eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2014-06-01
2
2
86
92
10.22038/abjs.2014.3071
3071
Evolution in diagnosis and treatment of Legg-Calve-Perthes disease
Seyed Mahdi Mazloumi
1
Mohammad Hoesin Ebrahimzadeh
2
Amir Reza Kachooei
akachooei@partners.org
3
Ghaem Hospital, Mashhad University of Medical Sciences,
Mashhad, Iran
Orthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran
Orthopedic Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran
Legg-Calvé-Perthes disease (LCPD) is an idiopathic osteonecrosis of the femoral head with variable complications and resultant deformity of the femoral head and osteoarthritis. Suggested risk factors are acetabular retroversion, obesity, latitude, hyperactivity, and coagulopathy. The most commonly applied classification is based on radiolucency in the lateral pillar of the femoral head, which is strongly correlated with the outcome. In the fragmentation stage of the disease involvement can be classified into three groups. After skeletal maturity, the outcome can be classified using the Stulberg classification based on the sphericity and congruence of the femoral head in relation to the acetabulum. The early goal of treatment is to prevent head deformation by weight transmitted forces during remodeling and ossification stages containment is the widely accepted principle of treatment. Although the Petrie cast still has a role in the short-term treatment of LCPD before and during the reossification stage, available data does not support additional benefits from braces during the course of LCPD.
https://abjs.mums.ac.ir/article_3071_ce09c70b9dd0517343986d72549d0359.pdf
Brace
Lateral Pillar
Legg-Calvé-Perthes
Osteotomy
Stulberg classification
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2014-06-01
2
2
93
97
10.22038/abjs.2014.3072
3072
Orthopedic Lesions in Tethered Cord Syndrome: The Importance of Early Diagnosis and Treatment on Patient Outcome
Mohammad Gharedaghi
1
Fariborz Samini
saminif@mums.ac.ir
2
Hosein Mashhadinejad
mashhadinejadm@mums.ac.ir
3
Mahdi Khajavi
khajavi @mums.ir
4
Mohammad Samini
saminim@mums.ac.ir
5
Orthopedic Research Center, Department of Orthopedic
Surgery, Faculty of Medicine, Mashhad University of
Medical Sciences, Mashhad, Iran
Orthopedic Research Center, Department of
Neurosurgery, Faculty of Medicine, Mashhad University
of Medical Sciences, Mashhad, Iran
Orthopedic Research Center, Department of
Neurosurgery, Faculty of Medicine, Mashhad University
of Medical Sciences, Mashhad, Iran
Faculty of Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran
Orthopedic Research Center, Faculty of Medicine,
Mashhad University of Medical Sciences, Mashhad, Iran
Background: Many of the patients with tethered cord syndrome (TCS) are admitted because of neurological symptoms, while some are admitted because of their orthopedic, urologic, anorectal, and dermatologic manifestations.Consequently, this study aimed to evaluate the importance of early diagnosis and treatment of tethered cord syndrome on patient outcome. Methods: Fourty-three patients who underwent surgery because of tethered cord syndrome from 2006 to 2010 were studied. Many of these cases were referred by orthopedic surgeons. All of the findings were recorded and follow up was done twice (1 and 3 years after surgery). Results: Thirty-seven patients were less than 7 years old and 6 were between 17 to 33 years old. According to clinical and neurological exams, satisfactory results were achieved in both groups. Those with early surgical intervention, especially in their early follow up assessment, had the best results. Seventeen cases were referred by an orthopedic surgeon because of manifestations such as leg weakness and numbness, leg pain and spasticity, pes cavus, claw toes, and leg or foot length discrepancy. Cerebrospinal fluid leakage occurred in 3 cases after surgery and 1 showed pseudomeningocele formation. Conclusions: After one year of follow up, initially the results of the treatment were better in early operated cases, but in later follow up assessment (after 3 years) the results were almost the same in both of the groups.
https://abjs.mums.ac.ir/article_3072_c6858b590d5ac15eafbbd7e890303b30.pdf
Orthopedic lesionsn
Tethered cord syndrome
Tight filum terminale
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2014-06-01
2
2
98
102
10.22038/abjs.2014.3073
3073
Comparison of Three Different Methods of Skin Closure in Anterior Midline Incisions of the Knee
Amir Mohammad Navali
1
Ali Tabrizi
2
Shahid Ghazi Teaching Hospital, Tabriz University of
Medical Sciences, Tabriz, Iran
Shohada Teaching Hospital,
Tabriz University of Medical Sciences Tabriz, Iran.
