Shoulder & Elbow
Shahwali Habib
Abstract
Background: To find causes and number of elbow joint dislocation in Kunduz regional hospital- Afghanistan in 2021. The aim is to understand what the causes are and try to reduce the incidence by informing the people and discuss with the government.Methods: We conducted a prospective case series study ...
Read More
Background: To find causes and number of elbow joint dislocation in Kunduz regional hospital- Afghanistan in 2021. The aim is to understand what the causes are and try to reduce the incidence by informing the people and discuss with the government.Methods: We conducted a prospective case series study to figure out causes and number of elbow joint dislocations in Kunduz Regional Hospital- Afghanistan from the beginning up to the end of 2021. This study included 23 patients; the age was above 5 years old. The data were entered in spreadsheet and analyzed in SPSS program. Results: Among 23 patients, 18 (78%) were male, 5 (22%) were female. Fourteen cases were 10-30 years of age; 15 (66%) were residents of Kunduz province. In 10 (43%) fall from height, 6 (26%) road traffic accident, 5 (22%) sports injuries, and in 2 (9%) family assault were the causes of elbow joint dislocation.In 19 (84%) cases posterior dislocation, in 1 (4%) anterior dislocation, in 1 (4%) lateral dislocation, in 1 (4%) open posterior dislocation with fracture and in 1 (4%) complex closed posterior dislocation; were the types of dislocations. Elbow dislocation was more on right side (61%). 21 (92%) of elbow dislocations were treated non-operatively, and 2 (8%) operatively. In 21 (92%) there was no complication, in 1 (4%) myositis ossificans and in 1 (4%) non-reduced dislocation treated by traditional bone setter were observed.Conclusion: The most common causes of elbow dislocation were fall from height and road traffic accident. Postero-lateral was the most commonly seen type of dislocation.
Masoud Shayeste Azar; Esmael Mokhtarnejad Ganji; Soheil Osia,; Mohammad Hossein Karimi nasab; Mohammad Osia
Abstract
Abstract
Background & Aim: Septic arthritis is one of the important childhood infections with a high number of complications. Given the rare occurrence of this infection in neonates and its low number of symptoms, the diagnosis of septic arthritis in infants is difficult and its prognosis is mainly ...
Read More
Abstract
Background & Aim: Septic arthritis is one of the important childhood infections with a high number of complications. Given the rare occurrence of this infection in neonates and its low number of symptoms, the diagnosis of septic arthritis in infants is difficult and its prognosis is mainly affected by early diagnosis and treatment. This study aimed to evaluate the results of neonatal hip septic arthritis treatment results in two training hospitals during 2001-2016.
Materials and Methods: This cross-sectional and descriptive research was performed on infants who were referred to hospitals in the North of Iran due to hip septic arthritis during 2001-2016. Medical information was two recorded in a checklist based on demographic indicators and clinical findings in the laboratory. In addition, the presence of complications in the participants was assessed via a phone call or by in-person visit.
Results: In this study, the left hip joint was the most involved joint in terms of septic arthritis (72.2%). In addition, the most common bacteria responsible for the infection were Klebsiella (50%), E.coli (22.2%), and Staphylococcus aureus (27.8%). According to the results, 50% of the subjects were treated completely with no complications, whereas 11% of the right and 38.9% of left hips had limping (p=o.615).
Conclusion: Given the high number of complications of neonatal hip infection, early diagnosis and timely treatment is needed to reduce the complications.
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 ...
Read More
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
Sajad Fakoor, MD; Afshin Farhadi, MD; Mohammad Fakoor, MD
Abstract
Background: Knee osteoarthritis is a common joint disorder in the older age patients. This study was performed to compare the efficacy of injection of methyl-prednisolone versus sodium-hyaluronate in symptomatic mild to moderate knee osteoarthritis.Methods: In a randomized clinical trial, 53 patients ...
