Spine
Hasan Ghandhari; Maryam Ameri Mahabadi; Farshad Nikouei; Saeed Sabbaghan; Abouzar Azizi; Alireza Mirzaei; Behrooz Givehchian
Volume 6, Issue 4 , July 2018, , Pages 324-330
Abstract
Background: Sagittal imbalance is known as the main radiographic driver of disability in adult spinal deformity (ASD).In this study, the association of radiological spinopelvic parameters and clinical outcomes was evaluated following thecorrective surgery of sagittal imbalance, in order to explore the ...
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Background: Sagittal imbalance is known as the main radiographic driver of disability in adult spinal deformity (ASD).In this study, the association of radiological spinopelvic parameters and clinical outcomes was evaluated following thecorrective surgery of sagittal imbalance, in order to explore the predictive ability of each parameter.Methods: A total of 23 patients, who underwent corrective osteotomy for restoration of sagittal balance, were included inthis study. The mean follow-up period of the patients was 15.5±2.1, ranging from 12 to 18 months. Pre- and postoperativeradiological parameters including pelvic tilt (PT), sagittal vertical axis (SVA) and pelvic incidence minus lumbar lordosis(PI-LL) were assessed for each patient. Clinical outcomes were evaluated using Oswestry disability Index (ODI).Results: The mean ODI improved 32% following the corrective osteotomy of sagittal imbalance. Postoperative ODIwas significantly correlated with all preoperative radiological parameters (r=0.608, P=0.002 for PI-LL; r=0.483, P=0.01for PT; and r=0.464, P=0.02 for SVA). ODI improvement was significantly correlated with PI-LL and SVA change (r=536,P=0.008 and r=416, P=0.04, respectively), but not with PT change (r=247, P=0.25). The outcome was better in pediclesubtraction osteotomy (PSO) compared to Smith-Petersen Osteotomy (SPO).Conclusion: Surgical correction of sagittal imbalance could limit the amount of disability caused by this misalignment.According to our results, while all the spinopelvic parameters could be used in the prediction of the outcomes ofcorrective surgery of sagittal imbalance, PI-LL was the most informative parameter and more attention should bedevoted to this parameter.
Trauma
Mohammadreza Minator Sajjadi; Adel Ebrahimpour; Mohamad A. Okhovatpour; Amin Karimi; Reza Zandi; Amir Sharifzadeh
Volume 6, Issue 5 , September 2018, , Pages 412-419
Abstract
Background: Pilon fracture is one of the challenging injuries in orthopedic surgery. Associated soft tissue injury is animportant factor in choosing treatment options. Two major methods of treatment are considered as one-stage openreduction internal fixation (ORIF) and two-stage treatment (primary external ...
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Background: Pilon fracture is one of the challenging injuries in orthopedic surgery. Associated soft tissue injury is animportant factor in choosing treatment options. Two major methods of treatment are considered as one-stage openreduction internal fixation (ORIF) and two-stage treatment (primary external fixation and secondary ORIF). The latter ismost accepted in literature. In the current study, we compared the results of these two methods.Methods: In a retrospective study, 41 patients were assigned to two groups containing one-stage primary ORIF (21patients) group, and two-stage group included external fixation and secondary ORIF (20 patients). The rate of infection(superficial or deep infection, osteomyelitis), malunion, nonunion, duration of hospital stay, neurovascular injury, painintensity, and patients’ satisfaction with AOFAS score, were compared between the two groups.Results: There was no significant difference between the two groups in measured variables except hospital staywhich was significantly longer for the two-stage group.Conclusion: Based on our findings, we recommend using one stage ORIF for a patient with Pilon fractures type Cand Tscherne 1, 2 if the patient is planned to be operated on during the first 24 hours after the injury.Level of evidence: II
Trauma
Konstantin Igorevich Novikov; Koushik Subramanyam; Sergey V. Kolesnikov; Oleg K. Chegurov; Elina S. Kolesnikova; Abhishek V. Mundargi
Volume 6, Issue 3 , May 2018, , Pages 240-242
Abstract
Ilizarov is an accepted technique for lengthening short amputation stumps to improve prosthetic function andrehabilitation. The relation of stump lengthening and phantom limb pain (PLP) has not been reported in literature.We present here a case report of a transfemoral amputee who had a flare up of PLP ...
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Ilizarov is an accepted technique for lengthening short amputation stumps to improve prosthetic function andrehabilitation. The relation of stump lengthening and phantom limb pain (PLP) has not been reported in literature.We present here a case report of a transfemoral amputee who had a flare up of PLP following stump lengthening.He responded well to a combination of pharmacological therapy and soft tissue manipulative techniques and desiredlength was achieved. This report alerts the possibility of aggravation of PLP following stump lengthening and discussesits management.Level of evidence: V
Joint Replacement
Hosseinali Hadi; Mahmood Jabalamoli; Abolfazl BagheriFard; Ehsanollah Ghaznavi-Rad; Ahmadreza Behrouzi; Ali Joorabchi; Amir Azimi
Volume 6, Issue 6 , November 2018, , Pages 554-559
Abstract
Background: Periprosthetic joint infection is a devastating complication of total joint arthroplasty. It seems that thepatient’s skin, nose, throat, and urine are important sites for microbial colonization. Colonization with staphylococcusaureus, especially methicillin resistant increases the risk ...
