The process of social death in patients with hip fracture

People with chronic disability and uncontrollable long-term complications following hip fracture have characterist.ics that may predispose them to social death. Continuous physical disability can have negative physical, psychological, and social consequences in these patients. To design care interventions for preventing and controlling social death, it is essential to identify the dimensions and characteristics of this process. Therefore, the present study aimed to explain the process of social death in hip fracture patients. In this study, which was conducted using a grounded theory approach, 20 patients were selected with maximum diversity and 9 professional and non-professional caregivers also through purposive sampling followed by theoretical sampling. Data were collected through semi-structured in-depth interviews, field notes, and observations. Data were analyzed using the approach proposed by Corbin and Strauss in stages including data analysis for concepts and their dimensions and characteristics, the context, process extraction, and integration of the categories. One core category and 16 main categories, which consisted of 55 subcategories and 212 primary concepts, were extracted. The results showed that the core process of social death in hip fracture is an intentional self-destruction for getting liberated from the conditions of the illness and the disrupted social life after the fracture, which ultimately leads to outcomes such as isolation-seeking and death ideations in these patients. The core category of liberating self-destruction reflects the close relationship between the context, process, and outcomes of social death. The process of social death is social, multidimensional, and complex. So far, no explanatory theory has been presented for this group of patients. Therefore, the results of this study can play an important role in designing helpful interventions for preventing, modifying, and changing the phenomenon of social death.

Investigating the correlation between hip abductor muscle strength and width in anteroposterior pelvic radiographs in hip revision candidates following previous total hip arthroplasty: a cross-sectional study

The changes in strength of hip abductor muscles after total hip arthroplasty may depend on its anatomical parameters. In the present study the correlation between the strength of the hip abductor muscles before hip revision surgery and the diameter of the abductor muscles in the pelvic anterior posterior X-ray was investigated.

Methods

This cross-sectional study included the patients underwent hip arthroplasty and were candidates for revision surgery. The diameter of the hip abductor muscles on the affected and unaffected sides were calculated based on plain radiography. Patients were also clinically examined and their abductor muscle strength on both sides were determined based on Medical Research Council Manual Muscle Testing scale.

Results

A total of 51 patients were included in the study and after exiting 20 patients; finally 31 patients' data were analyzed. Based on results there was a significant correlation between the ratios of muscle strength and muscle diameter in affected side to unaffected side (r=0.517, P=0.003). As indicated in Table 3, such significant association was revealed in men (r=0.719, P=0.001), but not in women (r=-0.092, P=0.754). Also, this relationship was found to be significant in patients older than 60 years (r=0.529, P=0.011), not in the younger.

Conclusion

In patients undergoing total hip arthroplasty revision surgery, there is a strong association between the ratio of strength and diameter of the abductor muscles in the affected side to the unaffected side especially in men and older ages.

Comparison of low-dose (162 mg) and high-dose (650 mg) Aspirin prophylaxis following total joint arthroplasty: a prospective cohort study

Since Aspirin's adverse effects are dose-dependent, and evidence supporting the use of low-dose (LD) Aspirin in preventing venous thromboembolism (VTE) after total hip arthroplasty (THA) is weak, the authors do not know what the minimal effective dosage of Aspirin is to prevent VTE. This study aimed to compare the rates of 90-day symptomatic VTE following THA and total knee arthroplasty in healthy patients taking LD Aspirin vs. high-dose (HD) Aspirin for 6 weeks postoperatively.

Materials and methods

A prospective cohort of patients with THA and total knee arthroplasty was conducted at two tertiary centres. Symptomatic VTE within 90 days of index arthroplasty was the primary outcome; gastrointestinal bleeding (GIB) and mortality were secondary outcomes.

