Degenerative Arthrosis Research Articles

Atlantoaxial Instability in the Era of Non-Inflammatory Degenerative Arthrosis: Surgical Strategy and Clinical Outcome in 36 Patients

Atlantoaxial Instability in the Era of Non-Inflammatory Degenerative Arthrosis: Surgical Strategy and Clinical Outcome in 36 Patients

상지 관절 기능의 정량적 평가 및 임상적 활용을 위한 스마트폰 기반 운동추적 의료 시스템 개발

Because shoulder diseases including the frozen shoulder, rotator cuff disease, and degenerative arthrosis have been rapidly increased, the need to develop a system that can measure quantitatively and objectively has been suggested for achieving the effective exercise and rehabilitation. However, the current method for therapeutic exercise of the shoulder joint consists of the manipulation directly performed by a doctor or physical therapist and self-passive joint movement through patient education. Recently, with the rapid development of information and communication technology (ICT) and combined with rehabilitative medicine, innovative changes are being made in the clinical field. In this paper, we introduce a system that can objectively and quantitatively evaluate the shoulder range of motion. This is a system that utilizes the image processing and server technology of a smartphone without purchasing additional equipment and can be used by himself. The assessment of shoulder motion was performed based on the normal arm and, when involved in both arms, they were evaluated with a single arm. With the development of intuitive UI/UX for this system, we will continue to conduct R&D with the orthopaedic surgeons who were affiliated with the medical university for constructing the raw data and conducting the clinical research.

MRI-guided sacroiliac joint injections in children and adults: current practice and future developments.

Common etiologies of low back pain include degenerative arthrosis and inflammatory arthropathy of the sacroiliac joints. The diagnostic workup revolves around identifying and confirming the sacroiliac joints as a pain generator. Diagnostic sacroiliac joint injections often serve as functional additions to the diagnostic workup through eliciting a pain response that tests the hypothesis that the sacroiliac joints do or do not contribute to the patient's pain syndrome. Therapeutic sacroiliac joint injections aim to provide medium- to long-term relief of symptoms and reduce inflammatory activity and, ultimately, irreversible structural damage. Ultrasonography, fluoroscopy, computed tomography, and magnetic resonance imaging (MRI) may be used to guide sacroiliac joint injections. The populations that may benefit most from MRI-guided sacroiliac joint procedures include children, adolescents, adults of childbearing age, and patients receiving serial injections due to the ability of interventional MRI to avoid radiation exposure. Most clinical wide-bore MRI systems can be used for MRI-guided sacroiliac joint injections. Turbo spin echo pulse sequences optimized for interventional needle display visualize the needle tip with an error margin of < 1mm or less. Published success rates of intra-articular sacroiliac joint drug delivery with MRI guidance range between 87 and 100%. The time required for MR-guided sacroiliac joint injections in adults range between 23-35min and 40min in children. In this article, we describe techniques for MRI-guided sacroiliac joint injections, share our practice of incorporating interventional MRI in the care of patients with sacroiliac joint mediated pain, discuss the rationales, benefits, and limitations of interventional MRI, and conclude with future developments.

Cervical spinal canal body ratio in normal individuals and Stenosis with Cervical Myelopathy: A simple but novel study using a graph paper over a plain X-ray lateral view of the cervical spine

Cervical spine spondylosis is so prevalent in almost all because it is a degenerative disease. Cervical spine spondylosis is a condition caused by the narrowing of the space required for the spinal cord and the nerve roots that pass through the spine to the rest of the body. Suspected cases or warranted cases are advised to avoid trauma or stress to prevent a dreadful complication that is myelopathy. This research is to study and assess the Cervical Spine Canal Body Ratio in healthy individuals and also in patients with myelopathy. The cervical spinal canal and body with disc space ratio are measured using lateral view plain X-ray of the cervical spine, placed over a graph paper. This test was done both in healthy individuals from the age group of twenty-five to thirty-five of female and male. Out of these, twelve patients were with cervical myelopathy. Cervical Spinal canal stenosis may be either congenital or acquired. The content of the canal that is the Spinal cord is more likely to get compromised when the canal is shallow even a minimal trauma or degenerative arthrosis can precipitate myelopathy. In healthy individuals it is unit and when &lt;0.85 it indicates stenosis. This simple, less expensive study can be done even in a peripheral set up. The healthy Canal Body ratio is 0.97 to 1.02. In myelopathy it is about 0.8. Corresponding sagittal diameter is 18 to 21 mm in normal and 9 to 11 mm in cervical stenosis.