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Background: Periprosthetic joint infection is a devastating complication of total joint arthroplasty. It seems that thepatient’s skin, nose, throat, and urine are important sites for microbial colonization. Colonization with staphylococcusaureus, especially methicillin resistant increases the risk of periprosthetic joint infection. The aim of this study was toassess the prevalence of staphylococcus aureus colonization in patients candidate for arthroplasty in central Iran aswell as cost-effectiveness of decolonization program for prevention of post-arthroplasty infection.Methods: A total of 226 patient candidates for total joint arthroplasty were enrolled in this prospective cross-sectionalstudy between January 2014 and January 2016. Specimens from nose, throat, groin skin, and urine were sent forbacteriologic culture and sensitivity test. Analysis cost-effectiveness was then performed for decolonization programme.Results: Patients had positive cultures from nose (15.9%), throat (4.4%), groin skin (3.1%), and urine (0.9%). Ingeneral, 20.8% of the patients had positive cultures for staphylococcus aureus, among whom, 1.8% were methicillinresistant. Based on cost-effectiveness analysis, decolonization program leads to 80% reduction in costs.Conclusion: According to our results, although colonization with methicillin sensitive staphylococcus aureus in patientsundergoing hip or knee arthroplasty is lower than other studies but colonization with methicillin resistant staphylococcusaureus is similar to others. Also, decolonization programme in these patients was found to be very cost-effective.Level of evidence: II
Biomaterials
Fereydoon Sargolzaei Aval; Mohamad R. Arab; Narjes Sargolzaei; Sanam Barfroushan; Mohsen Mir; Gholam Hossein Sargazi; Forough Sargolzaei Aval; Maryam Arab
Volume 7, Issue 2 , March and April 2019, , Pages 182-190
Abstract
Background: Repair of bone defects is challenging for reconstructive and orthopedic surgeons. In this study, we aimedto histomorphometrically assess new bone formation in tibial bone defects filled with octacalcium phosphate (OCP),bone matrix gelatin (BMG), and a combination of both.Methods: A total ...
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Background: Repair of bone defects is challenging for reconstructive and orthopedic surgeons. In this study, we aimedto histomorphometrically assess new bone formation in tibial bone defects filled with octacalcium phosphate (OCP),bone matrix gelatin (BMG), and a combination of both.Methods: A total of 96 male Sprague Dawley rats aged 6-8 weeks weighing 120-150 g were randomly allocatedinto three experimental (OCP, BMG, and OCP/BMG) and one control group (n=24 in each group). The defects inexperimental groups were filled with OCP (6 mg), BMG (6 mg), or a combination of OCP and BMG (6 mg, 2:1 ratio).No material was used to fill the defects in the control group and the defect was only covered with Surgicel. Sampleswere taken on days 7, 14, 21, and 56 after the surgery. The sections were stained with hematoxylin-eosin (H&E) andassessed using light microscopy.Results: In our experimental groups, bone formation was started from the margins of the defect towards the centerwith an increasing rate during the study period. Moreover, the formed bone was more mature. Bone formation in ourcontrol group was only limited to the margins of the defect. The newly formed bone mass was significantly higher inthe experimental groups (P=0.001).Conclusion: OCP, BMG, and OCP/BMG compound enhanced osteoinduction in long bones.Level of evidence: III
Hossein Saremi
Volume 6, supplement 1 , June 2018, , Pages 8-9
Abstract
This was Presented in 5th International Congress of Iranian Iranian Society of Knee Surgery, Arthroscopy, and Sports Traumatology (ISKAST), 14-17 Feb 2018- Kish, Iran
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This was Presented in 5th International Congress of Iranian Iranian Society of Knee Surgery, Arthroscopy, and Sports Traumatology (ISKAST), 14-17 Feb 2018- Kish, Iran
Knee
Hamidreza Yazdi; Alireza Yousof Gomrokchi; Ara Nazarian; Aron Lechtig; Philip Hanna; Mohammad Ghorbanhoseini
Volume 7, Issue 1 , January and February 2019, , Pages 67-74
Abstract
Background: Arthroscopic reconstruction of ACL is an effective method to restore knee stability after ACL rupture.Postoperative septic arthritis (SA) is very uncommon while the incidence of serious complications range between0.14% and 1.8%. Some of the devastating consequences of septic arthritis can ...
