Special issue on Rheumatology and Trauma care |

Open Access

Special issue on Rheumatology and Trauma care

Short Communication

Pages: 1 - 1

Percutaneous lumbar discal nucleoplasty (PLN): Initial experience in 53 patients affected by small/contained herniated disk

Fabrizio Fasoli

Statement of the Problem: The purpose of this study is to evaluate the medium-term (6 months) efficacy of Percutaneous lumbar nucleoplasty (PLN), finding positive outcome correlation with patient’s data and MRI morphological variables in patients with chronic lumbar back pain (LBP) with radiculopathy. Methodology & Theoretical Orientation: We included fifty-three patients with chronic LBP, who underwent PLN from October 2020 to February 2021. Clinical data are obtained using VAS indices (Visual analog scale) and ODI (Oswestry Disability Index) pre-and post-procedure at 1-3-6 months. In addition, all patients were advised to follow a rehabilitation program and MRI exams before and after treatment (3 months). Findings: 40/53 patients (75.4%) report positive results after six months; about 9/50 (16.9%) do not report any improvement, while 4/53 (7.5%) reported a clinical worsening. Postoperative at six months VAS and ODI scores showed an overall decrease from baseline of 4.11 points (p<0.001) and 23.45 points (p<0.001) with lower values (VAS -2.10 and ODI -15.11) in those who attended the rehabilitation. Postoperative MRI controls after three months showed an overall decrease in size of the disc protrusion (-1.4mm, p<0.001) compared to baseline, and an increase in the spinal canal area (SCSA) from baseline (+18mm^2); better values were registered in those patients who underwent the rehabilitation program. Conclusion & Significance: The technique we used provided us with excellent intradiscal maneuverability and precision, with no postoperative complications. Furthermore, PLN has shown excellent short-term clinical outcome results, significantly if associated with conservative rehabilitation techniques. That confirms the need for further studies and a multidisciplinary approach to chronic low back pain.

Short Communication

Pages: 2 - 2

Total hip arthroplasty after pelvic osteotomy for acetabular dysplasia: A systematic review

Jacob Shapira

The purposes were (1) to investigate and compare the findings of patients undergoing total hip arthroplasty (THA) following a corrective pelvic osteotomy (PO), to a control group of patients who underwent THA but not PO and (2) to evaluate the outcomes and complications for secondary THA after PO. Three studies recorded reduced cup anteversion in the osteotomy group. Two studies reported higher PROs for the control group. The most common complication after failed PAO was dislocations. PO may entail challenges on a subsequent THA, illustrated by higher intraoperative blood loss, lower consistency in cup positioning and compromised patients reported outcomes.

Short Communication

Pages: 3 - 3

Lateral Trochanteralgia: A new concept for an old concept

Aquiles Martinez

Statement of the problem: Certain medical terms used to describe different syndromes for musculoskeletal conditions such as Greater Trochanteric Pain Syndrome (GTPS) can be long and large enough to need an acronym. Objective of the study: The objective of the article is to propose a new concept using neologism to describe a broad spectrum of causes of lateral hip pain previously known as GTPS. Methodology and Theoretical orientation: Literature review of medical terms including Greco-Latin words that are widely used to refer to different anatomical areas and specific symptomatology was performed. Use of neologism was performed to create new words that can be short, meaningful, and straightforward to describe the broad spectrum of causes of lateral hip pain. Results: The medical terms facilitate scientific communication, standardized procedures, publication, and research. For this reason, m edical terminology must be as short, simple, straightforward, but meaningful as possible. The Greco – Latin words were found to be broadly used in the medical terminology. Discussion: The current term to describe the lateral hip pain syndrome is Greater Trochanteric Pain Syndrome (GTPS). And is large enough to need an acronym. This term is used to describe a broad spectrum of conditions that include disorders of the tendons, muscles, bursa, bones, and other structures surrounding the greater trochanter. The most common chief complaint is pain (“algia”) over the lateral aspect of the hip. The neologism Lateral Trochanteralgia is a shorter, simpler, clearer, and more meaningful term that can be used to describe this syndrome. Conclusion: Lateral Trochanteralgia is a short, simple, clear, and meaningful term to describe the broad spectrum of musculoskeletal conditions involving the pain in the lateral aspect of the hip. The standardized and universal use of this neologism will favor all processes of medical publi cation, communications, and digital search of related topics

Short Communication

Pages: 4 - 4

Inversed V-shaped high tibial osteotomy for severe varus deformity due to Blount disease

Seiju Hayashi

Introduction: Blount disease is a growth disorder of the medial proximal tibial physis causing a multi-planar deformity of the lower limb. Several types of surgical approaches have been described for the correction of angular deformity including external fixation, opened-/closed wedge high tibial osteotomy (HTO), and tibial condylar valgus osteotomy. However, they are associated with various disadvantages such as limb length discrepancy, risk of infections , and delayed union at the osteotomy site, especially in cases of severe varus deformity. Case presentation: We report a case of 16-year-old boy with unilateral severe genu varum caused by Blount disease. Although, several types of surgical approaches have been described for the correction of angular deformity of the knee, they are associated with various disadvantages such as limb length discrepancy, risk of infections, and delayed union or non-union at the osteotomy site, especially in case of such severe varus deformity. Considering that the current case patient was severely obese and a highly active young boy with severe unilateral genu varum, with the epiphyseal line almost closed, and with no abnormalities with respect to the intra-articular anatomical structures, inverted V-shaped HTO. After the treatment, the boy was not only able to perform his daily activities but was also able to participate in sports quite early. Although the required correction angle was quite large, inverted V-shaped HTO successfully correct the deformity with minimal disadvantages. Conclusion: Inverted V-shaped HTO would be selected as one of the effective treatments for a severely obese, young, and highly active patient suffering from severe genu varum caused by Blount disease.

Short Communication

Pages: 5 - 5

Radiologic evaluation and clinical effect of calcification in medial epicondylitis

Hee Dong Lee

Background: Although most radiologic findings of medial epicondylitis (ME) are normal, up to 25% show calcification, and little is known about the clinical relevance of soft tissue calcification in ME. The purpose of this study was to reveal the characteristics of calcification in ME, and to identify their clinical relevance. Methods: This study included 187 patients (222 elbows) who were diagnosed with ME. We classified calcification according to its anatomic location, and further evaluated its distribution. Logistic regression analysis was performed to calculate the odds ratios and 95% confidence intervals for possible factors that may affect calcification in ME: age, sex, laterality, hand dominance, visual analog scale (VAS) pain score, Mayo elbow performance score, symptom duration, history of steroid injection, number of steroid injections, concomitant ulnar neuropathy, and treatment method in terms of conservative treatment or surgery. Results: In a total of 222 elbows, 53% (118 of 222 elbows) showed calcification in radiologic findings. The VAS pain score, number of steroid injections, and concomitant ulnar neuropathy were significantly associated with calcification in ME. Calcification was most commonly identifi ed at the anatomical insertion site of the common flexor tendon (33%), followed by the pronator teres (18%), and the medial collateral ligament (10%). Of the total cases of calcification, 45% were distributed at multiple sites, and age was strongly associated with multiple distributions. Conclusions: Calcification in ME was more commonly identified than previously reported and was distributed over a relatively broad area. Calcification was associated with a higher VAS pain score, history of steroid injection, and combined ulnar neuropathy. The anatomical insertion site of the common flexor tendon most commonly showed calcification, and age was a strong indicator of a broad distribution of calcification.

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Citations: 1215

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