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
3
4
2015
10
01
Failure of Anterior Cruciate Ligament Reconstruction
220
240
EN
Gonzalo
Samitier
Department of Orthopaedics and Rehabilitation,
University of Florida, Gainesville, USA
gonzalo.samitier@hgvillalba.es
Alejandro
Marcano
Department of Orthopaedics and Rehabilitation,
University of Florida, Gainesville, USA
ale.marcano@gmail.com
Eduard
Alentorn-Geli
Duke Sport Sciences Institute, Department of Orthopaedic
Surgery, Duke University, Durham, NC, USA
ealentorngeli@gmail.com
Ramon
Cugat
Garcia-Cugat Foundation, Barcelona, Spain
Mutualidad de Futbolistas, Federación Española de
Fútbol, Delegación Cataluña, Barcelona, Spain
Artroscopia gc, Hospital Quirón, Barcelona, Spain
ramon.cugat@sportrauma.com
Kevin
Farmer
Department of Orthopaedics and Rehabilitation,
University of Florida, Gainesville, USA
farmekw@ortho.ufl.edu
Micheal
Moser
Department of Orthopaedics and Rehabilitation,
University of Florida, Gainesville, USA
mosermw@ortho.ufl.edu
10.22038/abjs.2015.4584
<br/><span style="font-size: xx-small;">The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL) surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient. </span>
ACL reconstruction,ACL revision,Allografts,Autografts,Failure of ACL reconstruction,Instability,Pain,Review
https://abjs.mums.ac.ir/article_4584.html
https://abjs.mums.ac.ir/article_4584_efd945720468b7a3027732d6bb8d4c79.pdf
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
3
4
2015
10
01
Knee Fusion or Above-The-Knee Amputation after Failed Two-Stage Reimplantation Total Knee Arthroplasty
241
243
EN
E. Carlos
Rodriguez-Merchan
0000-0002-6360-0113
Department
of Orthopaedic Surgery, La Paz University Hospital, Paseo de la
Castellana 261, 28046-Madrid, Spain
ecrmerchan@hotmail.com
10.22038/abjs.2015.4237
Prosthetic joint infection (PJI) is a serious complication of total knee arthroplasty (TKA). Control of infection after a failed two-stage TKA is not always possible, and the resolution of infection may require an above-knee amputation (AKA) or a the-knee (KF). <br/>The purpose of this review is to determine which treatment method (AKA or KF) yields better function and ambulatory status for patients after a failed two-stage reimplantation. <br/>A PubMed search related to the resolution of infection by means of an above-the-knee amputation (AKA) or a knee fusion was performed until 10 January 2015. The key words were: infected TKA and above-the-knee amputation. Five hundred and sixty-six papers were found, of which ten were reviewed because they were focused on the topic of the article. <br/>KF should be strongly considered as the treatment of choice for patients who have persistent infected TKA after a failed two-stage revision arthroplasty. Patients can walk at least inside the house, and activity of daily living independence is achieved by the patients with successful KF, although walking aids, including a shoe lift, are required. An intramedullary nail leads to better functional results than an external fixator. The functional outcome after AKA performed after TKA is poor. A substantial percentage of the patients never fit with a prosthesis, and those who are seldom obtain functional independence. Only 50% of patients are able to walk after AKA. <br/>Patients receiving KF for treating recurrent PJI after TKA have better function and ambulatory status compared to patients receiving AKA. KF must be recommended as the treatment of choice for patients who have persistent infected TKA after a failed two-stage reimplantation procedure.
