H Ghandhari; M Rashidi; S Sabbaghan; S M Mahdavi; E Mirzamohammadi; A Azizi; F Safdari
Abstract
Introduction: Correct-level surgery is one of the most important concerns in the treatment of patients with adolescent idiopathic scoliosis (AIS). Variations in vertebral number can potentially result in wrong-level surgery. It is possible that the incidence and type of these variations be affected by ...
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Introduction: Correct-level surgery is one of the most important concerns in the treatment of patients with adolescent idiopathic scoliosis (AIS). Variations in vertebral number can potentially result in wrong-level surgery. It is possible that the incidence and type of these variations be affected by different factors such as ethnicity. In the current retrospective study, the prevalence of these variations in Iranian AIS patients was investigated. Methods: Between 2012 to 2017, spinal fusion was performed for the treatment of AIS in 125 patients. The thoracic and lumbar vertebrae were enumerated on posteroanterior radiographs. The first thoracic vertebra was the one attached to the first pair of ribs. Enumeration was continued in a caudal direction. The lumbar level initiated just below the last vertebra with a pair of associated ribs.Results: Abnormal vertebral enumeration was found in 18 patients (14.4%). The prevalence of abnormal lumbar enumeration was higher than thoracic vertebrae (10.4% versus 4%). Eleven thoracic vertebrae were found in 5 patients (4%). Four lumbar vertebrae were found in eleven patients (8.8%). There were two patients with six lumbar vertebrae (1.6%). There was no patient with abnormal enumeration of both thoracic and lumbar vertebrae.Conclusion: The current study showed a relatively high rate of atypical number of thoracic and lumbar vertebrae in Iranian AIS patients. It is necessary to enumerate the vertebrae on the basis of an organized protocol preoperatively to prevent wrong-level surgery in AIS patients.
S M Kazemi; MR Abbasian; M Karimzadeh; F Safdari; H Mahdavi Mohtasham
Abstract
Background: Distal femoral intra-articular fractures (DFIAF) can be very challenging. Although, satisfactory outcomes have been reported, however, there are several complications interfering the patients after treatment. In current retrospective study, the outcomes of treating DFIAF with ...
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Background: Distal femoral intra-articular fractures (DFIAF) can be very challenging. Although, satisfactory outcomes have been reported, however, there are several complications interfering the patients after treatment. In current retrospective study, the outcomes of treating DFIAF with open reduction internal fixation (ORIF) using locking plates (LCP) were investigated.
Material and Methods: There were 51 patients enrolled. In last visit, Lysholm score was completed for all of the patients. Pain intensity and satisfaction were measured using visual analogue scale (VAS). Degenerative changes were assessed on plain x-rays. Bilateral knee range of motion was measured and compared. The patients were followed for 17.4±7.2 months.
Results: Fractures were united in all of the patients. Degenerative changes were found in 15 patients (29.4%). The pain intensity was 2.7±1.3. Nineteen patients required to use analgesics (37.2%). VAS for satisfaction averaged 7.7±1.1. The Lysholm score averaged 81.8±8.3. The range of knee motion was significantly limited inn operated side compared to the healthy one (116.6±12.4 Vs 125.3±7.3; p<0.001).
Conclusions: Treatment of DFIAF using ORIF can be associated with complete fracture healing. However, the incidence of degenerative changes and consequent complications such as pain and loss of ROM are considerably concerning.
Abstract
Background: Weaver-Dunn technique is one the prevalent methods for treating acute acromioclavicular joint (ACJ) dislocation. Until now, several modifications of this technique have been introduced. Regarding the drawbacks of the previous modifications and the importance of presence of an intact coracoacromial ...
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Background: Weaver-Dunn technique is one the prevalent methods for treating acute acromioclavicular joint (ACJ) dislocation. Until now, several modifications of this technique have been introduced. Regarding the drawbacks of the previous modifications and the importance of presence of an intact coracoacromial ligament (CAL), we introduced a new modification of Weaver-Dunn technique and investigated the preliminary results.
Materials and methods: There were 15 patients with acute ACJ enrolled in current study. In the modified surgical technique, the medial half of the CAL is dissected from the bone and passed through a hole made in the clavicle bone and tied on itself. Before the operation and at the last visit, CC distance was measured on both sides. At the last visit, Constant score and UCLA score were completed. The pain intensity was measured using visual analogue scale (VAS). The patients were followed for 4.2±2.6 years.
Results: Preoperatively, CC distance of injured side was significantly greater than the other side (19.5±1.6 mm Vs 7.1±0.5 mm; p<0.001). At the last visit, CC distance of the operated side was insignificantly greater than the healthy side (8.2±0.9 mm Vs 7.1±0.5 mm; p=0.318). Constant score averaged 93.3±13.2 and 95.1±10.8 for operated and healthy shoulders, respectively (p=0.118). UCLA averaged 32.6±3.3 and pain intensity was 1.4±0.8.
