@article { author = {S. Mudgal, Chaitanya}, title = {Many Drops Make a Lake}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {1-1}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {}, abstract = {The desire and drive for excellence in any endeavor in life requires an effort from the individual; in addition it requires a constellation of features around such individuals that help them to become successful. For surgeons, it is the operating room staff, the administrative and medical assistants and our residents and fellows. However, perhaps the most important contribution to a physician’s success, are his or her patients.  As I get older, I find myself doing and saying things that seemingly, just a few years ago I used to hear my own teachers say and do. And then with some wry amusement, I wonder...when did this change happen in me? Change is inevitable, progressive and relentless. However, what remains constant is the compassion and care that our patients need and deserve. In this day and age of advancing technology and minimally invasive surgery, sometimes we surgeons forget that our patients are human beings. Our patients are the ones who teach us the most. It is therefore incumbent upon us to treat them with the greatest amount of dignity and respect that is possible. Sir Isaac Newton had said “If I have seen further, it is by standing on the shoulders of giants”. My fervent advice to all my trainees is to recognize and acknowledge their own personal giants early and often, for it is their shoulders upon which they will stand to see further. First and foremost among my personal giants are my patients, and then my parents, my teachers, my wife and children. It is they who have collectively helped me to achieve my personal goals.  It is imperative that as clinicians and scientists we strive for excellence, and also continuously remember to be humble. Drs. Ebrahimzadeh, Kachooei and their team embody this very principle. Their efforts in getting this journal organized and come to fruition are enormous. Yet, it is the result of a collective effort to achieve excellence for the ongoing care of our patients; the desire to achieve greater knowledge, better skills and disseminate this knowledge through this journal to influence as many physicians and their patients as possible. They have taken the knowledge of their teachers, recognized their giants and are now poised to see further than ever before. My grandmother often used to quote to me a proverb from India, which when translated literally means “Many drops make a lake”. I cannot help but be amazed by the striking similarities between the words of Newton and this Indian saying. Therefore, while it may seem intuitive, I think it must be stated that it is vital for the betterment of all our patients that we recognize our own personal lakes to put our drops of knowledge into. More important is that we recognize that it is incumbent upon each and every one of us to contribute to our collective lakes of knowledge such as ABJS. And finally and perhaps most importantly we need to be utterly cognizant of never letting such lakes of knowledge run dry.... ever.}, keywords = {Many Drops Make a Lake}, url = {https://abjs.mums.ac.ir/article_2359.html}, eprint = {https://abjs.mums.ac.ir/article_2359_94f0122846c677e8c920ce32a289f7dd.pdf} } @article { author = {Graf, Reinhard}, title = {Is DDH still a problem?}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {2-3}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {}, abstract = {Developmental dysplasia of the hip (DDH) is the most frequent developmental disorder of the locomotor system. It is detected among 0.1–5.2% of newborns (1, 2). This might be the reason, that there is a high interest to detect DDH cases as early as possible. Undetected or late cases lead to catastrophes for the patient and family. Limping, leg length discrepancy, pain, frequent operations and sometimes femoral head necrosis, osteoarthritis, disability and finally total hip replacement even in young ages are results of a dysplastic hip that is not diagnosed on time or left untreated or treated improperly. Independent from individual patient problems the treatment costs for late or neglected cases are enormous. Costs of hospitalization, operations, rehabilitation, and indirect costs because of limited ability to work are incredible high. In countries with poor common health-system these patients have no chance for a normal life because of their disability.   How to solve or reduce the problem Clinical examination (Ortolani,Barlow etc.) is used very often in different countries routinely, but not generally worldwide. The literature is quite clear; clinical examinations can reduce but not solve the problem. It need “well trained and experienced doctors”! But what is the definition of a “well trained and experienced doctor”? How it can happen, that in spite of clinical examination we see neglected cases? More than 5o% of DDH cases does not have any “typical” risk factor. The clinical examination is very often so subjective, that even fully dislocated joints cannot be detected and may be missed.   