Amelioration of oxidative and inflammatory changes by Peganum harmala seeds in experimental arthritis

Background The present study was designed to investigate the therapeutic effects against oxidative stress and alleviative effects of Peganum harmala seeds (PH) in rats with Complete Freund’s Adjuvant (CFA) induced arthritis. Methods The extract was evaluated for its phytoconstituents, antiarthritic and antioxidant properties. The action of chloroform (PHC) and ethanolic (PHE) extracts of PH was evaluated in adult Lewis rats (150-200 g).with CFA induced arthritis. Arthritic rats received PH extracts 100 mg/kg orally for 28 consecutive days (Prophylactic treatment) and from 14th day of CFA injection (Therapeutic treatment). Results PHE significantly suppressed the arthritis severity in rats than PHC in 28 days. All complications shown significant reduction (p< 0.05) in arthritic rats including paw volume (63.09%), body weight loss, decreased locomotor activity, erythrocyte sedimentation rate and synovial/hepatic tissues lipid peroxidation and increase in cellular antioxidants superoxide dismutase (U/mg) activities and hemoglobin counts. The results showed the presence of alkaloids and flavonoids in PHE. Histology and radiographic analysis of arthritic ankle joints indicated abnormal changes. Marked reduction in inflammation and arthritic changes were observed after treatment with PHE. Conclusion Therefore, the investigation suggests that PHE at 100 mg/kg will be useful in the management of rheumatoid arthritis complications which may possibly be due to boosting the intracellular antioxidant defense.

Avascular necrosis of the lunate secondary to perilunate fracture dislocation: Case report and review of the literature

This is a 39-year-old male, fell from a bike, left wrist with trans-styloid perilunate fracture dislocation that underwent open reduction internal fixation, 20 months after surgery the patient developed avascular necrosis of the lunate, final wrist fusion was performed secondary to the arthritic changes on the wrist. Anatomic dissection was performed and vascularity of the lunate was identified, its origin is from the volar palmar arch, when dislocated palmarly and more than 90 degrees the vessel is still intact. More than 512 patients with perilunate dislocation and perilunate fracture dislocation are included we identified in the literature transient avascular necrosis of the lunate in nine and seventeen of pure avascular necrosis of the lunate. Concluding that avascular necrosis of the lunate after perilunate dislocation or perilunate fracture dislocation is an infrequent finding especially when the volar ligaments are intact.

Injuries to the Coronoid Process of the Ulna with Involvement of the Lesser Sigmoid Notch

Introduction This study aimed to describe the involvement of the lesser sigmoid notch in fractures to the coronoid process. We hypothesized that injuries to the lateral aspect of the coronoid process regularly involve the annular ligament insertion at the anterior lesser sigmoid notch. Material and Methods Patients treated for a coronoid process fracture at our institution between 06/2011 and 07/2018 were included. We excluded patients < 18 years, patients with arthritic changes or previous operative treatment to the elbow, and patients with concomitant injuries to the proximal ulna. In patients with involvement of the lesser sigmoid notch, the coronoid height and fragment size (anteroposterior, mediolateral, and craniocaudal) were measured. Results Seventy-two patients (mean age: 47 years ± 17.6) could be included in the study. Twenty-one patients (29.2%) had a fracture involving the lateral sigmoid notch. The mean anteroposterior fragment length was 7 ± 1.6 mm. The fragment affected a mean of 43 ± 10.8% of the coronoid height. The mean mediolateral size of the fragment was 10 ± 5.0 mm, and the mean cranio-caudal size was 7 ± 2.7 mm. Conclusion Coronoid fractures regularly include the lesser sigmoid notch. These injuries possibly affect the anterior annular ligament insertion which is important for the stability of the proximal radioulnar joint and varus stability of the elbow.