Conclusion: Treatment of acute ACJ dislocations using the modified technique was associated with favorable outcomes. Utilizing this method, the joint stability and function are preserved.
S Morteza Kazemi; Shahin Salehi; S Mohamad Qoreishi; Mehrshad Poursaeid Esfahani; Mohammad Hassbi; Jila Sharghi; Farshad Safdari
Abstract
Introduction: Hip dysplasia can be associated with early degenerative changes. Different values have been
reported for incidence of hip dysplasia in different countries. In the current study, we are reporting on the incidence
of hip dysplasia in a group of normal Iranians evaluated by measuring ...
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Introduction: Hip dysplasia can be associated with early degenerative changes. Different values have been
reported for incidence of hip dysplasia in different countries. In the current study, we are reporting on the incidence
of hip dysplasia in a group of normal Iranians evaluated by measuring the morphologic parameters of acetabulum on
radiographs.
Materials and Method: 586 hips (293 person) were enrolled in this study. On anteroposterior hip radiographs,
the following 5 parameters were measured: Central edge angle (CEA), acetabular angle (AA), acetabular depth (AD),
acetabular roof obliquity (ARO) and roof angle (RA). The normal and abnormal values were obtained in different
sexes and compared with the known normal values in orthopaedic literature. Furthermore, the correlation between
the above measurements was investigated.
Results: Based on CEA, 15 (2.6%) of hips were dysplastic:-0.7% definite and 1.9% mild. 19 hips (3.2%) were
dysplastic when using AA values. AD and RA were significantly higher in males. Except for lack of correlation
between AA and AD, the other parameters -in particular, CEA and AA- were closely correlated. CEA, AA, ARO and
RA were significantly different between dysplastic and non-dysplastic hips.
Conclusion: Definite or mild dysplasia was recognized in 0.7% and 1.9% of the “normal” population that was
studied. Since CEA was the same between males and females and was correlated with all other morphologic
parameters, it seems that CEA is a useful measurement to evaluate presence of hip dysplasia.
Ali Akbar Esmailiejah, MD طEsmailiejah, MD; Ali Akbar Esmailiejah, MD طEsmailiejah, MD; Manoochehr Vahid Farahmandi, MD; Mohammadreza Abbasian, MD; Ali Moazamipour, MD; Farshad Safdari, MSc
Abstract
Background: Forefoot fractures are the most common orthopaedic injuries. In this study the outcomes of nonoperative treatment of forefoot fractures using off-loading shoes was studied and compared with those of casting.Methods: In this case-control study, 60 patients with forefoot fractures in two hospitals ...
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Background: Forefoot fractures are the most common orthopaedic injuries. In this study the outcomes of nonoperative treatment of forefoot fractures using off-loading shoes was studied and compared with those of casting.Methods: In this case-control study, 60 patients with forefoot fractures in two hospitals in Tehran, Iran, who were not surgical candidates, were divided into two treatment groups: casting and off-loading shoe. The rate of bone healing was investigated. Also, patients' satisfaction and the pain severity were measured before and after treatment. The AFAOS (American Orthopaedic Foot and Ankle Society) was completed. The treatment results were compared between the two groups. The patients were followed for 36.5±4.2 days in group C and 33.3±4.7 days in OS group (p < /em>≥.05). Results: Clinical and radiolographic success were achieved in all of the cases and all the patients returned to their previous activities. At final visit, the pain intensity was as follows: 5.4±1.4 in group C versus 5.9±1.1 in group OS (p < /em>≥.05). The AOFAS was 92.3±14.7 points in group C and 94.5±12.3 in group OS Two patients developed skin problems and another one developed symptoms of deep venous thrombosis, all in group C. Conclusions: Off-loading shoes are suitable tools to treat forefoot fractures. Although no significant difference was found between the two groups, but due to satisfactory outcome and lack of complication, off-loading shoes are recommended in non-operative treatment of forfoot fractures.
Mohammadi Hadi Nouraei, MD; Mohammad Javdan, MD; Farhad Nouraei, MD; Abdolah Mohebbi Dehnavi, MD; Farshad Safdari, MSc
Abstract
Background: twenty years has passed since the Iran-Iraq war and little has been written on war amputees and their stump problems. With the continued use of prosthesis, its problems increases and meticulous attention by expert team of rehabilitation and orthopaedic surgeons is needed to prevent complications. ...
