The potential for many of the commonly used surgical site wound adhesives, skin antiseptic solutions, topical antibiotics, and suture materials to sensitize and subsequently result in allergic contact dermatitis (ACD) has become increasingly recognized within orthopedic surgery. Particularly with subsequent exposure to the offending allergen, the cutaneous allergic reaction may present in a similar fashion to cellulitis, thus making early differentiation between the two etiologies to initiate the appropriate and timely treatment crucial. Recognition of the characteristic appearance and severity of ACD surrounding a surgical wound often drives the initial management. This typically consists of anti-histamines, topical corticosteroids, and possible removal of the offending allergen for low grade findings and oral steroids and prophylactic oral antibiotics for the more severe reactions. Multidisciplinary care, including the expertise of a dermatologist or wound care specialist when faced with this challenging clinical scenario is critical and elective patch testing may be indicated to ascertain the exact allergen involved, particularly in patients with a prior history of wound issues. Finally, any clinical cases of ACD following an orthopedic procedure should be documented in the patient's chart so that exposure can be avoided with any future surgery.

The most critical step in the calculation of final limb length discrepancy (LLD) is estimating the length of the short limb after skeletal maturity(Sm). Paley's multiplier method is a fast, convenient method for calculating Sm and LLD after skeletal maturity; nonetheless, the calculation of the process of Sm and LLD in acquired type cases is complex in contrast to congenital type in this method. Notwithstanding, the multiplier method uses a variable called "growth inhibition" for the calculation process in acquired type LLD; however, its mathematical proof has not been published yet. The present study aims to find out whether there is an alternative way to estimate the length of Sm and LLD in skeletal maturity without using growth inhibition (GI) and its complex calculation process in acquired type LLD. We used trigonometric equations to prove the GI concept and conducted proportionality analysis to calculate the length of short limbs and LLD in skeletal maturity without using GI. Based on the results, the following proportionality can estimate the length of the short limb in skeletal maturity. (ΔLm/ΔL = ΔSm/ΔS). The GI concept can be proved trigonometrically; nonetheless, its numerical value is not necessary for estimating the length of the short limb in skeletal maturity. Instead, a simple proportionality analysis serves the purpose of calculation.

Open Bankart repair plus inferior capsular shift (OBICS) and Latarjet procedure (LA) are considered appropriate treatment alternatives for high-performance athletes. The purpose of this study was to evaluate the functional outcomes and recurrence rate of each surgery. Our hypothesis: there were no differences between the two treatments. A prospective cohort study was conducted with n=90 contact athletes divided into two groups of 45 patients. One group was treated with OBICS, and the other one with LA. The mean follow-up period was 25 (24-32) months for the OBICS group and 26 (24-31) months for the LA group. Primary functional outcomes of each group were assessed at baseline, six months, one year, and two years after surgery. The functional outcomes were also compared between the groups. The evaluation tools used were the Western Ontario Shoulder Instability score (WOSI) and the American Shoulder and Elbow Surgeons scale (ASES). In addition, recurrent instability and range of motion (ROM) were also evaluated. In each group, significant changes were found in the WOSI score and ASES scale from pre-op to postop. However, there were no significant differences between the functional outcomes of the groups at the final follow-up (P-values 0.73 and 0.19). Three dislocations and one subluxation (8.8%) were reported in the OBICS group, and three subluxations were reported in the LA group (6.6%), revealing no significant differences between the groups (P=0.37). Moreover, there were no significant differences between preoperative and postoperative ROM in each group or in terms of external rotation (ER) and ER in 90º abduction between the groups. No differences were found between OBICS and LA surgery. Both procedures can be indicated according to the surgeon's preference to reduce recurrence rates in contact athletes with recurrent anterior shoulder instability.

Bibliometric analysis is one of the most prevalent methods for analyzing and predicting the research trends of particular subjects. Through a bibliometric analysis, this study sought to look into and depict the hotspots and research trends in knee arthroplasty research over the previous five years. The Web of Science Core Collection database was used to find research articles on knee arthroplasty published between 2018 and 2022. The VOS viewer, Cite Space, and Bibliometrix were used to carry out the bibliometric study and network visualization. During the previous five years, 7,422 included knee arthroplasty publications were cited 57,087 times. The United States and the Journal of Arthroplasty were the top countries and journals regarding the number of articles. The top 10 global high-impact documents were determined using the citation ranking and citation burst. The most frequently referenced article revealed that the epidemiological characteristics of knee arthroplasty, perioperative care in knee arthroplasty, prosthetic joint infections, and opioid medications were the hot topics in knee arthroplasty research. Keyword burst analysis showed that the research trends in knee arthroplasty through 2022 were racial disparity, limb alignment, tibial slope, and meniscectomy. The analysis of the subject areas revealed the close connections and relationships between different subject areas, as demonstrated by the figures. The knee arthroplasty research community is highly productive and centralized. Recent hotspots in knee arthroplasty research were unicompartmental knee arthroplasty, periprosthetic joint infection, kinematic alignment, outpatient total knee arthroplasty (TKA), bariatric surgery, payment model, tranexamic acid, Robotic-Assisted TKA, patient-reported outcome measures, metaphyseal cone, opioid use, and patient-specific instrumentation. Research trends in knee arthroplasty research were racial disparity, limb alignment, tibial slope, and meniscectomy.

