Ahmad Shahla; Saeid Charehsaz; Afshin Aminzadeh Gohari
Abstract
Background: The tibial plate with tibial pro-fibular screws is adapted to treat distal tibial fractures, in elderly osteoporotic patients in the presence of insufficient bone stock for screw grip, and in young individuals when separate fixation of tibia and fibula with two incisions carries the risk ...
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Background: The tibial plate with tibial pro-fibular screws is adapted to treat distal tibial fractures, in elderly osteoporotic patients in the presence of insufficient bone stock for screw grip, and in young individuals when separate fixation of tibia and fibula with two incisions carries the risk of soft tissue damage.
Methods: In a retrospective study, 15 distal tibia and fibula fractures in 14 patients were treated with tibial pro-fibular screw/plate fixation in a period of 6 year in two hospitals in Urmia-Iran. The cases were evaluated using the AOFAS scoring system. The mean time of follow-up was 28 months.
Results: All the fractured had uneventful :::union:::. Tibio-fibular synostosis occurred in 2 patients. The AOFAS scores were good (80-90 in points) in 7, and acceptable (70-80 points) in remaining 7 patients. No patient had gait or any walking problem.
Conclusion: Fixation of comminuted distal tibia and fibular fractures with tibial pro fibular fixation in selective cases with osteoporosis or poor skin cordition is a useful technique
Shahin Narooyi; Amirreza Sadeghifar; Alia Ayatollahi Moussavi; Alireza Saied
Abstract
Background: Diagnosis of carpal tunnel syndrome is based on clinical findings and these findings are used to confirm the diagnosis. Sonography is also a noninvasive method for diagnosis of carpal tunnel syndrome. The purpose of this study was to investigate the role of sonography and electrodiagnostic ...
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Background: Diagnosis of carpal tunnel syndrome is based on clinical findings and these findings are used to confirm the diagnosis. Sonography is also a noninvasive method for diagnosis of carpal tunnel syndrome. The purpose of this study was to investigate the role of sonography and electrodiagnostic studies in diagnosis of this syndrome. Methods: In a prospective study, 76 hands with diagnosis of carpal tunnel syndrome (study group) were compared with 80 hands (control group) in a training hospital in Kerman-Iran. In both groups the diameter of median nerve was measured by sonography and electrodiagnostic studies were performed only on the study group. The study group, post surgery, was followed up for 6 months and the DASH preoperative functional scoring was compared with post operative scores. Results: The difference between the diameters of the median nerve measured by sonography (p=.0001) and also the difference between before and after-operation Dash Score in the patient group (p=.001) were statistically significant. Sonography was 95% sensitive and 93% specific for the diagnosis of carpal tunnel syndrome. A weak correlation was found between the severity of the disease in electrodiagnostic studies and sonography (p < .01, r=.38). No correlation was proved between the sonographic or electrodiagnostic findings and Dash score before and after the operation (p≥.05). Conclusion: sonography might be a suitable module for the diagnosis of carpal tunnel syndrome, but there were no correlation between its findings or electrodiagnostic findings and functional scores. Whether or not sonography could be substitute for electerodiagnostic tests, will need further investigation.
Mohammad Mahdi Sarzaeem; Gholamhossein Kazemian; Gholamhossein Kazemian; Mohammad Emami; Alireza Manafi Rasi,; Mohammad Emami; Arash Ghaffari; Salim Khani
Abstract
Background: One of the common complications following total knee arthroplasty (TKA) is excessive post operative blood loss. Tranexamic acid (TXA), an antifibrinolytic drug, is commonly used to control post-operative blood loss. However, the ideal route of administration is not yet quite clear. In this ...
