Roy Gigi

Deviations in gait metrics in patients with chronic ankle instability: a case control study

BackgroundGait metric alterations have been previously reported in patients suffering from chronic ankle instability (CAI). Previous studies of gait in this population have been comprised of relatively small cohorts, and the findings of these studies are not uniform. The objective of the present study was to examine spatiotemporal gait metrics in patients with CAI and examine the relationship between self-reported disease severity and the magnitude of gait abnormalities.MethodsForty-four patients with CAI were identified and compared to 53 healthy controls. Patients were evaluated with spatiotemporal gait analysis via a computerized mat and with the Short Form (SF) - 36 health survey.ResultsPatients with CAI were found to walk with approximately 16% slower walking velocity, 9% lower cadence and approximately 7% lower step length. Furthermore, the base of support, during walking, in the CAI group was approximately 43% wider, and the single limb support phase was 3.5% shorter compared to the control group.All of the SF-36 8-subscales, as well as the SF-36 physical component summary and SF-36 mental component summary, were significantly lower in patients with CAI compared to the control group. Finally, significant correlations were found between most of the objective gait measures and the SF-36 mental component summary and SF-36 physical component summary.ConclusionsThe results outline a gait profile for patients suffering from CAI. Significant differences were found in most spatiotemporal gait metrics. An important finding was a significantly wider base of support. It may be speculated that these gait alterations may reflect a strategy to deal with imbalance and pain. These findings suggest the usefulness of gait metrics, alongside with the use of self-evaluation questionnaires, in assessing disease severity of patients with CAI.

Effects of commonly used medications on bone tissue mineralisation in SaOS-2 human bone cell line

We analysed the effects of commonly used medications on human osteoblastic cell activity in vitro, specifically proliferation and tissue mineralisation. A list of medications was retrieved from the records of patients aged > 65 years filed in the database of the largest health maintenance organisation in our country (> two million members). Proliferation and mineralisation assays were performed on the following drugs: rosuvastatin (statin), metformin (antidiabetic), metoprolol (β-blocker), citalopram (selective serotonin reuptake inhibitor [SSRI]), and omeprazole (proton pump inhibitor (PPI)). All tested drugs significantly stimulated DNA synthesis to varying degrees, with rosuvastatin 5 µg/ml being the most effective among them (mean 225% (SD 20)), compared with metformin 10 µg/ml (185% (SD 10)), metoprolol 0.25 µg/ml (190% (SD 20)), citalopram 0.05 µg/ml (150% (sd 10)) and omeprazole 0.001 µg/ml (145% (SD 5)). Metformin and metoprolol (to a small extent) and rosuvastatin (to a much higher extent) inhibited cell mineralisation (85% (SD 5)). Our results indicate the need to evaluate the medications prescribed to patients in terms of their potential action on osteoblasts. Appropriate evaluation and prophylactic treatment (when necessary) might lower the incidence and costs associated with potential medication-induced osteoporosis.

The Effects of Direct Factor Xa Inhibitor (Rivaroxaban) on the Human Osteoblastic Cell Line SaOS2

Thromboprophylaxis reduces the risk of surgery-related deep vein thrombosis, but anticoagulants were associated with systemic osteoporosis, a known risk factor for poor fracture healing. Rivaroxaban (XARELTO®) is a novel anticoagulant with specific ability to inhibit factor Xa, a serine endopeptidase, which plays a key role in coagulation. This study investigated the direct effects of rivaroxaban on bone biology using an in vitro cell culture model from the human female osteoblastic cell line SaOS2. Cells at subconfluence were treated for 24 hr with different concentrations of rivaroxaban and analyzed for DNA synthesis and creatine kinase- and alkaline phosphatase-specific activities, and were treated 21 days for analyzing mineralization. Rivaroxaban (0.01–50 μg/ml) dose-dependently inhibited up to 60% DNA synthesis of the cells. Creatine kinase-specific activity was also inhibited dose-dependently to a similar extent by the same concentrations. Alkaline phosphatase-specific activity was dose-dependently inhibited but only up to 30%. Cell mineralization was unaffected by 10 μg/ml rivaroxaban. This model demonstrated a significant rivaroxaban-induced reduction in osteoblastic cell growth and energy metabolism, and slight inhibition of the osteoblastic marker, alkaline phosphatase, while osteoblastic mineralization was unaffected. These findings might indicate that rivaroxaban inhibits the first stage of bone formation but does not affect later stages (i.e., bone mineralization).

