Journal of Orthopedic and Spine Trauma

Pharmacological Thromboprophylaxis Effectiveness in Low-Risk Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial

Mohammadreza Minator Sajjadi — 2024-10-22

Background: There is a paucity of evidence and controversies regarding prophylaxis strategies in low-risk patients undergoing knee arthroscopy. This study aims to evaluate the effectiveness and safety of aspirin and low-molecular-weight heparin (LMWH) in an arthroscopic anterior cruciate ligament (ACL) reconstruction for low-risk patients.

Methods: We performed a preoperational evaluation a week before surgery for any sign of pulmonary embolism (PE) and deep vein thrombosis (DVT). For this purpose, we used single limited compression Doppler ultrasonography (CUS) of the lower extremities. Rehabilitation started before the time of the surgery to improve the range of motion (ROM) and quadriceps muscle function. A team of 3 orthopedists performed the procedures. The same surgical technique and graft were used with spinal anesthesia, and operation time was recorded.

Results: The mean age of participants was 31.4 ± 5.6 years, with 93 individuals (67%) being men and 23% women. No cases of DVT or PE were observed. Three cases in the LMWH group and one case in the aspirin group experienced minor surgical site bleeding. One case of hemarthrosis with normal ultrasonography occurred in the LMWH group. Regarding safety and effectiveness, there was no statistically significant difference between the parallel arms.

Conclusion: The use of LMWH or aspirin after simple arthroscopic ACL reconstruction in low-risk patients showed no difference in effectiveness. Hence, the routine use of thromboprophylaxis in this setting is questionable although adverse events are rare

The Effect of Reactive Neuromuscular Training versus General Warm-up on Proprioception and Balance in Female Handball Players with Rounded Shoulder: A Controlled Laboratory Study

Narges Farhani-Sameni — 2024-10-22

Background: This study aimed to compare the immediate effects of a session of reactive neuromuscular training (RNT) with warming-up exercises on shoulder proprioception and dynamic balance in female handball players with shoulder impingement.

Methods: In this controlled laboratory study, 18 female adolescent handball players from 14 to 18 years old were recruited from Samen City, Iran. The participants participated once in the warm-up routine program and once in the RNT program. Before and after each exercise program, shoulder proprioception was measured by photogrammetry and dynamic balance of the upper limb was measured using the Wye balance test. The paired t-tests, with a significance level of 0.05, were employed to compare pre-test and post-test data.

Results: Both exercise protocols had no significant effects on shoulder repositioning error (P > 0.05). However, participation in both exercise programs resulted in a significant improvement in the dynamic balance score of the upper limbs of the athletes (P < 0.001). Moreover, no significant differences were observed between the effect of routine handball exercises and the effect of RNT exercises on shoulder repositioning and dynamic balance in female handball players (P > 0.05).

Conclusion: It seems that routine warm-up exercises and RNT could not improve proprioception in the shoulders of student- athletes with round shoulders. However, both training methods caused a significant improvement in the dynamic balance of the upper limb, although there was no significant difference between the effects of the two methods.

Functional Outcome of Extra-Articular Distal Tibia Fracture Treated with Tibia Interlocking Nail: A Case Series

Ishani Patel — 2024-10-22

Background: Intramedullary interlocking nailing has emerged as one of the suitable management options for distal tibia fractures as it allows mechanical compression on weight-bearing, which stimulates bone healing. We studied 40 cases of extra-articular distal tibia fracture treated by intramedullary nailing.

Methods: We retrospectively studied 40 patients of both sexes above the age of 18 years with closed fractures and grade 1, 2, and 3A compound fractures treated at SVP Hospital, Ahmedabad, India. Clinically, the fracture was considered to be united when the patient was completely pain-free. Patients were followed up at monthly intervals till union. At each follow-up, patients were assessed both clinically and radiographically, and details were recorded based on proforma.

