The Open Orthopaedics Journal (Open Orthop J)

Publications in this journal

• Article: One stage conversion of an infected fused knee to total knee replacement - a surgical challenge.

  Mukartihal Ravikumar, Daniel Kendoff, Mustafa Citak, Stefan Luck, Thorsten Gehrke, Akos Zahar
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  ABSTRACT: Two-stage revision arthroplasty is a common technique for the treatment of infected total knee replacement. Few reports have addressed the conversion of a fused knee into a total knee replacement. However, there is no case reported of converting an infected fused knee into a hinge knee using a one-stage procedure. We report on a 51-year old male patient with an infected fused knee after multiple surgeries. A one-stage conversion of septic fused knee into total knee arthroplasty by a rotational hinge prosthesis was performed. The case highlights that with profound preoperative assessment, meticulous surgical technique, combined antibiotic treatment and the right implant, one-stage revision in a surgical challenge may have a role as a treatment option with good functional outcome.
  The Open Orthopaedics Journal 01/2013; 7:67-71.
• Article: Treatment of varus deformities of the lower limbs in patients with achondroplasia and hypochondroplasia.

  Ali Al Kaissi, Sebastian Farr, Rudolf Ganger, Jochen G Hofstaetter, Klaus Klaushofer, Franz Grill
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  ABSTRACT: Angular deformities of the lower limbs are a common clinical problem encountered in pediatric orthopaedic practices particularly in patients with osteochondrodysplasias. The varus deformity is more common than the valgus deformity in achondroplasia and hypochondroplasia patients because of the unusual growth of the fibulae than that of the tibiae. We retrospectively reviewed six patients (four patients with achondroplasia and two patients with hypochondroplsia) with relevant limb deformities due to the above-mentioned entities. All patients manifested significant varus deformity of the lower limbs. Detailed phenotypic characterization, radiologic and genetic testing was carried out as baseline diagnostic tool. We described the re-alignment procedures, which have been applied accordingly. Therefore, bilateral multi-level procedures, multi-apical planning and limb lengthening have been successfully applied. While recognition of the underlying syndromic association in patients who are manifesting angular deformities is the baseline for proper orthopaedic management, this paper demonstrates how to evaluate and treat these complex patients.
  The Open Orthopaedics Journal 01/2013; 7:33-9.
• Article: Midterm Results of 58 Fractures of the Coronoid Process of the Ulna and their Concomitant Injuries.

  J Kiene, J Wäldchen, A Paech, Ch Jürgens, A P Schulz
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  ABSTRACT: In general, fractures of the coronoid process are rare and usually occur in combination with additional elbow joint injuries. The treatment of these injuries aims to regain a stable as well as a flexible and loadable joint. Although there is currently little evidence, therapy recommendations remain controversial. Therefore, the aim of this study was to prognostically determine relevant factors for therapy recommendation by analysing a representative patient population of two trans-regional trauma centres. Seventy-seven patients with a fracture of the coronoid process were treated within an 8-year period (2001 to 2009). After an average of 48 months (SD 31), treatment outcome of 58 patients (75%) was acquired. The results were statistically analysed. The average age of the patient was 51.8 years (SD 13.6); 36 were male and 34 had a fracture on the right arm. Applying the fracture types of the coronoid process in accordance with Regan/Morrey, the result was: Type I (19), II (17) and III (22). Further injuries were also detected: 40 radial head fractures, 17 proximal ulnar fractures and 2 fractures of the olecranon. A luxation was detected in 44 of the 58 patients (76%). The patients' average MEPS (Mayo Elbow Performance Score) was 80.6 points (SD 18), with significant differences between the various therapy strategies. Fifteen% of the coronoid process fractures were reconstructable to a limited extent only by means of osteosynthesis. In 33% of the patients, instabilities remained. The average extension/flexion came to 107° (SD 28), and pronation and supination 153° (SD 38). At present, a surgical therapy of ligamentary injuries cannot be statistically justified. A stable osseous reconstruction appears to make more sense. The strongest negative prognostic parameters in our patient population were: therapy with an external fixator, immobilisation for more than 21 days, the occurrence of complications and unstable osteosyntheses on the coronoid process.
  The Open Orthopaedics Journal 01/2013; 7:86-93.
• Article: Should We Use Preoperative Epoetin-α in the Mildly Anemic Patient Undergoing Simultaneous Total Knee Arthroplasty?

