Seyed Abdolhossein Mehdinasab, MD; Naser Sarrafan, MD
Abstract
Background: Extensor tendon lacerations are more common than flexor tendon injuries. The outcome of repair in these lesions depends on multiple factors including severity of initial trauma, other coexisting injuries, anatomic site of the laceration, experience of the surgeon, and also the post operative ...
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Background: Extensor tendon lacerations are more common than flexor tendon injuries. The outcome of repair in these lesions depends on multiple factors including severity of initial trauma, other coexisting injuries, anatomic site of the laceration, experience of the surgeon, and also the post operative rehabilitation. The aim of this study is to evaluate the results of primary extensor tendon repair in different anatomic zones of the hand.Methods: During a period of 28 months, 32 patients with open extensor tendon lacerations -with no associated hand fracture- were repaired by modified Kessler technique using 4-0, non-absorbable suture in Ahwaz teaching hospitals from 2004 to 2006. The mean age of patients was 24.6 years (17-46 y).The patients were followed for a mean of 7 months, and were assessed using Miller’s rating system. Results: Seventy two extensor tendons in 32 patients were repaired. There was no re-rupture or infection. The most rupture was seen in zones 5 (36%) and 3 (34.7%) and the least in zones 1 (6.9%) and 4 (9.7%). The best results were obtained in zone 5, followed by zone 3) 88% and 84%(. The worst outcome was in repairs of zones 1, 2 and 4.Conclusions: The site of tendon rupture is a strong determinant of repair outcome .The ruptures in the complex extensor expansion or beneath the extensor retinaculum have the worst results of repair.
Kshitij Manchanda, M.D; Jennifer Rodgers,M A; Yassine Kanaan, M.D.; Chan Chan-Hee Jo, Ph.D; David A Podeszwa, M.D; John G Birch, M.D., FRCS(C)
Abstract
PURPOSE: We sought to determine the incidence, extent, and prognostic factors for physeal growth resumption after partial physeal bar resection.
METHODS: We performed a retrospective chart review of all patients treated between 1981-2017 by lower extremity physeal bar resection. All radiographic images ...
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PURPOSE: We sought to determine the incidence, extent, and prognostic factors for physeal growth resumption after partial physeal bar resection.
METHODS: We performed a retrospective chart review of all patients treated between 1981-2017 by lower extremity physeal bar resection. All radiographic images were reviewed from preoperatively until cessation of affected physeal growth, subsequent surgery, or skeletal maturity.
RESULTS: Eighty-nine patients met inclusion criteria (26 distal femora, 49 proximal tibiae (including 40 infantile Blount patients), 14 distal tibiae). Thirty-seven (42%) had at least two years’ normal growth (defined as “successful”), 13 (15%) showed less than two years’ growth (“partial”), and 39 (44%) had no growth (“failure”) after resection surgery. 56% of the “successful” and “partial” groups required subsequent surgery compared to 100% of the “failure” group. The use of methylmethacrylate (CranioplasticTM) as interpositional material was superior to autologous fat (p <0.01). Anatomic type of bar (peripheral, central, linear), physis affected, patient age, and etiology were not prognostic.
CONCLUSIONS: Approximately 40% of patients demonstrated useful resumption of growth after partial physeal bar resection. With the exception of interpositional material, other demographic variables were not prognostic. These results should be considered when determining whether physeal bar resection surgery is warranted in individual patients.
Advanced 3-D imaging reconstruction preoperatively, imaging confirmation of complete bar resection, markers to detect and monitor growth, and periodic radiographic follow up until cessation of growth or maturity should be incorporated in a standardized treatment regimen. LEVEL OF EVIDENCE: Level 3
KEY WORDS: Physeal Arrest, Physeal Bar, Bony Bridge, Physiolysis, Epiphysiolysis
Mohammad Mehdi Sarzaeem, MD; Mohammad Razi, MD; Farideh Najafi, MD; Mohammad Amin Najafi
Abstract
Background: The gold standard in ACL reconstructions has been the bone–patellar tendon–bone autograftfixed with interference screws. This prospective study, aimed to compare two method of fixation for BPTB grafts: press fit fixation vs. interference screw, over a 12 months follow-up interval.Methods: ...
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Background: The gold standard in ACL reconstructions has been the bone–patellar tendon–bone autograftfixed with interference screws. This prospective study, aimed to compare two method of fixation for BPTB grafts: press fit fixation vs. interference screw, over a 12 months follow-up interval.Methods: In a randomized clinical trial study, 158 patients with an average age of 29.8 years were treated for torn ACL with BPTB autograft in a teaching hospital in Tehran, Iran. In 82 patients press fit fixation technique, and in 76 cases an interference-screw was used. At the time of final follow-up, 71 patients in press-fit group and 65 patients in interference-screw group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC score and complications.Results: In the final follow-up, 59 cases in interference screw and 55 in press-fit screw group had good-to-excellent IKDC score (p < /em>≥.05). The mean laxity assessed improved to 2.7 mm and 2.5 mm in press-fit and screw group, respectively. Regarding Lachman and pivot shift tests, there was a statistically significant improvement in the integrity of the ACL in both groups, with no significant difference (p < /em>≥.05).Conclusions: the press-fit technique is an efficient procedure. Its outcome was comparable with the interference screw group. Furthermore it has unlimited bone-to-bone healing, no need for removal of hardware, ease for revision and cost effectiveness.
