http://www.josr-online.com The latest research articles published by Journal of Orthopaedic Surgery and Research 2010-03-11T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ Background: interstitial fluid flow induced by loading has demonstrated to be an important mediator for regulating bone mass and morphology. It is shown that the fluid movement generated by the intramedullary pressure (ImP) provides a source for pressure gradient in bone. Such dynamic ImP may alter the blood flow within nutrient vessel adjacent to bone and directly connected to the marrow cavity, further initiating nutrient vessel adaptation. It is hypothesized that oscillatory ImP can mediate the blood flow in the skeletal nutrient vessels and trigger vasculature remodeling. The objective of this study was then to evaluate the vasculature remodeling induced by dynamic ImP stimulation as a function of ImP frequency. Methods: Using an avian model, dynamics physiological fluid ImP (70mmHg, peak-peak) was applied in the marrow cavity of the left ulna at either 3Hz or 30Hz, 10 minutes/day, 5 days/week for 3 or 4 weeks. The histomorphometric measurements of the principal nutrient arteries were done to quantify the arterial wall area, lumen area, wall thickness, and smooth muscle cell layer numbers for comparison. Results: The preliminary results indicated that the acute cyclic ImP stimuli can significantly enlarge the nutrient arterial wall area up to 50%, wall thickness up to 20%, and smooth muscle cell layer numbers up to 37%. In addition, 3-week of acute stimulation was sufficient to alter the arterial structural properties, i.e., increase of arterial wall area, whereas 4-week of loading showed only minimal changes regardless of the loading frequency. Conclusions: These data indicate a potential mechanism in the interrelationship between vasculature adaptation and applied ImP alteration. Acute ImP could possibly initiate the remodeling in the bone nutrient vasculature, which may ultimately alter blood supply to bone. http://www.josr-online.com/content/5/1/18 Hoyan Lam Peter Brink Yi-Xian Qin Journal of Orthopaedic Surgery and Research 2010, 5:18 2010-03-11T00:00:00Z doi:10.1186/1749-799X-5-18 Journal of Orthopaedic Surgery and Research 1749-799X 5 18 2010-03-11T00:00:00Z PDF A case of a large recurrent hydatid cyst involving the right ilium and right hip treated with excision of the cyst, Total hip replacement and revision of the acetabular component with a Tripolar articulation for cyst recurrence and acetabular component loosening is presented along with a review of the relevant literature. To our knowledge there is no reported case of Total Hip replacement and revision for hydatid disease involving the bony pelvis. http://www.josr-online.com/content/5/1/17 Venkata Neelapala Coonoor Chandrasekar Robert Grimer Journal of Orthopaedic Surgery and Research 2010, 5:17 2010-03-11T00:00:00Z doi:10.1186/1749-799X-5-17 Journal of Orthopaedic Surgery and Research 1749-799X 5 17 2010-03-11T00:00:00Z PDF Background: Isolated thumb carpometacarpal dislocation is a rare injury pattern and the optimal treatment option is still controversial.Case Description: We present a 27-year-old basketball player who underwent an isolated dorsal dislocation of the thumb carpometacarpal joint after a fall. The dislocation was successfully reduced by closed means but the joint was found to be grossly unstable. Due to inherent instability, repair of the ruptured dorsoradial ligament and joint capsule was performed.The ligament was detached from its proximal insertion into trapezium and subsequently stabilized via suture anchors. The torn capsule was repaired in an end-to-end fashion and immobilization of the joint was applied for 6 weeks. Results: At 3-year follow up evaluation the patient was pain free and returned to his previous level of activity. No restriction of carpometacrpal movements or residual instability was noticed. Radiographic examination showed normal joint alignment and no signs of subluxation or early osteoarthritis. Conclusion: Surgical stabilization of the dorsal capsuloligamentous complex may be considered the selected treatment option in isolated carpometacarpal joint dislocations, that remain unstable after closed reduction in young and high demand patients.Level of Clinical Evidence: Level IV http://www.josr-online.com/content/5/1/16 Elias Fotiadis Theodoros Svarnas Christos Lyrtzis Alexis Papadopoulos Panagiotis Akritopoulos Byron Chalidis Journal of Orthopaedic Surgery and Research 2010, 5:16 2010-03-10T00:00:00Z doi:10.1186/1749-799X-5-16 Journal of Orthopaedic Surgery and Research 1749-799X 5 16 2010-03-10T00:00:00Z PDF Background: A major cause of osteonecrosis of the femoral head is interruption of a blood supply to the proximal femur. In order to evaluate blood circulation and pathogenetic alterations, a pig femoral head osteonecrosis model was examined to address whether ligature of the femoral neck (vasculature deprivation) induces a reduction of blood circulation in the femoral head, and whether transphyseal vessels exist for communications between the epiphysis and the metaphysis. We also tested the hypothesis that the vessels surrounding the femoral neck and the ligamentum teres represent the primary source of blood flow to the femoral head. Methods: Avascular osteonecrosis of the femoral head was induced in Yorkshire pigs by