The efficacy of hemiepiphysiodesis for idiopathic knee coronal angular deformity by reconstruction plate and screw: A pilot study

Background

Angular deformities of the lower extremities are among the most common findings in pediatric orthopedics. Alteration of the mechanical axis in the lower extremity affects the cosmetic appearance and may lead to gait disturbances, knee discomfort, patellar maltracking with or without pain, and early joint osteoarthritis. In the current study, we aimed to investigate the efficacy of 3-hole 3.5 mm reconstruction plates in tension-band temporary hemiepiphysiodesis for correcting idiopathic knee coronal angular deformities.

Methods

The surgical procedure was performed using an extraperiosteal tension band plate (a 3-hole reconstruction plate) and two 3.5 mm cortical screws to treat idiopathic knee coronal angular deformity in children. The location of the hemiepiphysiodesis was determined based on the type of angular deformity present. Postoperative follow-ups were conducted through x-rays to measure the medial proximal tibial angle and lateral distal femoral angle of the limbs. Statistical analysis was then performed to evaluate the efficacy of the surgical treatment based on the rate of alignment change exhibited.

Results

The study included 14 patients (25 limbs) with genu valgum deformity who underwent temporary hemiepiphysiodesis on both the distal femur and proximal tibia, with 16 proximal tibias and 15 distal femurs being corrected. The correction rate for genu valgum was found to be 0.59° per month for both proximal tibial and distal femoral hemiepiphysiodesis. Six patients (12 limbs) were also identified with genu varum deformity, and the correction rates for proximal tibial lateral hemiepiphysiodesis and distal femoral lateral hemiepiphysiodesis were 0.85° and 0.15° per month, respectively. During a mean follow-up duration of 11 ± 5.7 months, only one case of physeal plate closure was observed, and there were no other significant complications.

Conclusion

Temporary hemiepiphysiodesis with a 3-hole R-plate and two cortical screws takes advantage of physiological physeal growth to successfully treat idiopathic angular deformities with low complication rates.

Femoral and Popliteal Artery Pathway in Varus and valgus aligned lower limb; a CT Angiographic study

Objectives: This study aimed to compare the femoral and popliteal arteries pathway in varus and valgus- aligned lower limbs. Methods: A retrospective CT angiography (CTA) study from October to December 2021 was conducted. Distance of the femoral and popliteal artery to specific bony landmarks in thigh and knee was measured. Results: Eighty limbs including 40 varus and 40 valgus lower limbs were assessed. No significant difference between varus/valgus groups in terms of distances was noted. Conclusion: Our study compared pathway of PA and FA artery in varus and valgus knees using CTA images; and no significant differences was seen between the two groups of varus and valus.

Peroneus Longus Tendon Autograft versus Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Comparative Study with a Mean Follow-up of Two Years

BACKGROUND

Peroneus longus tendon can be a suitable alternative autograft for anterior cruciate ligament reconstruction (ACLR). The present study aimed to compare the clinical outcome and donor site morbidity in ACLR using peroneus longus tendon autograft versus hamstring tendon autograft.

METHODS

In a comparative cross-sectional study, ACLR was performed with quadrupled hamstring tendon autograft in 65 patients between 2017 and 2018, and in another group, peroneus longus tendon autograft was used for ACLR in 65 patients between 2018 and 2019. The same surgical technique, fixation method, and postoperative protocol were used in both groups. The knee functional outcomes were assessed according to the Lysholm score and the International Knee Documentation Committee scale at preoperative and at the end of at least 2 years after the procedure. Moreover, graft diameter was measured intraoperatively. Thigh circumference, the American Orthopedic Foot and Ankle Score (AOFAS), The Foot & Ankle Disability Index (FADI), and ankle range of motion (ROM) were used to evaluate ankle donor site morbidities.

RESULTS

A total of 130 patients (65 patients in each group) were evaluated with a minimum follow-up of 2 years (range 24-31 months). Both groups showed no significant differences in clinical outcomes and knee stability. The peroneus longus graft diameter was significantly larger than the hamstring diameter (P<0.001). Assessment of AOFAS, FADI, and ankle ROM showed no apparent ankle joint dysfunction in the peroneus longus tendon group.

CONCLUSION

Faster knee extensions, less anteromedial knee pain, and thigh hypotrophy were observed in peroneus longus tendon patients. Peroneus longus tendon autograft can be an appropriate autograft for ACLR due to its strength, larger graft diameter, and avoiding potential complications of hamstring autograft obtained from the knee region.

Rare case of lateral dislocation of the elbow without distinct radiological signs

While the elbow joint dislocation is one of the most common dislocations, lateral dislocation of elbow is so rare. In this study, we described a 65-year-old woman with lateral elbow dislocation referred to Akhtar Hospital. With full range of motion in supination, pronation, and extension, as well as 60º flexion, the most important finding with this case was that the radiographic findings could not help surgeon to diagnose the lateral dislocation. Therefore, CT-scan was performed. After confirmation, closed reduction was done via a standard maneuver. The patient was followed up for 2 weeks and physiotherapy was ordered. According to this case, when there was an elbow trauma with unusual radiograph without any specific finding to confirm the lateral dislocation, it is recommended to perform CT-scan. The closed reduction and following physiotherapy also are essential for management of this condition. 