Results

The final analysis included 312 consecutive patients: 158 in the LD group and 154 in the HD group. Two groups were similar regarding preoperative data, including sex, age, BMI, smoking, diabetes mellitus, Hgb and platelet count, and type of surgery. The LD group had one deep vein thrombosis (0.6%), and the HD group had two (1.3%) (P=0.62). Neither group had PTE. Therefore, VTE rates are the same as deep vein thrombosis rates and similar between the groups (0.6% vs. 1.3%, P=0.62)Regarding GIB due to anticoagulant therapy, no patient in the LD group reported GIB, whereas two (1.3%) patients in the HD group reported GIB within 90 days of arthroplasty. GIB rates did not differ significantly between groups (P=0.24). Considering VTE + GIB combined, the HD groups showed a higher rate of complications (N=4, 2.6%) than the LD groups (N=1, 0.6%) but not statistically significant (P=0.21).

Conclusions

Prophylactic administration of Aspirin with low doses (81 mg BID) and high doses (325 mg BID) for six weeks is equally effective at reducing VTE in total joint arthroplasty patients and had similar adverse effects.

Level of Evidence

Therapeutic Level II.

Single High-Dose Systemic Methylprednisolone Administered Preoperatively Improves Pain Control and Sleep Quality After Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial

Background

This study was performed to evaluate the efficacy of preoperative high-dose methylprednisolone on pain levels and sleep quality following primary total hip arthroplasty.

Material and methods

A double-blind, randomized controlled trial was performed in adults underdoing total hip arthroplasty. A computer-generated, permuted-block randomization scheme with a 1:1 ratio between the intervention (125 mg methylprednisolone) and control groups (normal saline) was utilized. Patients underwent a similar preoperative and postoperative protocol. Pain was assessed using the visual analog scale (VAS). Sleep quality was assessed at the 2-week postoperative visit using the Pittsburgh Sleep Quality Index (PSQI).

Results

With a total of 70 patients, 35 patients were included in the intervention and placebo groups. Hospital stay was significantly shorter in the intervention group (1.5 ± 0.7 vs 2.0 ± 0.5 days, P = .03). Preoperative pain levels were similar between groups, while satisfactory pain control was achieved in a significantly larger number of patients in the intervention group (18 vs 8 patients, P = .009). The intervention group was significantly more likely to have a good sleep quality than the placebo groups (74% vs 31%, P = .001). No significant differences were found between preoperative and postoperative blood sugar levels. We did not observe any cases of early postoperative wound complication, infection, or deep vein thrombosis among our patients.

Conclusion

In this randomized controlled trial, preoperative administration of 125 mg of methylprednisolone was found to improve pain control, as measured by VAS, 24 hours after surgery, and sleep quality, as measured by PSQI, 2 weeks following surgery.

Mortality Rate and Quality of Life in Patients with Intertrochanteric Fractures Treated with Dynamic Hip Screw

Background: Intertrochanteric (IT) fracture is one of the most common fractures in adults. Dynamic hip screw (DHS) surgery is a surgical procedure for IT fracture treatment. This study evaluated the mortality rate and quality of life (QOL) among these patients one year after the surgery. Methods: This cohort study was conducted on 110 patients with IT fractures treated with DHS from 2017 to 2019. A questionnaire was completed for each patient before, during, and after surgery. Preoperative information included demographics, height, weight, body mass index (BMI), smoking, diabetes, variables such as IT fracture classification, injury mechanism, lateral wall, and the American Society of Anesthesiologists (ASA) comorbidity classification. Tip-apex distance (TAD), nail position at the femoral head, and the amount of bleeding during the operation were achieved during and immediately after the surgery. The mortality rate was determined one year after the surgery, and the surviving patients were assessed by the 36-Item Short Form Survey (SF-36) questionnaire. Results: The mortality rate among patients who underwent DHS was 31.81%. There was no significant difference between living and dead patients regarding demographic information, surgical techniques, and comorbidities. There was no association between patients regarding the average of all areas of physical, mental, and overall health and gender. There was no significant relationship between the mean of physical and mental health with the duration of hospital stay and the amount of bleeding during surgery. A history of diabetes, high blood pressure, and smoking in these patients was not associated with mortality and QOL. Conclusion: The patient’s age is the most important risk factor for mortality after the DHS surgery.

