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.
Mohsen Karami, MD; Ali Akbar Esmailiejah, MD; Maryam Sedaghatnia, MD; Ali Akbar Esmailiejah, MD; Ramin Etemadi, MD; Ahmad shafaeizadeh, MD
Abstract
Background: The use of pedicle screws in thoracic or lumbar spinal fusion and deformity correction is becoming more privalent, even in children. Improper screw insertion can produce major complications. The accuracy of the screw placement is evaluated post operatively by CT scanning in a small group ...
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Background: The use of pedicle screws in thoracic or lumbar spinal fusion and deformity correction is becoming more privalent, even in children. Improper screw insertion can produce major complications. The accuracy of the screw placement is evaluated post operatively by CT scanning in a small group of children.Methods: In a cross section study, 7 children under 5 years of age who had undergone spinal surgery, using pedicular screws were evaluated in two training hospitals in Tehran, Iran. The position of pedicular screws was determined by an expert radiologist and documented along with probable neurovascular effect.Results: Seven children with total of 42 pedicle screws were assessed. 34 screws (80%) had been placed in the desired positions. The remaining 9 screws had produced minor breakage through the cortices, mainly in narrow thoracic pedicles. There was no case of neurovascular compromise, or stability problem in the 42 screws.Conclusions: Use of peducular screw in spinal fusion of young children is a proper technique.
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.
Hamid Reza Seyyed Hosseinzadeh, MD; Ali Akbar Esmaieliejah, MD; Seyyed Morteza Kazemi, MD; Mohammad Reza Bigdeli, MD; Mohammad Ali Jalili, MD; Farivar Baghery, MD; Reza Zandi, MD; Seyyed Reza Aghapoor, MD;; Ali Akbar Esmaieliejah, MD; Alireza Eajazi, MD; Farshad Safdari, MSc
Abstract
Background: Unstable pelvic fractures are major orthopaedic injuries with high rates of morbidity and mortality. Open surgical stabilization is the standard treatment for a great number of them. Percutaneous surgical fixation has become an accepted treatment method in last several years. We would like ...
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Background: Unstable pelvic fractures are major orthopaedic injuries with high rates of morbidity and mortality. Open surgical stabilization is the standard treatment for a great number of them. Percutaneous surgical fixation has become an accepted treatment method in last several years. We would like to report our experience with this relatively, newer technique in a small mixed group of unstable pelvic ring fractures.Methods: This is a report of 16 cases (13 males, 3 females) with mean age of 31±8 years of pelvic and acetabular fractures who received percutaneous iliosacral or iliopubic screw fixation, under C-arm imaging control, and had a 6 months period of clinical and radiographic follow-up.Results: All 16 cases had healed their fractures at follow-up and had full weight-bearing status. 12 cases returned to their pre-fracture activities. One screw break and one wound infection were the complications list. There was no neurological deficit, and average blood loss was 10 milliliters.Conclusion: Percutaneous iliosacral or iliopubic screw fixation for, respectively, posterior pelvic ring or anterior column acetabular injuries are useful surgical treatment options with low complication rates.
Hamid Reza Seyyed Hosseinzadeh, MD; Ali Akbar Esmaieliejah MD; Seyyed Reza Aghapoor, MD; Reza Zandi, MD; Mohmmad Reza Bigdeli, MD; Ali Aidenlo, MD; Jaafar Tavakolian, MD; Ali Akbar Esmaieliejah MD; Seyyed Morteza Kazemi, MD
Abstract
Background: Dislocation of total hip arthroplasty may happen for different reasons. Abnormal acetabular orientation is a common reason for such occurance. We would like to report the effect of acetabular inclination on incidence of dislocation.Methods: In a cross-sectional study all cases of total hip ...
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Background: Dislocation of total hip arthroplasty may happen for different reasons. Abnormal acetabular orientation is a common reason for such occurance. We would like to report the effect of acetabular inclination on incidence of dislocation.Methods: In a cross-sectional study all cases of total hip arthroplasty performed in a 2-yaer interval in one educational hospital in Tehran, were followed and assessed for possible dislocation in a 18.1 months (3-25 months) of follow-up. The inclination angles of acetabular components were measured, and the relationship of dislocation with gender, age and this angle was evaluated.Results: 132 cases entered the study. 4 patients (3%) encountered dislocation and all 4 had inclination angles of over 50 degrees. Gerder did not seem to play an important role. Older age, however, was probably contributing to risk of dislocation.Conclusion: Inclination angle of over 50 degree in acetabular component position is one of the factors making it more likely for the hip arthroplasty to dislocate.
