mohammad fakoor; s shahnam mousavi; Ali bahaari
Abstract
AbstractBackground: Medial open wedge high tibial osteotomy (MOWHTO) is effective for the treatment of medial compartment osteoarthritis of the knee. Several studies report that it produces patella baja and increases patellofemoral contact pressure in the patellofemoral joint. Pressure distribution due ...
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AbstractBackground: Medial open wedge high tibial osteotomy (MOWHTO) is effective for the treatment of medial compartment osteoarthritis of the knee. Several studies report that it produces patella baja and increases patellofemoral contact pressure in the patellofemoral joint. Pressure distribution due to underlying varus deformity has a major influence on the onset and development of osteoarthritis in the knee joint. This study is reporting on the effect of MOWHTO on patello-femoral joint.Methods: The present study was a retrospective case series study on the patients with symptomatic osteoarthritis of medial compartment of knee with varus deformity requiring correction, referring in a 2 year period to a teaching hospital. At the last follow-up, assessment of the patellar changes based on Insall and Blackburn indices, and mechanical axis deviation (MAD) measurements was done.Results: A total of 49 knees were recruited. 52.6% of patients were male. The mean age of patients was 26.55±5.876 years and the mean body mass index was 25.05±2.903 kg/m2. No knee needed revision surgery, no intra-articular fracture occured in any patient after surgery.The mean score of VAS[1] increased significantly after surgery (P <0.05). Patellar changes before and after surgery were not statistically significant based on radiographic indices. The mean pre-operative MAD of (−8.90° ± 3.07°) improved to (0.2° ± 2.780°) post-operative value.Conclusion: Based on the above results, proper correction in MAD was obtained and no significant change in patellofemoral joint biomechanics was seen.Keywords: Tibia, patellofemoral joint, Osteotomy, Biomechanics, mechanical axis
Ahmad Dashtbozorg; Ahmad Dashtbozorg; Seyed Abdolhossein Mehdinassab; Fatemeh Badakhshanmehr
Abstract
Background: Femoral neck fracture is uncommon but serious injuries in young adult with high complication rate. This study was designed to evaluate the outcome of surgical treatment of such a fracture fixed by screw in. Methods: In a descriptive prospective study form 2006 to 2009, 42 patients with the ...
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Background: Femoral neck fracture is uncommon but serious injuries in young adult with high complication rate. This study was designed to evaluate the outcome of surgical treatment of such a fracture fixed by screw in. Methods: In a descriptive prospective study form 2006 to 2009, 42 patients with the mean age of 37 years (15–60 yrs) were treated by closed or open reduction and screw fixation for femoral neak fractures in two university hospitals in Ahvaz- Iran. They all received surgery within the first 24 hours after injury. They were followed for 15 months on average. Results: In accordance with Garden classification, 2 patients were type I, 3 type II, 18 type III and 19 type IV Gorden fractures. Thirty two cases were fixed by open reduction and fixation and 10 by closed reduction. :::union::: was achieved in 30 pateints. The 12 (28.6%) cases of non:::union::: were seen in the ones who received open reduction and fixation. Avascular necrosis was observed in 7 patients (16.7%), 4 of whom had obtained :::union:::. Conclusion: Femoral neck fracture is associated with high complication rate, in particular, if open reduction becomes necessary.
Sadegh Saberi; Mahmood Farzan; Reza Mostafavi Tabatabaee
Abstract
Background: The use of stem cell is believed to reduce pain and delay the deterioration in the early stages of femoral head osteonecrosis.The aim of this study was to evaluate the effect of autologus concentrated mononuclear bone marrow cell implantation after core decompression in femoral heads that ...
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Background: The use of stem cell is believed to reduce pain and delay the deterioration in the early stages of femoral head osteonecrosis.The aim of this study was to evaluate the effect of autologus concentrated mononuclear bone marrow cell implantation after core decompression in femoral heads that were in the early stages of osteonecrosis. Methods: Twenty eight femoral heads with osteonecrosis that were undergoing core decompression were randomly divided into two groups of 14. One group received additional implantation of autologus bone marrow mononuclear cells. The two groups were, then evaluated within 2 years with WOMAC (Western Ontario and McMaster University osteoarthritis index), visual analogue pain index (VAS) and MRI of the femoral heads. Results: A significant improvement in WOMAC, and VAS scores was observed within the 2 years of follow-up in the implanted group, compared to the control group (p < /i>=.046), with 3 cases showing change to a lower osteonecrosis stage. The control group, on the other hand, showed worsening in the osteonecrotic heads (p < /i>
Saeid Tabatabaei, MD; Miremad Miremarati, MD
Abstract
Background: Rupture of the anterior cruciate ligament (ACL) is the most common knee injury during sport activities. The purpose of this study was to investigate the results of ACL reconstruction using middle 1/3 of the autologous patellar ligament by miniarthrotomy approach in young patients.
