Spine
Afshin Ahmadzadeh Heshmati; Shahab Ilka
Articles in Press, Accepted Manuscript, Available Online from 21 October 2018
Abstract
Background: The purpose of this prospective study was to determine accuracy of insertion of the pedicular screw without use of the fluoroscopy. Methods: 760 pedicular screws were inserted from C7 to S1 vertebrae without use of fluoroscopy and locations of screws were assessed with CT scan after surgery ...
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Background: The purpose of this prospective study was to determine accuracy of insertion of the pedicular screw without use of the fluoroscopy. Methods: 760 pedicular screws were inserted from C7 to S1 vertebrae without use of fluoroscopy and locations of screws were assessed with CT scan after surgery and results were analyzed with Chi square test in SPSS software. Results: 65 screws (16.8%) of 387 thoracic screws and 34 screws (9.1%) from 373 lumbar screws were perforated pedicle wall or vertebral body. The most frequent location of perforation in thoracic spine was anterior cortex of the vertebral body and in lumbar spine was medial wall of the pedicle. Except perforation of anterior vertebral body (P=0.0001), there was no deference between left or right sides or between thoracic and lumbar screws. No complication was seen due to screw perforation. Conclusion: Use of the fluoroscopy in spine surgeries for insertion of pediculate screws is not necessary and accuracy and complications of them are equal to other studies that has been used the fluoroscopy
Knee
S.M. Javad Mortazavi; Ahmad Ramezanpoor Asl; Hamed Jafari; Hojjat Asgari; Mohamad H. Kaseb; Mohammad J. Dehghanifiroozabadi
Volume 7, Issue 5 , September 2019, , Pages 463-468
Abstract
Background: The purpose of this study was to introduce a technical tip for the preparation of tibial tunnel in a posteriorcruciate ligament (PCL) reconstruction to reduce the chance of popliteal artery injury and duration of the surgery.Methods: This study included 18 patients who underwent PCL reconstructions ...
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Background: The purpose of this study was to introduce a technical tip for the preparation of tibial tunnel in a posteriorcruciate ligament (PCL) reconstruction to reduce the chance of popliteal artery injury and duration of the surgery.Methods: This study included 18 patients who underwent PCL reconstructions at Imam Khomeini University Hospital,Tehran, Iran, between 2016 and 2017. In all patients, the PCL tibial aimer device was inserted from the anteromedialportal and its tip aimed 8-9 mm below shiny white fibers in PCL facet. Subsequently, the smooth guide pin was insertedfrom anteromedial tibial cortex and advanced just to the posterior cortex but not through it based on the measurementof tibial tunnel length. Thereafter, the reaming was done over the guide pin. As the pin was engaged in the posteriorcortex, it was assured that it would not run before the reamer to the popliteal fossa. The pin was removed when thereamer touched the posterior cortex, and the reaming continued until reamer’s head appeared in the PCL facet. Othersteps of standard arthroscopic PCL reconstruction were done in this study. All patients were subjected to computedtomography scans.Results: The mean age of the patients and the mean duration of surgery were 25±3 years and 95 min, respectively.There was no vascular injury, and the position of the tibial tunnel in all cases was accurate. Moreover, the meandistance between the centers of the tibial tunnel to champagne-glass drop-off of the posterior cortex of tibia wasobtained at 7.42 mm (range: 4.6-10.4 mm).Conclusion: This study showed that avoiding the penetration of posterior cortex of the tibia by means of the pin duringtibial tunnel preparation for PCL reconstruction is a safe, reproducible, and time-saving technique. This techniqueeliminates the need for fluoroscopy during the procedure.Level of evidence: IV
Upper Extrimity
Hassan Taleb; Ahmadreza Afshar; mohammad j. shariati; Ali tabrizi
Volume 7, Issue 6 , November 2019, , Pages 545-550
Abstract
Background: This study was conducted to evaluate the clinical outcomes of the acromioclavicular joint (ACJ)fixation with hook plate (HP) and continuous loop double endobutton fixation (CLDE) in the treatment of acute ACJdislocation.Methods: This retrospective study was conducted on eight patients with ...
