Jennifer R. Arthurs1, Zubin Master2,  Shane A. Shapiro3*

1Regenerative Medicine Therapeutics Program, Mayo Clinic, Jacksonville, Florida, USA

2Biomedical Ethics Research Program and the Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA

3Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA

Stem cell therapies occupy a unique place in the American public’s consciousness which has led to excessive enthusiasm over their potential to cure orthopedic conditions. Much has been written about direct-to-consumer marketing of cell therapies for a myriad of medical conditions. Far less has been studied on the attitudes that drive many patients to seek stem cell and orthobiologic therapies for musculoskeletal conditions. Previously published research on patient motivations for seeking stem cell therapy to treat orthopedic maladies such as osteoarthritis and chronic tendinopathies has shown that some patients were motivated by factors not supported by current medical evidence. These differing responses strongly suggest the need for patient-centered counseling to address misinformation about stem cell therapies for musculoskeletal conditions and increase health literacy about outcomes of orthobiologics.

DOI: 10.29245/2767-5130/2022/3.1162 View / Download Pdf

Aneesh G. Patankar1*, Suleiman Y. Sudah2, Christopher R. Michel2, David S. Constantinescu3, Mariano E. Menendez4, Jeremy B. Ruskin5, Ajul Shah6

1Rutgers, Robert Wood Johnson Medical School, Piscataway, NJ, USA

2Department of Orthopedics, Monmouth Medical Center, Long Branch, NJ, USA

3Department of Orthopedic Surgery, University of Miami, Miami, FL, USA

4Midwest Orthopaedics at Rush, Rush University, Chicago, IL, USA

5Central Jersey Hand Surgery, Eatontown, NJ, USA

6The Center for Hand and Upper Extremity Surgery, Institute for Advanced Reconstruction, Shrewsbury, NJ, USA

Purpose: Sociodemographic factors have been shown to influence musculoskeletal health. However, little is known regarding the frequency of reporting and analysis of certain sociodemographic variables (e.g., age, sex, height, weight, body mass index (BMI), race, and ethnicity) in randomized clinical trials (RCTs) pertaining to hand surgery. The purpose of this study was to assess the rate of reporting and analysis of these variables in RCTs published in the Journal of Hand Surgery (JHS).

Methods: A systematic review was conducted of RCTs published in JHS between 2015 and 2021. For each study, we determined whether the following sociodemographic variables were reported and/or analyzed: age, sex, height, weight, BMI, race, and ethnicity. Frequencies were reported by year and as a cumulative total. Studies were evaluated using the Cochrane risk-of-bias tool.

Results: A total of 45 RCTs met inclusion criteria, with about half (53.3%) originating from the United States. Age (97.8%) and sex (91.1%) were the most frequently reported sociodemographic variables, followed by race (17.8%), BMI (11.1%), and ethnicity (8.9%). Age (17.8%) was the most frequently analyzed variable, followed by sex (13.3%), and race (4.4%); the remaining variables were not analyzed in any study.

Conclusions: While age and sex are reported at a high rate, only about 1 in 4 RCTs published in JHS report either race or ethnicity. All sociodemographic variables were infrequently included as part of statistical analysis. The significance of these findings should be recognized and used to interpret and enhance the methodology of future RCTs.

DOI: 10.29245/2767-5130/2022/2.1160 View / Download Pdf

Kathryn A. Barth, Claire D. Eliasberg, Karen M. Sutton*

Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

There has been an increasing focus on sex-specific differences within the context of sports medicine. Differences exist between the sexes leading to disparities in the types of injuries female athletes sustain and the rates at which they experience them. Recognition and awareness of subtle differences between the sexes can lead to a more nuanced diagnosis and treatment of such injuries. The purpose of this study is to review shoulder pathologies that are relevant to the female athlete, specifically adhesive capsulitis, multidirectional instability, and traumatic unidirectional shoulder instability, and highlight the differences in diagnosis, treatment, and outcomes between the sexes. Women suffer from adhesive capsulitis at a greater rate than men and there are risk factors such as breast cancer surgery that are unique to women. Females are much more likely to experience atraumatic shoulder instability than their male counterparts. While females represent a minority of patients who suffer traumatic unidirectional shoulder instability, they should not be overlooked with regards to this condition. There are challenges related to the diagnosis and treatment of these pathologies that are distinctive to female athletes.