Astragaloside IV protects ATDC5 cells from lipopolysaccharide-caused damage through regulating miR-203/MyD88

Context Osteoarthritis (OA) is a degenerative arthrosis sickness. Astragaloside IV (AS-IV) functions by relieving inflammatory damage. Objective We aimed to investigate the mechanism by which AS-IV protects ATD cells from lipopolysaccharide (LPS)-induced damage. Materials and methods ATDC5 cells were transfected with miR-203 inhibitor and NC inhibitor (150 nM) or pEX-MyD88 and sh-MyD88 (50 nM) for 48 h, pre-treated by 15 μg/mL AS-IV for 24 h, then treated by 5 μg/mL LPS for 12 h. Dual-luciferase activity testing was used to determine whether miR-203 could bind to MyD88. CCK-8 and flow cytometry were used to detect cell activity and apoptosis, respectively, and qRT-PCR, western blots, and ELISA were performed to detect expression levels of miR-203 and inflammatory cytokines. Results Based on the 50% inhibiting concentration (IC50), there was no significant difference of AS-IV (0 to 15 μg/mL) on cell viability. Fifteen μg/mL was the optimal concentration of AS-IV in treating LPS-induced inflammatory damage in subsequent experiments since this was a semi-lethal concentration. AS-IV significantly reduces LPS-induced viability, apoptosis and the release of TNF-α, IL-6 and iNOS mainly through up-regulating miR-203. Further, MyD88 was a target gene of miR-203 and negatively regulated by miR-203. Knockdown of MyD88 inhibited LPS-induced inflammatory damage by inhibiting the NF-κB signal pathway. Discussion and conclusions AS-IV protects ATDC5 cells against LPS-induced damage mainly via regulating miR-203/MyD88. Our results support a theoretical basis for in-depth study of the function of AS-IV and the clinical cure of OA.

Restorative procedures for articular cartilage in the ankle: state-of-the-art review

Articular cartilage is a highly specialised connective tissue that serves to lubricate joint surfaces and distribute loads across the joint. Injury to articular cartilage is a significant cause of pain and dysfunction that may eventually lead to osteoarthritis or degenerative arthrosis. Management of these injuries is complicated by the complex architecture and poor vascularity of this tissue. The field of articular cartilage restoration has evolved rapidly over the past several decades and current techniques offer promising results. However, despite the fast pace of progress in the treatment and repair of articular cartilage injury, a clear gold standard in management has yet to emerge. Current techniques for managing cartilage injuries discussed in this review include bone marrow stimulation, osteochondral transplantation, chondrocyte implantation, cell-based transplantation, biological augmentation and scaffold-based therapies. Heterogeneity in study design, including surgical procedures, lesion and patient characteristics, cell collection, biologics preparation protocols and outcome measures limits interpretation of results presented in the literature. Therefore, standardisation across research protocols and collaboration among centres will be necessary. This ‘state-of-the-art review’ presents the indications and techniques for managing ankle articular cartilage lesions, as well as future directions and geographical differences in management.

