Intra-articular Injections for Osteoarthritis: From Bench to Bedside, can we Teach Old Drugs New Tricks?

The two articles in this month’s press of The Journal of Arthritis, one by Ekinci et al. titled ‘A New Treatment Option in Osteoarthritis: Prolotherapy Injections’ and the other by Senatorov et al.

Titled ‘Clinical Outcome of Hylan G-F 20 Injections in Shoulder and Hip Osteoarthritis: A Retrospective Review’ raise several important points surrounding the topic of intra-articular injections. Firstly that there is a paucity of high quality literature in the field that often leads to inconclusive or misrepresented conclusions on drug efficacy in established treatments.

The articles also highlight the heterogeneity in injection procedure, site, concentration, preparation and outcome measurements. This editorial will, therefore, provide a concise review on some of the current injection therapies and suggest possible improvements to methodological structure to inspire readers strive for high quality data.

PDF LINK

Intra-articular Injections for Osteoarthritis: From Bench to Bedside, can we Teach Old Drugs New Tricks?

The two articles in this month’s press of The Journal of Arthritis, one by Ekinci et al. titled ‘A New Treatment Option in Osteoarthritis, Prolotherapy Injections’ and the other by Senatorov et al. titled ‘Clinical Outcome of Hylan G-F 20 Injections in Shoulder and Hip Osteoarthritis.

A Retrospective Review’ raise several important points surrounding the topic of intra-articular injections. Firstly that there is a paucity of high quality literature in the field that often leads to inconclusive or misrepresented conclusions on drug efficacy in established treatments.

The articles also highlight the heterogeneity in injection procedure, site, concentration, preparation and outcome measurements.

PDF LINK

Use of Finite Element Analysis to Predict Type of Bone Fractures and Fracture Risks in Femur due to Osteoporosi

Biomechanics is the study of science concerned with internal and external forces acting on the human body and the effects of forces on bone. Biomechanics uses the tools of mechanics which is a branch of physics involving the analysis of forces, to study anatomical and functional aspects of living organisms.

Computer simulation has become an essential part of science and engineering. Digital analysis of components, in particular, is important while developing new products or optimizing designs.

The advanced technology in medical field has been becoming a revolution in conducting surgical operations. This advanced technology helps to a lot in optimizing the results and also it reduces complexity in analysis.

PDF LINK

Delayed Complex Reconstruction of Achilles Tendon After Car-Train Accident: A Case Study

What can be done to salvage a limb after severe injury to the posterior compartment of the patient’s lower leg? If there is neurovascular compromise to the limb, below the knee amputation is recommended as the best treatment option. If there is viable circulation present in the posterior compartment a salvage procedure might be done especially if the patient refuses a below the knee amputation.

In this case the surgeon repaired what he could after determining most of the Achilles tendon was damaged beyond repair but part of the gastro-soleus muscle belly was intact. The patient states he had four operations with the last several procedures skin grafts to cover the remaining defects. Eventually his lower leg healed a year later.

What remained of his leg was a toe walking patient who used a cane most of the time to walk and on occasion crutches. He was never able to play baseball, run and jump after the injury which he regretted. He eventually got married and had several children who are now adults and who also have children.

PDF LINK

THE BEST SOLUTION FOR CHRONIC ACHILLES TENDON RUPTURE

The incidence of tendo-achilles rupture in the patients 30-40 years of age is increased specially in athletics to reach 75% of all cases. The tendon rupture is called neglected when the treatment is delayed more than four weeks from the date of injury.

The percentage of misdiagnosis of Achilles tendon ruptures may reach 20%. The delay in treatment of AT ruptures results in soft tissue retraction with degeneration of the tendon filling the gap between the ruptured ends with fibrotic scar tissue which leads to marked functional disability.

In neglected or chronic ruptures of Achilles Tendon (AT), the retraction and atrophy of the tendon ends create a gap filled with scar tissue and fibrosis which make the reconstruction difficult. The extent of the gap and the potential recovery of the muscle are factors that affect the repair after reconstruction.

PDF LINK

3D Printed Tubular Guides for Pedicle Screw Placement: The Answer for the Need of a Greater Accuracy in Spinal Stabilization

Vertebral stabilization with pedicle screws is currently considered the gold standard for many conditions, such as degenerative, traumatic and oncologic pathologies of the spine.The need for a more accurate surgical technique has led, during the years, to the research of methods and technical aids in order to reach the most accurate and safe pedicle screw placement, for clinical and medico-legal reasons.