Influence of First Metatarsophalangeal Joint Degenerative Changes on Functional Outcomes Following Hallux Valgus Correction

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Previous studies have documented the prevalence of 1st metatarsophalangeal (MTP) joint arthritis in the setting of hallux valgus, with the articulation between the metatarsal head and the sesamoids being particularly vulnerable. However, little is known as to whether such degenerative changes of the metatarsal head-sesamoid articulation have any influence on postoperative functional and pain scores following hallux valgus correction. The purpose of this study is to determine the influence of degenerative changes of the 1st metatarsal head on outcomes at 2 years postoperatively. Methods: Patients underwent correction of a hallux valgus deformity from 2016-2017 by a single fellowship trained foot and ankle surgeon. Degenerative changes were classified by dividing the articular surface of the metatarsal head into 6 zones: zones 1 through 4 represented the surface articulating with the base of the proximal phalanx, while zones 5 and 6 represented the plantar aspect. Cartilage loss in each zone was graded from 0-2, with 0 representing the absence of arthritis, 1 indicating fissures without exposed bone, and 2 representing degenerative changes with exposed bone. Scoring was performed via direct visualization during the procedure. At 2 years postoperatively, patients were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales and Visual Analog Scale (VAS) for pain. Spearman’s correlations and one-way analysis of variance (ANOVA) were performed to determine if degree of arthritis had any influence on outcomes. Results: One hundred and forty-one patients (87.9% female) with both intraoperative arthritic grading and 2-year functional outcomes were included. At a mean of 25.4 (range, 23.0-34.8) months postoperatively, patients reported a mean (+- standard deviation) FAAM-ADL of 88.9 +- 17.3, FAAM-Sport of 77.3 +- 26.0, and VAS pain of 20.8 +- 27.1. Arthritis in zone 2 (r=0.20, p= 0.027) was found to be positively correlated with FAAM-Sport scores. ANOVA revealed those with a total arthritis grade of 0 or 2 or more in zones 1-4 had a significantly greater reduction in VAS pain scores (means of -35.1 and -37.7, respectively) than those with a grade of 1 (mean: -14.3) (p=0.008). Conclusion: Patients demonstrated a significant influence of arthritis on 2-year functional outcomes following HV correction, with higher levels of degenerative changes in zone 2 generally associated with better functional outcomes. Patients with more severe arthritic changes in zones 1-4 and those whose arthritic changes were localized solely to zones 5 and 6 demonstrated greater pain relief than those with mild degenerative changes. While these findings were unexpected, it demonstrates that those with more pronounced arthritis may benefit more from surgical correction of HV. Furthermore, surgeon intraoperative evaluation of arthritis may allow for improved counseling of patients regarding expected postoperative functional improvement.

Complete Cubonavicular Coalition Associated with Midfoot Osteoarthritis

Introduction. Cubonavicular coalitions represent a relatively rare condition with less than forty cases described in the literature, the majority of which are fibrocartilaginous. To our knowledge, cubonavicular osseous coalition associated with osteoarthritis of the midfoot has never been described. Case Presentation. We present the case of a 26-year-old man with bilateral Achilles tendinosis, in whom radiological studies show an incidental finding of a complete osseous cubonavicular coalition, as well as a partial osseous cubo-third cuneiform coalition and a fibrous band between the first and second cuneiforms of the right foot, associated with arthritic changes of the tarsometatarsal joint. A nonosseous calcaneocubonavicular coalition was found on the left foot. These multiples coalitions were asymptomatic in this case. Discussion. Cubonavicular coalition, even asymptomatic, can cause midfoot osteoarthritis in young patients. We may therefore suspect that the immobility of the cubonavicular joint causes additional stress on the midfoot.

High Prevalence of Degenerative Changes at the Metatarsal Head Sesamoid Articulation Found During Hallux Valgus Correction Surgery