Surgical reconstruction of the posterior cruciate ligament: current perspectives

After over a century of orthopaedic attention, injuries to the posterior cruciate ligament (PCL) continue to pose a significant management challenge. Isolated PCL tears constitute the minority of cases, with multiligament trauma (most commonly posterolateral corner injuries) predominating. Surgical reconstruction of the PCL remains technically demanding. Historical long-term outcomes have been associated with persisting knee instability and secondary degenerative arthrosis, irrespective of surgical intervention. The past two decades have witnessed a renewed focus on understanding the anatomy and biomechanics of the PCL, and its spectrum of injury. This, along with advancements in surgical technology and techniques, has heralded a renewed impetus for operative reconstruction. While there remains no clinically demonstrated difference in outcomes of double-bundle surgery over single-bundle reconstruction, many prefer a double bundle approach due to empirical data supporting its biomechanical superiority. Concomitant bony realignment in the coronal and sagittal plane should be considered where necessary. Graft reinforcement is an emerging concept that may aid in protecting the neoligament during the early healing phase. With modern approaches, there are increasing reports of more favourable short and mid-term post-operative outcomes. Despite this, most studies remain of a low level of evidence, with relatively small case series, and there is a paucity of well-designed controlled studies contrasting operative techniques.

Seqex Therapy in Osteonecrosis of the Femoral Head: A Case Report

The cause of non-traumatic Avascular Necrosis of the femoral head (AVN) is unknown in a large proportion of cases. Unless diagnosed early and treated appropriately, it can progress to collapse of the femoral head leading to early degenerative arthrosis. With the advent of modern imaging techniques, AVN can be detected early. Accurate diagnosis of AVN leads to appropriate selection of effective joint-preserving treatment. Techniques aimed at preserving the femoral head, including core decompression, and vascularized/nonvascularized bone graft which are often advised for early necrosis, have shown varying clinical outcomes.

FEMOROACETABULAR IMPINGEMENT AS A RESULT OF MORPHOLOGICAL CHANGES OF THE PROXIMAL PART OF THE FEMUR

The proximal part of femur can have morphological changes of osteochondral type, in the form of bone hill–cam type, which can cause femoroacetabular impingement. The aim of this paper is to point out the morphological changes of the head and neck of femur that can affect the development of degenerative arthrosis of the hip joint in young people. We report a young female patient with severe clinical signs of femoroacetabular impingement. The removal of the bone deformation of the femur neck in the form of bone hill was done. With this removal we have optimized the joint space and eliminated the painful collision of the femur neck and acetabulum. Morphological changes of the proximal femur cause early hip arthrosis. They can be found in young people and they should be timely detected and treated surgically. Acta Medica Medianae 2015;54(3):59-63.

Osteochondral resurfacing with proximal row carpectomy: 8-year follow-up.

Degenerative arthrosis of the proximal row remains a challenging problem for both patients and surgeons. Proximal row carpectomy is a motion-preserving treatment option, with studies documenting acceptable long-term outcomes. Proximal row carpectomy is an attractive option because there is no need for fusion to occur between the carpal bones, as in 4-corner fusion. As a result, laborers and smokers may be able to return to work more quickly. However, capitate chondrosis traditionally has been considered a contraindication to proximal row carpectomy. The goal of this study was to review the long-term follow-up of patients who underwent osteochondral resurfacing of capitate chondrosis performed in the same setting as proximal row carpectomy. Final follow-up was obtained in 5 of 8 (63%) patients at an average of 101 months (range, 99-102) after surgery. Grip strength improved at each time point, but wrist flexion and extension decreased. The average Mayo Wrist Score was 74 (range, 65-85) and remained stable or improved in all patients between the 18-month visit and the final visit. The Disabilities of the Arm, Shoulder and Hand (DASH) score was unchanged at final follow-up compared with 18-month follow-up (P=.7). This study found that osteochondral resurfacing of the capitate in the setting of proximal row carpectomy for patients with capitate chondrosis offers good outcomes compared with standard proximal row carpectomy in patients without capitate chondrosis on patient-directed outcome tools (DASH, Mayo Wrist Score) at long-term follow-up of 101 months.

