Gholamhossein Shahcheraghi
Abstract
The record keeping of the experience gained at surgery is going “on-line”. This is the message of the paper presented in this issue by Qoreishy and colleagues.
Many programs, nowadays, have a final examination to evaluate the level of education of the trainees. “Logbook” has ...
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The record keeping of the experience gained at surgery is going “on-line”. This is the message of the paper presented in this issue by Qoreishy and colleagues.
Many programs, nowadays, have a final examination to evaluate the level of education of the trainees. “Logbook” has been used for years by many programs and disciplines, both surgical and medical, all over the world. It has been also customary in some programs in Iran including orthopaedics. This is primarily for assessing the exposure level of the residents to different surgeries. What a logbook of an orthopedic resident shows, in its most complete and accurate form, is the experience that has been gained in the operating room. It does not indicate the ability or competency of the trainee for any particular procedure.
There have been additional attempts in enriching the evaluation process by videotaping the procedure done by a resident, and have independent assessors to upraise the manual dexterity of a resident.
Simulation- experience obtained either on table-tops or by performing a procedure on cadavers -is another objective evaluation system of the trainee’s competency. It is an adjutant to skill training and also evaluation of the gained skill. This does not, certainly, compare to the experience obtained in operating room on a true patient on the table. Simulation, however, increases surgeon’s competency and also his/her confidence.
The on-line logbook is easy, efficient and, at the same time, very useful for assessing the deficiencies in exposure of a specialty candidate to different operations, and also the shortcomings of a training program. It can be effectively used by the Orthopaedic Board Examination and the Health Ministry for residency program accreditation, or re-appraisal following a probation. The collective data from logbooks can also define the strengths or the deficiencies of a program, helping constructive planning for a residency training program
There are, however, limitations in the accuracy of a logbook: a well-trained educator is needed to provide the reliable, honest assessment and an able body to give constructive feedback. If a trainer is weak, not well experienced or cannot stay objective in his/her assessment, then the appraisal of surgical abilities of a resident will not be reliable. The online program needs to be controlled, and monitored meticulously, and also needs frequent updating for the procedures that are pre-marked and included in the list of logbook items.
We should, however, remember that logbook still leaves out the other important aspects of a trainee’s evaluation like bed-side manner, sense of responsibility, ethical issues, relation with colleagues and medical personnel, ability of proper use of tests and investigations, the ability of accurate documentation of surgical findings by a good operating note dictation. It also lacks the ability to evaluate a resident in the clinic with a patient and in asking proper questions, doing the proper physical examination and ordering proper tests.
Mahzad Javid; Gholam Hossein Shahcheraghi
Abstract
Aim: Closed treatment using Ponseti casting technique is the standard management for clubfoot deformity. This study is investigating the efficacy of repeat use of Ponseti technique in late cases that had not achieved correction following previous attempts.
Method: A prospective study was conducted on ...
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Aim: Closed treatment using Ponseti casting technique is the standard management for clubfoot deformity. This study is investigating the efficacy of repeat use of Ponseti technique in late cases that had not achieved correction following previous attempts.
Method: A prospective study was conducted on clubfeet cases of over 3 months of age who had not achieved correction with previous casting and were referred for surgery to our clinics. The Baseline and final Pirani scores were compared in a 4 .5- year average follow-up. The functional scores, recurrence rates and additional procedures required for correction were also documented.
Results:79 feet in 53 patients of 3 months to 9 years of age were studied. They had mean Pirani scores of 4.4 and had previously received 7.8 ± 2.5 castings and 9 Achilles tenotomies. An average of 4.3 ± 1.7(2–8) castings and 32 Achilles tendon lengthening were needed to achieve complete correction in 77 feet (98%). Relapse of deformity was seen in 42 (53%) feet, which dropped the correction rate in the final follow-up to 89%. However, the functional score at the end , was good or excellent in 93% of the cases.
Discussion: Accurate re-use of Ponseti technique in cases of previously- failed clubfoot casting has high success rate, even in late referrals.
Level of Clinical Evidence : Level 4
Gholam Hossain Shahcheraghi, MD, FRCSC; Mahzad Javid, MD
Abstract
Background: The congenital absence of the tibia is a rare disease, and an orthopaedic surgeon may not encounter such cases during the course of his/her career. This is the largest report to date of the management of such cases by a single surgeon. The foot and leg were persevered in the majority of the ...
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Background: The congenital absence of the tibia is a rare disease, and an orthopaedic surgeon may not encounter such cases during the course of his/her career. This is the largest report to date of the management of such cases by a single surgeon. The foot and leg were persevered in the majority of the cases, and a functional evaluation system was used to report outcomes.
Methods: Thirty-six patients (19 girls, 17 boys) with 48 tibial deficient limbs were evaluated clinically and radiographically. The mean age of patients was 12 years old. The patients or their parents filled out the Pediatric Quality of Life and the parents’ satisfaction forms. The surgical interventions performed, and their effects on school attendance and the shoe type they wore were documented.