Gholam Hossain Shahcheraghi, MD, FRCS(C); Mahzad Javid, MD; Mohammad Arasteh, MD xArasteh, MD
Abstract
Background: Thromboembolic disease (TED) after knee arthroplasty occurs infrequently in Iran. The aim of this study was to examine the incidence of TED in patients with osteoarthritis undergoing knee replacement in Southern Iran while on prophylaxis.Methods: In a prospective case series study from ...
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Background: Thromboembolic disease (TED) after knee arthroplasty occurs infrequently in Iran. The aim of this study was to examine the incidence of TED in patients with osteoarthritis undergoing knee replacement in Southern Iran while on prophylaxis.Methods: In a prospective case series study from January to December 2012, 100 consecutive total knee arthroplasty (TKA) candidates were evaluated for TED by clinical evaluation and doppler sonography preoperatively and 2 months postoperatively and by clinical evaluation one year after surgery. The patients in this study randomly received either warfarin or enoxaparin prophylactically.Results: A total of 77 women and 23 men with mean age of 67 years (52-82 years) entered the study. The average hemoglobin drop of 2.7 g with warfarin and 3.3 with enoxaparin was observed. No case of TED, pulmonary embolus (PE), major bleeding, post-thrombotic syndrome, or hemarthrosis was observed.Conclusions: No clinically significant DVT was found using either enoxaparin or warfarin prophylaxis after TKA in Southern Iran. Relatively excessive postoperative bleeding was observed, particularly with enoxaparin.The article is published online in Journal of Orthopaedics, 01/2014: 12(2):86-91 and is available online at www.sciencedirect.comjournal homepage: www.elsevier.com/locate/jorCopyright 2014 by Professor P K Surendran Memorial Education Foundation. Publishing Services by Reed Elsevier India Pvt. Ltd. All rights reserved.
Saeed Solooki; Amir Rahmani Rasa; Narges Ghamari; Mohammad Mehdi Kamravan
Abstract
Background: Ewing's sarcoma is a primitive and malignant bone tumor that is a serious medical challenge in preserving the patient's life and choosing the appropriate treatment. The aim of this study was to consider the metastasis and survival rate after preoperative chemotherapy, surgery and postoperative ...
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Background: Ewing's sarcoma is a primitive and malignant bone tumor that is a serious medical challenge in preserving the patient's life and choosing the appropriate treatment. The aim of this study was to consider the metastasis and survival rate after preoperative chemotherapy, surgery and postoperative chemotherapy as a treatment protocol.Methods: In this study, 42 patients with Ewing's Sarcoma admitted to Chamran and Namazi Hospitals during 2005 to 2016 were enrolled. After considering inclusion and exclusion criteria, 27 patients were finally entered the study. Neo adjuvant chemotherapy and again restaging with MRI and chest CT scan was done. After restaging, treatment was selected. Treatments included amputation; only wide resection; wide resection and allograft; wide resection and prosthesis and only chemotherapy. After surgical treatments, patient had adjuvant chemotherapy.Results: In this study, 42 patients were investigated of whom 29 (%69) were male and 13 (%31) female respectively. The age mean and standard deviation were 21.45± 7.69 and 16.23± 4.9 in the male and female in respect. Femur (%30) and tibia (%23.8), respectively, were the more commonly involved sites. The treatments of 27 cases in the study group were amputation (5 subjects), only wide resection (6 subjects), wide resection and allograft (8 subjects) and wide resection and prosthesis (3 subjects). Patients with pelvis involvement received only chemotherapy (5 subjects). %46.2 of subjects had a 5-year survival period.Conclusion: Early diagnosis of Ewing's sarcoma and appropriate treatment using preoperative chemotherapy followed by, surgery through proper margin removal and then postoperative chemotherapy is highly recommended for this condition. Our study confirmed the above-mentioned points on preoperative chemotherapy followed by surgery and post operative chemotherapy.
Mohsen Movahedi Yeganeh, MD
Abstract
Background: Persistent instability following an acute lateral ankle sprain has been reported to vary in incidence from 15% to 48%. Surgery is indicated when conservative management fails to produce a satisfactory functional outcome. Associated intraarticular lesions of talus or extraarticualr lesions ...
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Background: Persistent instability following an acute lateral ankle sprain has been reported to vary in incidence from 15% to 48%. Surgery is indicated when conservative management fails to produce a satisfactory functional outcome. Associated intraarticular lesions of talus or extraarticualr lesions like peroneus Brevis tendon injuries can impact the functional outcome of lateral ankle reconstruction. The aim of this study was to report our short-term experience and treatment of concomitant lesions in chronic lateral ankle instability.Methods: 18 patients, aged 21 to 45 years with recurrent ankle sprain and lateral ankle instability who had not responded to at least 3 months conservative treatment and had underwent direct lateral ligament repair were studied. All the patients received ankle arthroscopy and exploration of peroneus Brevis tendon before repair of anterior talofibular and calcaneofibular ligaments with 14 months (6-22 months) follow-ups. The cases were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score.Results: The mean duration of injury was 19 months. In the diagnostic ankle arthroscopy, 6 patients had some degree of talar chondral lesions, two requiring shaving and drilling. Preoperatively, all patients had poor scores (
Ali Akbar Esmailijah, MD; Seyyed Mohammad Jazaeri, MD; Seyyed Mehdi Hosseini Khameneh, MD; Firooz Madadi, MD; Sohrab Keihani, MD; Keyghobad Ashoori, MD; Pooran Hakimi, MD; Reza Zandi, MD; Mehdi Rahimi, MD; Farshad Safdari, MSc
Abstract
Background: Incorrect tunneling is one of the concerns in arthroscopic anterior cruciate ligament reconstruction. The purpose of the current study was to determine the incidence of the correct femoral and tibial tunnel positions.Materials: In a cross-sectional study, the CT image positions of the tibial ...