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Background: Arthroscopic reconstruction of ACL is an effective method to restore knee stability after ACL rupture.Postoperative septic arthritis (SA) is very uncommon while the incidence of serious complications range between0.14% and 1.8%. Some of the devastating consequences of septic arthritis can encompass hyaline cartilage damage,arthrofibrosis, and in rare cases amputation. The purpose of this study was to evaluate the effect of gentamicin irrigationsolutions as a process to restrain septic arthritis following arthroscopic ACL reconstruction.Methods: In this retrospective cohort study, 1464 patients who underwent ACL reconstruction with hamstring tendonautograft in our institution over 7 years (February 2008 to January 2015) were included. The patients were dividedinto two groups based on the type of intra-articular irrigation solution used during the surgery. Patients in Group 1(Saline) received intra-articular irrigation with normal saline (0.9 % sodium chloride) solution, while those in Group 2(Gentamycin) received intra-articular irrigation with gentamicin (80 mg/L) added to the normal saline solution. Dataabout postoperative infection, its course, management, and outcome were obtained from patients’ records.Results: Seven patients developed SA, four of whom were from SALINE group (2.2%) and three from Gentamycingroup (0.23%). The incidence rate of SA after arthroscopic ACL reconstruction was significantly lower (P <0.05) whenirrigated with gentamicin solution than merely with saline solution.Conclusion: Gentamicin irrigation solution has a preservative and protective effect against SA development followingarthroscopic ACL reconstruction. We recommend evaluating this technique as a way in order to depreciate theprevalence of SA after ACL reconstruction.Level of evidence: III
Trauma
Mohammad Qoreishi; Hamid R. Seyyed Hosseinzadeh; Farshad Safdari
Volume 7, Issue 3 , May 2019, , Pages 284-290
Abstract
Background: The pelvic ring fractures (PRF) and acetabular fractures (AF) are among the major orthopedic injuriesassociated with high rates of morbidity and mortality. Open surgical stabilization is the standard treatment for themajority of these complications. Percutaneous minimally invasive surgical ...
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Background: The pelvic ring fractures (PRF) and acetabular fractures (AF) are among the major orthopedic injuriesassociated with high rates of morbidity and mortality. Open surgical stabilization is the standard treatment for themajority of these complications. Percutaneous minimally invasive surgical stabilization of the fractures has become anaccepted treatment method for the past several years. This study investigated the outcomes of percutaneous fixationof pelvic and acetabular fractures.Methods: Totally, 143 patients with PRF or AF of whom 95 cases were males underwent percutaneous fixation betweenFebruary 2015 and September 2016. All the operations were performed by a single surgeon in a supine position andunder C-arm fluoroscopy visualization. The patients were followed up for one year.Results: All the fractures healed in all of the patients within the first postoperative three months. The patients couldbear weight completely on both lower limbs. Out of 143 patients, 133 cases could get back to their preoperative work(93%). The mean amount of intraoperative blood loss was 29±19 cc. Of the total patients, seven cases required oralanalgesics because of moderate pain (4.9%). The means of operation time and length of incision were 32±8 min and3.2±2.4 cm, respectively. There was one screw back out and one deep infection. No neurovascular injury was reportedin this study.Conclusion: Closed reduction and percutaneous minimally invasive screw fixation for a pelvic ring or acetabularfractures is a useful surgical treatment option with low complication rates.Level of evidence: IV
General Orthopedics
Javad Khaje Mozafari; Karim Pisoudeh; kaveh Gharanizadeh; Mansour Abolghasemian
Volume 7, Issue 4 , July 2019, , Pages 373-378
Abstract
Background: Open hamstring lengthening (oHSL) is commonly performed to decrease knee contracture and improvegait and posture for children with spastic diplegia. Furthermore, percutaneous hamstring lengthening (pHSL) is alsogaining popularity as an alternative to the open approach. This study aimed to ...
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Background: Open hamstring lengthening (oHSL) is commonly performed to decrease knee contracture and improvegait and posture for children with spastic diplegia. Furthermore, percutaneous hamstring lengthening (pHSL) is alsogaining popularity as an alternative to the open approach. This study aimed to compare the results of pHSL versusoHSL and to determine the efficacy and safety of the percutaneous approach.Methods: This retrospective included 54 patients (108 knees) with spastic diplegia operated for flexed knee gait witheither open or percutaneous HSL. The mean age of the participants at the time of surgery was 10.3±1.7 years (agerange: 5-25 years) for the open and 8.5±1.5 years (age range: 7-23 years) for the percutaneous group. Overall, 29 and25 children were subjected to oHSL and pHSL, respectively.Results: The mean durations of follow-up were 19.1 months (range: 12-49 months) and 18.3 months (range: 14-45 months) for oHSL and pHSL groups, respectively. In the open group, the mean of preoperative popliteal angledecreased from 64.3±3.6 to 28.4±4.3 (P<0.001), and in the percutaneous group from 63.8±2.7 to 29.5±2.3 (P<0.001).The obtained results revealed no significant differences between the two approaches leading to a similar improvementamong the investigated patients (P=0.83).Although the Gross Motor Function Class Score improved significantly within each group (P<0.001); this improvementwas insignificant between the groups (P=0.88). The mean of hospital stay for the percutaneous group was 1.6 days(range:1-3 days) compared to 3.6 days (range: 2-6 days) for the open group, which indicated a significant difference(P=0.001). The mean values of total cost were $333 and $473 in the percutaneous group and open group (P=0.001),respectively. There was no significant difference between the groups regarding the complication rate (P=0.85).Conclusion: Percutaneous HSL is a safe, easy, rapid, and brief procedure that is as effective as the open technique forchildren with spastic diplegia in a short period of time. However, it is essential to examine the effects of this approachduring longer follow-ups to generalize the findings of the current study.Level of evidence: III
Trauma
Ali Sadighi; Touraj Asvadi Kermani; Parham Maroufi; Kosar Tarvirdizade; Atabak A.Kermani
Volume 8, Issue 2 , March 2020, , Pages 204-208
Abstract
Intrathoracic displacement of the humeral head is a very uncommon condition and can be life threatening due to lungor heart injuries. There is a report of this condition where intrathoracic bone fragment was missed. Because of rareincidence there is no guideline for approach and treatment of this condition.We ...
