Knee
Elsiddig Elhadi Mahmoud; Mohamedalmontazar Moawia Malik; Khalid Elfadil Husein
Abstract
Background: Acquiring knowledge about anatomic and geometric measurement of bone is among the most vital parameters in knee arthroplasty and has a significant effect on the subsequent outcomes. The aim of this study is to obtain anthropometric measurements of the distal femur of adult Sudanese Population ...
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Background: Acquiring knowledge about anatomic and geometric measurement of bone is among the most vital parameters in knee arthroplasty and has a significant effect on the subsequent outcomes. The aim of this study is to obtain anthropometric measurements of the distal femur of adult Sudanese Population and to compare the results with other populations.Methods: This descriptive study conducted at Alamal hospital in Khartoum, Sudan, between Sep. 2020 and Feb. 2021, included all adult patients attending the radiology clinic for CT scan with normal knees. The Femoral medio-lateral (ML) and anteroposterior (AP) dimensions of the distal femora were measured. The collected data was analysed using statistical package for social science (SPSS).Results: 385 adult Sudanese were studied. The mean age was 59.1±18.5 years (Range 20-86 years). 69.9% were male and 30.1% female. 45% were left knees and 55% right. The mean ML diameter was 76.6±6.0mm (rang 66.7-88.2mm), and the mean of AP was 45.640±4.9 mm (range 37.2-54mm). The anthropometric measurements of the distal femur of Sudanese people fall between Greek and Korean.Conclusion: There were differences in mean ML and AP dimensions between the Sudanese population and other ethnic groups which should be kept in mind when designing Total Knee Arthroplasty implants.
Pediatrics
Marina R. Makarov, MD; Connor M. Smith, MD; Taylor J. Jackson, MD; Chan Hee Jo, Ph.D; John G JBirch, MD, FRCS(C)
Abstract
Introduction: Pediatric patients with Blount disease frequently demonstrate secondary adaptive deformities in the adjacent distal femur. This study evaluates adaptation of longitudinal and angular proportions of the ipsilateral healthy femur to progressive leg length discrepancy in unilateral cases.Methods: ...
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Introduction: Pediatric patients with Blount disease frequently demonstrate secondary adaptive deformities in the adjacent distal femur. This study evaluates adaptation of longitudinal and angular proportions of the ipsilateral healthy femur to progressive leg length discrepancy in unilateral cases.Methods: The study included 55 children with unilateral Blount disease. Preoperative radiographs were analyzed to characterize the condition as infantile or adolescent and measure femoral/tibial lengths and mechanical lateral distal femoral angles (mLDFA). Results: There were 26 patients with infantile and 29 with adolescent Blount disease. Adolescent patients were significantly older (14.4 ± 2.0 vs. 9.2 ±2.4; p<0.01). Black race was prevalent in both groups (69-79%). The adolescent group was predominantly male (25/29; 86%), while the infantile group was predominantly female (15/26; 58%, p<0.01). Leg length inequality in adolescent patients was significantly greater than in the infantile group (2.8 ± 2.0 vs.1.5 ± 1.1cm; p<0.01) with ipsilateral femoral shortening (1.8 ± 1.8 cm) accentuating tibial shortening (1.0 ± 1.1cm). Patients with infantile Blount disease had more pronounced tibial discrepancy (2.0 ± 1.1 cm; p<0.01) but modest overgrowth of the ipsilateral femur (0.5 ± 0.7; p<0.01) partially compensating ipsilateral tibial shortening. There was a significant difference in tibial:femoral ratios between the groups (p<0.01). The infantile group had on average normal mLDFA (88°), most adolescent patients had accentuating distal femoral varus deformity (96° ± 5°; p<0.01).Conclusions: Patients with unilateral infantile and adolescent Blount disease demonstrated distinctly different adaptation of the ipsilateral femur. Concomitant ipsilateral femoral changes aggravate angular deformity and leg length discrepancy in adolescent Blount disease.
Parvindokht bayat; Mahdi hamzeh tofigh; Mohadeseh rahimi
Abstract
Background: Nutritional arteries are the main source of blood supply to long bones. These foramina enable the blood vessels and nerves to pass through the cortex of the bone. The exact location and distribution of nutrient foramina are important for preventing damage to blood vessels and maintaining ...