The Effect of Augmentative Plating for the Treatment of Nonunion of Femoral Shaft Fractures after Intramedullary Nailing: A Case Series

Background: Several treatment approaches are now considered to manage femoral nonunion following intramedullary (IM) nailing. Augmentation plating over a maintained IM nail was a successful treatment for femur fracture nonunion in recent years. We aimed to describe our experiences in evaluating the union of bone for these patients after plate augmentation with serial examinations and radiologic studies. Methods: This was a case study on 21 patients who had a nonunion or delayed union of the femoral shaft fracture (FSF) after IM nailing. After initial intervention, they were monitored for 20.4 months (range: 12-72 months). Results: A closed IM nail was used in 18 patients, while the other three patients were shown as non-IM nail cases with a dynamic hip screw (DHS) in one patient, an external fixator in one other patient, and plate fixation in another one that was planned for augmentation plating. After plating, appropriate union appeared in all patients. Fracture union took an average of 7 months ranging from 3 to 12 months. Conclusion: Augmentation plating for treating FSF nonunion with leaving the nail in place results in excellent and favorable clinical outcomes with the radiographic recovery of the nonunion site in all of the cases with no complication.

Evaluating the Effect of Double Plating Fixation with Bone Graft in Nonunion of Femoral and Tibial Fractures after Primary Surgery

Background: Several treatment approaches are now considered to manage tibial and femoral shaft nonunion after primary surgeries. Double-locking plates with channel bone grafting technology are treatments that surgeons could choose. We aimed to describe our experiences in evaluating the union of bone for these patients after using double-locking plates with channel bone grafting with serial examinations and radiologic studies. Methods: This case study was conducted on 33 patients consisting of 20 femoral nonunion and 13 tibial nonunion cases. They underwent double plate fixation with bone grafting at Sina Hospital, Tehran, Iran, from 2015 to 2020. They were monitored for an average of 60 months after surgery Results: Union was achieved in all the patients in a mean of 10.03 months (range: 8-18 months). During patients’ follow-up, no plate and screw breakage, device loosening, deformity, and infection were seen. No additional surgery was needed for any of our patients. Conclusion: There are various treatment options for nonunion of long bones. This study described the double plating approach for treating femoral and tibial shaft nonunion. The technique of double plate fixation and bone grafting had reasonable union rates in long bone nonunion. The present case series analysis also shows that it is more beneficial to manipulate this promising method for long bone nonunion whenever possible.

A Web-Based Dynamic Nomogram to Calculate the Risk of Nonhealing after Femoral Neck Fracture Fixation among Young Adults: Bench to bedside Translational Research

Background: The aim of this study was to develop a prognostic model to identify a subgroup of high-risk patients for non-healing after femoral neck fracture fixation among young adults. The model was implemented by presenting graphically as a nomogram that could be easily used in every day clinical cases. Methods: Data on a total of 129 patients were included in the current study. The mean [standard deviation (SD)] age of the participants was 42 (13) years and 28% of the patients were women. Harrell’s C statistic was used as a measure of discrimination predictive power. We calculated the Nam-D’Agostino χ 2 to examine calibration for prediction models. Results: Approximately, 83% of fractures united uneventfully, with avascular necrosis (AVN), fixation nonhealing, non-union, infection, arthroplasty, and death being observed. Body mass index (BMI) and head acetabular trabecular angle (HATA) were inversely associated with the risk of all-cause nonhealing. The final model showed excellent discriminatory power [Harrell’s C statistic: 0.820, 95% confidence interval (CI) (0.680-0.960)] and it was well-calibrated [Nam-D’Agostino χ 2 : 10.1, (P = 0.3456)]. A nomogram developed by incorporating significant predictors modelled without discretizing continuous variables. Conclusion: Using readily available clinical and radiological data, we developed a parsimonious, simple, accurate yardstick to measure the 5-year risk of nonhealing after femoral neck fractures among young adults. In order to add ease-of-use and to promote its integration into clinical practice, the prognostic model was demonstrated visually as a statistic nomogram.

