Surgical treatments of patients with periprosthetic humeral fracture and comorbidities

Background: Periprosthetic humeral fractures represent a complex and rare complication. Currently, there is no standardized procedure for management or classification of these fractures. Questions/purposes: This unique case series purpose was to look at surgical outcomes and comorbidity profiles of 10 PHF patients. Subsequent analysis looked at whether these outcomes could add to the discussion of a proposed standard of care in a patient cohort with significant comorbidities. Patients and methods: All patients with humeral fractures from 2008-2019 were analyzed for inclusion. A total of ten patients met the inclusion criteria; humeral fracture concurrent with a shoulder arthroplasty. Each patient was managed surgically using a locking plate with or without cerclage wiring. Outcome analysis was then performed for each patient. Humoral fractures managed conservatively were removed from the dataset along with periprosthetic fractures around an elbow arthroplasty, IM nail, or supracondylar fracture after shoulder arthroplasty. Results: The average union time in all patients was 13.27±2.90 (9.86-17.29) weeks. There was no significant difference between patients treated with cerclage wiring or without. All patients had successful union except for a patient with Osteogenesis Imperfecta. There were two radial nerve palsies. The average Deyo-Charlson score and BMI was 7.1±.84 (4-13) and 29.89 respectively. Conclusion: The treatment of PHFs using the technique of ORIF with locking plate with or without cerclage wiring provides satisfactory outcomes in a patient population that usually includes significant comorbidities. Level of evidence: Therapeutic Study Level IV Retrospective Review.

Can spectral doppler high specificity and gray scale nail assessment suggest inflammation in psoriatic arthritis patients and control groups?

Introduction: The use of high resolution ultrasonography (US) has become a very important tool in nail assessment. This study evaluated nails clinical and ultrasound measurements in psoriatic arthritis (PsA) patients. Methods: A cross sectional study was performed with a total of 60 patients, PSA patients, 10 healthy individuals and 6 hand osteoarthritis patients (OA). Only PsA patients meeting the CASPAR criteria were included in the study. Results: Spectral Doppler (sD) was used to analyze 208 nail beds. Nail plates on the gray scale (GS) showed loss of the normal three-layered pattern in 89 nails (45.9%). Power Doppler (PD) signal was detected in 189 nail beds (92.2%), showing inflammatory activity in most of the patients and nails assessed. Resistance index (RI) was significantly lower in PsA patients as compared to control groups in both the longitudinal and transverse planes (p<0.001).Nail enthesitis was observed when RI values were below 0.4, characterizing 100% sensitivity and 96% specificity (p<0.01). Conclusions: Nail US scanning presented statistical significance in PsA patients. Future studies could show many inflammatory situations, requiring treatment assessment.

Polypropylene prosthesis as cicatricial adjuvant after fasciotomy for compartment syndrome of the foot: Case report

The acute foot compartment syndrome is uncommon and occurs after high energy trauma. Your treatment is considered an orthopedic emergency and a fasciotomy becomes needed. However, after the inicial fase of damage control, the cover up of the incision is necessary. That can be done on the primary moment through parcial skin grafting or delayed primary, through the same technique or through direct suture. As an alternative, this case describes the use of polypropylene prosthesis, inicially described in musculoskeletal trauma of finger tips, as an adjunct to the healing process of foot fasciotomies. The main benefits of this technique are the achievement of one single surgical procedure and the absence of the typical morbidity that comes with skin grafting.

Modified Judet’s Quadricepsplasty with patella traction for extension contracture of knee

To see the clinical result of Modified Judet’s Quadricepsplasty (MJQP) with patella traction at BARI-ILIZAROV ORTHOPAEDIC CENTRE for the treatment of knee extension contracture. Materials and methods: We received 16 patients with knee extension contracture treated by MJQP with patella traction from January 2015 to January 2021, at our BARI-ILIZAROV ORTHOPAEDIC CENTRE. The age at revision surgery was 25-58 years. The time between fracture treatment to MJQP was 4 to 20 months and our follow up was 10-30 months. We assessed pre-operative and post-operative range of motion (ROM). Results: Knee range of motion pre-operatively was 5-50 (35± 10)° and 35-85 (55±10)° after MJQP and in average of 0-35(18+10) °. We applied patella traction for 12-14 (10±3)° When we removed the patella traction the knee range of motion at that time was 95-110 (93±4)° and increase of 10-70 compared with the range of motion after release of all arthrofibrosis in the joint. Our follow up time was 12-35 (19±5) months. Knee range of motion at first follow up was 85-135 (105±13)°, an increase of 45-105 (70±15) ° compared with pre-operatively and of 10-45 (12±12)° compared with the range of motion after patella traction removed. Knee function was excellent in 12 cases (70%), good in 3 (27%) and fair in one (3%). Conclusion: MJQP with patella traction lengthens the contracted Quadriceps femoris gives excellent result with proper post-operative care and CPM therapy.