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Intrathoracic displacement of the humeral head is a very uncommon condition and can be life threatening due to lungor heart injuries. There is a report of this condition where intrathoracic bone fragment was missed. Because of rareincidence there is no guideline for approach and treatment of this condition.We hereby present a case of intrathoracic displacement of fractured humeral head in a man due to a car roll-overaccident.This condition requires a concise team workup of trauma and orthopedic surgeons along with the physical therapistsfor the best possible decision making.Displaced fractured humoral head into the thorax is a rare condition that needs more punctuality for on time diagnosisand team approach.Level of evidence: V
Hand
Majid Farhadian; Zahra Morovati; Alireza Shamsoddini
Volume 7, Issue 6 , November 2019, , Pages 551-560
Abstract
Background: Osteoarthritis is one of the most prevalent joint diseases in older adults. Since hands play a key role indaily activities, their impairment causes disability and reduction of independency. The present study aimed to investigatethe effect of using Kinesio tape on pain, range of motion (ROM), ...
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Background: Osteoarthritis is one of the most prevalent joint diseases in older adults. Since hands play a key role indaily activities, their impairment causes disability and reduction of independency. The present study aimed to investigatethe effect of using Kinesio tape on pain, range of motion (ROM), hand strength, and functional abilities in patient withhand osteoarthritis (HOA).Methods: In this randomized clinical trial study, 38 patients with the diagnosis of HOA were selected and randomlyassigned to Kinesio tape plus exercise (KT-EXE) and exercise (EXE) groups. Each group included 19 subjects whoparticipated in an 8-week intervention. Visual analog scale, Disabilities of the Arm, Shoulder, and Hand questionnaire,as well as goniometer and dynamometer measurements, were used to assess pain severity, upper extremity functionaldisabilities, ROM, and grip strength, respectively, before and after the intervention and at 2 months of follow-up.Results: There was no significant difference in pre-intervention scores between the two groups. Statistical analysisrevealed significant improvement in pain, ROM, hand strength, and upper-extremity functional abilities after theintervention in KT-EXE and EXE groups. In addition, the follow-up analysis showed significant changes, compared tothe initial assessments except for the pain in the EXE group. Results of the independent t-test revealed that changewas significantly greater in KT-EXE group than that in the EXE group at post-intervention and 2-month follow-upassessments except for the wrist flexion and upper-extremity functional abilities at final evaluation.Conclusion: Obtained results of this study showed that Kinesio taping and hand exercise may have a positive effect onthe improvement of pain, ROM, hand strength, and upper-extremity functional abilities in patients with HOA. In addition,these two methods can be simultaneously used for the rehabilitation of this condition.Level of evidence: III
Foot
Salman Azarsina; Farsad Biglari; Bahar Hassanmirzaei; Adel Ebrahimpour; Azadeh Hakakzadeh
Volume 7, Issue 5 , September 2019, , Pages 469-473
Abstract
Intraosseous lipoma is a rare, benign primary tumor occurring in the bone. Herein, we reported a 45-year-old manwith chronic right posterior heel pain. In this study, the man was treated conservatively due to plantar fasciitis. Duringa one-month follow-up visit, the patient had no symptoms of relief ...
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Intraosseous lipoma is a rare, benign primary tumor occurring in the bone. Herein, we reported a 45-year-old manwith chronic right posterior heel pain. In this study, the man was treated conservatively due to plantar fasciitis. Duringa one-month follow-up visit, the patient had no symptoms of relief in the right heel pain. Initially, calcaneal X-raywas taken, which revealed an expansile unicameral lytic lesion with central calcification on the right calcaneus.Moreover, computed tomography scan revealed an expansile lytic lesion on the right calcaneus. The diagnosis wasconfirmed as calcaneal lipoma in magnetic resonance imaging. The patient underwent curettage and autogenousiliac crest corticocancellous bone graft under general anesthesia. In a 3-month postoperative follow-up, the patientreturned to full ambulation. Postoperative radiographs demonstrated continued remodeling and healing of the graftsite. The purpose of this article was to increase awareness among clinicians about the existence of this rare causeof calcaneal pain.Level of evidence: V
Shoulder
Jonathan D. Barlow; Grant Jamgochian; Zachary Wells; Dexter Kenneth Bateman; Amber A. Schmerfeld; Joseph A. Abboud; Gerald R. Williams
Volume 8, Issue 1 , January 2020, , Pages 75-82
Abstract
Background: It is unclear whether hemiarthroplasty (HA) or reverse shoulder arthroplasty (RS) are superior for patientswith cuff tear arthropathy (CTA) and preserved preoperative motion (elevation >90˚).Methods: This was a retrospective, single institution study. Patients who underwent RSA or HA ...