The estimated screw misplacement rate varies in the literature in a range from 6 to 31% with the free-hand technique and from 15 to 72% with the fluoroscopic guided technique, the two most widespread techniques.Recently, many different systems have been developed in order to help the spinal surgeon in the placement of pedicle screws, and to reduce the incidence of misplacement.

The most used system is surely the neuronavigator. Widely known and applied in oncologic brain surgery, its use is increasingly widespread also in spine surgery. A preoperative surgical planning is performed on the basis of a thin slice CT scan, with a margin of error starting from 0.5 mm.Despite its high cost, today a neuronavigator is available in the majority of neurosurgical departments.

PDF LINK

Therapeutic Effects of Intra-articular Botulinum Toxin Type A in Knee Osteoarthritis

Knee osteoarthritis (KOA) is an intractable and devastating consequence of degeneration that results in tremendous impact on daily activities. Painful disabling KOA occurs in more than 10% of people who are over 55 years old.

Those who are severely disabled account for up to 25% of aging people and KOA is a major cause of total knee replacement. Current osteoarthritis therapies largely rely on rest, weight loss, bracing and assistive devices, physical modalities, therapeutic exercises, and pharmacological interventions which are unsatisfactory for the majority of severe disabled patients, who are left with ambulation deficit despite vigorous treatment intervention.

Although numerous patients can be treated with surgery, some of them are not good candidates due to multiple co-morbidities. For these reasons, intra-articular (IA) treatments that reduce chronic joint pain and improve function is the long-term effective and safe alternative options. In a number of recent studies, pain intensity and functional performance resulted from osteoarthritis has been improved after IA injection of botulinum toxin type A (BoNT-A).

PDF LINK

The Ishiguro Technique for the Treatment of Adolescent Mallet Thumb Fracture

Mallet thumb is the avulsion of the extensor pollicis longus tendon from the base of the distal phalanx with or without bony fragment. It occurs because of the hyperflexion or axial loading of the interphalangeal joint, most often due to bicycle injuries and ball games.

Injuries of the abruption extensor tendon in adolescents are extremely rare. During the last 30 years 2 cases have been published in English.

Treatment options for mallet thumb fracture are primary conservative such as splint or cast. Splints or casts immobilize musculoskeletal injuries while alleviating pain and promoting healing. However, these interventions differ in their technique, indications, benefits, and risks.

PDF LINK

Frailty Screening and Pre-habilitation in Older Spine Patients Reversing the Effects of Sedentary Life-styles to Improve Surgical Outcomes for Older Patients and Reduce Healthcare Costs

Over the last century daily life for Homo Sapiens has become considerably easier, particularly for those individuals living in western industrialized societies. A combination of technological advances, including factory automation, farm machinery, labor saving devices for the home, the automobile, telephones, television and computers has allowed us to become steadily more productive.

At the same time these innovations have made our species much more sedentary, obese and prone to a variety of chronic degenerative diseases which put a considerable financial burden on the health care system.

Since the pioneering work of Jerry Morris in the early1950's that observed an increased risk of heart disease in sedentary London bus drivers, medical science has built a wealth of knowledge about the importance of physical activity for long-term health.

Failed Agility™ LP Total Ankle Replacement Salvaged with Tibio-Talo- Calcaneal Arthrodesis and Vascularized Pedicled Medial Malleolus and Fibula Onlay Bone Grafts

The concept and technique of performing a tibio-talo-calcaneal arthrodesis with bulk structural allograft fixated using a retrograde compression intramedullary nail as a salvage procedure for failed total ankle replacement is not new.

However, when compared with primary tibio-talo-calcaneal arthrodesis a higher complication rate exists with nonunion occurring in >50%, infection in 20% and below-knee amputation in nearly 20%.One reason for the high incidence of complications may be that the fibula is nearly universally resected with this procedure.

Instead, vascularized pedicled bone graft augmentation of these salvage arthrodesis procedures to treat failed total ankle replacement seems a logical choice to enhance union rate and functional limb salvage.

PDF LINK

Osteolytic Metatarsal Lesion: A Case of Foreign Body Foot

Foreign body injuries of the foot present orthopaedician with several intriguing dilemmas, in formulating a sound diagnostic and treatment plan. These injuries range from trivial trauma to sever incapacitation of an individual.

The injuries should not be considered trivial, since failure to remove all of the foreign body may lead to joint destruction, infection, or even loss of part of limb.History of the injury may be vague, but it is necessary for the treating physician to elicit clear and informative history for determining the diagnostic measures to be taken.