DOI: 10.29245/2767-5130/2022/2.1130 View / Download Pdf

Ryan S. Marder, Neil V. Shah, Aditya V. Maheshwari*

Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA

DOI: 10.29245/2767-5130/2022/2.1159 View / Download Pdf

Jenna M. Wahbeh1,2, Claire J. Bogosian1,3, Natalie M. Kistler1,4, Sang-Hyun Park1,5, Edward Ebramzadeh1,4,5, Sophia N. Sangiorgio1,2,5*

1The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, USA

2Department of Bioengineering, University of California, Los Angeles, CA, USA

3Department of Bioengineering, University of California, Berkeley, CA, USA

4Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA

5Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA

Background: Reviews of total disc arthroplasty (TDA) performance have focused on prospective randomized controlled trials (RCTs), excluding potentially important clinical information reported by others. The goal of the present study was to perform a comprehensive review, including both RCTs and non-randomized cohorts with more than five years of clinical outcome. We further explored the differences in outcome between prospective RCT and non-randomized, including retrospective studies.

Methods: A systematic literature review was performed following PRISMA guidelines. Inclusion criteria were: clinical follow-up ≥ 5 years with quantitative clinical and radiographic outcome. All studies that met these criteria, including retrospective and non-randomized studies, were included, for a total of 62 studies. As anterior cervical discectomies and fusion (ACDF) was included as a control group in the majority of the studies, comparisons between TDA and ACDF were conducted.

Results: Overall, there was a statistically significant difference between the rates of secondary surgeries reported for prospective RCTs and all other studies, with reoperation rates of 5.4% for prospective RCT studies v. 7.5% in all others (P<0.01). Including all studies, the reoperation rate for TDA patients was 5.6% and for fusion patients (included as control groups), 7.8%, (P=0.06). Overall, the reported incidence of adjacent segment degeneration was 26.2% in TDA patients and 43.9% in fusion patients (P<0.001).

Conclusions: These findings demonstrated the need for including all available data to assess the current outcomes of cervical disc arthroplasty and account for potential biases.

DOI: 10.29245/2767-5130/2022/2.1158 View / Download Pdf

Ann Spence1*, Carrie Gilligan, Janine Bartholomew2

1Department of Nursing, Carlow University, Pittsburgh, PA, USA

2Department of Biology, Portage Learning, Beaver Falls, PA, USA

DOI: 10.29245/2767-5130/2022/1.1155 View / Download Pdf

Ashim Gupta

General Therapeutics, Cleveland Heights, OH, USA

Future Biologics, Lawrenceville, GA, USA

South Texas Orthopaedic Research Institute(STORI Inc.), Laredo, TX, USA

DOI: 10.29245/2767-5130/2022/1.1157 View / Download Pdf

Adeel Hamid*, Usman Gill, Mian Hanif

Department of Orthopaedic Surgery, Lahore General Hospital and Post Graduate Medical Institute, Lahore, Pakistan

In order to achieve good results following Total hip replacement , proper and reproducible acetabular cup placement is of paramount importance. The safe zone described by Lewwinick is still considered to be the target cup position. Various techniques have been used to improve the precision and accuracy of cup placement including the use of computer navigation which is often prohibitively expensive for developing countries. We present a ‘No touch smartphone technique’ to check positioning of acetabular cup intra operatively, without compromising the sterility of the operative field which we have found to be simple, quick, inexpensive and reproducible.

DOI: 10.29245/2767-5130/2022/1.1156 View / Download Pdf

Jingqiao Chen1,3#, Kaiwei Shen1#, Zhiming Lu1,2, Eryou Feng1*

1Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China

2The Third School of Clinical Medicine, Fujian Medical University, Fuzhou Fujian, China

3The Second School of Clinical Medicine, Fujian University of Traditional Chinese Medicine, Fujian, China

#These authors contributed equally to this work

Background: Patients with severe lumbar spine diseases run a high risk of dislocation after total hip arthroplasty. Therefore, it is essential to determine the pathological effect of common lumbar diseases on pelvic motions before the surgery.