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Background: twenty years has passed since the Iran-Iraq war and little has been written on war amputees and their stump problems. With the continued use of prosthesis, its problems increases and meticulous attention by expert team of rehabilitation and orthopaedic surgeons is needed to prevent complications. In this research, the problem caused by amputation were studied. Methods: In a retrospective study, 150 cases were studied in two outpatient clinics in Isfahan, Iran. The cases referring to these centers from June 2003 to December 2011 were evaluated by direct examination and completing a questionnaire. Results: The problems according to their prevalence were hyperpigmentation, itching, linkification, hyperhydrosis, fuliculitis, stump atrophy, decreased soft tissue coverage at the end of stump, stump ulcer, soft unsuitable tissue, bone pain, muscular pain, phantom pain, and stump edema. Other problems with lower prevalent were bone overgrowth, hyopsthesis, fracture bone, too much stump fat, inadequate circulation, pain and pallor of stump. Overall, the skin problems were the most and vascular problems the least prevalent. The rest of issues were seen more frequently in below knee amputations.Conclusions: With the high rate of skin problems in stumps, hygenic care of stump skin, and proper duration of prosthetic use can decrease stump problems.
Hamidreza Seyyed Hosseinzadeh, MD; Ali Akbar Esmailiejah, MD; Seyed Roohollah Mousavi, MD; Farshad Safdari, MSc
Abstract
Background: Preoperative onlay templating is prevalently used to determine the size and placement of acetabular and femoral components before total hip arthroplasty (THA). The purpose of this study was to determine the accuracy and reliability of preoperative onlay templating in uncemented THA. Methods: ...
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Background: Preoperative onlay templating is prevalently used to determine the size and placement of acetabular and femoral components before total hip arthroplasty (THA). The purpose of this study was to determine the accuracy and reliability of preoperative onlay templating in uncemented THA. Methods: In a cross sectional study, 50 patients who underwent uncemented THA for hip osteoarthritis were selected in one teaching hospital, retrospectively. The study was done in a 4-month period. Using onlay templates, four surgeons determined the size of acetabular and femoral component on plain anteroposterior hip radiographs. Finally, the average percentage of agreement between template and implanted components were considered as the accurate representation. Kappa coefficient was utilized to determine the interobserver reliability.Results: The accuracy of templating for acetabular and femoral component size was 60% and 59.5%, and the interobserver reliability was 49% and 52%, respectively.Conclusions: Based on our findings, preoperative onlay templating cannot provide us with proper component selection and intraoperative determination of correct size is required for best outcome achievement.
Jalil Zare'e, MD; Jalil Zare'e, MD; Arefeh Hedayati, MD; Mohammad Reza Hedayati, MD; Mahmoud Vakili, MD; Farshad Safdari, MSc
Abstract
Background: There is a great debate about the proper autograft for arthroscopic anterior cruciate ligament reconstruction (ACLR). In current study, we compared the clinical and functional outcomes of ACLR using either medial hamstring (MH) tendon or patellar tendon (PT).
Methods: Eighty ...
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Background: There is a great debate about the proper autograft for arthroscopic anterior cruciate ligament reconstruction (ACLR). In current study, we compared the clinical and functional outcomes of ACLR using either medial hamstring (MH) tendon or patellar tendon (PT).
Methods: Eighty eight patients with anterior cruciate ligament (ACL) injury contributed to a retrospective study. The study was done in a teaching hospital in Yazd, Iran. Patients were divided into two groups based on the type of autograft used for ACLR: MD (48 patients) and PT (40 patients). In a follow-up of 18.5±2.2 months in MH and 19.3±2.9 months in PT group, the pain was analized using visual analogue scale (VAS) and the range of knee flexion was measured. The result of the surgery was assessed utilizing Tegner-Lysholm score, KOOS (Knee injury and osteoarthritis outcomes) and return to the previous activity.
Results: The two groups were the same in term of range of knee flexion, KOOS and Tegner-Lysholm score. The VAS averaged .9±.3 in MH and 1.15±.5 in PT groups, with no significant difference. Return to previous activity was seen in 80% of PT group and 85.4% of MH group.
Conclusions: ACLR using either MH or PT autograft, is effective in short-term, and is associated with satisfactory clinical and functional outcomes.
Mohsen Karami; Ali Akbar Esmailiejah; Mohammad Hossein Kazemi; Farshad Safdari, MSc
Abstract
Background: Hemivertebra is one of the common causes of congenital
scoliosis. In cases with curve progression, resection of the hemivertebra
through a combined anterior and posterior approach (CAPA) is one of the usual treatment
modalities which is associated with high morbidity. Recently, hemivertebra
resection ...
