Journal of Orthopedic and Spine Trauma

Duloxetine for Postoperative Pain in Orthopedic Surgeries: A Review Article

2025-01-06T09:17:08+00:00

Postoperative pain plays a key role in patients’ satisfaction. Since opioids may cause dependence and have a high abuse rate, non- opioid drugs such as duloxetine are being investigated for their effect in this matter. This review investigated the pharmacokinetics and the effects of duloxetine on postoperative pain after orthopedic surgeries. Duloxetine is a dual serotonin and norepinephrine reuptake inhibitor that causes a synergistic effect and can help manage postoperative pain. For this cause, it is prescribed as 60 mg per day. There have been studies in recent years proving its effectiveness both in total hip and knee arthroplasties and elective surgeries. The collective data show that duloxetine can be used for postoperative pain management, and with minimal side effects, it can lower opioid usage and dependence. However, considering duloxetine side effects including gastrointestinal (GI) disturbances (nausea, constipation), dry mouth, and loss of appetite, and the limitations of current literature, further studies need to be conducted.

Hueter-Volkmann Law; How It Influences the Correction of Scoliosis Curves with Braces

2025-01-06T09:20:55+00:00

Background: According to the Hueter-Volkmann law, there is asymmetry in the loads applied to the spinal structure on the convex and concave sides, which can increase the severity of scoliosis and its progression. The purpose of this review was to examine the asymmetry of vertebrae in subjects with scoliosis and explore how this theory can be utilized to enhance the effectiveness of braces in controlling and reducing scoliosis curves. A search was conducted in databases such as Google Scholar, PubMed, and ISI Web of Knowledge using keywords like Hueter-Volkmann law and asymmetry in relation to scoliosis. While there were limited studies on the asymmetry of vertebrae in individuals with scoliosis, the findings indicated significant differences in the height of vertebrae and discs between the concave and convex sides. Additionally, the degree of asymmetry was found to be correlated with the severity of scoliosis. It appears that the design of scoliotic braces is influenced by the Hueter-Volkmann law. It is recommended that new brace designs be developed based on the principles of this law to minimize the impact of gravity on the spine.

External Validity of the Novel Surrogate Measures for Occipitocervical Alignment

2025-01-06T09:24:13+00:00

Background: Occipitocervical fusion (OCF) is a rare and often challenging surgical procedure. Several methods have been introduced to obtain the best measures for occipitocervical alignment. The mandible-C2 angle was first introduced in 2020. In this study, we aimed to evaluate the out-of-sample validity of these measures.

Methods: We retrospectively studied 274 lateral cervical radiographs of patients aged 1 to 87 years with no cervical pathology evident on X-ray. A board-certified radiologist and a second-year radiology resident performed the measurements on five specific angles as suggested by Bellabarba. The five angles measured consisted of: 1) anterior C2 body/anterior mandible angle (AB/AM), 2) anterior C2 body/posterior mandible angle (AB/PM), 3) posterior C2 body/anterior mandible angle (PB/AM), 4) posterior C2 body/posterior mandible angle (PB/PM), and 5) occipito-C2 angle (OC2A).

Results: Inter-rater correlation data were calculated for single and average measures. The inter-rater agreement for individual angle measures of O-C2A, AB/AM, AB/PM, PB/AM, and PB/PM were 0.49, 0.11, 0.25, 0.33, and 0.49, respectively. The intraclass correlation coefficient (ICC) for average measures of O-C2A, AB/AM, AB/PM, PB/AM, and PB/PM were 0.66, 0.20, 0.40, 0.50, and 0.66, respectively.

Conclusion: Our study did not find statistically significant evidence to confirm that these angles were dependable indicators of occipitocervical alignment, except for the PB/PM angle, which showed a validity comparable to our reference angle

Effects of a Very Low Dose Naloxone Addition to Intraoperative Remifentanil Infusion on Postoperative Pain in Patients Undergoing Total Hip Replacement Surgery: A Randomized Clinical Trial

2025-01-06T09:24:56+00:00

Background: The objective of this study was to assess the effect of adding a very low dose of naloxone to a remifentanil infusion on postoperative pain in patients undergoing hip replacement surgery in the lateral position.

Methods: This randomized clinical trial involved 80 patients who underwent hip replacement surgery under general anesthesia and were randomly assigned into two groups through block randomization: group 1 received remifentanil at a dose of 0.3 μg/kg/minute, while group 2 received remifentanil at a dose of 0.3 μg/kg/minute with a very low dose of naloxone administered at 0.05 μg/kg/hour following injection. Postoperative pain [measured using the visual analog scale (VAS)], drowsiness caused by narcotics and analgesics in recovery, and the duration of getting out of bed were all monitored and recorded in the ward.