transecting the ligamentum teres and placing two ligatures around the femoral neck. After heparinized saline infusion and microfil perfusion via the abdominal aorta, blood circulation in the femoral head was evaluated by optical and CT imaging. Results: An angiogram of the microfil-casted sample allowed identification of the major blood vessels to the proximal femur including the iliac, common femoral, superficial femoral, deep femoral and circumflex arteries. Optical imaging in the femoral neck showed that a microfil-stained vessel network was visible in control sections but less noticeable in necrotic sections. CT images showed a lack of microfil staining in the epiphysis. Furthermore, no transphyseal vessels were observed to link the epiphysis to the metaphysis. Conclusion: Optical and CT imaging analyses revealed that in this present pig model the ligatures around the femoral neck were the primary cause of induction of avascular osteonecrosis. Since the vessels surrounding the femoral neck are comprised of the branches of the medial and the lateral femoral circumflex vessels, together with the extracapsular arterial ring and the lateral epiphyseal arteries, augmentation of blood circulation in those arteries will improve pathogenetic alterations in the necrotic femoral head. Our pig model can be used for further femoral head osteonecrosis studies. http://www.josr-online.com/content/5/1/15 Ping Zhang Yun Liang Harry Kim Hiroki Yokota Journal of Orthopaedic Surgery and Research 2010, 5:15 2010-03-06T00:00:00Z doi:10.1186/1749-799X-5-15 Journal of Orthopaedic Surgery and Research 1749-799X 5 15 2010-03-06T00:00:00Z PDF Symptomatic synovial lumbar facet cysts are a relatively rare cause of radiculopathy and spinal stenosis. This case and brief review of the literature, details a patient who presented with acutely symptomatic bilateral spontaneously infected synovial facet (L4/5) cysts. This report highlights diagnostic clues for identifying infection of a facet cyst. http://www.josr-online.com/content/5/1/14 Brett Freedman Tuan Bui S. Timothy Yoon Journal of Orthopaedic Surgery and Research 2010, 5:14 2010-03-05T00:00:00Z doi:10.1186/1749-799X-5-14 Journal of Orthopaedic Surgery and Research 1749-799X 5 14 2010-03-05T00:00:00Z PDF The medical cost associated with back pain in the United States is considerable and growing. Although the differential diagnosis of back pain is broad, epidemiological studies suggest a correlation between adult and adolescent complaints. Injury of the pars interarticularis is one of the most common identifiable causes of ongoing low back pain in adolescent athletes. It constitutes a spectrum of disease ranging from bone stress to spondylolysis and spondylolisthesis. Bone stress may be the earliest sign of disease. Repetitive bone stress causes bone remodeling and may result in spondylolysis, a non-displaced fracture of the pars interarticularis. A fracture of the pars interarticularis may ultimately become unstable leading to spondylolisthesis. Results in the literature support the use of bone scintigraphy to diagnose bone stress in patients with suspected spondylolysis. Single photon emission computed tomography (SPECT) provides more contrast than planar bone scintigraphy, increases the sensitivity and improves anatomic localization of skeletal lesions without exposing the patient to additional radiation. It also provides an opportunity for better correlation with other imaging modalities, when necessary. As such, the addition of SPECT to standard planar bone scintigraphy can result in a more accurate diagnosis and a better chance for efficient patient care. It is our expectation that by improving our ability to correctly diagnose bone stress in patients with suspected injury of the posterior elements, the long-term cost of managing this condition will be lowered. http://www.josr-online.com/content/5/1/13 Katherine Zukotynski Christine Curtis Frederick Grant Lyle Micheli S Treves Journal of Orthopaedic Surgery and Research 2010, 5:13 2010-03-03T00:00:00Z doi:10.1186/1749-799X-5-13 Journal of Orthopaedic Surgery and Research 1749-799X 5 13 2010-03-03T00:00:00Z PDF Background: The study objective was to assess the influence of a SLAP lesion on onset of EMG activity in shoulder muscles during a front on rugby football tackle within professional rugby players. Methods: Mixed cross-sectional study evaluating between and within group differences in EMG onset times. Testing was carried out within the physiotherapy department of a university sports medicine clinic. The test group consisted of 7 players with clinically diagnosed SLAP lesions, later verified on arthroscopy. The reference group consisted of 15 uninjured and full time professional rugby players from within the same playing squad. Controlled tackles were performed against a tackle dummy. Onset of EMG activity was assessed from surface EMG of Pectorialis Major, Biceps Brachii, Latissimus Dorsi, Serratus Anterior and Infraspinatus muscles relative to time of impact. Analysis of differences in activation timing between muscles and limbs (injured versus non-injured side and non injured side versus matched reference group). Results: Serratus Anterior was activated prior to all other muscles in all (P = 0.001-0.03) subjects. In the SLAP injured shoulder Biceps was activated later than in the non-injured side. Onset times of all