Social death in patients: Concept analysis with an evolutionary approach

Social death is an important concept that should be considered in a wide range of patients, especially in chronic diseases. Despite, there is still no clear and comprehensive definition of social death in medicine. The present study was thus conducted with Rodgers' evolutionary concept analysis method to identify the key features and provide a clear definition of social death in patients and understand its background and consequences. Considering the stages of concept analysis, an initial search was carried out in scientific databases (PubMed, Science Direct, Google Scholar, Magiran, and SID) without time limit until 2020. The search resulted in 400 articles in the first stage, which were screened according to the study objective and, all the items and points consistent with the concept's attributes, antecedents, consequences, associated concepts, alternative terms and definition were extracted. According to the results of different studies, the attributes of social death in patients can be classified into three main themes: The loss of social identity, loss of social relations (social isolation), and deficiencies related to the inefficiency of the body and various diseases. Generally, antecedents' social death in patients can be including; the factors related to the patient, Family neglect, Medical personnel's treatment of the patient as a corpse, Having no social situation. Also, there is little information available about the effect of social death on the patients themselves and their families, specialists, health care institutions and the society. Mankind's perception of social death is multidimensional and may have consequences such as bad death, disgraceful death deprivation of belonging to the society, financial vulnerability, removed or weakened legal support, stigma, and the loss of social identity. The proper understanding of social death in patients not only determines the role and importance of care in the process of incidence of this phenomenon, but also paves the way for designing an evidence-based care program for its prevention and control.

Neglected Total Hip Dislocation

Background: Dislocation of total hip arthroplasty (THA) needs prompt intervention and reduction either closed or open. It is unusual to left THA dislocated. Hence in this study, the outcomes of neglected prosthesis after THA were determined. Methods: In this case series study, 15 neglected cases of total hips which had been left unreduced for long time (more than 3 months) were assessed. Cause of postponing reduction, femoral side and acetabular side defects, approach and type of revised prosthesis, Harris hip score (HHS), and other complications were studied. Results: The results in this study demonstrated that financial issues were the cause of delayed attempt for treatment in 5 cases and the other 10 cases had delay for treatment, because they searched for a specialist to accept performing an operating on them. There were some acetabular side and femoral side defects. By Paprosky classification, in femoral side, there were 6 defects: four type 2, one type 3A, and one 3B. In acetabular side, there were 10 defects (three type 1, one type 2a, three type 2b, one type 3a, and two type 3b). In one developmental dysplasia of the hip (DDH) case, previous osteotomy site was revised (distal segment rotated and then refixed) Conclusion: Totally, according to the obtained results, it may be concluded that outcomes were relatively good in neglected prosthesis cases after THA. However, recognition of high-risk cases and reduction of delay time may improve the outcomes.

A Case Report of Simultaneous Ipsilateral Floating Knee and Hip

Background: Simultaneous ipsilateral floating knee and hip is a very rare injury and so far, no standard guideline has been determined for its treatment. Case Report:In the current study, we report a surgical technique for the treatment of a 17-year-old patient with this condition on his left side. Conclusion: We recommend to start the fixation from proximal and stabilize the pelvic ring at first, then fix the posterior part of the acetabulum and femoral shaft with the same posterior approach.

Different Scenarios of Asymptomatic Coronavirus Disease 2019 in Orthopedic Trauma Patients: Case Series and Practical Guide

Background: During the outbreak of the novel coronavirus disease 2019 (COVID-19), Sina Hospital in Tehran, Iran, dedicated a majority of its facilities and workforce to fight this crisis. Meanwhile, our academic trauma center continued to admit emergency trauma patients. Case Report: In this case series, we tried to discuss five previously healthy trauma patients who underwent orthopedic surgery and were diagnosed with COVID-19 later. Also, we described our detailed protocol for the management of orthopedic patients during the pandemic. Conclusion: During COVID-19 time, we continued to provide our best service to the trauma patients while keeping our personnel as far as possible from direct contact with the patients until it was necessary.