CORR Insights®: Knee Muscle Strength After Recent Partial Meniscectomy Does Not Relate to 2-year Change in Knee Adduction Moment

Where Are We Now? This important paper by Hall and colleagues explores the potential relationship between the knee’s muscle strength and knee degenerative arthrosis after partial medial menisectomy. Knee adduction moment, as measured during gait analysis, is a surrogate for medial compartment loading and has been associated with both radiographic disease progression and knee pain. Peak knee adduction moment relates the peak force generated during walking and is velocity dependent. Impulse knee adduction moment is the average midstance value of the knee adduction moment. It is clear that knee adduction moment increases after partial medial meniscectomy [1, 3]. Cross-sectional evidence suggests that the knee adduction moment may be greater with weak knee extensors [3]. Despite this background, the authors were unable to find an improvement in peak or impulse knee adduction moment with increasing strength in patients 30 to 50 years of age postmenisectomy. The peak knee adduction moment increased 9% from the baseline assessment. Impulse knee adduction moment was unchanged from baseline. Although this is important work, the current study had some important limitations. The authors did not present any outcomes data (such as pain scores), so we do not know the relationship of increasing knee adduction moment to knee pain after menisectomy. The power analysis was performed after data collection, therefore the study was not designed to have a large enough study population to detect a difference in the primary outcome of knee adduction moment. The amount of clinically important knee adduction moment is unknown. The muscles tested are primarily sagittal-plane functional, whereas knee adduction moment is more of a coronal-plane phenomenon. As the authors acknowledge, other muscles such as medial gastrocnemius may be more important to control knee adduction moment. Where Do We Need To Go? While there is an association between knee adduction moment and knee osteoarthritis after knee menisectomy, the role of knee adduction moment after partial medial menisectomy has yet to be determined. As always, diagnostic findings need to be carefully correlated with symptoms, specifically pain. As the authors note in their limitations, there may be more appropriate muscles to measure. Similarly, the association between partial menisectomy and same compartment osteoarthritis is not completely understood. Is the relationship between altered joint contact forces causative? Could the menisectomy alter the proprioceptive capabilities? The small amount of knee laxity resulting from menisectomy may contribute to the degenerative changes [2]. Biochemical changes have been detected in joints with osteoarthritis. Does menisectomy contribute to the pathologic joint mileu? [5]. Perhaps this is simply natural history. Osteoarthritis is common in cadaver dissections, and meniscus tearing may be due to age-related joint changes. The investigation explores a potentially modifiable variable in knee adduction moment. However, based on this investigation, knee flexor and extensor strengthening does not appear to be important in controlling knee adduction moment. While this investigation did not offer a modifiable solution to knee adduction moment after partial menisectomy, in the next section we hope to offer some opportunities to gain further insights into an important and vexing issue. How Do We Get There? In order to improve validated self-reported outcome measures, we must accurately discriminate between patients with differing outcomes that do not have the ceiling effect of some of the presently used measures. Investigators clarifying the relationship between menisectomy and same compartment osteoarthritis could use these tools. MRI, particularly delayed gadolinium enhanced MRI of cartilage, may be useful in a longitudinal fashion to define the impact of the altered joint contact forces after menisectomy. Areas of cartilage loss or alteration can be compared to known areas of contact force concentration. As measurement of joint laxity improves, subtle laxity or abnormal joint motion may shear articular cartilage. Similarly, MRI would be of value for this application. Further synovial fluid research and cartilage biopsies will elucidate the biochemical impact of the menisectomy on the joint [5]. On a topic related to this investigation, Hall and colleagues, the same group that authored this investigation, have registered a Level I study proposing to compare physiotherapy with and without neuromuscular training as treatment for patients after menisectomy who are 30 to 50 years of age [4]. Neuromuscular training is a multiplane activity that may directly and notably impact knee adduction moment after partial menisectomy. Surface electromyography, commonly used in gait analysis, may target muscles for future intervention. Osteoarthritis and its etiology are treated with a multimodal approach after partial menisectomy. Its relationship to knee adduction will need a multifaceted approach.

Detailed shoulder MRI findings in manual wheelchair users with shoulder pain.