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Background: It is unclear whether hemiarthroplasty (HA) or reverse shoulder arthroplasty (RS) are superior for patientswith cuff tear arthropathy (CTA) and preserved preoperative motion (elevation >90˚).Methods: This was a retrospective, single institution study. Patients who underwent RSA or HA for CTA were included ifthey had preserved preoperative motion with a minimum of 2 years of follow-up, or until complication/revision. ShoulderROM and functional outcomes scores were obtained.Results: Twenty-six HAs and 21 RSAs were evaluated at mean of 38.6 months (HA) and 36.3 months (RSA). Patientsin the RSA group were significantly older at surgery (73.9 versus 65.1 years; P=0.003). Postoperatively, the meanchange in active elevation was -15° for HA versus 26° for RSA, with RSA having significantly greater active elevation(153° versus 123°; P=0.01). There were no significant differences in final internal or external rotation between groups.Superior outcomes were seen for RSA versus HA for ASES score (84 vs. 66, P=0.003), Simple Shoulder Test (8.8 vs.7.3, P=0.3), Single Assessment Numeric Evaluation (85 vs. 70, P=0.017), and 100mm VAS pain (7 vs. 33, P<0.001).Conclusion: In patients with CTA and preserved preoperative forward elevation, RSA provided greater pain relief,superior functional outcomes, and better ROM compared with HA.Level of evidence: IV
Hadi Makhmalbaf; Ali Moradi; Saeid Ganji; Farzad Omidi-Kashani
Volume 1, Issue 2 , December 2013, , Pages 94-97
Abstract
Background: The knee joint is prone to injury because of its complexity and weight-bearing function. Anterior cruciate ligament (ACL) ruptures happen in young and physically active population and can result in instability, meniscal tears, and articular cartilage damage. The aim of this study is ...
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Background: The knee joint is prone to injury because of its complexity and weight-bearing function. Anterior cruciate ligament (ACL) ruptures happen in young and physically active population and can result in instability, meniscal tears, and articular cartilage damage. The aim of this study is to evaluate the accuracy of Lachman and anterior drawer test in ACL injury in compare with arthroscopy. Methods: In a descriptive, analytical study from 2009 to 2013, 653 patients who were suspected to ACL rapture were entered the study. Statistical analysis was performed by the usage of SPSS 19.0. Multiple comparison procedure was performed for comparing data between clinical examination and arthroscopic findings and their relation with age and sex. Results: Mean age of patients was 28.3±7.58 years (range from 16 to 68 years). From 428 patients, 41.2% (175 patients) were between 26 and 35, 38.8% (165 ones) between 15 and 25 and 20% (85 patients) over 36 years. 414 patients were male (97.2%) and 12 were female (2.8%). Sensitivity of anterior drawer test was 94.4% and sensitivity of Lachman test was 93.5%. Conclusion: The diagnosis and decision to reconstruct ACL injury can be reliably made regard to the anterior drawer and Lachman tests result. The tests did not have privilege to each other. These test accuracy increased considerably under anesthesia especially in women.
Mohammad H Ebrahimzadeh; Hadi Makhmalbaf; Ali Birjandinejad; Farideh Golhasani keshtan; Hosein Asghar Hoseini; Seyed Mahdi Mazloumi
Volume 2, Issue 1 , March 2014, , Pages 57-62
Abstract
Background: Osteoarthritis of the knee is the most common chronic joint disease that involves middle aged and elderly persons. There are different clinical instruments to quantify the health status of patients with knee osteoarthritis and one example is the WOMAC score that has been translated ...
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Background: Osteoarthritis of the knee is the most common chronic joint disease that involves middle aged and elderly persons. There are different clinical instruments to quantify the health status of patients with knee osteoarthritis and one example is the WOMAC score that has been translated and adapted into different languages. The purpose of this study was cultural adaptation, validation and reliability testing of the Persian version of the WOMAC index in Iranians with knee osteoarthritis. Methods: We translated the original WOMAC questionnaire into Persian by the forward and backward technique, and then its psychometric study was done on 169 native Persian speaking patients with knee degenerative joint disease. Mean age of patients was 53.9 years. The SF-36 and KOOS were used to assess construct validity. Results: Reliability testing resulted in a Cronbach’s alpha of 0.917, showing the internal consistency of the questionnaire to be a reliable tool. Inter-correlation matrix among different scales of the Persian WOMAC index yielded a highly significant correlation between all subscales including stiffness, pain, and physical function. In terms of validity, Pearson`s correlation coefficient was significant between three domains of the WOMAC with PF, RP, BP, GH, VT, and PCS dimensions of the SF-36 health survey (P<0.005) and KOOS (P <0.0001) . Conclusions: The Persian WOMAC index is a valid and reliable patient- reported clinical instrument for knee osteoarthritis.