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Background: Incorrect tunneling is one of the concerns in arthroscopic anterior cruciate ligament reconstruction. The purpose of the current study was to determine the incidence of the correct femoral and tibial tunnel positions.Materials: In a cross-sectional study, the CT image positions of the tibial and femoral tunnels in 40 patients that had undergone arthroscopic ACL reconstruction using single-bundle hamstring tendon were studied. The parameters that were evaluated were: tibial tunnel position in axial and sagittal cuts, femoral tunnel position in axial cut, appropriate thickness of the posterior cortex at the intercondylar notch, and femoral exit point.Results: The correct position of the tibial and femoral tunnels, appropriate thickness of the posterior cortex at the intercondylar notch, and the correct position of the "femoral exit point" were respectively recognized in 60%, 52.5%, 70%, and 67.5%. In total, the correct position of the femoral and tibial tunnels was seen on 37.5% of patients. These parameters were compared with known standard anatomic positions.Conclusion: Although the incidence of correct tibial and femoral tunnel positioning in ACL reconstruction, when viewed separately, was acceptable when looked at as one tunnel was not satisfactory. More precise attention and expertise seem necessary for the operating orthopaedic surgeons.
Arash Maleki; Firoozeh Madadi; Ramin Arjang; Firooz Madadi
Abstract
Background: Tibial torsion is a term used to describe the physiologic twist of the distal relative to the proximal articular axis of the tibial bone in the transverse plane around its longitudinal axis. This study focuses on a method of tibial torsion measurement with computerized tomography cuts. Methods: ...
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Background: Tibial torsion is a term used to describe the physiologic twist of the distal relative to the proximal articular axis of the tibial bone in the transverse plane around its longitudinal axis. This study focuses on a method of tibial torsion measurement with computerized tomography cuts. Methods: Sixty four volunteers aged over 16 years old had CT imaging of proximal and distal tibia in a teaching hospital in Tehran-Iran. The images were evaluated for leg rotation by four physicians using two different techniques in two different occasions, one month apart. In the first technique the middle of tibia and middle of fibula were used as reference points and in the second method the perpendicular axis to the line connecting the distal fibular notches on CT scans was used. The values were analyzed, and the intra and inter observer agreements for tibia torsions were assessed. Results: The inter-observer agreement in tibial torsion was .861 and .863 in the first and second methods respectively. The intra-observer reliability in both measurements techniques were .868. The two techniques also had excellent agreement in tibial torsion measurements. Conclusion: The second technique has high reliability and reproductivity in assessing tibial rotation in fibula deformity.
zahra khoz; mohammad nikkhoo; Chih-Hsiu Cheng
Abstract
Background: Low back pain is one of the most common problems that force individuals to seek medical care. Since surgery is the last treatment strategy, predicting the process of conducting surgical procedures seems beneficial and somehow crucial. In this regard, the first step is having a validated biomechanical ...
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Background: Low back pain is one of the most common problems that force individuals to seek medical care. Since surgery is the last treatment strategy, predicting the process of conducting surgical procedures seems beneficial and somehow crucial. In this regard, the first step is having a validated biomechanical model based on the anatomical parameters of patients’ lumbar spine. Despite the impressive progress in this field, there is still a need to designing a model that could include important anatomical parameters and be applicable in terms of clinical applications.Methods: This study aimed to develop the personalized spinal finite element model with 23 anatomical parameters. The initial data was extracted from the radiology picture of the average healthy volunteers and was designed in Catia software. Afterwards, the finite element model was analyzed in Abaqus, and results of the range of motion of motionsegments in movements of flexion, extension and left and right lateral bending were verified based on the results of experimental studies present in the literature.Results: In order to observe the application of the patient-specific spinal parametric model, a model of a patient after spinal fusion was presented. Moreover, results of the range of motion of the motion segments and intradiscal pressure were compared to the healthy model.Conclusion: Since acceptable results were obtained at each step, it is possible to predict the result of spinal fusion and compare the biomechanical results in case of decreased or increased fusion level by developing a parametric parient-specific model for each patient, which can be an effective achievement for clinical fields.
Gholam Hossain Shahcheraghi, MD, FRCSC; Mahzad Javid, MD
Abstract
Background: The congenital absence of the tibia is a rare disease, and an orthopaedic surgeon may not encounter such cases during the course of his/her career. This is the largest report to date of the management of such cases by a single surgeon. The foot and leg were persevered in the majority of the ...