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Background: This study was conducted to evaluate the clinical outcomes of the acromioclavicular joint (ACJ)fixation with hook plate (HP) and continuous loop double endobutton fixation (CLDE) in the treatment of acute ACJdislocation.Methods: This retrospective study was conducted on eight patients with HP and nine patients with CLDE fixations foracute ACJ dislocations. The subjects were evaluated by various criteria, including disabilities of the Arm, Shoulder,and Hand (DASH), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES), Universityof California, Los Angeles (UCLA) shoulder rating scale, Shoulder Constant score, Simple Shoulder Test (SST), andcoracoclavicular (CC) distance.Results: The differences between the mean scores of the visual analog scale for pain, DASH, ASES, UCLAshoulder rating scale, and Shoulder Constant, and SST were statistically significant in favor of the CLDE group.Mean difference of CC distance was 8.6±0.9 mm in the HP group; however, it was 11.6±1.2 mm in the CLDE group.The operation time was shorter in the HP fixation, compared to that in the CLDE fixation (51±13.3 versus 105±9.7min; PHP group.Conclusion: The CLDE fixation was reported with better clinical outcomes than HP fixation; however, it was a technicallydemanding procedure. The HP maintained the CC distance better than CLDE with a technically easy application. TheHP requires a second surgery for the removal and development of subacromial erosion and osteoarthritis of the ACJthat can be regarded as major concerns.Level of evidence: III
Trauma
Sayyed Hadi Sayyed Hoseinian; Mohammad H. Ebrahimzadeh; Mohammad T. Peivandi; Farshid Bagheri; Jalil Hasani; Sogol Golshan; Ali Birjandinejad
Volume 7, Issue 4 , July 2019, , Pages 367-372
Abstract
Background: Motorcyclists are among the most vulnerable groups of road accident victims, who are prone to a growingmortality rate due to the constant rise in the number of accidents. This study was performed to investigate the injurypatterns among motorcyclist trauma patients admitted to Kamyab Hospital, ...
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Background: Motorcyclists are among the most vulnerable groups of road accident victims, who are prone to a growingmortality rate due to the constant rise in the number of accidents. This study was performed to investigate the injurypatterns among motorcyclist trauma patients admitted to Kamyab Hospital, the largest trauma center affiliated withMashhad Univercity of Medical Sciences, Mashhad, Iran, due to an accident.Methods: This cross-sectional study was conducted on motorcyclists referred to our hospital due to accidents fromAugust 23, 2014 to August 22, 2016 to receive treatment. After the accurate examination of the collected data andcorrection of the potential errors, they were subjected to analysis. The gathered data included the demographicvariables, injury pattern, accident time, and accident type. Data analysis was performed in Stata Software, version 12.Results: A total of 4,205 motorcycle accident cases were hospitalized (14% of all cases were hospitalized during thetwo-year study period). The mean age of the patients was 30 years, and 88% of them were male (a male to female ratioof 7.3). Car- and pedestrian-motorcycle collisions were the most common causes of injury that accounted for 68% and22% of the cases, respectively. The head was the most commonly injured site of the body; in this regard, 59.7% of theadmitted patients and 85.4% of total death cases had a head injury. In addition, 67% of the target population receivedtrauma in more than two parts of their body. The elbow, arm, and hip were the least regions involved.Conclusion: Motorcycle accidents cause severe physical injuries to the patients’ body. Head injury was the mostcommon type of trauma, leading to a wide range of disabilities. Therefore, the use of crash helmets and avoidance ofdangerous driving behaviors will remarkably decrease such trauma.Level of evidence: IV
Hand
Ludovico Lucenti; Kevin F. Lutsky; Lauren Banner; Zachary Lazev; Pedro K. Beredjiklian
Volume 8, Issue 1 , January 2020, , Pages 70-74
Abstract
Background: The hemi-hamate arthroplasty (HHA) can restore joint congruity and stability in chronic fracturedislocationsof the proximal interphalangeal joint (PIPJ). Purpose of this study was to compare the width of the distalhamate articular surface (DHAS) to the width of the base of the middle phalanges ...
