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.
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.
Seyed Mohammad Jalil Abrisham, MD; Saeed Kargar, MD; Mohammad Hossein Akhavan Karbassi, MD; Jalil Zare Mehrjardi, MD; Mohammad Reza Haji Esmaeili, MD; Atefeh Zare Mehrjardi
Abstract
Background: Mechanical articulated devices can replace the intervertebral disc in patients with chronic back degenerated pain. We would like to report our short-term experience with a disc prosthesis in a small group of L5-S1 disc degeneration.Methods: In a cohort study, 21 consecutive patients (17 males, ...
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Background: Mechanical articulated devices can replace the intervertebral disc in patients with chronic back degenerated pain. We would like to report our short-term experience with a disc prosthesis in a small group of L5-S1 disc degeneration.Methods: In a cohort study, 21 consecutive patients (17 males, 4 females) with degenerative L5-S1 disc disease with over 6 months history of disabling back symptoms non-responsive to conservative treatment were treated by disc prosthesis. The mean age was 36±5.7 years (22-48 years) at surgery and the average follow-up was 11 months (13-24 months). The cases were evaluated by visual analogue scale (VAS) for pain, Oswestry disability index (ODI) for disability, and also for personal satisfaction at 3, 6, 12 and 24 months post surgery.Results: Early improvement with pain control and return to function were seen in all patients (p < /em>
Mohammad Javad Fatemi, MD; Hamid Elmirad, MD; Fatemeh Rajabi, MD
Abstract
Background: Hand injury is the most frequent body injury, requiring long duration of treatment with great cost to any community. The aim of this study is to review the epidemiology of such an organ in a teaching unit in Tehran, Iran.Methods: Between a period of one year, 2042 patients were treated for ...
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Background: Hand injury is the most frequent body injury, requiring long duration of treatment with great cost to any community. The aim of this study is to review the epidemiology of such an organ in a teaching unit in Tehran, Iran.Methods: Between a period of one year, 2042 patients were treated for hand injuries in a referral center for hand injuries in Tehran. Age, sex, cause and place of injury, mechanism and type of trauma, traumatized structures, duration of admission, type of treatment and type of insurance were evaluated.Results: 2042 patients (89.3% male, 10.7% female) referred to this hospital with hand injury. The average age was 26.8±11.9 years. The predominant group was industrial workers (65.6%). Men were mostly injured by mechanical instruments and women by glass cuts. Children were more commonly injured by door closing on their fingers or cut by glass. Bony fractures were seen in 34.7% of the cases. Tendon and nerve were the most common structures injured. The majority of injuries were sharp lacerations. The mean hospital stay was 1.33 days (1-49 days). 58.36% of the cases have insurance coverage admission.Conclusion: hand injuries are seen more commonly in men, in particular industrial workers. Tendon and nerve injuries are most common afflicted and one third of cases have bony injuries.
Mohammad Dehghani, MD
Abstract
Background: Fractures of distal radius are common injuries. Unstable distal radius fractures present a challenge to the treating orthopaedic surgeon. One of the therapeutic methods is Ilizarov hybrid external fixator. In this study short-term result of this method in a small group is reported.Methods: ...
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Background: Fractures of distal radius are common injuries. Unstable distal radius fractures present a challenge to the treating orthopaedic surgeon. One of the therapeutic methods is Ilizarov hybrid external fixator. In this study short-term result of this method in a small group is reported.Methods: 18 consecutive patients with unstable fracture of distal radius were treated with non-bridging hybrid Ilizarov external fixator for 7 weeks. Clinical and radiological evaluation was performed at one and 7 days, and at 6 weeks and 6 months after surgery.Results: All fractures united but anatomic reduction was achieved in only 16 cases (90%). The achieved range of motion was: 80% flexion, 85% extension and 90% supination and pronation. Compared to the normal side, no extensor tendon injury and tendonitis of pin loosening occurred. Only 5 mild pin track infection was observed that resolved by findings of oral antibiotic therapy.Conclusion: The technique of hybrid non bridging external fixator is safe and reliable option method for unstable intra and extra-articular distal radius fractures. It permits free wrist motion during treatment preventing joint stiffness.
