Fixation method can affect posterior tibial slope in opening-wedge high tibial osteotomy: a retrospective study

BACKGROUND

Posterior tibial slope (PTS) alterations following open-wedge high tibial osteotomy (OWHTO) can cause instability and excessive tibial translation in the sagittal plane. These changes can be influenced by the type of fixation. This study aims to compare PTS changes between patients undergoing OWHTO with Puddu plate or TomoFix plate fixation.

METHODS

In this retrospective cohort study, we included 104 knees from 85 patients undergoing OWHTO, with a mean age of 41.98 ± 9.95 years; 51.8% of the participants were male. Seventy-two knees were fixed with Puddu plates, while 32 knees were fixed with TomoFix plates. PTS changes, demographic factors, Cincinnati Knee Rating Score (CKRS), Tegner-Lysholm score (TLS), length of stay (LOS), and complications were evaluated. PTS changes were measured preoperatively, immediately postoperatively, and at the 6-month follow-up.

RESULTS

Demographic factors were similar between the Puddu plate and TomoFix groups. There were no significant differences in preoperative, postoperative, or follow-up PTS measurements between the two groups. PTS changes were not significant in the TomoFix group postoperatively or at follow-up. However, the Puddu plate group showed a significant increase in PTS both postoperatively (P = 0.027) and at follow-up (P = 0.014). CKRS, TLS, LOS, and complications did not significantly differ between the groups.

CONCLUSION

While overall PTS changes did not significantly differ between the Puddu Plate and TomoFix Plate groups, analyzing changes within each group revealed distinct results. TomoFix fixation exhibited nonsignificant PTS changes, while Puddu plate fixation resulted in a significant increase in PTS after surgery and at the 6-month follow-up. Our findings suggest that the choice of fixation may influence PTS changes after OWHTO.

LEVEL OF EVIDENCE

Level III.

The results of allogenic cancellous bone graft in medial opening wedge high tibial osteotomy

PURPOSE

There is no clear consensus regarding the optimal filling agent in the medial opening wedge high tibial osteotomy (MOWHTO). In this study, we evaluated the clinical and radiologic outcomes of MOWHTO with an allogeneic cancellous bone graft and TomoFix plate.

METHODS

Medical profiles of 122 patients who underwent MOWHTO with cancellous bone graft from iliac crest were retrospectively reviewed. One hundred and two patients (120 knees) who met the study criteria were included in the analysis. The osteotomy site was fixed with a TomoFix plate. The mean age of the patients was 40.85 ± 22.15 years. The mean follow-up of the patients was 33.2 ± 29 months. The primary outcome measures were the union of osteotomy site and loss of correction that were investigated on postoperative radiographs. Secondary outcome measures were postoperative complications that were extracted from the patients' medical records.

RESULTS

Union of the osteotomy site was observed in all patients within three months after the operation. Loss of correction at the osteotomy site occurred in two knees (1.7%), both of which underwent revision surgery. Three patients had non-infected prolonged wound drainage and underwent reoperation for allograft removal. Nine other complications were also recorded that did not require intervention, including superficial infection (n = 2), compartment syndrome (n = 1), deep vein thrombosis (n = 1), loss of knee flexion (n = 2), and transient pain at the site of the osteotomy (n = 3).

CONCLUSION

Allogenic cancellous bone graft provides efficient gap healing in MOWHTO and can be used as an effective alternative to the autogenous bone graft.

Gait initiation and lateral wedge insole for individuals with early knee osteoarthritis

BACKGROUND

People with knee osteoarthritis are at higher risk of postural deficits and locomotor adaptations which could be manifested in transient tasks like gait initiation. To better understand the effect of early knee osteoarthritis on gait initiation, we measured the gait initiation in two groups of early knee osteoarthritis and healthy age-matched controls and assessed the effect of lateral wedge insole in knee osteoarthritis group.

METHODS

Twenty-one individuals with early knee osteoarthritis, mean (SD) age = 53.1 (7.4, years), and 19 age- and sex-matched asymptomatic healthy individuals, mean (SD) age = 47.5 (11.2, years), participated. Centre of pressure trajectories were used to quantify the two phases of gait initiation in barefoot condition: anticipatory postural adjustment, and locomotor phase. The immediate and four-week effect of lateral wedge insole and shod condition were also compared for individuals in knee osteoarthritis group.

FINDINGS

Longer duration of anticipatory postural adjustment phase (P = 0.046), locomotor phase (P = 0.049), and total duration of gait initiation (P = 0.035) with lower length and velocity of the center of pressure trajectories in anticipatory postural adjustment phase (P = 0.002, and 0.008, respectively) were observed in knee osteoarthritis group compared to controls. Lateral wedge insole could increase the length and velocity of the centre of pressure in locomotor phase compared to barefoot condition (P = 0.001, and 0.002, respectively).

INTERPRETATION

Our study outlined that people with early knee osteoarthritis adopt different gait initiation strategies mainly in postural preparation phase. The potential effect of lateral wedge insole was shown with better performance of the locomotor phase.

CLINICAL TRIAL REGISTRY NUMBER

IRCT2016060628310N1.

The effect of a lateral wedge insole and a subtalar strap on gait parameters in knee osteoarthritis

Background: Lateral wedge insole (LWI) aims to reduce loading on medial compartment of tibiofemoral joint in mild knee osteoarthritis (KOA). This effect may be augmented by concomitant use of subtalar strap to fix the ankle joint. Moreover, longitudinal arch support embedded in insoles can cause foot comfort and may be beneficial for people with KOA. Therefore, this study aimed to assess the immediate effect of LWI with an arch support with and without a subtalar strap on the kinetics and kinematics of walking in mild KOA.

