American Journal of Orthopedic Research and Reviews

Recent years, the risk of hip fractures in elderly people has exponentially increased due to a progressive loss of bone mass and bone structure deterioration due to osteoporosis and increased incidental falls. It is, therefore, expected that the prediction of femoral strength and fracture location of specific patient will be clinically very useful. It is also considered that some typical femoral diseases such as osteoarthritis (OA) and avascular necrosis (AVN) could affect the strength and fracture behaviour of the femurs. In this study, 130 computational femoral models were constructed using CT images of 73 patients. Then, CT image based finite element method (CT-FEM) combined with a damage mechanics analysis was applied to predict the fracture load as the femoral strength and the fracture location of the femoral models. The computational results exhibited that the fracture load tended to increase with increase of the volumetric bone mineral density (vBMD) estimated in the femoral head and neck region in all the three types of models, although AVN models showed much wider scatter in the data than the other two types. The bone fracture behaviour was expressed as expressed as the distribution of failure elements in the head and neck region. The bone fracture mainly took place in the neck region for all types of femoral model. In addition, a combination of the head and neck fracture was also observed in all the models. A combination of neck and intertrochanteric fracture was also observed in the normal and AVN groups.

Introduction: Tibial plateau fractures form a wide spectrum of injuries accounting for 1.2% of all fractures and a prevalence of 10 cases per 100,000 inhabitants. Methodology: A prospective consecutive multicentre study from May 2018 to May 2021 was carried out in Yaounde. All consenting cases of tibial plateau fracture underwent surgical treatment while patients with pathologic fractures, previous knee osteoarthritis, medically unfit for surgery, and discharging against medical advice were excluded. Data was analysed with SPSS 26.0 and the level of significance set at p

The Kocher-Langenbeck (K-L) approach is the ‘workhorse’ of surgery for acetabular fractures needing posterior fixation. It is indicated for most of these fractures for proper surgical technique and optimal outcome. We therefore evaluated the outcome of surgically treated acetabular fractures through the K-L approach in our setting with limited resources. 57 patients were operated by the K-L approach during the 3-year study period. The most common indications of this approach were: posterior wall (38.6%) and transverse + posterior wall fractures (36.8%). Based on Matta’s criteria of fracture reduction, 81 % were judged anatomic, 16% imperfect and 3 % poor. A surgery waiting time of 8 to 14 days after injury, significantly favoured anatomic fracture reduction. The MAP score was excellent in 72 % and unacceptable in 10.6 %. Factors associated with poor outcomes were poor fracture reduction and the development of early post-operative complications. Iatrogenic sciatic nerve palsy (ISNP) was the most significant post-operative complication (19.3%). The levering of Hohmann retractors in the sciatic notches was the major risk factor for developing ISNP, compared to the use of sciatic nerve retractors. Other early and late complications included surgical site infections (12.3%) and heterotopic ossification (8.8 %), respectively. The overall outcome following surgery by the K-L approach is satisfactory. However, there is need to ameliorate the technique, especially at the level of instrumentation, to limit post-operative complications.

Objectives: Gout has a predilection for the foot and ankle, but the impact of gout has limited presence in the literature. The aim of this systematic review was to synthesise existing literature which has investigated the characteristics of foot and ankle involvement in gout; identifying consensus and highlighting areas for further study. Methods: Studies were included if they were published in English and involved participants over 18 years of age with gout, and presented original findings relating to outcome measures associated with the foot and ankle. Methodological quality was assessed using a modified version of the Quality Index Tool. Results. Of 707 studies identified, 16 met the inclusion criteria and were included in this review. The mean (range) quality score was 68.1% (38.9%-88.9%). Compared to controls, participants with gout reported higher levels of activity limitation, foot-related pain and disability and walked more slowly. Plain radiography, dual-energy Computer Tomography and diagnostic ultrasound consistently demonstrated pathological features of gout in the first metatarsophalangeal joint and Achilles tendon. However, studies offered limited quality, particularly around recruitment strategies, validity and potential impact of confounding factors, making definitive statements difficult. Conclusions: This systematic review highlights the negative impact of gout on the structure and function of the foot and ankle causing significant impairment and disability. To effectively guide management, improvements in methodological quality are recommended.

Among pelvic serious injuries is the so-called “open book” injury of the pelvis, with Sacroiliac Joint Disruption (SIJD) in combination with upper pubic ramus or anterior column fracture, contralateral or ipsilateral, or both. This combination of pelvic injury could be classified according Young and Burgess classification as LCIII or CM type (Combined Mechanism) and as 61-B3.1 61-B3.2 following AO/OTA classification. Specifically, the upper pubic ramus fracture can be classified according to Nakatani classification as type I medial of the foramen, type II within the foramen and type III lateral to the foramen. The difficulty to deal with these fractures is how to close and reduct the pubic symphysis in mechanically stable way since there is fracture in one or both the upper pubic ramus. The existence of these fractured elements, in this type of pelvis injury allow a lot of degrees of freedom which must be managed from the surgeon in the proper sequence. The incision and the approach are also mandatory for successfully treating these lesions. Anterior Intrapelvic Approach (AIP) or Stoppa approach in conjunction with the first window of ilioinguinal approach is the most appropriate surgical exposure for reduction and fixation.

Pilomatricoma is a rare, benign skin tumour arising from the hair matrix. The usual locations are the head and neck. Localization in the lower limbs is exceptional. The diagnosis of certainty is histological. Treatment is complete surgical removal to avoid recurrence. We report in this article the case of a rare localization of a pilomatricoma on the right leg, in a 25-year-old patient operated with complete surgical removal. The postoperative course was simple and without recurrence after 2 months of follow-up.