Above-the-knee amputation,Infection,Knee fusion,Total knee arthroplasty
https://abjs.mums.ac.ir/article_4237.html
https://abjs.mums.ac.ir/article_4237_da0ba13ebba4cbbda14e70c8bf2b9849.pdf
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
3
4
2015
10
01
Correlation of Reconstructed Scaphoid Morphology with Clinical Outcomes
244
249
EN
Ahmadreza
Afshar
0000-0002-3676-5932
Department of Orthopedics, Urmia University of Medical
Sciences, Urmia, Iran
afshar_ah@yahoo.com
Afshin
Mohammadi
Department of Radiology, Urmia University of Medical
Sciences, Urmia, Iran
mohamadi_afshin@yahoo.com
Kian
Zohrabi
Department of Orthopedics, Urmia University of Medical
Sciences, Urmia, Iran
k_zohrabi@yahoo.com
Nasrin
Navaeifar
Department of Orthopedics, Urmia University of Medical
Sciences, Urmia, Iran
navaeifarnasrin@yahoo.com
Sam
Sami
Department of Orthopedics, Shafa Yahyaian Hospital, Iran
University of Medical Sciences, Tehran, Iran
samhaji@yahoo.com
Hassan
Taleb
Department of Orthopedics, Urmia University of Medical
Sciences, Urmia, Iran
hassantaleb_dr@yahoo.com
10.22038/abjs.2015.4712
<br/><span style="font-size: xx-small;">Background: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Scaphoid malunion alters the carpal kinematics and impairs clinical outcome because of pain, weakness, restricted range of motion and predisposing the wrist joint to early osteoarthritis. The aim of this study was to evaluate </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">the influence of the scaphoid morphological angles on clinical outcomes in patients with reconstructed scaphoid by non-</span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">vascularized bone graft. </span></span><br/><span style="font-size: xx-small;">Methods: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Seventeen male patients with the mean age of 31.7±3.7 years and mean non-union time of 31.5±14.7 months were enrolled in this retrospective study. Average follow up was 48.8±9.4 months. At the last follow-up, the patients were </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">evaluated clinically for pain, wrist range of motion, grip strength, and wrist functional status. They were also evaluated radiologically by wrist radiographs and computerized tomography (CT). The overall clinical outcomes were evaluated by the Cooney wrist function score. The morphology of the reconstructed scaphoids was evaluated by the lateral </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">intrascaphoid angle, antroposterior intrascaphoid angle, dorsal cortical angle, measuring the length (mm), and height-to-</span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">length ratio on CT scan. The radiological measurements were compared against the overall clinical outcomes. </span></span><br/><span style="font-size: xx-small;">Results: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">There were 7 excellent, 7 good, 3 fair clinical results. The mean Cooney wrist function score was 83±4. The mean lateral intrascaphoid angle was 34.8±1.4 degrees, mean antroposterior intrascaphoid angle was 33.4±2.2 degrees, mean dorsal cortical angle was 158.3±4.8 degrees, mean scaphoid length was 22.1± 0.7 mm, and mean scaphoid height-to-length ratio was 0.74±0.04. There were no significant statistical correlations between the lateral intrascaphoid angles, antroposterior intrascaphoid angles, dorsal cortical angles, scaphoid lengths and scaphoid height-to-length ratios and </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Cooney wrist scores in the patients. </span></span><br/><span style="font-size: xx-small;">Conclusion: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">In the current study, all the patients had some degree of scaphoid malunion; however, the radiological measurements of the reconstructed scaphoids did not correlate with the clinical outcomes. </span></span>
Intrascaphoid angle,Scaphoid fracture,Scaphoid non-union,Scaphoid mal-union,Scaphoid morphology
https://abjs.mums.ac.ir/article_4712.html
https://abjs.mums.ac.ir/article_4712_a98059feca726881d40283bfe63d88e2.pdf
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
3
4
2015
10
01
Normal Age-Related Alterations on Distal Radius Radiography
250
253
EN
Hamid
Namazi
Bone and Joint Disease Research Center, Shiraz University
of Medical Sciences, Shiraz, Iran
namazih@sums.ac.ir
Rohallah
Khaje
Bone and Joint Disease Research Center, Shiraz University
of Medical Sciences, Shiraz, Iran
khajehr@sums.ac.ir
10.22038/abjs.2015.4677