Critical questions 1- What is the Ortolani and the Barlow sign, the Glissement, the dry click sign, the phenomenon of the loose joint capsule and the “click” according to Tönnis D? 2- What sign in what age is normal? When does one of these signs change to the other one? 3- What is the pathology inside the joints, when you feel one of these clinical signs?   First conclusion Clinical examination is good, but has a lot of problems. We cannot solve the problem only with manually examination of risk babies, we need EVIDENCE! We must look for a method, which is objective with measurable results, which is reproducible, independent from doctor`s experience and skill, without radiation and with low costs.   The solution is Hip Sonography! We introduced this technique in 1980s and developed continuously in the last 30 years (3). In many European countries with a high standard of the common health system (e.g Germany, Austria, Switzerland etc.) all babies will be checked after birth sonographically by Graf technique.   The screening is a very effective method Diagnosis and treatment, if necessary, within the first 5 weeks reduce the operation rate (open reductions, acetabularplasties) as well as head necrosis clearly and shorten the time for conservative treatment (4). The costs for ultrasound-screening and the treatment together are one third cheaper than the treatment cost alone before introduction of ultrasound-screening (5).   Where are the problems and how to solve them? 1- Methodical problems The method was developed continuously and we learned from our mistakes. It is frustrating to see “modified” techniques in some other countries with the same mistakes we have done 20 years ago. Statements like “Ultrasound leads to over diagnose” or “not all dislocated hips can be detected by sonography” are based on “modified” techniques. These techniques are forbidden in Europe.   2- Teaching and learning curve In our countries we have restrict rules, who can do hip sonography? the doctors need a certificate after training courses by authorized teacher. The qualities of the sonograms are controlled by a special commission.   3- To screen or not to screen” is not the question, it`s politics! With hip sonography, the doctors in our countries cannot earn much money, but it must be clear to us, that it is a service to our babies and the next generation, also to our future. Before any discussions about screening, we must look for good trained colleagues. It`s better to do nothing, than to do it in a wrong way! DDH often is seen in cold climates worldwide. In central Europe (especially Alp region), DDH prevalence was high up to early 80`s, before introduction of ultrasound screening of the hip. It was a very frequent orthopedic problem. The infant hip surgeries were the main daily business of a great number of orthopedic surgeons in German speaking countries, Stolzalpe/Austria above all, in the past. Now, after a long period of development of the infant hip sonography and detecting the DDH is as good as gone. The pediatric orthopedic surgeons have in fact no more infant hips to operate, which is good for the children and their parents and even good for the economy of the health service. Although there is no longer a challenge for the surgeons, we have to improve the diagnosis of DDH and simplify its treatment. I am happy to see such a great interest and efforts for Hip sonography around the globe. It is my pleasure to introduce the technique to Iranian colleagues. I am honored to support my Iranian friends with training courses in Teheran and Mashhad and to welcome colleagues from your wonderful country also in Stolzalpe/Austria.}, keywords = {DDH}, url = {https://abjs.mums.ac.ir/article_2360.html}, eprint = {https://abjs.mums.ac.ir/article_2360_db60820c662ff6a344e8ab19ae3df51c.pdf} } @article { author = {Rodriguez-Merchan, E. Carlos}, title = {Evidence Based Conservative Management of Patello-femoral Syndrome}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {4-6}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2361}, abstract = {Background:   Patellofemoral pain syndrome (PFPS) is defined as pain surrounding the patella when sitting with bent knees for prolonged periods of time or when performing activities like ascending or descending stairs, squatting or   athletic activities. Patella dislocation is not included in PFPS.     Purpose:   This review analyzes the evidence based conservative management of PFPS.   Methods:   A Cochrane Library search related to PFPS was performed until 18 January 2014. The key words were: patellofemoral pain syndrome. Eight papers were found, of which three were reviewed because they were focused   on the topic of the article. We also searched the PubMed using the following keywords: evidence based conservative   management of patellofemoral pain syndrome. Twelve articles were found, of which seven were reviewed because   they were focused on the topic of the article. Overall ten articles were analyzed.     Results:   Different treatments can be tried for PFPS, including pharmacotherapy, therapeutic ultrasound, exercise therapy, and taping and braces.     