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Background: The congenital absence of the tibia is a rare disease, and an orthopaedic surgeon may not encounter such cases during the course of his/her career. This is the largest report to date of the management of such cases by a single surgeon. The foot and leg were persevered in the majority of the cases, and a functional evaluation system was used to report outcomes.
Methods: Thirty-six patients (19 girls, 17 boys) with 48 tibial deficient limbs were evaluated clinically and radiographically. The mean age of patients was 12 years old. The patients or their parents filled out the Pediatric Quality of Life and the parents’ satisfaction forms. The surgical interventions performed, and their effects on school attendance and the shoe type they wore were documented.
Results: The mean time of follow-up was 9 years. The 48 limbs included 14 type I, 16 type II, 11 type IV, and 7 unclassified by using the Jones classification; and 6 type I, 11 type II, 16 type III, 1 type IV, and 14 type VII by using the Weber classification. Primary amputation was performed in 10 limbs (8 patients) and limb preservation surgery on 38 legs (28 patients). Tibiofibular synostosis, centralization of the ankle, and Ilizarov lengthening were the most common procedures. Non::union:: of tibiofibular synostosis (2 cases) and knee stiffness (6 cases) were the main complications. Among the reconstructed limbs, 12 were in regular and 18 in modified shoes. The Pediatric Quality of Life of 68 points in the reconstructed group was a significant achievement, and it was also better than the score of patients who had undergone amputation.
Conclusions: Reconstruction of tibial hemimelia with foot preservation provides good functional outcome in the majority of cases.
Mahmood Karimi Mobarakeh, MD; Alireza Saeed, MD; Ali Nemati, MD
Abstract
Background: Knee replacement is one of the final remedies for severe, symptomatic knee destruction. The results of this surgery are usually excellent. The number of reports from Iran on this subject is very few. We would like to report our experience with knee replacement in Kerman.Methods: In a clinical ...
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Background: Knee replacement is one of the final remedies for severe, symptomatic knee destruction. The results of this surgery are usually excellent. The number of reports from Iran on this subject is very few. We would like to report our experience with knee replacement in Kerman.Methods: In a clinical trial and prospective study, 54 patients (11 males, 43 females) with knee disease who underwent joint replacement from 2001 to 2006 in a Teaching hospital in Kerman, were studied. Mean age was 65 years (41-80) and mean follow-up 34.4 months (3 months to 5 years). 46 cases had osteoarthritis and 8 rheumatoid arthritis. The pre and post operative findings were assessed using the ‘Knee Society’ evaluation system. The opposite knees were used to compare the patients’ satisfaction from the procedure.Results: In a study on 54 cases, the pain score of ‘Knee Society’ improved from 33 to 77 and the functional score improved from 41 to 72. Ninety six percent of the cases were satisfied with their surgeries. The complications included 1 deep and 1 superficial infection, 2 wound healing problem and one patellar dislocation. Three revisions become necessary: 2 due to infection, one for loosening and deformity in tibial component.Conclusions: Knee replacement in Kerman is associated with high satisfaction rate in short-term. Early failure is mostly related to infection or technical errors in surgery.
Fardin Mirzatolooei; Michael Tafkiki Alamdari; Hamidreza Khalkhali
Abstract
Background: The use of platelet-rich plasma (PRP) as an adjuvant to tissue repair is gaining favour in orthopaedic surgery. Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a recognised phenomenon that could compromise revision surgery. The purpose of this study was to determine ...
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Background: The use of platelet-rich plasma (PRP) as an adjuvant to tissue repair is gaining favour in orthopaedic surgery. Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a recognised phenomenon that could compromise revision surgery. The purpose of this study was to determine whether PRP might prevent tunnel widening in ACL reconstruction. Methods: In a randomized clinical study, during one year patients undergoing ACL reconstruction using a hamstring graft were randomly allocated either to have PRP introduced into the tunnels (group 1) peri-operatively or not (group 2). Each group comprised 25 patients. CT scanning of the knees was carried out on the day after surgery and at three months post-operatively and the width of the tunnels was measured. Patients were also evaluated clinically at three months, when laxity was also measured. Results: Three months post-operatively, all patients were pain-free with stable knees, a negative Lachman test and a good range of movement. Arthrometric results had improved significantly in both groups (p < /i>≥.05). Conclusions: We conclude that PRP has no significant effect in preventing tunnel widening after ACL reconstruction.
Amir Mohammad Navali, MD; Mohammad Ali Mohseni, MD; Mir Bahram Safari, MD; Aisan Nozad, MD
Abstract
Background: Magnetic Resonance Imaging (MRI) of the knee joint has often been regarded as the noninvasive alternative to diagnostic arthroscopy. New technology, however, masks the importance of history and physical examination. This study aims at evaluating the accuracy of physical examination and MRI ...