Shoulder pain and pathology are common in manual wheelchair (MWC) users with paraplegia, and the biomechanical mechanism of injury is largely unknown. Establishing patterns of MRI characteristics in MWC users would help advance understanding of the mechanical etiology of rotator cuff disease, thus improving the logic for prescribed interventions. The purpose of this study was to report detailed shoulder MRI findings in a sample of 10 MWC users with anterolateral shoulder pain. The imaging assessments were performed using our standardized MRI Assessment of the Shoulder (MAS) guide. The tendon most commonly torn was the supraspinatus at the insertion site in the anterior portion in either the intrasubstance or articular region. Additionally, widespread tendinopathy, CA ligament thickening, subacromial bursitis, labral tears, and AC joint degenerative arthrosis and edema were common. Further reporting of detailed shoulder imaging findings is needed to confirm patterns of tears in MWC users regarding probable tendon tear zone, region, and portion. This investigation was a small sample observational study and did not yield data that can define patterns of pathology. However, synthesis of detailed findings from multiple studies could define patterns of pathological MRI findings allowing for associations of imaging findings to risk factors including specific activities.

Patellar calcar: MRI appearance of a previously undescribed anatomical entity

The femoral calcar is a constant anatomical structure within the proximal femur representing a condensation of bone trabeculae. It is our impression that a similar structure is present within the patella. The purpose of this retrospective study was to define the prevalence, appearance, location, and configuration of the patellar calcar on MRI examinations. One hundred consecutive unenhanced knee MRIs were retrospectively reviewed by two readers who were blinded to the clinical indication. The patellar calcar was defined as a dark signaling, linear or curvilinear structure subjacent to the patellar articular surface. If present, the patellar calcar was assigned to a "well seen," "moderately well seen," or "faintly seen" category. Location of the calcar within the patella, orientation, configuration, and thickness were recorded. Confounding variables, such as marrow edema, patellar chondromalacia, bipartite patella, or postoperative changes were also recorded. The patellar calcar was visualized in 81 out of 100 (81%) MRIs. When detected, the calcar was well seen in 20 out of 81 (25%), moderately well seen in 35 out of 81 (43%), and faintly seen in 26 out of 81 (32%). The anteroposterior width of the calcar measured at its thickest segment was: < 1mm in 43 out of 81 (53%), 1mm in 28 out of 81 (35%), and >1mm in 10 out of 81 (12%). The patellar calcar was seen in the majority of knee MRIs and had a consistent imaging appearance. The calcar may be obscured by degenerative arthrosis of the patella and rarely may mimic patellar stress fracture or osteochondritis dissecans. Radiologists and clinicians should be familiar with this normal anatomical structure.

Magnetic resonance imaging of the wrist: Bone and cartilage injury

Magnetic resonance imaging (MRI) is particularly useful for imaging the wrist due to its superior soft tissue contrast and ability to detect subtle bone marrow changes and occult fractures. A high field (1.5T or greater) strength, dedicated wrist coil, and high in-plane and through-plane resolution must be utilized to successfully visualize the relatively thin cartilage of the wrist. MRI can be used to detect occult carpal bone fractures, identify complications following scaphoid fractures, and assess for avascular necrosis in the setting in Kienböck's and Preiser's disease. MRI is useful to identify secondary soft tissue and chondral pathology in impaction/impingement syndromes. The use of an intermediate-echo time fast spin echo sequence allows for accurate assessment of articular cartilage, allowing evaluation of chondral wear in the setting of primary osteoarthritis and posttraumatic degenerative arthrosis. MRI is the most sensitive imaging modality for the detection of early inflammatory arthropathies and can detect synovitis, bone marrow edema, and early erosions in the setting of negative radiographs.