Intraosseous Stab Wound of Scapula: A Case Report

Background: Intraosseous stab wounds are extremely rare. Only a few cases have been reported in the upper extremity. Case Report: In this report, we presented a case of stab wound to the right shoulder with penetration to the scapula. The patient was successfully managed in a team-based approach. During a 12-month follow-up, he showed no abnormality in passive and active movements or physical examination. Conclusion: Relying on the physical examinations and paraclinical studies may be an appropriate substitution for exploration surgery when possible iatrogenic injuries may affect the patient's quality of life.

The Post-operative Outcome of Stoppa Approach in the Treatment of Anterior Column Acetabular Fractures

Background: Choosing the proper approach to surgical treatment of various types of acetabular fractures can play an important role in minimizing adverse outcomes during and after surgery. In the present study, we described our experience on the outcome of Stoppa approach in anterior column acetabular fractures. Methods: This was a retrospective analysis of 40 patients with acetabular anterior column fractures that had undergone surgery with Stoppa approach. The study information, Harris Hip Score (HHS), and pre- and post-operative radiographic findings were collected by reviewing the hospital recorded files. Results: HHSs of 80 to 100 were achieved in 75.0% of patients. Completed (anatomic reduction less than 2 mm) displacement reduction was found in 97.5%. 2 mg/dl decreased serum level of hemoglobin (Hb) was found in 75.0%, leading to blood transfusion in 60% of subjects. Regarding post-procedural complications, the common event was infection in 15.0%, followed by degenerative joint disease (DJD) in 15.0%. The post-operative complications were similar in men and women, but were significantly higher in patientsolder than 50 years than the younger patients. Conclusion: Stoppa approach is associated with high success rate and the occurrence of rare and tolerable major complications.

Kocher-Langenbeck Approach in Prone Position

Background: The posterior approach for acetabular fractures is the Kocher-Langenbeck (K-L) approach which is performed in lateral and prone positions. Lateral position is a familiar position for most orthopedic surgeons. Prone position yields multiple advantages compared to lateral position. Methods: Between years 2016 and 2019, 18 patients with selected acetabular fractures in which the best decision was surgical fixation using K-L approach were studied. The surgical procedure was done using K-L approach with the patient in prone position and we used Matta scoring system to evaluate post-operative reduction quality. Results: According to the Matta system, the anatomic reduction was observed in 13 patients (86.6%). Imperfect reduction was observed in 2 patients (13.3%), no patient had poor reduction. Avascular necrosis (AVN) of the femoral head was seen in one patient (6.6%) and no infectio and heterotopic ossification (HO) were noted. Conclusions: The advantage of this approach in prone position is believed to be better exposure and greater access to the quadrilateral plate (QLP) and anterior column indirectly. One of the most important advantages is that in prone position, handling the reduction devices to indirectly reduce anterior column or QLP is much easier

A Novel Parsimonious Method as Accurate as Extravagant Counterparts: Streolithographically-Modeled Patient-Specific Drill Guide Template for Subaxial Cervical Pedicle Screw Insertion