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Background: The hemi-hamate arthroplasty (HHA) can restore joint congruity and stability in chronic fracturedislocationsof the proximal interphalangeal joint (PIPJ). Purpose of this study was to compare the width of the distalhamate articular surface (DHAS) to the width of the base of the middle phalanges (P2) of the fingers. We hypothesizedthe dimensions of the width of the DHAS would be similar to those of P2, leaving a small amount of residual DHASwidth after autograft harvest.Methods: Fifty-nine CT scans of the hand without any bony pathology were evaluated. Three observers measured thefollowing parameters and compared: (a) Width of the DHAS in the axial and coronal planes; (b) Width of the P2 articularbases of all four fingers; (c) Maximum capitate length (MaxCap) in the coronal plane.Results: The residual DHAS on the coronal plane after graft harvest (bone remaining on the radial and ulnar aspectseach, not accounting for saw blade or osteotomy width thickness) among all patients was 1.3, 0.9, 1.4, and 2.4 mm forthe index, long, ring and small fingers respectively. There was a strong correlation between DHAS and MaxCap r=0.76.Conclusion: There is likely to be a very small amount of residual hamate articular surface width left after the graft isharvested if the entire base of P2 is reconstructed.Level of evidence: III
General Orthopedics
Taylor D. Ottesen; Rameez A. Qudsi; Alexis K. Kahanu; Belychagard Jean Baptiste; Pierre Marie Woolley; Adrienne R. Socci; George S.M. Dyer
Volume 8, Issue 2 , March 2020, , Pages 198-203
Abstract
Healthcare is expensive and often inaccessible to many. As a result, surgeons must consider simple, less expensiveinterventions when possible. For wound care, an older but quite effective cleaning agent is Dakin’s solution (0.5%sodium hypochlorite), an easily made mixture of 100 milliliters (ml) ...
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Healthcare is expensive and often inaccessible to many. As a result, surgeons must consider simple, less expensiveinterventions when possible. For wound care, an older but quite effective cleaning agent is Dakin’s solution (0.5%sodium hypochlorite), an easily made mixture of 100 milliliters (ml) bleach with 8 teaspoons (tsp) baking soda into agallon of clean water or 25 ml bleach and 2 tsp baking soda into a liter of water. Gauze is then wet with this solution,placed on the wound, and replaced every 24 hours as needed. Our team of surgeons in Haiti and the United Statesis currently using Dakin’s solution for wound care following orthopedic surgery and finds it to be a low-cost, safe, andeffective treatment for post-surgical wound care for both resource-limited and non-resource strained environments.This report aims to update the current literature and encourage the consideration of Dakin’s solution for modernwound care.Level of evidence: III
Amir Reza Sadeghifar; Ali Reza Saeed
Volume 1, Issue 1 , September 2013, , Pages 41-43
Abstract
Retained gauze after surgery is an uncommon error and it may be associated with many complications. We are reporting our case to call attention to the fact that retained gauze may become symptomatic even after a very long interval. Herein we report on a patient who developed infection and fistula ...
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Retained gauze after surgery is an uncommon error and it may be associated with many complications. We are reporting our case to call attention to the fact that retained gauze may become symptomatic even after a very long interval. Herein we report on a patient who developed infection and fistula with discharge from this error 35 years after a surgery for femur fracture and insertion of a IM nail. The diagnosis was easily made because of a marker in the gauze. Removal of the gauze and irrigation and debridement of the wound in two stages led to complete recovery of the patient as was shown in the 1 year follow up. Retained gauze after surgery is a preventable complication and may be asymptomatic for a very long period, but can become a complication post-operatively at any time. Hence, if diagnosed immediately after the surgery or at any other time, the gauze should be removed.
Mohammad Hallaj Moghadam; Ali Moradi; Farzad Omidi-Kashani
Volume 1, Issue 2 , December 2013, , Pages 90-93
Abstract
Background: Legg-Calve´-Perthes disease is a juvenile idiopathic osteonecrosis in which the blood supply of femoral head is not sufficient and the bone dies provisionally. The aim of this study is to evaluate outcome of Femoral osteotomy in children with LCPD in our University Hospital. ...
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Background: Legg-Calve´-Perthes disease is a juvenile idiopathic osteonecrosis in which the blood supply of femoral head is not sufficient and the bone dies provisionally. The aim of this study is to evaluate outcome of Femoral osteotomy in children with LCPD in our University Hospital. Methods: In a descriptive analytic study, between 2008 and 2013, patients with the diagnosis of Legg-Calve’-Perthes confirmed with lateral pillar calcification of B and B/C border were entered and patients were encouraged to come to an outpatient clinic for follow-up. Descriptive analysis of the demographics was performed and relation between variables was tested using a two-sided Student’s t test with statistical significance set at (p=0.05). Results: Mean age of patients was 9±1.3 years, with the range of 4 to 12 years old. 25 patients (86.2%) were male and 4 patients (13.4%) female. There was no positive family history in patients. 17 patients (58.6%) had history of trauma. Duration of symptom presentation was 7±6.3 months, with the range of 3 to 36 months. In 20 of patients (69%) left hip and in 12 (41.4%) right hip was involved. There was significant relation between femoral head asymmetry, trochanter enlargement (P=0.04), acetabolum changes (P<0.000), femoral neck shortening (P<0.000). There was no relation between age (P=0.28) and duration of disease (P=0.8) with femoral neck shortening. Conclusion: Intrtrochantric Osteotomy led to improvement in pain, limping and increase range of motion. Subluxation before surgery is one of the criteria, which could influence further prognosis. Acetabulom changes and femoral neck shortening are two factor seriously effect hip ROM.