<span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;"> </span></span> <br/><span lang="EN-GB">Background: </span><span lang="EN-GB">The present study was designed to ascertain serial changes on distal radius radiographic parameters attributable to aging.</span> <br/> <br/><span lang="EN-GB"> </span> <br/> <br/><span lang="EN-GB">Methods:</span><span lang="EN-GB"> In this prospective study, the sample consisted of 120 healthy individuals who were divided into four age groups each containing 15 males and 15 females. In the two below-20-year-old groups, only ulnar variance could be investigated. Wrist radiography was taken and then parameters of the distal radius were measured and compared based on age and sex. </span><br/> <br/><span lang="EN-GB"> </span> <br/> <br/><span lang="EN-GB">Results:</span><span lang="EN-GB"> Average UV was -2.48 mm and -1.6 mm in the 2-9 and 10-19-year-old age groups, respectively. Also, in the two above-20-year-old groups, the average radial inclination (RI), palmar tilt (PT), radial length (RL), and UV was 23.7º, 12.4º, 10.5 and +1.1 mm, respectively. Considering ulnar variance, no significant difference was found between the 2-9- and 10-19-year-old groups, as well as among the two above-20-year-old groups. However, a significant difference was observed between the below 20 and above 20 groups. The study results showed no significant differences between males and females in any of the study groups. </span><br/> <br/><span lang="EN-GB"> </span> <br/> <br/><span lang="EN-GB">Discussion:</span><span lang="EN-GB"> There is significant ulnar variance change toward less negative ulnar variance with aging until maturity.</span> <br/>
AGE,Palmar tilt,Radial inclination,Radial length,Ulnar variance
https://abjs.mums.ac.ir/article_4677.html
https://abjs.mums.ac.ir/article_4677_363b932687f50c47865bfde45a25eb36.pdf
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
3
4
2015
10
01
Introduction of a New Suture Method in Repair of Peripheral Nerves Injured with a Sharp Mechanism
254
259
EN
Alireza
Saied
Kerman Neuroscience Research Center, Dr Bahonar
Hospital, Kerman University of Medical Sciences, Kerman,
Iran
arsaiedmd@yahoo.com
Majid
Asadi Shekar
Kerman Neuroscience Research Center, Dr Bahonar
Hospital, Kerman University of Medical Sciences, Kerman,
Iran
m_asady@yahoo.com
Amirreza
Sadeghifar
0000-0003-3412-9534
Kerman Neuroscience Research Center, Dr Bahonar
Hospital, Kerman University of Medical Sciences, Kerman,
Iran
amirsf2000@yahoo.com
Ali
Karbalaeikhani
AJA University of
Medical Sciences, Emam Reza Hospital , Tehran, Iran
a.karbalaei48@yahoo.com
10.22038/abjs.2015.4680
<br/><span style="font-size: xx-small;">Background: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The standard method for repair of an injured peripheal nerve is epineural repair with separate sutures. Herein we describe a method in which the nerve is sutured with continous sutures. In fact this method has not been utilized for nerve repair previously and our purpose was to compare it to the standard method. If it proved to be successful it would replace the standard method in certain circumstances. </span></span><br/><span style="font-size: xx-small;">Methods: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The proposal of the clinical trial was given a reference number form the ethics comitee. 25 dogs in which the scaitic nerve was cut by a sharp blade under genaeral anesthesia were divided randomly into three groups: control (5 dogs), repair of sciatic nerve with simple sutures (10) and repair with continous sutures (10). In the control group the nerve was not repaired at all. After 6 weeks the dogs were killed and the nerve was studied by light and electronic microscopes. The amount of consumed suture material, time of repair, myelin thickness and axon diiameter were </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">examined. Ultrastructural studies were performed to assess degeneration and regeneration findings. </span></span><br/><span style="font-size: xx-small;">Results: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Time of repair and the amount of consumed suture material were significantly lower in the continous group </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">(</span></span><em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">P</span></span></em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;"><0.001). No difference was found with regard to light microscopy findings and regeneration was confirmed by </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">electron microscopy in the continous group. </span></span><br/><span style="font-size: xx-small;">Conclusion: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The method described in the present study, provided a result similar to the standard method. Though undobtfully it has some limitations, can replace the standard method in many circumstances. </span></span>
Nerve regeneration,Peripheral nerve injuries,Sutures
https://abjs.mums.ac.ir/article_4680.html
https://abjs.mums.ac.ir/article_4680_92b7bccab91b98bd5c56a9062e9ad282.pdf
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
3
4
2015
10
01
Outcome of ACL Reconstruction and Concomitant Articular Injury Treatment
260
263
EN
Seyed Mohammad
Tahami
0000-0002-3722-8426
Bone and Joint Diseases Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran
mohammad.tahami@yahoo.com
Seyed Mohammad
Derakhshan rad
Bone and Joint Diseases Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran
