Marius Niculescu

Impact and alternative metrics for medical publishing: our experience with International Orthopaedics.

PurposeThis paper compares the traditional tools of calculation for a journal’s efficacy and visibility with the new tools that have arrived from the Internet, social media and search engines. The examples concern publications of orthopaedic surgery and in particular International Orthopaedics.Methods and resultsUntil recently, the prestige of publications, authors or journals was evaluated by the number of citations using the traditional citation metrics, most commonly the impact factor. Over the last few years, scientific medical literature has developed exponentially. The Internet has dramatically changed the way of sharing and the speed of flow of medical information. New tools have allowed readers from all over the world to access information and record their experience. Web platforms such as Facebook® and Twitter® have allowed for inputs from the general public. Professional sites such as LinkedIn® and more specialised sites such as ResearchGate®, BioMed Central® and OrthoEvidence® have provided specific information on defined fields of science. Scientific and professional blogs provide free access quality information. Therefore, in this new era of advanced wireless technology and online medical communication, the prestige of a paper should also be evaluated by alternative metrics (altmetrics) that measure the visibility of the scientific information by collecting Internet citations, number of downloads, number of hits on the Internet, number of tweets and likes of scholarly articles by newspapers, blogs, social media and other sources of data.Conclusions and discussionThis article provides insights into altmetrics and informs the reader about current tools for optimal visibility and citation of their work. It also includes useful information about the performance of International Orthopaedics and the bias between traditional publication metrics and the new alternatives.

Position of anterior cruciate ligament after single-bundle arthroscopic reconstruction

PurposeThe goal of this study was to assess the position of the reconstructed anterior cruciate ligament (ACL) in arthroscopic single-bundle ligamentoplasties through an anteromedial portal technique based on a clinical case series of 74 patients followed prospectively.MethodsThis cohort study involved 100 patients who underwent arthroscopic ACL reconstruction between January 2012 and January 2014. Patients who underwent isolated ACL reconstruction were selected from 194 cases with associated lesions. Graft placement at the femoral side was within the femoral footprint of ACL. All patients received computed tomography scans and magnetic resonance imaging of both knees to compare ACL graft position to tht of the native ACL in the unaffected knee and to show whether drilling the femoral tunnel through the anteromedial portal closely approximates the native ACL alignment.ResultsSeventy-four patients were available for follow-up. Mean value for the sagittal angle was 52.6°u2009±u20092.9° for the graft–Blumensaat angle was 4.73°u2009±u20090.75°., closely matching measurements in the contralateral normal knee.ConclusionUsing the anteromedial portal for single-bundle arthroscopic ACL reconstruction enables graft positioning within the normal footprint and as close as possible to anatomic ACL orientation.

Extra-articular distal tibia fractures—controversies regarding treatment options. A single-centre prospective comparative study

Distal tibia fractures are reported to have a high complication rate pre-operatively as well as post-operatively, which can include open fractures, soft tissue damage, infection, malalignment, pseudarthrosis and ankle arthrosis. The operative treatment for the extra-articular distal tibia fractures is a controversial topic in the orthopaedic literature. Some of these fractures are proximal enough to be treated with an intramedullary nail while others are too distal for that. The aim of our study was to compare the results we have had with intramedullary nail (IMN) and minimally invasive plate osteosynthesis (MIPO) in distal metaphyseal (extra-articular) tibia fractures. The study was designed prospectively between January 2013 and March 2016 and took place on the Orthopaedics and Traumatology ward of a Clinical Emergency County Hospital in western Romania. The follow-up visits were scheduled one month, three months and six months post-operatively. For evaluating the ankle function, we used the Olerud–Molander ankle score (OMAS) and union was evaluated at six months on ankle X-rays. At the six-month follow-up visit the average scores were 75.55 (20-100) for the IMN lot and 74.23 (20-90) for the MIPO lot, without finding any statistical difference between the two groups (p >0.1). At the six-month follow-up, X-ray union was objected in 48 (90.5%) of our patients, the IMN lot having worse results (85.18%) than the MIPO lot (96.15%). The results we encountered showed little to no statistical difference when it comes to the functional score we used (OMAS score), leading us to believe that you can achieve comparable results with both implants.

