Vol 2-2 Commentary

Commentary: Regulation of autoimmune arthritis by the SHP-1 tyrosine phosphatase

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
Vol 2-2 Mini Review

Endoprosthetic Reconstruction in Limb Salvage for Malignant Bone Tumours in Children

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
Vol 2-2 Case Report

Polytraumatized patient with two columns fracture of the acetabulum and skin abrasion, which incision to use with soft tissue: A case report at 15 years follow-up

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
Vol 2-2 Review Article

Smoking-Induced Oxidative Stress in Bone: The Effects on Bone Turnover

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
Vol 2-2 Research Article

Relationship between ulnar collateral ligament thickness and joint hypermobility in young adults

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
Vol 2-2 Research Article

Early Ambulation in Hip Replacement Patients Regarding Length of Hospital Stay

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