brusella2000@yahoo.com
10.22038/abjs.2015.4305
<br/><span style="font-size: xx-small;">Background: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Articular cartilage injuries are a common clinical problem at the time of ACL reconstruction with an incidence rate of 16-46%. Good results of ACL reconstruction combined with the treatment of chondral lesions have been published in some studies. </span></span><br/><span style="font-size: xx-small;">Method: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">After statistical analysis 30 patients were selected and divided in 2 groups. TheFfirst group consisted of 15 patients wite isolated ACL tear without any other concomitant injuries and the second group consisted of 15 patients with ACL tear and concomitant high grade (grade 3 or 4 of outerbridge classification) contained articular cartilage injuries </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">during arthroscopy. Group 1 underwent ACL reconstruction and group 2 underwent ACL reconstruction combined with chondroplasty via the drilling and microfracture technique. For each patient the Lysholm knee score questionnaire was completed before surgery, 6 months and 1 year after surgery. </span></span><br/><span style="font-size: xx-small;">Results: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The mean Lysholm knee score in both groups improves: 9.6 points after 6 months and 16.06 points after 1 </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">year in group 1 and 23.26 points after 6 months and 30.66 after 1 year in group 2, whict was statistically significant </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">(</span></span><em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">P</span></span></em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">value<0.05). </span></span><br/><span style="font-size: xx-small;">Conclusion: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Improvement in the Lysholm knee score in both groups showed that ACL reconstruction concomitant with high grade chondral injury chondroplasty with microfracture and drilling techniques have good results with patient satisfaction and improves their quality of life. </span></span>
anterior cruciate ligament,Chondral injury,Lysholm knee score
https://abjs.mums.ac.ir/article_4305.html
https://abjs.mums.ac.ir/article_4305_661f3aa77841552251fe1ae358b22760.pdf
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
3
4
2015
10
01
Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study
264
268
EN
Satish
Shervegar
MS Ramaiah Medical College, Bangalore, Karnataka, India
amitgrover88@yahoo.co.in
Prashanth
Nagaraj
Sparsh Hospitals, Bangalore, Karnataka, India
drprashanthnagaraj@rediffmail.com
Amit
Grover
0000-0001-7448-8342
MS Ramaiah Medical College, Bangalore, Karnataka, India
amitgrover88@gmail.com
Niranthara
Ganesh D.J.
MS Ramaiah Medical College, Bangalore, Karnataka, India
drniranthar@gmail.com
Abdul
Ravoof
Adichunchungiri Institute of Medical Sciences, Bellur,
Bangalore, Karnataka, India
drrohitchopra71@gmail.com
10.22038/abjs.2015.4338
<br/><span style="font-size: xx-small;">Background: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">reconstruction. </span></span><br/>Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. <br/>Study design: Retrospective observational study. <br/><span style="font-size: xx-small;">Methods: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. </span></span><br/><span style="font-size: xx-small;">Results: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively.Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26 .Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test </span></span><em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">P</span></span></em><span style="font-family: Arial,Arial; font-size: xx-small;"> <br/><span style="font-size: xx-small;">Conclusions: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation </span></span></span>
anterior cruciate ligament,Arthroscopy,Interference screw,Rigid fix,Tegner score
https://abjs.mums.ac.ir/article_4338.html
https://abjs.mums.ac.ir/article_4338_e3cb7ca2fdacfec3120e5f882ec5a1f0.pdf
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
3
4
2015
10
01
Risk of Spermatic Cord Injury During Anterior Pelvic Ring and Acetabular Surgery: An Anatomical Study
269
273
EN
Reza
Firoozabadi
0000-0002-0221-2408
Department of Orthopaedic Surgery and Sports Medicine,
Harborview Medical Center, Seattle, WA USA
rezaf2@uw.edu
Milton
Routt
Department of Orthopaedics Surgery, The University of
Texas Medical School at Houston, Houston, TX USA
chiproutt@gmail.com
Paul
Stafford
Orthopedic and Trauma Service of Oklahoma, Tulsa, OK
USA
paulryanstafford@gmail.com
10.22038/abjs.2015.4303