  Lawrence A Delasotta, Fabio Orozco, S Mehdi Jafari, Jamie L Blair, Alvin Ong
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  ABSTRACT: Simultaneous knee arthroplasty is associated with significant blood loss. To prevent transfusion, three preoperative doses of epoetin-α were offered to mildly anemic simultaneous knee arthroplasty patients. A retrospective review, using ICD-9 codes, identified twenty patients from 2007-2009. Epoetin-α increased hemoglobin levels preoperatively (12.6 to 13.9, p<0.01). Twenty patients who did not receive epoetin-α were matched to study patients. Study patients were transfused less (55% vs 95%, p=0.012) and had similar inpatient length of stay. The average blood loss without transfusion was 4.6g/dL. The mildly anemic patient is at high-risk for packed red cell transfusion during simultaneous knee arthroplasty. Three preoperative doses of epoetin-α in the mildly anemic patient decreased total transfusions; however, it did not affect inpatient length of stay.
  The Open Orthopaedics Journal 01/2013; 7:47-50.
• Article: No positive effect of Acid etching or plasma cleaning on osseointegration of titanium implants in a canine femoral condyle press-fit model.

  H Saksø, T Jakobsen, M Saksø, J Baas, Ss Jakobsen, K Soballe
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  ABSTRACT: Implant surface treatments that improve early osseointegration may prove useful in long-term survival of uncemented implants. We investigated Acid Etching and Plasma Cleaning on titanium implants. In a randomized, paired animal study, four porous coated Ti implants were inserted into the femurs of each of ten dogs. PC (Porous Coating; control)PC+PSHA (Plasma Sprayed Hydroxyapatite; positive control)PC+ET (Acid Etch)PC+ET+PLCN (Plasma Cleaning) After four weeks mechanical fixation was evaluated by push-out test and osseointegration by histomorphometry. The PSHA-coated implants were better osseointegrated than the three other groups on outer surface implant porosity (p<0.05) while there was no statistical difference in deep surface implant porosity when compared with nontreated implant. Within the deep surface implant porosity, there was more newly formed bone in the control group compared to the ET and ET+PCLN groups (p<0.05). In all compared groups, there was no statistical difference in any biomechanical parameter. In terms of osseointegration on outer surface implant porosity PC+PSHA was superior to the other three groups. Neither the acid etching nor the plasma cleaning offered any advantage in terms of implant osseointegration. There was no statistical difference in any of the biomechanical parameters among all groups in the press-fit model at 4 weeks of evaluation time.
  The Open Orthopaedics Journal 01/2013; 7:1-7.
• Article: Multiple congenital bilateral trigger digits in a 2-year-old child: case report.

  V De Luna, V Potenza, L Garro, P Farsetti, R Caterini
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  ABSTRACT: Trigger finger is a rare condition in children. In this paper, we report on a 2-year-old boy with multiple congenital bilateral trigger digits. The patient had no history of perinatal trauma, viral or bacterial infections, or metabolic disorders. The patient was treated with physiotherapy for one year. At the one-year follow-up, the boy presented with six trigger fingers (3 on the right hand, 3 on the left hand). Neither thumb was involved. The six trigger fingers were treated surgically: first, the right-hand trigger fingers and, six months later, those of the left hand. After each operation, a 4-week brace in extension was applied to the operated hand. The symptoms were completely resolved after surgical treatment. Many authors have recommended surgical release for the treatment of trigger finger in children; empirical treatment with physiotherapy may be an option when symptoms present or appear at an older age.
  The Open Orthopaedics Journal 01/2013; 7:75-7.
• Article: Desmoplastic fibroma: a case report with three years of clinical and radiographic observation and review of the literature.