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Background: One of the common complications following total knee arthroplasty (TKA) is excessive post operative blood loss. Tranexamic acid (TXA), an antifibrinolytic drug, is commonly used to control post-operative blood loss. However, the ideal route of administration is not yet quite clear. In this study, the different administration routes of TXA for blood loss control after TKA will be evaluated. Methods: In a clinical trial study, 200 patients who were scheduled for knee arthroplasty were randomly divided into 4 groups. In group 1, TXA (500 mg mixed in 100 cc of saline) was administered intravenously at the time of wound closure. In group 2, the knee joint cavity was irrigated and soaked for 5 minutes with 3 g of TXA in 100 cc of saline just before wound suturing. In group 3, immediately after wound closure, 1.5 g of TXA in 100 cc of saline was injected into the knee through the drain. Group 4 (control group) received no TXA , but the drain was clamped completely for an hour. The amount of blood loss and transfusion, and changes in hemoglobin levels were documented accordingly. Results: The mean post-operative blood loss in the groups 1 to 4 were respectively 476.8±114.8, 743.2±116.5, 173.9±60.5, and 860.5±152.2 ml (p < /i>
Reza Erfanian Reza; Masoumeh Firouzi, PhD; Mohammad Hossein Nabian, MD; Masoud Darvishzadeh, PhD; Leila Oriadi Zanjani, MD; Shayan Abdollahzadegan; Reza Shahryar Kamrani, MD
Abstract
Background: The use of fibrin adhesive has broad background in medicine and peripheral nerve repair. The physical properties of these adhesives has restricted their usage. This experiment studied the performance and physical characteristics of fibrin glue (which is prepared from single donor human plasma) ...
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Background: The use of fibrin adhesive has broad background in medicine and peripheral nerve repair. The physical properties of these adhesives has restricted their usage. This experiment studied the performance and physical characteristics of fibrin glue (which is prepared from single donor human plasma) in the repair of posterior tibial nerve of rat.Methods: In this study, posterior tibial nerves of 40 rats were transected. In group A no repair was performed in group B repair was done by one microsuture in group C repair was done by three microsutures in group D by one suture plus fibrin adhesive and in group E repair was done just with fibrin adhesive. After 8 weeks of follow-up, Tibial Function Index and at the end of the study, adhesive strength inflammation and scar formation were measured.Results: Functional recovery in the eighth week for groups A and E were significantly lower than groups B and C (p < /em>=.03). No rat repaired with fibrin adhesive had dehiscence, while half of rats in group A had complete dehiscence- was significantly higher than the others groups (p < /em>=.002). Inflammation and scar tissue were similar between the groups.Conclusion: The produced fibrin adhesive provides required adhesive and could hold nerve stumps in long term.
Mohammad Taghi Peivandi, MD; Amir Reza Bidkhori, MD
Abstract
Background: Fracture of talus is a relatively rare disease, and treatment outcome is not always predictable. The aim of this study is to report our experience with the surgical treatment of fractures of talar body and neck.Methods: In a retrospective study, 16 patients (12 men, 4 women) with body and ...
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Background: Fracture of talus is a relatively rare disease, and treatment outcome is not always predictable. The aim of this study is to report our experience with the surgical treatment of fractures of talar body and neck.Methods: In a retrospective study, 16 patients (12 men, 4 women) with body and neck fractures of talus were evaluated in a teaching hospital in Mashhad. The mean age was 24.8 years (15-50 years). The fracture pattern, mechanism of trauma, associated injuries, :::union::: rate, avascular necrosis, pain and disability were evaluated in mean follow-up period of 18 months (12-24 months).Results: All the patients showed :::union::: during the follow-up. Five patients (31%) had avascular necrosis. The mean for Hawkins score system was 8.25. All the cases showed evidence of pain and some disability at the end of study.Conclusion: Talus fracture is a disabling injury and high incidence of pain and activity restriction should always be expected, even with surgical treatment.
Javad Gorji, MD; Behnam Panjavi, MD; Mohammad Reza Abbaszadeh, MD
Abstract
Background: Classification and treatment of lateral humeral condyle fracture in children is a matter of controversy. We report the results of treatment in 26 cases along with a comprehensive literature review.Methods: Medical records and radiographs of 26 children (8 girls, 18 boys) who had been treated ...