Aim: This study reviewed the literature on the hip-spine relationship during total hip arthroplasty and explored the degenerative presentations and management of four common lumbar disorders. The review showed that patients with the spinal deformity in ankylosing spondylitis (AS) were characterized by thoracolumbar kyphosis with corresponding hip extension and pelvic retroversion, prone to anterior hip dislocation; patients with lumbar spinal fusion (LSF) were more susceptible to prosthetic impingement and ultimate dislocation, especially in the limited posterior tilt of the pelvis while sitting; those with degenerative disc disease (DDD) had a greater compensatory pelvic posterior angle while standing and greater hip joint flexion while sitting to compensate for the reduced lumbar flexion; those with degenerative lumbar spondylolisthesis (DSPL) demonstrated a pelvic flexibility with a much wider range and relative acetabular anteversion, especially when standing.

Recommendation: According to the literature, spinal osteotomy and total hip arthroplasty are the most common surgical interventions in AS cases. DSPL is classified into the Flexible & Unbalanced type and should be placed more posteriorly, but the literature suggests that patients with lumbar instability should first be placed in a more predictable position. In contrast, LSF and DDD are categorized as the Rigid & Balanced type. For these two types of disorders, the literature suggests that acetabular prostheses require more anterior tilt at the time of implantation.

Conclusion: These findings indicate that for degenerative lumbar disorders, a balance between stable component implantation and minimal wear should be based on the different changes in spinopelvic mobility.

DOI: 10.29245/2767-5130/2022/1.1151 View / Download Pdf

Ryan P. Hubble1,2, Henry Wang1,3, Paul Nagelkirk3, Jason M. Avedesian1,4, Robert Wilkinson1,3, D. Clark Dickin1,3*

1Biomechanics Laboratory, Ball State University, Muncie, IN, USA

2Wesley College of Health and Behavioral Sciences, Public and Allied Health, Delaware State University, Dover, DE, USA

3School of Kinesiology, Ball State University, Muncie, IN, USA

4Clemson University, Clemson, SC, USA

Plyometric training is one commonly used method of improving jump performance through improving explosive power generation. Research has also demonstrated that whole body vibration (WBV) can improve jumping and enhance explosive strength especially when supplementing resistance and plyometric training programs. With the drop jump being a common training skill, proper lower extremity landing mechanics are important to consider. Limited evidence suggests that WBV may reduce ground reaction forces and improve knee stability however, its influence on knee loading have not been reported. This study sought to examine the effects of WBV on ground reaction forces and knee valgus during a drop jump. 19 participants (10 female) completed drop jumps pre, immediately post, 10 & 20 minutes post WBV. Results were analyzed by repeated measures ANOVA. Main findings indicated that valgus knee angle increased significantly (p=0.011) post vibration and remained elevated across the 10 & 20 minute post vibration time intervals. Significant differences between sexes revealed that females demonstrated greater internal knee abduction moments (p=0.038). Findings that WBV increases knee valgus angle, a position linked to anterior cruciate ligament injury, suggest further investigation understand the effects of WBV on neuromuscular control and eccentric loading. Strength and conditioning professionals should exercise caution when incorporating WBV into plyometric protocols.

DOI: 10.29245/2767-5130/2021/1.1152 View / Download Pdf

Adel A Elbeialy1*, Abdlnby M Bauomi2, Basma M Elnaggar1, Hala M Elzomor1

1Department of Rheumatology, Al-Azhar faculty of Medicine, Cairo, Egypt

2Department of Radiology, Al-Azhar faculty of Medicine, Cairo, Egypt

DOI: 10.29245/2767-5130/2022/1.1153 View / Download Pdf

Freddy Mertens Bombah¹*, Alphonse Ngalame², René Essomba³, Yannick Ekani Boukar², Enrique Zoa Nkoa4, Daniel Handy Eone4

1Department of Surgery and Specialty, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon

2Department of Gynecology and Obstetrics, Faculty of Health Sciences, University of Buea, Cameroon

3Department of Surgery and Specialty, Higher Institute of Medical Technology, University of Douala, Cameroon

4Department of Surgery and Specialty, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon

Introduction: Obstetric fractures or Birth fractures are rare events following childbirth. Although fracture of the femur is a relatively uncommon injury, it is the most common fracture of the lower extremity in the newborn. Since evolution of cesarean section rates in Africa, it is one of the most commonly practiced modes of delivery for breech. We described one case of fracture of the femur at cesarean section treated at Adlucem hospital in bonabéri-Douala (Cameroon).

