A proximal femur aneurysmal bone cyst resulting in amputation: A rare case report

Aneurysmal bone cyst (ABC) is blood filled expansile cystic lesion that most commonly occurs in patients during the second decade of their lives. Traditionally it has been described as a benign lesion but can be locally aggressive and result in the destruction of the involved bone. Treatment methods include surgical excision and curettage with or without bone grafting. We report a proximal femur aneurysmal bone cyst, which resulted in the amputation of the lower extremity, even though all available classic methods of treatment were applied for it. © 2015 Tehran University of Medical Sciences. All rights reserved

Distal radius radiographic indices and perilunate fracture dislocation

Background: Distal radius radiographic indices may play a role as risk factors in pathogenesis of Kienbock's disease, scaphoid fracture and nonunion. Perilunate fracture dislocations are devastating wrist injuries, and their relationship and distal radius indices have not been addressed in the literature. Objectives: The aim of this study was to evaluate the possible role of distal radius radiographic indices including radial height, radial inclination, ulnar variance and volar tilt as risk factors in the perilunate fracture dislocation injury of the wrist. Patients and Methods: We studied distal radius radiographic indices including radial height, radial inclination, ulnar variance and volar tilt in 43 patients with perilunate fracture dislocations and compared them with 44 wrists in the control group. Results: The mean values of the radial height, radial inclination, ulnar variance and volar tilt were 12.74 (5-18), 24.20 (7-35),-0.73 (-5-4) and 12.28 (2-20) in the patient group. These values were 12.68 (9-22), 23.22 (17-30),-0.11 (-4-3) and 11.05 (-3-20), respectively in the control group. There was no statistically significant difference between the two groups. Conclusions: This study did not show that distal radius anatomical indices including the radial height, radial inclination, ulnar variance and volar tilt influence perilunate fracture dislocation as risk factors. Copyright © 2016, Trauma Monthly

COVID-19 among patients with orthopedic surgery: our experience from the Middle East

Background: We report our experiences with COVID-19 in one of the largest referral orthopedic centers in the Middle East and aimed to describe the epidemiology and clinical characteristics of these patients. Methods: During February 20 and April 20, 2020, patients who underwent orthopedic surgery and healthcare staff who were in contact with these patients were screened for COVID-19. To identify patients who were in the incubation period of COVID-19 during their hospital stay, all patients were tested again for COVID-19 4 weeks after discharge. Results: Overall, 1244 patients underwent orthopedic surgery (1123 emergency and 121 elective) during the study period. Overall, 17 patients were diagnosed with COVID-19 during hospital admission and seven after discharge. Among the total 24 patients with COVID-19, 15 were (62.5) males with a mean (SD) age of 47.0±1.6 years old. Emergency surgeries were performed in 20 (83.3) patients, and elective surgery was done in the remaining 4 patients which included one case of posterior spinal fusion, spondylolisthesis, acromioclavicular joint dislocation, and one case of leg necrosis. A considerable number of infections occurred in patients with intertrochanteric fractures (n=7, 29.2), followed by pelvic fractures (n=2, 8.3), humerus fractures (n=2, 8.3), and tibial plateau fractures (n=2, 8.3). Fever (n=11, 45.8) and cough (n=10, 37.5) were the most common symptoms among patients. Laboratory examinations showed leukopenia in 2 patients (8.3) and lymphopenia in 4 (16.7) patients. One patient with a history of cancer died 2 weeks after discharge due to myocardial infarction. Among hospital staff, 26 individuals contracted COVID-19 during the study period, which included 13 (50) males. Physicians were the most commonly infected group (n = 11), followed by operation room technicians (n = 5), nurses (n = 4), and paramedics (n = 4). Conclusions: Patients who undergo surgical treatment for orthopedic problems, particularly lower limb fractures with limited ambulation, are at a higher risk of acquiring COVID-19 infections, although they may not be at higher risks for death compared to the general population. Orthopedic surgeons in particular and other hospital staff who are in close contact with these patients must be adequately trained and given appropriate personal protective equipment during the COVID-19 outbreak. © 2021, The Author(s)