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Background: Magnetic Resonance Imaging (MRI) of the knee joint has often been regarded as the noninvasive alternative to diagnostic arthroscopy. New technology, however, masks the importance of history and physical examination. This study aims at evaluating the accuracy of physical examination and MRI scanning in diagnosis of knee injury, including meniscal tears and cruciate ligaments ruptures.Methods: In a cross-sectional, analytic-descriptive study, 120 patients (108 males, 12 females) with knee injury who were candidates for arthroscopy were recruited in a Hospital in Tabriz during a one-year period. Prior history of arthroscopy or knee surgery was considered as exclusion criteria. A complete history and physical examination was performed and diagnosis was documented before looking at the MRI results. The final arthroscopic diagnosis was then compared with clinical and MRI studies.Results: 120 knee injury cases with a mean age of 29 (16-54) years were enrolled. Accuracy, sensitivity and specificity of clinical examination was respectively 85, 94.8 and 75.8 percent for medial meniscus, 85, 70.8 and 88.5 percent for lateral meniscus, 95.8, 98.6 and 91.7 percent for anterior cruciate ligament and 100 percent for posterior cruciate injuries. Accuracy, sensitivity and specificity of MRI were respectively 77.5, 84.2 and 71.4 percent for medial meniscal. 85.8, 56.5 and 92.8 percent for lateral meniscal, 92.5, 98.6 and 83.3 percent for anterior cruciate, and 100 percent for posterior cruciate injuries. Overall, in isolated injuries, the accuracy of clinical examination was relatively better than MRI in complex injuries, while MRI had higher accuracy in complex intra-articular injuries.Conclusion: According to our results, both physical examination and MRI scanning are very sensitive and accurate in diagnosis of knee injuries, with a slight preference of physical examination. MRI should be reserved for doubtful or complex injuries.
nader tanideh; Mohammad Amin Rostami Nasab; Ida Hasssanpour; Omid Koohi Hosseinabadi; Maryam Mojahed; Sara Sadat Nabavizadeh
Abstract
Background: Osteoarthritis (OA) is widespread degenerative joint disease. Although many therapeutic policies exist, no clear preventive remedy exists. Due to various side effects caused by conventional medication; we aim to evaluate the effect of leaf of Psidium guajava essential oil on animal model ...
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Background: Osteoarthritis (OA) is widespread degenerative joint disease. Although many therapeutic policies exist, no clear preventive remedy exists. Due to various side effects caused by conventional medication; we aim to evaluate the effect of leaf of Psidium guajava essential oil on animal model of OA.Methods: This 8-week animal model study was conducted on 25 male rats with induced osteoarthritis with collagenase. The rats were divided into 5 groups randomly, the first group that serves as negative control group and received intra-articular injections of saline, the second group received olive oil, the third group intra articular(IA)Hyalgan, the fourth group received low dosage (25 λ) essential oil of Psidium guajava L. leaf, and the last group which received high dosage (50 λ) essential oil of Psidium guajava L. leaf. All groups received their medication for 4 weeks. After 8 weeks from beginning of study, all of the animals were euthanized with CO2 and samples harvested. All the samples underwent histopathological and radiological evaluation and data were collected and analyzed by Kruskal-Wallis nonparametric test (distribution free) by SPSS version 23.00.Results: In histopathological findings illustrate a considerable difference between high dose (50λ) treatment group and the control group. Moreover; in radiographic findings, significant difference was observed between groups in evaluation of distribution in joint space width. (P value =0.0001)Conclusion: Essential oil of Psidium guajava L. leaf has a considerable positive effect on osteoarthritis.Trial registration: 94-01-01-9732
Abas Sheykh; Shahnaz Shahrbanian; Houman Minounejad
Abstract
Background: Determining the association between knee joint proprioception and stability in Taekwondo players shows the importance of incorporating proprioception exercises in the Taekwondo training program. In addition, it can be considered by athletes and Taekwondo coaches as one of the components that ...
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Background: Determining the association between knee joint proprioception and stability in Taekwondo players shows the importance of incorporating proprioception exercises in the Taekwondo training program. In addition, it can be considered by athletes and Taekwondo coaches as one of the components that promote the professional level of performance. Therefore, this study aimed to compare the knee proprioception and postural stability between Iranian amateur and professional Taekwondo players.Materials & Methods: This cross-sectional comparison study was performed on 40 Taekwondo players who were randomly divided into two amateur and professional groups. The level of players (professional and amateur) was considered as the independent variable, whereas the mean error of target angle reconstruction at 30, 60, and 90 degrees and postural stability were recognized as the dependent variables. Knee joint proprioception and postural stability were assessed using a gyroscope and Biodex stability system, respectively. Data analysis was performed using independent t-test, and its non-parametric equivalent, Mann-Whitney U (in case of lack of establishment of the assumptions of parametric test).Results: A significant difference was found between amateur and professional groups regarding proprioception at 30 (P=0.001), 60 (P=0.001) and 90 (P=0.008) degrees as well as postural stability (P=0.001), where the professional group obtained better results, compared to the other group.Conclusion: According to the results of the study, performing professional Taekwondo techniques can positively affect joint proprioception and postural stability by increasing physical performance. These issues are important factors for the difference between professional and amateur players.
Mohammad Reza Miniator Sajjadi; Reza Zandi; kamyar makvandi
Abstract
Background: In a total knee arthroplasty surgery the goal is to produce 90 degree angle between the knee articular lobe and the mechanical femoral line. Most orthopedic surgeons usually utilize a 5 to 7 degree for distal femoral cutting angle. In this study we will aim at clearing this question, that ...