Case report: A 2.1 kg male infant was delivered by lower segment cesarean section for breech presentation. Clinical and radiological examination showed shaft fracture of femur with good evolution.

Discussion: Fractures of the long bones are associated with cesarean section, breech delivery with assistance and low birth weight. Femoral fractures are the most associated long bones fracture with cesarean section.

Conclusion: The clinical and paraclinical diagnosis is simple and the management is mostly non-operative. It is important to explain to the parents and especially to the mother the benignity of the lesion.

DOI: 10.29245/2767-5130/2021/3.1150 View / Download Pdf

Nicholas M Bertha, Adeshina Adeyemo, Kevin J Perry, Gary F Updegrove*

Department of Bone and Joint, Penn State Milton Hershey Medical Center, Hershey, Pennsylvania, USA

DOI: 10.29245/2767-5130/2021/3.1146 View / Download Pdf

Gregory W. Kunis1*, Joshua A. Berko1, Jeffrey C. Shogan1, Joshua B. Sharan1, Derek Jones2

1Nova Southeastern University, Kiran C. Patel College of Osteopathic Medicine, Florida, USA

2Department of Orthopedic Surgery, Broward Health, Florida, USA

Intro: Tibial tuberosity avulsion fractures are rare fracture patterns accounting for less than 1% of all pediatric fractures. These fractures occur when there is a sudden unbalancing of forces through the patellar tendon that separates the tibial tubercle from the anterior portion of the proximal tibia. These forces are commonly introduced in sporting activities and show a predominance for adolescent males. Treatment with open reduction internal fixation commonly results in favorable outcomes with minimal complications. In this presentation, we explore a case of a tibial tuberosity avulsion fracture and give an in-depth review of all aspects concerning this fracture pattern.

Case Description: A 14-year-old male with no significant past medical history presented via emergency medical services after a ground level fall while playing basketball. Radiographs of the left knee and tibia revealed an Ogden Type III, distracted avulsion fracture of the tibial tuberosity with suprapatellar effusion. Surgical intervention was achieved through open reduction internal fixation of the left tibial tubercle.

Discussion: Although a relatively rare fracture pattern, this case demonstrates a classic presentation and treatment of a tibial tuberosity avulsion fracture. This case serves as a reminder that despite the rarity of the injury, a clinician with an appropriate index of suspicion can accurately diagnose and treat this fracture and achieve positive outcomes in returning the patient to pre-injury activities. For those reasons, we provide a comprehensive overview of all aspects regarding this fracture pattern including the anatomy, embryology, mechanism of action, predisposing conditions, treatment considerations, complications and associated injuries.

DOI: 10.29245/2767-5130/2021/3.1149 View / Download Pdf

Spencer W. Sullivan*, Ioonna Félix

Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA

This clinical case presents an elite level 23-year-old female tennis athlete with a high-grade partial thickness tear of the supraspinatus with associated pain, dysfunction, and deficits in strength and range of motion (ROM) of her trunk and lower extremities. The purpose was to determine the efficacy of using a regional interdependence approach in the treatment of a partial supraspinatus tear with associated kinetic chain deficits in an elite level athlete. Following 24 physical therapy sessions, pain, mobility (ROM), strength, and function improved in the dominant shoulder in addition to further symmetry of the trunk and lower extremity due to a regional interdependence rehabilitation approach and returned to elite level of play. As a result of this case, it is important for clinicians to consider a comprehensive, global approach to patient rehabilitation following injury.

DOI: 10.29245/2767-5130/2021/3.1147 View / Download Pdf

Jamie Heimroth1*, Max L. Willinger1, Nipun Sodhi1, Luke J. Garbarino1, Peter A. Gold1, Jonathan R. Danoff2, Sreevathsa Boraiah2

1Department of Orthopedic Surgery, Long Island Jewish Medical Center, Queens, NY, USA

2Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY, USA

Chronic refractory pain after total joint replacement is debilitating and a source of dissatisfaction for patients. The management of pain following total joint replacement varies during the acute postoperative period compared to the 3 months postoperative at which point the pain is considered chronic pain. Acute postoperative pain relief programs have seen promising results with multimodal pain control through the use of combinations of opioids, acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids and ketamine. The addition of regional blocks to the multimodal regimen has improved acute postoperative pain control following total joint replacements. On the other hand, chronic pain can be successfully managed with options including genicular nerve radioablation therapy (GN-RFA), neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), and peripheral subcutaneous field stimulation (PSFS). While there is still minimal data on chronic pain relief regimens, meta-analyses and case reports have demonstrated the effectiveness and promising outcomes. This paper aims to evaluate the current medications and treatment options for managing refractory pain following TJA.