Protrusion of an Artificial Femoral Head A Rare Complication of Chronic Dislocation of the Prosthetic Hip

Chronic dislocation is considered a rare complication after total hip arthroplasty. We have treated a patient with a complication related to chronic dislocation-protrusion of the prosthetic femoral head through the skin. This 86-year-old bedridden patient with a known dislocated total hip arthroplasty presented with fever and protrusion of an artificial femoral head after 2 months of a nonhealing pressure sore. The care of this patient was partial removal of the prosthetic components and intravenous antibiotics. Chronic dislocation is rarely reported, yet it may cause severe complications in debilitated and demented patients. Special attention should be warranted to these patients as they might benefit from earlier surgical treatment.

Biomechanical evaluation of two arthroscopic techniques for biceps tenodesis: triple loop suture versus simple suture

BACKGROUND Several techniques and procedures have been described to treat long head of the biceps pathology; however, tenodesis and tenotomy are the 2 most common procedures performed. This study evaluated the initial fixation strength of the biceps tenodesis triple loop suture (TLS) technique and compared it with that of the simple suture technique (SST). METHODS Twenty fresh frozen cadaveric human shoulders (humeral head and neck with attached biceps tendons) were harvested. The biceps tendon was tenotomized proximally before reattachment to the bicipital groove of the matching humerus using suture anchors. Tenodesis was performed using the SST or the TLS technique. Specimens were tested biomechanically for load to failure, stress, and stiffness. The mechanism of failure was evaluated and compared between the 2 suture techniques. RESULTS Maximal load to failure was significantly greater using the TLS technique (122.2 ± 26.73 N) than the SST (46.12 ± 14.37 N, P < .001). There was no difference in the mean stiffness (SST: 7.33 ± 4.41 N/mm, TLS: 7.46 N/mm ± 2.67, P = .94). The failure mechanism in all SST samples occurred by suture cutout through the longitudinal fibers of the tendon. In all TLS samples, the failure occurred by suture slippage. CONCLUSION This study demonstrated superior load to failure of the TLS compared with the SST technique for biceps tenodesis. Furthermore, this study provides the first description of the TLS technique as a possible application in biceps tenodesis. Clinical application of the TLS must be carefully considered, because although it achieved a superior biomechanical profile, experience with this stitch is limited.

Ochrobactrum anthropi-Caused Osteomyelitis in the Foot Mimicking a Bone Tumor: Case Report and Review of the Literature

Osteomyelitis due to Ochrobactrum anthropi, a new genus Ochrobacterum widely distributed in the environment and occasionally associated with human infection, has been described in only a few case reports. We present a report of an unusual case of osteomyelitis caused by O. anthropi that was identified 9 years after a nail puncture to the lateral cuneiform bone. The patient was an 18-year-old male with a painful foot lesion that had originally been misdiagnosed as an osteolytic tumor. He underwent surgery and 2 firm pieces of rubber measuring 7 and 10 mm were removed from the lower portion of the lateral cuneiform bone, which appeared to be affected by an infection. After surgical debridement, O. anthropi was isolated from the bone cultures. The patient was successfully treated with a 6-week course of oral ciprofloxacin and clindamycin. At 1 year after the corrected diagnosis and appropriate treatment, he was symptom free and had resumed regular activities and an athletic lifestyle.

Adult Closed Distal Radius Fracture Reduction: Does Fluoroscopy Improve Alignment and Reduce Indications for Surgery?

Background: This study compared the radiological outcomes of adult closed distal radius fractures (DRFs) reduction with and without fluoroscopy. We hypothesized that fluoroscopy-assisted reduction would not improve radiographic alignment or decrease the need for surgery. Methods: Hospital medical records and radiographic images of all patients who presented with DRFs between April to June 2009 and April to June 2013 were reviewed. All patients underwent closed reduction and immobilization with or without fluoroscopic assistance. Reduction attempts were noted and pre- and postreduction posteroanterior and lateral radiographs were reviewed for fracture stability. Results: Eighty-four patients underwent reduction without fluoroscopy (group 1), and 90 patients underwent reduction with the aid of fluoroscopy (group 2). According to accepted radiographic guidelines, nonsurgical treatment was indicated for 62% of patients in group 1 and 56% of patients in group 2 (P = .44). In addition, no significant difference between the groups was observed in any postreduction radiographic parameters (P > .53) or postreduction alignment of unstable fractures (P = .47). Conclusions: Reduction without the use of fluoroscopy demonstrated noninferiority when compared with fluoroscopy-assisted reduction in the emergency department for closed adult DRFs.