Background: Few clinical trials have studied the functional and cosmetic outcomes of different closure tech- niques of surgical incisions. Skin wound and incision closure methods may influence the healing process and cos- metic outcome. The present study aims at comparing three different suture techniques of skin closure. Methods: In a clinical trial, sixty patients with anterior cruciate ligament reconstruction surgery were studied. At the end of the operation and after subcutaneous tissue closure, the skin incision was divided into three equal parts. Each part was randomly sutured using one of three methods: simple, vertical mattress, or semisubcuticular suture. After six months follow-up, we took a photograph of the healed wound in each individual. The cosmetic outcome was evaluated and rated by three orthopedic surgeons according to the visual analogue scale (zero to 10). During the study, wounds were followed up regularly for dehiscence, infection or abnormal discharges. Results: There were no significant differences between cosmetic results of different suturing methods. The mean and standard deviation of VAS scores obtained from three different observer were 5.62±1.39, 5.62±1.13, 5.65±1.29 for the simple suture; 6.05±1.33, 6.13±1.01, 5.93±1.02 for the vertical mattress technique and 5.72±1.82, 5.81±097 and 5.77±0.99 for the semisubcuticular method. The overall agreements between observers were weak to moderate. Slight superiority of the cosmetic outcome of semisubcuticular sutures was not statistically significant. Conclusions: The methods used for suturing an anterior midline incision of the knee does not seem to affect the final cosmetic outcome and the concept of different surgeons from a favorable cosmetic result may vary considerably.
https://abjs.mums.ac.ir/article_3073_90517ee490346d876997682d075d839a.pdf
Cosmetic
Knee Surgery
Skin Closure
Suture technique
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2014-06-01
2
2
103
105
10.22038/abjs.2014.3074
3074
Comparison of Outcome of Femoral Shaft Fracture Fixation with Intramedullary Nail in Elderly Patient and Patients Younger than 60 Years Old
Asgar Elmi
1
Ali Reza Rohani
2
Ali Tabrizi
3
Shohada Teaching Hospital, Tabriz University of Medical
Sciences, Tabriz, Iran
Shohada Teaching Hospital, Tabriz University of Medical
Sciences, Tabriz, Iran
Shohada Teaching Hospital, Tabriz University of Medical
Sciences, Tabriz, Iran
Background: Although intramedullary nailing (IMN) is an established and accepted operative treatment for femoral shaft fracture in patients younger than 60, there is a lack of data on the results of this treatment on those over 60. The purpose of this study was to determine if the outcome of IMN for femoral shaft fracture in elderly patients is also acceptable. Particular challenges in this group of patients included osteopenia and other associated multiple medical problems frequently observed. Methods: The outcome of 84 patients who had IMN for femoral shaft fracture was reviewed and the results were compared between two groups of patients (younger than 60 and over 60 year old patients). Complications and mortality was analyzed for each group, and then compared between the two groups by testing the null hypothesis that the outcome of treatment in the two groups are similar (P>0.05). Results: The mean duration of follow up was 57.3 months (range: 10-94 months). Incidence of malunion, nonunion, infection, DVT, and dependence on walker/crutch in the groups were similar and differences were not significant (P>0.05). However, incidence of mortality (P<0.05), knee pain, loss of motion, and dependence on cane were significantly higher in elderly patients (P<0.05). Conclusions: There is no significant difference between the outcomes of femoral shaft fracture treatment with IMN fixation in younger patients when compared with elderly patients. However, elderly patients with IMN have more symptoms when compared with younger patients.