Background. Despite the absence of complications and a restoration of normal hallux alignment, some patients have suboptimal outcomes from hallux valgus correction surgery. One risk factor for persistent pain may be the presence of arthritic changes at the metatarsal head articulation with the sesamoids, an area not easily assessed with standard radiographs unless dedicated sesamoid views are obtained. In this study, we prospectively evaluated the metatarsal head for degenerative changes during hallux valgus correction surgery and identified preoperative risk factors associated with these changes. Methods. We prospectively evaluated 200 feet in 196 patients who underwent hallux valgus surgery intraoperatively for the pattern and severity of arthritic changes at the metatarsal head. Mann-Whitney U testing was implemented to compare differences in arthritic scores between preoperative deformity groups. The Spearman correlation test was used to determine the association between age and preoperative deformity with the severity of degenerative changes. Results. More than half of all feet assessed had severe arthritic changes at the plantar medial aspect of the metatarsal head and 40% of feet at the plantar lateral aspect. Age and intermetatarsal angle were found to be positively correlated with arthritis in this area. Conclusion. Our prospective study has demonstrated the high prevalence of arthritic changes at the metatarsal head sesamoid articulation and the positive influence of age and severity of deformity on metatarsal head arthritic changes seen during hallux valgus correction surgery. Furthermore, these arthritic changes were found to have no significant influence on preoperative functional and pain levels. Levels of Evidence: Level IV: Case series

High Prevalence of Degenerative Changes at the Metatarsal Head Sesamoid Articulation Found During Hallux Valgus Correction Surgery

Category: Bunion Introduction/Purpose: Despite absence of complications and a restoration of normal hallux alignment, some patients have suboptimal outcomes from hallux valgus correction surgery. One risk factor for persistent pain may be the presence of arthritic changes at the metatarsal head articulation with the sesamoids, an area not easily assessed with standard preoperative radiographs. In this study, we prospectively evaluated the metatarsal head for degenerative changes during hallux valgus correction surgery and identified preoperative risk factors associated with these changes. Methods: We prospectively evaluated 200 feet in 196 patients who underwent hallux valgus surgery intraoperatively for the pattern and severity of arthritic changes at the metatarsal head. Intraoperatively, the first metatarsophalangeal and sesamoid metatarsal joint were assessed for arthritic changes. The articular surface of the metatarsal head was divided into zones 1-6 (Figure 1). Cartilage loss in each zone was graded from 0-2 based on a novel grading system, with a score of 0 representing the absence of arthritis. A score of 1 indicated fissures without exposed bone, and a score of 2 represented degenerative changes to the level of exposed bone. Mann-Whitney U testing was implemented to compare differences in arthritic scores between preoperative deformity groups. Spearman’s correlation test was used to determine the association between age and preoperative deformity with the severity of degenerative changes. Results: One-hundred two out of 200 feet (51%) assessed had severe arthritic changes at the plantar medial aspect of the metatarsal head, and 40% (80/200) at the plantar lateral aspect. The mean preoperative hallux valgus and intermetatarsal angles were 29.6 ± 8.5 (range, 9.8-55.3) and 14.2 ± 3.3 (range, 6.6-25.9), respectively. Those presenting with an intermetatarsal angle (IMA) >/= 14 degrees had a significantly higher level of arthritis when compared to those presenting with an IMA < 14 degrees (p < 0.001). No difference in arthritis scores was found for HVA. Age was found to have a strong and significant (p < 0.001) correlation with zone 5, zone 6, total plantar zone, and total arthritis scores. Conclusion: The high prevalence of arthritic changes at the metatarsal head articulation with the sesamoids may be partially responsible for suboptimal outcome following hallux valgus correction surgery. Since these changes were associated with greater age and preoperative deformity, operating earlier in the pathology of hallux valgus may be of benefit.

Arthrodiastasis in the management of stiff hip

<p class="abstract">Arthrodiastasis (using external fixator and distraction) has been used for various pathologies including deformity correction/stiff hip/slipped capital femoral epiphysis. Historically this has been used for treatment of Perthes disease. The purpose of our study is to evaluate efficacy of arthrodiastasis in management of stiff hip. A 15 year old boy with stiff hip presented with complaints of pain in the left hip for past 6 months. Radiologically the left proximal femur was found to be deformed with metaphyseal widening, sclerosis and arthritic changes. Hip spanning external fixator using limb reconstruction system was done. Distraction was done at a rate of 1 mm/day. After 2 months, fixator was removed. Hip was mobilized under anaesthesia. Good range of all movements was achieved. Arthrodiastasis seems to be a good option in young adolescent in whom total hip replacement needs to be delayed as much as possible.</p>