Patellectomy, an old treatment in patellar fracture which is still alive: A case report.

INTRODUCTION: Comminuted patella fractures comprise 55 % of patellar fractures. In spite of advances in internal fixation of patella, patellectomy remains an effective treatment in comminuted fractures. In the shadow of different efficient methods of internal fixation, little attention is paid to patellectomy as an old treatment in patellar fracture which is a treatment option in circumstances like comminuted fractures and osteomyelitis. PRESENTATION OF CASE: A 54-year-old male presented with complaint of knee pain and limited range of motion. The patient experienced patella fracture four years ago and several sessions of surgery have been performed on his patella including tension band wiring, partial patellectomy, and arthroscopic release. Lastly, pain and severe limited range of motion, convinced us to perform total patellectomy. The result is satisfactory after one year; flexion is up to 90° and no limping or extension lag is observed. The only complaint is mild anterior knee pain. DISCUSSION: Patella has two important biomechanical functions including linking and displacement. Preserving even a single fragment of the patella substantially improves linking and displacement function of the patella. Total patellectomy is reserved for conditions like failed internal fixation, comminuted fractures, and patellar osteomyelitis. Although function of the knee cannot be thoroughly restored after removing of the patella, total patellectomy can lead to a relative satisfaction in performing activities of daily living. CONCLUSION: In spite of various types of treatment for patellar fracture, total patellectomy, is still an efficient treatment option in circumstances like comminuted fractures, failed internal fixation, and osteomyelitis.

Gait and muscle activity measures after biomechanical device therapy in subjects with ankle instability: A systematic review.

INTRODUCTION: Health specialists suggest a conservative approach comprising non-pharmacological interventions as the initial course of action for individuals with repetitive ankle sprain due to ankle instability. This systematic review aimed to assess the effectiveness of biomechanical devices (Foot Orthoses, Ankle Orthoses, and Taping) on gait and muscle activity in individuals with ankle instability. METHODS: A systematic search was performed on electronic databases, including PubMed, EMBASE, Clinical Trials.gov, Web of Science, and Scopus. The PEDro scoring system was used to evaluate the quality of the included studies. We extracted data from population, intervention, and outcome measures. RESULTS: In the initial search, we found 247 articles. After following the steps of the PRISMA flowchart, only 22 reports met the inclusion criteria of this study. The results show that biomechanical device therapy may increase swing time, stance time, and step. Additionally, studies suggest that these devices can reduce plantar flexion, inversion, and motion variability during gait. Biomechanical devices have the potential to optimize the subtalar valgus moment, push-off, and braking forces exerted during walking, as well as enhance the activity of specific muscles including the peroneus longus, peroneus brevis, tibialis anterior, gluteus medius, lateral gastrocnemius, rectus femoris, and soleus. CONCLUSION: Biomechanical devices affect gait (spatiotemporal, kinetic, and kinematic variables) and lower limb muscle activity (root mean square, reaction time, amplitude, reflex, and wave) in subjects with ankle instability.

Efficacy of 16S rRNA variable regions high-resolution melt analysis for bacterial pathogens identification in periprosthetic joint infections.

BACKGROUND: Accurate and rapid identification of microorganisms causing periprosthetic joint infections (PJIs) are necessary for choosing an appropriate antibiotic therapy. Therefore, molecular techniques are suggested for diagnosis in suspected PJIs. The Broad-range PCR and High-Resolution Melt Analysis (HRMA) were evaluated for the identification of causative organisms of PJIs in this study. RESULTS: For 47 of 63 specimens, both the culture and broad-range PCR were positive. The culture was found to be able of organism's detection in 74.6% (47/63) of patients. Of 47 positive cultures, 11 (23.4%) were polymicrobial and 36 (76.59%) were monomicrobial cultures, in which 34 (91.89%) cases were detected by HRM assay. The sensitivity, specificity of HRMA vs monomicrobial culture were 91.89, 93.75%, respectively. The sensitivity, specificity of total HRMA (mono + poly) vs culture were 82.92, 93.75%. CONCLUSIONS: HRM assay coupled with broad-range PCR are effective screening, rapid, and relatively cost-effective methods for discrimination of PJIs especially in aiding culture method. Using computer programs such as the Matlab-2018b program for HRM data analysis is also valuable and helpful in diagnosis.

The Influence of Tibial Tuberosity-trochlear Groove Distance on Development of Patellofemoral Pain Syndrome.

Background: Tibial tuberosity-trochlear groove distance (TT-TGD) measurements play a decisive role in evaluating patellofemoral joint disorders. However, the prevalence of pathological TT-TGD among patients with patellofemoral pain remains unclear. The purpose of this study was to compare the size of TT-TGD among patients with patellofemoral pain syndrome (PFPS) and those with no history of patellofemoral pain. Methods: A total of 100 cases participated in this case-control study, among whom 53 individuals were in the case group and 47 individuals were in the control group. TT-TGD was measured by magnetic resonance imaging. Results: The mean TT-TGD was 12.3±3.3 in patients and 9.3±2.4 in controls (P<0.001). Among patients, we had totally 34 patients with TT-TG equal or lower than 13 (64.2%) and in 18 patients, it was higher than 13 (34%). Conclusion: The mean TT-TGD in patients with PFPS was greater than that in the control group (P=0.001). An increase in TT-TGD can be considered one of the factors behind the development of PFPS.

Use of the Ponseti method in the Iranian population.

BACKGROUND: The most common congenital orthopaedic condition requiring treatment is clubfoot. The Ponseti method, which has improved the recurrence rate, is at present the most attractive method of treatment in the north of America. The purpose of this study was to evaluate the outcome of this method in an Iranian population and look for characteristics that may affect the treatment process. METHODS: A total of 78 patients (129 feet) were treated by precisely adhering to the technique originally introduced by Ponseti. Relapse was defined as any return of each of 4 clubfoot components according to the Dimeglio-Bensahel system. The mean follow-up period was 24.7 months and relapse was analyzed with respect to severity of primary disorder, number of casts, compliance with postcorrection bracing and stretching exercise, and educational level of parents. RESULTS: At the end of the follow-up, 24 (18.6%) clubfeet experienced relapse as defined. The mean time to relapse was 13.7 months, 30 feet had brace noncompliance, and stretching was not done for 35 feet. Significant association was detected between recurrence and severity of clubfoot, number of casts for complete correction, and bracing and stretching exercise noncompliance. CONCLUSIONS: The Ponseti method is a successful treatment protocol for idiopathic clubfoot. Its success rate will increase with use of abduction orthosis after complete correction and also by performing regular stretching exercises. LEVEL OF EVIDENCE: Therapeutic level II.