Fixed versus mobile weight-bearing prosthesis in total knee arthroplasty.

PURPOSE: This study was designed to compare clinical, radiological, and general health results of two prostheses (mobile vs. fixed weight-bearing devices) that are used in total knee arthroplasty with a 5-year follow-up. METHODS: This randomized controlled study was conducted from 2004 to 2010 in the Department of Orthopedic Surgery at two university hospitals in Isfahan, Iran. Three hundred patients with expected primary total knee arthroplasty (TKA) without severe deformity (a fixed varus or valgus deformity greater than 20°) received fixed weight-bearing (n = 150) or mobile weight-bearing (n = 150) devices. Clinical, radiological, and quality of life outcomes were compared between the two groups at six-month intervals for the first year, after which the comparisons were made annually for the next 4 years. RESULTS: Both groups had similar baseline characteristics. Although there was significant improvement in both groups, there was no significant difference between the groups with regard to the means of the Knee Society Scores, which were 92 (SD: 12.1) for the fixed weight-bearing device and 93 (SD: 14.2) for the mobile weight-bearing device (n.s.) at the final follow-up point. Radiographs showed that there was no significant difference in prosthetic alignment and no evidence of loosening. After TKA, the SF-36 score increased in both groups, but there was no statistical difference between the groups in quality of life at the final follow-up (62 (12.2) vs. 64 (14.3), n.s.). There was no revision after 5 years. CONCLUSIONS: In terms of clinical, radiological or general health outcomes for people who underwent TKA, the results of this study showed no clear advantage of mobile weight-bearing over the fixed weight-bearing prosthesis at the five-year follow-up. LEVEL OF EVIDENCE: I.

Xanthogranulomatous osteomyelitis.

Xanthogranulomatous osteomyelitis is a rare type of inflammatory process which is characterized by composition of immune cell aggregation on histological studies. Delayed-type hypersensitivity reaction of cell-mediated immunity may be implicated in its pathogenesis. Gross and radiological examination can mimic malignancy, and differentiation should be confirmed by histopathological evaluation. We describe the case of a 14-year-old Afghan boy presenting with pain in right shoulder and left leg with prior history of trauma. Fever, limitation in right shoulder range of motion, and tenderness in right shoulder and left thigh were detected following examination. Mild leukocytosis, elevated alkaline phosphatase, and increased erythrocyte sedimentation rate with negative C-reactive protein (CRP) were revealed. X-ray imaging showed mixed density, periosteal reaction, and cortical disruption. Computed tomography (CT) scan revealed lesions involving medulla and cortex, periosteal reaction with soft tissue component, and bone marrow infiltration in right humerus and left fibula. On magnetic resonance imaging (MRI), signal abnormalities in medulla, metaphysis, and diaphysis of the left fibula associated with cortical irregularity and diffuse soft tissue hypersignal areas were demonstrated. Finally, xanthogranulomatous osteomyelitis was confirmed by histological sample. The clinical manifestations and radiographic and laboratory findings of this rare condition are discussed.

Titanium elastic nailing versus hip spica cast in treatment of femoral-shaft fractures in children.

BACKGROUND: There is no consensus on treatment of closed femoral-shaft fractures in children. We compared hip spica cast with titanium elastic nailing (TEN) in the treatment of femoral-shaft fractures in children. MATERIALS AND METHODS: Forty-six children, 6-12 years old, with simple femoral-shaft fractures were randomized to receive skeletal traction followed by hip spica cast (n = 23) or TEN (n = 23). Length of hospital stay, time to start walking with aids, time to start independent walking, time absent from school, parent satisfaction, and range of knee motion were compared between the two groups 6 months after injury. RESULTS: The two groups were similar in background characteristics. Compared with the children treated with spica cast, those treated with TEN had shorter hospital stay (P < 0.001) and took a shorter time to start walking with support or independently (P < 0.001), returned to school sooner (P < 0.001), and had higher parent satisfaction (P = 0.003). Range of knee motion was 138.7 ± 3.4° in the spica cast group and 133.5 ± 13.4° in the TEN group (P = 0.078). Three patients (13.0%) in the spica cast group compared with none in the TEN group had malunion (P = 0.117). Postoperative infection was observed in three patients (13.0%) in the TEN group. CONCLUSIONS: The results showed significant benefits of TEN compared with traction and hip spica cast in the treatment of femoral-shaft fractures in children. Further trials with longer follow-ups and comparison of TEN with other methods, such as external fixation, in children's femoral fractures are warranted.

Unicameral bone cyst of the scaphoid: a report of two cases.

Unicameral bone cysts are benign, fluid-filled lesions that occur mostly in long bones (proximal humerus, 50-60%; femur, 30%) of male children aged 5 to 15 years. Occurrence in the scaphoid of an adult is rare. We report 2 such patients who presented with wrist pain, with and without a history of trauma. Both underwent curettage and bone grafting (harvested from the distal radius) and achieved good functional recovery.

Diagnostic accuracy of preoperative clinical examination in upper limb injuries.

BACKGROUND: Injuries in hands and forearms may cause significant discomfort and disability. AIM: To evaluate the accuracy of preoperative clinical examination in depicting lesions caused by penetrating wounds of hands or forearms. SETTING AND DESIGN: This prospective study was conducted from August 2006 to September 2009 at Kashani University Hospital, Isfahan University of Medical Sciences, Iran. MATERIALS AND METHODS: Two hundred and fifty patients with clean penetrating injury to the hand/forearm were enrolled in this study. After patient's data registration, a careful clinical examination and routine exploration without expansion of wound were done by an orthopedic resident. Each tendon was tested at each joint level. Nerves were evaluated with a two-point discrimination test, and arteries were tested with palpable pulses. Surgical exploration was done by a single hand surgeon in operation room. Accuracy of clinical examination was compared to surgical examination. RESULTS: During the study period, 180 (72%) males and 70 (28%) females with mean age of 28±4 years participated. The preoperative examination showed a predominance of the volar zone IV injuries followed by volar zone II, III, thumb zone II, volar zone V and thumb zone III. Despite the enough accuracy of preoperative examinations in dorsal side injuries of hands and forearms (error rate = 8.3%), the preoperative examinations significantly underestimated the amount of damage to soft tissues on the volar side of hands and forearms (error rate = 14%). CONCLUSIONS: The precise surgical evaluations should be considered in patients with penetrating injury to the hand or forearm, especially in those with volar side injuries.