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   Table of Contents - Current issue
October-December 2020
Volume 4 | Issue 4
Page Nos. 171-238

Online since Wednesday, October 21, 2020

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Learn from the past, treat in the present, and keep an eye on the future
Commentary on: Injectable orthobiologic substances
p. 171
Emad S. B. Saweeres
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The future of injectable orthobiologic substances for knee osteoarthritis: Options beyond platelet-rich plasma p. 173
Sandeep Patel, Karan Jindal, Mandeep S Dhillon
The management of young arthritic knee and early grades of osteoarthritis (OA) aims to reduce morbidity and improve the quality of life for which newer modalities are emerging. Orthobiologics have emerged as a viable alternative option as they promote tissue regeneration and could be potential disease-modifying agents. Platelet-rich plasma (PRP) has been promising and is among the frontline treatment options in early OA knee; newer orthobiologic research is progressing beyond this and newer products are being tried. Various combinations of PRP with carriers and growth factor extracts from PRP are some new developments. Additional options beyond PRP include autologous conditioned serum, alpha-2 macroglobulin, adipose tissue derivative, bone marrow aspirate concentrate, and gene therapy. This review aims to shed light on the current literature and future potential of the use of these intra-articular orthobiologics in the 21st century.
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Musculoskeletal hydatid disease of extremities: A topical mini-review of recent articles p. 182
Ganesh S Dharmshaktu, Navneet Adhikari, Pankaj Mourya
Hydatid disease is an uncommon but important parasitic infection that presents itself with various clinical problems. It is reported from both endemic and nonendemic regions. Its common presentation may be either an asymptomatic mass or site-specific symptoms that pose a diagnostic or treatment challenge. More articles are added in the medical literature about this disorder every passing year but mostly limited to sporadic case reports or small series. Consensus on the diagnostic approach and management guidelines is nonexistent owing to the rarity of the condition. An attempt has been made in this article to highlight relevant information from published articles in the last 5 years (the year 2015 onward) on the subject. This article is aimed to serve as a brief overview of the recent updates for general clinicians and orthopedists alike.
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Effectiveness of single injection of platelet-rich plasma over corticosteroid in the treatment of plantar fasciitis – A randomized, comparative study p. 187
Pabitra K Sahoo, Nageshwar A Ujade, Sakti P Das
Objectives: Plantar fasciitis (PF) is not an uncommon cause of heel pain whose treatment is not yet standardized. Although platelet-rich plasma (PRP) and corticosteroid (CS) injections are the two commonly used modalities, yet not much importance has been given to the comparison of their roles in sustained functional improvement. We aimed to study the effect of PRP and CS injections in PF and compare their effectiveness with respect to pain relief and improvement of functional and patient satisfaction. Methods: Seventy-three cases were randomized into two groups: 39 patients (Group A) received a single injection of autologous PRP and 34 in Group B received a single injection of CS (40 mg of methylprednisolone) by the random selection. A structured home exercise program was demonstrated to both the groups, as baseline management. The effectiveness was assessed and compared in preinjection and postinjection at 3- and 6-months follow-up. Visual Analog Scale (VAS), Roles and Maudsley (RM), and Foot Function Index (FFI) scoring systems were used as outcome measures. Results: CSs had an early effect, reducing pain to a moderate level in 82.4% of patients compared to PRP (P = 0.000). However, the effect was not sustainable over a long period. On the other hand, PRP was found to have better pain relief over 3 months and 6 months follow-up with a mean VAS score of 2.0 ± 0.9 and 0.8 ± 0.8, respectively (P = 0.000). There was a significant improvement of FFI and RM score as well as at 6 months follow-up (P = 0.000). Conclusion: Injection of CS had an early effect, which is not sustainable, whereas PRP was found to have a prolonged impact on pain relief and better patient satisfaction with treatment outcomes. Therefore, PRP can be advised for sustained and prolonged improvement in PF.
