Open Journal of Orthopedics
ISSN / EISSN : 2164-3008 / 2164-3016
Published by: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 429
Latest articles in this journal
Open Journal of Orthopedics, Volume 11, pp 183-198; https://doi.org/10.4236/ojo.2021.116018
Background: The number of total knee arthroplasty (TKA) surgeries performed each year is increasing worldwide and mechanical alignment (MA) is currently seen as the gold standard procedure. However, taking neutral alignment as the universal goal may be mistaken. In our hospital, we currently conduct kinematically aligned TKA (KA-TKA). Three different types of implants are used: the cruciate-retaining (CR) type, cruciate-sacrificing (CS) type, or bi-cruciate-retained (BCR) type. We aimed to compare the coronal alignment observed following KA-TKA and MA-TKA and in normal knees, as well as that achieved with different types of implants. Methods: The study comprised 206 knees of Japanese patients who underwent KA-TKA using varying implants in our Hospital between May 2019 and April 2020. Measurements of pre- and postoperative coronal alignment were determined from weight-bearing full-leg standing radiographs. The postoperative results were compared to measurements taken from patients who underwent MA-TKA (N = 96) and normal knees (N = 60). Results: No significant differences between the KA-TKA group and normal knees were found for the medial proximal tibial angle (MPTA) (–4.2° ± 2.6° vs –3.8° ± 2.5°) or joint line orientation angle (JLOA) (0.2° ± 1.9° vs 0.3° ± 1.4°). However, when MA-TKA was compared to KA-TKA and normal knees, there were significant differences in both the MPTA and JLOA (p Conclusions: Here, we demonstrated that following KA-TKA, the articular surface of the tibia exhibited a similar varus alignment as that of normal knees, meaning that the technique reproduces the native knee. Furthermore, KA is patient-specific, and does not have the same failures as MA-TKA. Therefore, we anticipate a paradigm shift from mechanical to kinematic alignment, which may help reduce the dissatisfaction rate of TKA patients.
Open Journal of Orthopedics, Volume 11, pp 199-205; https://doi.org/10.4236/ojo.2021.116019
Introduction: Transfemoral amputation results in a prosthesis which bears weight on the ischium. Gait disturbance, lack of an end-bearing stump and discomfort in the groin from the socket even while sitting, are important issues. Methods: This is a pilot report of an ongoing randomized blind clinical trial of a new intramedullary implant post transfemoral amputation. Here, we describe a single case illustrating the surgical technique and clinical outcome of a dysfunctional post-traumatic transfemoral amputation addressed with this implant. Clinical gait analysis, SF-12 and VAS were assessed pre- and post-intervention at 6 months of follow-up. Results: An improved stump control is accomplished by means of myoplasty and myodesis through an end-cap. Stride width improved from 0.21 m pre-op to 0.13 m post-op, and more symmetrical stride length (△0.21 m pre-op vs. △0.06 m post-op) was noted, indicating improved gait quality and stability. Gait velocity increased (0.51 ± 0.04 m/s pre-op vs. 0.64 ± 0.02 m/s post-op). Conclusion: This technique reveals improvements in gait parameters in a transfemoral amputee treated with a new procedure. Improved prosthesis control, sitting comfort, greater hip range of motion, better gait stability, and enhanced walking abilities were noted.
Open Journal of Orthopedics, Volume 11, pp 146-152; https://doi.org/10.4236/ojo.2021.114014
In orthopaedic patients, peripheral intravenous (IV) cannulation is a common procedure for various clinical purposes. This patient was introduced with a 17G cannula in the basilic vein of the dorsal venous arch of the left hand prior to knee replacement surgery. Post knee surgery patients use walking aids for mobilization. Cannula which has been placed at the dorsum of the hand has a potential to bend at the neck of the cannula when the wrist bend while holding the walking aid. Repeated bending can result in fatigue fracture of the cannula neck. In this patient at the time of cannula removal, it was noted the catheter part is broken and proximal migration. Ultrasound guided localization was done and removed with a venotomy under local anesthesia. It is advisable to place peripheral venous cannulas well away from the wrist joint, which will prevent catheter bending and fracture. This is a very important point to consider when placing cannulas in orthopaedic patients who undergo surgical procedures.