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Background: In a total knee arthroplasty surgery the goal is to produce 90 degree angle between the knee articular lobe and the mechanical femoral line. Most orthopedic surgeons usually utilize a 5 to 7 degree for distal femoral cutting angle. In this study we will aim at clearing this question, that whether the” five-seven degree” distal femoral cutting angle supposed to be an equable spectrum?Method: In this three year course of study, 123 candidate patients for knee arthroplasty with varus knee deformities underwent pre operatore radiologic assessment before joint replacement surgery. The femoral bowing angle, distal femoral cutting angle, neck shaft angle, angle between knee articular line and mechanical femoral angle were assessed and statistically analyzed.Results: The mean varus angle was in 13.71±4.34 in male and 16.41±7.87 in female. The mean distal femoral cutting angle (DFCA) was 6.50±1.09 in male and 7.38±1.75 in female. In 48 patients (%39) the female DFCA was out of 507 degree range. In 32 (26%) of patients the DFCA was 7-9 degrees and in 8 (%6) it was over 9 degrees, and in 8 (%6) was less than 5. The angle differences had no sex-related variation. There was a good co-relation between DFCA and bowing angle (r=0.769). The co-relation between DFCA and NSA was moderator (r=0.523). The co-relation between DFCA and DFA (r=0.11) and varus angle with LDFA (r=0.28) was low. LDFA was also related to NSA (r=0.15). Therefore, the candidates for knee replacement who have varus deformity may need a distal femoral cutting angle over 7 degrees. Based on these results, the distal femoral cutting angle in patients in need of a knee arthroplasty and varus deformity might be more than seven degrees.Conclusion: The distul femoral cutting angle in knee arthroplasty in face of severe varus does not have a constant value and maybe over 7 degrees. A long standing radiograph is needed to measure the mechanical and correlate with axis the anatomic axis of distal third of femur. When the bowing angle is high the DFCA will need to be higher.
Fardin Mirzatolouei, MD; Ahmad Reza Afshar, MD; Rima Sarhadian, MD; Fariba Shishavi, MD
Abstract
Background: Treatment of femoral fractures in children sometimes requires open reduction and plate fixation. There is potential for complication in any type of fixation, leg length discrepancy being one of them. We are reporting the results of plate fixation, with special emphasis on limb length inequality ...
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Background: Treatment of femoral fractures in children sometimes requires open reduction and plate fixation. There is potential for complication in any type of fixation, leg length discrepancy being one of them. We are reporting the results of plate fixation, with special emphasis on limb length inequality problem.Materials: In a cross-sectional study, 42 patients at 6-12 years of age with femoral shaft fractures treated dynamic compression plate fixation were assessed for mal:::union:::, non:::union:::, infection, device failure, and limb length discrepancy in a mean follow-up of 26 months (18-60 months). Physical examination, serial X-rays and scanogram were used for assessment.Results: Out of the 42 cases, 32 (76.2%) were boys and the remaining 10(23.8%) were girls. Seven patients had comminuted fractures, 5 fractures were open Gustillo type 1. Twenty four were associated with polytrauma. The mean limb length discrepancy at the end of treatment was 1.17 centimeters (0.4-2.4 centimeters). There were no device failure, mal-:::union:::, or infection.Conclusion: Treatment of paediatric femoral shaft fracture with dynamic compression plating has minimal side effects and causes minimal, if any, inequality in the length of the femur.
Seyed Abdolhossein Mehdinasab, MD; Seyed Ali Marashi Nejad, MD; Nasser Sarrafan, MD
Abstract
Background: There have been many operations for treatment of recurrent anterior shoulder dislocation. The Bristow procedure with its dynamic and static effect can prevent shoulder dislocation. The aim of this study was to evaluate the long term results of this procedure in our center.Methods: 19 patients ...
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Background: There have been many operations for treatment of recurrent anterior shoulder dislocation. The Bristow procedure with its dynamic and static effect can prevent shoulder dislocation. The aim of this study was to evaluate the long term results of this procedure in our center.Methods: 19 patients with mean age of 25 years had undergone Bristow procedure for anterior shoulder instability. A retrospective clinical evaluation was not performed with an average follow-up of 7.5 years (3-14 years). Pain, recurrence of instability, range of motion and ability to return to sporting activities were the parameters evaluated by constant shoulder score (CSS).Results: No dislocations but 3 cases of instability feeling were observed. The two athletes (one volleyball player and one wrestler) were unable to return to their sports. Fifteen patients (78.9%) gad excellent or good CSS scores.Conclusions: Bristow is a good procedure for controlling recurrent shoulder dislocation, but because it produces limitation in external rotation of shoulder, is not recommended as the first choice for athletic population. The radiographs of the shoulders at follow-up revealed early osteoarthritis in 3 cases. These were the same cases that had limited external rotation.
Mahmood Karimi Mobarakeh, MD; Mohammad Hasan Fadaee, MD; Massoud Mehdinejad Yazdi, MD
Abstract
Background: Ipsilateral fractures of femur and tibia, the so called “floating knee” are usually the result of high-energy trauma. They are associated with increased risk of local soft tissue injuries around the knee including ligamentous injuries, delayed :::union:::, and more importantly, vascular ...