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Background: Classification and treatment of lateral humeral condyle fracture in children is a matter of controversy. We report the results of treatment in 26 cases along with a comprehensive literature review.Methods: Medical records and radiographs of 26 children (8 girls, 18 boys) who had been treated for lateral humeral condyle fracture over 20 year period were reviewed. The cases had a mean age of 4.5 years (1.9-8 years). The patients were evaluated for elbow range of motion, deformity, neurological deficit, and avascular necrosis with an average follow-up of 6 (3-20) years. Results: From the 26 cases, 17 patients had less than 2 millimeters displacement, and had been treated non-operatively 8 patients with displaced fracture had received internal fixation. One case that presented late and had ulnar nerve symptom with fracture non-:::union:::, underwent only anterior transposition of the nerve. The cases had all full range of motion, with no avascular necrosis. The one non-:::union::: case had a carrying angle of 26 degrees.Conclusions: Lateral humeral condyle fracture in children requires surgical treatment more than most other pediatric fractures. Initial displacement of over 2 millimeters or any later displacement in the early post fracture period would require surgical intervention.
Hamid Behtash, MD; Mohammad Saleh Ganjavian, MD; Ebrahim Ameri, MD; Bahram Mobini, MD; Seyed Hossein Vahid Tari, MD; Marzieh Nojoumi, MD
Abstract
Background: Congenital vertebral development produces the congenital scoliosis which is often progressive requiring surgical intervention. Convex hemiepiphysiodesis of the involved segments is a useful technique in young children. We are reporting our experience with such a treatment.Methods: Among the ...
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Background: Congenital vertebral development produces the congenital scoliosis which is often progressive requiring surgical intervention. Convex hemiepiphysiodesis of the involved segments is a useful technique in young children. We are reporting our experience with such a treatment.Methods: Among the congenital scoliotic curves treated in Shafa hospital in Tehran in 19-year period, the ones that had undergone convex hemiepiphysiodesis were identified. Twenty three patients (13 females, 10 males) with a mean follow-up of 5.6 years (2-19 years) were clinically and radiographically evaluated, and the pre and post operative findings were analyzed.Results: Improvement in curve magnitude was best observed in hemivertebra cases. Nine cases of hemivertebra obtained 18 degrees correction while in 14 cases of type III (mixed type) anomally 15 degrees correction was observed (p < /em>=.04). Failure (continued progression of scoliotic curve) had a large kyphotic angle at the beginning.Conclusions: Convex vertebral hemiepiphysiodesis in congenital scoliosis, especially hemivertebral cases is a useful procedure when performed in early childhood.
Reza Shahryar Kamrani, MD; Masoumeh Firuzi; Mohammad Hosein Nabian; Leila Oriadi Zanjani; Mostafa Shaahrezaee, MD
Abstract
Background: The treatment of large peripheral nerve defect in scarred tissue is still a major challenge. Two-stage grafting with preparation of a smooth bed before grafting is a technique used for tendon or bone defects in the past. We are now reporting such a technique for large scarred gaps in the ...
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Background: The treatment of large peripheral nerve defect in scarred tissue is still a major challenge. Two-stage grafting with preparation of a smooth bed before grafting is a technique used for tendon or bone defects in the past. We are now reporting such a technique for large scarred gaps in the sciatic nerves of rat.Methods: In each of the 20 female Wister rats, 15 centimeters of the sciatic nerve was excised. The nerve bed was then covered by tetracycline powder to induce scar tissue formation. In half of the rats a silicone tube was sutured into the nerve ends to produce a smooth tunnel for a two-stage grafting. In the second group the cut nerve ends were covered by silicone caps. After 4 weeks each rat received nerve grafting of its sciatic nerve defect from its bilateral median nerves. 15 weeks following the grafting the rats were tested for their sciatic nerve functions, then the nerves were excised for histological evaluation of the nerve regeneration and the scar tissue.Results: The motor and sensory motor function recovery of the nerves, as measured by “External Postural Thrust”, and “Withdrawal Reflex Latency”, were greater in the group that had the grafts replacing the silicone tubes. The histological evaluation also confirmed the presence of more nerve fibers and less scarring in the silicone tube treated group.Conclusions: Two-stage nerve grafting in severely scarred bed can improve the functional results of a nerve graft.