Open Journal of Orthopedics, Volume 11, pp 170-182; https://doi.org/10.4236/ojo.2021.115017
Background: Synovial cysts of the hip are commonly found in patients with intra- or extraarticular pathologies of the joint. Symptoms are mostly unspecific. To date there are no guidelines for a gold standard of treatment. Aim of this article is to show up how lesions of the ligamentum teres (LT) might possibly lead to a specific formation of synovial cysts of the hip joint and how this can be treated arthroscopically. Methods: This case series included 3 patients with ganglia of the hip. All patients had impingement symptoms, combined with untypical location of pain. All patients qualified for joint preserving surgery and underwent hip arthroscopy with pre- and postoperative MRI imaging. The mean follow-up time was 22 months. Results: MRI imaging showed extensive ganglia, presumably originating from the pelvic root of LT, extending to the obturator lodge. In 2 of 3 cases MRI showed lesions of the LT. Hip arthroscopy revealed damage of the LT in all cases, caused by chronic instability of the joint. The postoperative MRI showed a complete regression of the ganglia in all patients after offset correction. After follow-up, 2 of 3 patients were mostly symptom free. One patient was still suffering from a chronic weakness of the gluteus medius muscle. Conclusion: Whenever unspecific radiating pain of surrounding areas of the hip is encountered and cannot be explained by common pathologies of the hip, possible compression of nerves by ganglion cysts should be excluded. This should be done by MRI arthrography. A partial rupture of the LT can occur during FAI with consecutive formation of ganglia in the obturator canal, compressing the obturator nerve. Primarily the articular pathology needs to be repaired. In our cases, this was feasible by hip arthroscopy, as a minimally invasive and safe technique.
Open Journal of Orthopedics, Volume 11, pp 110-125; https://doi.org/10.4236/ojo.2021.114011
Background: The main purpose of the present study was to assess the short term performance of a cementless femoral stem in total hip replacement. Methods: Cross-sectional observational study of a 48-patient cohort with Phenom? femoral stems implanted between June 1, 2014 and September 1, 2018, to determine clinical performance, stability, and radiographic osseointegration. Patients were followed-up from 13 to 76 months (mean: 44.5 months) and assessed using the Harris Hip Score-HHS, the Hip Disability and Osteoarthritis Outcome Score-HOOS and radiographs. Results: All stems were radiologically stable. Mean Harris Hip Score was 89.8 and the HOOS was 80.4. No statistical differences were observed among patients with different diagnoses. Conclusions: The short-term results revealed satisfactory clinical outcomes and radiological signs of implant stability in all cases. Using two functional scores was useful in detecting biases and a low to moderate agreement was found between the scores.
Open Journal of Orthopedics, Volume 11, pp 47-66; https://doi.org/10.4236/ojo.2021.112006
The Kirschner wires (K-wires) are stiff and straight wires made of smooth stainless steel. These are used in surgery to aid in repairing the process of a fractured bone. In forefoot elective surgeries, these pins are mostly used for fixation of the phalangeal or metatarsal area. These wires are usually either buried or exposed, The exposed wires do not require another operation to remove them and are generally preferred. In using the forefoot surgery history of a single surgeon which was taken for 3 years. The purpose of this study is to evaluate the occurrence of infections following elective surgeries of the forefoot that were fixed using k-pins and to indicate an effective treatment option for resolving the infection. The inclusion criteria set for this study was to remove any patient having any disease except for diabetes. Moreover, the age limit was set to be 18 - 44, making a final sample of 50 people, prescribed prophylactic antibiotics or early removal of k-pins, where necessary. The researcher recorded demographic and biological data from the patients such as age, BMI, and smoking status were recorded. The researcher conducted a Univariate analysis via a Chi-square test. 50 Patients (82 K-wires) were analyzed. Results showed that surgery type, BMI, and smoking were three variables that affect the infection growth significantly while diabetes and type of cleaning disinfectant had marginal effects. Further study is required to clarify the best treatments in this area, as the treatment option antibiotics have nearly similar results.
Open Journal of Orthopedics, Volume 11, pp 126-137; https://doi.org/10.4236/ojo.2021.114012
Objective: The purpose of this pilot study is to compare the transverse palatal widths in untreated adult cleft palate patients with normal adult patients. Methods and Materials: The study was conducted in Bangladesh recruiting 10 patients with adult sized untreated cleft palate and 15 patients with normal adult sized palates. The control group was comprised of 7 males and 8 females with a mean age of 30.5 ± 4.4 years. The affected group comprised of 7 males and 3 females with a mean age 17 ± 3.3 years. Alginate impressions of the maxillary arch were taken and poured into plaster dental casts. The inter-canine, inter-premolar and intermolar widths were measured to evaluate the maxillary growth pattern in patients with unoperated cleft palate. Due to the small sample size, both independent T-test and Mann Whitney non-parametric tests were performed to analyze the statistical significance of the data. Results: According to both the T-test and Mann Whitney non-parametric tests, the inter-premolar width including both the first and second premolars was statistically significantly smaller in the affected group with p values of 0.003 and 0.00 respectively. There was no significant difference in the inter-canine width between the affected and control group due to the variable canine position in cleft palate patients. Due to small sample size, no significant difference in the intermolar width between the affected and control group could be established. Conclusion: The interpremolar width is significantly smaller in patients with adult sized cleft palates than individuals with normal adult sized palates.