Sohrab Keihani, MD; Ali Akbar Esmaieliejah, MD; Mohammad Reza Abbassian, MD; Seyyed Morteza Kazemi, MD; Ali Akbar Esmaieliejah, MD; Hamid Reza Seyed Hosseinzadeh, MD; Amer Sadeghi, MD
Abstract
Background: Medial opening-wedge valgus high tibial osteotomy has gained popularity. However, the reported complication rate is high. The technique has been modified to remedy the problems of patellar descent and alteration in angle of the inclination of the tibial plateau and delayed :::union:::. Our ...
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Background: Medial opening-wedge valgus high tibial osteotomy has gained popularity. However, the reported complication rate is high. The technique has been modified to remedy the problems of patellar descent and alteration in angle of the inclination of the tibial plateau and delayed :::union:::. Our aim is to compare the modified retrotubercle opening-wedge osteotomy with the conventional technique.Methods: In a clinical trial study, 72 consecutive patients with varus knees who were candidates for high tibial valgus osteotomy were, randomly treated with either conventional medial opening-wedge upper tibial osteotomies (34 patients) or retrotubercle opening-wedge osteotomies (38 patients) from Feb 2006 to Feb 2008. These matched cases were evaluated for patellar height and upper tibial slope as well as tibial inclination measurements. The intra and inter-observer reliability of the radiographic measures were also assessed before surgery and in a mean follow up of 13 months (10-21 months).Results: In retrotubercle open-wedge osteotomies no surgical change in patellar length or any patellar infra was seen. The tibial plateau inclination also showed no significant change from the pre-operative values. On the other hand, the conventional medial open-wedge technique showed significant reduction in patellar height as well as increase in tibial plateau inclination as compared to pre-operative values.Conclusion: In high tibial valgus osteotomies for genu varum retrotubercle medial open-wedge osteotomy negates the ill-effect of conventional open-wedge osteotomy in producing patella infra or increased tibial plateau slope or change in Q-angle of quadriceps mechanism.
Sohrab Keyhani, MD; Ali Akbar Esmaieliejah, MD; Mehran Soleimanha, MD; Ali Akbar Esmaieliejah, MD; Seyed Morteza Kazemi, MD; Mohammad Reza Abbassian, MD; Reza Rokni, MD
Abstract
Background: The purpose of this study was to evaluate the short-term outcomes after one-stage arthroscopic reconstruction in chronic multiligamentous knee injuries.Methods: In a prospective study, 15 men with chronic multiligamentous knee injuries underwent one-stage reconstruction with autogenous semitendinosus ...
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Background: The purpose of this study was to evaluate the short-term outcomes after one-stage arthroscopic reconstruction in chronic multiligamentous knee injuries.Methods: In a prospective study, 15 men with chronic multiligamentous knee injuries underwent one-stage reconstruction with autogenous semitendinosus and gracilis grafts for anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). Any associated other ligamentous injuries were repaired by Achilles tendon allografts. The results were assessed by IKDC, and Lysholm score and ligament integrity by MRI with a mean follow-up of 9 (4-19) months. Clinical examination, regular radiography and a subjective questionnaire completed the evaluation procedures. Results: With a mean age of 23 (18-35) years, the final IKDC score was normal (grade A) in 1, nearly normal (grade B) in 10, abnormal (grade C) in 3 and grossly abnormal (grade D) in 1 patient. The mean subjective IKDC score was 83±14. The preoperative Lysholm score of 62±13 become 94±5 in follow-up.Conclusions: Multiple ligament injuries of knee can be successfully treated arthroscopically with autologous hamstring tendon graft, and if necessary, additional of Achilles tendon allograft.
Seyed Morteza Kazemi, MD; Ali Akbar Esmaeileijah, MD; Ali Akbar Esmaeileijah, MD; Farshad Adib, MD
Abstract
Background: In spite of common occurrence of ankle sprains, syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed.Methods: In 100 patients the sensitivity and specificity of standard radiography and physical examination were tested against MRI of the ankle for the diagnosis ...
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Background: In spite of common occurrence of ankle sprains, syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed.Methods: In 100 patients the sensitivity and specificity of standard radiography and physical examination were tested against MRI of the ankle for the diagnosis of syndesmosis sprain. The clinical tests included: syndesmosis tenderness, squeeze test, external rotation test, and crossed-leg test.Results: Four patients had syndesmosis sprain. In comparison with MRI, the sensitivity and specificity for standard radiography were 25% and 100%. The values for crossed-leg test they were 100%, 74%, for external rotation test 100%, 62.5%, for squeeze test 75%, 61.5%, and for tenderness of syndesmosis were 100%, 58% respectively.Conclusions: Physical examination has high sensitivity and low specificity for diagnosis of syndesmosis sprain. Crossed-leg test is more accurate than the other tests. AP and mortise views have low sensitivity and high specificity. Clinical evaluation and regular radiographs do not yield an accurate account of tibiofibular syndesmotic injury. MRI is recommended in athletes or those with equivocal findings.