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Background: Nutritional arteries are the main source of blood supply to long bones. These foramina enable the blood vessels and nerves to pass through the cortex of the bone. The exact location and distribution of nutrient foramina are important for preventing damage to blood vessels and maintaining blood circulation during various surgical procedures. While inheritance and race are among the most effective factors in the distribution of these foramina, no relevant study has been conducted in Iran. Therefore, we aimed to evaluate this issue in Iran and find differences in comparison with other studies.Methods: This study was performed on 157 lower limb bones present in moulage hall in the school of medicine, including long bones of the femur (N=65), tibia (N=65) and fibula (N=27).Results: In this study, 39.09% of the femurs had two nutrient foramina, 90.78% of the tibia had a nutrient foramen, and 66.67% of the fibulas lacked a nutrient foramen. The location of the nutrient foramen in the femur was 95.35% at the lower two-thirds. In the tibia, the nutrient foramina were mainly in the upper third (72.15%). In the fibula, the nutrient foramina were mostly in the middle third (66.67%).Conclusion: This study provides more information on morphological and topographic anatomy of the nutrient foramina of long bones of the lower extremity. While techniques such as microvascular bone transfer have become more popular, further research is required to determine the effect of inheritance and race for an anatomical description of bone nutrition.
Ali Birjandi nejad; Hamid Farzadfard; Shokofeh Farzadfard; Moslem Mokhtari fard
Abstract
Introduction: The Preferential method in Fixation of some long bone fractures consists of using intramedullary nailing. The benefit of this method lies in its better biomechanical stability, as well as preventing additional surgical trauma to the fracture site. Despite these benefits, few surgeons conduct ...
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Introduction: The Preferential method in Fixation of some long bone fractures consists of using intramedullary nailing. The benefit of this method lies in its better biomechanical stability, as well as preventing additional surgical trauma to the fracture site. Despite these benefits, few surgeons conduct this method as it is time-consuming, risky (Performing x- ray fluoroscopy) and also tedious.
Method: Seven male patients with diaphyseal femoral fractures, with an average age of 32.28, underwent closed femoral nailing surgery making use of the innovative set. The duration of operation, fracture type and fracture site were evaluated.
The innovative solution: To align the bone fragments and make the guidance stick cross the fracture site closely, the present close reduction set was designed to make crossing the guidance stick through the fracture site possible on the normal bed of operation room in a short period of time without fluoroscopy, with the least possible extra trauma and the least degree of annoyance in the reduction stage.
Results: All the patients with diaphyseal femoral fracture, without any peripheral fractures, underwent nailing surgery, while total time of the surgery was 116.57 minutes on average; and pure time of the innovative set application and passing guidance stick to the bottom of the distal canal was 21.85 minutes.
Conclusion: The results indicated that closed intramedullary nailing of femoral fractures without performing Fluoroscope, using the aforementioned innovative set is possible for the patients with utter convenience in an appropriate time period.
S M Kazemi; MR Abbasian; M Karimzadeh; F Safdari; H Mahdavi Mohtasham
Abstract
Background: Distal femoral intra-articular fractures (DFIAF) can be very challenging. Although, satisfactory outcomes have been reported, however, there are several complications interfering the patients after treatment. In current retrospective study, the outcomes of treating DFIAF with ...
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Background: Distal femoral intra-articular fractures (DFIAF) can be very challenging. Although, satisfactory outcomes have been reported, however, there are several complications interfering the patients after treatment. In current retrospective study, the outcomes of treating DFIAF with open reduction internal fixation (ORIF) using locking plates (LCP) were investigated.
Material and Methods: There were 51 patients enrolled. In last visit, Lysholm score was completed for all of the patients. Pain intensity and satisfaction were measured using visual analogue scale (VAS). Degenerative changes were assessed on plain x-rays. Bilateral knee range of motion was measured and compared. The patients were followed for 17.4±7.2 months.
Results: Fractures were united in all of the patients. Degenerative changes were found in 15 patients (29.4%). The pain intensity was 2.7±1.3. Nineteen patients required to use analgesics (37.2%). VAS for satisfaction averaged 7.7±1.1. The Lysholm score averaged 81.8±8.3. The range of knee motion was significantly limited inn operated side compared to the healthy one (116.6±12.4 Vs 125.3±7.3; p<0.001).
Conclusions: Treatment of DFIAF using ORIF can be associated with complete fracture healing. However, the incidence of degenerative changes and consequent complications such as pain and loss of ROM are considerably concerning.