Conclusions:   Non-steroidal anti-inflammatory drugs (NSAIDs) may reduce pain in the short term, but pain does not improve after three months. Therapeutic ultrasound appears not to have a clinically important effect on pain relief for   patients with PFPS. The evidence that exercise therapy is more effective in treating PFPS than no exercise is limited   with respect to pain reduction, and conflicting with respect to functional improvement. No significant difference has   been found between taping and non-taping. The role of knee braces is still controversial. More well-designed studies are needed.    }, keywords = {Conservative Management,knee,patellofemoral pain syndrome}, url = {https://abjs.mums.ac.ir/article_2361.html}, eprint = {https://abjs.mums.ac.ir/article_2361_c81954f0712dde869bc2f0866c8c011e.pdf} } @article { author = {parsa, Ali and Hallaj Moghadam, Mohammad and Taraz Jamshidi, Mohammad H}, title = {Relapsing and Residual Clubfoot Deformities After the Application of the Ponseti Method:A Contemporary Review}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {7-10}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2362}, abstract = {  The Ponseti method is a safe and effective treatment for congenital clubfoot, and radically decreases the need for extensive corrective surgery. But a group of patients will still present with under corrected residual equinovarus deformities despite the proper use of the Ponseti method. About 25% of operated clubfeet will develop recurrence or show a marked residual deformity (recurrent clubfoot); however, in the recent literature, the failure rate of the Ponseti method, defined by the need for corrective surgery, ranges from 3% to 5%. Deformities encountered in patients with residual clubfeet comprise of various degrees of equinus, varus, adduction, supination, cavus, and toe deformity. Joint flexibility or stiffness, tarsal dysmorphism, articular incongruence, and progressive degrees of degeneration may be also present. We try to emphasize the current solutions for these deformities. }, keywords = {clubfoot,Ponseti,Relapse,Residual}, url = {https://abjs.mums.ac.ir/article_2362.html}, eprint = {https://abjs.mums.ac.ir/article_2362_3c719fe72d718efa77d198a08ee03920.pdf} } @article { author = {Tan, Haitao and Luo, Xiang and Yang, Keqin and Jiang, Jianzhong and Wei, Pingou and Zhao, Jinming}, title = {Repair of Minor Tissue Defect in Hand by Transfer of Free Tissue Flap from the Toe}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {11-16}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2366}, abstract = {Background:   To introduce our experience of using the free neurovascular flap from great and second toe. Methods:   Thirteen patients (fifteen fingers) sought surgical treatment for soft tissue defects of the hand at our medical institutin between March 2006 and September 2009. In two patients, fibular side skin-nail flaps of great toe were applied to cover the dorsal defect of distal thumb. In twelve, in the treatment of pulp defect of finger with fibular side flap of great toe or tibial side flap of second toe. In one, in the treatment of defect of distal middle with composite flap with distal digital bone of second toe. Results:   All flaps were survived. The average subjective satisfaction score was 8.08 (range 4-10). Nine patients (69%) experienced cold intolerance, and 2 patients (15%) dysesthesia. The Semmes-Weinstein sensitivity score was between 3.47and 4.72 on the flap, and 0-4.18 on the donor site. The mean two-point discrimination was 6.8 mm (range 4-12). Grip strength was 10% less than in the unaffected hand. The proximal interphalangeal mobility loss was less than 15 degrees. Conclusions:   Our results indicated that these free flaps from toe are useful for patients with a small soft-tissue defect in hand.}, keywords = {Free neurovascular flap,Hand tissue defect,Toe}, url = {https://abjs.mums.ac.ir/article_2366.html}, eprint = {https://abjs.mums.ac.ir/article_2366_950f0a016541e8a49277c0ee2eeb53e0.pdf} } @article { author = {Rao, Ting and Wu, Fei and Xing, Danmou and Peng, Zhengren and Ren, Dong and Feng, Wei and Chen, Yan and Zhao, Zhiming and Wang, Huan and Wang, Junweng and Kan, Wusheng and Zhang, Qingsong}, title = {Effects of Valproic Acid on Axonal Regeneration and Recovery of Motor Function after Peripheral Nerve Injury in the Rat}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {17-24}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2367}, abstract = {Background:   Valproic acid (VPA) is used to be an effective anti-epileptic drug and mood stabilizer. It has recently been demonstrated that VPA could promote neurite outgrowth, activate the extracellular signal regulated kinase pathway, and increases bcl-2 and growth cone-associated protein 43 levels in spinal cord. In the present research we demonstrate the effect of VPA on peripheral nerve regeneration and recovery of motor function following sciatic nerve transaction in rats. Methods:   The rats in VPA group and control group were administered with valproic acid (300mg/kg) and sodium chloride respectively after operation. Each animal was observed sciatic nerve index (SFI) at 2-week intervals and studied electrophysiology at 4-week intervals for 12 weeks. Histological and morphometrical analyses were performed 12 weeks after operation. Using the digital image-analysis system, thickness of the myelin sheath was measured, and total numbers of regenerated axons were counted. Results:   There was a significant difference in SFI, electrophysiological index (motor-nerve conduct velocity), and morphometrical results (regenerated axon number and thickness of myelin sheath) in nerve regeneration between the VPA group and controls (   P<0.05). Conclusions:   The results demonstrated that VPA is able to enhance sciatic nerve regeneration in rats, suggesting the potential clinical application of VPA for the treatment of peripheral nerve injury in humans.