https://abjs.mums.ac.ir/article_3074_2aaf92266d804eae98f9e7659f662513.pdf
Elderly
Femoral shaft fracture
Intermedullary nail
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2014-06-01
2
2
106
110
10.22038/abjs.2014.3075
3075
Prevalence of Malignant Soft Tissue Tumors inExtremities: An Epidemiological Study in Syria
Habib Reshadi
1
Alireza Rouhani
2
Saeid Mohajerzadeh
saeid_mohajerzadeh@yahoo.com
3
Marvan Moosa
4
Asghar Elmi
5
Orthopedic Department, Shohada Hospital, Faculty of
Medicine, Tabriz University of Medical Sciences, Tabriz,
Iran
Orthopedic Department, Shohada Hospital, Faculty of
Medicine, Tabriz University of Medical Sciences, Tabriz,
Iran
Orthopedic Department, Shohada Hospital, Faculty of
Medicine, Tabriz University of Medical Sciences, Tabriz,
Iran
The Chief of Surgery and Orthopedic Surgery,
Department of Damascus University, Movasat and
Beyrooni Teaching Hospital, Damascus, Syria
Orthopedic Department, Shohada Hospital, Faculty of
Medicine, Tabriz University of Medical Sciences, Tabriz,
Iran
Background: Although the majority of soft tissue masses are benign, it is important to consider malignancy in differential diagnoses. Because most soft tissue sarcomas present as a painless mass, clinicians must watch for signs suggestive of malignancy, including large size, rapid growth, and site deep into the deep fascia.The purpose of this study was to determine the relative prevalence according to sex and age, site of tumor, skeletal distribution, and treatment (surgery, chemotherapy and radiotherapy) before and after surgery, and ascertain the relative frequency of these tumors in specific anatomic sites and age groups based on pathological studies. Methods: A total of 308 patients, with a musculoskeletal tumor were evaluated retrospectively. All of the patients enrolled into this study were referred to the Beirouni Hospital of Damascus University with a proven diagnosis of alignant soft tissue tumors from the beginning of January 2008 until the end of 2010. The prevalence of the malignant soft tissue tumors in these patients was analyzed. For purposes of analysis, all lesions were placed in 1 of 9 categories: hand and wrist, forearm, humorous (arm), proximal limb girdle (axilla and shoulder), foot and ankle, thigh, hip and buttocks region, trunk, and other lesions. Age and sex also were recorded. Results: Malignant tumors consisted of seven diagnostic categories: malignant fibrous histiocytoma (23%), liposarcoma (22%), rhabdomyosarcoma (9%), leiomyosarcoma (8%), malignant schwannoma (5%), dermatofibrosarcoma protuberans (5%), synovial sarcoma (10%), fibrosarcoma (13%), extraskeletal chondrosarcoma (1%), and extraskeletal Ewing sarcoma (4%). Conclusions: Despite the multitude of pathologic possibilities, most malignant soft-tissue tumors are classified into a small number of diagnoses. These may be further defined when the site of the lesion and the age of the patient are considered. Knowledge of tumor prevalence will assist radiologists in establishing a suitably ordered differential diagnosis when a soft-tissue tumor has a nonspecific radiologic appearance.
https://abjs.mums.ac.ir/article_3075_0aac55e1b0e60cf6b632890265afa6ce.pdf
Malignant
Soft tissue tumors
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2014-06-01
2
2
111
113
10.22038/abjs.2014.3076
3076
Snow Catastrophe Conditions: What is its Impact on Orthopedic Injuries?
Mohsen Mardani-Kivi
dr_mohsen_mardani@yahoo.com
1
Mahmoud Karimi-Mobarakeh
2
Ehsan Kazemnejad
kazemnejad.e@gmail.com
3
Khashayar Saheb-Ekhtiari
dr.khashi@gmail.com
4
Keyvan Hashemi-Motlagh
dr.keyvan.hashemi@gmail.com
5
Road Trauma Research Center, Guilan University of
Medical Sciences, Rasht, Iran
Orthopedic Department, Bahonar Hospital, Kerman
University of Medical Sciences, Kerman, Iran
Road Trauma Research Center, Guilan University of
Medical Sciences, Rasht, Iran
Road Trauma Research Center, Guilan University of
Medical Sciences, Rasht, Iran
Road Trauma Research Center, Guilan University of
Medical Sciences, Rasht, Iran
Background: Iran places sixth amongst high risk natural disaster countries and Guilan province of Iran shoulders a large amount of socio-economic burden due to snow catastrophes. The more knowledge of circumstances we have, the more efficient our future encounters will be. Methods: In this retrospective study, of all of the patients admitted to Poursina Hospital due to snow and ice related trauma in the first two weeks of February 2014, 306 cases were found eligible for entry into the present study. Results: Of the 306 eligible patients (383 injuries), there were 175 men (57.2%) and 131 women (42.8%). Most patients suffered from orthopedic injuries (81%) and the most common fractures were distal radius fractures in the upper extremities and hip fractures in the lower extremities. Slipping was the most common and motor vehicle accidents had the rarest injury mechanisms. It was shown that the frequency of injuries were higher on icy days (67.6%) than snowy days (32.4%). Conclusions: Snow crises may lead to increased risk of slipping and falling situations, especially on icy days. The peak of injury rates is a few days after snowfall with the most common injury being distal radius fracture. Providing essential instructions and supporting resource allocation to better handle such catastrophes may improve outcomes.
https://abjs.mums.ac.ir/article_3076_8494a8581640ddb7559b26bd3e7fd186.pdf
Epidemiology
Natural crisis
Trauma
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2014-06-01
2
2
114
116
10.22038/abjs.2014.3077
3077
Posterior Vertebral Injury; Is This a Burst Fracture or a Flexion-Distraction Injury?