Armin Nikzad, BSc; Farid Abbaszade, MSc; Zahra Saghaei, MSc; Soheil Mehdipoor, MD; Firooz Madadi, MD; Morad Karimpoor, PhD
Abstract
Background: Total knee arthroplasty is an accepted method for treatment of osteoarthritis of the knee. Measuring the distal femoral rotation is one of the most important problems in such operations. In the conventional 2D method, measuring the angle is based on CT scan images but these methods usually ...
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Background: Total knee arthroplasty is an accepted method for treatment of osteoarthritis of the knee. Measuring the distal femoral rotation is one of the most important problems in such operations. In the conventional 2D method, measuring the angle is based on CT scan images but these methods usually contain errors. In this study, the three-dimensional measurement of the aforementioned angle was investigated.
Methods: In this research, using CT scans and 3D modeling, 3D lower extremity models of 40 patients were extracted. The rotation of distal femur was measured for plane perpendicular to the anatomical and the plane of mechanical axis of femur. Four axes were drawn on these planes using anatomical landmarks: posterior condylar line (PCL), anatomical and surgical transepicondylar line (ATEA+STEA), and the Whiteside line (WL).
Results: The mean difference of these measurements on the plane perpendicular to the mechanical axis of the femur, between PCL and WL, STEA, ATEA was 3.41, -1.31, 5.53; and angles on the plane perpendicular to the anatomical axis of femur were -0.74, -1.26, and 5.67, respectively. In addition, Bland-Altman diagram was plotted between every two measurements and no relationship found, except for STEA and ATEA.
Conclusions: The measurements between PCL, ATE, and STEA are not affected by the plane on which these measurements are carried out on, except for the 4 degrees difference present in WL axis. With a greater sample size and proper grouping, some relationship might be found between the aforementioned axes.
Pooneh Dehghan, MD; Zahra Saghaei ,MSc; Farid Abbaszadeh, MSc; Morad Karimpour, PhD; Soheil Mehdipoor, MD
Abstract
Background: Femoral neck anteversion is usually measured on the 2-dimensional (2D) images on CT slices. The 3D method uses 3-dimensional model of the femur reconstructed from CT scan images. The aim of this study was to compare these two methods of measurement of femoral ante-version. Methods: In ...
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Background: Femoral neck anteversion is usually measured on the 2-dimensional (2D) images on CT slices. The 3D method uses 3-dimensional model of the femur reconstructed from CT scan images. The aim of this study was to compare these two methods of measurement of femoral ante-version. Methods: In a retrospective study, CT scans of 40 patients (6 men, 34 women) of a teaching hospital in Tehran-Iran were included. Both methods use the same anatomical landmarks, i.e. center of femoral head, femoral neck axis and posterior apex of the femoral condyles. In the 3D method, anteversion angle was measured on a plane perpendicular to the anatomical axis of femur. Whereas in the 2D method the measurement is performed on CT scan slices.Results: Mean anteversion was found to be 9.8 for the 2D and 16.11 for the 3D method. Bland-Altman plot shows that the difference between the two methods is significant.Conclusions: This difference between 2D ad 3D measurement of femoral anteversion may be depend on the level of the selected CT slices, patients positioning during CT examination, and the impact of the deformity. The 3D method eliminates obvious sources of error, namely identifying landmarks and individual orientation of femur. Due to the lack of any gold standard there is a need to further review and study the measurement of this angle.
Amirreza Sadeghifar, MD; Arash Akbari, MD; Mahmood Karimi Mobarakeh, MD
Abstract
Background: Knee osteoarthritis is a common etiology of disability in older age group. There are evidences suggesting that varus or valgus deformity can be from distal of femur, proximal of tibia or because of ligamentous laxity. Osteotomy in incorrect location may create zigzag deformity and may contribute ...