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.
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.
Pooneh Dehghan, MD; Zahra Saghaei ,MSc; Farid Abbaszadeh, MSc; Morad Karimpour, PhD; Soheil Mehdipoor, MD
Abstract
Background: Femoral neck anteversion is usually measured on the 2-dimensional (2D) images on CT slices. The 3D method uses 3-dimensional model of the femur reconstructed from CT scan images. The aim of this study was to compare these two methods of measurement of femoral ante-version. Methods: In ...
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Background: Femoral neck anteversion is usually measured on the 2-dimensional (2D) images on CT slices. The 3D method uses 3-dimensional model of the femur reconstructed from CT scan images. The aim of this study was to compare these two methods of measurement of femoral ante-version. Methods: In a retrospective study, CT scans of 40 patients (6 men, 34 women) of a teaching hospital in Tehran-Iran were included. Both methods use the same anatomical landmarks, i.e. center of femoral head, femoral neck axis and posterior apex of the femoral condyles. In the 3D method, anteversion angle was measured on a plane perpendicular to the anatomical axis of femur. Whereas in the 2D method the measurement is performed on CT scan slices.Results: Mean anteversion was found to be 9.8 for the 2D and 16.11 for the 3D method. Bland-Altman plot shows that the difference between the two methods is significant.Conclusions: This difference between 2D ad 3D measurement of femoral anteversion may be depend on the level of the selected CT slices, patients positioning during CT examination, and the impact of the deformity. The 3D method eliminates obvious sources of error, namely identifying landmarks and individual orientation of femur. Due to the lack of any gold standard there is a need to further review and study the measurement of this angle.
Alireza Saied, MD; Seyed Mohammad Sabet Jahromi, MD
Abstract
Background: Fracture of phalanx is common upper extremity fracture. Two pining methods are used for fixation of extraarticular proximal phalanx transverse fractures: transarticular parallel pins passing through (MCP) joint and extraarticular cross pining of fracture with out going through MCP joint. ...
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Background: Fracture of phalanx is common upper extremity fracture. Two pining methods are used for fixation of extraarticular proximal phalanx transverse fractures: transarticular parallel pins passing through (MCP) joint and extraarticular cross pining of fracture with out going through MCP joint. The purpose of this study was to comparie these two fixation methods.
Methods: This clinical trial study was done on proximal phalanx transvers fracture using two methods in a training center in Kerman-Iran. In first method, two parallel pins were used from metacarpal head passing through MCP joint into proximall phalanx. In second method two cross pins were used from proximall phalangeal condyles across the fracture. The active range of motion for MCP, PIP and DIP joints, the duration of resuming patients their daily activities, and post operation complications were evaluated.
Results: The mean active range of motion for MCP, PIP and DIP joints, 3 and 6 months after surgery showed no significant difference between the two methods of surgery. There was no significant difference between the two methods in age, gender and the duration of returining to work.
Conclusions: There was no difference in the results for using cross pining or parallel transarticular pin fixation for proximal phalanx fractures. Since intramedullary method is easier with less use of C-ARM, less damage to soft tissue damage and less distraction of fracture, using transarticular intramedullary parallel pins fixation for proximal phalanx fracture is suggested.
Alireza Saeed; Afshin Ahmadzadeh; Amirreza Sadeghifar; Elham Rasaee
Abstract
Backgrounds: several tests are used to assess the presence of Palmaris longus tendon. In the present study we attempted to assess the interobserver and intraobserver reliability of five of the most famous ones and also the examination of fifth superficial flexor function.
Methods: Two observers, ...
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Backgrounds: several tests are used to assess the presence of Palmaris longus tendon. In the present study we attempted to assess the interobserver and intraobserver reliability of five of the most famous ones and also the examination of fifth superficial flexor function.
Methods: Two observers, who had been trained about the tests and had practiced on them, examined 105 volunteers on two separate occasions and in one-month interval and the results were recorded. The reliability of each method was assessed with Kappa measurement.
