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  • ISSN: 2373-9290
    Volume 2, Issue 2
    Research Article
    Yoichiro Takata, Toshinori Sakai, FumitakeTezuka, YuichiroGoda, KosakuHigashino and Koichi Sairyo*
    Abstract: Various techniques to directly repair a pars defect have been described. The aim of these procedures is to restore normal lumbar kinesiology, preserve a spinal motion segment and retain the associated spinal mobility. We have already reported a minimally invasive technique for the direct repair of a pars defect using a percutaneous pedicle screw system. This time, we report the clinical outcome obtained with this procedure. In all patients, both the Japanese Orthopedic Association score and pain assessed using a visual analogue scale improved postoperatively. Bony union was attained in 80% of the patients. Using this procedure, normalization of the lumbar kinesiology in terms of the instantaneous axis of rotation during lumbar extension/flexion was attained. Also, it was possible to preserve the spinal motion segment and to retain lumbar spine mobility.
    Bobby Dezfuli1*, Christopher Larkins2, John T Ruth1 and Lisa M Truchan1
    Abstract: Background: Pediatric supracondylar humerus fractures are the most common elbow fracture in children. Operative management includes closed reduction and placement of 2 to 3 laterally based pins. Occasionally, a medial pin is used to create a crossed fixation pattern, although risking nearly 10% iatrogenic ulnar nerve injury. The objective of this study was to assess the trends and outcomes in the operative management of pediatric supracondylar humerus fractures at a level one academic trauma center.
    Material and Methods: A retrospective review was performed on all children sustaining a Gartland type II or III supracondylar humerus fractures treated by closed or open reduction and percutaneous pinning in 2006-2008 and 2009-2011 at a level one academic trauma center by two of the authors (JTR, LMT). Pin placement patterns were evaluated and compared based on year performed. Outcomes measured were rates of ulnar nerve symptoms, non-union, re-operation, and varus malalignment. Data analysis was performed using a Fisher exact test on STATA software.
    Results: A total of 49 patients met inclusion criteria. Of 22 patients treated in 2006-2008, 5 (23%) were type II and 17 (77%) were type III. From 2009-2011, 16 (59%) were type II and 11 (41%) were type III. Comparison of pinning pattern in type II fractures between 2006-2008 and 2009-2011 did not indicate statistical significance (p=0.429). Comparison of pinning pattern in type III fractures during the same time period did show that there was a statistically significant decrease (p=0.010) in the number of cross pin fixation. There were no ulnar nerve injuries, non-unions, re-operations, or varus malalignment in any patient on final follow up.
    Conclusion: This study shows that there has been a significant decrease in cross pin fixation for pediatric type III supracondylar humerus fractures with equivalent clinical outcomes at a Level I trauma center. Furthermore, performing lateral pinning for type III fractures has eliminated the risk of iatrogenic ulnar nerve injury. Level of Evidence: Level III - Retrospective cohort study.
    Gavin Heyes*, Adam Tucker, Anthony Michael and Richard Wallace
    Abstract: We report regional epidemiological data for Tendo Achilles rupture over a 13 year period in the South Eastern Health and Social Care Trust, Northern Ireland.
    Materials and Methods: We performed a retrospective review of 1044 patient referred between the periods of 1996 to 2008 inclusive.
    Results: 975 (93.4%) patients were confirmed as having a Tendo Achilles rupture, with a mean incidence of 75 Tendo Achilles ruptures per year. We found a 3:1 ratio in Male vs. Female ruptures respectively. The average age of rupture was 48 years. Patients with ruptures from sport were significantly younger than those who ruptured from non-sporting means, 42.8 and 53.5 years respectively. Most common sporting injuries were from rugby, football and racquet sport. Co morbid illness such as cardiovascular disease, steroid use and diabetes appear to be associated with rupture.
    Conclusion: The data in this study highlights at risk individuals as those who are male, in their 5th decade and who participate in sport particularly activities with regular vigorous leg push off.
    Kent T Yamaguchi1, Lindsay Andras1*, Christopher Lee2 and David L. Skaggs2
    Abstract: Background: In the last 20 years, there have been no reports on bracing for Scheuermann's kyphosis with 2-year follow-up. The purpose of this study was to retrospectively review patients treated with a thoracolumbosacral orthosis (TLSO) with greater than 2-year follow-up.
    Methods: 126 patients treated at a single center with Scheuermann's kyphosis were reviewed. Inclusion criteria included the diagnosis of Scheuermann's kyphosis, treatment with TLSO and a minimum of 2-yr follow-up. Charts and radiographs were reviewed. Worsening or improvement of deformity was defined as a radiographic change of greater than 5 degrees.
    Results: 12 patients met the inclusion criteria. Overall 8/12(67%) improved and 4 of the 8 patients (50%) who improved were skeletally mature at the time of brace treatment initiation. Of the 5 patients with curves greater than 70 degrees, 3 remained unchanged, 2 of these improved, and none progressed. The average improvement in kyphosis was 11 degrees in this group. Of the 7 patients with curves less than 70 degrees, 1 worsened and 6 improved; the average improvement in kyphosis was 7 degrees.
    Conclusions: In this study, improvement of kyphotic deformity was observed in patients regardless of skeletally maturity and initial severity of kyphosis. These results suggest that a trial of brace treatment may be warranted even in patients that have severe kyphosis or are skeletally mature.
    Review Article
    Yanjun Kong2, Qiande Zhang2 Muxin Wei1*
    Abstract: Rheumatoid arthritis (RA) is a chronic systemic disease in which immunologically mediated inflammation of synovia-lined joints can result in marked disruption of joint structure and function. In Traditional Chinese Medicine (TCM), it belongs to "Be Syndrom", the outcome of the struggle between body resistance and pathogenic factors. RA is a highly disabling disease of which untreated patients show about 50% disability in two years. One cause of the high morbidity of RA is the long latency from the onset of symptoms to the definitive diagnosis of RA and the initiation of appropriate treatment. The difficult to make diagnoses of early RA since the early manifestations were atypical and the lack of specific diagnostic methods. This case is about the effectiveness of TCM treatment of patients with early RA which is reflected in both the diagnosis part and the treatment process. The patient in this case, Male, 56 years old, had been diagnosed of RA by TCM almost ten years earlier than that his symptoms could reach the Western diagnostic requirements. The important role of preventive thought -"preventive treatment of diseases"- in TCM in the early diagnosis and treatment of RA needs to be emphasized. It can be a practical way to treat RA with early TCM diagnose and treatment that impact disease activity and ultimately have been shown to slow or arrest structural joint damage, and then turn up to Western medicine treatment if the patient's symptoms reach the Western diagnostic requirements.
    Review Article
    Robert Li Y1-4* and John M Kauffman1*
    Abstract: Rheumatoid arthritis (RA) is an inflammatory autoimmune disorder that affects joints as well as other organs and systems. It is one of the most common types of arthritis and associated with progressive disability, systematic complications, premature death, and socioeconomic costs. Although the past several decades have witnessed remarkable improvement in the management of this disease, RA remains incurable and continues to be a significant health problem. This article provides a concise review of the recent advances in the molecular pathophysiology of RA and the development of mechanistically-based novel molecular therapeutics. Special considerations are given to the causal involvement of novel molecular pathways, including cytokines, growth factors, and intracellular signaling cascades in RA pathophysiology, and the emerging role of targeted therapeutic agents in the management of RA. The article also considers the impact of genetic variations on RA therapeutics in the context of molecular medicine and individualized patient care.
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