}, keywords = {Bcl-2,Growth cone-associated protein 43,Myelin,Rat,Sciatic nerve index,Valproic acid}, url = {https://abjs.mums.ac.ir/article_2367.html}, eprint = {https://abjs.mums.ac.ir/article_2367_f34087cf7dcb74f2f86369f7ba954171.pdf} } @article { author = {Siavashi, Babak and Zehtab, Mohammad Javad and Mohseni, Nima and Ramim, Tayeb}, title = {Clinical Outcomes of Total Hip Arthroplasty in Patients with Ankylosed Hip}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {25-30}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2368}, abstract = {Background:   Various drugs are administered intra-articularly to provide postoperative analgesia after arthroscopic 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.}, keywords = {Analgesia,Dexmedetomidine,Intra-articular,Knee Surgery,Postoperative pain}, url = {https://abjs.mums.ac.ir/article_2368.html}, eprint = {https://abjs.mums.ac.ir/article_2368_6d66aff07e159f6770376d9837a90244.pdf} } @article { author = {Fakoor, Mohammad and Sarafan, Naser and Mohammadhoseini, Payam and Khorami, Mohsen and Arti, Hamidreza and Mosavi, Seyedshahnam and Aghaeeaghdam, Amir}, title = {Comparison of Clinical Outcomes of Scarf and Chevron Osteotomies and the McBride Procedure in the Treatment of Hallux Valgus Deformity}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {31-36}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2412}, abstract = {Background:   Hallux valgus deformity is a common chronic problem in middle age and elderly. Different surgical procedures have been introduced so far with their proposed indications for each. This study aimed to compare three   current procedures namely Chevron osteotomy, Scarf osteotomy and McBride technique.     Methods:   In this study, 44 patients were included from 2010 to 2013. All patients had been undergone one of the three current procedures including Chevron, Scarf or McBride techniques. Preoperative and follow-up radiographies     were evaluated in terms of hallux valgus and intermetatarsal angles. Foot Ankle Disability Index was filled to assess the functional. A Visual Analogue Scale evaluated pain. Also, satisfaction, aesthetic and the rate of recurrence were evaluated. Results:   Functional score, aesthetic and satisfaction level were higher in Scarf technique rather than Chevron and McBride techniques. Also, pain score and recurrence rate were lower in Scarf Technique rather the other two techniques.     Conclusions:   With respect to better results with Scarf osteotomy in this study, we recommend Scarf osteotomy as   a first choice for treatment of moderate hallux valgus deformity.}, keywords = {Chevron osteotomy,Hallux valgus,McBride procedure,Scarf osteotomy}, url = {https://abjs.mums.ac.ir/article_2412.html}, eprint = {https://abjs.mums.ac.ir/article_2412_eb9eeeba9c0d15e800bebc975a6b5da7.pdf} } @article { author = {Mashhadinezhad, Hosein and Samini, Fariborz and Zare, Reza}, title = {Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {37-42}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2369}, abstract = {Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA) granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05)   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.    }, keywords = {Autograft,Cage,Hydroxyapatite granules,Interbody fusion,Settling ratio}, url = {https://abjs.mums.ac.ir/article_2369.html}, eprint = {https://abjs.mums.ac.ir/article_2369_211106998b78a03ec49fb05a0d7c4e73.pdf} } @article { author = {Aslani, Hamid Reza and Zafarani, Zohreh and Ebrahimpour, Adel and Salehi, Shahin and Moradi, Ali and Sabzevari, Soheil}, title = {Early Clinical Results of Arthroscopic Remplissages in Patients with Anterior Shoulder Instability with Engaging Hill-Sachs Lesion in Iran}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {43-46}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2370}, abstract = {Background:   To assess the outcome of the remplissage arthroscopic surgical method in patients with anterior shoulder dislocation associated with Hill-Sachs lesion.     Methods:   Ten patients with anterior shoulder dislocations and Hill-Sachs lesions were entered into this study and were operated on by the remplissage arthroscopic surgical method. They were followed up 22 months after surgery in   order to evaluate the outcome of the treatment, including recurrence of dislocation and motion limitation.     