Mohammad Alipour; Masoomeh Tabari; Reza Farhadifaz; Hadi Makhmalbaf; Maryam Salehi; Seyed Mostafa Moosavitekye
Volume 2, Issue 1 , March 2014, , Pages 52-56
Abstract
knee surgery. The purpose of this study was to assess the analgesic effects of intra-articular injection of a dexmedetomidine following knee arthroscopy. Methods: Forty six patients schadualed for arthroscopic knee surgery under general anaesthesia, were randomly devided into two groups. Intervention ...
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knee surgery. The purpose of this study was to assess the analgesic effects of intra-articular injection of a dexmedetomidine following knee arthroscopy. Methods: Forty six patients schadualed for arthroscopic knee surgery under general anaesthesia, were randomly devided into two groups. Intervention group received 1μg/kg dexmedetomidine (D) and isotonic saline. Control group received 25ml isotonic saline (P). Analgesic effects were evaluated by measuring pain intensity (VAS scores) and duration of analgesia. Results: There was no significant difference between the two groups in terms of age, sex and weight. The mean of post-operation pain severity in 1, 3, 6,12, and 24 h was significantly lower in the intervention group (D) in comparison with the control group (P). the mean of the total dose of tramadol consumption was significantly lower in the interven tion group in comparison with the control group ( P<0.001). Conclusions: Intra-articular injection of dexmedetomidine at the end of arthroscopic knee surgery, alleviates the patients’ pain; reducing the postoperative need for narcotics as analgesics, and increase the first analgesic request after operation.
Amir Reza Kachooei; Samantha M Chase; Jesse Jupiter
Volume 2, Issue 3 , September 2014, , Pages 180-184
Abstract
Background: Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ) such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna. The development of DRUJ prosthesis has significantly ...
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Background: Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ) such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna. The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker) prosthesis. Methods: We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months). Also, patients were contacted prospectively by phone in order to minister the disabilities of the armshoulder and hand (DASH), patient rated wrist evaluation (PRWE), and visual analogue scale (VAS), and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median followup time of 60 months (range: 2 to 102 months). Results: No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively. Conclusions: Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation.
Mohammad T. Rajabi Mashhadi; Hosein Mashhadinejad; Mohammad H Ebrahimzadeh; Farideh Golhasani-Keshtan; Hanieh Ebrahimi; Zahra Zarei
Volume 3, Issue 1 , January 2015, , Pages 56-63
Abstract
Background: To test the psychometric properties of the Persian version of Zarit Burden Interview (ZBI-12) in the Iranian opulation. Methods: After translating and cultural adaptation of the questionnaire into Persian, 100 caregiver spouses of Iran-Iraq war (1980-88) veterans with chronic ...
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Background: To test the psychometric properties of the Persian version of Zarit Burden Interview (ZBI-12) in the Iranian opulation. Methods: After translating and cultural adaptation of the questionnaire into Persian, 100 caregiver spouses of Iran-Iraq war (1980-88) veterans with chronic spinal cord injury who live in the city of Mashhad, Iran, invited to participate in the study. The Persian version of ZBI-12 accompanied with the Persian SF-36 was completed by the caregivers to test validity of the Persian ZBI-12.A Pearson`s correlation coefficient was calculated for validity testing.In order to assess reliability of the Persian ZBI-12, we administered the ZBI-12 randomly in 48 caregiver spouses again 3 days later. Results: Generally, the internal consistency of the questionnaire was found to be strong (Cronbach’s alpha 0.77). Intercorrelationmatrix between the different domains of ZBI-12 at test-retest was 0.78. The results revealed that majority of questions the Persian ZBI_12 have a significant correlation to each other. In terms of validity, our results showed that there is significant correlations between some domains of the Persian version the Short Form Health Survey -36 with the Persian Zarit Burden Interview such as Q1 with Role Physical (P=0.03),General Health (P=0.034),Social Functional (0.037), Mental Health (0.023) and Q3 with Physical Function (P=0.001),Viltality (0.002), Socil Function (0.001). Conclusions: Our findings suggest that the Zarit Burden Interview Persian version is both a valid and reliable instrument for measuring the burden of caregivers of individuals with chronic spinal cord injury.