  Alexander Nedopil, Peter Raab, Maximilian Rudert
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  ABSTRACT: BACKGROUND: Desmoplastic fibroma (DF) is an extremely rare locally aggressive bone tumor with an incidence of 0.11% of all primary bone tumors. The typical clinical presentation is pain and swelling above the affected area. The most common sites of involvement are the mandible and the metaphysis of long bones. Histologically and biologically, desmoplastic fibroma mimics extra-abdominal desmoid tumor of soft tissue. CASE PRESENTATION AND LITERATURE REVIEW: A case of a 27-year old man with DF in the ilium, including the clinical, radiological and histological findings over a 4-year period is presented here. CT scans performed in 3-year intervals prior to surgical intervention were compared with respect to tumor extension and cortical breakthrough. The patient was treated with curettage and grafting based on anatomical considerations. Follow-up CT scans over 18-months are also documented here. Additionally, a review and analysis of 271 cases including the presented case with particular emphasis on imaging patterns in MRI and CT as well as treatment modalities and outcomes are presented. CONCLUSION: In patients with desmoplastic fibroma, CT is the preferred imaging technique for both the diagnosis of intraosseus tumor extension and assessment of cortical involvement, whereas MRI is favored for the assessment of extraosseus tumor growth and preoperative planning. While tumor resection remains the preferred treatment for DF, curettage and grafting prove to be an acceptable alternative treatment modality with close follow-up when resection is not possible. Curettage and grafting have been shown to provide good clinical results and are associated with long recurrence free intervals.
  The Open Orthopaedics Journal 01/2013; 8:40-6.
• Article: Periosteal augmentation of allograft bone and its effect on implant fixation - an experimental study on 12 dogs().

  Jeppe Barckman, Jorgen Baas, Mette Sørensen, Joan E Bechtold, Kjeld Soballe
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  ABSTRACT: Periosteum provides essential cellular and biological components necessary for fracture healing and bone repair. We hypothesized that augmenting allograft bone by adding fragmented autologous periosteum would improve fixation of grafted implants. In each of twelve dogs, we implanted two unloaded cylindrical (10 mm x 6 mm) titanium implants into the distal femur. The implants were surrounded by a 2.5-mm gap into which morselized allograft bone with or without addition of fragmented autologous periosteum was impacted. After four weeks, the animals were euthanized and the implants were evaluated by histomorphometric analysis and mechanical push-out test. Although less new bone was found on the implant surface and increased volume of fibrous tissue was present in the gap around the implant, no difference was found between treatment groups regarding the mechanical parameters. Increased new bone formation was observed in the immediate vicinity of the periosteum fragments within the bone graft. The method for periosteal augmentation used in this study did not alter the mechanical fixation although osseointegration was impaired. The observed activity of new bone formation at the boundary of the periosteum fragments may indicate maintained bone stimulating properties of the transplanted cambium layer. Augmenting the bone graft by smaller fragments of periosteum, isolated cambium layer tissue or cultured periosteal cells could be studied in the future.
  The Open Orthopaedics Journal 01/2013; 7:18-24.
• Article: Short term complications of titanium elastic nail in the treatment of diaphyseal fracture of the femur in children().

  Ranadeb Bandyopadhyay, Arindam Mukherjee
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  ABSTRACT: Femoral shaft fracture is the most common major paediatric orthopaedic. For generations traction and casting was the standard treatment for all femoral shaft fractures in children. Over the past two decades the advantages of fixation and rapid mobilisation have been increasingly recognised. A prospective study was conducted in five private hospitals in the district of Bankura, West Bengal over a period of two years (April 2010 to March 2012) on 70 patients with closed shaft femur fractures between 6- 14 years age of either sex. The aim was to find out the short term complications of titanium elastic nailing in diaphyseal fracture of femur in children and compare the findings of this study with pre- existing studies in this field. In our study the most common complication was pain at nail entry site (60%). 5.71% had local inflammatory reaction due to nails. Superficial infection occurred in 2.85%. At the end of 1 year, 2.85% had limb length discripancies. Proximal migration occurred in 2.85%. 2.85% encountered acute reactive synovitis, 5.71% developed angulation of fracture site and 2.85% developed per operative breakage of nail. The treatment of paediatric shaft femur fracture has been drastically changed over the last two decades to internal fixation by elastically stable intra- medullary nail (ESIN). In our study, we encountered only a few complications most of them being minor. Most of the complications were surgical technique related and were seen at the initial phase of the learning curve.
  The Open Orthopaedics Journal 01/2013; 7:12-7.
• Article: Synovial Angioma of the FDP Flexor Sheath: A Rare Cause of Carpal Tunnel Syndrome.