Results:   During the internal follow up period no case of recurrence was found. Motion limitation during the follow up   period was not significant (internal rotation limitation=5°±1°, and external rotation limitation=4°±1°) Conclusions:   Our findings suggest that the remplissage arthroscopic surgical method is an acceptable, safe and   reliable treatment for anterior shoulder dislocation with engaging Hill-Sachs lesion.}, keywords = {Anterior shoulder dislocation,Hill-Sachs,Remplissage and arthroscopy}, url = {https://abjs.mums.ac.ir/article_2370.html}, eprint = {https://abjs.mums.ac.ir/article_2370_a149c3ede3fb9b8bf4944c3101941a36.pdf} } @article { author = {Ebrahimipour, Hossein and Mirfeizi, Seyedeh Zahra and Vafaee Najar, Ali and Kachooei, Amir Reza and Ariamanesh, Amir Shahriar and Ganji, Reza and Esmaeeli, Habibollah and Salari, Hedayat and Vejdani, Marjan}, title = {Developing an Appropriateness Criteria for Knee MRI Using the Rand Appropriateness Method (RAM)-2013}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {47-51}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2371}, abstract = {  Background: Knee pain is one of the most common reasons patients visit their physician. In this regard Magnetic Resonance Imaging (MRI) is the tool of preference for diagnosis. The aim of this study was to determine appropriate guidelines for knee MRI administration using the RAND Appropriateness Method (RAM)-2013   Methods: This qualitative study was done in the Mashhad University of Medical Sciences in 2013. The most appropriate approved knee MRI administration clinical guidelines were evaluated using Guidelines Evaluation and Research Appraisal (AGREE). Panel members consisting of six orthopedic and three rheumatologic doctors gave scores ranging from 1 to 9 for each scenario. The indications were grouped as appropriate, equivocal and inappropriate. Data were analyzed by descriptive statistics and SPSS ver. 18 software. Results: Sixty-three scenarios were extracted from the guidelines and then the scenarios were evaluated in 26 indications. Thirty-two (50.79%) cases were considered appropriate, 12 (19.04%) cases uncertain and 19 (30.1%) cases inappropriate. Conclusions: The RAND appropriateness method is helpful in identifying the opinion of stakeholders in health care systems. Moreover, making practical use of clinical guidelines can improve patients’ quality of care and prevent unnecessary costs. }, keywords = {Guideline,Knee joint,MRI,RAND Appropriateness Method}, url = {https://abjs.mums.ac.ir/article_2371.html}, eprint = {https://abjs.mums.ac.ir/article_2371_72fce7253173df438f3bbf0476fa62a4.pdf} } @article { author = {Alipour, Mohammad and Tabari, Masoomeh and Farhadifaz, Reza and Makhmalbaf, Hadi and Salehi, Maryam and Moosavitekye, Seyed Mostafa}, title = {Effect of Dexmedetomidine on Postoperative Pain in Knee Arthroscopic Surgery; a Randomized Controlled Clinical Trial}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {52-56}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2372}, 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 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.}, keywords = {Dexmedetomidine,Intra-articular,Knee Surgery,Postoperative pain}, url = {https://abjs.mums.ac.ir/article_2372.html}, eprint = {https://abjs.mums.ac.ir/article_2372_4865adad5c8557e3148e06ec5b176e09.pdf} } @article { author = {Ebrahimzadeh, Mohammad H and Makhmalbaf, Hadi and Birjandinejad, Ali and Golhasani keshtan, Farideh and Hoseini, Hosein Asghar and Mazloumi, Seyed Mahdi}, title = {The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian Speaking Patients with Knee Osteoarthritis}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {57-62}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2373}, 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 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. }, keywords = {Iranian version,Knee Osteoarthritis,KOOS,Persian,Reliability,Validity,WOMAC}, url = {https://abjs.mums.ac.ir/article_2373.html}, eprint = {https://abjs.mums.ac.ir/article_2373_5340e98d9e945c92b95c19316a30b834.pdf} } @article { author = {Bazavar, Mohammadreza and Rouhani, Alireza and Tabrizi, Ali}, title = {Simultaneous Dorsal Base Fracture and FDP Avulsion of Distal Phalanx of the Little Finger}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {63-65}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2375}, abstract = {Avulsion injury of the flexor digitorum profundus (FDP) with concomitant fracture of the distal phalanx dorsal base is uncommon. Simultaneous avulsion fractures of the insertion of this tendon associated with rupture of the tendon from the bony fragment and combination with dorsal base fracture is very rare and also complicated. A 36- year- old man fell and injured his right little finger. FDP avulsion with simultaneous dorsal base fracture (containing extensor Tendon insertion) was detected. Our surgical repair by a single midlateral incision the avulsed fragment was replaced on the palmar base of the distal phalanx and successfully immobilized with 1.5 mm screw. After three months, patient had 20 degree range of motion in DIP joint. The digit was pain free and also relatively functional. It seems that FDP avulsion classification need to be extended and include this uncommon type as described in this case report for better management of these uncommon type.