Seyed Abdolhossein Mehdinassab, MD; Saeid Saeid Tabatabaei, MD; Ali Asghar Haddadpoor, MD; Saeid Saeid Tabatabaei, MD; Nasser Sarrafan, MD; Seyed Mohammad Seyedi, MD
Abstract
Background: Fracture dislocation of the hip is a result of high energy trauma and can lead to hip dysfunction and patient disability. Stable and perfect reduction of the femoral head and acetabular wall are the two most important prognostic factors. The aim of this study was to compare the results of ...
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Background: Fracture dislocation of the hip is a result of high energy trauma and can lead to hip dysfunction and patient disability. Stable and perfect reduction of the femoral head and acetabular wall are the two most important prognostic factors. The aim of this study was to compare the results of surgical treatment with nonsurgical treatment in this injury.Methods: In a period of 2 years, the cases of posterior hip dislocation with acetabular rim fracture were studied. Two groups were recognized after closed reduction of dislocation. First group (18 patients) received open reduction and plating of acetabular fracture followed by 3-5 weeks of skeletal traction. The second group (14 patients) was treated by skeletal traction of 5-6 weeks. The patients were evaluated for hip motion, stability, complications or nerve injury and early osteoarthritis, and acetabular fracture index in average one year follow-up. The results were compared in the two groups.Results: Restriction of hip motion was more common in nonsurgical patients. Sciatic nerve injury was noted in 3 patients of surgical group with recovery in 2 of them. Perfect reduction was seen in 17 (94.4%) of surgical and 9 (64.3%) of nonsurgical patients. Primary osteoarthritis was seen in 7 patients (38.9%) of surgical and 8 patients (57%) of nonsurgical group. AFI in surgical and nonsurgical groups were 55.2% and 32.5% respectively. Surgical patients had better functional results.Conclusion: Articular damage by initial trauma, perfect reduction of the hip and stable anatomic fixation of the acetabular wall are the important prognostic factors. The patients with surgical treatment obtain better functional outcome.
Seyyed Morteza Kazemi, MD; Reza Minaei, MD; Ramin Zanganeh, MD; Mohammad Reza Miniator Sajadi, MD; Mohammad Ali Okhovatpoor, MD
Abstract
Background: Change in the position of the patella in relation to the tibiofemoral joint (PB/PPB) is an important but often neglected complication of total knee arthroplasty. Such change may result in pain and decreased knee range of motion after surgery. The aim of this study is to measure the incidence ...
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Background: Change in the position of the patella in relation to the tibiofemoral joint (PB/PPB) is an important but often neglected complication of total knee arthroplasty. Such change may result in pain and decreased knee range of motion after surgery. The aim of this study is to measure the incidence of patella baja and pseudo-patella baja after total knee arthroplasty. Methods: In a retrospective study, 60 patients (49 women, 11 men) who had knee arthroplasty between 1992 and 2002 at Akhtar teaching Hospital in Tehran were studied for patellar problem. At the time of the study, patients were at least one year and at most eleven years from their operation. All measurements were made by a single person. All the patients received posterior cruciate ligament retaining prosthesis knees through a medial parapatellar arthrotomy. The average age at the time of the study was 62.5 years and the average follow-up was 27.5 months. The Knee Society Scoring System was used to score the knees. Patients' radiographs were examined using the Insall Salvati and Blackburne Peel methods. Results: Pseudo-patella baja was found in 15 (25%) patients while simultaneous baja and Pseudo-patella baja in 2 (3%) patients. While patella baja or Pseudo-patella baja were associated with more incidence of knee pain or limitation of motion, no relation was seen with final knee society scores.Conclusion: Patella baja or Pseudo-patella baja after knee arthroplasty may cause pain or limitation in knee range of motion. Attention to proper bone cuts and patellar tracking during surgery is suggested.
Mohammad Taghi Peivandi, MD; Javad Sheikhian, MD; Hossein Ebrahimzadeh, MD; Farshid Bagheri, MD
Abstract
Background: Low back pain, in any community has a high prevalence. Acute sciatica does not usually have a very quick and effective non-operative remedy. Lingering disability and very slow return to work is a major finding in most cases. We aimed at testing the effect of early epidural steroid injection ...