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Background: Hemivertebra is one of the common causes of congenital
scoliosis. In cases with curve progression, resection of the hemivertebra
through a combined anterior and posterior approach (CAPA) is one of the usual treatment
modalities which is associated with high morbidity. Recently, hemivertebra
resection through a posterior only approach (POA) is introduced. In the current
study, we are reporting our experience with a single posterior approach. Methods: Ten
patients with lumbar CS who had undergone hemivertebra resection through a POA
with transpedicular instrumentation and short segment fusion, between 2009 and
2012 were retrospectively studied. The main and the compensatory scoliotic
curves and kyphotic curves were measured and compared before surgery and by the
16.1±10 months follow-up. Results: Fusion was
obtained in all of the patients. The mean drop in the main, compensatory and
kyphotic curves were 39.6±6.6 to 11.3±5 degrees, 12.9±5.1 to 7.8±3.4 degrees
and 15.6±8.1 to 2.7±8.2 degrees, respectively (p < /i>
Farivar A Lahiji, MD; Hamidreza Aslani, MD; Amir Bisadi, MD; Seyed Mahdi Hosseini Khameneh, MD; Elham Rahimian, MD; Ali Fotouhi Maleki, MD; Seyyed Rouhollah Mousavi, MD; Farshad Safdari, MSc
Abstract
Background: Some authors suggested using ultrasound
in diagnosis of carpal tunnel syndrome (CTS), however the efficacy of
ultrasound in determining the severity of disease is unclear. In current study,
we aimed to investigate the diagnostic efficacy of ultrasound in determining
the severity of ...
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Background: Some authors suggested using ultrasound
in diagnosis of carpal tunnel syndrome (CTS), however the efficacy of
ultrasound in determining the severity of disease is unclear. In current study,
we aimed to investigate the diagnostic efficacy of ultrasound in determining
the severity of CTS in comparison with NCV using measurement of cross-sectional
area of median nerve. Methods: In
a prospective study, 181 CTS suspected wrists (94 patients) were investigated.
The cross-sectional area of the median nerve was measured using ultrasound and
the severity of disease was determined based on criteria of El Miedany et al. Based on the NCV,
the patients were divided into four groups of normal, mild, moderate or severe
CTS. Finally, the mean cross-sectional area was compared between the groups and
the kappa agreement coefficient for determining the severity of disease by the two
methods was calculated. Results: The mean cross-sectional area increased
significantly with increase in disease severity (p < /i>>.001). Conclusions: Determination of cross-sectional area of
median nerve with ultrasound can be a useful tool in decision-making about
surgical intervention in carpal tunnel syndrome. However, the clinical
correlation is mandatory.
Firooz Madadi; Mahdi Bahari Mehrabani; Mohammad Ali Jalili; Farshad Safdari, MSc
Abstract
Background: The knowledge about acetabular version and angle changes in different conditions is important. The normal acetabular version may be different in various populations. We would like to report measurement of this value in a small sample of Iranains with non-orthopaedic conditions. Methods: One ...
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Background: The knowledge about acetabular version and angle changes in different conditions is important. The normal acetabular version may be different in various populations. We would like to report measurement of this value in a small sample of Iranains with non-orthopaedic conditions. Methods: One coronal pelvic CT film of 81 patients (54 male, 27 female) who had undergone CT scanning for non-orthopaedic reasons was examined in a retrospective cross-sectional study. The acetabular versions were measured and compared for different genders and different age decades. The patients were aged 41.5±14.1 years. Results: The acetabular version was 17.7±3.4 degrees (range: 8 to 32 degrees). There was no significant relationship between acetabular version and age or gender in this sample. Conclusions: The acetabular version in this Iranian group ranged from 17.4 to 19.4 degrees with 95% confidential intervals.
Seyyed Morteza KazemiSeyyed Morteza Kazemi; Seyyed Mohammad Qoreishi; Mahdi Bahari Mehrabani; Farshad Safdari
Abstract
Background: It has been suggested that double-level osteotomy can prevent the occurrence of joint line obliquity, as one of the complications following high tibial osteotomy. In this study, we compared the preoperative distal femoral and proximal tibial obliquity in patients with primary genu varum with ...
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Background: It has been suggested that double-level osteotomy can prevent the occurrence of joint line obliquity, as one of the complications following high tibial osteotomy. In this study, we compared the preoperative distal femoral and proximal tibial obliquity in patients with primary genu varum with a group of normal subjects.
Methods: 75 patients with primary genu varum and 75 normal persons, contributed to a case-control study. The medial distal femoral mechanical angle (MDFMA), medial proximal tibial mechanical angle (MPTMA) and joint diversion angle (JDA) were measured and compared between the two groups. The percentage of patients with >3 degrees in both distal of femur and proximal of tibia were determined.
Results: The mean of MDFMA and MPTMA was significantly lower and the mean of JDA was significantly higher in genu varum group compared to normal group (p < /em>3 degrees.