}, keywords = {Dorsal Base Fracture,FDP avulsion,Phalanx}, url = {https://abjs.mums.ac.ir/article_2375.html}, eprint = {https://abjs.mums.ac.ir/article_2375_ab1a8d27d324d273b696d84ddaf1c5f6.pdf} } @article { author = {Sdeghifar, Amir R and Ahmadzadeh Heshmati, Afshin}, title = {Dysplasia Epiphysealis Hemimelica (Trevor Syndrome) of Talus in a 21-Year Old Woman; Case Report}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {66-68}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2377}, abstract = {Dysplasia epiphysealis hemimelica is a rare nonhereditary epiphyseal disease that mimics synovial chondromatosis and osteochondroma of the joints. The disease mainly involves long bones of the lower extremities and tarsal bones. Herein we report 21-year old woman who presented with pain and limited range of ankle motion, who underwent surgical excision of talus exostosis after preoperative imaging and careful planning. after that she was discharged and her problem improved and she have no problem in three year follow up .pathologic examination of specimen confirm the diagnosis.}, keywords = {Dysplasia epiphysealis hemimelica,Talus}, url = {https://abjs.mums.ac.ir/article_2377.html}, eprint = {https://abjs.mums.ac.ir/article_2377_3845175242682036ad3d433cb13de2b6.pdf} } @article { author = {Solooki, Saeed and Azad, Ali}, title = {Simultaneous of Mid Third Clavicle Fracture and Type 3 Acromioclavicular Joint Dislocation; A Case Report}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {69-71}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2379}, abstract = {  Simultaneous mid third clavicle fracture and acromioclavicular joint dislocation is a rare combination injury, as a result of high-energy trauma. We report a patient with a middle third clavicle fracture and ipsilateral grade three-acromioclavicular joint dislocation, which is a rare combination. The patient wanted to get back to work as soon as possible, so the fracture was fixed with reconstruction plate after open reduction and plate contouring; and acromioclavicular joint dislocation was reduced and fixed with two full threaded cancellous screws. One screw was inserted through the plate to the coracoid process. Clinical and radiographic finding revealed complete union of clavicle fracture and anatomical reduction of acromioclavicular joint with pain free full joint range of motion one year after operation. }, keywords = {Acromioclavicular joint dislocation,Level of evidence: IV,Mid-third clavicle fracture}, url = {https://abjs.mums.ac.ir/article_2379.html}, eprint = {https://abjs.mums.ac.ir/article_2379_1598a441cb6f9ade06b1b57638446954.pdf} } @article { author = {Fattahi, Asieh Sadat and Maddah, Godratollah and Motamedolshariati, Mohammad and Ghiasi–Moghadam, Taghi}, title = {Chronic Low Back Pain due to Retroperitoneal Cystic Lymphangioma}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {72-74}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2380}, abstract = {  Abdominal cystic lymphangioma is a rare benign neoplasm. Less than 1% of lymphangiomas is in the retroperitoneum. Lymphangioma is mostly asymptomatic. Chronic symptoms were reported in retroperitoneal type more than others. Acute symptoms due to complications like infection, cyst rupture or hemorrhage may occur. We report an 18-years-old girl with low back pain from 6 months ago with huge pelvic mass and diagnosis of retroperitoneal cystic lymphangioma. }, keywords = {Low back pain,Lymphangioma,Retroperitoneum}, url = {https://abjs.mums.ac.ir/article_2380.html}, eprint = {https://abjs.mums.ac.ir/article_2380_04bcb3480dc9b22ddc4434c90fa847fa.pdf} } @article { author = {Taraz Jamshidi, Mohammad H and Mirkazemi, Masoud and Birjandinejad, Ali}, title = {Posterior Hip Fracture -Dislocation Associated with Ipsilateral Intertrochantric Fracture; a Rare Case Report}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {75-78}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2383}, abstract = {Hip dislocation occurs when the femur does not break and the force is transmitted towards the hip joint leading to a posterior dislocation of the femoral head with or without posterior acetabular fracture. We present the case of a 26 year old patient involved in motor vehicle accident. Clinical and imaging (radiography, CT) examination revealed an intertrochanteric fracture associated with ipsilateral posterior hip dislocation and posterior acetabular wall fracture simultaneously with epsilateraal tibial and fibular fractures. Such associations is very rare and can be explained by an extremely powerful force generated the three lesions simultaneously. This case is important not only because of its extreme rarity but also because of treatment method.