Sekundäre Rekonstruktion des digitalen A2-Ringbands

Secondary reconstruction of A2 flexor pulley for after closed rupture. Persisting impairment of finger function and strength after combined injury of A2 and C1 pulley. Passive free movement of all finger joints. Fixed flexion contractures of interphalangeal joints after complex finger injuries. Degenerative arthrosis of interphalangeal joints. A strip of extensor retinaculum approximately 10 mm in width together with the periosteum from the second floor of the extensor tunnel was used for reconstruction of the A2 pulley. After drilling bilateral burr holes in the palmar aspect of the phalanx at the distal and proximal ends of the A2 pulley, the graft was fixed by the periosteum to the bone of the phalanx, placing the synovial layer innermost. Postoperatively, patients in both treatment groups wore a palmar splint which extended from the distal interphalangeal joint to the proximal palmar crease for 4 weeks. The metacarpophalangeal joint and the proximal interphalangeal joint were held in full extension. After removing the splint, physiotherapy was started. Full load-bearing, hard manual work and sport activities were not permitted for 3 months. Fifteen patients were treated using the extensor retinaculum for reconstruction of the A2 flexor pulley. The mean follow-up time was 48 months. The average range of motion of the PIP joint was 97 %, the average power grip strength 96 %, the finger pinch strength 100 %, and the average circumference 95 % of the uninjured contralateral side. The Buck-Gramcko score showed the following results: 10 excellent, 2 good, and 1 fair.

Paper 201: The Prevention of Post-operative Arthrosis Following ACL Reconstruction Is Possible if Osseous Homeostasis is Restored and Maintained

Recent reports from the USA, Europe, and Asia have documented the disconcerting phenomenon of early knee arthrosis following even biomechanically well done ACL reconstructive surgery. In prior work, we have suggested that the achievement of a normal Tc 99-MDP bone scan - representing an objective marker of the restoration of osseous/joint homeostasis – following ACL reconstructive (and other) knee surgery is predictive of the absence of DJD out to 7 years. In this work, we report on 19 patients with 20 ACL reconstructed knees followed to between 10 to 15 years postoperatively both radiographically and scintigraphically. 19 patients (14 males and 5 females with a mean age of 28 - range 18 to 43 -at the time of single bundle BTB autograft reconstruction by SFD) with 20 reconstructed knees are included in this report. In addition to a history and physical examination, all patients had a Rosenberg X-ray and a standard 3 hr delayed static Tc 99MDP bone scan of the knees between 10 and 15 (mean 12.8) years post reconstruction. 18/20 knees demonstrated a normal or nearly normal Rosenberg X-ray and bone scan of the involved knee. Two of the 20 knees demonstrated a positive bone scan associated with radiographic signs of degenerative arthrosis (joint space narrowing and osteophyte formation). The degree of post-operative laxity did not correlate with the absence of degenerative changes. In prior work, we have shown that persistent loss of osseous homeostasis (manifested by positive bone scans) identifies knees “at risk” of developing early arthritis. In this work we have demonstrated in a population of ACL reconstructed knees using a single-bundle BTB autograft technique - the principle that if osseous/joint homeostasis can be restored and maintained (currently best documented by normal bone scans) such knees can remain free of degenerative changes out to a mean of 12.8 years post-operatively. For those who may wish to avoid irreversible degenerative arthrosis in ACL reconstructed knees, it is recommended that the achievement of osseous/ joint homeostasis become a clinical priority.

Changes of contact pressure and area in patellofemoral joint after different meniscectomies

We investigated the contact pressure and area of the patellofemoral joint both before and after different meniscectomies to provide a biomechanical basis for selecting meniscectomy and its clinical application for meniscus injuries. Six fresh cadaveric knees were used in the study. Using Staubli robots and an ultra-low-min-type pressure-sensitive tablet, changes in contact area and stress in the patellofemoral joint were measured at various flexion angles following different parts and degrees of meniscectomy. The patellofemoral contact area enlarged with the increase of knee flexion angle. From the values obtained from contact areas and average contact pressure of the patellofemoral joint, we found no significant difference between partial meniscectomy and intact knees, but a significant difference was found between total meniscectomy and intact knees. The contact area after lateral meniscectomy was statistically less than that of intact knees. The mean patellofemoral contact pressure after lateral meniscectomy was larger than in intact knees at each angle of flexion. No significant difference in contact area was observed between intact knees and medial meniscectomy. The average patellofemoral contact pressure after medial meniscectomy was larger than in intact knees from 0° ~ 30° of knee flexion, and no significant differences were found between intact knees and medial meniscectomy while knee bending from 60° to 90°. Different meniscectomies result in high contact pressure or disordered distribution of contact pressure, which may be the cause of postoperative patellofemoral degenerative arthrosis.