Conclusions: The alignment of distal femur and proximal tibia is significantly different in patients with primary genu varum and normal controls. Abnormal alignment of joint line is a common finding in both primary genu varum and normal people but more commonly in the cases of genu varum. As double level osteotomy may be required in many patients with genu varum, it is important to investigate distal of femur alignment before high tibial osteotomy
Hossein Nayeb Aghaie; Hossein Safdari; Khalil Komlakh; Farshad Safdari
Abstract
Background: There are many cases with lumbar disk herniation in which asymptomatic lumbar canal stenosis will be diagnosed radiologically. In current study, we compared the outcomes of treating these patients with either laminectomy or laminotomy. Methods: In this randomized clinical trial, there were ...
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Background: There are many cases with lumbar disk herniation in which asymptomatic lumbar canal stenosis will be diagnosed radiologically. In current study, we compared the outcomes of treating these patients with either laminectomy or laminotomy. Methods: In this randomized clinical trial, there were 40 patients with lumbar disk herniation and asymptomatic lumbar canal stenosis assigned to 2 groups: laminectomy and fenestration. The severity of pain and disability were determined utilizing visual analogue scale (VAS) and Oswestry disability index (ODI) both before and after the surgery and the scores were compared in each group and between the two groups. The outcome of surgery was also compared using Japanese Orthopaedic Association (JOA) scoring system in a one year follow-up. The surgical time, blood loss and duration of hospital stay were also compared. Results: Significant postoperative decrease in severity of pain and ODI were found in both groups (p < /i>
Gholamhossein Kazemian; Gholamhossein Kazemian; Reza Tavakoli Darestani; Alireza Manafi Rasi; Mohammad Mahdi Sarzaeem; Ramin Farhang Zanganeh; Arash Ghaffari; Farshad Safdari
Abstract
Osteosarcoma is the most common malignant tumor of bone in young people. We report a case of recurrent post-radiation osteogenic sarcoma in the clavicle of a 28-year-old man with a history of Hodgkin’s lymphoma.
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Osteosarcoma is the most common malignant tumor of bone in young people. We report a case of recurrent post-radiation osteogenic sarcoma in the clavicle of a 28-year-old man with a history of Hodgkin’s lymphoma.
Gholamhossein Kazemian; Gholamhossein Kazemian; Reza Tavakoli Darestani; Mohammad Emami Tehrani Moghaddam; Alireza Manafi Rasi; Behrouz Asghari; Ali Nemati; Farshad Safdari
Abstract
Two patients with iatrogenic femoral neck fracture following intramedullary fixation of the diaphyseal fractures are reported. This is a rare complication of intramedullary nailing (IMN), has poor prognosis and is preventable. It seems that choosing the piriformis fossa as the entry point, increased ...
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Two patients with iatrogenic femoral neck fracture following intramedullary fixation of the diaphyseal fractures are reported. This is a rare complication of intramedullary nailing (IMN), has poor prognosis and is preventable. It seems that choosing the piriformis fossa as the entry point, increased neck-shaft angle (coxa valga) and excessive nail insertion increased the risk of the iatrogenic neck fracture.
Seyyed Massoud Hashemi; Mehrdad Taheri; Farivar A Lahiji; Seyyed Morteza Kazemi; Farshad Safdari
Abstract
Background: ''Suprascapular nerve block'' is a well known technique for treating chronic shoulder pain. Ultrasonography-guided nerve block is a new technique hoping to decrease the complications of inadvertent injection of drug into the vessels or nerve sheet by increasing the accuracy and efficacy of ...
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Background: ''Suprascapular nerve block'' is a well known technique for treating chronic shoulder pain. Ultrasonography-guided nerve block is a new technique hoping to decrease the complications of inadvertent injection of drug into the vessels or nerve sheet by increasing the accuracy and efficacy of the injections. Methods: In a trial clinical study, 50 Patients suffering from chronic shoulder pain were divided randomly into two groups. In the first group, nerve block was applied under the ultrasonograpy guide and in the second group using direct anatomic landmarks (Moore technique). Pain score was assessed using a visual analog scale (VAS) and shoulder function was evaluated by constant shoulder score (CSS) before the injection and after the block. The patients' satisfaction rate and efficacy were also evaluated and compared between the two groups. Results: There was no statistically significant difference between the two groups in pain or shoulder functional scores before the procedure (p≥.05). One week after the nerve block, the first group revealed significantly improvement in pain score p=.035). Although shoulder function improved in both groups, the difference was not significant. (p≥.05). One month later, pain and shoulder functional scores showed better improvement in group one compared to group two (p=.000). No complication occurred in either group. Conclusion: Ultrasonography-guided suprascapular nerve block has better outcome in pain score and shoulder function compared with ''blindly'' blocking the nerve.
Alireza Manafi Rasi; Gholamhossein Kazemian; Gholamhossein Kazemian; Amir Hossein Fallahi; Mohammad Mahdi Bagherian Lemraski,; Ali Nemati; Farshad Safdari
Abstract
Background: The use of prophylaxis for deep vein thrombosis (DVT) in patients with ankle trauma treated with below knee cast is a controversial issue. The purpose of current study was to investigate the incidence of DVT to look into the necessity of thromboprophylaxis in these patients. Methods: Ninty ...