Open Journal of Orthopedics, Volume 11, pp 138-145; https://doi.org/10.4236/ojo.2021.114013
Background: Klippel Feil syndrome (KFS) is a congenital malformation characterised by the presence of, at least, one fused cervical segment and results from faulty segmentation along the embryo’s developing axis during weeks 3 - 8 of gestation. The KFS increases the risk for spinal cord injury after minor trauma as a result of the disturbance of the biomechanics of the cervical spine. Persons with KFS often have associated congenital anomalies. Aim: The purpose of this study was to show the surgical management difficulties of this pathology in a low income country such as Senegal and to make a review of the literature. Case presentation: A 32-year-old man developed a tetraparesis secondary to a fall from his height while carrying a bag of rice on his head. Radiological explorations revealed fusedC2-C3 and C4-C5 vertebral bodies with a C3-C4 disc herniation associated to a spine contusion. The patient underwent surgical removal of the herniated disc via an anterior approach followed by interbody fusion and anterior plating. A complete recovery was noted at 4 months follow-up. Conclusion: Understanding of the cervical spine biomechanics of Klippel-Feil anomaly may allow an optimal management of patients. Patients with KFS should be warned of the increased risk of spinal cord injury after a low velocity trauma. Timing for surgery should be shortened.
Open Journal of Orthopedics, Volume 11, pp 1-11; https://doi.org/10.4236/ojo.2021.111001
Osteoporosis is an increasingly prevalent malady of the elderly that is associated with bone fragility and increased risk of fractures. Osteoporosis treatments focus on restoring bone strength and quality. Teriparatide (TPTD) is a therapeutic agent that has been shown to increase bone strength by improving the volume and connectivity of trabecular bone. Exercise is also known to have pro-osteogenic effects. Here we used a rat model of severe osteoporosis (ovariectomized and tail-suspension) to evaluate the effects of TPTD, exercise and a combination of TPTD and exercise on the microstructure of trabecular bone. TPTD mono-therapy and TPTD combined with exercise treatment significantly increased bone mineral density (BMD) in the whole body. Micro-computed tomography analysis revealed that a combination of exercise and TPTD treatment significantly decreased bone surface to volume and trabecular separation compared with those of the control and exercise groups. Node-strut analysis indicated that exercise or TPTD alone did not affect trabecular bone connectivity. However, the combination of exercise and TPTD treatment significantly decreased measures of trabecular bone connectivity (node number) that are consistent with a transition from rod-like to plate-like of trabecular bone microstructures. The combination treatment with exercise and TPTD improved microstructure of trabecular bone in the OVX and tail-suspended rats. These results indicate that combining exercise with TPTD represents a viable means to improve cancellous bone strength in osteoporosis populations.
Open Journal of Orthopedics, Volume 11, pp 85-95; https://doi.org/10.4236/ojo.2021.113009
Background: Corona Mortis is an abnormal blood vessels connecting Between obturator and external iliac systems of vessels and inferior epigastric vessels. It is located behind the superior public ramus at a variable distance from the symphysis pubis. Orthopaedic surgeons and obestitrtion found these vessels in the field of surgery. So displaced fractures or iatrogenic injury, can cause life threatening bleeding and hence these vascular anomalies are referred to us crown of death. The bulk of the studies about the corona mortise were conducted in the cadavers or 3D CT angiography and there was no studies were conducted about corona mortise in Sudan. The purpose of this study was to study the corona mortis anatomical and clinical implication in the anterior approaches to the pelvis and acetabulum in Sudanese patient. Methodology: Hospital based descriptive cross-sectional study was conducted among patients sustaining anterior pelvic anterior acetabulum fracture and underwent open reduction internal fixation by reconstruction plates. This study was conducted in Bahri Teaching Hospital from June 2017 to June 2018. Through the most common anterior approaches to the pelvis and acetabulum (Stoppa-modified stoppa-ilioinguinal), done by single surgeon and fulfil data sheet intra-operatively. Results: In a total of 30 pelvic halves corona mortis was detected in 13 patients (43%).The Majority in the Rt.hemipelvies 7 (53.8%) specimens: arterial 4/13 (30.8%), venous 1/13 (7.7%) and both arterial and venous in 8/13 (61.5%) specimens respectively. Of these (53.9%) had a large Diameter > 5 mm and the largest one measure 80 mm, with mean distance From the symphysis 5.8 + 1.6 mm. Conclusion: Only 13 patients have corona mortis, 12 of them were arterial with diameter more than 5 mm (53%), and thus surgeon should exercise caution during Surgery and secure its site to help minimizing surgery time, Clear surgical field and prevent iatrgenic injury.