Results: The mean time of follow-up was 9 years. The 48 limbs included 14 type I, 16 type II, 11 type IV, and 7 unclassified by using the Jones classification; and 6 type I, 11 type II, 16 type III, 1 type IV, and 14 type VII by using the Weber classification. Primary amputation was performed in 10 limbs (8 patients) and limb preservation surgery on 38 legs (28 patients). Tibiofibular synostosis, centralization of the ankle, and Ilizarov lengthening were the most common procedures. Non::union:: of tibiofibular synostosis (2 cases) and knee stiffness (6 cases) were the main complications. Among the reconstructed limbs, 12 were in regular and 18 in modified shoes. The Pediatric Quality of Life of 68 points in the reconstructed group was a significant achievement, and it was also better than the score of patients who had undergone amputation.
Conclusions: Reconstruction of tibial hemimelia with foot preservation provides good functional outcome in the majority of cases.
Mahzad Javid, MD; Gholamhossain Shahcheraghi, MD, FRCS (C); Farivar Lahiji,MD; Azis Ahmadi, MD
Abstract
Background: Doing surgery on wrong location, or wrong person, or doing a different surgery by mistake, are all horrible, though not infrequent happenings. This is a report on an attempt to determine the incidence of "wrong-site” surgery among the Iranian Orthopaedic Surgeons.Method: A one-page questionnaire, ...
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Background: Doing surgery on wrong location, or wrong person, or doing a different surgery by mistake, are all horrible, though not infrequent happenings. This is a report on an attempt to determine the incidence of "wrong-site” surgery among the Iranian Orthopaedic Surgeons.Method: A one-page questionnaire, regarding personal experience or having witnessed or heard about "wrong-site" surgery during the last 2 years, was mailed to the active members of Iranian Orthopaedic Association (IOA). All the members were also contacted by phone to confirm the receipt of the questionnaires and request an earlier return of the forms. The returned forms and the telephone responses were analyzed.Results: From the 736 questionnaires sent out to the IOA members, 54 (5.7%) written response was received back. 368 (50%) members denied having personally faced or heard of any "wrong site" surgery. 313 IOA members (%42.5) did not participate, and gave no answer – nor on phone, neither by writing. Among the 54 returned questionnaires, 29 members had encountered or were aware of 40 cases of "wrong", surgery which included 32 mistakes in the side of surgery and 8 cases of wrong limb surgery.Conclusions: The response rate to questions regarding "wrong" surgery is very low in IOA members. Adherence to a strict protocole in avoiding wrong-site or wrong limb surgery may decrease the number of mistakes in any busy operating room.
Gholamhossain Shahcheraghi; Alireza Tavakoli
Abstract
Background: Spinal deformity in neurofibromatosis, when associated with dystrophic change, is a major treatment challenge. Resection of the vertebral body as an additional step in correction and fusion has not been previously investigated. The purpose of this study is to report an experience with corpectomy ...
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Background: Spinal deformity in neurofibromatosis, when associated with dystrophic change, is a major treatment challenge. Resection of the vertebral body as an additional step in correction and fusion has not been previously investigated. The purpose of this study is to report an experience with corpectomy and circumferential fusion in dystrophic spines of neurofibromatosis. Methods: In a retrospective study, among 16 patients with dystrophic spinal curves, nine cases who had undergone anterior and posterior fusion with 6.7 years (range 2-11.9) average follow-up were evaluated. Results: Nine cases with a mean age of 11.8 years (range 7.8-17) at surgery consisted of seven kyphoscoliotic patients, who had received one or two levels of cord decompression and corpectomy. Surgery improved the mean preoperative scoliosis of 87 (range 60-110) and local kyphosis of 69.3° (range 50-100) to 49 (range 15-85) and 49° (range 35-70), respectively. Loss of correction of 5° in the scoliosis and 13° in the kyphosis angles was observed in the final follow-up. Fusion was achieved in all cases. The average SRS-22 score of 4.1 (range 3-4.6) was obtained. Conclusions: Simultaneous anterior and posterior fusion with corpectomy for dystrophic neurofibromatosis spinal deformities is associated with a high fusion rate, good correction, and also good functional outcome.
Mahzad Javid, MD; Gholam Hossain Shahcheraghi, MD, FRCS(C)
Abstract
Background: Shoulder deformity and contracture is a common finding after brachial plexus birth palsy even in those who have had good recovery of nerve function or have had micro surgical nerve repair at infancy. We would like to report our results with the reconstructive shoulder surgery in a group of ...