Results: The evaluation of the result was done using American Orthopedic Foot and Ankle Society (AOFAS) criteria. Thirty-three patients had excellent functional results, five had good functional results, and Two had fair functional results. In this study, 38 (95%) patients had radiological union within 24 weeks. Two patients had union after 28 weeks.

Conclusion: Intramedullary nailing is a minimally invasive procedure that preserves the soft tissue and the fracture hematoma. It maintains the length, alignment, and rotation and allows micromotion at the fracture site on weight-bearing, which stimulates callus formation. It has a good functional outcome with gratifying results when used in extra-articular distal tibia fractures.

Comparison of Surgical and Non-Surgical Treatments for Proximal Humerus Fractures: A Cross-Sectional Study

Saeed Kokly — 2024-10-22

Background: The proximal humerus fracture (PHF) is one of the most common fractures of the upper limbs. PHF is more common in older people, usually following a fall, whereas in younger people this form of fracture is typically caused by high-energy trauma. There are several treatment options for PHFs, including surgical and non-surgical procedures. Our aim was to compare the outcomes of surgical and non-surgical treatment methods in Iranian patients with PHFs.

Methods: Sixty patients with PHFs participated in this single-center cross-sectional study. Medical records were reviewed and evaluated according to demographic characteristics, underlying diseases, type of treatment, complications, need for reintervention, and Constant score.

Results: The mean age of the patients was 45.65 years. Among those older than 50 years, women significantly outnumbered men (66.7%, P = 0.009). Thirty-one patients received surgical treatment, while 29 patients received non surgical care. The Constant scores of patients who underwent surgery were considerably higher than those of non-surgical patients [mean ± standard deviation (SD): 80.41 ± 1.89 versus 69.82 ± 1.82, P = 0.009]. This significant relationship was observed only in the age group of 18 to 49 years.

Conclusion: Overall, the complications arising from both surgical and nonsurgical treatments were not statistically significant; however, patients under the age of 50 and men had higher Constant scores, indicating better clinical outcomes.

Arthroscopic Fixation of Posterior Cruciate Ligament Tibial Bony Avulsion Fractures: The Double Suture Bridge Technique and Evaluation of Results

Mihir R. Patel — 2024-10-22

Background: Surgical fixation is required for displaced posterior cruciate ligament (PCL) tibial bony avulsion fractures or with fractures having grade 2 or more posterior instability. The purpose of this study is to evaluate the results of arthroscopic fixation of PCL tibial bony avulsion fractures using the double suture bridge technique.

Methods: A retrospective study was done involving 24 patients having displaced PCL tibial bony avulsion fractures. The arthroscopic double suture bridge technique was used to fix these fractures. Patients were followed up for three years and assessed for knee-related symptoms, signs, Lysholm Knee Score, and satisfaction.

Results: The study group consisted of 21 men and three women. Fracture union was achieved in all cases two months postoperatively. The mean Lysholm Knee Score at follow-ups of three months, six months, one year, two years, and three years was 86.6, 96.5, 98.8, 99.1, and 99.4, respectively. At the latest follow-up, all the patients were satisfied with their knee function with respect to pain, range of motion (ROM), stability, and resumption of pre-injury activity level.

Conclusion: The arthroscopic double suture bridge technique is an effective method for the fixation of PCL tibial bony avulsion fractures with respect to knee stability, ROM, and resumption of pre-injury activity level.

Correction of Triphalangeal Thumb with Small Delta Phalanx by Closed Wedge Osteotomy of the Proximal Phalanx: A Case Report

Mohammad Ali Okhovatpour — 2024-10-22

Background: Triphalangeal thumb (TPT) is a rare congenital anomaly, especially in the Asian population. Traditional treatments depend on the type of deformity and the presence of concomitant anomalies and include either excision in addition to the ligament reconstruction or fusion and shortening osteotomy. Instability and stiffness are the major concerns following the traditional techniques.