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Background: The use of prophylaxis for deep vein thrombosis (DVT) in patients with ankle trauma treated with below knee cast is a controversial issue. The purpose of current study was to investigate the incidence of DVT to look into the necessity of thromboprophylaxis in these patients. Methods: Ninty five patients with stable fractures of the foot or ankle or ankle sprains contributed in this cross-sectional study. The level of D-dimer was determined between 7-14 days post-casting. If the level of D-dimer was higher than 0.2 µg/mL, the result of the test was considered positive and patient was referred for further examination for DVT using doppler ultrasonography. The role of risk factors in the development of DVT was evaluated. Results: There were 46 patients with at least one DVT risk factor. The D-dimer test was positive in 21 patients (22.1%). Based on the doppler ultrasonography, 3 patients developed DVT. There was a statistically significant relation between the presence of multiple risk factors (≥3) and increased risk of DVT development (p=.01). Conclusion: DVT is not a common complication in below knee casting and routine thromboprophylaxis is not necessary in patients with less than 3 risk factors.
Morteza Jannesari Ladani; Alireza Farahmandi; Mohammad Reza Guiti; Mohammad Reza Hedayati; Alireza Rahimnia; Farshad Safdari
Abstract
Background: Anterior glenohumeral instability is associated with anteroinferior rim defect of glenoid. Evaluation of such bony lesions may play a role in determining proper treatment and predicting recurrence of instability. The main purpose of the current study was to investigate the relation between ...
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Background: Anterior glenohumeral instability is associated with anteroinferior rim defect of glenoid. Evaluation of such bony lesions may play a role in determining proper treatment and predicting recurrence of instability. The main purpose of the current study was to investigate the relation between number of dislocations and extent of bony lesion of the glenoid and also determine the sensitivity and specificity of 3-D CT for detection of patients requiring bone-grafting surgery. Methods: Thirty patients with recurrent anterior shoulder dislocation contributed to this study. The patients underwent bilateral 3-D CT imaging to determine the glenoid index (GI). Then, the correlation between the number of dislocations and GI, and also sensitivity and specificity of CT were determined. Results: The bony lesion was present in 28(94%) of patients. There was no meaningful relationship between the number of dislocations and GI (p=.05). Based on the CT, 2 patients required open surgery and bone grafting and 28 patients only Bankart procedure. This was proved to have been wrong in 2 cases at surgery. So, the sensitivity and specificity of 3-D CT was 50% and 96% respectively. Conclusion: The number of dislocations cannot determine the extent of the bony glenoid defect in recurrent shoulder dislocation lesion. 3-D CT can help in knowing the expansion and location of the lesion, but is not a reliable tool for surgical technique.
Hamid Reza Hosseinzadeh; Reza Zandi; Seyyed Morteza Kazemi; Seyyed Mohammad Qorashi; Sina Shahi; Farshad Safdari; Mohammad Reza Bigdeli; Siyavosh Hemmati Eslamlou; Mohammad Ali Jalili
Abstract
Background: Posterior tibial slope is the normal anteroposterior inclination of the tibia slope and plays an important role in the biomechanics of the knee and function of the cruciate ligaments. Posterior tibial slope angle varies in different populations and there is no report about its measurement ...
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Background: Posterior tibial slope is the normal anteroposterior inclination of the tibia slope and plays an important role in the biomechanics of the knee and function of the cruciate ligaments. Posterior tibial slope angle varies in different populations and there is no report about its measurement in the Iranian population. The aim of this study was to investigate the normal posterior tibial slope in a teaching hospital in Tehran-Iran. Methods: In a desreptive study, 108 knees in 70 men and 38 female patients, with no history of prior knee problem were evaluated by lateral knee rodiographs in a teaching hospital in Tehran-Iran. The average age in these cases was 38 years (23-60 years). These patients had refered because of recent knee trauma, but no fracture or intra-articular derangement had been found. The angle of tibial slope was measured in all the cases and analyzed. Results: The mean slope angle was 9.4±1.8 degrees. There was no statistical relationship between age and gender and posterior tibial slope (p≥.05). Conclusion: The normal posterior tibial slope angle in this Iranian population was different from other countries. It may be necessary to consider these differences in designing tibial and femoral components for knee arthroplasty.
Farivar A Lahiji; Reza Zandi; Sohrab Keyhani; Farshad Safdari; Arash Maleki; Seyyed Reza Aghapour; Salman Azarsina
Abstract
Background: Kienbock disease resulting from avascular necrosis of lunate bone leads to pain and disability in young active patients. Radial shortening is one of the treatment methods in this disease. In this study, we evaluated the mid-term results of treatment of Kienbock using radial shortening. Methods: ...