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Background: Shoulder deformity and contracture is a common finding after brachial plexus birth palsy even in those who have had good recovery of nerve function or have had micro surgical nerve repair at infancy. We would like to report our results with the reconstructive shoulder surgery in a group of older children.Methods: Shoulder contracture from brachial plexus birth palsy was surgically released in 24 older children, with simultaneous transfer of the latissimus dorsi and teres major tendons to the posterolateral humerus or rotator cuff. The mean age at surgery was 8 years 11 months. The children were evaluated at a mean follow-up time of 6 years 8 months by the Modified American Shoulder and Elbow Surgeons Form and Shoulder Pain and Disability Index standardized shoulder assessment forms, a questionnaire assessing activities of daily living, and parent and patient satisfaction scales.Results: The fixed internal rotation deformity of 30º±12º improved to 72.5º±27º of external rotation. Improvements of 65º±26º and 47º±33º were seen in abduction and forward elevation, respectively, all without preoperative casting or manipulation. Increased external rotation had a more positive correlation with a higher functional score than abduction. Patients with lower preoperative functional scores had more rotational gain and higher functional scores after surgery. Those aged over 9 years had a functional gain similar to that of the younger children.Conclusion: Simultaneous release of contracted shoulder and transfer of latissimus dorsi and teres major tendons in brachial plexus birth paralysis is effective, and rewarding even in older children who have had late referral, and might have already developed glenoid dysplasia.
Sedigheh Najafipour, MS; Gholamhossain Shahcheraghi, MD, FRCS(C); Mohammad Hossein Fallahzadeh, MD; Marzieh Kargar, MS
Abstract
Background: Secondary hypertension in newborns and children may occur in many conditions including trauma and extremity fractures. This study was undertaken in two hospitals of Shiraz to determine the prevalence of hypertension among children undergoing orthopedic procedures.Methods: Sixty children (34 ...
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Background: Secondary hypertension in newborns and children may occur in many conditions including trauma and extremity fractures. This study was undertaken in two hospitals of Shiraz to determine the prevalence of hypertension among children undergoing orthopedic procedures.Methods: Sixty children (34 boys, 26 girls) aging 3-14 years old were cases of 7 clubfeet, 35 femoral fractures, 5 developmental dislocation of hip, 2 poliomyelitis, 3 pelvic fracture, 3 congenital short leg, and 5 miscellaneous conditions were studied in a six month interval. Blood pressures were measured.Results: Hypertension was observed in 30 children in age groups of 3-14 years old from the second to fourth day after orthopaedic surgery, without any previous history of hypertension. Severe hypertension was demonstrated in 4 boys and 2 girls and returned to normal after changing of the traction angles and alignments of fixators. 24 cases had moderated increase in blood pressure that was normal on sixth post operative day. Femoral shaft fractures treated with skeletal traction, postsurgical casting of clubfoot deformities and leg-lengthening with external fixator were the top three causes of such findings.Conclusions: Secondary hypertension may happen among children undergoing orthopaedic procedures and needs careful monitoring.
Mahzad Javid, MD; Gholamhossain Shahcheraghi, MD, FRCS (C); Farivar A Lahiji, MD; Aziz Ahmadi, MD; Afshin Farhadi, MD; Gholam Ali Akasheh, MD
Abstract
Background: To find the patterns and common mechanisms of motor-vehicle related pediatric trauma in a metropolitan city (Tehran-Iran), to guide the health planners of the city in proper planning and resource application and distribution.Methods: A pilot study was started in three major pediatric-trauma ...
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Background: To find the patterns and common mechanisms of motor-vehicle related pediatric trauma in a metropolitan city (Tehran-Iran), to guide the health planners of the city in proper planning and resource application and distribution.Methods: A pilot study was started in three major pediatric-trauma referral centers in Tehran by the Iranian Orthopaedic Association. All the cases below age 14 who visited the emergency department of those three hospitals, with body trauma resulting from a vehicle-related accident were studied. Cases were collected on a 24-hours basis in one month of each four seasons of the last year. The data collection was done by contracted physicians with the use of a detailed questionnaire.Results: From a total of 318 children that visited the emergency departments because of motor–vehicle related accident, 287 patients had trauma to various parts of the body (215 male 72 females), 151 cases had only musculoskeletal trauma and 31 others had sustained no significant injury of any kind. Multiple trauma was seen in 33.6% of the cases.52.8% of accidents happened in spring & summer, 21/7% in autumn, and 25/5% in winter season. The place of accidents were usually on the streets (70%), followed by small allies (17/5%), then major roads (12/5%). 65% of the accidents had happened at night and 35% during the day. The injuries were from motorcycles hitting pedestrians in 33.7% and, car–pedestrian accidents in 31.9%. The musculoskeletal injuries included fracture of tibia and fibula (62 cases), femoral fracture (25 cases), forearm (18 cases) and humerus (11 cases) in order of frequency. 24% of patients were transferred by ambulance and the rest by their family members or by- standing people. Conclusions: Children become disabled far too frequently in the city, from lack of proper training, proper enforcement of traffic rules by the children and the drivers. An appropriate measure of safety in the crowded metropolitan city of Tehran is essential, and this report can be a guide for the other major cities of the third world.
