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Clinical evaluation of the anterior translation of glenohumeral joint using ultrasonography: an intra- and inter-rater reliability study

Joseph LH, Hussain RI, Pirunsan U, Naicker AS, Htwe O, Paungmali A

Acta Orthop Traumatol Turc, 2014;48(2):169-74.
PMID: 24747625 DOI: 10.3944/AOTT.2014.3184

The aim of this study was to investigate the intra- and inter-rater reliability of ultrasonography (US) to measure anterior translation of the humeral head (ATHH) among healthy subjects and patients with sacroiliac joint dysfunction.
Fulltext Rapid progression of scoliosis curve in a mature patient with undiagnosed pituitary macroadenoma: A rare case report

Chung WH, Chiu CK, Wei Chan CY, Kwan MK

Acta Orthop Traumatol Turc, 2020 Sep;54(5):561-564.
PMID: 33155569 DOI: 10.5152/j.aott.2020.19144

Growth hormone secreting pituitary tumor or gigantism has not been previously reported to be associated with rapid progression of scoliosis in the literature. However, there are some reports indicating scoliosis can be worsened by growth hormone therapy in children and adolescents. A 19-year-old boy was referred to our institution for the treatment of a right thoracolumbar scoliosis. The Cobb angle had worsened from 29° to 83° over two years' duration. He attained puberty at the age of 13. He had a previous history of slipped upper femoral epiphysis (SUFE), which was operated in 2015, with no clinical features of gigantism. Preoperative assessment was performed. He was diagnosed with growth hormone secreting pituitary macroadenoma by magnetic resonance imaging with a high serum level of insulin-like growth factor-I (IGF-I). Computed tomography (CT) of the pancreas showed a pancreatic endocrine tumor. The patient was later diagnosed with multiple endocrine neoplasia type 1 (MEN 1). He underwent endoscopic endonasal excision of the pituitary mass and distal pancreatectomy. This case indicates that growth hormone secreting pituitary macroadenoma could result in rapid progression of scoliosis.
Fulltext Clinical outcome and operative cost comparison: Locked compression plate versus reconstruction plate in midshaft clavicle fractures

Gan JT, Chandrasekaran SK, Tuan Jusoh TB

Acta Orthop Traumatol Turc, 2020 Sep;54(5):483-487.
PMID: 33155556 DOI: 10.5152/j.aott.2020.19219

OBJECTIVE: The aim of this study was to compare the clinical outcomes and operative cost of a locked compression plate (LCP) and a nonlocked reconstruction plate in the treatment of displaced midshaft clavicle fracture.
METHODS: From January 2013 till March 2018, a total of 55 patients with acute unilateral closed midshaft clavicle fracture were treated with either a 3.5-mm pre-contoured LCP [32 patients; 25 men and 7 women; mean age: 35 years (range: 19-63 years)] or a 3.5-mm nonlocked reconstruction plate [23 patients; 20 men and 3 women; mean age: 31.4 years (range: 17-61 years)]. The clinical outcomes in terms of fracture union, Quick Disability of Arm, Shoulder and Hand (DASH) score, implant irritation, failure rate, and reoperation rate were evaluated retrospectively. The patient billing records were reviewed to obtain primary operation, reoperation, and total operative cost for midshaft clavicle fracture. These values were analyzed and converted from Malaysia Ringgit (RM) to United States Dollar (USD) at the exchange rate of RM 1 to USD 0.24. All patients were followed up for at least one-year duration.
RESULTS: The mean time to fracture union, implant irritation, implant failure, and reoperation rate showed no significant difference between the two groups of patients. The mean Quick DASH score was significantly better in the reconstruction plate group with 13 points compared with 28 points in the LCP group (p=0.003). In terms of total operative cost, the LCP group recorded a cost of USD 391 higher than the reconstruction plate group (p<0.001).
CONCLUSION: The 3.5-mm reconstruction plate achieved not only satisfactory clinical outcomes but was also more cost-effective than the LCP in the treatment of displaced midshaft clavicle fractures.
LEVEL OF EVIDENCE: Level III, Therapeutic study.
Fulltext Concomitant fat embolism syndrome and pulmonary embolism in a patient with patent foramen ovale

Dk Yeak R, Liew SK

Acta Orthop Traumatol Turc, 2020 Jul;54(4):465-468.
PMID: 32812879 DOI: 10.5152/j.aott.2020.20035

We present a rare case of a patient with concurrent fat embolism and pulmonary embolism, in a closed femur fracture with patent foramen ovale (PFO). A 24-year-old man was involved in a motor vehicle accident with a closed left midshaft femur fracture. He developed fat embolism syndrome (FES) on day 3 of admission, and plating was performed. The D-dimer concentration was also high, which raised the suspicion of pulmonary artery embolism. Computed tomography pulmonary angiography (CTPA) revealed right inferior lobar pulmonary artery embolism and FES. A transthoracic echocardiogram (TEE) was performed, which showed a PFO. The presence of a PFO in patients with pulmonary embolism increases the risk of systemic embolism. Therefore, we recommend the routine echocardiogram for patients with pulmonary embolism to exclude any cardiac defect in causing right-to-left shunts, which predisposes the patient to paradoxical embolism.
Fulltext Peculiar reaction of oxidized zirconium from a total knee arthroplasty prosthesis: A case report

Keun Seon J, Anwar Ayob K, Giun Noh M, Yeol Yang H

Acta Orthop Traumatol Turc, 2024 Jan;58(1):68-72.
PMID: 38525513 DOI: 10.5152/j.aott.2024.23115

Oxidized zirconium (OxiniumTM) prostheses, made up of a metallic alloy of zirconium with a ceramic surface formed by oxidizing the outer layer, were developed as an alternative bearing surface to reduce polyethylene wear and decrease failure of total knee arthroplasty (TKA). We report a unique catastrophic failure of an Oxinium TKA with consequent accelerated wear and severe metallosis. Intraoperatively, we observed extensive wear grooving of the femoral component with exposure of the underlying silver layers and the complete wear of polyethylene on the medial side. Metallic debris had a peculiar arthrogram appearance, noted within the cut surface of the femur and tibia, indicative of the osteolysis that occurred, leading up to the failure of the implants. The histopathologic examination revealed a collection of macrophages with foreign-body reactions and black-pigmented metal-induced wear particles. Oxinium has clear benefits regarding superior wear properties; however, surgeons need to be aware that there is a risk of exposure to the underlying layers that may precede accelerated wear, deformation, and metallosis. Uncovering the deeper layers could result in the appearance of an arthrogram on plain radiographs. Early identification of polyethylene wear and prompt revision is crucial to avoid the rapid progression of subsequent metallosis and catastrophic implant failure, specifically when using oxidized zirconium components for TKA. To the best of our knowledge, this is the first report presenting a detailed histologic analysis to provide insight into the mechanisms of the failed Oxinium components.