Association of new coronavirus disease with fragility hip and lower limb fractures in elderly patients

The novel coronavirus-induced infection (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. Iran is one of the countries with a high incidence of COVID-19 infection. Data on three patients with fragility hip fracture and COVID-19 infection were collected from one hospital located in Badrud, Isfahan, Iran, from March 1, 2010, to March 30, 2020. All patients were elderly and had fracture induced by fall from standing height. All patients (n=3) were admitted with fragility hip fracture due to low energy trauma. The most common symptoms were weakness and fatigue. Positive C-reactive protein (CRP) and Leukopenia were the most common abnormal laboratory evaluations. According to the results, two patients underwent surgical treatment, and one patient had negative reverse transcription-CRP; however, all of them underwent medical treatment for COVID-19 infection. There is a possible relationship between COVID-19 infection and fragility hip fracture in elderly patients. It could be induced by fatigue and weakness due to COVID-19 disease. COVOID-19 infection should be considered in elderly patients with fragility hip fracture during the coronavirus pandemic

Validity and Reliability of the Persian Version of WOrk-Related Questionnaire for UPper Extremity Disorders (WORQ-UP)

Background: We aimed to evaluate the validity and reliability of the Persian version of the WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP) questionnaire in a working population with upper extremity musculoskeletal disorders. Methods: We enrolled 181 patients with upper extremity conditions to complete the Persian WORQ-UP. A total of 35 patients returned after 1 week to complete the questionnaire again. To test the construct validity, patients responded to the Persian Quick Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH) at the first visit. The correlation between Quick-DASH and the WORQ-UP was assessed using Spearman correlation coefficient. Internal consistency (IC) was tested using Cronbach's alpha, and test-retest reliability was measured using the intraclass correlation coefficient (ICC). Results: Spearman correlation coefficient was 0.630 (p < 0.001), indicating a strong correlation between Quick-DASH and WORQ-UP. Cronbach's alpha was 0.970, which is considered excellent. ICC for the total score of the Persian WORQ-UP was 0.852 (0.691-0.927), indicating good to excellent reliability. Conclusions: Our study demonstrated that the Persian version of the WORQ-UP questionnaire has excellent reliability and IC. Construct validity showed a moderate to strong correlation between WORQ-UP and Quick-DASH, which provides a platform for the workers' population to assess the extent of disability and follow the progress along the treatment course

Prevalence of comorbidities in COVID-19 patients: A systematic review and meta-analysis

Background: In this study, we aimed to assess the prevalence of comorbidities in the confirmed COVID-19 patients. This might help showing which comorbidity might pose the patients at risk of more severe symptoms. Methods: We searched all relevant databases on April 7th, 2020 using the keywords ("novel coronavirus" OR COVID-19 OR SARS-CoV-2 OR Coronavirus) AND (comorbidities OR clinical characteristics OR epidemiologic∗). We reviewed 33 papers' full text out of 1053 papers. There were 32 papers from China and 1 from Taiwan. There was no language or study level limit. Prevalence of comorbidities including hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, chronic kidney disease, malignancies, cerebrovascular diseases, chronic liver disease and smoking were extracted to measure the pooled estimates. We used OpenMeta and used random-effect model to do a single arm meta-analysis. Results: The mean age of the diagnosed patients was 51 years. The male to female ratio was 55 to 45. The most prevalent finding in the confirmed COVID-19 patients was hypertension, which was found in 1/5 of the patients (21%). Other most prevalent finding was diabetes mellitus (DM) in 11%, cerebrovascular disease in 2.4%, cardiovascular disease in 5.8%, chronic kidney disease in 3.6%, chronic liver disease in 2.9%, chronic pulmonary disease in 2.0%, malignancy in 2.7%, and smoking in 8.7% of the patients. Conclusion: COVID-19 infection seems to be affecting every race, sex, age, irrespective of health status. The risk of symptomatic and severe disease might be higher due to the higher age which is usually accompanied with comorbidities. However, comorbidities do not seem to be the prerequisite for symptomatic and severe COVID-19 infection, except hypertension

Electrodiagnostic Grade and Carpal Tunnel Release Outcomes: A Prospective Analysis