Case series of patients with pathological dyaphiseal fractures from metastatic bone disease

IntroductionFractures on pathologic bone have major impact on life quality. The appropriate treatment is not standardized, but the current literature delineates that surgery must provide adequate stabilization for the life expectancy. We aimed to review the epidemiology, treatment outcomes and survival in our department.Material and methodsThe electronic database from a major referral centre was searched for patients treated for tumours and fractures by the corresponding ICM-10 codes over fivexa0years. Eighty-nine patients were identified. Eleven females and nine males, with an average age of 64xa0years underwent 23 operations during the selected timeframe. Six fractures were subtrochanteric, five at the femoral neck and five at the femoral diaphysis. Seventeen cases were metastatic carcinomas, out of which five mammary, three pulmonary and seven carcinomas of undetermined origin without immunohistochemistry.ResultsFourteen types of surgical intervention were osteosynthesis with intramedullary nails and six were partial hip replacements of which one had proximal femur resection and revision stem hemiarthroplasty. Four patients had single metastatic lesions which underwent resection and defect filling using PMMA cement (polymethylmethacrylate). The follow-up period ranged between two and sevenxa0years or until death. Only five patients (25%) were alive at the last follow-up. Local recurrence appeared in one patient. There was one immediate post-operative complication (dehiscent wound) and one implant failure after five years and was replaced with a larger diameter (exchange nailing).ConclusionBoth hip arthroplasty and femoral nailing are safe and routine procedures that are performed with relatively technical ease and low surgical stress and few peri-operative complications for the patient. They allow for immediate mobilization and weight-bearing with moderate and rapidly decreasing pain and discomfort.

Sagittal balance parameters correlate with spinal conformational type and MRI changes in lumbar degenerative disc disease: results of a retrospective study

PurposeSpinopelvic parameters can be useful in identifying risk factors for lumbar degenerative disc disease, but few studies assess patients with single-level disc herniation and most do not evaluate symptoms. This comparative retrospective study was aimed to analyse spinopelvic parameters, symptoms and MRI changes in patients with single-level lumbar disc herniation undergoing conservative or surgical treatment.MethodsPatients with clinical and radiological assessment (Japanese Orthopaedic Association Score) and an MRI evaluation of the lumbar spine were identified and divided into two groups: surgically treated (group A) and not requiring surgery (group B). Spinopelvic parameters were determined on standing profile radiographs of the lumbar spine and pelvis, and mean values were compared to those reported in the literature for normal subjects. MRI findings were graded according to the system described by Pfirrmann et al.ResultsThe study included 71 patients with single-level lumbar disc herniation: 26 in group A (39.4xa0±xa012.1xa0years) and 45 in group B (51.4xa0±xa017.2xa0years). The notable differences in spinopelvic parameter means between the two groups did not reach statistical significance. A positive correlations of age with pelvic tilt and Pfirrmann changes with pelvic incidence was only found in group A, while both groups showed highly significant positive correlations of pelvic incidence with the spine’s conformational type (pxa0=xa00.001).ConclusionsCharacteristic changes in spinopelvic parameters identified in patients with lumbar degenerative disc disease were a reduction in pelvic incidence, sacral slope and lumbar lordosis, with an increased pelvic tilt. These were found to correlate with MRI changes in surgically treated patients.

Deep vein thrombosis following the treatment of lower limb pathologic bone fractures – a comparative study

BackgroundDeep vein thrombosis is a well-known complication of fracture occurrence, lower limb surgery and periods of prolonged immobilisation. Its incidence can be increased even more in specific cases with metastatic bone disease and adjuvant treatment. There is a small amount of literature that addresses the incidence of DVT by comparing osteosynthesis and arthroplasty as surgical treatments. Current recommended anticoagulation protocols might be inadequate for specific groups of cancer patients undergoing osteosynthesis or arthroplasty.MethodsThe study was designed and performed in a retrospective manner and carried out on patients that presented at our Emergency Clinical County Hospital between 01.01.2008–31.12.2016. The patients’ evolution was followed for a standard of 2xa0months. All our deep vein thrombosis events were diagnosed via venous duplex imaging. The studied lot (nu2009=u200985) was paired with a control group (nu2009=u2009170) with similar baseline characteristics.ResultsOur lot was comprised of 85 patients that underwent 85 surgeries, on both of our hospital’s Orthopaedic and Traumatology wards. When performing the student t-test and calculating OR (odds ratio) and RR (risk ratio) we encountered 11 cases of DVT in our studied group and 12 cases of DVT in our control group (pu2009<u20090.04). We found statistical significance when correlating DVT with type of implant (prosthesis), the presence of metastases over primary tumour and the choice of implant (prosthesis over intramedullary nail). There was no statistical significance found when correlating DVT events with the type of anticoagulation and the amount of blood transfusion units required.ConclusionPatients who undergo surgical treatment for lower limb pathological fracture due to malignancy are at increased risk of DVT or death due to PE under current general thromboprophylaxis regimens. The risk is higher for the immediate postoperative period (10xa0days). The risk is increased by metastasis, arthroplasty and adjuvant therapy (radiotherapy, chemotherapy), and we think that a more aggressive prophylactic protocol should be used.