DOI: 10.29245/2767-5130/2021/3.1143 View / Download Pdf

Jay Moran1, Mark D. Miller2, Michael J. Medvecky1*

1Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA

2Department of Orthopaedics, University of Virginia, Charlottesville, VA, USA

DOI: 10.29245/2767-5130/2021/3.1148 View / Download Pdf

Jayme Bristol

APRN-C, Orthopedic Department at Nebraska Medical Center in Omaha, NE; Clarkson College, Omaha, NE, USA

Background: Total hip replacement surgeries are one of the most common orthopedic surgeries performed today1. This number continues to rise. One way to accommodate the growing need for inpatient orthopedic beds is through high hospital turnover. High turnover can possibly be accomplished through early ambulation. The goal of the study is to see if standing or walking before eight hours post-operative decreased overall length of hospital stay. Methods: This research study is a retrospective chart review that looked at 92 randomly selected general anesthesia total hip replacement patients from Nebraska Medicine in Omaha, NE from August 2017 to August 2018. This research study makes a clear definition of early ambulation after total hip replacement surgery: standing or walking within eight hours of surgery. Results: From the analyzed research the average length of stay for all 92 total hip replacement patients was 4.23 days. For those total hip replacement patients who were ambulated within eight hours of surgery completion the average length of stay was 2.83 days. For the total hip replacement patients who were ambulated after eight hours of surgery completion the average length of stay was 5.14 days. Conclusion: There is a statistically significant difference in length of hospital stay for total hip replacement patients at Nebraska Medicine who were ambulated within eight hours of surgery completion compared to those who were not.

DOI: 10.29245/2767-5130/2021/2.1137 View / Download Pdf

Peter R. Reuter*, Arie J. van Duijn, Kaylee R. Fichthorn, Lacy Mroz

Department of Rehabilitation Sciences, Marieb College of Health & Human Services, Florida Gulf Coast University, Fort Myers, Florida, USA

Joint hypermobility is largely understood as a dysfunction of collagen fibers within connective tissues, allowing for a range of motion markedly increased over validated normal values. The ulnar collateral ligament (UCL) of the elbow provides stability to the elbow during valgus stress and, thus, has great significance in overhead throwing sports due to its susceptibility to injury. Our cross-sectional study explored the relationship between the length and width of the anterior bundle of the ulnar collateral ligament of the elbow and joint hypermobility. Two hundred and eighty-four undergraduate students completed a Beighton score assessment. Ultrasound images of the participants’ UCL were obtained in both arms at rest and under gravity induced valgus force. Sixty-one participants reported hypermobility in at least one elbow joint, and hypermobility in one elbow joint was correlated with hypermobility in the other. There were moderate correlations between UCL thickness and joint gapping between left and right elbow joints. However, there was no significant difference in UCL anterior bundle thickness or medial elbow joint gapping at rest or under valgus stress between those with and without hypermobile elbow joints. The thickness of the anterior bundle of the UCL and humeroulnar joint gap at rest moderately correlates to corresponding thickness and width under valgus stress. There is no significant difference in UCL anterior bundle thickness or joint width in people with elbow hypermobility and those without.

