Comparative clinical study of ultrasound-guided A1 pulley release vs open surgical intervention in the treatment of trigger finger

AIM To investigate the effectiveness of ultrasound-guided release of the first annular pulley and compare results with the conventional open operative technique.METHODS In this prospective randomized, single-center, clinical study, 32 patients with trigger finger or trigger thumb, grade Ⅱ-Ⅳ according to Green classification system, were recruited. Two groups were formed; Group A(16 patients) was treated with an ultrasound-guided percutaneous release of the affected A1 pulley under local anesthesia. Group B(16 patients) underwent an open surgical release of the A1 pul ey, through a 10-15 mm incision. Patients were assessed pre- and postoperatively(follow-up:2,4 and 12 wk) by physicians blinded to the procedures. Treatment of triggering(primary variable of interest) was expressed as the "success rate" per digit. The time for taking postoperative pain killers, range of motion recovery, QuickD ASH test scores(Greek version), return to normal activities(including work), complications and cosmetic results were assessed.RESULTS The success rate in group A was 93.75%(15/16) and in group B 100%(16/16). Mean times in group A patients were 3.5 d for taking pain killers, 4.1 d for returning to normal activities, and 7.2 and 3.9 d for complete extension and flexion recovery, respectively. Mean Quick DASH scores in group A were 45.5 preoperatively and, 7.5, 0.5 and 0 after 2, 4, and 12 wk postoperatively. Mean times in group B patients were 2.9 d for taking pain killers, 17.8 d for returning to normal activities, and 5.6 and 3 d for complete extension and flexion recovery. Mean QuickD ASH scores in group B were 43.2 preoperatively and, 8.2, 1.3 and 0 after 2, 4, and 12 wk postoperatively. The cosmetic results found excellent or good in 87.5%(14/16) of group A patients, while in 56.25%(9/16) of group B patients were evaluated as fair or poor.CONCLUSION Treatment of the trigger finger using ultrasonography resulted in fewer absence of work days, and better cosmetic results, in comparison with the open surgery technique. It is a promising method that represents excellent results without major complications, so that it could be possibly be established as a first-line treatment in the trigger finger's disease.

Vanishing bone disease(Gorham-Stout syndrome): A review of a rare entity

Vanishing bone disease(Gorham-Stout syndrome) is a rare entity of unknown etiology, characterized by de struction of osseous matrix and proliferation of vascula structures, resulting in destruction and absorption o bone. Despite the extensive investigation of the patho genetic mechanisms of the disease, its etiology hasn'been clarified and several theories exist. The syndrome can affect one or multiple bones of the patient, includ ing the skull, the upper and lower extremities, the spine and pelvis. The clinical presentation of a patient suffer ing from vanishing bone disease includes, pain, func tional impairment and swelling of the affected region although asymptomatic cases have been reported, as well as cases in which the diagnosis was made after a pathologic fracture. In this short review we summarize the theories regarding the etiology as well as the clini cal presentation, the diagnostic approach and treat ment options of this rare disease.

Common controversies in total knee replacement surgery: Current evidence

Total knee replacement(TKR) is a widely used operation that has radically improved the quality of life of millions of people during the last few decades. However, some technical details, concerning the surgical procedure and the rehabilitation following total knee arthroplasty, are still a matter of a strong debate. In this review of the literature, we have included the best evidence available of the last decade, in an effort to shed light on some of the most controversial subjects related to TKR surgery. Posterior-stabilized or cruciate-retaining prosthesis? To use a tourniquet during operation or not? Do patients need continuous passive motion for their post-surgery rehabilitation? To resurface patella or not? These are some of the most controversial topics that until now have been persistent dilemmas for the orthopedic surgeon. Results of this systematic review of the literature are highly controversial. These conflicting results are an indication that larger and more well conducted high quality trials are needed in order to gain more secure answers. At the same time, it is becoming apparent that a meticulous operative technique, respecting the soft tissue envelope and knowing the principles of alignment and soft tissue balancing, aresome of the parameters that might contribute more to achieving the optimal results for the patients.