Methods: ...
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Background: Rupture of the anterior cruciate ligament (ACL) is the most common knee injury during sport activities. The purpose of this study was to investigate the results of ACL reconstruction using middle 1/3 of the autologous patellar ligament by miniarthrotomy approach in young patients.
Methods: In a descriptive study, 57 patients (55 male, 2 female) at age of 20 to 45 years old, who were referred with ACL rupture and treated with ACL reconstruction using autograft bone-patellar-bone during a 2-year period in a training hospital in Ahvaz, Iran, were studied. The clinical results were investigated with an 11.7 months (7-28 months) follow-up, using Lysholm Knee Score, and physical re-evaluation.
Results: In 33 cases, right knee and in 24 left knee was affected. Eighty-six percent of the patients had no limitation in knee motion after surgery, and 82 percent had no knee instability. Ninety-six percent of the patients could return to the pre-injury sport activity. The mean Lysholm knee score was 83.63 (69-93).
Conclusions: Reconstruction of the anterior cruciate ligament using autograft bone-patellar-tendon with miniarthrotomy has clinically acceptable results.
Hossein Khatibi, MD; Ali Asghar Kousari, MD
Abstract
Background: Calcaneal fracture is the most common tarsal bone fracture, and is often associated with a high complication rate and disfunction. Open surgical treatment of calcaneal fracture is one of the most challenging orthopaedic procedures with somewhat vague functional outcome.Methods: In a retrospective ...
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Background: Calcaneal fracture is the most common tarsal bone fracture, and is often associated with a high complication rate and disfunction. Open surgical treatment of calcaneal fracture is one of the most challenging orthopaedic procedures with somewhat vague functional outcome.Methods: In a retrospective study, the clinical and radiographic results of 18 calcaneal fractures in 17 patients (13 males, 4 females) with mean age of 31 years (21-53 years) that had undergone open reduction during a 4-year period (2002-2006) were evaluated with an average follow-up of 19 months (9-48 months). The Amerian Orthopaedic Foot ad Ankle Society (AOFAS) scoring system was used to assess the treatment outcomeResults: Thirteen fractures were type II and 5 type II Sander's class.The preoperative average Bohler's angle of 7 degrees changed to 21.8 degrees in follow-up. The collective average AOFAS score was 89.05. This score was 93.3 for type II and 78 for type III Sander's fractures. Subtalar osteoarthritis was observed in 4 patients.Conclusion: Open reduction and internal fixation of intra-articular calcaneal fractures, with achievement of good reduction of posterior articular facet, can result in good or excellent outcome.
Hamid Namazi; Fatemeh Dehghani Nazhvani
Abstract
Osteoarthritis is a chronic systemic disease that can involve any joint in the body, but more often lower limb bearing joints and hand joints. The prevalence of this disease in humans increases with age and obesity. Biomechanical and biological changes that occur after knee injuries are involved in the ...
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Osteoarthritis is a chronic systemic disease that can involve any joint in the body, but more often lower limb bearing joints and hand joints. The prevalence of this disease in humans increases with age and obesity. Biomechanical and biological changes that occur after knee injuries are involved in the development of post-traumatic osteoarthritis and, as a degenerative joint disease, cause irreversible hyaline cartilage destruction; which reduces the quality of life by causing permanent pain and joint dysfunction.
In order to better understand how osteoarthritis progresses, it needs to be modeled in animals; especially in the early stages of the disease, as well as the evaluation of the effects of new drugs and therapies. These models can be spontaneous or inductive. Spontaneous osteoarthritis can occur naturally in genetically engineered strains of rats. Intra-articular injection of chemicals such as mono-iodiacetate can also induce osteoarthritis. Today, many surgical modelings are also used to induce osteoarthritis, all of which indicate joint instability to cause the disease. Guinea pigs are commonly used for research on articular cartilage and are common models for studying the reconstruction process of focal cartilage defects. The development of experimental conditions inducing osteoarthritis is similar to the natural course of the disease in human due to joint instability and the final gross pathology is exactly the same.
The recent used methods to modeling osteoarthritis include the removal of lateral meniscus and anterior cruciate ligament transection, which appear to reduce inflammation and only create a mild joint instability; that way not only creates repeatable lesions in the model, but also the same kind as the lesions of osteoarthritis in humans. This method allows for the evaluation of cartilage degeneration by radiography, histology and molecular analysis.
Issa Navab, MD; Saeed Reza Mehrpour, MD; Mehdi Jaafari, MD
Abstract
Background: This study was intended to assess the total hospital cost of the patients with hip fractures (intertrochantric and femoral neck) in a teaching hospital. The aim was to show the financial burden on the patients and the society, and argue on the benefits of osteoporosis prophylaxis in order ...