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Background: Knee osteoarthritis is a common etiology of disability in older age group. There are evidences suggesting that varus or valgus deformity can be from distal of femur, proximal of tibia or because of ligamentous laxity. Osteotomy in incorrect location may create zigzag deformity and may contribute to increase risk of osteoarthritis. The objective of this study was to find the correct location of deformity in genuevarum or genuevalgum.Methods: We studied 40 patients with knee deformity at a mean age of 27.4 years (19-38), prospectively. Standing 3-point view radiographs were obtained on each patient, and the limb axis was determined. The data on limb malalignment was analyzed statistically.Results: In 94.5% of cases the location of varus deformity was proximal of tibia and in 5.5% in distal of femur, the best location of osteotomy. Our study also revealed multiple factors contributing to varus deformity, i.e. distal femur in 67.5%of cases, proximal tibia deformity in 92.5% of cases and ligamentous laxity in 77.5%.Conclusions: Varus knee deformity can be from proximal tibia, distal femur or knee laxity. Before any corrective surgery one must clarify location of deformity
Fardin Mirzatolouei, MD; Majid Mohseni Kabir, MD
Abstract
Background: Perfect rotational positioning of femoral component in total knee arthroplasty is mandatory for good outcome, particularly in knees with severe varus. Posterior condylar line (PCL) and transepicondylar axis TEA are the two current methods used to determine the appropriate rotational positioning ...
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Background: Perfect rotational positioning of femoral component in total knee arthroplasty is mandatory for good outcome, particularly in knees with severe varus. Posterior condylar line (PCL) and transepicondylar axis TEA are the two current methods used to determine the appropriate rotational positioning of femoral component. The aim of this study was to compare the accuracy of femoral component rotation after TKA, using either PCL or TEA reference points. Methods: In a retrospective study, 42 consecutive TKA candidates with severe varus knees were divided into two groups: In group I posterior condylar line, and in group II transepicondylar axis was considered as the primary landmark for rotational positioning. Erosion of medical femoral condylar was recorded in millimeters. One year after operation all the patients underwent CT scan and the angles between TEA and PCL of the prosthesis was meausured. The degree of knee flexion and also WOMAC scores were recorded. Results : The female gender was prominent in both groups (81% in group 1, 85.7% in group II). There was no significant femoral condylar erosion in either group. The mean Womac score in group 1 was 71.4±17.51 and 72.07±15.48 in group II (p < /i>=.9). The degree of external rotation according to condylar twisting angle was 3.35±1.74 in group 1 and 1.9±1.7 in group 2 (p < /i>=.009). Conclusions: In severe Knee-varus deformity, TEA landmark gives more external rotation position for femoral component, despite of lack of significant erosion in femoral condyle.
Saeid Tabatabaei; Ahmad Dashtbozorg; Ahmad Dashtbozorg
Abstract
Background: In patients with late diagnosis of DDH after open reduction of the hip joint, we can use pelvic osteotomy or varus-derotational osteotomy (VDO) of the femur to make the open reduction more stable. The goal of the present study is to report on redirection of the femoral head towards acetabulum ...
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Background: In patients with late diagnosis of DDH after open reduction of the hip joint, we can use pelvic osteotomy or varus-derotational osteotomy (VDO) of the femur to make the open reduction more stable. The goal of the present study is to report on redirection of the femoral head towards acetabulum by femoral osteotomy. Methods : In this prospective study we performed only VDO in 67 hips in 46 patients (36 females, 10 males) after open reduction of the hip in cases of 18 months to 10 years of age whom Salter innominate osteotomy was needed in a hospital in Ahvaz, Iran. The patients were followed up until complete weight bearing and plate removal. Results : Concentric reduction was achieved in 67 hips. Acetabular index showed 6 degrees of reduction after 26 months. No redislocation was seen after plate removal in 61 hips (91%) but pelvic osteotomy was done in 6 hips (9%) due to redislocation or residual displasia. Ninety percent of patients were classified as group 1 or 2 in "severin" classification. Conclusions : VDO is a simple operation with low complication rate. Although more than 90% success rate was observed in these patients, in order to see possible residual dysplasia in these patients longer follow-ups are needed.
Mahzad Javid; John H Wedge
Abstract
Background: Treatment of Legg–Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined osteotomies are generally provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical ...
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Background: Treatment of Legg–Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined osteotomies are generally provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical head and congruent joint. The purpose of the study was to evaluate the radiographic outcomes of simultaneous femoral and pelvic osteotomies. Methods : We reviewed the radiographic changes of 20 patients with Legg–Calvé–Perthes disease with a disease onset of over eight years of age who had undergone combined femoral and Salter innominate osteotomies. The hips in these 20 patients comprised 11 lateral pillar (LP) groups B, 7 B/C, and 2 C. The patients were evaluated with a mean follow-up of five years and five months using the Stulberg radiographic assessment. Results: Among those 20 hips, six became Stulberg II (SII), nine SIII, and five SIV. From the 11 LPB hips, five became SII, four SIII, and two SIV. The seven LPB/C turned out to be SII in one case, SIII in four, and SIV in two. One of the two LPC hips became SIII and one SIV. The three female patients had one LPB, one LPB/ C, and one LPC hip, and surgery resulted in SIII hips in all. Conclusions: Combined osteotomies in older children with a higher LP grouping can marginally improve the radiographic outcome in comparison with the natural history in LPB/C and LPC cases by converting a number of poor to fair results.