Physical examination of a plantar puncture wound with surrounding edema, erythema, and tenderness is suggestive of a retained foreign body. In trivial injuries and chronic cases such features are usually lacking. These foreign bodies may implant deeply, and if not quickly removed, can be a source of chronic frustration to both the patient and treating doctor.

PDF LINK

Treatment by Quacks Still An Issue of Concern

It was not all about writing a research paper or a case report. This time it was writing our experience regarding mismanagement of simple injuries or fractures by quacks.Lots of patients frequently come to our orthopaedic OPD with complaints of deformities, stiffness of joint, non union of fractures or an ugly swelling.

It is not uncommon to see patient left handicapped by a quack after a simple fracture. Not only do these quacks treat injuries but they also put their hands on other orthopaedic ailments like rheumatoid arthritis. Most of time history is same.History of trauma sustaining injury to limbs and often injury is of 5 to 6 months old.

Usually the patients are form lower socioeconomic group.The so called different treatment tactics by these quacks keeps on puzzling you and make your work even difficult. The outcome is now further complicated if these cases reach late, after initially getting treatment from “Quacks” in the form of massage and traditional manipulations.

PDF LINK

Analgesic Effect of Textile Supports with Static Field Magnets in Patients with Osteoarticular Pain Syndrome

osteoarticular diseases are the most common and disabling chronic condition in the general population and the pain associated with these complications negatively impacts upon the quality of life, particularly in the elderly.

In a systematic review published in 2005 and focused on the effect of magnetic therapy on pain perception in patients with osteoarticular pain of various origin, 13 studies out of 21 (i.e. 62%) reported an analgesic effect of stable magnetic fields.

furthermore, in a small clinical trial performed in a series of patients with postpolio syndrome and bone pain, the local application of magnetic fields associated with a 60% reduction in pain perception. however, to date the analgesic effect of stable magnetic fields in osteoarticular diseases remains matter of debate.

PDF LINK

Minimal Invasive Medial Patellofemoral Ligament Reconstruction by Hamstring Tendon Auto-graft

Anatomic abnormalities can lead to patellar instability. Valgus alignment at the knee leads to an increased Q angle and increased lateral tension on the patella. Similarly, rotational misalignment of the extremity specifically, increased femoral anteversion combined with external tibial torsion leads to increased lateral tension on the patella.

With increased flexion at the knee, the bony constraints become more important and trochlear dysplasia can lead to insufficient constraint in flexion. Patients with patella alta engage their bony constraints at a deeper flexion angle and can therefore be more prone to subluxation and dislocation.

In extension the important static constraint to lateral subluxation and dislocation is the medial patellofemoral ligament (MPFL). In this same range, the vastus medialis obliqus acts as a dynamic restraint to instability. In any single patient, several of these factors can act together, leading to his or her symptoms.

PDF LINK

Connexin43 Gap Junctions Influences Osteoblast Signalling and Enhances Osteoarthritis Gene Expression

In multicellular organism, cells communicate with each other by gap junctions. The subunits of gap junction channels are proteins called connexins. Six-connexin proteins interact to form a ring-like pore structure called a hemichannel or connexon.

These hemichannels dock to hemichannels on neighbouring cells, forming a gap junction’s pore, which provides a direct intercellular passage for small molecules               or ion to move between cells. Most of the gap junction possesses four transmembrane regions, with cytoplasmic amino and carboxyl regions.

Gap junction communication plays a critical role in bone cells such as osteoblast, osteocytes and osteoclast. In humans, more than twenty connexins have been identified but Cx43, Cx45, Cx40, Cx46 and Cx37 are expressed in the bone.

PDF LINK

In vitro effect of transforming growth factor-B1 (TGF-B1) on gene expression in human flexor digitorum profundus tendon cells

Each year, millions of North Americans injure their hands resulting in significant morbidity and lost workdays. In the USA, among all the injuries reported at private, state, and local government, 12.7% were hand injuries; and the average days away from work was 5 days in 2014.

Among hand injuries, flexor tendon lacerations remain a challenge for hand surgeons. While flexor tendons heal with reduced mechanical strength, the most clinically relevant issue is adhesion formation, which impairs hand activity. There are presently no therapeutic agents available for the prevention of tendon adhesions.

In fact, the only accepted means of preventing adhesion formation in flexor tendons is physical therapy. Even with physical therapy, the strength of healed tendons is markedly less than uninjured tendon, and debilitating adhesions have been reported to occur in as many as 50% of zone II flexor tendon injuries.

PDF LINK