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Background: This study was intended to assess the total hospital cost of the patients with hip fractures (intertrochantric and femoral neck) in a teaching hospital. The aim was to show the financial burden on the patients and the society, and argue on the benefits of osteoporosis prophylaxis in order to decrease incidence of such fractures.Methods: The study was a chart review of 164 patients over 65 years of age with hip fractures hospitalized in Shariati hospital in a 3-year interval. The in-hospital expenses were calculated.Results: In 92 females and 72 males, the age range varied from 65 to 98 years. The average hospitalization period was 8 days. 85 patients spent an average of 2 days in the intensive care unit. The hospital cost for such person was 7.873.900 Rials (830 $US). The highest cost was 31.800.000 Rials, and the lowest, in a person who did not receive any operation, was 670.000 Rials. The total hospital expense in one year for hip fracture was 2000 million Rials.Conclusions: Personal and society costs are high for any hip fracture. Screening and treatment of osteoporosis may help to decrease this cost.
Ali Birjandinejad, MD; Mohammad Hossein Ebrahimzadeh, MD; Eghbal Sadri Mahvelati, MD
Abstract
Background: Proximal tibial fractures are complex injuries and are, historically associated with high complication rates. The purpose of this study is to evaluate the clinical usefulness of locking compression plates (LCP) in comparison with T-buttress plates in treating proximal tibial fractures.Methods: ...
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Background: Proximal tibial fractures are complex injuries and are, historically associated with high complication rates. The purpose of this study is to evaluate the clinical usefulness of locking compression plates (LCP) in comparison with T-buttress plates in treating proximal tibial fractures.Methods: In a prospective study, 62 patients (51 men, 11 women) with proximal tibial fracture referring to Mashhad Medical University Trauma Center were treated with T-buttress plate fixation in 35 and LCP in 27 cases. The treatment outcome was evaluated clinically and radiographically with 24 months (18-36 months) average follow-up.Results: In LCP group, there were 3 cases of Knee motion limitation, 1 mal:::union:::, 1 infection and no non-:::union::: and in T-plate group, 4 cases of knee motion limitation, 6 mal:::union:::s, 2 non-:::union:::s and 4 infections. There was, therefore, no significant difference in terms of joint range of motion between the two groups. Mal:::union::: and infection were, however, more common in T-plate fixation group.Conclusions: Locking compression plating in proximal tibial fractures provides stronger fixation and is associated with less mal:::union::: and infection as compared to T-plate fixation.
Soheil Mehdipour, MD; Farid Abbaszadeh, MSc; Morad Karimpour, PhD; Farzam Farahmand, PhD; Zahra Saghaie, MSc
Abstract
Background: Conventional X-rays, due to 2D viewing, may not have accuracy in assessing lower limb deformities. The aim of this study was to analyze the deformities in 3D and simulated the corrective surgery in virtual space and to built patient-specific guide to achieve the precise correction.Methods: ...
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Background: Conventional X-rays, due to 2D viewing, may not have accuracy in assessing lower limb deformities. The aim of this study was to analyze the deformities in 3D and simulated the corrective surgery in virtual space and to built patient-specific guide to achieve the precise correction.Methods: In this descriptive study, 10 lower limbs with various deformities around the knee were studied. Weight bearing alignment x-rays and CT scans were processed digitally to produce 3D weight bearing models.The landmarks were determined and lower limb indices were calculated to determine the deformities in 3 dimensions Under surgeon's supervision, virtual correction of the deformity was performed, based on which, a patient-specific guide was designed and printed in 3D. The guide was then used in the surgery.Results: The deformity and deviation from standard angles was obsereved in frontal plane in 6 cases, frontal and sagittal planes in one, frontal and axial planes in two, and a three planar deformity in one cases. The results showed that this method is effective in achieving the precise correction of the deformity. In all the patients who underwent surgery, the correction was the same or very close to what had been planned in frontal and sagittal planes (±1). Clinical assessment was used for rotational correction in the absence of postoperative CT-scan.Conclusions: The computer-assisted pre-op planning and patient-specific guide usage can highly optimize the results of corrective osteotomies, especially in difficult deformities around the knee.
Seyyed Morteza Kazemi, MD; Seyed Mehdi Hosseini Khameneh, MD; Siavash Hemati Islamloo, MD; Ramin Farhang Zanganeh, MD; Mohammad Reza Bigdeli, MD; Seyyed Mohammad Ghoreishi, MD
Abstract
Background: Prior to 1980 decade, surgical ideas and facts were mainly based on the individual surgeon’s experience and the collective judgment of groups of surgeons. In the 1980’s the concept of “Evidence Based Medicine” became popular suggesting that all surgical practices must be based on ...