}, keywords = {Hip,Hip Dislocation,Hip fracture-dislocation,Intertrochantric fracture}, url = {https://abjs.mums.ac.ir/article_2383.html}, eprint = {https://abjs.mums.ac.ir/article_2383_a9816858992c22d96811bb5b5b035e2e.pdf} } @article { author = {Gharehdaghi, Mohammad and Hassani, Mohammad and Khooei, Ali R and Ghodsi, Elaheh and Taghizadeh, Ali}, title = {Multicentric Myxoid Liposarcoma; a Case Report and Literature Review}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {79-81}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2413}, abstract = {  Liposarcoma is a common malignant soft tissue tumor, accounting for 10% to 16% of all sarcomas. Multicentric myxoid liposarcoma is an uncommon condition. Differentiation between several primary tumors and metastasis of a single liposarcoma represents the main difficulty in diagnosis. A 47-years old woman presented with right thigh myxoid liposarcoma and underwent wide margin tumor resection. Other investigations like CXR, abdominal and pelvic CT-scans were negative. After 18 months another myxoid liposarma was found in her ipsi-lateral breast without any evidence of other organs metastasis. Second lesion location, time between two presentation and cytogenetic differences are accepted criteria to site a sarcoma in multicentric category, but in myxoid liposarcoma these can be explained by the special features inherent to this tumor.  }, keywords = {Liposarcoma,Multicentric,Myxoid}, url = {https://abjs.mums.ac.ir/article_2413.html}, eprint = {https://abjs.mums.ac.ir/article_2413_1322e04eee9420d0317ed1be72a113b5.pdf} } @article { author = {Ortiz, Mario I. and Romero-Quezada, Luis C.}, title = {Analgesic Effect of Gabapentin on Post-Operative Pain After Arthroscopic Anterior Cruciate Ligament Reconstruction}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {82-83}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2384}, abstract = {To the Editor Mardani-Kivi et al presented results about a triple blinded randomized controlled trial with gabapentin in patients that underwent anterior cruciate ligament (ACL) reconstruction (1). In their manuscript, the introduction section is very illustrative about the subject. With respect to methodology, it is well known that the physical diagnosis of ACL injury is particularly difficult in several patients, and partial ACL tears are also difficult to diagnose on physical examination. In this particular case, how did the authors obtain the diagnosis of ACL in the patients? Likewise, ACL reconstruction can be delayed several weeks or months until the swelling has decreased and there is an appropriate range of motion. For this reason, I want to ask: was the cause of the ACL injury homogeneous in all patients?; was the time delay of the surgery the same for everyone; and was the type of damage the same for all participants? Meperidine is an opioid with analgesic effects. The American Pain Society and the Institute for Safe Medication Practice (ISMP) do not recommend meperidine use as pain relieving medication or they recommend it only in very special cases and with many precautions during its administration (2, 3). What was the rationale of the authors choosing meperidine as analgesic drug? In this same sense, authors did not indicate in their manuscript whether meperidine was administered by oral, intramuscular or intravenous pathways or patient-controlled analgesia. The time schedule of meperidine administration was not indicate in the manuscript; was meperidine administered q4h or q6h? How many doses were received by patients? I think it was a mistake to publish the demographic data of all patients (n=114). You had to eliminate the patients deleted in the presentation of the demographic characteristics of the patients (n=108), that is more correct. Table 2 and 3 were poorly prepared. Table 2 has missing data about the results at 24 hours in the placebo group. Table 3 does not specify the meaning of the values (milligrams or administration times or what the units were?)(Table 1, 2). Finally, pre-emptive analgesia is defined as the treatment that is initiated before and is operational during the surgical procedure in order to reduce the physiological consequences of nociceptive transmission provoked by the procedure (4). Do authors have any idea or hypothesis about the possible mechanism of gabapentin to produce pre-emptive analgesia in your patients? Are the injury and the surgical technique employed in your study candidate to pre-emptive analgesia? Was the meperidine utilization in your study the better option to get pre-emptive analgesia?  }, keywords = {Analgesic Effect,Gabapentin,anterior cruciate ligament,Reconstruction}, url = {https://abjs.mums.ac.ir/article_2384.html}, eprint = {https://abjs.mums.ac.ir/article_2384_d31ccedb030fc17897fd875c3ed48cb6.pdf} } @article { author = {Mardani-Kivi, Mohsen}, title = {Reply to "Analgesic Effect of Gabapentin on Post-Operative Pain After Arthroscopic Anterior Cruciate Ligament Reconstruction"}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {82-83}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2406}, abstract = {In Reply Dr. Ortiz and Dr. Romero-Quezada evaluated our study precisely and authors are grateful for their great survey on our article. There were some questions and concerns that we are going to answer. We wish it could help others to come up with better ideas and conclusions. 1. ACL tear may occur in two scenarios and we believe that there is not a third one: 1st- the ACL injury functionally disables the patient and becomes symptomatic; in this scenario the patient would suffer from giving way and the “Lachman test” is definitely positive (3+ or 4+) (1). Intra-operatively (post anesthesia) “Pivot shift test” is almost positive in all cases. 