Introduction: Osteoarthritis (OA) is the most common rheumatologic disease in the world and the elderly are the most affected, although there is no defined age for its onset. Obesity is a risk factor, with healthy eating habits and physical exercise practices being recommended for treatment and prevention. The pharmacological treatment for OA is oral chondroprotective agents and viscosupplements, although anti-inflammatory drugs are widely prescribed, they do not cause clinical improvement, they only treat the symptoms of the disease. Objective: This study gathered articles from clinical trials in Brazil with the purpose of investigating whether the pharmacological treatments used are effective. Methods: The electronic platforms used for data collection were: Scielo, CAPES Journal Portal and Google Academic. Articles published in the last six years with clinical trials in Brazil were considered. Articles involving surgeries, those that used physiotherapy as an adjunct therapy and those that used animal or non-human research in their research were excluded. The search was through the descriptors: hyaluronic acid, glucosamine and chondroitin. Results: The search resulted in six articles, in which three were used chondroprotectors and the other three viscosupplements. Chondroprotectors were effective in 66.66% of clinical trials and viscosupplements in 100%. Conclusion: Pharmacological treatments for OA showed high efficacy, however the sample of the present work was small, thus, further studies are needed to confirm the results obtained.

Objective: To report the experience of the effects of kinesiotherapy exercises applied to a patient with low back pain associated with bone demineralization and lumbar hypolordosis. Methods: Physiotherapeutic monitoring of a 55-year-old female patient from Bahia is presented, presenting a condition compatible with low back pain, secondary to bone demineralization in the lumbosacral spine, dorsal and lumbar hypolordosis. In the assessment, the Owestry questionnaires (14 points), Visual Analogue Scale (grade 6), FABQ-Brazil subscale (43 points), absence of lateral shift, hip movement (internal rotation D = 27º, E = 31º) were applied , segmental mobility test of the thoracolumbar spine (hypermobile vertebrae = L1 to S1), Pronation Instability test (positive), symptoms longer than 16 days, aberrant movements with finger climbing, centralization of symptoms in the flexion and lateral inclination movements, and periphery to knee E. in extension. Thus, it was classified in the Mobilization / Manipulation and Stabilization groups, which was subjected to physical therapy intervention during 12 visits. Therapeutic approaches were based on segmental stabilization exercises associated with co-contraction of the abdominal and pelvic muscles, passive stretching, myofascial release with digit pressure and pelvic, sacroiliac and thoracic mobilization exercises. Results: After treatment, there were positive effects on low back pain and when performing movements, gaining flexibility, mobility and muscle strength, as well as feeling of well-being and improved sleep. Conclusion: It is inferred, therefore, that the conduct based on clinical reasoning is of paramount importance for the physiotherapeutic performance in the kinetic-functional problems arising from low back pain, which contributed to the improvement of the pathological condition and promotion of quality of life.

Introduction: Screening for cigarette use is standard in the orthopedic pre-operative clinic, however traditional biochemical testing methods, including serum and urine cotinine assays, do not differentiate active smoking from nicotine replacement therapy (NRT). In this prospective pilot study, we hypothesize that exhaled carbon monoxide (eCO) testing will be non-inferior to the gold standard serum cotinine (SC) test in screening for pre-operative cigarette use, will differentiate active smoking from NRT, and will allow for substantial cost savings in a clinic setting. Methods: Adult orthopaedic veterans indicated for elective surgery at our institution were offered inclusion. Self-reported smoking status (SRS), eCO and SC levels were obtained preoperatively. An eCO level of >6 parts per million and a SC level >3 ng/ml were considered positive for recent cigarette use. Agreement between SRS, eCO levels and SC levels, and eCO level test-retest reliability were evaluated. Results: Of the 55 patients enrolled into the study, 4 were self-reported Current Smokers and 51 were self-reported Ex-Smokers or Non-Smokers. Combining SRS with eCO levels as a screening tool for recent cigarette use yielded a sensitivity of 100%, a specificity of 98%, a positive predictive value of 95% and a negative predictive value of 100%. eCO testing differentiated NRT from cigarette use in all non-smoking patients. Test-retest reliability for eCO levels showed perfect agreement for 16 patients that had two or more eCO levels pre-operatively. Conclusion: Exhaled CO testing is as effective as SC testing but can differentiate active smoking from NRT, while maintaining a high level of accuracy and reliability when combined with SRS as a screening tool.

Background: It is a common notion that motion of a femoral component during cementation should be avoided as it may weaken the cement mantle. We created an in vitro model of cemented femoral components and subjected them to varying rotational motion during the cement curing process, to measure the effect on the pullout strength of the stem. Methods: 21 sawbones femurs were separated into four groups. The first group served as control and was cemented in a standard fashion. The remainder of the stems were divided into groups and subjected to angular rotational displacement within the cement mantle during curing . Anteroposterior and lateral radiographs were obtained of each model to evaluate for cement defects. Pullout strength testing was performed. Results: Despite rotational displacement, no cement defects were noted on imaging. The control stems showed an average pullout strength of 3735.79N. The experimental groups showed a trend for lower failure loads but it was not statistically significant (P=0.063). Of the 21 stems tested, three encountered cement mantle failure and associated stem pullout and the remainder failed by peripros-thetic fracture. Conclusion: Despite conventional thinking that rotational displacement during the cementing process leading to disruption of the cement mantle integrity, this was not borne out in our study. This should give surgeons confidence that in the set-ting of unintended rotational displacement of a femoral stem, returning the stem to its original position does not significantly compromise the integrity of the cement mantle or the pullout strength of the femoral implant. Small displacement of the femoral stem with prompt correction during cement curing does not cause evident cement mantle defects or a loss of femoral stem pullout strength.