Results: The median [interquartile range (IQR)] of time to administration of the first sedative drug was 0 (0, 4) hours in the control group and 4 (0, 4) hours in the intervention group. The difference between the groups was statistically significant (P < 0.0001). The frequency of pain after surgery at 0, 4, and 8 hours was significantly different between the control and intervention groups (P = 0.003, P < 0.0001, and P = 0.021, respectively).

Conclusion: Based on the results, we recommend using a very low dose of naloxone along with remifentanil infusion in patients undergoing complete hip replacement surgery to reduce their pain and the need for painkillers

A Survey on Outcomes of Patients Operated with Kocher Approach in the Posterior Acetabulum Wall Fractures

2025-01-06T09:25:28+00:00

Background: There are many challenges in using the type of treatment method for acetabular fractures, and the incorrect treatment of these fractures can have many complications for the patient. Therefore, we decided to do some research to examine the treatment results of patients who underwent surgery with a posterior approach.

Methods: The files of patients admitted to the orthopedic department of the hospital were examined. After contacting the patients, performance outcomes were examined six months after the treatment results and final follow-up using the Harris Hip Score (HHS).

Results: In this study, the total number of patients was 25, of which 80% were men and 20% were women. Treatment results were evaluated as good or excellent in 15 (60%) patients and had no statistically significant relationship with age and gender. 48% had no pain and lameness, and the others showed different degrees of pain. 96% of the people were able to climb the stairs, but 4% were unable to climb the stairs. 76% of the people could use public transportation, and the rest of the people could not. 40% of the people did not need to use crutches, and the rest depended on crutches to varying degrees.

Conclusion: According to the therapeutic results obtained from the surgery, it can be concluded that this surgery has acceptable results.

Knee-Spine Syndrome, a Common Presentation in Elderly Patients Who Are Candidate for Knee Arthroplasty: Educational Corner

2025-01-06T09:29:43+00:00

Low back pain (LBP) is a significant issue in both clinical and public health settings, resulting in high healthcare and social costs. While knee joint pain is more prevalent than hip joint pain, standing posture is influenced not only by spinal alignment but also by hip and knee joint alignment. The knee and spine are interconnected anatomically, and degenerative changes in one area could often cause discomfort in the entire axis, leading to what is known as "knee-spine syndrome". LBP is a common condition associated with knee pain and can significantly affect the results of total knee arthroplasty (TKA). Surgeons need to consider knee-spine syndrome before any surgical intervention in patients with knee or back pain and explain it to the patients before the surgery.

Diagnosis and Management of Freeman-Burian Syndrome: A Case Report

2025-01-06T09:27:59+00:00

Background: Freeman-Burian syndrome (FBS) is a rare genetic disorder characterized by facial deformities, arthrogryposis, and difficulties in orthopedic management.

Case Report: A case study of a nine-month-old female patient with FBS is presented, who exhibited facial abnormalities and contractures of the hands and feet. Non-operative treatment, including stretching, massage, and splinting, was initially advised. At nine months, bilateral Achilles tenotomy was performed under local anesthesia due to anesthetic risks. Serial casting and bracing were used to maintain the correction.

Conclusion: The authors recommend prompt treatment, especially with non-operative methods, and early training of parents in non-operative therapy for optimal results, as multiple surgeries and anesthetic complications can lead to suboptimal outcomes. Massage, stretching, and achieving stable plantigrade feet are crucial for independent walking in patients with FBS.

Management of a Garré Sclerosing Osteomyelitis of Forearm: Report of a Resistant Case

2025-01-06T09:28:23+00:00

Background: Garre’s sclerosing osteomyelitis (GSO) is a rare chronic inflammatory condition characterized by sclerosis and thickening of bone cortices with mandibular affection in children and young adults. It involves periosteal reactions without abscess formation in young adults. Treatment typically includes analgesics and antibiotics, with surgery for non-responders. In this study, we report a rare case of GSO of the upper extremity involving radius and ulna bones.

Case Report: A young man with a history of forearm trauma treated by a bonesetter developed worsening pain and swelling over two years. At age 34, he underwent debridement for chronic osteomyelitis, followed by four additional surgeries. In 2004, a non- vascularized fibular graft was applied, achieving union, but persistent pain led to further interventions. By 2011, lab tests showed increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and the lesion had recurred, necessitating resection and a free vascularized fibular graft. In 2013, after irrigation and debridement, the Masquelet technique was utilized. Four years post-surgery, the patient reports no pain or symptoms.

Conclusion: On the basis of this case, we suggest that in extreme cases of chronic GSO, when bone resection remains the chosen treatment option, and we have a significant bone defect, a Masquelet technique is a valid and possible method.