Prakash Jayakumar; David Ring
Volume 3, Issue 2 , April 2015, , Pages 130-133
Abstract
Anatomically precontoured locking plates are intended to facilitate the fixation of articular fractures and particularly those associated with osteoporosis. Fractures of the distal humerus are relatively uncommon injuries where operative intervention can be exceptionally challenging. The distal humeral ...
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Anatomically precontoured locking plates are intended to facilitate the fixation of articular fractures and particularly those associated with osteoporosis. Fractures of the distal humerus are relatively uncommon injuries where operative intervention can be exceptionally challenging. The distal humeral trochlea provides a very narrow anatomical window through which to pass a fixed-angle locking screw, which must also avoid the olecranon, coronoid, and radial fossae. We describe 3 patients (ages 27, 49, and 73 years) with a bicolumnar fracture of the distal humerus where very short distal locking screws were used. Intra-articular screw placement was avoided but loss of fixation occurred in two patients and a third was treated with a prolonged period of immobilization. We postulate that fixed-angle screw trajectories may make it difficult for the surgeon to place screws of adequate length in this anatomically confined region, and may lead to insufficient distal fixation. Surgical tactics should include placement of as many screws as possible into the distal fragment, as long as possible, and that each screw pass through a plate without necessarily locking in.
Ahmadreza Afshar; Mehdi Koushkzari
Volume 3, Issue 3 , July 2015, , Pages 212-216
Abstract
Overlapped pubic symphysis is a rare but serious pelvic injury. This study presents a case of overlapped dislocation of the pubic symphysis. He was managed by closed reduction under general anesthesia. The patient had urethral transsection.At the latest follow up, seven months post injury; he was able ...
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Overlapped pubic symphysis is a rare but serious pelvic injury. This study presents a case of overlapped dislocation of the pubic symphysis. He was managed by closed reduction under general anesthesia. The patient had urethral transsection.At the latest follow up, seven months post injury; he was able to walk well without any pelvic pain. However, his urologic problems were continued. We also reviewed the literature and analyzed the data of the previous reports as well as the current case collectively. The two terms of “locked pubic symphysis” and “overlapped pubic symphysis”have been used synonymously in the literature. Overlapped pubic symphysis is commonly associated with fracture of the sacrum and urethral injury in the male patients. After closed or open reduction, if pelvic instability persists, it needs anterior and may posterior internal fixation to achieve a stable pelvis.
Omid Momenzadeh; Mohamad Gerami; Sepideh Sefidbakht; Sakineh Dehghani
Volume 3, Issue 4 , October 2015, , Pages 286-290
Abstract
Background: The objective of this study was to determine the diagnostic value of magnetic resonance imaging for shoulder joint pathologies and then compare the results with arthroscopy, the standard for joint diagnosis. Methods: In this cross-sectional study, 80 patients with shoulder joint disorders, ...
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Background: The objective of this study was to determine the diagnostic value of magnetic resonance imaging for shoulder joint pathologies and then compare the results with arthroscopy, the standard for joint diagnosis. Methods: In this cross-sectional study, 80 patients with shoulder joint disorders, who underwent final arthroscopy, were studied. Based on patients’ medical history and physical examinations, shoulder MRI was requested if paraclinical investigations were. If non-surgical therapies failed, arthroscopy of the affected shoulder was done and the same structures were inspected. Subsequently, sensitivity, specificity, and positive and negative predictive values (PPV) and (NPV) of MRI were determined by arthroscopy comparisons. Results: The highest sensitivity, specificity, PPV and NPV were found in MRI pathology reports that included: Hill-Sach lesion (0.910), infraspinatus tendon (0.985), supraspinatus tendon (0.930), and biceps tendon (0.954), respectively. Rotator interval (0.250), biceps labrum complex (0.805), subscapularis tendon (0.538) and anterior labrum lesions (0.604) had the lowest sensitivity, specificity, PPV and NPV, respectively. Conclusion: The results showed that MRI can be a useful tool in ruling out possible abnormalities in the shoulder and to give clues to the most probable diagnosis. Although knowing some practical skills in order to successfully perform the procedure and experience of the radiologist with suitable feedback by surgeon is necessary.