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Background: Kienbock disease resulting from avascular necrosis of lunate bone leads to pain and disability in young active patients. Radial shortening is one of the treatment methods in this disease. In this study, we evaluated the mid-term results of treatment of Kienbock using radial shortening. Methods: In a retrospective study, 9 males and 6 females with Kienbock disease with average age of 28.6±9.37 years who had undergone radial shortening, were examined in a teaching hospital in Tehran-Iran. There were 2 patients in stage II, 5 in IIIa and 8 in step IIIb of Lichman’s class. In a mean follow-up of 5±2.44 years, these 15 cases were evaluated for wrist motion and gap strength and also with quick-DASH score. The radiograph Stahl index and carpal height ratio were also assessed. Results: Pain and range of motion improved and grip strength was favorable in 13 patients. Quick-DASH score was 8.5±.84 in patients with stage II, 12.72±5.09 in stage IIIa, and 27.57±18.87 in stage IIIb. Stahl index and carpal height ratio were the same in patients with stage II, but significantly decreased in other patients. Kienbock disease progressed in 2 cases. Conclusion: Radial shortening can relief clinical symptoms, even in stage III and IIIb of Kienback diseases, although the disease X-ray show radiographic worsening.
Mohammad Mahdi Sarzaeem; Mohammad Emami; Mohammad Emami; Gholamhossein Kazemian; Gholamhossein Kazemian; Alireza Manafi Rasi; Mohammad Mahdi Bagherian Lemraski; Farshad Safdari
Abstract
Background: Large defects in chronic Achilles tendon ruptures are difficult to rapair. The purpose of this study was to evaluate the clinical and functional outcomes following reconstruction of the chronic large gaps in Achilles tendon ruture using free semitendinosus interposition tendon grafting. Methods: ...
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Background: Large defects in chronic Achilles tendon ruptures are difficult to rapair. The purpose of this study was to evaluate the clinical and functional outcomes following reconstruction of the chronic large gaps in Achilles tendon ruture using free semitendinosus interposition tendon grafting. Methods: In a case series study, eleven male patients with mean age of 30±4 years and average defect size of 8.31±1.96 cm in their old Achilles tendon underwent reconstruction during 6 years in a teaching hospital in Theran-Iran. Ipsilateral semitendinosus free tendon graft was used for reconstruction. The cases were evaluated by Ankle-Hindfoot Scale of American Orthopaedic Foot and Ankle Society (AOFAS), and the Achilles Tendon Rupture Score (ATRS) to with a mean follow-up of 25.36±3.3 months. Results: The pre-operative AOFAS and ATRS of 70.4±5.3 and 31.7±5.7 preoperatively improved to 91.8±4.8 and 88.7±4.2 values. The ankle dorsiflexion showed a significant decline – postoperative value of 13.5±4.2 degrees compared to preoperative of 17.2±3.9 degrees (p=.04). All the cases except a professional athlete, returned to their previous activities. Conclusion: This technique offers good clinical and functional results in patients with large defects and is associated with no donnersite morbidity. We recommend this technique for the reconstruction of the chronic at ruptures in patients with over 6 cm defects.
Seyyed Morteza Kazemi; Siyavosh Hemmati Eslamlou; Arash Maleki; Reza Zandi; Mohammad Ali Jalili; Keyghobad Ashoori; Farshad Safdari
Abstract
Background: The role of increased posterior tibial slope in rupture of the anterior cruciate ligament (ACL) is controversial. The purpose of current study was to determine the effect of posterior slope on the ACL injury. Methods: In a case control study, 61 consecutive cases with ACL injury, who were ...
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Background: The role of increased posterior tibial slope in rupture of the anterior cruciate ligament (ACL) is controversial. The purpose of current study was to determine the effect of posterior slope on the ACL injury. Methods: In a case control study, 61 consecutive cases with ACL injury, who were candidates for reconstruction, were compared with 61 persons with normal knees who were matched for age and sex, over a 2-year period at a teaching hospital in Tehran, Iran. The posterior tibial slope angles were measured on true lateral radiographs on all the cases. The measurement variations were analyzed between the two groups. Results: The mean posterior tibial slope was 9.4±1.8 degrees in controls and 12.3±4.4 in patients with ruptured ACL (p < .001). The incidence of tibial slope greater than 10 degrees in patients with ruptured ACL was 3.1 times greater than that of the controls. Conclusion: This study suggests that increased tibial slope angle may contribute to increased risk for ACL rupture.
Keyghobad Ashouri; Ali Akbar Esmailijah; Farivar A Lahiji; Ali Akbar Esmailijah; Seyed Mehdi Hoseini Khameneh; Firooz Madadi; Farivar Bagheri; Mehdi Rahimi; Reza Zandi; Farshad Safdari
Abstract
Background: The prevalence of palmaris longus agenesis (PLA) has been variously reported to be from 1.5% to 64% in different ethnic groups. Finding the state of PLA among Iranian people was the aim of this study. Methods: 1008 participants were included in this descriptive study during a 6-month period ...