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Background: Prior to 1980 decade, surgical ideas and facts were mainly based on the individual surgeon’s experience and the collective judgment of groups of surgeons. In the 1980’s the concept of “Evidence Based Medicine” became popular suggesting that all surgical practices must be based on evidence and not experience. According to the widespread publication of medical articles nowadays, the question often arises about the dependability and strength of the evidence. We are reporting the level of evidence (LOE) of articles published in the Journal of the Iranian Orthopaedic Association between 1995 and 2008. Methods: All the articles published in the Iranian Journal of Orthopaedic Surgery (1995-2008) were studied separately by 5 groups of physicians. The level of evidence rating system was based on the Journal of Bone and Joint Surgery, which classifies articles into therapeutic, prognostic, diagnostic and economic subgroups. The articles are subsequently divided into five levels in accordance with the defined levels of evidence.Results: Over half of the articles (54%) were therapeutic, 9% diagnostic, 35% prognostic and 2% economic. Overall 2% were placed as level I, 8% level II, 5% level III, 84% level IV and 1% level V.Conclusion: Therapeutic and prognostic articles and evidence level IV were the most common types observable in the articles published in the Iranian Journal of Orthopaedic Surgery. Furthermore, level I to III articles in this journal had increased over 3.5 times between 1995 and 2008.
Ali Moazemi pour; Farivar Lahiji; Mehrak Ashouri
Abstract
Background: Previous studies suggest an existingassociation between massive rotator cuff tear (RCT) and peripheral neuropathy. However, the findings are often inconsistent. In the present prospective study we assessed the prevalence of peripheral neuropathy in patients with massive RCT. In addition, ...
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Background: Previous studies suggest an existingassociation between massive rotator cuff tear (RCT) and peripheral neuropathy. However, the findings are often inconsistent. In the present prospective study we assessed the prevalence of peripheral neuropathy in patients with massive RCT. In addition, we evaluated the effect of surgical repair of this rupture on thetreatment outcomes of neuropathies.Methods: In this study, 58 patients were evaluated with a massive RCT. All patients underwent arthroscopic repair using suture anchor groups. Before surgery, electromyography (EMG)/nerve conduction velocity(NCV)were performed to check for neuropathy.In addition, before and after the surgery, Quick Disabilities of the Arm, Shoulder and Hand (DASH) score was calculated for all patients and the pain intensity was measured using visual analogue scale (VAS). Patients were followed up for 6 months. In the final visit, EMG/NCV was reperformed for those patients with neuropathy.Results: A total of 8 patients with neuropathy were observed (13.5%), of which 5 cases were presented with suprascapular neuropathy, 2 cases of upper trunk neuropathy and 1 case of neuropathy. In the final visit examinations, all cases except one suprascapular neuropathy and an upper trunk neuropathy were recovered.In the final visit, the average Quick DASH score was significantly reduced from 72.6 to 19.7 (p <0.001).Similarly, the severity of pain significantly decreased from 5.3 to 1/1 (p <0.001). In the final visit, the most important complaint of the patients was a limitation of motion in 11 patients (19%). Three patients also complained of pain, two of whom were those whose neuropathy had not improved.Conclusion:Precise screening for neurological damage is recommended in all patients with extensive RCT.Moreover,electromyographic studies can be of benefit in suspected cases of neuropathy before repair of rotator cuff.
Kamran Asadi; Ahmad Reza Mirbolook; Ali Karimi; Mohammad Sadegh Mousavi; Sepehr Saghari; Sadegh Abedi; Ord Gharibi; Ali Tabrizi
Abstract
Background: Bleeding
from proximal screw drill-site in femoral neck fractures may have the ability
to predict the occurance of avascular necrosis of femoural head. In this study
the relationship of bleeding from proximal screw drill-site during internal
fixation of femoral neck fractures with rate ...
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Background: Bleeding
from proximal screw drill-site in femoral neck fractures may have the ability
to predict the occurance of avascular necrosis of femoural head. In this study
the relationship of bleeding from proximal screw drill-site during internal
fixation of femoral neck fractures with rate of avascular necrosis was studied. Methods:
This study is a cross-sectional study that was carried out on 19 to 60 year
patients with femoral neck fracture that referred to health care centers in
Rasht, Iran during the year 2008. The age, sex, type of fracture based on
Garden Category were recorded. Then, presence or absence of bleeding from the
proximal screw holes within the first 5 minutes was recorded. Results: In
this study, 40 patients were enrolled with mean age of 39.78±14.4. Twenty two
patients (55%) had bleeding from the proximal end of the screw, and 18 (45%)
did not have any bleeding. Bleeding from proximal screw hole in patients
without avascular necrosis was seen in 11 cases (61.1%). This difference was
statistically significant (p < /i>=.005). Conclusions: Presence of bleeding from proximal screw
hole in femoral neck fracture reduces odds of AVN in femoral head fracture and
can help deciding between internal fixation or arthroplasty for treatment of
such a fracture.