Mohsen Mardani-Kivi; Behzad Zohrevandi; Khashayar Saheb-Ekhtiari; Keyvan Hashemi-Motlagh
Volume 4, Issue 1 , January 2016, , Pages 60-64
Abstract
Background: Considering the importance of an early diagnosis and proper decision-making in regards to the treatment of pediatric distal radius and elbow fractures, this study examines emergency medicine specialists’ accuracy in the diagnosis and treatment of these patients. Methods: From ...
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Background: Considering the importance of an early diagnosis and proper decision-making in regards to the treatment of pediatric distal radius and elbow fractures, this study examines emergency medicine specialists’ accuracy in the diagnosis and treatment of these patients. Methods: From 2012 and 2013, children less than 14 years old who were referred to an academic hospital emergency department with elbow or distal radius fractures were enrolled. Initially, patients were examined by an emergency medicine specialist and then they were referred to an orthopedic surgeon. Type of fracture and the proposed treatment of two specialists were compared. Results: In total, there were 108 patients (54 patients in each group) with a mean age of 8.1+3.3 years. Identical diagnosis in 48 cases (88.9%) of distal radius and 36 cases (66.7%) of elbow trauma were observed. We found a difference between diagnosis of the two specialists in diagnosing lateral condyle of the humerus fracture in the elbow group and growth plate fracture in the distal radius fracture group, but the differences were not significant. Among 108 patients, 70 patients (64.8%) received identical treatment. Conclusion: Although the emergency medicine specialists responded similarly to the orthopedic specialists in the diagnosis of pediatric distal radius and elbow fractures, diagnosis of more complicated fractures such as lateral condylar humoral fractures, distal radius growth plate and for choosing the proper treatment option, merits further education.
Ahmadreza Afshar
Volume 5, Issue 1 , January 2017, , Pages 63-65
Abstract
During fixation of a femoral neck fracture in a 23-year-old male patient with cannulated screws, a broken guide wire fragment inadvertently advanced through the hip joint and protruded into the pelvis. A second surgical approach was needed to remove the broken fragment from the pelvis. Awareness ...
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During fixation of a femoral neck fracture in a 23-year-old male patient with cannulated screws, a broken guide wire fragment inadvertently advanced through the hip joint and protruded into the pelvis. A second surgical approach was needed to remove the broken fragment from the pelvis. Awareness of such a potentially devastating complication will make surgeons more cautious during implementation of orthopedic instruments and increases patient’s safety during surgery.
Michiel Hageman; Jeroen Bossen; Valentin Neuhaus; Chaitanya Mudgal; David Ring; Science Variation Group
Volume 4, Issue 2 , April 2016, , Pages 150-155
Abstract
Background: As part of the process of developing a decision aid for carpal tunnel syndrome (CTS) according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses ...
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Background: As part of the process of developing a decision aid for carpal tunnel syndrome (CTS) according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict. Methods: One-hundred-twenty-three observers of the Science of Variation Group (SOVG) and 84 patients with carpal tunnel syndrome completed a survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). Results: On average, patients had significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons.Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one’s goals in spite of pain), and higher PDRQ (relationship between patient and doctor). Surgeons from Europe have--on average--significantly more decision conflict than surgeons in the United States of America. Conclusions: Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict.
Michiel G.J.S. Hageman; Anne Caroline Döring; Silke A. Spit; Thierry G. Guitton; David Ring; Science Of Variation group
Volume 4, Issue 4 , October 2016, , Pages 353-358
Abstract
Background: As an early step in the development of a decision aid for idiopathic trigger finger (TF) we were interested in the level of decisional conflict experienced by patients and hand surgeons. This study tested the null hypothesis that there is no difference in decisional conflict between ...
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Background: As an early step in the development of a decision aid for idiopathic trigger finger (TF) we were interested in the level of decisional conflict experienced by patients and hand surgeons. This study tested the null hypothesis that there is no difference in decisional conflict between patients with one or more idiopathic trigger fingers and hand surgeons. Secondary analyses address the differences between patients and surgeons regarding the influence of the DCS-subcategories on the level of decisional conflict, as well as the influence of patient and physician demographics, the level of self-efficacy, and satisfaction with care on decisional conflict. Methods: One hundred and five hand surgeon-members of the Science of Variation Group (SOVG) and 84 patients with idiopathic TF completed the survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). Results: On average, patients had decisional conflict comparable to physicians, but by specific category patients felt less informed and supported than physicians. The only factors associated with greater decisional conflict was the relationship between the patient and doctor. Conclusions: There is a low, but measurable level of decisional conflict among patients and surgeons regarding idiopathic trigger finger. Studies testing the ability of decision aids to reduce decisional conflict and improve patient empowerment and satisfaction with care are merited.