<br/><span style="font-size: xx-small;">Background: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Anterior pelvic ring surgery includes a variety of plating techniques and insertion of retrograde superior pubic ramus screws. </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Anterior acetabular surgery also includes fixation through an ilioinguinal or Stoppa approach. These exposures risk injury to the spermatic cord and accompanying genital branch of the genitofemoral nerve. The </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">primary aim of this study was to identify the distance between the midline and the spermatic cords in adult male cadaveric specimens. The secondary aim was to determine spermatic cord diameters and measure the distance between the spermatic cord and implant during instrumentation of a retrograde superior pubic ramus medullary screw. </span></span><br/><span style="font-size: xx-small;">Methods: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Extended Pfannenstiel and Stoppa approaches were performed on 18 embalmed male cadavers bilaterally. Spermatic cord characteristics were recorded and a number of measurements were performed to determine the </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">distance of implants and the midline from the spermatic cord. </span></span><br/><span style="font-size: xx-small;">Results: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The average distance between the midline and spermatic cords was 34.2 mm. The average distance </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">between the spermatic cord and implant was 18.2 mm. Eleven of the thirty-six dissections had abnormalities including cord lipomas and inguinal hernias. The average cord diameter was 18.6 mm. The average cord diameter in those with abnormalities was 24.9 mm and 16 mm in those without abnormalities, this difference was statistically significant. </span></span><br/><span style="font-size: xx-small;">Discussion: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Due to the proximity of the spermatic cord, the surgeon should either formally expose the cord or limit lateral dissection from the midline during Pfannenstiel and Stoppa exposures. Similarly, the surgeon should use soft-tissue sleeves and oscillating drills to avoid injury to the contralateral spermatic cord during the insertion of retrograde </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">superior pubic ramus medullary screws. </span></span>
Acetabular surgery,Ilioinguinal approach,Retrograde ramus screw,Spermatic cord,Stoppa
https://abjs.mums.ac.ir/article_4303.html
https://abjs.mums.ac.ir/article_4303_b55ab633a13811291a69320106d0ad70.pdf
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
3
4
2015
10
01
Inguinal Abnormalities in Male Patients with Acetabular Fractures Treated Using an Ilioinguinal Exposure
274
279
EN
Reza
Firoozabadi
0000-0002-0221-2408
Department of Orthopaedic Surgery and Sports Medicine,
Harborview Medical Center, Seattle, WA USA
rezaf2@uw.edu
Paul
Stafford
Orthopedic and Trauma Service of Oklahoma, Tulsa, OK
USA
paulryanstafford@gmail.com
Milton
Routt
Department of Orthopaedics Surgery, The University of
Texas Medical School at Houston, Houston, TX USA
chiproutt@gmail.com
10.22038/abjs.2015.4582
Purpose: Surgeons performing an ilioinguinal exposure for acetabular fracture surgery need to be aware of aberrant findings such as inguinal hernias and spermatic cord lesions. The purpose of this study is to report these occurrences in a clinical series of adult males undergoing acetabular fracture fixation and a series of adult male cadavers. The secondary aim is to characterize these abnormalities to aid surgeons in detecting these abnormalities preoperatively and coordinating a surgical plan with a general surgeon.<br/>Methods: Clinical study- Retrospective review of treated acetabular fractures through an ilioinguinal approach. Incidence of inguinal canal and spermatic cord abnormalities requiring general surgery consultation were identified. Corresponding CT scans were reviewed and radiographic characteristics of the spermatic cord abnormalities and/or hernias were noted.<br/>Cadaveric study- 18 male cadavers dissected bilaterally using an ilioinguinal exposure. The inguinal canal and the contents of the spermatic cord were identified and characterized.<br/>Results: Clinical Study- 5.7% (5/87) of patients had spermatic cord lesion and/or inguinal hernia requiring general surgical intervention. Preoperative pelvic CT scan review identified abnormalities noted intraoperatively in four of the five patients. Cord lipomas visualized as enlargements of the spermatic cord with homogeneous density. Hernias visualized as enlarged spermatic cords with heterogeneous density. <br/>Cadaver Study- 31% (11/36) of cadavers studied had spermatic cord and/or inguinal canal abnormalities. Average cord diameter in those with abnormalities was 24.9 mm (15-28) compared to 16 mm (11-22) in normal cords, which was statistically significant.<br/>Conclusion: The clinical and cadaveric findings emphasize the importance of understanding inguinal abnormalities and the value of detecting them preoperatively. The preoperative pelvic CT scans were highly sensitive in detecting inguinal abnormalities.