Mark van Suchtelen; Stephanie Becker; Jillian S Gruber; David Ring
Volume 2, Issue 3 , September 2014, , Pages 185-191
Abstract
Background: This study tested the null hypothesis that nonoperatively treated patients would not show disease progression of carpal tunnel syndrome (CTS) over time according to median nerve distal motor latency (DML) on two electrodiagnostic tests. Methods: This retrospective ...
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Background: This study tested the null hypothesis that nonoperatively treated patients would not show disease progression of carpal tunnel syndrome (CTS) over time according to median nerve distal motor latency (DML) on two electrodiagnostic tests. Methods: This retrospective study analyzed sixty-two adult nonoperatively treated patients who were diagnosed with CTS confirmed by a minimum of two electrodiagnostic tests at our institution between December 2006 and tober 2012. A Wilcoxon signed-rank test was conducted to test the difference between electrodiagnostic measurements between the first and last test. Results: The mean time between the first and last electrodiagnostic test was 26±12 months (range, 12 to 55 months). The only electrodiagnostic measurement that increased significantly was the difference between median and ulnar DML on the same side (r=0.19, P =0.038). The time between the electrodiagnostic tests was significantly longer for patients with at least 10% worsening of the DML at the second test compared to cases of which the DML did not worsen or improve a minimum of 10% (P =0.015). Conclusions: There is evidence that—on average—idiopathic median neuropathy at the carpal tunnel slowly progresses over time, and this can be measured with electrodiagnostics, but studies with a much longer interval between lectrodiagnostic tests may be needed to determine if it always progresses.
Seyed Houssein Saeed-Banadaky; Sima Valizadeh; Marzieh Ghilian
Volume 3, Issue 1 , January 2015, , Pages 64-66
Abstract
Fat embolism syndrome is a clinical diagnosis, and diagnostic procedures are not specific. In every trauma patient, Fat embolism syndrome has to be considered as a possibility and supportive treatment should begin as soon as possible. The authors reported a rare case of Fat embolism syndrome whose ...
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Fat embolism syndrome is a clinical diagnosis, and diagnostic procedures are not specific. In every trauma patient, Fat embolism syndrome has to be considered as a possibility and supportive treatment should begin as soon as possible. The authors reported a rare case of Fat embolism syndrome whose only neurological symptom was motor aphasia. A young man sustained comminuted femoral shaft fracture following an accident presented dyspnea, motor aphasia and petechial rash. The Po2 and O2 Saturation were 53 and 91.1%. The body temperature was 38.5 °C. The hemoglobin decreased from 12.9 to 8.7 and platelet from 121000 to 84000 mg/dl. The pulse rate was 120 bpm. The CT scan and MRI were normal. Fat embolism syndrome was diagnosed according to both Gurd and Schonfeld criteria ruling out other possible causes. Patient recovered completely. Although rare, focal neurological symptoms and motor aphasia should be kept in mind as a part of diagnostic criteria.
T.V. Ravi Kumar; Daksh Gadi; Rao Raghavendra; Joseph Vinay Mathew
Volume 3, Issue 2 , April 2015, , Pages 134-136
Abstract
Spinal epidural haemorrhage may present as back pain associated with radicular symptoms and can be a catastrophic clinical scenario with progression to paraplegia or even sudden death. Being a rare entity, it needs a high index ofclinical suspicion to diagnose it. Fractures have been documented as a ...
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Spinal epidural haemorrhage may present as back pain associated with radicular symptoms and can be a catastrophic clinical scenario with progression to paraplegia or even sudden death. Being a rare entity, it needs a high index ofclinical suspicion to diagnose it. Fractures have been documented as a cause of hematorrachis but such hematomas only extend to one or two vertebral segments. Large epidural hematomas are usually associated with conditions like bleeding diathesis, arterio-venous malformations, plasma cell myeloma, and non-Hodgkin’s lymphoma. Surgical management with immediate evacuation of the hematoma is the usual line of management in patients with neurological deficits. Though rare, monitored and careful conservative management can lead to recovery of neurological symptoms and resolution of the hematoma. We report a case of a very large post traumatic epidural hematorrchis extending to 11 vertebral segments from D3 to L1 vertebral bodies, who had a gradual spontaneous recovery.
Selahattin Ozyurek
Volume 3, Issue 3 , July 2015, , Pages 217-217
Abstract
Dear Editor,We have greatly enjoyed reading the case report entitled “‘Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature in the issue of Arch Bone Jt Surg. 2015;3(2) with great interest. We would like to commend the ...