Knee
Karim Z. Masrouha; Youssef El-Bitar; Marc Najjar; Said Saghieh
Volume 4, Issue 3 , July 2016, , Pages 259-263
Abstract
The management of soft tissue defects in tibial fractures is essential for limb preservation. Current techniques are not without complications and may lead to poor functional outcomes. A salvage method is described using three illustrative cases whereby a combination of flaps and antibiotic-impregnated ...
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The management of soft tissue defects in tibial fractures is essential for limb preservation. Current techniques are not without complications and may lead to poor functional outcomes. A salvage method is described using three illustrative cases whereby a combination of flaps and antibiotic-impregnated polymethylmethacrylate beads are employed to fill the bony defect, fight the infection, and provide a surface for epithelial regeneration and secondary wound closure. This was performed after the partial failure of all other options. All patients were fully ambulatory with no clinical, radiographic or laboratory sign of infection at their most recent follow-up. Although our findings are encouraging, this is the first report of epithelialization of the skin on a polymethylmethacrylate scaffold. Further studies investigating the use of this technique are warranted.
Upper Extrimity
Michael P. Gaspar; Patrick M. Kane; Sidney M. Jacoby; A. Lee Osterman
Volume 5, Issue 2 , March 2017, , Pages 129-130
Abstract
Challenges in Evaluating Sleep Disturbances in Patients with Hand and Upper Extremity Disease
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Challenges in Evaluating Sleep Disturbances in Patients with Hand and Upper Extremity Disease
Abdolreza Malek; Mohammadhassan Aelami; Narges Afzali; Ali Parsa; Havva Jalalinia
Volume 5, Issue 3 , May 2017, , Pages 196-200
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare aseptic, auto-inflammatory bone disorder. CRMO presents with bone pain with or without fever. The diagnosis of CRMO is a diagnosis of exclusion and should be included in the differential diagnosis of chronic inflammatory bone lesions ...
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Chronic recurrent multifocal osteomyelitis (CRMO) is a rare aseptic, auto-inflammatory bone disorder. CRMO presents with bone pain with or without fever. The diagnosis of CRMO is a diagnosis of exclusion and should be included in the differential diagnosis of chronic inflammatory bone lesions in children. Cultures of the bone are typically sterile, antibiotic therapy does not result in clinical improvement whereas anti-inflammatory drugs improve the condition. Furthermore, biopsy should be considered in chronic and relapsing bone pain and swelling unresponsive to treatment. Herein, we present a nine-year-old boy complaining of recurrent pain in his upper and lower extremities. On examination he had mild fever and cervical lymphadenopathy. He also had experienced bone pain and weight loss in the recent month. Based on biopsy and bone scan he was finally diagnosed with CRMO. Naproxen and Pamidronate was prescribed and he was getting better and returned to normal life and activity without need to corticosteroids.
Knee
Elham karimi; Mohsen Norouzian; Ali Birjandinejad; Reza Zandi; Hadi Makhmalbaf
Volume 5, Issue 6 , November 2017, , Pages 435-439
Abstract
Background: Posterior tibial slope (PTS) is an important factor in the knee joint biomechanics and one of the bone features, which leads to knee joint stability. Posterior tibial slope affects flexion gap, knee joint stability and posterior femoral rollback that are related to wide range of knee motion. ...
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Background: Posterior tibial slope (PTS) is an important factor in the knee joint biomechanics and one of the bone features, which leads to knee joint stability. Posterior tibial slope affects flexion gap, knee joint stability and posterior femoral rollback that are related to wide range of knee motion. During high tibial osteotomy and total knee arthroplasty (TKA) surgery, proper retaining the mechanical and anatomical axis is important. The aim of this study was to evaluate the value of posterior tibial slope in medial and lateral compartments of tibial plateau and to assess the relationship among the slope with age, gender and other variables of tibial plateau surface. Materials and methods: This descriptive study was conducted on 132 healthy knees (80 males and 52 females) with a mean age of 38.26±11.45 (20-60 years) at a medical center in Mashhad, Iran. All patients required to MRI admitted for knee pain with uncertain clinical history and physical examination that were reported healthy at knee examination were enrolled in the study. Results: The mean posterior tibial slope was 7.78±2.48 degrees in the medial compartment and 6.85±2.24 degrees in lateral compartment. No significant correlation was found between age and gender with posterior tibial slope (P≥0.05), but there was significant relationship among PTS with mediolateral width, plateau area and medial plateau. Conclusions: Comparison of different studies revealed that the PTS value in our study is different from other communities, which genetic and racial factors can be involved in these differences. The results of our study are useful to PTS reconstruction in surgeries.