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Internal fixation of scapular body fractures: Short-term results of a prospective study p. 194
Ahmed Afifi, Islam Khaled
Objectives: Most scapular body fractures can be treated conservatively with good-healing capacity. Indications of surgical treatment of these fractures are often debatable. The purpose of this study was to evaluate the short-term results of open reduction and internal fixation of displaced scapular body fractures. Methods: This prospective case series was conducted between 2016 and 2019. It included 10 male patients with displaced scapular body fractures treated with open reduction and internal fixation using Judet approach. Their mean age was 35.9 years (range, 18–60). The mean follow-up period was 16 months (range, 12–18). Patients were assessed radiologically for union and functionally using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results: Union was achieved in all patients at a mean of 11.3 weeks (range, 8–14). The mean DASH score in the 12th month after the surgery was 30.8 (range, 26.7–36.7). Conclusions: Internal fixation of scapular body fractures gives good functional outcomes with a low complication rate.
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Magnetically controlled growing rods' use for early-onset scoliosis management: A single-center experience p. 199
Monerah M Annaim, Ali A Alhandi, Abdulellah A Alsheddi, Samir Alsayegh, Sami I Aleissa
Objectives: The challenge in treating early-onset scoliosis (EOS) lies behind the nature of the disease and the technical difficulties. Magnetically controlled growing rods (MCGR) provide a noninvasive option of distraction in EOS. This study reports a single-center experience with the system, assessing hardware-related complications, radiological improvement of curves, and need for revision surgeries. Methods: This was a retrospective study of patients who underwent MCGR placement in a single center with a minimum of 2-year follow-up. Patient demographic data, etiology, and pre/postoperative sagittal and coronal plane images were reviewed. Results: Ten patients were analyzed. The mean age at surgery was 5.1 years. The average preoperative coronal curves were 22.9° in upper thoracic, 71.9° in thoracic, and 47.9° in lumbar, and the mean sagittal curves were 20.9 ± 26.6 in thoracic and 41.3 ± 28.1 in lumbar. The mean follow-up was 3.8 years. The average of progression in all planes was monitored in follow-ups, 15.1° (upper thoracic coronal), 41.0° (thoracic coronal), 24.7° (lumbar coronal), 30.8° (thoracic sagittal), and 18° (lumbar sagittal). The mean percentage of improvement was 47% in the main curve. Seven patients had complications, including, three rod malfunction, four screw pullout that was prominent in two patients. Three patients had revisions due to suspected infection and failure of expansion. Conclusions: In this study, MCGR showed promising results where it enabled growth and showed acceptable improvement in the coronal plane with considerably fewer operations and complications. However, all patients had an alteration in the sagittal plane.
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Patients' satisfaction and outcomes of minimally invasive sacroiliac joint fusion at a tertiary care center p. 205
Omar A Al-Mohrej, Naji U Khan, Saif Ur Rehman, Anwar M Al-Rabiah
Objectives: Sacroiliac (SI) joint dysfunction usually relates to SI joint pain that results from unusual patterns of motion within the joint, whether excessive or insufficient. SI joint pain is a frequent reason for axial back pain, which is suffered by around 30% of the population. This retrospective study intends to examine the safety and efficiency of minimally invasive (MI) SI joint fusion that employs triangular implants for individuals where conservative management has not succeeded. Methods: An observational study with eight patients on whom one surgeon performed ten consecutive SI joint fusion operations; all patients have completed their 12-month review. The study has examined medical records for demographic details, perioperative data, pain scores, satisfaction levels, safety procedures, complications, and fusion rates 1 year after the operation. Results: At the time of surgery, the patients had a mean age of 37.87 years (ranging from 17 to 58). All but one patient were female. Between 2016 and 2019, 10 SI joints in these eight patients underwent fusion. Four patients had left side fusion, two had right side fusion, and two had bilateral SI joint fusion. Pain scores were reduced considerably, with a mean drop of 6. On the 12-month follow-up, with only one joint had not undergone satisfactory fusion. Conclusions: This study demonstrated that MISI joint fusion employing triangular implants is both safe and effective for treating this particular cohort of patients.