  Robert George, Kenneth Lee
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  ABSTRACT: It has been previously noted that synovial haemangiomas in the hand and wrist are very rare pathological entities. We report the case of a 34-year-old right hand dominant male who presented to his general practitioner with an enlarging left volar wrist/ palmar mass, who further developed symptoms consistent with carpal tunnel syndrome. An MRI scan subsequently confirmed a large, complex mass with area of necrosis and peripheral enhancement. The rate of mass growth and radiological features raised the possibility of a soft tissue malignancy, and the gentleman was urgently referred to our unit for surgical exploration and removal of tumour. Surgical exploration demonstrated a tan-coloured soft tissue mass on the ulnar aspect of the median nerve. It appeared to arise from, and marginally infiltrated, the tendon sheath of the FDP tendon to the ring finger and the lumbrical muscle of the fourth ray; the distal and proximal extent of the tumour was difficult to define due to the diffuse growth of the tumour. Resection was achieved with macroscopic margins, with excellent functional recovery immediately and at 6 month follow-up. Histological analysis was consistent with a synovial haemangioma, comprising of numerous thin-walled blood vessels with a central cystic cavity containing blood and fibrin. Our case further demonstrates the diagnostic challenges posed by compressive neuropathy due to soft tissue masses, even with thorough clinical and radiological assessment. In the context of a rapidly growing tumour, malignancy must always be suspected and might highlight a role for pre-operative biopsy.
  The Open Orthopaedics Journal 01/2013; 7:72-4.
• Article: Outcome of percutaneous sacroiliac joint fixation with porous plasma-coated triangular titanium implants: an independent review.

  Jong T Kim, Leonard M Rudolf, John A Glaser
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  ABSTRACT: Independent retrospective review of a single surgeon's experience with a new technique of SI fixation. Examine results of percutaneous fixation of the SI joint with porous coated triangular titanium implants. Diagnosis and treatment of a dysfunctional sacroiliac joint is challenging as well as controversial. Recently, percutaneous stabilization techniques have been implemented for fixation. There is minimal literature published on this technique. Charts, radiographs, and CT scans of 31 patients operated on by a single surgeon were de-identified and randomized and then reviewed by investigators not involved with the care of the patients. Reviewers had no relationship with the implant manufacturer at the time of the review. intraoperative and postoperative complication, EBL, hospital stays, postoperative image location and number of lucent implants, ingrowth into implants, and bone across SI joint. 27 patients expressed satisfaction, 4 patients did not. Pain relief was noted to be Complete (16 patients), Excellent (5 patients), Good (9 patients), and Fair (1 patients). Four patients had postoperative complications. These were infected hematoma (2), L5 nerve root irritation (1), and L5-S1 discitis (1). One patient required revision. On 6 month postop CT scan, 18/19 patients had radiographic evidence of bone ingrowth and bone into or across the SI joint was evident in 8/19 patients. Lucency was noted around at least one implant in 5/19 patients. Results are promising for the use of this novel implant for a carefully selected group of patients with disabling SI dysfunction.
  The Open Orthopaedics Journal 01/2013; 7:51-6.
• Article: A physiological dynamic testing machine for the elbow joint.

  Johannes Kiene, Robert Wendlandt, Marcus Heinritz, Angelika Schall, Arndt-Peter Schulz
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  ABSTRACT: The aim of our study was to develop a test setup combining realistic force transmission with physiological movement patterns at a frequency that mimicked daily use of the elbow, to assess implants in orthopedic joint reconstruction and trauma surgery. In a multidisciplinary approach, an in vitro biomechanical testing machine was developed and manufactured that could simulate the repetitive forceful movement of the human elbow joint. The construction involved pneumatic actuators. An aluminum forearm module enabled movements in 3 degrees of freedom, while motions and forces were replicated via force and angular sensors that were similar to in vivo measurements. In the initial testing, 16 human elbow joint specimens were tested at 35 Nm in up to 5000 cycles at a range of 10° extension to 110° flexion. The transmitted forces led to failure in 9 out of the 16 tested specimens, significantly more often in females and small specimens. It is possible to construct a testing machine to simulate nearly physiological repetitive elbow motions. The prototype has a number of technical deficiencies that could be modified. When testing implants for the human elbow with cadaver specimens, the specimen has to be chosen according to the intended use of the implant under investigation.
  The Open Orthopaedics Journal 01/2013; 7:78-85.
• Article: Effects of indigo carmine on human chondrocytes in vitro.

