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  • ISSN: 2373-9290
    Volume 5, Issue 2
    Review Article
    Thomas Knapper*, Karl Logan, and Daniel Gheorghiu
    Paget's disease of the bone remains the second commonest metabolic bone disease in adults. Early diagnosis and appropriate management is essential to reduce the risk of potentially debilitating consequences. Diagnosis can be challenging; with many patients initially asymptomatic. In the majority of cases it is a diagnosis made incidentally with either an unexplained alkaline phosphatase or radiographic abnormalities. In this review we focus on providing a clear understanding of the current concepts and theories regarding aetiology, pathophysiology, diagnosis and treatment of Paget's disease.
    Al-Mutair Angham* and Alsubhi Rajaa
    Rickets is a disorder that results from decreased mineralization of the growth plate in the growing infant, child and adolescent. Rickets can occur as heritable disorders with multiple genes mutations in different etiologies of types of rickets. There are different ways of classifying types of rickets, the most commonly used is to be classified as calciopenic and phosphopenic rickets. Calciopenic rickets is due to nutritional deficiency of vitamin D and or calcium and rarely due to vitamin D defect in its cellular action or its metabolism to active metabolite-calcitriol or due to excess loss of calcium in urine. Phosphopenic rickets is mainly due to renal phosphate wasting either due to primary renal tubular defect or excess generation of phosphatonin, compounds that inhibit phosphate reabsorption from renal tubules but unusually related to dietary phosphate deficiency that is wide available. Abnormalities in the alkaline phosphate synthesis impaired bone mineralization can be a rare cause of rickets. Serum 25-hydroxyvitamin D concentrations are low in vitamin D deficiency rickets and hereditary form of rickets due to inactivating mutations in CYP2R1 gene while may be normal in other hereditary forms of rickets in these latter disorders, the serum 1,25-dihydroxy vitamin D concentrations are often low or inappropriately in the normal range and can be high in vitamin D-resistant rickets. Treatment of each type of rickets depends on the underlying etiologies.
    Case Series
    Acker A, Portnoy L, Ohana N, and Korngreen A
    The use of intramedullary devices to fix intertrochanteric Neck of Femur fractures is an internationally well-established fixation method which demonstrated mechanical and biological advantages, especially in the treatment of unstable fractures patterns. Despite the biomechanically proved advantages of the proximal femoral nails, some complications had occurred over the years. A very rare type of complication was sporadically reported over the last few years, and was termed "Cut-in" or "medial migration" of the blade. We will present our experience of 2 cases with the "cut-in" complication and review the latest literature.
    Stasinopoulos Dimitrios*
    One of the most common tendinopathies of the upper limb is Lateral Elbow Tendinopathy (LET). LET is defined as pain in the lateral epicondyle1 and is characterized by disorganized collagen, an increased presence of fibroblasts, the absence of prostaglandins and inflammatory cells [1].
    Case Report
    Cornelius Wimmer, ElsayedShaheen, Thomas Pfandlsteiner, and Ahmed Ezzat Siam
    Purpose: Reporting preliminary results of MCGR.
    Study design: A prospective uncontrolled, single-center, single-surgeon, clinical and radiological study
    Patient sample: Between November 2012 and March 2015, 14 children with EOS were treated using MCGR
    Outcome measures: Preoperative, postoperative and final follow-up (FFU) whole spine radiographs were reviewed to determine the degree of spinal deformity and correction, measured using Cobb angle. T1-S1 length was calculated. Clinical notes to determine number of rod lengthening procedures using remote control device and to record any complications during surgery or FU period.
    Methods: Mean age was 12.1 years, 2 boys and 12 girls, nine children had primary correction by MCGR; five of them had neuromuscular, three infantile and one congenital scoliosis. All had a dual MCGR implanted. The remaining five patients had previously undergone other growing rod operation before converting to MCGR implant.
    Results: Mean pre-operative Cobb angle of the primary group was 73.4°, postoperative 34.8° (51.3% correction), FFU 28.8°. Mean initial percentage of the lengthening was 18.4%. Thoracic kyphosis changed significantly from preoperative mean of 48.7° to 31.2° postoperatively (p=0.008). Of the revision group, mean pre-operative Cobb angle was 49.6°, postoperative 41.1° (16.5% correction) and 40.3° at FFU. Mean initial percentage lengthening was 6.9%. One patient had wound infection, two had pull-out of proximal screws, one sustained a breakage of a single-rod construct 6 months after surgery and was replaced by a double magnetic-rod construct.
    Conclusions: In our consecutive series of patients treated with MCGR we found that scoliosis was well controlled. Cobb angle was significantly reduced following surgery in patients who had MCGR performed as a primary procedure. Generally, the correction was maintained at FFU. Comparing our results for MCGR and other growing rod techniques, they are comparable, without need to repeated surgery.