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Correlation of preoperatively predicted and intraoperative soft-tissue releases in total knee arthroplasty p. 210
Mohammad M Alzahrani, Thomas J Wood, Lyndsay E Somerville, James L Howard, Edward M Vasarhelyi, Brent A Lanting
Objectives: Soft-tissue balancing is one of the key components to achieving a successful total knee arthroplasty (TKA), but the planned soft-tissue release may not always correlate with the required releases intraoperatively to achieve a balanced knee. The aim of our study is to explore whether these required releases can be predicted accurately preoperatively and if their accuracy correlates with the level of training. Methods: Two hundred and fifty-one patients undergoing primary TKA were included in the study. Preoperatively, the consultant, fellow, and resident independently predicted the required releases to gain a balanced knee. Postoperatively, the performed releases were recorded and compared to the preoperative predictions. Results: Consultants had the highest exact match (62%), while the fellows and residents were less accurate (57% and 58%, respectively). Fellows and consultants had the least deviation of their prediction from the performed soft-tissue release. The intraclass correlation coefficients were also highest for consultants, followed by fellows and then residents, but this was not statistically significant. Conclusion: We found that participants irrespective of their level of training were able to accurately predict the required soft-tissue balancing in TKA. We believe this can be a valuable educational and assessment tool for trainees at all levels.
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Correlation between functionality and satisfaction index after total hip or knee replacement p. 213
Alejandro Miravete-Galvez, Ana M Serrano-Ardila, Javier Camacho-Galindo
Objectives: The evaluation of a successful replacement surgery varies between physicians and patients. Approximately 1 in 5 patients undergoing this type of joint surgery are not satisfied with the result obtained 12 months after their surgery. The aim of this work is to find out the correlation between satisfaction and functionality in patients with either osteoarthritis (OA) or inflammatory joint disease (IJD) who had undergone knee or hip replacement surgery in our institution charity clinic, the satisfaction with program's surgery rate and to the patients' clinical improvement. Methods: This is a prospective cross-sectional study with patients who underwent surgery between 2015 and 2018. The Self-Administered Patient Satisfaction Scale (SAPS) questionnaire was applied at least 12 months after the procedure and correlated to the functional scales Harris hip score (HHS) or Knee Society Score (KSS). Results: The HHS and KSS functional scales had a good and statistically significant correlation with the SAPS of 0.44 (P < 0.001). The program's satisfaction index for surgery had a mean of 95%. Pre- and post-operative assessments (at least 12 months) of the HHS/KSS functional scales obtained an initial median of 39.14 points and a final result of 87 for IJD and 93 for OA with a mean of 90 points (P = 0.000). Conclusions: The correlation between SAPS and the functional scores (HHS/KSS) 0.44 is good/moderate and it is statistically significant. The satisfaction with the program's surgery rate based on SAPS had a mean of 95%. Functionality assessed with HHS/KKS had a mean of 90 points. Using SAPS and HHS/KSS scales, we can conclude that the patients had a favorable clinical outcome. According to SAPS, IJD patients have better satisfaction indices than OA even though they have worst functional end results.