INGUINAL ABNORMALITIES IN ACETABULAR FRACTURES
https://abjs.mums.ac.ir/article_4582.html
https://abjs.mums.ac.ir/article_4582_f813d75a7f51b54d6b43c562625561e2.pdf
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
3
4
2015
10
01
Comparison of Intravenous Morphine with Sublingual Buprenorphine in Management of Postoperative Pain after Closed Reduction Orthopedic Surgery
280
285
EN
Ghasem
Soltani
0000-0003-2043-1564
Cardiac Anesthesia Research Center, Imam Reza Hospital,
Faculty of Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran
soltanigh@mums.ac.ir
Mahmood
Khorsand
Cardiac Anesthesia Research Center, Imam Reza Hospital,
Faculty of Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran
khorsandm901@mums.ac.ir
ALireza
Sepehri Shamloo
Student Research Committee, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran
sepehria871@mums.ac.ir
Lida
Jarahi
Mashhad University of Medical Sciences, Faculty of
Medicine, Mashhad, Iran
jarahil@mums.ac.ir
Nahid
Zirak
0000-0002-6488-3039
Cardiac Anesthesia Research Center, Imam Reza Hospital,
Faculty of Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran
zirakn@mums.ac.ir
10.22038/abjs.2015.4700
<br/><span style="font-size: xx-small;">Background: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Postoperative pain is a common side effect following surgery that can significantly reduce surgical quality and patient’s satisfaction. Treatment options are morphine and buprenorphine. We aimed to compare the efficacy of </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">a single dose of intravenous morphine with sublingual buprenorphine in postoperative pain control following closed reduction surgery. </span></span><br/><span style="font-size: xx-small;">Methods: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">This triple blind clinical trial was conducted on 90 patients referred for closed reduction orthopedic surgery. They were older than 18 years and in classes I and II of the American Society of Anesthesiologists (ASA) with an operation time of 30-90 minutes. Patients were divided into two groups of buprenorphine (4.5μg/kg sublingually) and morphine (0.2mg/kg intravenously). Baseline characteristics, vital signs, pain score, level of sedation and pharmacological side effects were recorded in the recovery room (at 0 and 30 minutes), and in the ward (at 3, 6 and 12 hours). SPSS version </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">19 software was used for data analysis and the significance level was set at </span></span><em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">P</span></span></em><span style="font-family: Arial,Arial; font-size: xx-small;"> <br/><span style="font-size: xx-small;">Results: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Ninety patients were studied, 60 males and 30 females with a mean age of 37.7±16.2 years. There was no </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">significant difference between the two groups in terms of baseline characteristics.Pain score in the morphine group was significantly higher than the buprenorphine group with an average score of 2.5 (</span></span><em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">P</span></span></em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;"><0.001). Postoperative mean heart rate in the buprenorphine group was four beats lower than the morphine group (</span></span><em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">P</span></span></em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;"><0.001). Also, in the buprenorphine 48.6% and in the morphine group 86.7% of cases were conscious in recovery (</span></span><em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">P</span></span></em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">=0.001) with a higher rate of pruritus in the latter group (</span></span><em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">P</span></span></em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">=0.001). </span></span><br/><span style="font-size: xx-small;">Conclusion: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Sublingual buprenorphine administration before anesthesia induction in closed reduction surgery can lead to better postoperative pain control in comparison to intravenous morphine. Due to simple usage and longer postoperative sedation, sublingual buprenorphine is recommended as a suitable drug in closed reduction surgery. </span></span></span>