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Dear Editor,We have greatly enjoyed reading the case report entitled “‘Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature in the issue of Arch Bone Jt Surg. 2015;3(2) with great interest. We would like to commend the authors for their detailed and valuable work. Although various case reports have described postoperative distal femur fracture at a range of time intervals (1,2) intraoperative intra-articular distal femur fracture is a unique entity.However, we believe that some important additional observations seem necessary to be contributed through this study. In this article, the authors stated that, to the best of their knowledge, there is no other case report in the literature introducing a femoral condyle fracture during arthroscopic ACL reconstruction or revision reconstruction. Nevertheless, we would like to call the attention of the readers to the fact that that the literature contains one additional case report reporting on intraoperative distal femoral coronal plane (Hoffa) fracture during primary ACL reconstruction (2). Werner BC and Miller MD presented of case report of an intraoperative distal femoral coronal plane (Hoffa) fracture that occurred during independent femoral tunnel drilling and dilation in a primary ACL reconstruction. As in the their case, this type of fracture can occur with appropriately placed femoral tunnels, but the risk can increase with larger graft diameters in patients with smaller lateral femoral condyles The patient was treated with open reduction and internal fixation, without compromise of graft stability and with good recovery of function. We believe that tailoring graft size to the size of the patient is important to prevent similar adverse events.
Mohammad GHarehdaghi; Mohammad Hassani; Elaheh Ghodsi; Alireza Khooei; Amir Moayedpour
Volume 3, Issue 4 , October 2015, , Pages 291-295
Abstract
Background: Tuberculosis is an essential problem for healthcare systems especially in developing countries . All newborns are given Bacillus Calmette-Guérin (BCG) vaccine in Iran which is prepared from live bovine tuberculosis bacillus, and is given to protect against tuberculosis. Osteomyelitis ...
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Background: Tuberculosis is an essential problem for healthcare systems especially in developing countries . All newborns are given Bacillus Calmette-Guérin (BCG) vaccine in Iran which is prepared from live bovine tuberculosis bacillus, and is given to protect against tuberculosis. Osteomyelitis secondary to BCG vaccination is rare and usually involves epiphysis of long tubular bones. Methods: 4 patients, 3 males and a female entered this study and were between 11 to 24 months old. The involved bones were first metatarsi, talus, humerus and tibia bone. The main radiologic finding was lytic lesion with cortical destruction and periosteal reaction. Results: 3 patients underwent core needle biopsy and the one with the proximal tibia involvement, underwent open surgery. Pathology report suggested granulomatous osteomyelitis and typical caseous necrosis compatible with tuberculosis. Surgical treatment for these patients was curettage and debridement of the bone lesion and involved tissues around. The patients got standard anti TB pharmacotherapy, were completely cured and no short term complication was seen in a one year follow up. Conclusion: BCG osteomyelitis and cold abscess, should be kept in mind when assessing a child presenting chronic symptoms like pain, limping or local swelling of extremities. The long interval time between BCG vaccination and outbreak of the culture-negative abscess is a major point which emphasizes on pathologic evaluation. Imageguided tissue biopsy and PCR studies confirm diagnosis. Early use of a surgical curettage and debridement along with chemotherapy soon afterwards, enabled these children to enjoy a satisfactory clinical outcome.
Sohrab Keyhani; Ali Akbar Esmailiejah; Mohammadreza Abbasian; Farshad Safdari
Volume 4, Issue 1 , January 2016, , Pages 65-69
Abstract
Background: The most appropriate route of tranexamic acid administration is controversial. In the current study, we compared the efficacy of intravenous (IV) and topical intra-articular tranexamic acid in reducing blood loss and transfusion rate in patients who underwent primary total knee arthroplasty. ...
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Background: The most appropriate route of tranexamic acid administration is controversial. In the current study, we compared the efficacy of intravenous (IV) and topical intra-articular tranexamic acid in reducing blood loss and transfusion rate in patients who underwent primary total knee arthroplasty. Methods: One hundred twenty 120 patients were scheduled to undergo primary total knee arthroplasty. Patients were randomly allocated to three equal groups: IV tranexamic acid (500 mg), topical tranexamic acid (3 g in 100 mL normal saline) and the control. In the topical group, half of the volume was used to irrigate the joint and the other half was injected intra-articularly. The volume of blood loss, hemoglobin (Hb) level at 24 hours postoperative, and rate of transfusion was compared between groups. Results: The blood loss and Hb level were significantly greater and lower in the control group, respectively (P<0.05). Also, the rate of transfusion was significantly greater in the control group (P<0.05). However, IV and topical groups did not differ significantly in terms of measured variables. No patient experienced a thromboembolic event in our study. Conclusion: Tranexamic acid is a useful antifibrinolytic drug to reduce postoperative blood loss, Hb drop, and rate of blood transfusion in patients undergoing total knee arthroplasty. The route of tranexamic acid administration did not affect the efficacy and safety.
Dimitrios N Lyras; Konstantinos Kazakos; Konstantinos Tilkeridis; Anna Kokka; Athanasios Ververidis; Sotirios Botaitis; George Agrogiannis
Volume 4, Issue 2 , April 2016, , Pages 156-160
Abstract
Background:The aim of this study is to find out the spatial and temporal expression of TGF-b1 during the tendon healing, after application of Platelet Rich Plasma (PRP). Methods: A patellar tendon defect model in rabbits was used for this purpose. 48 skeletally mature New Zealand White rabbits, ...