Purpose: The value of electrodiagnostic (EDX) study grades as a prognostic indicator of clinical results after carpal tunnel release (CTR) remains controversial. In this study, we tested the primary null hypothesis that symptom relief after CTR would not differ based on EDX grade. Secondarily, we evaluated the degree of symptomatic and functional postoperative improvement relative to preoperative EDX grade. Methods: We prospectively evaluated 199 consecutive patients with 256 hands after CTR confirmed with EDX. Data were collected before surgery and patients were observed at 2 weeks and 3 months after surgery. There were 20 hands with mild, 126 with moderate, and 110 with severe involvement in the preoperative EDX. Demographic, EDX grade (mild, moderate, or severe); surgical parameters; Quick–Disabilities of the Arm, Shoulder, and Hand questionnaire; symptom severity scale, functional status scale, pain catastrophizing scale, and visual analog scale data were collected and analyzed. Results: There was significant improvement in Quick–Disabilities of the Arm, Shoulder, and Hand, symptom severity scale, and functional status scale scores from the preoperative to 2-week and 3-month postoperative visits in all categories of EDX grade. There was no significant difference in the extent of recovery by the 2-week and 3-month visits relative to EDX grade. Catastrophic thinking did not have a significant effect on any of the 3 groups. Pain decreased dramatically at 2 weeks after surgery but there was no additional significant difference in visual analog scale scores between the 2-week and 3-month postoperative visits. Postoperative pain improvement occurred regardless of EDX grade. There were no major complications or reoperations in any group. Conclusions: Carpal tunnel release demonstrated consistently significant improvement in outcomes regardless of EDX grade at initial and final follow-up. The extent of postoperative improvement after CTR overall was also not statistically different between groups with differing EDX severity. Older patients with severe CTS achieved more modest gains. Type of study/level of evidence: Prognostic II

High serum alpha-2-macroglobulin level in patients with osteonecrosis of the femoral head

Background: Diagnosis of osteonecrosis of the femoral head (ONFH) is complicated due to the lack of reliable serum biomarkers. Up-regulation of alpha-2-macroglobulin (A2M) gene has been reported in glucocorticoid-induced ANFH rat model. This study aimed to investigate whether the serum level of alpha-2-macroglobulin (A2M) can be used for ONFH diagnosis. Methods: Serum protein capillary electrophoresis was performed on the sera of 36 ONFH patients. Also, human enzyme-linked immunosorbent assay was performed to evaluate the serum levels of A2M. Results: Alpha-2 subunit level, composed of alpha-2-macroglobulin, ceruloplasmin and 2-2 haptoglobin phenotype, was increased significantly as compared to healthy subjects (P=0.0001). Moreover, ELISA assay confirmed significant elevation in the A2M (P=0.037). Conclusion: Our findings suggest that avascular necrotic femur head presumably directly or indirectly elevates A2M in the bloodstream. Thus, serum level of A2M might be used as a reliable diagnostic tool in clinical practice

Radiocapitellar prosthetic arthroplasty: short-term to midterm results of 19 elbows

Few studies have discussed the short-term results of radiocapitellar (RC) prosthetic arthroplasty (PA). In this study, we assessed the short-term to midterm functional and radiographic results of elbows after RC PA. Our secondary aim was to assess the survival of the RC PA. We included 19 elbows in 18 patients with a mean follow-up of 35 months (range, 12-88 months). Patients were examined for instability and range of motion and were assessed using Mayo Elbow Performance Index and Oxford Elbow Score at any subsequent visits. RC PA was the primary treatment in 16 elbows, and 3 were revision radial head arthroplasty with concomitant capitellar resurfacing. Range of motion, pain, and functional scores improved significantly from the preoperative to the final follow-up visit. Categoric grouping of the final Mayo Elbow Performance Index outcome scores showed 9 excellent, 5 good, 3 fair, 0 poor, and 2 missing data. However, stability of the elbow remained unchanged. There was no pain in 11 patients, mild pain in 5, and moderate pain in 3. Radiographic assessment showed no significant progress in ulnohumeral arthritis, although 3 elbows showed osteoarthritis progression to a higher grade. There were no major complications, including infection, revision, disassembly of the components, or conversion to total elbow arthroplasty. Survival of the RC PA was 100%. Elbow arthritis seems to become stationary after RC PA. Symptomatic RC osteoarthritis would probably benefit from RC PA regardless of the etiolog