    Imane Ben Slama*, F Allali, S El kabbaj, T Lakhdar, L Medrare, A Ngeuleu, R Abouqal, H Rkain, and N Hajjaj Hassouni
    Background: Disease Activity Score-28 joints (DAS-28) is nowadays the gold standard for measuring the disease activity in patients with RA. The original DAS-28 was based on erythrocyte sedimentation (ESR), but an alternative formula incorporating C-reative protein (CRP) [DAS-28(CRP)] has been developed.
    Objectives: To compare the disease activity score DAS28-ESR versus DAS28–CRP, and to determine the factors that might influence their difference. To estimate the disease activity score DAS28-CRP threshold values that correspond to DAS28- ESR values in Moroccan patients with rheumatoid arthritis.
    Patients and methods: Patients with RA were included in a cross-sectional study. We have collected the demographic characteristics and the characteristics of the RA: duration of evolution, global disease activity on a 100 mm visual analogue scale assessed both by the patient (GDAP), morning stiffness in minutes, functional impact of the disease assessed by the HAQ (Health Assessment Questionnaire), and current corticosteroid dose. The disease activity was assessed by the DAS28-ESR and DAS28-CRP. A concordance correlation between DAS28-ESR and DAS28 -CRP was performed. We defined a new variable DIFDAS=DAS28-ESR – DAS28-CRP (differences between the two indexes). Factors influencing this difference were tested by univariate then multivariate logistic regression. Using DAS28-ESR as gold standard, the passing Bablok and Bland- Altman methods were used to assess the agreement between DAS28-ESR and DAS28-CRP.
    Results: 103 patients were included with a female predominance (87.4 %). Mean age was 49.7 ± 11.4 years. Median disease duration was 8 years [3-14]. There was a strong positive concordance between the two indexes of 0.93 with CI 95% [0.91-0.95], although the DAS28-ESR value obtained was higher than that of DAS28-CRP at approximately 90% of the visits (n= 93). Significantly, the difference between both indexes was higher than 0.6 in 42.7% of the visits studied (n=44). In multivariate analysis, factors significantly associated with this difference were high dose of steroids and significant functional impairment (p< 0.05). There was a difference between DAS28-ESR and DAS28-CRP values (p< 0.05). Using bland and Altman method, we found that DAS28-CRP under-estimate threshold values of DAS28-ESR by 0.49 with CI 95% [-1.96, +1.96].
    Conclusion: Our study showed a positive concordance between the DAS28-ESR and DAS28 -CRP. But DAS28-ESR would be higher than DAS28-CRP in patients with high dose of corticosteroids and significant functional impairment.
    Zhang Hongwei, Wang Chaoyang, Sun Jianhua, DU Xinhui, Fang Qinzheng, and Moris Topaz*
    Currently, open fracture in lower extremity is a common trauma, which can easily form the skin defect. If the skin defect become an ulcer or ulcer like wound, the treatments will encounter a sticky situation that is hard to heal. Although skin flap grafting, tissue stretching and expansion can be available in this situation, however, they all have disadvantages, such as time consuming, costly, and difficult to operate, etc.. In this case, we reviewed one novel treatment, RNPT (regulated negative pressure-assisted wound therapy) combined with Topclosure (skin stretching and wound closure-secure system) , for an skin defect patient with lower extremity open fracture, which achieved sound outcome.
    Ali Zein AA Alkhooly* and Ahmed A Zein AA Alkhooly
    Restoration of elbow flexion is of great importance for a good clinical and functional outcome. Depending on the level of injury and the degree of reinnervation there are different types of surgical procedure. The surgical goal is to restore good muscle strength through a range of elbow motion (30 to 130 degrees).
    We introduced modification of flexor- plasty descriped by Steindler (1918) to restore elbow flexion after brachial plexus injury and paralysis of elbow flexor and the result was good after short period of follow.
    Review Article
    Cesar Salcedo Canovas*
    The use of external fixation is the most common technique for bone elongation. While this technique is very versatile, its use is not free of difficulties, and some surgeons have used it to perform elongations over an intramedullary nail to minimize the time the patient has the fixator implanted.
    Theoretically, the reduction of the external fixation time would imply fewer problems of infection of the screws, more comfort for the patient, and less joint stiffness. In addition, having an internal support would reduce angular deviations and decrease the fracture rate of the regenerated bone.
    To compare the two techniques, two groups of 15 femurs (N=30), homogeneous in terms of age, the amount of elongation, the elongation difficulty (according to Paley’s criteria), and the etiology of the shortening, were paired. From these groups, the external fixation time, external fixation rate (fixation time per centimeter of elongation), consolidation index (months per centimeter of elongation), complication rate (classified according to Paley’s criteria), and range of motion of the knee were analyzed.
    After analyzing the data, statistically significant differences were found in favor of elongation over a nail in the external fixation time, in the external fixation index, in the rate of complications, and in the range of articular motion. No differences were found in the bone consolidation index or the clinical results obtained.
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