Ghader Ghanizadeh; Mohammad Reza Naghii; Giti Torkaman; Mohamood Mofid; Mehdi Hedayati; Peyman Darwishi; Yousef Ebrahimpoor
Abstract
Background: Optimal nutrition plays a role in formation and maintenance of bone. Besides major components of mineralization such as Ca, P and Vitamin D, other nutrients like Boron and Fluoride have also beneficial role. In this study, we are reporting the effect of these elements on metabolic hormones ...
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Background: Optimal nutrition plays a role in formation and maintenance of bone. Besides major components of mineralization such as Ca, P and Vitamin D, other nutrients like Boron and Fluoride have also beneficial role. In this study, we are reporting the effect of these elements on metabolic hormones and biomechanical parameters of bone in rat. Methods: 34 male wistar rats were divided into five groups: Control diet, Fluoride, Fluoride+Boron, Fluoride+ Ca+D, and Fluoride+B+Ca+D. Boron equal to 1.23 mg, Ca and Vit D 210 mg-55 IU and F, 0.7 mg/rat/day was added to their drinking water for 8 weeks. The serum level of the above elements was analyzed. The change in mechanical properties of femur and fifth vertebral body were also tested. Results: The addition of F+B intake revealed significant effects on bone mechanical changes properties and bone metabolic hormones. These findings suggested that combined intake of the above two elements had beneficial effect on bone stinffness and breaking strenght compared with Ca+Vit D supplementation. Conclusion: Dealing with health problems related to the skeletal system in humans, this paper justifies further investigation into the role of Boron and Fluoride in bone mass and strength.
Javad Esmaeilzadeh; saeed hesaraki; mohammad-mehdi Hadavi; mohammad hosein Ebrahimzadeh
Abstract
Background: To study the creep behavior for a series of biodegradable nanocomposites, which are used as implantable devices in the body such as bioscrews, is a crucial factor. In the current paper, we are investigating these biomaterials -short-time creep and creep recover manners- in several classic ...
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Background: To study the creep behavior for a series of biodegradable nanocomposites, which are used as implantable devices in the body such as bioscrews, is a crucial factor. In the current paper, we are investigating these biomaterials -short-time creep and creep recover manners- in several classic models.Methods: The creep and creep recovery behaviors of nanocomposites composed of biodegradable polymer blends, poly (D/L) lactic acid (PDLLA) and polycaprolactone (PCL) reinforced with three different contents of 1, 3 and 6 percent weight percentage (Full name?)% bioactive glass nanoparticles (m-BGn) were modeled. Several theoretical models including Findley power law, Burgers and Weibull models were used to establish the relations between m-BGn dispersion and final creep and creep-recovery behaviors of nanocomposites.Results: The Findley power law model confirmed that the lowest ‘A’ and highest ‘n’ parameters ( A is the amplitude of the transient creep strain and n is the time exponent) belong to the sample with the highest young modulus and the nanocomposites compared to PDLLA/PCL blends have the lower ‘A’ and higher ‘n’ which can be related to retardation effect of m-BGn on creep strains. Besides, the burgers model results illustrated that all viscoelastic and viscoplastic parameters for nanocomposites possess higher values than those of the neat PDLLA/PCL blend. It means that the addition of glass nanoparticles leads to decrease creep strain , increasing the Burgers model prediction values which have inverse trend with . Moreover, the weibull distribution model results acknowledge that the introduction of m-BGn into PDLLA/PCL polymeric blends cause decrease in the viscoelastic strain recovery values. This is due to hindering effects of m-BGn on creep recovery behavior of nanocomposites.Conclusion: The results obtained from modeling of creep-recovery manners of PDLLA/PCL blend and its nanocomposites approved that the bioactive glass reinforcement nanoparticles play impeding role on creep and creep recovery behaviors. Level of evidence: I
Seyed Abdolhossein Mehdinassab, MD; Nasser Sarrafan, MD; Omid Jangjoo, MD
Abstract
Background: Tibial plateau fracture is an intraarticular injury that can affect the stability of the knee joint and lead to patient disability. The aim of this study was to determine the functional outcome of surgically treated tibial plateau fractures.Methods: In a prospective study, 70 patients (46 ...
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Background: Tibial plateau fracture is an intraarticular injury that can affect the stability of the knee joint and lead to patient disability. The aim of this study was to determine the functional outcome of surgically treated tibial plateau fractures.Methods: In a prospective study, 70 patients (46 males, 24 females) with average age of 38 years (23-54 years), with closed tibial plateau fractures who treated by open reduction and plate fixation was studied in two hospitals in Iran, with a one year follow-up. The functional outcome was evaluated by "Hospital for Specific Surgery (HSS)" and SF-36 scores.Results: The average time to :::union::: was 13 weeks with a mean range of motion of 125 degrees one year after injury. Functional results showed a mean HSS score of 80 points (Range: 19-100). Schatzker type I, II, II, IV fractures showed statistically significant better results compared with Shatzker type V & VI fractures. With regard to SF-36 score 1 year after injury, of eight SF-36 subscales, the results were low in 6 subscales. The majority of patients were able to perform most of the pre-injury daily activities after 1 year. The most important independent factors influencing functional results in this study were age of the patients and fracture type.Conclusion: Functional results after open reduction and internal fixation of tibial plateau fractures seem to be excellent according to HSS score, however overall patients' subjective appraisal was not satisfactory.