Total elbow arthroplasty (TEA) is increasingly used, especially in patients with rheumatoid arthritis (RA) and distal humerus fractures (DHFs). This narrative review of the recent literature published in 2022 reached the following conclusions: 1) Age greater than 80 is not a contraindication for TEA. 2) The estimated 10-year survival reported for linked TEAs is 92%, and unlinked TEAs 84%. 3) For DHFs in the elderly, regarding the flexion/extension arc, TEA gives substantially better results than open reduction and internal fixation (ORIF). The reoperation and elbow stiffness rates are substantially lower in TEA than in ORIF. 4) Comparing distal humeral hemiarthroplasty (DHH) vs. TEA in individuals over 65 years with a non-reconstructable DHF favors DHH regarding the range of motion but with a similarly high rate of adverse events in the two surgical techniques. 5) The rate of eradication of periprosthetic joint infection (PJI) is 69-76% with two-stage, 71% with resection arthroplasty, 67% with one-stage, 58% with DAIR, and 40% with elbow arthrodesis.

Rotator Cuff Tear (RCT) is a multifactorial disease, but an important one is the increased collagen degradation that would lead to a higher chance of tear. MMP-8 is a protein that degrades type I collagen, and it is known that MMP-8 has a polymorphism in which a T allele in the gene promoter region increases its transcription activity. This study aims to investigate the association between MMP-8 polymorphism g.-799 C>T (rs11225394) and RCT. To do that, we collected DNA samples from buccal epithelial cells of 128 patients (separated into RCT group and control group in a proportion 1:1) and genotyped the DNA using PCR. The statistical analyses were done using the ARLEQUIN Version 2.0, and the data normality was tested with the Shapiro-Wilk test. The results showed a significantly higher frequency of T/T genotype in the test group (29% in the control group and 39% in the test group, p=0.0417), and that would represent a risk factor for increased collagen degradation. The MMP-8 g.-799 C>T (rs11225394) SNP was associated with RCT. With the description of a new risk factor, future research can be done to analyze how to prevent RCT or develop new treatment strategies since the disease's failure index is currently high.

Although the diffuse type of tenosynovial giant cell tumor (D-TGCT) is rare, bone involvement is common in such lesions. However, the optimal management of bone lesions in D-TGCT is not well-described. In this study, we reported the outcomes of total synovectomy, curettage, and bone grafting/cementation in the treatment of D-TGCT with subchondral bone involvement. We also described the prevalence, demographic, and characteristic features of the lesions. In a retrospective study, we included 13 patients with D-TGCT of large joints and associated subchondral cyst/cyst-like bone lesions of ≥ 5 mm that were managed with total synovectomy and curettage. Cavities with a bone defect of ≤ 30 mm (n=12) were filled with bone grafts. Cavities of > 30 mm (n=1) were augmented with bone cement. The limb function was evaluated by the Musculoskeletal Tumor Society (MSTS) score. The study population consisted of 6 (46.1%) males and 7 (53.9%) females with a mean age of 30 ± 7.9 years. The most frequent sites of involvement were the knees and ankle joints (n=5 each, 38.5%). The mean follow-up of the patients was 69.2 ± 32.9 months. The mean MSTS score of the patients was obtained at 98.2 ± 3.2 (range 90-100). The D-TGCT recurred in two patients, both of which were in the synovium. Postoperative complications were three cases of transient pain and one case of knee joint stiffness. While no patient had an osteoarthritic change in preoperative radiographs, two patients had osteoarthritic change (grade II) in the last follow-up, one in the knee and one in the hip. Curettage and filling the defect with bone graft or cement are adequate treatments for managing bone lesions in D-TGCT.

Genu recurvatum associated with Osgood-Schlatter disease (OSD) has been reported in several studies. In this report, we describe a rare complication of a case of OSD with flexion contracture (tfighat is the exact opposite of the knee deformity classically associated with OSD) and increased posterior tibial slope. In the current article, we report a 14-year-old case of OSD referred to our center with a fixed knee flexion contracture. Radiographic evaluation revealed a tibial slope of 25 degrees. There was no limb length discrepancy. Bracing that was prescribed in the primary center before referring to us was not successful in treating this deformity. He underwent anterior tibial tubercle epiphysiodesis surgery. After a year, the flexion contracture of the patient was significantly reduced. The tibial slope decreased by 12 degrees and reached 13 degrees. The present report suggests that OSD may affect the posterior tibial slope and lead to knee flexion contracture. Surgical epiphysiodesis can correct the deformity.

Tibia open fractures and lower limb soft tissue injuries are undesired conditions for orthopedic and general surgeons, and there is no ideal procedure for treating recalcitrant ulcers or severe traumatic ulcers. Recently, several novel approaches have been proposed, such as bone marrow stem cells, platelets, fibrin glue, and collagen matrix. The current study was conducted to evaluate the effectiveness of combining platelets, fibrin glue, and a collagen matrix for treating a serious limb-threatening wound in a 33-year-old male with a right lower limb injury. After treatment, the wound was fully closed, tissue granulation was grown, skin grafting was done, and the right leg was saved. In conclusion, the combination of the mentioned components can be utilized to synergistically enhance wound healing and preserve the limb.