Intravenous morphine,Orthopedic surgery,Patient Satisfaction,Post-operative pain,Sublingual buprenorphine
https://abjs.mums.ac.ir/article_4700.html
https://abjs.mums.ac.ir/article_4700_d0f7f9c973fbf9e5c9d111fe90495133.pdf
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
3
4
2015
10
01
Assessment of Correlation Between MRI and Arthroscopic Pathologic Findings in the Shoulder Joint
286
290
EN
Omid
Momenzadeh
Shiraz University of Medical Sciences, Chamran Hospital,
Shiraz, Iran
momenzadeh_o@yahoo.com
Mohamad
Gerami
6104-3379-1066-7623
Shiraz University of Medical Sciences, Chamran Hospital,
Shiraz, Iran
dr.h.gerami@gmail.com
Sepideh
Sefidbakht
Shiraz University of Medical Sciences, Chamran Hospital,
Shiraz, Iran
sepidehsepidbakht@yahoo.com
Sakineh
Dehghani
Shiraz University of Medical Sciences, Chamran Hospital,
Shiraz, Iran
dehghanis90@gmail.com
10.22038/abjs.2015.4505
<br/><span style="font-size: xx-small;">Background: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The objective of this study was to determine the diagnostic value of magnetic resonance imaging for shoulder joint pathologies and then compare the results with arthroscopy, the standard for joint diagnosis. </span></span><br/><span style="font-size: xx-small;">Methods: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">In this cross-sectional study, 80 patients with shoulder joint disorders, who underwent final arthroscopy, were </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">studied. Based on patients’ medical history and physical examinations, shoulder MRI was requested if paraclinical investigations were. If non-surgical therapies failed, arthroscopy of the affected shoulder was done and the same </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">structures were inspected. Subsequently, sensitivity, specificity, and positive and negative predictive values (PPV) and (NPV) of MRI were determined by arthroscopy comparisons. </span></span><br/><span style="font-size: xx-small;">Results: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The highest sensitivity, specificity, PPV and NPV were found in MRI pathology reports that included: Hill-Sach lesion (0.910), infraspinatus tendon (0.985), supraspinatus tendon (0.930), and biceps tendon (0.954), respectively. Rotator interval (0.250), biceps labrum complex (0.805), subscapularis tendon (0.538) and anterior labrum lesions (0.604) had the lowest sensitivity, specificity, PPV and NPV, respectively. </span></span><br/><span style="font-size: xx-small;">Conclusion: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The results showed that MRI can be a useful tool in ruling out possible abnormalities in the shoulder and to give clues to the most probable diagnosis. Although knowing some practical skills in order to successfully perform the procedure and experience of the radiologist with suitable feedback by surgeon is necessary. </span></span>
Arthroscopy,MRI,sensitivity,shoulder,specificity
https://abjs.mums.ac.ir/article_4505.html
https://abjs.mums.ac.ir/article_4505_bc2f1491d44c6f442f13c80b489e0efc.pdf
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
3
4
2015
10
01
Bacille Calmette-Guérin osteomyelitis
291
295
EN
Mohammad
GHarehdaghi
Mashhad University of medical sciences
gharahdaghim@mums.ac.ir
Mohammad
Hassani
0000-0002-8671-5191
Department of Orthopedic Surgery, Mashhad University
of Medical Sciences, Mashhad, Iran
drmhasani57@sbmu.ac.ir
Elaheh
Ghodsi
Mashhad University of Medical Sciences, Mashhad, Iran
ela.ghodsi@gmail.com
Alireza
Khooei
0000-0002-8011-5486
Department of Orthopedic Surgery, Mashhad University
of Medical Sciences, Mashhad, Iran
khooeiar@mums.ac.ir
Amir
Moayedpour
Department of Orthopedic Surgery, Mashhad University
of Medical Sciences, Mashhad, Iran
moayedpoura@gmail.com
10.22038/abjs.2015.4825