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Background: Low back pain, in any community has a high prevalence. Acute sciatica does not usually have a very quick and effective non-operative remedy. Lingering disability and very slow return to work is a major finding in most cases. We aimed at testing the effect of early epidural steroid injection in pain relief and in shortening the disability period.Methods: Forty patients (25 male, 15 female) referring to two hospitals in Meshhad with acute radiculor pain during one-year period were enrolled in a prospective study. The cases had clinical and MRI proof of a disc herniation occurring within 6 weeks of their referral and had not responded to regular medical treatment for 2 to 3 weeks. After full evaluation and completing the “Prolo” scoring questionnaire, the patients were injected epidurally with 40mg of Triamcinolone and 2% Lidocaine for 3 times in two days intervals. The cases were then assessed shortly after injection and in 3 and 6 months.Results: Improvement in SLR positivity was statistically evident after the third injection. Dramatic reduction in pain and therefore, analgesic medication use was observed in second and third follow-up (p < /em>≥.05). Over all 27.5% of patients were fully satisfied and 62.5% were partially satisfied with the results.Conclusion: Epidural steroid injection following acute radicular back pain has short-term dramatic effect in pain control, but does not improve function or effectiveness of an individual to a significant degree.
Babak Siavashi, MD; Mohammad Reza Golbakhsh, MD; Ali Kooshan, MD
Abstract
Background: Unstable pelvic fracture means those fractures which are both vertically and rotationally unstable. The site of posterior instability could be in sacrum, posterior ilium, or sacro-iliac joint. The anterior injury may be in the symphysis pubis or pubic rami. Posterior fixation of pelvis ...
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Background: Unstable pelvic fracture means those fractures which are both vertically and rotationally unstable. The site of posterior instability could be in sacrum, posterior ilium, or sacro-iliac joint. The anterior injury may be in the symphysis pubis or pubic rami. Posterior fixation of pelvis with double rods inserted into the sacral alae of the ilium compressed together by knots is a stabilizing surgical option when iliosacral screw fixation is not feasible or available.Materials: Eleven patients with unstable pelvic fracture who had received posterior stabilization with two threaded rods and bolts in prone position after reduction of fracture with skeletal traction were studied retrospectively. The anterior fixation was either symphyseal plating or external fixator.Results: with a 6 months follow up, there was no evidence of device failure, infection, neurological deficit, or non-:::union:::. There was, however, some leg length discrepancy due to imperfect initial reduction.Conclusion: Posterior stabilization of pelvis by transiliac rods, in unstable pelvic fractures, is a simple procedure to be used effectively when more secure fixation is not available.
Massoud Saghafi, MD; Azita Azarian, MD
Abstract
Background: Rheumatoid arthritis is the most prevalent chronic inflammatory joint disease. Popliteal cyst may appear during the disease course and with increasing intra-articular pressure is extended down to the posterior aspect of the involved leg to produce a giant Baker's cyst. Local compression, ...
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Background: Rheumatoid arthritis is the most prevalent chronic inflammatory joint disease. Popliteal cyst may appear during the disease course and with increasing intra-articular pressure is extended down to the posterior aspect of the involved leg to produce a giant Baker's cyst. Local compression, dissection, or rupture of the cyst may also, lead to a clinical presentation simulating thrombophlebitis. The aim of this paper is to report the clinical features, predisposing factors, diagnostic techniques, course and management of giant Baker’s cyst in patients with rheumatoid arthritis.Methods: In a retrospective cohort study, the complications of giant Baker's cyst in 993 patients with arthritis admitted in the rheumatology unit during the last 20 years were studied. Based on the clinical picture and confirmation of imaging techniques, 23 patients (12 female, 11 male) had giant Baker's cyst which extended lower than the inferior level of the popliteal fossa. This was the material for this study.Results: The mean age of the patients was 48 years old (24-71) and mean duration of the rheumatoid disease by the time of development of giant Baker’s cyst was 6.8 years (1-20). Right knee was involved in 13 and left knee in 10 patients. The clinical features- other than the underlying disease- were: pain and tenderness of the involved leg in 8 (34.8%), and the symptoms similar to thrombophlebitis in 15 patients (65.2%). There was a deep vein thrombosis accompanied with giant Baker’s cyst in one patient. Rupture of the cyst was detected in 5 patients (21.7%). The management was generally medical and conservative and resulted into satisfactory outcome. Two patients, however, had recurrence of Baker's cyst and signs of rupture of the cyst. They underwent surgical cystectomy along with synovectomy of the involved knee joint.Conclusion: Popliteal cyst in patients with rheumatoid arthritis should be considered and preventive and conservative management should be performed before it extends to become a giant Baker's cyst leading to complications of local compression, rupture, and pseudothrombophlebitis.