Universal Total Wrist Arthroplasty: Midterm Follow-Up Study

We reviewed 21 consecutive patients who underwent a total wrist arthroplasty as a primary procedure between October 2001 and February 2007. The purposes of the present study were to communicate our midterm results and to compare them with previously published series. We evaluated all patients clinically and radiologically. We used the Patient-Related Wrist Evaluation a primary outcome measure. The mean follow-up was 5.5 years (range, 3-8 years). A total of 14 patients had rheumatoid arthritis, including 1 with juvenile arthritis, and 1 each had psoriatic arthritis, systemic lupus erythematosus, and undifferentiated spondyloarthropathy. Of the remaining 4 patients, 2 had grade IV Kienböck disease, 1 had degenerative arthrosis, and 1 had chondrocalcinosis. Postoperative Patient-Related Wrist Evaluation scores averaged 24 points (SD, 21 pints) out of 100 (worst score). When the patients were specifically asked about pain and function of the arthroplasty, 20 claimed to be satisfied or very satisfied with the procedure. Two early and 3 late complications occurred. One patient had a wound hematoma and another had a superficial wound infection, both of which resolved with no further complications during the immediate postoperative period. In 2 patients, there was some osteolysis around the screw inserted into the medullary canal of the index metacarpal, but not in the trapezoid bone. One patient had a slight loosening of the distal component with subsidence on the ulnar side of the carpus. There have been no dislocations or surgical revisions of the components. Based on our study, a total wrist arthroplasty should be considered as a good alternative to arthrodesis for patients who wish to preserve some degree of mobility of the wrist. Therapeutic IV.

(P2-62) An Infrequent Case of Orthopedic Emergencies – Open Dorsal Dislocation of the Proximal Interphalangeal (PIP) Joint Dislocation

IntroductionReducible open dorsal dislocation of the single finger's PIP joint is an infrequent case of orthopedic emergencies. The severity of this injury may be underestimated. These injuries are associated with long-term complications such as synovitis, stiffness, degenerative arthrosis, septic arthritis, and loss of the digit if suboptimally treated.CaseA 90-year-old male came to the emergency department with an open dorsal PIP dislocation due to a fall on his right hand. There was a transverse skin laceration just proximal to the PIP flexion crease of his small and ring fingers. The condyles of his small finger's proximal phalanx protruded through the wound. X-rays showed a dorsal dislocation of the PIP joint without fracture. There was no neurovascular injury determined. The proximal phalanx was hyperextended slightly with gentle axial traction. After irrigation, the skin wound was closed primarily without repair of damaged structures, and systemic antibiotherapy was performed for a week. The PIP joint was immobilized for three weeks by applying the splint dorsally with the joint in 20 degrees of flexion. Active range of motion exercises were then implemented, and the patient regained full digital flexion with only a 10 degree loss of extension within eight weeks.DiscussionForced hyperextension with axial compression causes a dorsal dislocation of the PIP joint. Dorsal PIP dislocations are more common than volar IP dislocation. Open dorsal dislocation of the PIP joint is an infrequent case of orthopedic emergencies. Such injuries can be treated safely in the emergency department by closed reduction and extensor splinting until a definite treatment plan is made by an orthopedic hand surgeon. The complications must be taken into consideration. Early active motion leads to significantly superior results in the range of motion than static splinting, because prolonged immobilization may result in flexion contracture.