Case Report: In this study, we report a case of right TPT with a small delta phalanx in a nine-year-old boy who was treated by proximal phalanx radial closed wedge osteotomy without delta phalanx resection or intracapsular dissection. The angular deformity and the appearance of the thumb were corrected by this simple procedure without resulting in instability and stiffness in the interphalangeal joint.

Conclusion: Proximal phalanx closed wedge osteotomy is a rapid, simple, and effective technique with a low risk of unexpected complications for correcting the appearance in the cases of TPT with a small delta phalanx.

Management of Neglected Pediatric Monteggia Fracture-Dislocation: A Case Report and Literature Review

Sudhir Shankar Mane — 2024-10-22

Background: Missed or neglected Monteggia lesions are defined as classical fracture-dislocation presenting at least four weeks after injury. This injury in children is often challenging to treat and requires complex methods to achieve optimal results.

Case Report: We report a 6-year-old girl with a 2-month-old neglected Bado type-I Monteggia fracture-dislocation. Our patient underwent ulnar osteotomy, bone grafting, and fixation with a semi-tubular plate along with open radial head reduction. Although the patient experienced wound complications at the bone graft harvest site, she achieved an excellent outcome with restored functionality and range of motion (ROM).

Conclusion: Neglected Monteggia injuries in pediatric patients demand multifaceted treatment approaches due to their complexity and potential for long-term functional impairment. The absence of a consensus on definitive treatment underscores the importance of early diagnosis and open reduction to enhance long-term outcomes. This case report highlights the effectiveness of ulnar osteotomy, plate fixation, and open radial head reduction in achieving favorable results.

Pseudomyxoma Peritonei Lesion of the Thoracic Spine: A Case Report and Literature Review

Hieu Kim Huynh — 2024-10-22

Background: Pseudomyxoma peritonei (PMP) is a rare condition, with no previously described location in the spine. Here is presented a case of PMP extension to the thorax and then the spine, treated with two-level vertebrectomy, laminectomy, and posterior fusion.

Case Report: We report here the case of a 64-year-old man presenting pathological fractures of T6 and T7 due to PMP extension to the pleural cavity and thoracic spine. He presented interscapular pain with mild spinal cord compression symptoms. He was treated by achieving T5-T8 laminectomy, T2-T10 pedicle fixation, and T6-T7 vertebrectomy. The postoperative course was uneventful apart from a pulmonary embolism (PE) with favorable evolution under anticoagulants.

Conclusion: To achieve spinal cord decompression, kyphosis correction, and spine stabilization, a two-level vertebrectomy, laminectomy, and posterior fusion would be beneficial for a PMP lesion of the thoracic spine.

A Case Report of a Rare Presentation of Semimembranosus Tibial Plateau Avulsion: The Bony Ramp Lesion

Arash Sharafat Vaziri — 2024-10-22

Background: Tibial plateau posteromedial rim avulsions by semimembranosus tendon are a rare entity that have been reported in a few studies so far with controversial mechanisms. They are reported to accompany anterior cruciate ligament (ACL) or meniscal injuries. Their main fracture planes are usually placed in the coronal plane.

Case Report: The patient was a 52-year-old man with a hyperextension-valgus tibial plateau fracture. The imaging studies revealed a compression fracture of the lateral and an avulsion fracture of the posteromedial plateau. However, no soft-tissue injuries were detected. The fragment was avulsed in the axial plane and covered by the medial meniscal posterior horn, creating the pattern of a longitudinal tear in the meniscal ramp lesion, but actually without any soft-tissue injuries. It was fixated using the tension band wiring technique with two Kirschner wires (K-wires) and one cancellous screw. Radiological and functional outcomes were excellent at 12-month follow-up.

Conclusion: This fracture pattern merits special attention due to its unusual presentation, causing the meniscal posterior horn to separate from the articular surface. “Bony ramp lesion” best describes the simultaneous separation of the posterior horn of the medial meniscus (PHMM) and its underlying bony fragment without the meniscal tear that takes place in an actual medial meniscal ramp lesion.