Results: Kappa ranged from 0.541 (moderate reliability) to 0.813 (almost complete agreement) for Palmaris. The highest interobserver and intraobserver reliability and also the best agreement with other tests was of Schaeffer. The lowest Kappa was for Thompson and the others had good to excellent reliability. Kappa for interobserver and intraobserver reliability for fifth flexor was respectively 0.415 and 0.500 (moderate reliability).
Conclusion: the tests that were assessed have good reliability except for Thompson that has a moderate one. It seems that the standard test (Schaeffer) is the best method for assessment of Palmaris Longus absence or presence. The method assessed for evaluation of fifth superficial flexor variations assessment has a moderate interobserver and intraobserver reliability.
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.
Hanon Sadoni; Saeed Tabatabaei; Hamidreza Arti; Mohammadreza Ghasemi; Shahab Yousefifar
Abstract
AbstractBackground: Developmental dysplasia of the hip (DDH) includes a wide range of abnormalities of the hip that can emerge at any time including embryonic period, infancy, or childhood. The purpose of this study was to examine the clinical and radiographic outcomes of patients with DDH, treated with ...
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AbstractBackground: Developmental dysplasia of the hip (DDH) includes a wide range of abnormalities of the hip that can emerge at any time including embryonic period, infancy, or childhood. The purpose of this study was to examine the clinical and radiographic outcomes of patients with DDH, treated with adductor tenotomy and closed reduction.Methods: The study was retrospectively performed on 30 children (33 joints) with DDH,who were treated with adductor tenotomy, closed reduction and SpicaCast in Ahvaz Razi Hospital during 2015-2017. Inclusion criteria were patients diagnosed with DDH and below 2 years of age. Exclusion criteria were connective tissue diseases, secondary dislocation due to previous infection and acetabulum dysplasia in the context of specific syndrome. After the operation, the patients were evaluated for the severity of injuries associated with dislocation or subluxation of hip joint and hip joint congruity. Theradiographic results were studiedbased on Severin, Tonnis grading, McKay and acetabularindices.Results: The preoperative mean acetabular index of36.54 ± 3.27 degrees significantly dropped to postoperativeof 27.06 ± 2.15 degrees. According to McKay criteria, 90.9% of the patients had excellent and good therapeutic results after the surgery. According to Tonnis criteria, 93.9% of patients were in Class I and II after the surgery. Moreover, in radiographic evaluations,96.9% of the patients were in Class Ia and Ib based on Severin criteria.In 1 patient (3.03%), osteonecrosis of the head was found, in 2 patients (6.06%), walking and lameness impaired walking, and in 3 patients (9.09%), sitting was reported. All patients were female in this study.Conclusion: According to the clinical results and evaluations of this study, closed reduction along with adductor tenotomy can be used as an appropriate technique for the treatment of patients with DDH at an early age.
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.
Pediatrics
Marina R. Makarov, MD; Connor M. Smith, MD; Taylor J. Jackson, MD; Chan Hee Jo, Ph.D; John G JBirch, MD, FRCS(C)
Abstract
Introduction: Pediatric patients with Blount disease frequently demonstrate secondary adaptive deformities in the adjacent distal femur. This study evaluates adaptation of longitudinal and angular proportions of the ipsilateral healthy femur to progressive leg length discrepancy in unilateral cases.Methods: ...