Adverse local tissue reaction after 2 revision hip replacements for ceramic liner fracture: A case report

Introduction: In younger patients, ceramic-on-ceramic (CoC) bearing surfaces are usually recommended for total hip replacement (THR) because of their low wear rate and longer expected functional life. Although technical advancements have reduced the risk of ceramic bearings fracture, this complication remains a major concern. Case description: We present the case of a 56-year-old patient undergoing 3 revision hip arthroplasties of the right hip due to ceramic liner fractures. Initial THR (2008) was performed with a CoC bearing, followed by liner fracture due to trauma a year later. The acetabular component and liner were replaced, with a minor incongruence between the old head and new insert. The 2nd ceramic insert fractured 3.5 years later, following minor trauma. Upon revision, the bearing surface was changed to metal-on-polyethylene (MoP). The performed retrieval analysis demonstrated stripe and rim wear, and evidence of adhesive wear. The patient was referred to us a month later, with a fistula on the lateral side of the hip, discharging black, petroleum-like liquid. Radiology showed well-fixed implants, no dislocation and no apparent polyethylene wear. Microbiological assessment of the discharge showed no infection. Intraoperatively massive metallosis was noticed, with stable acetabular and femoral components. The metal femoral head was heavily abraded, with almost 1% volumetric wear. Hematoxylin and eosin stained frozen tissue samples showed muscular and adipose tissue necrosis, while polarized light microscopy highlighted metal, polyethylene, and ceramic particles. Conclusion: The present case is yet another report showing the adverse outcomes of using MoP bearings for revision after ceramic liner fracture in THR.

Fractographic Evaluation of the Metallic Materials for Medical Applications

The manner of studying of the fracture modes could be done through fractography. Fractography is the study of fracture surface morphologies and it gives an insight into damage and failure mechanisms, underpinning the development of physically-based failure criteria. In composites research it provides a crucial link between predictive models and experimental observations. Fractographic methods are routinely used to determine the cause of failure in all engineering structures, especially in product failure and the practice of forensic engineering or failure analysis. In material science research, fractography is used to develop and evaluate theoretical models of crack growth behavior. One of the aims of fractographic examination is to determine the cause of failure by studying the characteristics of a fracture surface. Different types of crack growth produce characteristic features on the surface, which can be used to help identify the failure mode. The overall pattern of cracking can be more important than a single crack, however, especially in the case of brittle behavior materials. Initial fractographic examination is commonly carried out on a macro scale utilizing low power optical microscopy and oblique lighting techniques to identify the extent of cracking, possible modes and likely origins. When it is needed to identify the nature of failure, an analysis at high magnification is required and scanning electron microscopy (SEM) seems to be the best choice. The problem of fracture behavior of biometallic materials is a real one, being well and repeatedly presented in literature. Variations in alloy compositions can lead to subtle differences in mechanical, physical, or electrochemical properties. However, these differences are minor compared with the potential variability caused by differences in fabrication methodology, heat treatment, cold working, and surface finishing, where surface treatments are particularly important for corrosion and wear properties. The aim of this paper, therefore, is to summarize the different types of metals and alloys used as biomaterials, the corrosion of metals in the human body, and different failure damages of metallic implants.

Titanium Implants Used in Traumatology Failed Sometime in Clinical Practice: Case Study

Tibial fractures were, still are and will be a challenge for the orthopedic surgeon. In this paper we conducted a case study on a system plate-screw made by titanium that was used in clinical practice for reduction and fixation of a tibial pilon fracture. After eight months the patient returns for the ablation of metallic implants. Clinical and strengthen the fracture callus is found radiologic hypertrophic and degradation plaque.On retrieved plate were made following investigations in order to establish the causes that lead to the failure: determining the chemical composition through spectral analysis, macrostructural analysis using stereomicroscopy, microstructure analysis using optical microscope metallographic, and fractographic analysis using scanning electron microscopy. Complex analysis of the fracture surfaces of the locking plate has led to the ultimate conclusion that the material has been made self-locking plate is inadequate chemical purity satisfactory embedding, which has led to breakage within an area of non-homogeneous structure. Breaking looks fragile behaviour by transgranular cleavage with sharp facets. There were also highlighted intergranular cracks between planes of cleavage sides.

Obesity and Knee Arthroscopy – a Review

Abstract Obesity is currently a global epidemic, often referred to as “globesity”, impacting the life of millions worldwide. A risk factor for many diseases, obesity can also be linked to developing intra-articular lesions of the knee, affecting the menisci, ligaments and cartilage. Furthermore, obesity has been shown to influence the outcome of surgical interventions, including those of the musculoskeletal system. Although many studies addressed the relationship of obesity and joint replacement, articles relating to arthroscopy and obesity, and knee arthroscopy in particular, are a bit scarcer. The majority of data suggest that an increase in BMI leads to a similar increase in the rates of intra- and postoperative complications, and most authors agree that a higher body mass index can influence both the procedure itself and its outcomes, including the subjective results reported by the patients. Still, some studies show different results, especially in patients that are overweight or with low-grade obesity, where the outcomes are comparable to those of the non-obese population. Thus, it can be concluded that obesity is an important patient characteristic that needs to be taken into consideration when planning, performing, and assessing the results of knee arthroscopy.