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Swaddling as a risk factor for developmental dysplasia of the hip: Perception and knowledge of family medicine and pediatric residents p. 218
Majed N Alosaimi, Ahmed H Kaneetah, Meshari M Alzhrani, Sara G Qadi, Wael H Alrammaal
Objectives: Several risk factors were associated with developmental dysplasia of the hip (DDH); however, the most common modifiable risk factor is swaddling. Swaddling is a common practice in Saudi Arabia with different unsafe techniques. The aim of our study is to evaluate the awareness and perception of family medicine and pediatric residents of swaddling techniques and their relations to DDH and to look for the effectiveness of an educational intervention on changing their attitude and perception regarding this topic. Methods: This cross-sectional study targeted family medicine and pediatric residents. Each of the participants received a validated questionnaire that was filled before and after a presentation by a pediatric orthopedic consultant regarding different aspects of DDH. Results: The study included 61 residents. Participants' age ranged from 25 to 30 years. There was a significant correlation between the prelecture scores and the practicing period of the physicians (P = 0.003). Results showed that participants' mean knowledge score before the intervention was 3.801 ± 2.18 (out of 8) while after the intervention increased to 6.903 ± 1.12. Conclusion: More than half of the participants lacked the knowledge about swaddling and DDH. The educational intervention significantly increased their knowledge and perception. This clearly means that first-line physicians encountering DDH patients need educational sessions on this topic to manage them safely and educate them about safe swaddling techniques.
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Surgical solution and clinical outcome for an initially undertreated vaughan-jackson syndrome p. 223
Efraín Farias-Cisneros, Ignacio Palafox-Carral
Vaughan-Jackson syndrome was described as a progressive rupture of the hand's extensor tendons due to tendon attrition at the wrist. It is frequently associated with osteoarthritis and rheumatoid arthritis. We present a 75-year-old male patient with a painless limitation of the extension of the little finger of the left hand. Initially, he presented a palmar displacement of the left carpus while lifting a heavy object. Vaughan-Jackson syndrome was diagnosed. At first, an end-to-side repair of the affected tendons was performed. Four months later, the patient returned with spontaneous extension lag of the left little and ring fingers. A second surgery was performed with the transfer and reconstruction of extensor tendons with a favorable outcome. Vaughan-Jackson syndrome causes functional impairment and detriment to the quality of life; thus, it is imperative to make an accurate and early diagnosis. Surgical treatment must be done in a timely and appropriate manner. We aim to report the outcome of a patient with an initially undertreated Vaughan-Jackson syndrome, highlighting the necessity of comprehensive treatment of the underlying pathophysiology, to obtain a desirable outcome.
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Bilateral total knee arthroplasty in a patient with bilateral knee lipoma arborescens p. 228
Salim S Al Habsi, Jatinder S Luthra, Soubhik Ghosh, Ismail S Al Habsi, Mina George
Lipoma arborescens (LA) is an uncommon intra-articular tumor of the synovium that can affect any joint in the body. A few cases of bilateral knee LA with osteoarthritis (OA) have been studied in the literature. We report the first patient with bilateral knee LA associated with advanced OA changes, who was operated upon with staged bilateral total knee replacement (TKR). Our case was complicated by immediate postoperative hematoma and wound complications on both sides. We describe the possible postoperative challenges that we encountered after TKR for knee OA combined with LA.
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Birth-related distal humerus epiphyseal separation: Outcome following surgical management p. 232
Ali M Aldossari, Ghadeer A Alsagr, Raghad A Alotaibi, Majed M Shogair, Hani Alharbi, Bander S Alrashedan
Distal humerus epiphyseal separation is a rare entity that can present as a birth-related injury. It commonly presents in children younger than 2 years of age and can be a result of a fall or forceful manipulation during delivery. It commonly presents with elbow swelling and decreased movement in newborns. It can be misinterpreted as elbow dislocations due to the lack of ossification in the distal part of the humerus on plain radiographs. Several treatment approaches have been reported in the literature including surgical and nonsurgical treatment modalities. We present a 2-day-old girl with a right distal humerus epiphyseal separation following spontaneous vaginal delivery. An anatomical and a stable reduction of the fracture was the aim in the management of this injury and was achieved using an arthrogram-assisted closed reduction and a single percutaneous Kirschner wire fixation. The patient was followed for 12 months and showed a satisfactory outcome.
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RE: Prevalence of burnout of residents in oman medical specialty board: A cross-sectional study in Oman p. 236
Mohamed S Al-Shamsi, Nasser H Al-Azri
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Case of traumatic ankle pain p. 237
Nizar A Al-Nakshabandi
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