Background: This study was conducted to develop a modified, parsimonious, faster to produce, easier to implement, and patient-specific drill guide template and also to examine if such a modification might affect the accuracy. Methods: On two cadaveric spines, using reverse engineering, the orientation of pedicles and safe corridors for pedicle screw were determined. A drill template was designed with a surface that was the inverse of the posterior vertebral surface. The drill template was manufactured using rapid prototyping technique. To decrease the costs, the cervical spine corresponding prototypes were not manufactured. In contrary to previous studies, to preserve the stability from posterior element, the templates were designed in such a way that removing interspinous and supraspinous ligaments was not necessary. The accuracy was evaluated by computed tomography (CT) images and classified into three grades of 0: correct placement, 1: malposition by less than a half screw diameter, and 2: malposition by more than a half screw diameter. Results: Of 20 positions available, we inserted 19 screws, because the trajectory of one of the patient-specific drill guide templates was misdirected. The overall accuracy rate for cervical pedicle screw (CPS) placement was 84.2% (16 of 19). Safely inserted screws, combining the grades 0 and 1 categories, were as high as 100%. We observed no “unsafe screw placement”. Conclusions: The total cost and the latency period before the operation was reduced and the interspinous and supraspinous ligaments were preserved. A good applicability and high accuracy was obtained for subaxial CPS (SCPS) insertion.

Evaluation of the Degenerative Changes of the Distal Intervertebral Discs after Internal Fixation Surgery in Adolescent Idiopathic Scoliosis

STUDY DESIGN

Retrospective study.

PURPOSE

Lumbar intervertebral disc degeneration is an important cause of low back pain.

OVERVIEW OF LITERATURE

Spinal fusion is often reported to have a good course for adolescent idiopathic scoliosis (AIS). However, many studies have reported that adjacent segment degeneration is accelerated after lumbar spinal fusion. Radiography is a simple method used to evaluate the orientation of the vertebral column. magnetic resonance imaging (MRI) is the method most often used to specifically evaluate intervertebral disc degeneration. The Pfirrmann classification is a well-known method used to evaluate degenerative lumbar disease. After spinal fusion, an increase in stress, excess mobility, increased intra-disc pressure, and posterior displacement of the axis of motion have been observed in the adjacent segments.

METHODS

we retrospectively secured and analyzed the data of 15 patients (four boys and 11 girls) with AIS who underwent a spinal fusion surgery. We studied the full-length view of the spine (anterior-posterior and lateral) from the X-ray and MRI obtained from all patients before surgery. Postoperatively, another full-length spine X-ray and lumbosacral MRI were obtained from all participants. Then, pelvic tilt, sacral slope, curve correction, and fused and free segments before and after surgery were calculated based on Xray studies. MRI images were used to estimate the degree to which intervertebral discs were degenerated using Pfirrmann grading system. Pfirrmann grade before and after surgery were compared with Wilcoxon signed rank test. While analyzing the contribution of potential risk factors for the post-spinal fusion Pfirrmann grade of disc degeneration, we used generalized linear models with robust standard error estimates to account for intraclass correlation that may have been present between discs of the same patient.

RESULTS

The mean age of the participant was 14 years, and the mean curvature before and after surgery were 67.8 and 23.8, respectively (p<0.05). During the median follow-up of 5 years, the mean degree of the disc degeneration significantly increased in all patients after surgery (p<0.05) with a Pfirrmann grade of 1 and 2.8 in the L2-L3 before and after surgery, respectively. The corresponding figures at L3-L4, L4-L5, and L5-S1 levels were 1.28 and 2.43, 1.07 and 2.35, and 1 and 2.33, respectively. The lower was the number of free discs below the fusion level, the higher was the Pfirrmann grade of degeneration (p<0.001). Conversely, the higher was the number of the discs fused together, the higher was the Pfirrmann grade.

CONCLUSIONS

we observed that the disc degeneration aggravated after spinal fusion for scoliosis. While the degree of degeneration as measured by Pfirrmann grade was directly correlated by the number of fused segments, it was negatively correlated with the number of discs that remained free below the lowermost level of the fusion.

Iranian Joint Registry (Iranian National Hip and Knee Arthroplasty Registry)

Periodic evaluation and monitoring the health and economic outcome of joint replacement surgery is a common and popular process under the territory of joint registries in many countries. In this article we introduce the methodology used for the foundation of the National Iranian Joint Registry (IJR) with a joint collaboration of the Social Security Organization (SSO) and academic research departments considering the requirements of the Iran's Ministry of Health and Education.