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Introduction: Pediatric patients with Blount disease frequently demonstrate secondary adaptive deformities in the adjacent distal femur. This study evaluates adaptation of longitudinal and angular proportions of the ipsilateral healthy femur to progressive leg length discrepancy in unilateral cases.Methods: The study included 55 children with unilateral Blount disease. Preoperative radiographs were analyzed to characterize the condition as infantile or adolescent and measure femoral/tibial lengths and mechanical lateral distal femoral angles (mLDFA). Results: There were 26 patients with infantile and 29 with adolescent Blount disease. Adolescent patients were significantly older (14.4 ± 2.0 vs. 9.2 ±2.4; p<0.01). Black race was prevalent in both groups (69-79%). The adolescent group was predominantly male (25/29; 86%), while the infantile group was predominantly female (15/26; 58%, p<0.01). Leg length inequality in adolescent patients was significantly greater than in the infantile group (2.8 ± 2.0 vs.1.5 ± 1.1cm; p<0.01) with ipsilateral femoral shortening (1.8 ± 1.8 cm) accentuating tibial shortening (1.0 ± 1.1cm). Patients with infantile Blount disease had more pronounced tibial discrepancy (2.0 ± 1.1 cm; p<0.01) but modest overgrowth of the ipsilateral femur (0.5 ± 0.7; p<0.01) partially compensating ipsilateral tibial shortening. There was a significant difference in tibial:femoral ratios between the groups (p<0.01). The infantile group had on average normal mLDFA (88°), most adolescent patients had accentuating distal femoral varus deformity (96° ± 5°; p<0.01).Conclusions: Patients with unilateral infantile and adolescent Blount disease demonstrated distinctly different adaptation of the ipsilateral femur. Concomitant ipsilateral femoral changes aggravate angular deformity and leg length discrepancy in adolescent Blount disease.
Mehran Soleymanha; Sohrab Keyhani; Maryam Mousavi; Zahra Mehrpouya
Abstract
Background: The anterior cruciate ligament (ACL) reconstruction is one of the most frequent surgeries on the adult knee. Auto grafts are essential for providing knee stability while minimizing donor site morbidity. The peroneus longus tendon may be an alternative auto graft for ACL reconstruction. This ...
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Background: The anterior cruciate ligament (ACL) reconstruction is one of the most frequent surgeries on the adult knee. Auto grafts are essential for providing knee stability while minimizing donor site morbidity. The peroneus longus tendon may be an alternative auto graft for ACL reconstruction. This study aimed to evaluate the short-term clinical outcomes and donor site morbidity of ACL reconstruction using the peroneus longus tendon.Methods: This cross-sectional study was conducted on patients with an ACL tear, who underwent arthroscopic reconstruction using the peroneal longus tendon. The knee functional outcomes were investigated based on the Lysholm and IKDC scores at preoperative and end of at least one year after the procedure. The follow-up period was at least one year, and the graft diameter was measured intra-operatively. In addition, the American Orthopaedic Foot and Ankle Score (AOFAS), the Foot & Ankle Disability Index (FADI), and ankle range of motion were applied to evaluate ankle donor site morbidities.Results: A total of 50 patients (47 men and three women) were followed up for at least one year with a mean age of 24.2 years (17 to 50 years old). The mean follow-up time was 19 months (12-24 months). The mean diameter of the peroneal longus auto graft was 8.22 ± 0.5 mm (7-9 mm). The AOFAS, FADI and ankle range of motion indicated no obvious ankle joint dysfunction.Conclusion: According to the results, arthroscopic anterior cruciate ligament reconstruction with the peroneal longus tendon is be a safe and effective auto graft source.
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
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.
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>
Firooz Madadi, MD; Seyed Morteza Kazemi, MD; Armin Aalami Harandi, MD; Mohammad Reza Abbassian, MD; Farivar Abdollahzadeh Lahiji, MD; Hamid Hossienzadeh, MD; Fooad Rahimi, MD
Abstract
Background: Avascular necrosis (AVN) of femoral head, with resultant joint destruction, is a common disabling disease of fourth and fifth decades of life. Metal-on-metal resurfacing is a relatively newer treatment modality for this disease. The aim of this study is to compare the result of resurfacing ...