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.
Mahzad Javid; John H Wedge
Abstract
Background: Treatment of Legg–Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined osteotomies are generally provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical ...
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Background: Treatment of Legg–Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined osteotomies are generally provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical head and congruent joint. The purpose of the study was to evaluate the radiographic outcomes of simultaneous femoral and pelvic osteotomies. Methods : We reviewed the radiographic changes of 20 patients with Legg–Calvé–Perthes disease with a disease onset of over eight years of age who had undergone combined femoral and Salter innominate osteotomies. The hips in these 20 patients comprised 11 lateral pillar (LP) groups B, 7 B/C, and 2 C. The patients were evaluated with a mean follow-up of five years and five months using the Stulberg radiographic assessment. Results: Among those 20 hips, six became Stulberg II (SII), nine SIII, and five SIV. From the 11 LPB hips, five became SII, four SIII, and two SIV. The seven LPB/C turned out to be SII in one case, SIII in four, and SIV in two. One of the two LPC hips became SIII and one SIV. The three female patients had one LPB, one LPB/ C, and one LPC hip, and surgery resulted in SIII hips in all. Conclusions: Combined osteotomies in older children with a higher LP grouping can marginally improve the radiographic outcome in comparison with the natural history in LPB/C and LPC cases by converting a number of poor to fair results.
Iraj Karimi, PhD; Amin Bigham-Sadegh, PhD; Ahmad Oryan, PhD; Zohre Rahmani, DVM
Abstract
Background: Rupture of tendons is a common injury. The outcome of surgical repair of injured tendon is often unsatisfactory. At best, the restored tendon is about half of its initial mechanical properties. In this study the effect of zenologous and autologous platelet gel were compared in rabbit ...
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Background: Rupture of tendons is a common injury. The outcome of surgical repair of injured tendon is often unsatisfactory. At best, the restored tendon is about half of its initial mechanical properties. In this study the effect of zenologous and autologous platelet gel were compared in rabbit model.
Methods: 45 rabbits in the age range of 7 months to 1 year old were divided into autologous, zenologous and control groups. Superficial digital flexor tendon was cut transversely and then sutured with Mayer stitch pattern. Then 5cc of either aotologous or zenologous platelet gel was injected to the incision area. The control group had no material injection. On 7th, 14th, and 28th post-operative days, five rabbits of each group were euthanized and tendons were harvested for histopathological and biomechanical evaluations. The results were analyzed statistically.
Results: Biomechanical factors were significantly superior in the autologous and zenologous groups than the control group. In histopathological examination the autologous groups showed a significant difference in fibroblast maturation in all the tested weeks. The collagen fiber alignment at 7th postoperative day and collagen accumulation on 7th and 28th postoperative days were superior in autologous compared with zenologous and control groups.
Conclusions: Utilization of zenologous platelet gel has a positive effect on tendon healing, but not as good as autologous platelet gel.
Amin Razi; Mohammad taghi Peivandi; Ali Birjandinejad; Sara Amel Farzad
Abstract
Abstract
Background: Nonunion is a serious complication following long-bone fracture that is known as a therapeutic challenge for surgeons and is associated with significant morbidity. It has been shown that osteogenesis stimulating factors combined with optimization of the mechanical environment could ...
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Abstract
Background: Nonunion is a serious complication following long-bone fracture that is known as a therapeutic challenge for surgeons and is associated with significant morbidity. It has been shown that osteogenesis stimulating factors combined with optimization of the mechanical environment could facilitate and accelerate nonunion healing. In this study, we aimed to treat nonunion using autologous bone marrow-derived mononuclear cell (BMDMC) aspirate as a source of osteoprogenitor cells combined with internal fixation.
Methods: From November 2010 to May 2013, 19 cases of nonunion were treated with bone marrow-derived mononuclear cell (BMDMC) grafting, that included 15 males and 4 females with an average age of 37.8 years (range, 18-81 years). The time from injury to therapy was 7 to 28 months, with an average of 13.4 months. At first, decortications were performed around the nonunion site to prepare a suitable bed for bone marrow grafting. Then, 2 ml of bone marrow concentrated cells was applied to the nonunion site in a mixture with partially demineralized cortical cancellous allograft chips. The healing rate in each patient was clinically and radiologically evaluated every 4 weeks.