Chondromyxoid fibroma of pelvis, surgical management of 8 cases

Background: Chondromyxoid fibroma is a rare benign primary bone tumor of cartilaginous origin, which most commonly involves the metaphyseal bone of proximal tibia and distal femur. The purpose of the study is to report our experience with diagnosis and surgical management of Chondromyxoid fibroma in the pelvic region. Methods: Eight consecutive patients with a final diagnosis of pelvic Chondromyxoid fibroma were treated from 2001 to 2010. We considered the presentations and outcome for surgical complications and local recurrence after extended curettage and allogenic corticocancellous bone grafting. Results: Three patients were female and five were male. The median follow up period was 72 (30�126) months. The mean age of cases was 31.9 (20�41) years. Five patients had left side involvement and in the remaining three, the right side was involved. Four involved periacetabulum, two involved the ilium and the remaining two cases were ischiopubic. The mean Musculoskeletal Tumor Society Score was 94.1. The major complications were recurrence in one case and herniation after pubic rami resection in another case. Conclusion: Chondromyxoid fibroma should be distinguished from chondrosarcoma. Management recommendation includes extensive curettage and corticocancellous bone grafting. We also advocate use of fibular strut allograft for reconstruction of pubic rami after its resection to prevent hernia in cases with pubic rami involvement. Level of evidence- IV. © 2015, Academy of Medical Sciences of I.R. Iran. All rights reserved

Avulsions-of-Triceps-Brachii-:-associated-injuries-and-surgical-treatment-;-a case series

This study reports the clinical presentations, intra operative findings, type of the treatments, outcome of the treatment and specially associated injuries in patients with the avulsion of the distal end of the triceps brachii (TB) tendon. We studied 6 patients with rupture or avulsion of the distal end of the TB tendon. The medical records, imaging files, clinical outcomes at the final follow up visit were reviewed. The clinical outcomes were assessed by Mayo Elbow Score at the final follow-up visit. All patients were male, 4 of them having injury in the left hand as the non-dominant hand. Mean age of them was 34.5 years. All cases had small bony fleck in the posterior of elbow in lateral radiograph. Three patients had associated injuries including intra-articular fractures and medial collateral ligament rupture. In one case V-Y plasty of the distal TB was done. In 4 patients the results of surgery were excellent, one was good and one was fair. Although TB tendon rupture is rare, it should be considered in differential diagnosis of the upper extremity trauma and its associated injuries should be addressed properly. © 2016, Acta Orthopedica Belgica

Tele-orthopaedics: A systematic mapping study

Introduction: The use of telemedicine in orthopaedics can provide high-quality orthopaedic services to patients in remote areas. Tele-orthopaedics is widely acknowledged for decreasing travel, time and cost, increasing accessibility and quality of care. In the absence of a comprehensive review on tele-orthopaedics applications and services, here, we systematically identify and classify the tele-orthopaedic applications and services and provide an overview of the trends in the field. Methods: In this study, a systematic mapping was conducted to answer six research questions, we searched the databases Scopus, PubMed, IEEE Digital Library and Web of Science up to 2019. Consequently, 77 papers were screened and selected on the basis of specific inclusion and exclusion criteria. Results: We found that mobile-based teleconsultation was mostly asynchronous, while non-mobile teleconsultation was synchronous. The results showed that the physician�patient relationship was more common than other interactions, such as physician�physician and physician�robot interactions. In addition, more than half of the services provided by tele-orthopaedics have been used for orthopaedic diseases/traumas in which joint replacement and fracture reduction have been the most important orthopaedic procedures. It has been noted that more attention has been paid to tele-orthopaedics in developed countries such as the USA, Australia, Canada and Finland. Discussion: Telemonitoring (teleconsultation and telemetry) and telesurgery (telerobotics and telementoring) were found to be the two major forms of tele-orthopaedics. Mobile phones were used asynchronously in most of the teleconsultations. The development of different applications may result in the use of multiple smartphones applications in real-time teleconsultation. The use of smartphones is expected to increase in the near future. © The Author(s) 2020