Cemented Müller straight stem total hip replacement:18 year survival,clinical and radiological outcomes

AIM: To present the 18 year survival and the clinical and radiological outcomes of the Müller straight stem, cemented, total hip arthroplasty(THA).METHODS: Between 1989 and 2007, 176 primary total hip arthroplasties in 164 consecutive patients were performed in our institution by the senior author. All patients received a Müller cemented straight stem and a cemented polyethylene liner. The mean age of the patients was 62 years(45-78). The diagnosis was primary osteoarthritis in 151 hips, dysplasia of the hip in 12 and subcapital fracture of the femur in 13. Following discharge, serial follow-up consisted of clinical evaluation based on the Harris Hip Score and radiological assessment. The survival of the prosthesis using revision for any reason as an end-point was calculated by KaplanMeier analysis.RESULTS: Twenty-four(15%) patients died during the follow-up study, 6(4%) patients were lost, while the remaining 134 patients(141 hips) were followedup for a mean of 10 years(3-18 years). HSS score at the latest follow-up revealed that 84 hips(59.5%) had excellent results, 30(22.2%) good, 11(7.8%) fair and 9(6.3%) poor. There were 3 acetabular revisions due to aseptic loosening. Six(4.2%) stems were diagnosed as having radiographic definitive loosening; however, only 1 was revised. 30% of the surviving stems showed no radiological changes of radiolucency, while 70% showed some changes. Survival of the prosthesis for any reason was 96% at 10 years and 81% at 18 years. CONCLUSION: The 18 year survival of the Müller straight stem, cemented THA is comparable to those of other successful cemented systems.

Mixed reality for visualization of orthopedic surgical anatomy

In the modern era,preoperative planning is substantially facilitated by artificial reality technologies,which permit a better understanding of patient anatomy,thus increasing the safety and accuracy of surgical interventions.In the field of orthopedic surgery,the increase in safety and accuracy improves treatment quality and orthopedic patient outcomes.Artificial reality technologies,which include virtual reality(VR),augmented reality(AR),and mixed reality(MR),use digital images obtained from computed tomography or magnetic resonance imaging.VR replaces the user’s physical environment with one that is computer generated.AR and MR have been defined as technologies that permit the fusing of the physical with the virtual environment,enabling the user to interact with both physical and virtual objects.MR has been defined as a technology that,in contrast to AR,enables users to visualize the depth and perspective of the virtual models.We aimed to shed light on the role that MR can play in the visualization of orthopedic surgical anatomy.The literature suggests that MR could be a valuable tool in orthopedic surgeon’s hands for visualization of the anatomy.However,we remark that confusion exists in the literature concerning the characteristics of MR.Thus,a more clear description of MR is needed in orthopedic research,so that the potential of this technology can be more deeply understood.

Two-level reconstruction of isolated fracture of the lesser tuberosity of the humerus

Fractures of the lesser tuberosity of the humerus are typically met in combination with other injuries of the shoulder. Case reports of isolated lesser tuberosity fractures are particularly rare and, consequently,therapeutic protocols have not yet been completely clarified. Conservative as well as surgical treatment has been recommended, while several operative techniques have been applied. We present a case of a 39-yearold man with an isolated lesser tuberosity fracture who was treated surgically in our institution. Due to fracture comminution, a two-level reconstruction technique with headless screws and buttress plate was applied. As far as we know, this method of fixation of this type of fracture has not been previously described in the literature.The patient tolerated the procedure well and excellent results were obtained at the latest follow-up.

Role of fetuin A in the diagnosis and treatment of joint arthritis

Osteoarthritis is a slowly progressive disease which includes the intervention of several cytokines, macrophage metalleinoproteinases reaction, leading to the degradation of the local cartilage but also having an impact on the serum acute phase proteins(APPs). Subsequently, biomarkers seem to be essential to estimate its progression and the need for any surgical intervention such as total arthroplasty, but also can be used as therapeutic agents. Recently, among APPs, fetuin A drew attention regarding its possible anti-inflammatory role in animal models but also as a therapeutic agent in the inflammatory joint disease in clinical trials. In contrast with other APPs such as C-reactive protein, fetuin A appears to be lower in the serum of patients with degenerative joint disease in comparison with the healthy ones, and also acts as an antagonist of the anti-proliferative potential of transforming growth factor-b(TGF-b) cytokines. Because of its lower serum levels in arthritis, an unregulated binding of TGF-b and bone morphogenetic proteins takes place leading to further arthritic lesions. The purpose of the present review is to assess the current evidence regarding the multipotent role of the alpha-2-HSglycoprotein or as also known Fetuin-a in animal models but also as a biomarker of the degenerative joint arthritis in clinical trials.