Alireza Rahimnia; Peyman Mirshahvalad; Hossein Soleymanloo
Abstract
Background: There are various methods to correct leg length discrepancy (LLD), each with their own specific problems and complications. We would like to report the results of lengthening over an intramedullary nail. Methods: In a prospective study, twelve patients who had LLD from previous femoral fractures ...
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Background: There are various methods to correct leg length discrepancy (LLD), each with their own specific problems and complications. We would like to report the results of lengthening over an intramedullary nail. Methods: In a prospective study, twelve patients who had LLD from previous femoral fractures underwent lengthening with Wagner external fixator over intramedullary nail in a training hospital in Tehran-Iran. The intramedullary nails were locked with screws after the projected length was achieved and external fixator was removed. The outcome of treatment and the complications were evaluated in a 2-year follow-up. Results: The average achieved lengthening was 4.2 cm (3-6 cm). Eight patients developed pin track infection, one case had osteomyelitis. All the cases united, with no mal:::union::: of fracture. The increased duration of external fixation remaining on the limb was closely related to the occurrence of pin track infection (r=.821, p=.001). Conclusion: Femoral lengthening over a nail decreases the duration of external fixator usage, improves patient’s comfort and compliance and avoids axial deviation and fracture of regenerate bone.
Mohammad Mehdinezhad Kashani, MD; Behiyeh Zarif Zakerian, MD; Khosro Shayan, MD; Fatemeh Riyasi, MD
Abstract
Xanthogranulomatous osteomyelitis is a rare bone disease. Its primary presentation is similar to bone tumors. According to our research, only 3 cases of this disease have been reported in the literature. In this case report, a 22 years old patient with right thigh pain, fever and significant weight loss, ...
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Xanthogranulomatous osteomyelitis is a rare bone disease. Its primary presentation is similar to bone tumors. According to our research, only 3 cases of this disease have been reported in the literature. In this case report, a 22 years old patient with right thigh pain, fever and significant weight loss, associated with radiographic features resembling signs of Ewing's sarcoma is presented. The pathologic diagnosis was xanthogranulomatous osteomyelitis. The patient underwent wide spectrum antibiotic therapy and achieved complete recovery.
Mohammad Fakoor, MD; Zahed Safikhani, MD; Shiva Razi, MSc
Abstract
Background: The alignment of lower limbs change with growth and accurate knowledge of such a change in any particular geography is necessary to differentiate the pathologic conditions from normal variations. We are reporting the normal variations in tibiofemoral alignment in young people in a region ...
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Background: The alignment of lower limbs change with growth and accurate knowledge of such a change in any particular geography is necessary to differentiate the pathologic conditions from normal variations. We are reporting the normal variations in tibiofemoral alignment in young people in a region of Iran.Methods: A cross-sectional study on 853 children (455 girls, 398 boys) of 3 to 16 years age was performed. Tibiofemoral angles and intermalleolar distances were measured in standing position. Normal limits of tibiofemoral angles and intermalleolar distances were separately determined based on age and sex.Results: A valgus alignment was observed in all. The tibiofemoral angles in boys between ages 3 to 7 years were 7.1±0.35 and 4.97±0.36 between 8 to 16 years of age. The tibiofemoral angle in girls aged 3 to 7 years were 7.1± 0.38 and in girls of 8 to 16 years were 4.95±0.37 degrees. There was no significant difference between the tibiofemoral angle in girls and boys. The internalleolar distance in boys of 3 to 7 years old was 2.7±0.9 and in boys of 8 to 16 years were 1.4±0.86 centimeters. The intermalleolar distance was 2.6±0.88 centimeters in 3 to 7 year old girls and 2.29±0.93 centimeters in 8 to 16 year old girls. Pierson correlation coefficient showed a reverse relationship between tibiofemoral angle and intermalleolar distance.Conclusion: The tibiofemoral alignment in Iranian children is similar to that of Europe, North America and Turkey but different from Chinese children.