An Unusual Presentation of Chaput Tubercle Fracture with Coexisting Bimalleolar Component Involving Lateral and Posterior Malleoli: A Case Report

Prem Kumar Kothimbakkam — 2024-10-22

Background: Chaput tubercle fracture is a counterpart to adolescent Tillaux fracture, which occurs at the anterolateral part or the attachment site of the antero-inferior tibiofibular ligament on the distal tibia. It is rare, and its presentation may not be well appreciated in X-rays, which depicts the importance of a computed tomography (CT) scan of the ankle to reveal the same.

Case Report: A 25-year-old gentleman presented to Chettinad Hospital, India, casualty with acute onset of pain, swelling, and restricted movements at the ankle joint following a road traffic accident. Ankle CT revealed a Chaput fracture along with a bimalleolar fracture (posterior and lateral malleoli). The complex displaced fracture was managed with open reduction internal fixation (ORIF) with plate osteosynthesis for the posterior malleoli and lateral malleoli, and tension band wiring was done for the Chaput tubercle fracture. At the end of two-year follow-up, the patient was able to mobilise without any support.

Conclusion: Through this case report, we would like to enumerate the rarity of Chaput tubercle fracture associated with bimalleolar fracture of the ankle, which will be evaluated better with a CT evaluation in the first place. At the same time, it gives valuable information for the preoperative surgical plan.

Clinical Management, Prognosis, and Outcomes of Bilateral Acetabular Fractures: A Case Report

Reza Zandi — 2024-10-22

Background: Bilateral acetabular fractures are a rare type of acetabular fracture, and due to the scarcity of information regarding these types of fractures, managing bilateral acetabular fractures presents significant challenges. We presented a 25-year-old man with bilateral acetabular fractures (left transverse fracture of the acetabulum and right posterior column fracture of the acetabulum) secondary to severe trauma following a road accident with no other pelvic damage.

Case Report: Because the displacement was more on the patient's left side (although the patient's pain was more on the right side), the open reduction and internal fixation (ORIF) surgery was first performed on the left side, and secondary ORIF surgery was performed on the right side, under general anesthesia with Kocher-Langenbeck approach for both sides.

Conclusion: Due to the increase in road traffic accidents (RTAs) and improper safety of cars, especially in developing countries, this type of fracture may be repeated in the future, and regarding the complexity and comorbidities associated with this type of fracture, the high experience of the surgeon and detailed investigations are required to achieve successful results.

Osgood-Schlatter Disease in an Adult Athlete: A Case Report and Review of the Literature

Arash Sharafat Vaziri — 2024-10-22

Background: Osgood-Schlatter disease (OSD), a form of traction apophysitis, predominantly affects adolescents engaged in high- impact activities. While conservative management is often effective, surgical intervention becomes necessary in refractory cases.

Case Report: A 29-year-old male athlete with persistent OSD symptoms underwent arthroscopic surgery after unsuccessful non- surgical treatments. Arthroscopic removal of the bony particle was undertaken using six portals with a novel setting (consisting of medial and lateral superior, standard, and inferior portals) to minimize the damage to the patellar tendon and intermeniscal ligaments. This setting of portals also obviates the need for fluoroscopy since it provides adequate visualization for confirmation of complete removal of the bony particle. The lower portals also provide more convenient access to the bony particle, minimizing the possibility of incomplete removal and persistence of symptoms. The patient experienced complete resolution of anterior knee pain and prominence within six months post-surgery. Arthroscopic removal of the ossicle involved the use of superior portals for optimal access and visualization. Low portals were strategically employed to eliminate the need for fluoroscopy, offering a unique advantage. Postoperative rehabilitation included immobilization followed by a gradual return to weight-bearing and full range of motion (ROM).

Conclusion: Arthroscopic removal remains the preferred method for treating OSD, emphasizing fewer complications. However, challenges related to limited access and anatomical restoration persist.