0.02). CONCLUSION: The results of this study indicate that knot resistance in submeniscal horizontal is similar to vertical loop resistance. The stability of the restored gap in vertical loop technique is more than submeniscal horizontal techniques. Vertical loop causes greater stability against tensile force.