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Background: The prevalence of palmaris longus agenesis (PLA) has been variously reported to be from 1.5% to 64% in different ethnic groups. Finding the state of PLA among Iranian people was the aim of this study. Methods: 1008 participants were included in this descriptive study during a 6-month period in a teaching hospital in Tehran-Iran. The Schaeffer test was used to detect the presence or absence of palmaris longus. The role of gender and handedness was also assessed in PLA. Results: The prevalence of PLA was estimated at 22.8% - 10.2% agenesis on the right side, 5.9% on left side and 6.7% on both sides. The relationship between PLA and gender didn’t appear to be significant. Right handedness was seen in 90.9% of cases with PLA and 72.5% of those without PLA (p=.000, OR=3.8). Conclusion: The prevalence of PLA in Iranian people studied, were comparable to the average Caucasian values in the literature.
Mohammad Reza Farahanchi Baradaran; Seyyed Morteza Kazemi; Seyyed Mehdi Hosseini Khameneh; Seyyed Mohammad Jazaeri; Firooz Madadi; Keyghobad Ashoori; Katayoon Kazemi; Reza Zandi; Farshad Safdari
Abstract
Background: Arthroscopic reconstruction of the anterior cruciate ligament is one the most common orthopaedic surgeries. There are scattered reports about the beneficial effects of post operative cox2-inhibitors administration on knee motion. The purpose of the current study was to determine the effects ...
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Background: Arthroscopic reconstruction of the anterior cruciate ligament is one the most common orthopaedic surgeries. There are scattered reports about the beneficial effects of post operative cox2-inhibitors administration on knee motion. The purpose of the current study was to determine the effects of cox-2 inhibitor on pain, range of motion and weight bearing after arthroscopic reconstruction of the anterior cruciate ligament. Methods: In this clinical trial, 70 patients who underwent arthroscopic reconstruction of the anterior cruciate ligament were assessed in a teaching hospital in Tehran-Iran. They were divided into case (cox2-inhibitor) and control groups. Postoperatively, pain, inflammation, range of motion and ability for full weight bearing were measured. Results: The mean of pain at the postoperative day 3 was 5.3±1.04 (visual analogs scale of 0 to 10) in the control and 3.3±0.71 in the case group. 29.6% of the patients in the control group and 82.8% in the case group were able to flex the knee more than 90° one week postoperatively. In the first week, all of the patients in the case group and only 28.6% in the control group were able to walk without any assistive device. The post operative knee circumstances were 2.73±0.59 and l.61±0.92 centimeters smaller respectively in case and control groups. Statistical analysis showed significant differences between the two groups, in the above measurements. Conclusion: Cox-2 inhibitor is effective in relieving pain reducing the inflammation, and accelerating the rehabilitation program after arthroscopic reconstruction of the anterior cruciate ligament.
Sohrab Keyhani, MD; Seyyed Reza Sharifzadeh, MD; Mohammad Reza Abbasian, MD; Touraj Shafaghi, MD; Soheil Mehdipour, MD; Farshad Safdari, MSc
Abstract
Background: The purpose of this study was to evaluate the functional outcome of arthroscopic treatment of chondral and osteochondral lesions of the knee with arthroscopic osteochondral autograft transfer (Mosaicplasty), and to evaluate the factors affecting the treatment outcome.Methods: In a before ...
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Background: The purpose of this study was to evaluate the functional outcome of arthroscopic treatment of chondral and osteochondral lesions of the knee with arthroscopic osteochondral autograft transfer (Mosaicplasty), and to evaluate the factors affecting the treatment outcome.Methods: In a before and after clinical trial, 56 patients with grade 4 full thickness chondral lesion (outer bridge classification) were treated by the arthroscopic mosaicplasty technique over a 4-year period at an hospital in Tehran, Iran. The mean time of follow-up was 21±4 months (16-32 months). The patients were assessed by International Knee Documentation Committee (IKDC) and Lyshom knee scoring scale (LKSS). The impact of age, site of chondral lesion (medial or lateral femoral condyle), extent of the lesion (number of plugs) and associated lesions, preoperative active levels, tourniquet time and surgery complications were studied. In 3 cases, second-look arthroscopy was performed.Results: The result of 78.6% was excellent and 21.4 good, based on IKDC. Preoperative Lysholm score was 67.1±17.6 and postoperative score increased to 93.2±6.5 (p < /em>=.0004). Clinical outcomes were better significantly in patients with associated articular lesions, lateral condyles lesions, professional athletes and younger patients, also in cases with lower plug numbers and sport injuries (p < /em>
