Journal of Musculoskeletal Research

The purpose of this scoping review was to identify and describe the current body of evidence on internal fracture fixation devices that require compression screws. Electronic literature searches were conducted and 665 unique studies were included. Investigations on avulsion fractures represented a small proportion of these studies (45 studies), the remainder being those on patients with fractures with vascular compromise risk. The most common type of avulsion injury investigated was tibial avulsion fractures, followed by fifth metatarsal and calcaneal avulsions. For vascular compromised fractures, greater than half of the studies were on femoral neck injuries while scaphoid injury studies also represented a substantial proportion of this evidence base. Most of the studies were case series and there was limited randomized clinical trial evidence. A total of 429 studies provided sufficient information on the devices used in their investigation; DePuy-Synthes and Acumed ranked as the top two companies in cumulative publications over the last decade. There is a large body of evidence on internal fixation compression screw devices used in the management of fractures; however, the literature is generally dominated by non-comparative research studies. Opportunities to improve the evidence base are large. Manufacturer priority on evidence-based product development is key to ongoing research inquiry.

Purpose: This study reports the clinical effects of $z$-shaped titanium cages (ReBorn Essence Z-Brace cages) and compares the clinical outcomes between $z$-shaped titanium cages (ZTC group) and polyetheretherketone cages (PEEK cages, PK group) for the application in transforaminal lumbar interbody fusion (TLIF). Methods: A retrospective and case control study with six patients using PEEK cages and four patients using ZTC was conducted. All patients underwent TLIF and had a 3-month follow-up. The Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) were selected to assess the pain of low back and neurological status. The intervertebral disc height (DH) and segmental angle (SA) were also measured to estimate the radiological changes. At the 3-month follow-up, the fusion and subsidence rates were evaluated. Results: There was no significant difference between the two groups regarding the ODI and VAS scores. At the 3-month follow-up, the subsidence rates were 42% and 0% for the PK and ZTC groups, respectively; the bony fusion rates were 67% and 100% for the PK and ZTC groups, respectively. Conclusion: The study has indicated that both PEEK and $z$-shaped titanium cages can be effective options used to treat degenerative disc disease (DDD). Moreover, the higher fusion and lower subsidence rates have revealed that $z$-shaped titanium cages may be a better choice compared to PEEK cages for lumbar reconstruction after TLIF.

Musculoskeletal symptoms are the most frequent occupational health problems and accounts for a large number of losses in working days and disability for workers in modern industrialization. The aim of this paper was to investigate the relationship between the self-reported prevalence of musculoskeletal symptoms in the head/neck, upper back and lower back and certain individual, work- related physical, psychological and general health factors. A cross-sectional study was conducted using a descriptive questionnaire which was distributed to 350 oil refinery workers in Iran and collected between April to December 2016. A total of 282 workers returned completed questionnaire, yielding a response rate of 81%. For the head/neck region, working at the long periods in uncomfortable posture (adjusted $\mathrm{\text{OR}}=1.98$, 95% $\mathrm{\text{CI}}=1.55$–2.58) and doing repetitive activity (adjusted $\mathrm{\text{OR}}=1.93$, 95% $\mathrm{\text{CI}}=1.46$–2.67) increased the risk experiencing head/neck symptoms. For the upper back region, lifting and transferring during work increased the risk of experiencing upper back symptoms (adjusted $\mathrm{\text{OR}}=1.86$, 95% $\mathrm{\text{CI}}=1.42$–2.79). For the lower back region, working for more than 8h a week shows the strongly significant association for the risk of lower back symptoms. Lower back pain was associated with symptoms of anxiety and dysfunction in social functioning. Some physical and psychological factors were associated with the prevalence of musculoskeletal symptoms in the spine among oil refinery workers. These data emphasize the need to develop and implement preventive measures that reduce the prevalence of musculoskeletal symptoms among workers.