Methods: A convenient sample of 17 individuals with mild KOA (Kellgren and Lawrence grade II), aged ≥ 40 years were assessed in 3 conditions: without the insole; LWI; and LWI with a subtalar strap, where an arch support was embedded in all insoles. The primary outcomes were external knee adduction moment and angular impulse. The secondary outcomes were hip flexion and adduction moments, knee flexion angle, ankle eversion moment, and walking speed. The repeated measurements ANOVA was used to compare the primary and secondary outcomes between the conditions using SPSS. Significance level was set at 0.05.

Results: LWI and a subtalar strap can significantly increase the knee flexion angle at 0%-15% of the stance phase compared to no insole (p<0.001). No other changes were observed (p=0.142).

Conclusion: LWI with an arch, with or without a subtalar strap, cannot impose any immediate changes on the kinetics and kinematics of lower limb joints during walking in people with mild KOA.

A systematic review on the validity and reliability of tape measurement method in leg length discrepancy

Background: Leg length discrepancy measurement is an essential part of musculoskeletal clinical assessment, and tape measurement is a common clinical method. This study aimed to systematically review the results of the findings of studies on validity and reliability of the tape measurement method and the quality of reporting the literature on this topic.

Methods: A search was performed in PubMed, EBSCO, Science Direct, Web of Knowledge, Scopus, Embase, and Google Scholar using selected keywords from inception to December 2017.This systematic review was based on the PRISMA guideline. After a systematic selection process, the quality of the included studies was assessed independently by 2 reviewers using the Brink and Louw Scale for quality assessment.

Results: A total of 11 studies were finally considered for this systematic review. Two studies were about the validity of (a measurement tool) studies and 4 were reliability analysis only. Validity and reliability analyses were simultaneously applied to 5 studies. Also, 9 out of 11 studies were deemed to be of high quality based on Brink and Louw Scale. Studies showed high (ICC=0.7) to very high (ICC=0.9) levels of interrater and intrarater reliability. The validity of the methods ranged from low to very high depending on subjects.

Conclusion: Tape measurement method has acceptable reliability and validity in healthy people, but it does not have acceptable validity in measuring obese people and patients with musculoskeletal disorders. Thus, using a suitable method for LLD leg length discrepancy measurement seems to be necessary for obese and individuals with leg length discrepancy.

Evaluation of Methylobacterium radiotolerance and Sphyngomonas yanoikoaie in Sentinel Lymph Nodes of Breast Cancer Cases

It has been established that different kinds of bacteria agents are involved in various cancers. Although the mechanism of tumorigenesis is not clearly understood, there is evidence for the presence of bacteria within tumors, with at least a progression effect for some bacteria that prepare suitable microenvironments for tumor cell growth. The aim of current study was to evaluate bacterial dysbiosis in sentinel lymph nodes of breast cancer patients. One hundred and twenty three fresh-frozen sentinel lymph nodes and a corresponding number of normal adjacent breast tissue specimens and five normal mastectomy samples were investigated employing RT-PCR. In addition using genus-specific primers were applied. There was a significant differences as presence of Methylobacterium radiotolerance DNA recorded between patients and normal control group (p= 0.0). Based on our research work, further studies into the role of microbes in breast cancer would be of great interest.

The immediate effect of lateral wedge insoles, with and without a subtalar strap, on the lateral trunk lean motion in patients with knee osteoarthritis

BACKGROUND

Orthotic interventions for knee osteoarthritis (OA) aim to reduce mechanical loading on the medial compartment of the knee and may lessen the lateral trunk lean as the most important compensatory gait strategy. The lateral wedge insole is a known orthotic intervention for knee OA. However, the question whether the addition of a subtalar strap to the wedge improves its effect has not been addressed in the literature.

OBJECTIVE

To compare the effects of lateral wedge insoles, with and without a subtalar strap, on the lateral trunk lean in patients with knee OA.

METHODS

Twenty-three patients aged over 40 years, with grade I or II OA of the medial compartment of one knee, based on the American College of Rheumatology criteria, were included in this study. The patients were diagnosed with OA based on a clinical examination, and the diagnosis was confirmed with radiographs. A 3-dimensional motion measurement system was used to collect the gait data for 3 different conditions: (1) with no insole, (2) with a lateral wedge insole, and (3) with a lateral wedge insole and a subtalar strap. The immediate effect of the 3 test conditions on the lateral trunk lean was compared during a gait cycle a stance phase and at the point of midstance.

RESULTS

Based on the laboratory coordinate system, the 3 conditions had no significant effect on the lateral trunk lean during a gait cycle and a stance phase and at the point of midstance in patients with knee OA.

CONCLUSION

The results of this study demonstrated that the lateral wedge insoles, with and without a subtalar strap, had no immediate effect on the lateral trunk lean in patients with knee OA. However, the long-term effect of lateral wedge insoles on the lateral trunk lean in these patients requires further investigation.

Fulminant spread of a femur anaerobic osteomyelitis to abdomen in a 17-year-old boy

To our knowledge, distant spread of infection in anaerobic osteomyelitis has not been described before. In this article, we report a case of anaerobic osteomyelitis of femur with fulminant spread of infection to the abdomen in a 17-year-old boy with no predisposing medical factors and minimal bone involvement.

Pseudoaneurysm of a high origin radial artery treated by ultrasound-guided compression

A high origin of the radial artery from the brachial artery is the most frequently encountered arterial anomaly in an upper extremity, and is reported in seven percent of individuals. This variant is vulnerable to injury because of its more superficial location. A 59-year-old man developed a pseudoaneurysm following the inadvertent cannulation of a high origin radial artery. We report the successful treatment of the pseudoaneurysm by ultrasound-guided compression. Ultrasound-guided compression is an available and simple method for the repair of arterial pseudoaneurysms, and delayed complete thrombosis can be expected even if a residual flow remains after the initial compression.