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Background: Avascular necrosis (AVN) of femoral head, with resultant joint destruction, is a common disabling disease of fourth and fifth decades of life. Metal-on-metal resurfacing is a relatively newer treatment modality for this disease. The aim of this study is to compare the result of resurfacing for osteonecrosis with that of resurfacing for other causes.Methods: Twenty eight patients with stage III or IV (Ficat & Arlet) osteonecrosis who underwent metal-on- metal hip resurfacing were compared with 24 cases of grade IV or V (Croft’s) osteoarthritis (OA) who had undergone the same kind of arthroplasty during a 2 year period in Akhtar hospital in Tehran. These cases were matched in terms of gender and age, and were assessed by Harris hip score with 41(±22) months follow-up.Results: The AVN cases had 30.86 (±7.5) and OA cases 47.88 (±12.6) years at surgery. Three patients from each of the above groups had sustained complications of either femoral neck or acetabular cup fracture and had required revision surgery. The average Harris hip score was 94(±7.2) in AVN and 91.2(±9.4) in OA group. The collective hip range of motion was 216(±6.2) in AVN and 196±(5.6) in AO patients.Conclusions: Metal-on-metal hip resurfacing gives similar satisfactory results in avascular necrosis and in osteoarthritis of hip joint in short-term, with no statistically significant difference.
Mohammadreza Minator Sajjadi; Adel Ebrahimpour; Mohammad Ali Okhovatpour; Reza Zandi; Hooria Emami
Abstract
AbstractAbstractPurpose: The aim of this study was to assess the incidence and patterns of meniscus tear accompanying the posterior cruciate ligament (PCL) lesion.Method: 81 patients with a diagnosis of chronic PCL tear that underwent PCL reconstruction surgery were included in the study. The patients’ ...
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AbstractAbstractPurpose: The aim of this study was to assess the incidence and patterns of meniscus tear accompanying the posterior cruciate ligament (PCL) lesion.Method: 81 patients with a diagnosis of chronic PCL tear that underwent PCL reconstruction surgery were included in the study. The patients’ files were reviewed. The location and grade of cartilage damage, the location and pattern of meniscus tears, the interval between diagnosis and surgical procedure, and the treatment method were collected.Result: The average interval between the incidence of trauma and surgery was 16.73±33.1 months. The interval between the incidence of trauma and surgery in patients with meniscal tear was 24.6±4.86 months and in patients without meniscal tear was 12.76±2.1 months Meniscal tear was detected in 27 patients (33.3). It was in medial meniscus in 19 (23.5%) and in lateral menisci in eight (9.9%) patients. The most common site of meniscal tear was root tear and mostly avulsion of meniscus root. Of these, 6 patients had posterior root avulsion of medial menisci. Cartilage lesions were detected in 14 patients (17.3%).Conclusion: Based on the present study. The most common pattern of meniscal tear in cases of PCL tear is posterior medial meniscus avulsion tear. Such a tear deteriorates overtime.
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.
Amin Bigham-Sadegh; Siavash Sharifi; Iraj Karimi; Ahmad Oryan; Mina Maleki
Abstract
Background: Orthopedic surgeons are trying to find best substitutes for bone grafting in human and veterinary medicine. Bone autografts are still as a golden standard in comparison with other bone grafts. Diced ear cartilage from dog and rabbit have been used on bone healing previously, in the ...
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Background: Orthopedic surgeons are trying to find best substitutes for bone grafting in human and veterinary medicine. Bone autografts are still as a golden standard in comparison with other bone grafts. Diced ear cartilage from dog and rabbit have been used on bone healing previously, in the present study effects of rabbit and bovine rib cartilages will evaluated in bone healing of rabbit bone defect model.
Method: In this study, 20 adult rabbits weighing approximately 2 kg were used. The rabbits were randomly divided into 4 groups. The bone segment was removed from the mid radial bone. In the first group (N = 5) in the gap segement of bovine rib cartilage was implanted. In the second group (N = 5) in the gap, segement of rabbit rib cartilage was implanted. In the third group (empty control group), (N = 5) the defect was left without implantation. Finally, the fourth group (autograft Group), (N = 5) the defect was filled with a same harvested bone. The skin and muscles were sutured routinely. X-rays were taken on 14th , 28th , 42nd and 56th postoperative days.
Result and conclusion: After 8 weeks bone samples were taken from healed area for for histopathological evaluation. The results of our study indicate allogenic and xenogenic cartilage acted almost like autograft groups and were better than empty group.