Read More
Background: Knee osteoarthritis is a common joint disorder in the older age patients. This study was performed to compare the efficacy of injection of methyl-prednisolone versus sodium-hyaluronate in symptomatic mild to moderate knee osteoarthritis.Methods: In a randomized clinical trial, 53 patients with knee osteoarthritis were assigned to receive either methyl-prednisolone (26 patients) or sodium-hyaluronate (27 patients) in a hospital in Tehran, Iran. Sodium-hyaluronate three injections within 2-weeks interval and a single injection of 40 mg of methyl-prednisolone were given. The improvement rate was compared after one and six months.Results: The total score significantly improved in both groups (p < /em>=.001). There was no significant difference between the two groups after the first month (p < /em>≥.05) but the results were better after six months in sodium-hyaluronate injection group (p < /em>=.001).Conclusions: Intra-articular injection of sodium-hyaluronate in comparison with methyl-prednisolone has longer efficacy in treatment of symptoms of mild to moderate knee osteoarthritis.
Mohammad Reza Shakeri, MD; Saeed Reza Mehrpour, MD; Amir Salari, MD; Amir Mahlisha Kazemi, MD; Bahador Aalami Harandi, MD
Abstract
Background: Treatment of intra-articular calcaneal
fracture is a major orthopaedic challenge. The aim of this study was to
evaluate the results of non-operative treatment of intra-articular calcaneal
fractures, its effects and performance. Methods: In a retrospective study, 58 patients (44 males,
14 ...
Read More
Background: Treatment of intra-articular calcaneal
fracture is a major orthopaedic challenge. The aim of this study was to
evaluate the results of non-operative treatment of intra-articular calcaneal
fractures, its effects and performance. Methods: In a retrospective study, 58 patients (44 males,
14 females) with intra-articular calcaneal fracture were evaluated clinically
and radiographically using a general performance and AOFAS, and FFI questionnaires
between 2003 and 2011 in Tehran, Iran. The mean follow-up time was 3.27 years
(2-6 years). Radiographic signs of osteoarthrities were also evaluated. Results: The mean age of patients was 38.4
(18-85 years). Ten cases (17.2%) were "tangue" and 48 (82.8%)
"joint depression" type. Spine injury was abserved in 13.8%, other
limb injuries in 27.6%, and head injury in 3.4% of the cases. The mean AOFAS
score was 79.14 and FFI score 24.7. Osteoarthritis of moderate degree was seen
in 48% and severe in 17% of the cases an radiographs. By the time of follow-up,
5 patients had required surgeries to treat the delayed complications. Conclusions: Treatment of intra-articular calcaneal
fracture is a real challenge. Close treatment, although maybe painless and give
comparable results with open surgery in AOFAS and FFI testing, will show
radiographic signs of osteoarthirits in about 50% of the time-even in short or
mid-term follow-up.
Siamak Afshin Majd; Shahryar Poorfarzam; Daryoosh Mehdi Barzi; Masoud Moghadamnia
Abstract
Background: Carpal tunnel syndrome is the entrapment of median nerve in carpal tunnel, resulting in pain and numbness in hand and fingers. It is the most common cause of nerve entrapment in the upper limb. There are two main treatment protocoles: medical and surgical. Methods: In a cohort study, in 220 ...
Read More
Background: Carpal tunnel syndrome is the entrapment of median nerve in carpal tunnel, resulting in pain and numbness in hand and fingers. It is the most common cause of nerve entrapment in the upper limb. There are two main treatment protocoles: medical and surgical. Methods: In a cohort study, in 220 patients with carpal tunnel syndromes, splinting was compared with sugery. During a 12 months period, symptoms relief and function improvement were evaluated, using the Levine questionnaire. Results: There was no difference between the two groups at the beginning. In the first and third months of follow-up the symptoms severity was lower in splint group but in the six and twelve month evaluation, the surgical group had less symptoms. Regarding functional improvement, the same results occurred with better results in one and three months for splint group and in six and twelve months for surgical group. Conclusions: Although splinting for carpal tunnel syndrome had superior results in first two months, the improvement with surgery is better maintained into 6-12 months .