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Background:The aim of this study is to find out the spatial and temporal expression of TGF-b1 during the tendon healing, after application of Platelet Rich Plasma (PRP). Methods: A patellar tendon defect model in rabbits was used for this purpose. 48 skeletally mature New Zealand White rabbits, weighing 3.5 kg, were used for this study. Equal numbers of animals from both groups were sacrificed at 4 different time points (1st, 2nd, 3rd, and 4th week). A full thickness patellar tendon substance in the right limb of each animal was excised from its central portion during the operation. PRP with a gel form was applied and filled the tendon defect in PRP group. No PRP was applied in the tendon defect of controls. Histological sections with hematoxylin-eosin and immunohistochemical sections with an anti-TGF-b1 primary antibody were made for the evaluation of the results. Results: A differentiation of the healing process was observed in the PRP group in comparison with the control group. TGF-b1 expression was detected in various cell populations (inflammatory cells, endothelial cells, macrophages, and tenocytes). Both cytoplasmic and nuclear expressions were present. The larger amounts of immunoexpression were localized in epitenon and in the repair site. PRP group showed stronger and more extensive staining at 1st and 2nd week (P<0.0001), whereas control group showed more extensive staining at the 3rd and 4th week (P<0.0001). Conclusions: Our study demonstrates that locally application of PRP result in an alteration of TGF-b1 expression during the healing of a patellar tendon defect.
Hiren Patel; Atul Kamath
Volume 4, Issue 3 , July 2016, , Pages 264-268
Abstract
Subchondral insufficiency fracture of the femoral head (SIFFH) is characterized by acute onset hip pain without overt trauma. It appears as a low intensity band with bone marrow edema on T1-weighted MRI. The most common course of treatment is protected weight bearing for a period of several weeks. Total ...
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Subchondral insufficiency fracture of the femoral head (SIFFH) is characterized by acute onset hip pain without overt trauma. It appears as a low intensity band with bone marrow edema on T1-weighted MRI. The most common course of treatment is protected weight bearing for a period of several weeks. Total hip arthroplasty (THA) has been commonly used if the patient does not respond to the initial protected weight bearing treatment. We present a case of a 48-year-old male with SIFFH who was treated with core hip decompression and bone void filler as a hip-preserving alternative to THA. The patient has an excellent clinical and radiographic result at final follow up. Core hip decompression with bone void filler is a less invasive alternative to THA, and may be a preferred initial treatment strategy for SIFFH in the young and active patient who has failed conservative measures.
Hugo H. Hermanussen; Mariano E. Menendez; Neal C. Chen; David Ring; Ana-Maria Vranceanu
Volume 4, Issue 4 , October 2016, , Pages 359-365
Abstract
Background: Little is known about the influence of habitual participation in physical exercise and diet on upper-extremity physical function in older adults. To assess the relationship of general physical exercise and diet to upper-extremity physical function and pain intensity in older adults. ...
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Background: Little is known about the influence of habitual participation in physical exercise and diet on upper-extremity physical function in older adults. To assess the relationship of general physical exercise and diet to upper-extremity physical function and pain intensity in older adults. Methods: A cohort of 111 patients 50 or older completed a sociodemographic survey, the Rapid Assessment of Physical Activity (RAPA), an 11-point ordinal pain intensity scale, a Mediterranean diet questionnaire, and three Patient- Reported Outcomes Measurement Information System (PROMIS) based questionnaires: Pain Interference to measure inability to engage in activities due to pain, Upper-Extremity Physical Function, and Depression. Multivariable linear regression modeling was used to characterize the association of physical activity, diet, depression, and pain interference to pain intensity and upper-extremity function. Results: Higher general physical activity was associated with higher PROMIS Upper-Extremity Physical Function and lower pain intensity in bivariate analyses. Adherence to the Mediterranean diet did not correlate with PROMIS Upper-Extremity Physical Function or pain intensity in bivariate analysis. In multivariable analyses factors associated with higher PROMIS Upper-Extremity Physical Function were male sex, non-traumatic diagnosis and PROMIS Pain Interference, with the latter accounting for most of the observed variability (37%). Factors associated with greater pain intensity in multivariable analyses included fewer years of education and higher PROMIS Pain Interference. Conclusions: General physical activity and diet do not seem to be as strongly or directly associated with upper-extremity physical function as pain interference.
Shoulder
Davod Jafari; Hooman Shariatzadeh; Farid Najd Mazhar; Mohammad Ali Okhovat; Mehran Razavipour
Volume 5, Issue 1 , January 2017, , Pages 66-69
Abstract
Osteochondritis dissecans (OCD) is a common joint disorder in knee, ankle and elbow, however it can be rarely found in glenohumeral joint. In this study, we report an asymptomatic case of humeral head OCD, which was detected incidentally following a trauma. X-rays showed an area of lucency around ...
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Osteochondritis dissecans (OCD) is a common joint disorder in knee, ankle and elbow, however it can be rarely found in glenohumeral joint. In this study, we report an asymptomatic case of humeral head OCD, which was detected incidentally following a trauma. X-rays showed an area of lucency around an oval bony fragment measuring about 1 cm on the superior aspect of the humeral head. However, the patient was pain-free and the shoulder range of motion was normal.