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Background: Ipsilateral fractures of femur and tibia, the so called “floating knee” are usually the result of high-energy trauma. They are associated with increased risk of local soft tissue injuries around the knee including ligamentous injuries, delayed :::union:::, and more importantly, vascular injuries.Methods: In a cross sectional study of “floating knee” injuries treated in a training hospital of Kerman-Iran over a 1 year period (2003 to 2004) was performed. Seventy eight patients (69 males, 9 females), with a maximum follow-up of 2 weeks entered the study and are reported here. The injury type and, in particular, the vascular status of the limb in terms of prevalence and the fate of limb in first two weeks were the points of concern. Seventy eight “floating knee” patients comprised the study group that was divided into six groups in accordance with the limb vascular status. Each “floating knee” case was further classified according to the level and type of each bone fracture.Results: Out of 78 cases 18 has no pulse and did not regain any hemodynamic stabilization, and 13 had angiography and 5 went directly for arterial exploration. In general 15 cases (19.2%) of “floating knees” had vascular compromise, 8 of whom ended up with amputation. The vascular damage had no direct correlation with age, or anatomic location of fractures.Conclusions: Simultaneous ipsilateral fractures of femur and tibia are associated with around 20 percent chance of vascular injury. Careful and immediate assessment of limb circulation is mandatory for any “floating knee” injuries.
Reza Shahriar Kamrani; Seyyed Hossein Shafiei; Lida Shafieian
Abstract
Background: Enchondroma is the most common benign bone tumor in hand, which can be seen in various manifestations such as swelling, pain, deformity and pathologic fracture. Different surgical treatments were reported for enchondroma to prevent the progressive deformity and pathological fractures. The ...
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Background: Enchondroma is the most common benign bone tumor in hand, which can be seen in various manifestations such as swelling, pain, deformity and pathologic fracture. Different surgical treatments were reported for enchondroma to prevent the progressive deformity and pathological fractures. The purpose of this study was to investigate the result of treatment of enchondroma of hand with curettage alone. Methods: In a cross sectional study, 17 patients with average age of 32 years with enchondroma of hand who were operated in a 6-year period in a training hospital in Tehran-Iran were evaluated. The patients received the treatment of tumor removal without filling the resultant defect. The cases were evaluated for range of motion, grip power and radiographic Tordai classification. Results: In a 15.2 month (12-88 months) follow-up no recurrence was observed and all of the patients re-gained their previous finger range of motion. Conclusion: Treatment of enchondroma of hand with curettage alone, without filling the defect would result in satisfactory outcome with low recurrence rate and good restoration of power and function.
Mikaeil Tafkiki Alamdari; Ahmadreza Afshar
Abstract
Background: Knee dislocation, although a rare injury, is a severe injury which can endanger the limb viability or cause a significant impairment in the knee function. The purpose of this study was to evaluate the knee function and knee osteoarthritis in the patients who had sustained an acute traumatic ...
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Background: Knee dislocation, although a rare injury, is a severe injury which can endanger the limb viability or cause a significant impairment in the knee function. The purpose of this study was to evaluate the knee function and knee osteoarthritis in the patients who had sustained an acute traumatic knee dislocation . Methods: In a retrospective study, 19 consecutive patients with knee dislocation who were treated by different therapies were studied during 5 years in a teaching hospital in Urmia, Iran. Vascular injuries lead to amputation in 3 patients. The follow-up study was performed on the remaining 16 patients within 37±13 months. The patients were evaluated for knee stability, range of motion and the "Tegner-Lysholm" knee function scores. The development of knee osteoarthritis was classified according to Kellgren and Lawrence classification . Results: The knee function was excellent in one, good in 3, fair in 9, and poor in 3 cases. The younger patients and knees with wider range of motion had better "Tegner-Lysholm" scores. The knee scores had significant correlation with the severity in the class of dislocation. The time of surgical reconstruction, whether early or delayed, had no significant effect on the outcome. The mean knee range of motion for the 12 patients who were treated surgically was 120±15 degrees and for the 4 patients who were treated non-surgically was 115±28 degrees. There was a significant correlation between the "Tegner-Lysholm" scores and knee range of motion. Conclusions: Knee dislocation is a very severe complex trauma and normal knee functional outcome is not often achieved. The knees with the more extensive ligament injuries have less favorable outcomes. Younger patients and knees with larger range of motion had better functional outcomes.
Knee
Alireza Naseri; Abbasali Dehghani; Mohammad Reza Moharrami
Abstract
Introduction: Deep vein thrombosis (DVT) is accompanied by adverse effects after surgery and the prevalence of this complication is unknown following knee replacement surgery in patients with a history of chemotherapy. Therefore, the present study aimed to investigate the frequency of DVT after knee ...
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Introduction: Deep vein thrombosis (DVT) is accompanied by adverse effects after surgery and the prevalence of this complication is unknown following knee replacement surgery in patients with a history of chemotherapy. Therefore, the present study aimed to investigate the frequency of DVT after knee replacement surgery in patients with a history of chemotherapy.Methods: This descriptive-analytical study was performed on 189 candidates for knee replacement surgery who had a history of chemotherapy during 36 months ending in March 2016 and referred to Shohada and Imam Reza hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. After surgery, patients were evaluated for the incidence of DVT and the factors, influecing it based on the instrument of determining DVT and Doppler ultrasound. Statistical analysis was completed by Spearman’s correlation and regression tests.Results: The mean standard deviation of DVT score was 43.49 ± 6.66, which indicates that after knee replacement surgery, patients with a history of chemotherapy are at high risk for DVT. The prevalence of DVT was 25.92% (N=49) and the number of chemotherapy sessions (P=0.001) correlated with the occurrence of DVT.Conclusion: The prevalence of DVT following knee replacement surgery in people with a history of chemotherapy is above the normal mean reported in the literature. Consequently, further therapeutic and preventive measures are required.