<br/><span style="font-size: xx-small;">Background: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">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. </span></span><br/><span style="font-size: xx-small;">Methods: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">4 patients, 3 males and a female entered this study and were between 11 to 24 months old. The involved </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">bones were first metatarsi, talus, humerus and tibia bone. The main radiologic finding was lytic lesion with cortical </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">destruction and periosteal reaction. </span></span><br/><span style="font-size: xx-small;">Results: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">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. </span></span><br/><span style="font-size: xx-small;">Conclusion: </span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">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 </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">tissue biopsy and PCR studies confirm diagnosis. Early use of a surgical curettage and debridement along with </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">chemotherapy soon afterwards, enabled these children to enjoy a satisfactory clinical outcome. </span></span>
BCG,Cold abscess,Needle biopsy,Osteomyelitis
https://abjs.mums.ac.ir/article_4825.html
https://abjs.mums.ac.ir/article_4825_6d34d9a54cd9ab3d3fb5b1fe68ce73a4.pdf
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
3
4
2015
10
01
Unusual Presentation of Synovial Sarcoma as Meniscal Cyst: A Case Report
296
299
EN
Khodamorad
Jamshidi
0000-0001-9475-5866
ShafaYahyaian Hopital, Iran University of Medical
Sciences, Tehran, Iran
jamshidi_k@yahoo.com
Hooman
Yahazadeh
0000-0003-3463-5699
ShafaYahyaian Hopital, Iran University of Medical
Sciences, Tehran, Iran
yahyazadehhooman@yahoo.com
Abolfazl
Bagherifard
0000000249658810
ShafaYahyaian Hopital, Iran University of Medical
Sciences, Tehran, Iran
bagherifd@gmail.com
10.22038/abjs.2015.4657
<br/><span style="font-size: xx-small;">Periarticular cyst and cystic soft tissue lesion around the knee are common. Synovial sarcoma is a rare and malignant soft tissue tumor accounting for approximately 5% of soft tissue sarcoma. A case is presented where a lesion adjacent to the joint line of the knee was diagnosed clinically and on imaging as a meniscal cyst. MRI signal was homogenous and no concomitant meniscal tears were seen. The tissue diagnosis was monophasic synovial sarcoma. </span>
knee,Meniscal cyst,Synovial sarcoma
https://abjs.mums.ac.ir/article_4657.html
https://abjs.mums.ac.ir/article_4657_181636675b649a0a9a2d78696afeb724.pdf
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
3
4
2015
10
01
First Carpometacarpal Joint Dislocation and Review of Literatures
300
303
EN
Farivar
Lahiji
Department of Orthopedic Surgery, Akhtar Hospital,
Shahid Beheshti Medical University, Tehran, Iran
farivarlahiji@yahoo.com
Reza
Zandi
0000-0002-0095-6745
Department of Orthopedic Surgery, Taleghani Hospital,
Shahid Beheshti Medical University, Tehran, Iran
reza.zandi.md@gmail.com
Arash
Maleki
0000-0002-0053-5406
Department of Orthopedic Surgery, Akhtar Hospital,
Shahid Beheshti Medical University, Tehran, Iran
arashmal@yahoo.com
10.22038/abjs.2015.4586
<br/><span style="font-size: xx-small;">Dislocation of the first carpometacarpal (CMC) is a rare occurrence. Treatment of this dislocation varies from closed reduction and casting to ligament repair. Neglected dislocation or incomplete reduction of the 1</span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">st </span></span><span style="font-size: xx-small;">CMC cause chronic instability and painful arthritis, muscle imbalance and decreased grip force. </span><br/>In our study 6 patients is evaluated that were visited in less than 24 hours from their injury. All were primarily reduced and except one patient later injured ligament were repaired. All patient after 6 months had normal range of motion without pain and they had not any complaint. <br/><span style="font-size: xx-small;">Stability at the 1</span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">st </span></span><span style="font-size: xx-small;">CMC joint is dependent on static and dynamic forces. However, dislocation of the 1</span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">st </span></span><span style="font-size: xx-small;">CMC occur rare, but important function of the thumb specially in gripping and grasping makes it a significant problem. Injured ligament should repair for increased stability of 1</span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">st </span></span><span style="font-size: xx-small;">CMC joint, because neglected dislocation or incomplete reduction cause chronic instability and painful arthritis. </span>
FIRST CMC JOINT DISLOCATION
https://abjs.mums.ac.ir/article_4586.html
https://abjs.mums.ac.ir/article_4586_d0e3e38135ef66392f96364c1791cf7f.pdf