Clinical outcomes of total hip arthroplasty in patients with ankylosed hip

BACKGROUND

Hip ankylosis includes the limitation of hip motion and hip arthroplasty is the recommended treatment. This study aimed to evaluate the clinical and radiographic outcomes in the treatment of ankylosis of the hip joint by the Harris Hip Score (HHS).

METHODS

This interventional study was performed on patients with ankylosis in one or both hip joints, who were referred to Sina Hospital, Tehran, Iran from 2011-13. Electromyogram and nerve conduction studies were taken from the hip abductor muscles before surgery and HHS was calculated. Type of surgery and prosthesis, osteotomy required for the neck and trochanteric region of the femur, periprosthetic fracture and the need to restore the acetabulum were studied in the patients. Postoperative complications such as infection and dislocation at 3, 6 and 12 months after surgery were examined and then the HHS was calculated.

RESULTS

Six patients were excluded after six month and two patients were excluded after 12 month due to surgery complications. The mean HHS of patients before surgery was 48.53±6.28 and it progressed to 88.22±3.78 after 12 month (P<0.001).

CONCLUSIONS

Total hip arthroplasty for patients with ankylosed hip can improve the range of joint motion, especially in the long-term follow-up. However, good results should be considered in the absence of pre- and post-operative complications.

Plantar fasciitis

Heel pain, mostly caused by plantar fasciitis (PF), is a common complaint of many patients who requiring professional orthopedic care and are mostly suffering from chronic pain beneath their heels. The present article reviews studies done by preeminent practitioners related to the anatomy of plantar fasciitis and their histo-pathological features, factors associated with PF, clinical features, imaging studies, differential diagnoses, and diverse treatment modalities for treatment of PF, with special emphasis on non-surgical treatment. Anti-inflammatory agents, plantar stretching, and orthosis proved to have highest priority; corticosteroid injection, night splints and extracorporeal shock wave therapy were of next priority, in patients with PF. In patients resistant to the mentioned treatments surgical intervention should be considered.

Ochronosis of hip joint; a case report

Background

Ochronosis is connective tissue manifestation of Alkaptonuria. Joint involvement specially hip and knee destruction is seen. The cartilage is pigmented and destroyed. It is interested for both pathologists and orthopedic surgeons.

Case Presentation

A 54 years old woman with hip fracture after simple falling is candidate for surgery, but, after skin and subcutaneous incision over deep fascia there was dark blue pigmentation which continues toward hip joint. After biopsy of soft tissues and bone, in another operation, we replace hip joint.

Conclusion

In this case, besides of cartilage destruction of hip joint, there was a lythic lesion of neck of femur which causes pathologic fracture of hip joint. We planned Total hip replacement instead of bipolar for her because of cartilage damage of acetabulum.

The predictive value of extensor grip test for the effectiveness of treatment for tennis elbow

OBJECTIVE

To compare the effectiveness of 5 different modalities, and determine the usefulness of recently proposed extensor grip test (EGT) in predicting the response to treatment.

METHODS

In a randomized controlled clinical trial, 92 of 98 tennis elbow patients in Sina Hospital Tehran, Iran between 2006 and 2007 fulfilled the trial entry criteria. Among these patients 56 (60.9%) had positive EGT result. The stratified EGT result, were randomly allocated to 5 treatment groups: brace, physiotherapy, brace plus physiotherapy, injection, and injection plus physiotherapy.

RESULTS

Patients with a positive EGT result had better response to treatments. Among them, injection plus physiotherapy was the most successful, then brace plus physiotherapy, physiotherapy, and brace injection was the worst treatment modality. Response to treatment was comparable in all groups between EGT positive and negative patients except bracing, in which positive EGT was correlated with a dramatic response to treatment.

CONCLUSION

In all patients, injection plus physiotherapy and then brace plus physiotherapy is recommended, but in EGT negatives, bracing seems to be of no use. Injection alone is not recommended in either group.