Abstract
Congenital dislocation of the knee ranges from hyperextension of the knee to complete translation of the femur on the tibia. Treatment is usually started in very early infancy. In this report, a 16-year-old girl presented with a grade III untreated congenital dislocation of the knee. She received surgical ...
Read More
Congenital dislocation of the knee ranges from hyperextension of the knee to complete translation of the femur on the tibia. Treatment is usually started in very early infancy. In this report, a 16-year-old girl presented with a grade III untreated congenital dislocation of the knee. She received surgical treatment at this late age, and managed to stand upright and walk.
Bahram Mobini, MD; Ebrahim Ameri, MD; Hamid Behtash, MD; Hassan Ghandhari, MD; Mohammad Khakinahad, MD
Abstract
Background: Postural round back is a common entity with unknown etiology. Reports on the results of brace treatment are scarce. The purpose of this study was to determine the effect of bracing in different stages of treatment and also the amount of preservation of kyphosis after stopping the brace.Methods: ...
Read More
Background: Postural round back is a common entity with unknown etiology. Reports on the results of brace treatment are scarce. The purpose of this study was to determine the effect of bracing in different stages of treatment and also the amount of preservation of kyphosis after stopping the brace.Methods: from 1991 through 2005, 165 cases (39 male, 126 female) who had a diagnosis of idiopathic postural kyphosis were treated with a Milwaukee brace. The mean age at the initiation of treatment was 13.06 years (8-16 years), at the completion of treatment was 15.06 years (11-17 years) and at the final follow-up was 17.9 years (12-25 years). The mean initial kyphosis was 59.26° (51°-74°). The patients were evaluated after an average follow-up of 34 months (6-102 months).Results: The mean angle of kyphosis was 42° (28°-68°) at completion of treatment, and 47.9° (28°-75°) at the final follow-up. Angle of kyphosis was 50° or less in 85.9% at the end of treatment and in 74.7% of patients at final follow-up. 5.9 degrees of original correction was lost in final follow-up. Two cases underwent surgery. Brace was effective in correction of kyphosis (p < /em>=.001).Conclusion: Milwaukee brace is effective in treatment of postural kyphosis. Longer period of treatment, even after maturity, is needed in more stiff deformities.
Hamid Behtash, MD; Bahman Ghezelbash, MD; S Mohammad Fereshtehnejad, MD; Mohammad Saleh Ganjavian, MD; Ebrahim Ameri, MD; Bahram Mobini, MD
Abstract
Background: Low back pain is common disease which usually causes considerable individual and community-related functional disability. Lumbar disc herniation is one of the common causes of back pain in the third or forth decade of life. Surgical treatment imposes a heavy functional burden on the patient ...
Read More
Background: Low back pain is common disease which usually causes considerable individual and community-related functional disability. Lumbar disc herniation is one of the common causes of back pain in the third or forth decade of life. Surgical treatment imposes a heavy functional burden on the patient and the society. For this reason we have decided to evaluate the effectiveness of non-surgical treatment in lumber disc herniation in middle age people.Methods: Forthy five patients, who had referred with documented lumber disc herniation with positive clinical and CT scan evidence, were evaluated before and after six months of conservative treatment. The treatment included NSAID steroid 3-cyclic antidepressant, rest, physiotherapy and, at times, bracing or traction. Clinical and repeat CT scan was used for re-evaluation.Results: Among the 45 cases, clinical improvement was seen in 39 (86.7%) and 6 (13.3%) required surgical exploration. The 35 cases who referred for repeat CT scanning, 24 (68.6%) showed regression of disc bulge. Conclusions: In view of high rate of regression of symptoms and improvement on CT scans in this study, it is recommended not to rush to surgery for lumber disc herniation in non-urgent cases, and expect high rate of improvement with conservative approach.