2nd- ACL injury does not conflict with the patient’s routine and social activity and giving way are usually negative and Lachman test can be negative, 1+ and in the most severe condition 2+ positive. Partial ACL tear may be reported in MRI, however authors believe these cases do not benefit from a surgical intervention, and conservative treatment should be performed. 2. Although most of our patients were suffered from sports trauma, mechanisms of ACL tears were not the same in all patients. The duration between traumas to surgeries in all patients enrolled in this study were at least 6 weeks which were included the proceeding from acute trauma phase to performing physical therapy and accomplishing full range of motion pre-operatively. Since the present study was not about surgical technique and pre or post rehab protocols and programs, authors avoided such additional issues. 3. About Pethidine issue, this drug is the main protocol one in our hospital to provide analgesics for post-operative pain, so authors routinely decided to utilize the pethidine as analgesics such as recent relative article (2). We used the pethidine intravenously and by patient’s demand; if a patients requested for pain killers, we provided him/her with 0.5 mg-per-Kg pethidine which was injected intravenously. The time and amount of requested pethidine for every patient were different and patient-dependent and were registered in the medical file for further evaluations. 4. Since randomization was performed prior to surgery, all eligible cases were first randomized in the intervention or control groups. So to our knowledge, primary demographic characteristics were better to contain all eligible case rather than those who remained in the trial. If we would demonstrated the data, as you had commented, one may object that the data is not complete and how can someone be sure about the randomization, so we prefer to put all the data. 5. The criticism about table 2 is correct. The table we have sent to the journal has been probably mis-typed during the publishing process. The original table is attached to the end of this manuscript. Your comment about the table 3 is correct again; it is the mean pethidine consumption during the first 6 and 24 hour (in milligrams). 6. The main purpose of this study is to apply another agent to decrease the opioid consumption after arthroscopic surgeries such as recent works (3, 4). It was the main reason of utilizing Gabapentin as an adjuvant to the pethidine to evaluate whether it could facilitate the decrease of opioid consumption and its complication. Finally authors wanted to show their appreciations to Dr. Ortiz and Dr. Romero-Quezada for their precise and meticulous comments.}, keywords = {Analgesic Effect,Gabapentin,Anterior cruciate ligament reconstruction}, url = {https://abjs.mums.ac.ir/article_2406.html}, eprint = {https://abjs.mums.ac.ir/article_2406_a88050194dbf00b9eb6430422ecc13a0.pdf} } @article { author = {Rivlin, Michael and Kachooei, Amir Reza}, title = {Benefits of Either Operative or Non-Operative Treatment for Perilunate Dislocation and Fracture Dislocations}, journal = {The Archives of Bone and Joint Surgery}, volume = {2}, number = {1}, pages = {84-85}, year = {2014}, publisher = {Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association}, issn = {2345-4644}, eissn = {2345-461X}, doi = {10.22038/abjs.2014.2437}, abstract = {Dear Editor We read the article by Bagheri et al with great interest (1). We found the study interesting and comprehensive as four groups of patients, including operative and nonoperative in either pure dislocation or fracture dislocation, were compared in terms of Mayo wrist score, Grip strength, range of motion and radiographic parameters. It seems that the results were comparable to studies by Capo, Chou, Laporte, Malovic, Kremer, Forli and Lutz (Table 1) (2-8). In the studies listed above, all the patients were treated by operative fixation and none of them reported any experience with non-operative treatment (2-8). Their operative results are almost similar to Bagheri’s operative results in which they demonstrated better outcomes in terms of motion and Mayo score than the non-operative counterpart. In the current study by Bagheri et al, non-operative treatment is also discussed, which has little literature support so far (1). We wonder what the indications were leading the patient and the surgeon electing nonoperative treatment versus operative intervention. Since the outcomes of non-operative care were comparable to the operative outcomes, weighing the benefits of non surgical management may be an area of further investigation.The authors didn’t describe the operative intervention in detail making comparisons with outer studies difficult. Therefore, we note the need to compare different operative techniques in the literature to figure out which provide the most optimal outcomes and expedite patients’ rehabilitation.}, keywords = {Non-operative treatment,Perilunate Dislocation,Fracture Dislocations}, url = {https://abjs.mums.ac.ir/article_2437.html}, eprint = {https://abjs.mums.ac.ir/article_2437_b9a386f6f5889081494d06600c606b20.pdf} }