DOI: 10.29245/2767-5130/2021/2.1140 View / Download Pdf

R. Spagnolo1*, D. Porreca2, M. Vimercati3, F. Pace4

1Department of Orthopaedic Surgery, Hospital Niguarda Cà Granda, Milan, Italy

2Physiotherapist, ASST BergamomOvest-Hospital, Treviglio Caravaggio, Italy

3Physiotherapist, Hospital Niguarda Cà Granda, Milan, Italy

4First Orthopaedic Clinic-Hospital Gaetano Pini, University of Milan, Italy

Posterior fractures of the acetabulum are the most frequent pattern of acetabular fractures. Based on the works of Judet and Letournel, accurate reduction and stable osteosynthesis with early mobilization have become the gold standard for the treatment of posterior acetabular fractures. Recently, a less invasive approach has been described to decrease Kocher-Langenbeck (K-L) approach complications. The clinical case describes a patient affected by two-column fractures of the acetabulum with skin abrasions of the gluteus. The clinical evaluation was based on Merle d’Aubigne and Postel scoring, which Matta has modified. The approach used is a modified, less invasive K-L: a straight skin incision from the midpoint between the posterior superior iliac spine and the posterior tip of the greater trochanter. We observed the essential advantages using this approach were a lesser split of the gluteus maximus and no risk of damage for the superior gluteal nerve. In the early postoperative rehabilitation, we examined the strength of the gluteus maximus, which was better than in patients treated with the typical Kocher–Langenbeck approach. The patient resumed after fifteen years after surgery; hip mobility is complete and painless.

DOI: 10.29245/2767-5130/2021/2.1133 View / Download Pdf

Júlia Benini Kohler1, Jader Joel Machado Junqueira1, Taysa Cristiane Moreira da Silva3, Marco Antonio Gonçalves Pontes Filho3,4, Iolanda De Fátima L C Tibério1, Fernanda Degobbi T Q S Lopes1, Alexandre Póvoa Barbosa1,2*

1Department of Medicine, Laboratory of Experimental Therapeutics (LIM-20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil

2Department of Orthopaedics, Hospital do Coração - SP Brazil

3Department of Rheumatology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil

4Departments of Orthopaedics and Rheumatology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil

Despite of clinical evidence of increased incidence of bone diseases amongst smokers as well as worsening recovery in orthopedic surgeries, it is still unclear which pathological mechanisms are induced by smoking and how these events impair bone turnover.

Animal models and in vitro studies have been used to better elucidate these questions and smoking-induced oxidative stress have been pointed as playing crucial role in the worsening of bone cells activities leading bone damage.

Oxidative stress is a physiological mechanism characterized by an imbalance between oxidants and antioxidants components. This imbalance leads cell damage and consequent release of inflammatory mediators, resulting in structural changes that impair the functionality of compromised organ.

In this review, we summarize findings from clinical, animal models and in vitro studies that have elucidated the importance of the oxidative stress induced by smoking in different bone cells activities, leading bone mineral and organic matrix structural changes.


We present the newest findings in understanding the impact of smoking in bone matrix composition. Review the clinical and experimental evidence for smoking-induced oxidative stress potential roles in bone turnover. Descript future directions for research and clinical management.

DOI: 10.29245/2767-5130/2021/2.1138 View / Download Pdf

Sagar Tontanahal1, Gahukamble Abhay Deodas1, Deeptiman James1, Anand Kurian2, Thomas Palocaren1*

1Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India

2Department of Orthopaedics, Christian Medical College, Vellore, India

Background: The management of malignant bone tumors in children has come a long way in the past few decades. The transition from amputation to limb salvage has been made possible due to the rapid development in the diagnosis and the oncological management of these malignant tumors. However, there exist significant reservations regarding endoprosthetic reconstruction in children.

Material and methods: A mini-review was conducted of articles detailing the use of prosthetic reconstruction following tumor resection in children. The data regarding complications and functional outcomes following surgery were collected and presented.

Results: The studies reviewed reported a 5-year survival rate between 60 – 70 %. Uniform across the studies was the need for multiple surgeries when endoprosthesis was used for limb reconstruction, ranging between 2.8 – 3.5 surgeries. The most common complication noted across the studies was related to soft tissue problems such as joint instability followed by structural failure of the prosthesis. Infections were noted with a frequency of 10 – 15 %. Studies showed successful management of limb length discrepancy with expandible prosthesis. Musculoskeletal Tumor Society (MSTS) score used to evaluate the functional outcome showed satisfactory outcomes.

Conclusion: Limb salvage surgery, with recent advances in technique and prosthesis design, is an attractive option in children with extremity malignant bone tumors. In recent time, endoprosthetic reconstruction of extremities have yielded good functional results and are well accepted by the child and the parents. The purpose of this mini-review is to shed some light on the use of endoprosthetic reconstruction in children following tumor resection with its potential benefits and drawbacks.