Results: Bone union was obtained in 18 of the 19 patients during 1.06 to 6 months with an average time of 3.5 months. No complications during anesthesia nor any infection, hematoma or chronic pain at the nonunion site were observed in any patient.
Conclusion: Transplantation of autologous BMDMC aspirate is a reasonable, effective and easy treatment option for tibial and femoral nonunion after internal fixation.
Trial registration: This study has been registrated in ClinicalTrials.gov (https://clinicaltrials.gov).
TRN:NCT01788059
Hamidreza Aslani, MD; Hamid Farrokhi, MD; Hamed Vahedi, MD; Manoochehr Ghazaleh, MD
Abstract
Background: Rotator cuff tear is one of the most prevalent shoulder disorders in middle aged and old people and MRI is gold standard paraclinic diagnostic test. This research is aimed at assessing the accuracy of MRI reports in rotator cuff tears.Methods: A cross-sectional study was done from May 2005 ...
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Background: Rotator cuff tear is one of the most prevalent shoulder disorders in middle aged and old people and MRI is gold standard paraclinic diagnostic test. This research is aimed at assessing the accuracy of MRI reports in rotator cuff tears.Methods: A cross-sectional study was done from May 2005 to February 2006 in two hospitals in Tehran. Fifty consecutive patients who had been investigated with MRI and then undergone shoulder arthroscopy were assessed. The reports on MRI findings of the shoulder were compared with the arthroscopic findings. The sensitivity, specificity, positive and negative predictive values of MRI in reference to the arthroscopic findings were studied.Results: MRI in these 27 men and 23 women showed 97.4% sensitivity, 45.4% specificity, 86.3% positive predictive value, 83.3% negative predictive value and 84% accuracy. The values for the same parameters were respectively 83.9%, 78.9%, 86.7%, 75% and 82% for complete and 50%, 76.2%, 28.6%, 88.9% and 70% for partial rotator cuff tears.Conclusions: The MRI reports for rotator cuff disease, in our center, are reliable for complete tears, but not for partial tears.
James Roach
Abstract
In my experience Guest Speakers have three tasks, they need to be somewhat interesting, a little funny, and not too long. Hopefully, I will achieve these goals. The talk is Skeptic Driven Innovation. I have no disclosures and really no claim to innovation. But I have always had an interest ...
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In my experience Guest Speakers have three tasks, they need to be somewhat interesting, a little funny, and not too long. Hopefully, I will achieve these goals. The talk is Skeptic Driven Innovation. I have no disclosures and really no claim to innovation. But I have always had an interest in business innovation and in the qualities that enhance one company’s success over another. In business it is clearly understood that the status quo kills companies and those enterprises that challenge the status quo often improve their products or even develop new industries.
Rasoul Rahimzadeh, PhD; Pejman Nazem Zomorrodi, PhD; Mohammad Farzin Tajavanchi
Abstract
Background: Nano could promote strong biological bonding between implants. In this study the effect of cancellous bone scaffold coated with/without Nano-hydroxyapatite in vivo using an animal model of bone healing was studied. Methods: In an experimental study, 18 adult male New Zealand white rabbits ...
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Background: Nano could promote strong biological bonding between implants. In this study the effect of cancellous bone scaffold coated with/without Nano-hydroxyapatite in vivo using an animal model of bone healing was studied. Methods: In an experimental study, 18 adult male New Zealand white rabbits were used dividing into three groups of six rabbits each. A segmental bone defect of 10 mm in length was created in the middle of the right radial shaft under general effective anesthesia in all rabbits. The defects in group I were left as such without filler, in group II the defect were filled up with harvested 10 mm rib bone and in group III the defect were packed with rib bone covered with nano-hydroxyapatite. The operated radiuses were removed on the 60th day and were pathologically and biomechanically evaluated. Results: The radiographs showed a trace of internal callus filled the gap in 60 days in group I, whereas in group II and III internal callus almost was formed on 30 days. Repair defect in group I and II with group III and load bearing of group II, III compared with group I showed no significant difference (p < /em>
Seyed Mohammad Tahami; Seyed Ali Hashemi; Armin Akbarzadeh; Mohammad hadi Gerami; Amir Aminian; Seyed Amirreza Mesbahi; Amin Zarrabi; Rasool Safari
Abstract
Background: The novel COVID-19 disease was presented at first in Wuhan, China, in December 2019. During COVID-19 pandemic, elective surgeries were postponed, and health care facilities and resources were reorganized to provide efficient service for the large number of infected patients with COVID-19. ...