Firooz Madadi, MD; Mohammad Reza Abbassian, MD; Fooad Rahimi, MD; Farivar Abdollahzadeh Lahiji, MD; Armin Aalami Harandi, MD; Farzam Farahmand; Tahereh Yazdanyar; Firozeh Madadi; Reza Sadeghian
Abstract
Background: Several different methods for fixation of grafts in anterior cruciate ligament (ACL) reconstruction have been used. The purpose of present study is to compare two techniques of tibial fixation in hamstring quadruple graft reconstruction. Methods: In a randomized clinical trial study, 46 ...
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Background: Several different methods for fixation of grafts in anterior cruciate ligament (ACL) reconstruction have been used. The purpose of present study is to compare two techniques of tibial fixation in hamstring quadruple graft reconstruction. Methods: In a randomized clinical trial study, 46 cases of isolated tears were reconstructed using hamstring grafts. In 24 cases the tibial fixation sites were fixed with interference screw, and in 22 patients the remnant end of graft at tibia was passed through a bony tunnel and fixed with suture to the bone. The cases were all assessed with a mean follow-up of one year with “Cincinnati knee ligament rating scale” and “KT-2000” examination.Results: The score in 22 “target group” cases was 8, and in 24 “control group” was 9. In “KT-2000” examination, 11 patients of double fixation were excellent and 11 good. In control group 4 cases had excellent and 20 good results (p < /em>=0.01).Conclusions: Double tibial fixation for ACL reconstruction with Hamstring tendon graft has a better outcome on “Symptom” evaluation and “KT-2000” instrument compared to single tibial-site fixation.
Mohammad Saleh Ganjavian, MD; Hamid Behtash, MD; Ebrahim Ameri, MD; Bahram Mobini, MD; Seyed Hossein Vahid Tari, MD; Marzieh Nojoomi, MD
Abstract
Background: Reports on associated intraspinal and other organ anomalies in congenital scoliosis are variable. We are reporting such findings in two orthopaedic referral centers in Tehran-Iran.Methods: During a period of 15 years, in a case series study, 381 patients with congenital scoliosis were evaluated ...
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Background: Reports on associated intraspinal and other organ anomalies in congenital scoliosis are variable. We are reporting such findings in two orthopaedic referral centers in Tehran-Iran.Methods: During a period of 15 years, in a case series study, 381 patients with congenital scoliosis were evaluated for intraspinal abnormalities with physical examination, radiographs, MRI and/or myelograms. They were also assessed for cardiac urogenital or anomalies in other areas by physical exam, sonography and echocardiography.Results: Cord anomaly was present in 83 (21%) cases, 26 of whom had neurologic abnormality. Tethered cord syndrome was the most common neurologic problem in 38 patients (45.8%). Anomalies in other parts of body detectable by physical examination were observed in 155 patients, and detected by help of clinical evaluation in 121 and paraclinical tests in 34 patients. 84 cases had trunk anomalies, 4 genitourinary and 10 heart anomaly, 37 head and neck, 7 maxillofacial, 3 upper and 23 lower extremities, 14 Urogenital, 10 heart and 8 cases of gastrointestinal anomalies were also detected.Conclusion: The anomalies of nervous system associated with congenital scoliosis are often without clinical manifestations. Cardiac and urogenital anomalies are not very common in congenital scoliosis.
Ali Dianat, MD; Alireza Saeed, MD
Abstract
Psychosomatic disorders may occasionally present in the upper extremity and their diagnosis and treatment may prove to be extremely difficult. Herein, we describe one such patient and review the literature on this subject.
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Psychosomatic disorders may occasionally present in the upper extremity and their diagnosis and treatment may prove to be extremely difficult. Herein, we describe one such patient and review the literature on this subject.