DOI: 10.29245/2767-5130/2021/2.1135 View / Download Pdf

Adrienn Markovics1*, Daniel M. Toth2, Tibor T. Glant1, Katalin Mikecz1

1Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

2Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Rheumatoid arthritis (RA) is a systemic autoimmune disease leading primarily to the inflammatory destruction of the synovial joints, ultimately resulting in loss of mobility and a decreased quality of life. Recent advances in RA-related research resulted in the introduction of Janus kinase (JAK) inhibitors to the therapeutic arsenal. JAK inhibitors are orally available and provide efficacy similar to that of disease-modifying anti-rheumatic drugs. However, due to the limited selectivity of these drugs, many RA patients experience adverse effects. The potential benefit of modulating protein tyrosine phosphatases, instead of inhibiting kinases, has not been explored. Using an animal model of RA, our group investigated the role of the Src homology region 2 domain-containing phosphatase 1 (SHP-1) in inflammatory arthritis. The purpose of the present article is to highlight important conclusions of our previous paper entitled “Regulation of autoimmune arthritis by the SHP-1 tyrosine phosphatase”. Herein we briefly present and discuss the observations of this study. We also outline future directions toward investigating the therapeutic potential of targeting SHP-1 in inflammatory arthritis in order to develop a new type of orally available drugs for the treatment of RA.

DOI: 10.29245/2767-5130/2021/2.1134 View / Download Pdf

Sophia L. Mancini1, Clark Dickin1, Dorice A. Hankemeier2, Lindsey Rolston3, Henry Wang1*

1Biomechanics Laboratory, Ball State University, Muncie, IN, USA

2Ball State University, Muncie, IN, USA

3Henry County Center for Orthopedic Surgery & Sports Medicine, New Castle, IN, USA

Soccer is becoming an increasingly popular sport amongst women. Common movements during play, such as jumping and cutting, require rapid acceleration and deceleration of multiple lower-limb joints. The anterior cruciate ligament (ACL), which contributes to stabilization of the knee, is often injured during these events. ACL injury typically requires costly surgery, extended time away from sports, and jeopardizes long-term joint health. Due to sex-specific factors such as menstruation and anatomical disadvantages, women are more susceptible to tearing their ACL. Injury often occurs in non-contact scenarios during rapid acceleration or deceleration movements. Research has examined these movements and established several kinematic and kinetic mechanisms as well as muscle activation patterns that frequently occur at the time of injury, however results tend to vary based on population. This article summarizes recent and relevant literature of ACL injury mechanisms and highlights the lack of specific research in the high-risk female soccer athlete population. Due to inconclusive risk factors, injury prevention programs within this population have been inconsistent. ACL injury risk for female soccer athletes should be closer examined so that more specific injury risks can be established, and effective protective measures can be taken. Raised awareness of this need may capture attention in the research and medical communities and potentially stimulate the development of strategies that limit future ACL injury and thus the challenges it brings to the high-risk female soccer athlete.

DOI: 10.29245/2767-5130/2021/1.1128 View / Download Pdf

Kentaro Amaha

Department of Orthopedic Surgery, Foot and Ankle; St. Luke's International Hospital, Tokyo, Japan

Metatarsalgia is one of the most common causes of forefoot pain, and it is characterized by pain in the front part of the foot under the head of the metatarsal bones. Primary metatarsalgia is idiopathic, but it has been suggested to be related to forefoot plantar compression. Because of the various causes of metatarsalgia, there is the need to thoroughly consider the etiology of metatarsalgia to find novel, effective, and conservative treatments for metatarsalgia to avoid surgical treatment. Pressure reduction or redistribution can be achieved using toe exercise, flat shoe inserts, metatarsal pads, custom-molded inserts, and rockerbars. There was no need for one treatment. If toe function was poor, toe exercises were recommended. If dorsiflexion of the ankle joint was limited, the Achilles tendon was stretched. If the pain was localized to the plantar aspect of the 2nd MTP, a decompression insole was applied. If the pain was limited to the plantar aspect of the 2nd MTP, a decompression insole was worn. If swelling occurred, anti-inflammatory drugs were indicated to reduce inflammation. The combination of the two was appropriate for this condition. Toe exercises can improve balance and are worth trying. An in-depth understanding of the various etiologies of metatarsal and toe deformities is essential for successful treatment.

DOI: 10.29245/2767-5130/2021/1.1131 View / Download Pdf