  Timo Zippelius, Arnd Hoburg, Bernd Preininger, Pauline Vörös, Carsten Perka, Georg Matziolis, Eric Röhner
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  ABSTRACT: Joint infections following or accompanying superficious soft tissue infections are severe complication in orthopedic surgery. The use of intra-articular blue staining is a helpful method to visualize a fistula and to differentiate between superficial and intra-articular infections. Regarding this clinical implication data about the effects of indigo carmine, a frequently used blue staining substance, on cartilage is missing. The hypothesis of this study was that indigo carmine damages human chondrocytes in a time and concentration dependent manner. Human chondrocytes were isolated from donors with osteoarthritis who were treated with TKA. Cells were cultivated and treated with different concentrations of indigo carmine for 5 and 10 minutes. Morphologic damage was examined by light microscopy. Toxicity was quantified by counting vital cell number and lactate dehydrogenase (LDH) expression. Analysis by light microscopy showed defected cell structure and loss of cell number after treatment with 100% indigo carmine for 10 minutes. Treatment with 10% and 1% indigo carmine showed no significant cell defects and loss of cells. Counting vital cell number showed loss of vital cells after treatment with 100% and 10% indigo carmine for 10 minutes. LDH expression was significantly increased after treatment with 100% indigo carmine.Toxic effects were shown after treatment with indigo carmine. Therefore, it should be used in 1:100 dilution. This is both, sufficient for visualizing a fistula in a possible clinical application and could be protective for chondrocytes.
  The Open Orthopaedics Journal 01/2013; 7:8-11.
• Article: Synergistic Effect of TGF-β1 And BMP–7 on Chondrogenesis and Extracellular Matrix Synthesis: An In Vitro Study

  Synergistic Effect of TGF-β1 And BMP–7 on Chondrogenesis, Extracellular Matrix Synthesis: An In Vitro Study
  The Open Orthopaedics Journal 01/2012;
• Source

  Available from: PubMed Central

  Article: A systematic review of dynamometry and its role in hand trauma assessment.

  Mafi P, Mafi R, Hindocha S, Griffin M, Khan W
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  ABSTRACT: The dynamometer was developed by American neurologists and came into general use in the late 19th century. It is still used in various ways as a diagnostic and prognostic tool in clinical settings. In this systematic review we assessed in detail the different uses of dynamometry, its reliability, different dynamometers used and the influence of rater experience by bringing together and evaluating all published literature in this field. It was found that dynamometry is applied in a wide range of medical conditions. Furthermore, the great majority of studies reported acceptable to high reliability of dynamometry. Jamar mechanical dynamometer was used most often in the studies reviewed. There were mixed results concerning the effect of rater experience. The factors influencing the results of dynamometry were identified as age, gender, body weight, grip strength, BMI, non/dominant hand, assessing upper/lower limbs, rater and patient's strength and the distance from the joint where the dynamometer is placed. This review provides an understanding of the relevance and significance of dynamometry which should serve as a starting point to guide its use in hand trauma assessment. On the basis of our findings, we suggest that hand dynamometry has a great potential, and could be used more often in clinical practice.
  The Open Orthopaedics Journal 01/2012; 6:95-102.
• Source

  Available from: PubMed Central

  Article: The epidemiology, genetics and future management of syndactyly.

  D Jordan, S Hindocha, M Dhital, M Saleh, W Khan
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  ABSTRACT: Syndactyly is a condition well documented in current literature due to it being the most common congenital hand defect, with a large aesthetic and functional significance.There are currently nine types of phenotypically diverse non-syndromic syndactyly, an increase since the original classification by Temtamy and McKusick(1978). Non-syndromic syndactyly is inherited as an autosomal dominant trait, although the more severe presenting types and sub types appear to have autosomal recessive and in some cases X-linked hereditary.Gene research has found that these phenotypes appear to not only be one gene specific, although having individual localised loci, but dependant on a wide range of genes and subsequent signalling pathways involved in limb formation. The principal genes so far defined to be involved in congenital syndactyly concern mainly the Zone of Polarizing Activity and Shh pathway.Research into the individual phenotypes appears to complicate classification as new genes are found both linked, and not linked, to each malformation. Consequently anatomical, phenotypical and genotypical classifications can be used, but are variable in significance, depending on the audience.Currently, management is surgical, with a technique unchanged for several decades, although future development will hopefully bring alternatives in both earlier diagnosis and gene manipulation for therapy.
  The Open Orthopaedics Journal 01/2012; 6:14-27.
• Article: Recent advances and developments in knee surgery.

  A Malik, Ws Khan
  The Open Orthopaedics Journal 01/2012; 6:266-7.