Farzad Omidi-Kashani
omidif@mums.ac.ir
1
Orthopedic
Research Center, Orthopedic Department, Imam Reza Hospital,
Mashhad University of Medical Science, Mashhad, Iran.
In thoracolumbar spinal fractures with posterior column injury for applying proper management, it is important to distinguish a flexion-distraction injury (FDI) from a three column burst fracture (BF) as in clinical examination, both may have a similar significant tenderness on direct spinal palpation. Careful attention to the comprehensive clinical examination and detailed imaging features are essential in making an accurate diagnosis and thus appropriate treatment.
https://abjs.mums.ac.ir/article_3077_543b0a70c819a75cecf52ce34ee58a7b.pdf
Burst fracture
Flexion-distraction injury
Thoracolumbar spine
Trauma
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2014-06-01
2
2
117
120
10.22038/abjs.2014.3078
3078
Trend of Elevator-Related Accidents in Tehran
Ali Khaji
akhaji@razi.tums.ac.ir
1
Syyed Mohammad Ghodsi
ghodsism@sina.tums.ac.ir
2
Sina Trauma and Surgery Research Center, Sina General
Hospital, Tehran University of Medical Sciences, Tehran,
Iran
Sina Trauma and Surgery Research Center, Sina General
Hospital, Tehran University of Medical Sciences, Tehran,
Iran
Background: Elevator-related accidents are uncommon, but can cause significant injury. However, little data exist on these types of accidents. To compile and analyze accident data involving elevators in an effort to eliminate or at least significantly reduce such accidents. Methods: In this retrospective study we investigated 1,819 cases of elevator-related accidents during a four-year period (1999-2003) in Tehran. The data were obtained from the Tehran Safety Services & Fire Fighting Organization (TSFO) that is officially and solely responsible to conduct rescue missions of civilians in Tehran. Results: The number of elevator accidents has increased steadily during the four year study period. During these four years here was a positive upward trend for serious injuries and mortality resulting from elevator accidents. Technical problems were the main cause with 74.5%, followed by power loss and overcapacity riding with 11.5% and 7.9%respectively. Sixty-three individuals sustained serious injury and 15 people died as a result of elevator accidents. The number of accidents was significantly higher in summer (x2=18.32, P=0.032) and a considerable proportion of incidences (54%, 947 cases out of 1819) occurred between 5 and 12 pm. Conclusions: Establishment of an organization to inspect the settings, maintenance, and repair of elevators is necessary
https://abjs.mums.ac.ir/article_3078_bd59d4fe9fb54b86d33d8a57311e7184.pdf
Elevator
Elevator-related accidents
Mortality
Serious injury
Tehran
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2014-06-01
2
2
121
125
10.22038/abjs.2014.3079
3079
Contribution of Surgery in Solitary Plasmacytoma of Spine; A Case Report
Babak Mirzashahi
1
Hamed Mazoochy
2
Reza Khalili Jamnani
3
Abdolnaser Farzan
4
Orthopaedic Surgery Department, Imam-Khomeini Hospital,
Tehran University of Medical Sciences, Tehran, Iran
Orthopaedic Surgery Department, Imam-Khomeini Hospital,
Tehran University of Medical Sciences, Tehran, Iran
Orthopaedic Surgery Department, Imam-Khomeini Hospital,
Tehran University of Medical Sciences, Tehran, Iran
Neurosurgery Department, Mofid Hospital, Shahid
Beheshti University of Medical Sciences, Tehran, Iran
Solitary plasmacytoma of bone is a rare malignant tumor mostly involving the axial skeleton. The tumor occurs in middle- aged or elderly people (mean age: 55 years) and has a high risk of progression to multiple myeloma. Radiotherapy is the preferred treatment for this disease. We report a case of recurrent solitary plasmacytoma of the fourth lumbar vertebra in a 35-year-old male. The patient suffered from intractable pain due to a pathologic fracture and instability. We performed two-stage posterior and anterior surgical procedures on him. Our method was useful for immediate pain relief and early return to activity, spinal decompression and biomechanical stabilization of the involved vertebra. Afterward, the patient underwent radiotherapy as the adjuvant therapy. The patient is asymptomatic without any recurrenceafter a one-year follow up. We recommend surgery as an appropriate option for patients with intractable pain as a result of pathologic fracture, vertebral instability, neurological compromise, failure of radiotherapy or a combination of these disorders.
https://abjs.mums.ac.ir/article_3079_54a5d3e9aeacb673c8e66656152cb34f.pdf
Radiotherapy
Solitary plasmacytoma
Spinal tumors
Surgery