Mohsen Mardani Kivi; Ali Karimi; Keyvan Hashemi Motlagh
Abstract
Background: The purpose of clinical examination is to make a correct diagnosis. There are several clinical tests with different diagnostic values for meniscus injuries. The aim of the present study was to evaluate the diagnostic value of modified "axial loading McMurray test". Methods: In a cross sectional ...
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Background: The purpose of clinical examination is to make a correct diagnosis. There are several clinical tests with different diagnostic values for meniscus injuries. The aim of the present study was to evaluate the diagnostic value of modified "axial loading McMurray test". Methods: In a cross sectional diagnostic study, 146 patients (120 male, 26 female) with a mean age of 35 years who had clinical symptoms of knee meniscus injury and were candidates for arthroscopic evaluation entered the study in a teaching hospital in Guilan-Iran. "Axial loading Mc Murray – ALMM" test was performed in all the cases just before doing arthroscopic evaluation of the knees. The accuracy, sensitivity, specificity, positive and negative predictive values of the ALMM in relation to the later arthroscopic findings were analyzed. Results: From the 146 patients, 92 had evidence of meniscus tear on ALMM testing. The arthroscopy was, however, positive in 82 patients. In the remaining 54 cases with negative ALMM test, 38 patients had meniscus tear at arthroscopy. 56% of tears were seen in medial meniscus, 75% of which were in posterior horn. The ALMM test had 67.1% accuracy, 68.3% sensitivity, 61.5% specificity, 89.1% predictive positive value and 29.6% negative predictive value. Conclusion: Positive "Axial loading Mc Murray" for knee meniscus injury is expected to show meniscal tear in 89% of cases
Mohammad Reza Farahanchi Baradaran, MD; Mehrnoush Hassas Yeganeh, MD; Mohammad Reza Bigdeli, MD; Syavash Hemmati Eslamloo, MD; Farshad Safdari, MS; Reza Zandi, MD; Hamid Reza Seyyed Hosseinzadeh, MD; Seyyed Morteza Kazemi, MD; Alireza Eajazi, MD; Laleh Daftari Besheli, MD
Abstract
Background: Hip fracture in older population is frequent and often costly. The patients, however, do not commonly regain their pre-fracture activity levels. We are reporting the outcome of surgery in intertrochanteric hip fractures during a ten-year period.Methods: This is a retrospective study of the ...
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Background: Hip fracture in older population is frequent and often costly. The patients, however, do not commonly regain their pre-fracture activity levels. We are reporting the outcome of surgery in intertrochanteric hip fractures during a ten-year period.Methods: This is a retrospective study of the intertrochanteric hip fractures treated from 1994 to 2004 in one teaching hospital of Tehran-Iran. The cases were called in for a full hip examination, evaluation of their activity levels and also measurement of Harris Hip Scores (HHS), as well as radiographic assessment.Results: 293 patients, comprised of 194 males (66.2%) and 99 females (33.9%), with a mean age of 65±6.67 years were studied. The cases had a one-year of follow-up. 252 (86%) cases had obtained :::union:::. Acceptable ligament was observed in 158 (54%) cases. Harris Hip Scores over 60 points was seen in 222 (75.8%). Only 90 patients had returned to their pre-operative activity level.Conclusion: Patients with intertrochanteric hip fracture do not often return to pre-fracture activity of daily living.
Hamidreza Aslani, MD; Hamed Vahedi, MD
Abstract
Background: Rotator cuff tear is one of the most common causes of shoulder complaint in the older age group. Treatments differ depending on the severity of tear and patient’s condition. Surgery is one of the important treatment options which may be done arthroscopically or by open technique. In this ...
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Background: Rotator cuff tear is one of the most common causes of shoulder complaint in the older age group. Treatments differ depending on the severity of tear and patient’s condition. Surgery is one of the important treatment options which may be done arthroscopically or by open technique. In this study we would like to report a short-term result of arthroscopic repair of complete tears of rotator cuff.Methods: A cross-sectional study was done in 3 hospitals in Tehran, Iran. 183 patients were treated for their rotator cuff disease by arthroscopic technique from January 2003 to August 2006. 107 cases that had complete tears, and had at least one year follow-up were considered for the study. 89 patients (56 male, 33 female) attended the assessment sessions and were evaluated by UCLA (University of California, Los Angeles) Shoulder and Elbow scoring system. The scores were compared with the preoperative UCLA scores. Acromioplasty was performed in 83 patients.Results: With a mean age of 53.2 (32-71) years, the average UCLA score was 11.3 before surgery and 31.4 in follow-ups. There were 11 patients with excellent, 62 good, 11 fair and 5 poor scores. Nine of the 11 cases with excellent scores and 34 of the good scores were younger than 55 years of age. Out of the 16 fair or poor results, 13 were older than 60 years of age.Conclusions: A significant improvement in UCLA scores is possible after arthroscopic repair of complete rotator –cuff tear, in short term. The treatment results are better in younger patients.