The Effect of Body Mass Index on the Outcome of Lumbar Epidural Steroid Injections: Six-Month Follow-up

Obesity is a risk factor for severe, radicular, and debilitating lumbosacral pain. The use of non-surgical treatment methods in obese patients is important. Epidural steroid injection (ESI) is a common procedure that helps patients with low back pain and radicular symptoms. So far, using ESI in patients with lumbar herniated discs remains to be controversial among physicians. Thus, the current study was carried out to compare the therapeutic effects of ESI's in obese and non-obese patients with spinal disc herniation. This prospective, clinical trial study was conducted among 124 patients (58=non-obese, 66=obese) with low back pain caused by a lumbar herniated disc, who referred to our Pain Clinic from 2017 to 2018. The ESI was done using the parasagittal inter-laminar approach. The severity of pain was measured by the patients’ self-report of pain and using the visual analog scale (VAS) before the treatment and two and six weeks after the treatment. The Oswestry Disability Index (ODI) was also measured in the treatment groups. Patients were followed for 6 weeks (IRCT20131124015515N3). Overall, 58 (46.8%) patients had a BMI of 20-25 kg/m2, 38 (30.6%) had a BMI of 25-30 kg/m2, and 28 (22.6%) patients had a BMI of >30 kg/m2. The changes in the pain scores and ODI at different time periods showed no statistically significant differences in the two groups (P=0.685, P=0.995), respectively. The ESI is an effective, safe, minimally invasive, and cost-effective method that can result in pain relief and improvements in patients' function after a short period of time. Hence, we suggested that this treatment be considered for all patients with acute/chronic low back pain as well as radiculopathy.

Magnetic Resonance Imaging Assessment of Hip Abductor after Total Hip Arthroplasty Using a Direct Lateral Approach

Background

Surgical techniques and rehabilitations after total hip arthroplasty (THA) play a significant role in the improvement of pain and limping. This study aimed to assess hip abductor muscle's diameter and its strength after 6 months postoperative THA performed by Hardinge approach.

Methods

After obtaining the patients' demographic characteristics, the preoperative values of patients' hip abductor muscle diameter were measured using magnetic resonance imaging, and were compared with postoperative values 6 months later. Moreover, the hip abductor muscle's strength was assessed using the Trendelenburg test.

Results

A total of 88 patients participated in this study with a mean age of 47.3±1.574 years. It should be noted that 55.7% of the participants were male. Muscle diameter decreased from a mean value of 27.07±7.485 preoperative to mean value of 25.64±7.353 mm postoperative (P<0.001). Moreover, the degrees of Trendelenburg test (i.e., mild or severe) decreased after surgery (P<0.001). There was no significant difference between the frequencies of different grades of limping according to the studied variables.

Conclusion

A decrease was observed in gluteus medius muscle diameter, and the Trendelenburg test results were improved in this study. Moreover, the difference between pre- and postoperative gluteus medius muscle diameters were measured using MRI. It can be concluded that MRI is not an appropriate diagnostic tool for the assessment of abductor strength after THA in the 6-month postoperative visit. Accordingly, it is suggested to evaluate muscle strength before and after each surgery to schedule the following treatment protocol required for each patient.

Sterile Parts of Operating Gown during Lower Limb Joint Replacement Surgery

BACKGROUND

The prevention of surgical site infection is one of the most concerning issues in operating rooms. Surgical gowns are worn as one of the intraoperative strategies for infection prevention. The present study investigated whether the gowns remained sterile during the surgical procedure. Furthermore, this study examined which parts of the surgical gown were more prone to contamination.

METHODS

The sterility of the gowns was investigated during eight total joint arthroplasties all of which were performed by four surgeons. The samples were taken from the arms and frontal part of the sterile gowns pre- and postoperatively. In the anterior surface of the gown, the sampling was initiated at a strip with 50 cm height from the ground followed by the strips with 15 cm distances from caudal to cephalad. Furthermore, the frontal part of the gown was divided into three parts in relation to the operating room table. Finally, the contamination rate was evaluated in each part. A semiquantitative method was used for the analysis of bacterial culture.

RESULTS

Before the operation, there were four samples tested positive for bacterial culture (1.06%). All of these samples were taken from the most proximal strip near the neckline. After the surgery, the rate of contamination in the strips on the frontal part of the gown was reported as 3.1% to 53%. Based on the operating table, the contamination rate was 35.9%, 8.9%, and 47.3% in the distal, middle, and proximal parts of the gown, respectively. The contamination rate at the elbow crease was 23%, and at 5 and 10 cm above the creases were 24% and 36%, respectively.

CONCLUSION

The high rate of gown contamination during the operation is concerning. However, part of the gown that was in contact with the operating room table remained clean most of the time. More safe strategies should be used for infection prevention in operating rooms.

Evaluation of Changes in the Tibiotalar joint after High Tibial Osteotomy

BACKGROUND

There are limited studies regarding the effects of high tibial osteotomy (HTO) on other areas of lower extremity. In current study, we investigated the changes of tibiotalar joint following HTO.

METHODS

A total of 39 patients with genu varum requiring HTO were enrolled in this before and after study. The genu varus, joint diversion (JDA), lateral distal tibial (LDTA) and lateral distal tibial-ground surface (LDT-GSA) angles were measured before the operation and compared with 6 months after the surgery.

RESULTS

Twenty threeout of39 patients (59%) were females. The genu varus angle decreased significantly (13°±1.7° versus 0.6°±1°). No significant changes were seen in JDA (P=0.45) and LDTA (P=0.071). LDT-GSA changed significantly (P=0.011) from 8.1°±1° in varus to -0.3°±0.5° in valgus.

CONCLUSION

Although HTO did not change the JDA and LDTA, however, significant change in LDT-GSAindicates that HTO can significantly decrease the shearing forces exerted on the ankle joint.