Anteromedial Impingement in the Ankle Joint: Outcomes Following Arthroscopy in the First One Hundred Cases (SS-54)

Introduction Anteromedial impingement (AMI) is a common and chronic ankle joint condition characterized by anteromedial talotibial osteophytes, soft tissue synovial hyperplasia and cicatrization, thereby causing pain and a mechanical obstruction to normal joint motion. AMI is a common condition found primarily in athletes, but particularly soccer players. The first case series of the arthroscopic resection of AMI has been previously described. The current authors' present an update of an ongoing series with the retrospective results of the first one hundred patients treated arthroscopically for AMI. Methods Between January 2005 and January 2010, 100 patients underwent arthroscopic resection of AMI under the care of the senior author. Any patient with evidence of pre-existing degenerative arthrosis was excluded. Patients were followed for a minimum 1-year time period postoperatively. All patients had pre- and postoperative AOFAS hindfoot and SF-36V2 scores. Results The mean patient age was 30.4 years (range, 13-60 years) and the mean follow-up time was 25.1 months (range, 6-81 months). 91% of patients reported good to excellent functional outcomes and would recommend the procedure. Mean AOFAS score improved significantly from 59 points preoperatively to 92 points at follow-up. The SF-36V2 score also improved significantly by a mean 32 points at follow-up. Return to play in the athletic population was a mean of 7 weeks. Five patients experienced complication (5%). Conclusion The typical presentation of AMI is medial ankle joint pain while running, kicking, or stair climbing and is explained by the entrapment of soft tissue inflammation between the osteophytes during dorsiflexion of the ankle. In the current authors' experience, the diagnosis of AMI is often delayed, caused prolonged time lost to injury in athletes. Proper diagnosis should include physical examination in addition to oblique AMI-view radiographs and MRI. When medial ankle joint pain is present, the diagnosis of AMI should be considered until proven otherwise. The poor results of conservative treatment therapies for impingement syndromes of the ankle have led the current authors to advocate arthroscopic debridement as a first line treatment to expedite return to competitive sport. AMI is a common condition seen in athletes and when treated arthroscopically can be expected to do well and return to sport at previous levels. Anteromedial impingement (AMI) is a common and chronic ankle joint condition characterized by anteromedial talotibial osteophytes, soft tissue synovial hyperplasia and cicatrization, thereby causing pain and a mechanical obstruction to normal joint motion. AMI is a common condition found primarily in athletes, but particularly soccer players. The first case series of the arthroscopic resection of AMI has been previously described. The current authors' present an update of an ongoing series with the retrospective results of the first one hundred patients treated arthroscopically for AMI. Between January 2005 and January 2010, 100 patients underwent arthroscopic resection of AMI under the care of the senior author. Any patient with evidence of pre-existing degenerative arthrosis was excluded. Patients were followed for a minimum 1-year time period postoperatively. All patients had pre- and postoperative AOFAS hindfoot and SF-36V2 scores. The mean patient age was 30.4 years (range, 13-60 years) and the mean follow-up time was 25.1 months (range, 6-81 months). 91% of patients reported good to excellent functional outcomes and would recommend the procedure. Mean AOFAS score improved significantly from 59 points preoperatively to 92 points at follow-up. The SF-36V2 score also improved significantly by a mean 32 points at follow-up. Return to play in the athletic population was a mean of 7 weeks. Five patients experienced complication (5%). The typical presentation of AMI is medial ankle joint pain while running, kicking, or stair climbing and is explained by the entrapment of soft tissue inflammation between the osteophytes during dorsiflexion of the ankle. In the current authors' experience, the diagnosis of AMI is often delayed, caused prolonged time lost to injury in athletes. Proper diagnosis should include physical examination in addition to oblique AMI-view radiographs and MRI. When medial ankle joint pain is present, the diagnosis of AMI should be considered until proven otherwise. The poor results of conservative treatment therapies for impingement syndromes of the ankle have led the current authors to advocate arthroscopic debridement as a first line treatment to expedite return to competitive sport. AMI is a common condition seen in athletes and when treated arthroscopically can be expected to do well and return to sport at previous levels.