muscles of the non-injured shoulder in the injured player were consistently earlier compared with the reference group. Whereas, within the injured shoulder, all muscle activation timings were later than in the reference group. Conclusions: This study shows that in shoulders with a SLAP lesion there is a trend towards delay in activation time of Biceps and other muscles with the exception of an associated earlier onset of activation of Serratus anterior, possibly due to a coping strategy to protect glenohumeral stability and thoraco- scapular stability. This trend was not statistically significant in all cases http://www.josr-online.com/content/5/1/12 Ian Horsley Lee Herrington Christer Rolf Journal of Orthopaedic Surgery and Research 2010, 5:12 2010-02-25T00:00:00Z doi:10.1186/1749-799X-5-12 Journal of Orthopaedic Surgery and Research 1749-799X 5 12 2010-02-25T00:00:00Z PDF Aplasia of both cruciate ligaments is a rare congenital disorder. A 28-year-old male presented with pain and the feeling of instability of his right knee after trauma. The provided MRI and previous arthroscopy reports did not indicate any abnormalities except cruciate ligament tears. He was referred to us for reconstruction of both cruciate ligaments. The patient again underwent arthroscopy which revealed a hypoplasia of the medial trochlea and an extremely narrow intercondylar notch. The tibia revealed a missing anterior cruciate ligament (ACL) footprint and a single bump with a complete coverage with articular cartilage. There was no room for an ACL graft. A posterior cruciate ligament could not be identified. The procedure was ended since a ligament reconstruction did not appear reasonable. A significant notch plasty if not a partial resection of the condyles would have been necessary to implant a ligament graft. It is most likely that this would not lead to good knee stability. If the surgeon would have retrieved the contralateral hamstrings at the beginning of the planned ligament reconstruction a significant damage would have occurred to the patient. Even in seemingly clear diagnostic findings the arthroscopic surgeon should take this rare abdnormality into consideration and be familiar with the respective radiological findings. We refer the abnormal finding of only one tibial spine to as the "dromedar-sign" as opposed to the two (medial and a lateral) tibial spines in a normal knee. This may be used as a hint for aplasia of the cruciate ligaments. http://www.josr-online.com/content/5/1/11 Maurice Balke Jonas Mueller-Huebenthal Sven Shafizadeh Dennis Liem Juergen Hoeher Journal of Orthopaedic Surgery and Research 2010, 5:11 2010-02-25T00:00:00Z doi:10.1186/1749-799X-5-11 Journal of Orthopaedic Surgery and Research 1749-799X 5 11 2010-02-25T00:00:00Z PDF Paediatric supracondylar fractures of the femur are not common. The treatment options depend on the age of child, the site of the fracture, the pattern of injury and the surgeon's preference. We report a case of an 11-year old boy who sustained a comminuted displaced supracondylar fracture of the femur and was treated with indirect reduction and internal fixation with the Less Invasive Stabilization System (LISS) tibial plate. http://www.josr-online.com/content/5/1/10 Hoi Yan Lam Chun Kwong Lo Kai Yin Cheung Journal of Orthopaedic Surgery and Research 2010, 5:10 2010-02-18T00:00:00Z doi:10.1186/1749-799X-5-10 Journal of Orthopaedic Surgery and Research 1749-799X 5 10 2010-02-18T00:00:00Z XML Background: Intertrochanteric fractures are surgically treated by using different methods and implants. The optional type of surgical stabilization is still under debate. However, between devices with the same philosophy, different design characteristics may substantially influence fracture healing. This is a prospective study comparing the complication and final functional outcome of two intramedullary devices, the intramedullary hip screw (IMHS) and the ENDOVIS nail.Materials and methodsTwo hundred fifteen patients were randomized on admission in two treatment groups. Epidemiology features and functional status was similar between two treatment groups. Fracture stability was assessed according to the Evan's classification. One hundred ten patients were treated with IMHS and 105 with ENDOVIS nail. Results: There were no significant statistical differences between the two groups regarding blood loss, transfusion requirements and mortality rate. In contrast, the number of total complications was significantly higher in the ENDOVIS nail group. Moreover, the overall functional and walking competence was superior in the patients treated with the IMHS nail. Conclusions: These results indicate that the choice of the proper implant plays probably an important role in the final outcome of surgical treatment of intertrochanteric fractures. IMHS nail allows for accurate surgical technique, for both static and dynamic compression and high rotational stability. IMHS nail proved more reliable in our study regarding nail insertion and overall uncomplicated outcome. http://www.josr-online.com/content/5/1/9 Konstantinos Makridis Vasileios Georgaklis Miltiadis Georgoussis Vasileios Mandalos Vasileios Kontogeorgakos Leonidas Badras Journal of Orthopaedic Surgery and Research 2010, 5:9 2010-02-18T00:00:00Z doi:10.1186/1749-799X-5-9 Journal of Orthopaedic Surgery and Research 1749-799X 5 9 2010-02-18T00:00:00Z XML