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Background: The novel COVID-19 disease was presented at first in Wuhan, China, in December 2019. During COVID-19 pandemic, elective surgeries were postponed, and health care facilities and resources were reorganized to provide efficient service for the large number of infected patients with COVID-19. Therefore, approaching trauma patients, who could have had COVID-19, was a challenging issue requiring special considerations and healthcare set up.Methods: This retrospective cohort study was conducted at Rajaei hospital, the main trauma center of the south of Iran, between March 2020 and August 2020 from the beginning of the COVID-19 pandemic. The COVID-19 infection was considered positive by either positive lung CT scan or PCR test. Trauma-related data such as the mechanism and pattern of trauma and injury, and surgical intervention procedures on the suspicious patients were recorded. Baseline characteristics including age, sex, cigarette smoking, and comorbidities were also collected. Need for ICU admission and mortality rates for the Covid and non-Covid cases were investigated and compared together as outcome variables.Results: During a six-month period of the pandemic Covid-19, 9248 patients referred to our trauma center. While 222 patients were suspected to have Corona infection, Sixty-four cases were confirmed to be positive that had mean age of 44 years. Among the 64 COVID-19 -positive patients, 33 cases with mean age of 36.4 had orthopaedic injuries. 23 patients underwent surgical treatment due to the orthopaedic injuries. 24 patients were victims of motor vehicle accidents which included 7 cases of pelvic and acetabulum fractures.The mortality rate of COVID-19 -positive cases were 15.6 % (10 patients out of the 64 cases and COVID-19 negative ones was 10.1 % (16 patients out of 158). The difference was not statistically significant (p.value:0.25). Multivariate analysis of the effect of the baseline and trauma related factors on mortality rate, showed that older age (p. value: 0.001), COVID-19 infection (p. value: 0.033), and surgical procedure (p.value:0.038) were the poor prognostic factors associated with mortality rate.Conclusion: The mortality rate of trauma patients with COVID-19 positive infection was 15.6 % (10 patients). Older age, COVID-19 infection, and surgical procedure were associated with higher mortality rate.
Alireza Saied, MD; Seyed Masood Moddarressi, MD طModdarressi, MD
Abstract
Background: Use of Tourniquet in orthopaedics, to produce a bloodless field, is mainly for the comfort of the surgeon. It is, however, associated with potential dangers. This study was performed to assess the effects of tourniquet use on patients’ and surgeons’ comfort when plating tibial fractures.Methods: ...
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Background: Use of Tourniquet in orthopaedics, to produce a bloodless field, is mainly for the comfort of the surgeon. It is, however, associated with potential dangers. This study was performed to assess the effects of tourniquet use on patients’ and surgeons’ comfort when plating tibial fractures.Methods: 138 patients with acute extraarticular tibia fractures were randomized into “tourniquet” and no "no tourniquet" groups. Postoperatively patients' pain, the amount of blood drainage, time to complete bony :::union:::, development of infection and non:::union::: was compared between the two groups in a minimum one year follow-up.Results: 73 cases who were in “no tourniquet” group had significantly less bloold drainage, and less postoperative pain in the first 24 hours. The surgical time was however shorter in 65 patients that had tourniquet. The :::union::: or infection rates showed no difference.Conclusion: Avoidance of tourniquet use does not decrease the time to :::union::: or the infection rate after plating of tibia fractures, but is associated with a decrease in pain perception by the patient in the early postoperative period.
Azin Zargham; Karim Leilnahari; Soheil Mehdipoor; Elnaz Nouri; Sohrab Keihani
Abstract
Background: Anterior cruciate ligament (ACL) tear is a common injury in sports. Different technigues for reconstruction of this ligament have been suggested. This paper compares the knee kinematics between "single bundle" and "double bundle" ACL reconstruction with hamstring tendon in a computerized ...
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Background: Anterior cruciate ligament (ACL) tear is a common injury in sports. Different technigues for reconstruction of this ligament have been suggested. This paper compares the knee kinematics between "single bundle" and "double bundle" ACL reconstruction with hamstring tendon in a computerized knee model. Methods: A computer-knee modle was constructed. Then "single bundle" and "double bundle" ACL reconstruction was performed. The knee stability and ligament tension were tested in 3 different settings: 1) At 30° knee flexion under isolated postero-anterior load, valgus and rotational torque was applied, 2) In weight-bearing flexion range (from extension to 70° of flexion) an anterior load of 134 Newton was applied, 3) Knee model was loaded by a non-contact pivot farce to produce ACL rupture. Results: The results showed no significant difference between "single bundle" and "double bundle" under isolated loading. The second and third model, however, showed 4 times greater tension on the ligament in "single bundle". The "single bundle" in the second technique of testing (weight bearing) showed at most 7 mm more displacement compared with "double bundle". In the third testing technique "double bundle" was stronger than "single bundle" in valgus torque resistance. The internal rotation stability was also more in "double bundle". Conclusion: Functional stability of knee model of ACL reconstruction with a "double bundle" graft is superior to a "single bundle" graft.