Locked intramedullary nailing technique of the femur without brilliance amplifier at the trauma and orthopedics department of the university hospital of peace series on 35 cases during 1 year

Femoral fractures increase the length of hospital stay for our patients for several reasons such as lack of blood, economic resources, and lack of infrastructure. The use of a C-arm has been shown to reduce patient morbidity due to early functional recovery and reduced hospital stay. Objective: To develop an intramedullary nailing technique without c-arm with a closed focus to reduce the duration of hospitalization of its patients as well as the cost related to the equipment used for follow-up. Methodology: prospective study on 35 patients for 1 year August 2020 to August 2021 Results: We followed 35 patients in which the mean age was 37.83 years with extremes of 18 and 78 years. The male sex predominates 21 against 14 women or 60% against 40% respectively. The sex ratio is 1.5. A total of 19 diaphyseal fractures (54.3%) were nailed, 9 supracondylar (25.7%) and 7 subtrochanteric (20%). Twenty-seven were closed fractures (71.1%), and 8 were open fractures (22.9%). The length of hospitalization was less than 3 days for 30 patients (85.7%), and more than 3 days for 5 patients (14.3%). Conclusion: We recommend that we promote this closed-hearth technique because it improves the postoperative follow-up of patients. Additionally, it would reduce exposure to radiation from c-arm in hospitals that have this equipment.

Management of diabetic foot ulcer & atherosclerosis using tibial transverse bone lengthening technique; Bangladesh experience

Diabetic foot ulcers (DFU) are chronic skin ulcers associated with deep tissue destruction around the foot and ankle region with varying degrees of lower extremity vasculopathy and neuropathy. Diabetic foot ulcer is associated with a high rate of morbidity, disability, mortality and psycho-social cost.

Original positioning method to determine the clinical and radiographic parameters of the hip joint in patients with cerebral palsy

Relevance: Obtaining true radiographic parameters of the hip joint helps to choose therapeutic tactics for children with cerebral palsy. Goal of the study: Improvement of the diagnostic results in pathology of the hip joint among patients with cerebral palsy by using our original method. Materials and methods: The number of examined patients – 30 persons (60 joints), 15 boys and 15 girls, 26 joints were operated. The age of patients ranged between 3-15 years. All patients underwent a clinical evaluation – Ruwe's femoral torsion, as well as radiography of the hip joints using our original method (utility model patent №137567). The offered method is cheap, simple and accessible to all medical institutions with an X-ray room, for the diagnosis and screening of pathology of the hip joint. The our original method can be used to determine all the main parameters of the hip joint (femoral torsion, neck-shaft angle, Viberg angle, Reimers’ index, acetabular angle, Sharp’s angle) in patients with cerebral palsy. Making only single radiograph, one obtains true radiographic parameters of both hip joints, which significantly reduces the radiation load upon the patient. Our method can be used in the examination and screening of patients with developmental disorders and other diseases of the hip joint.

Patella dislocation with unusual osteochondral fracture, whilst playing virtual reality game

Case: We present case of a 37-year old male who sustained Patella dislocation with an unusual osteochondral fracture (OCF) involving the posterolateral femoral condyle, whilst playing a virtual game, wearing virtual game headset with goggles. He was treated conservatively for patella dislocation and had the OCF treated surgically. At 18 months follow up, his patella was stable and the OCF had healed. Conclusion: OCF of posterolateral femur following patella dislocation is unusual. It must be suspected in patients who sustain patella dislocation whilst doing deep flexion maneuvers. Patella dislocation can conceal an unusual OCF.

Failure due to metallosis after cruciate retaining total knee replacement

Background: Rupture of PCL on cruciate retaining TKA can cause abnormal accelerated wear of polyethylene component which may result in metal/metal articulation and development of massive infiltration of metal debris in the periprosthetic soft tissue (metallosis). Patient and methods: Eight cases (Five females, 3 males, mean age 64.6 years) with failed primary cruciate retaining knee arthroplasty were retrospectively studied. Revisions were performed after a mean of 59.8 months due to pain and instability. All the patients had variable degrees of clinically relevant posterior knee instability. Infection was excluded in all cases through microbiological examination and synovial fluid analysis. Results: Abnormal direct metal-on-metal articulation between the femoral component and the tibial base plate with advanced polyethylene wear were found intraoperatively in all cases in addition to extensive tissues black staining, advanced osteolysis and pseudotumor formation. All cases were managed by single stage revision surgery with implant removal, profound synovectomy and revision using a more constrained modular revision knee system. Conclusion: Metallosis after total knee arthroplasty is a rare situation that should be suspected in total knee arthroplasty cases with radiologically evident advanced polyethylene wear especially in cruciate retaining knee systems. It could lead to significant osteolysis making revision surgery technically challenging.

Bilateral elbow indirect Cubital tunnel syndrome due to mass effect of Gouty tophi

Gout is an inflammatory arthritis associated with raised uric acid levels in blood. The pathology involves infiltration and destruction of ligament, cartilage, tendons, bone and skin by deposition of urate crystals. Our purpose of writing this case is to report rare bilateral neurological symptoms due to compression, by tophaceous gout around elbows. A 32-year-old male had presented with episodic tingling in bilateral ulnar nerve distributions for fourteen days. Surgical excision of the tophi around elbows that were causing the neural compression symptoms was done and symptoms relieved gradually over 6 weeks. Tophi are late presentations. They can present with symptoms from depositing at different sites that is evidenced in existing literature case reports. Controlling serum uric acid levels below deposition threshold either by dietary or pharmaceutical drugs is the mainstay of management, resulting in dissolution of monosodium urate crystals.