Hand
Amir R. Kachooei; David Ring
Volume 5, Issue 4 , July 2017, , Pages 264-269
Abstract
Two patients-one with a terrible triad fracture dislocation and one with an anterior olecranon fracture dislocation—weretreated for maltracking of the elbow (medial subluxation). The radial head articulated with the lateral trochlea while theulnar trochlear notch was perched over the medial trochlea. ...
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Two patients-one with a terrible triad fracture dislocation and one with an anterior olecranon fracture dislocation—weretreated for maltracking of the elbow (medial subluxation). The radial head articulated with the lateral trochlea while theulnar trochlear notch was perched over the medial trochlea. The late revision surgery could not correct the subluxationbecause the joints were accustomed to the new alignment, however the overall function was reasonable.
Hip
Uttam Chand Saini; Nirmal Raj Gopinathan; Sameer Aggarwal; Ramesh Sen
Volume 6, Issue 2 , March 2018, , Pages 155-156
Abstract
Breakage of DHS guide wire during surgery and its migration into the pelvis through the hip joint is a rare complication and its removal can be very challenging for the surgeon. We share our experience of a similar case wherein we used an ‘iliofemoral’ approach to successfully remove the ...
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Breakage of DHS guide wire during surgery and its migration into the pelvis through the hip joint is a rare complication and its removal can be very challenging for the surgeon. We share our experience of a similar case wherein we used an ‘iliofemoral’ approach to successfully remove the broken transfixing guidewire from the hip joint. Although iliofemoral approach is similar to the lateral window of conventional ilioinguinal approach, yet it is less invasive, has lesser complications, requires less expertise and is easily reproducible by an average orthopaedic trauma surgeon. We recommend that surgical approaches for removal of these broken or migrated wires should be individualized depending upon the exact location of the wire tip in the hip joint or pelvis and need for exposure.
Anesthesiology
Mohammad Haghighi; Mohsen Mardani-Kivi; Ahmadreza Mirbolook; Samaneh Ghazanfar Tehran; Nasim Ashouri Saheli; Keyvan Hashemi-Motlagh; Khashayar Saheb-Ekhtiari
Volume 6, Issue 1 , January 2018, , Pages 63-70
Abstract
Background: Several studies have put an effort to minimize the tourniquet pain and complications after conventionaldouble tourniquet intravenous regional anesthesia (IVRA). We expressed in our hypothesis that an upper arm singlewide tourniquet (ST) may serve a better clinical efficacy rather than the ...
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Background: Several studies have put an effort to minimize the tourniquet pain and complications after conventionaldouble tourniquet intravenous regional anesthesia (IVRA). We expressed in our hypothesis that an upper arm singlewide tourniquet (ST) may serve a better clinical efficacy rather than the conventional upper arm double tourniquet (DT)in distal upper extremity surgeries.Methods: In this randomized controlled trial, 80 patients undergoing upper limb orthopedic surgeries were randomizedinto two groups. IVRA was administered using lidocaine in both groups. Tourniquet pain was recorded based on visualanalogue scale (VAS). In case of pain (VAS>3) in the DT group, the proximal tourniquet was replaced with a distaltourniquet while fentanyl 50μg was injected in the ST group. The onset time of tourniquet pain, time to reach to maximumtourniquet pain and the amount of fentanyl consumption were compared between the two groups.Results: No significant difference was seen in demographic characteristics. The onset time of tourniquet pain (VAS=1)in the ST group (26.9±13.2 min) was longer than that of the DT group (13.8±4.8 min) (P<0.0001). The median of time toreach to maximum tourniquet pain (VAS>3) in DT and ST groups were 25 and 40 minutes, respectively; indicating thatthe patients in ST group reached to pain level at a significantly later time (P<0.0001). The total opioid consumption inthe DT group (61μg) was significantly lower than the ST group (102μg) (P<0.0001); however, both groups were similarregarding fentanyl consumption before 40 minutes of surgeries.Conclusion: It seems that in upper limb orthopedic surgeries with less than 40-minute duration, a single tourniquetmay serve as a proper alternative opposed to the conventional double tourniquet technique.