Objective: To assess the effect of scapular taping on the functional throwing performance index and medicine ball throwing performance. Design: A Randomized crossover trial. Setting: Out-patient Physiotherapy department at a university hospital. Participants: Forty-four healthy participants were randomly assigned to scapular and sham taping procedure. Outcome measure: Functional throwing performance index (FTPI) and Medicine ball throw (MBT) were recorded at baseline and following each taping procedure. Results: Analysis of variance with repeated measures on the dependent variable (Index percentage for FTPI and distance in meters for MBT) were used for analysis. Significant improvements were observed following scapular taping ($p<0.05$) on FTPI and MBT. Post hoc analysis for FTPI and MBT obtained a statistically significant difference between the scapular taping condition to baseline ($p<0.05$) with a mean difference of $19.20\pm 11.45$%; $0.17\pm 0.21$m, respectively. Similarly, scapular taping to sham taping ($p<0.05$) shown a significant difference of $18.32\pm 10.20$% on FTPI and $0.16\pm 0.17$m in MBT. No significant differences were found following sham taping on FTPI and MBT. Conclusion: Scapular taping improves functional throwing performance index and medicine ball throwing performance among normative young adults.

Introduction: Kyphoplasty, an established low-risk procedure for the management of symptomatic osteoporotic fractures, has been a topic of debate due to doubts regarding its efficacy and its associated complications like adjacent segment fractures and cement leakage. We present a unique case of failure of kyphoplasty due to dynamic instability through the vertebral body in a patient with a recent onset osteoporotic fracture treated by double-balloon kyphoplasty. To the best of our knowledge, there are no reported cases of dynamic instability with paraparesis after kyphoplasty for a fresh stable osteoporotic fracture associated with adjacent multiple healed osteoporotic fractures. Case Presentation: A 78-year-old female with complaints of back pain and imaging suggestive of old osteoporotic fractures of T12 and L1 vertebra with a fresh stable osteoporotic fracture L2 vertebra was treated with kyphoplasty after the failure of conservative treatment. After an initial good response, the patient started complaining of back pain and anterior thigh pain with weakness in both lower limbs. Dynamic X-rays and MRI of the patient revealed intra-vertebral instability at the L2 level. The patient was operated with interbody fusion L1–L2 and posterior stabilization L1–L3, and co-existing L5–S1 spondylolisthesis was dealt with by postero-lateral fusion L5–S1. Discussion: Recurrence of back pain after kyphoplasty can be caused by re-fracture at the same level or adjacent vertebral fracture. Neurological complications are rarely reported after balloon kyphoplasty and are mostly related to cement leakage into the spinal canal. The old adjacent segment fractures altering the biomechanics with resulting undue stress on the augmented stiff vertebra may have resulted in intra-vertebral instability and paraparesis. In balloon kyphoplasty, cement is put in the anterior part of the vertebral body and the posterior body lacks support. This may also have contributed to instability. Conclusion: Dynamic instability at the intra-vertebral level can be a cause of failure of kyphoplasty especially when adjacent osteoporotic fractures are altering the biomechanics of the spine. The treatment of osteoporotic fractures should be individualized and in the presence of such factors, they may be better managed by alternative methods.

Separated ossicle at the tip of lateral malleolus, a rare condition called os subfibulare, sometimes is a cause of ankle pain. There are two theories regarding the origin of os subfibulare. One theory proposes that it is caused by an avulsion fracture attributable to pull of the anterior talofibular ligament, whereas the other theory proposes that it is the result of an accessory ossification center. Accessory bones may be stable or may sustain injuries and become avulsed. Most cases have described the surgical treatment of avulsion fractures with excision of the fragment and anterior talofibular ligament reconstruction. We describe a rare case of a symptomatic Os subfibulare caused by an accessory ossification center in a 27-year-old female with no previous history of trauma. Surgical excision was done without ligament reconstruction and the symptoms resolved completely after the surgery and there was no residual ankle instability.