Aziz Ahmadi
Abstract
I have had concerns about a possible decline in the Orthopaedic Residency Program in the recent years. I, therefore, looked at the residency programs in few other countries, namely Canada, England, Russia, Australia, India, and Saudi Arabia. The following fields were looked up and compared with the present ...
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I have had concerns about a possible decline in the Orthopaedic Residency Program in the recent years. I, therefore, looked at the residency programs in few other countries, namely Canada, England, Russia, Australia, India, and Saudi Arabia. The following fields were looked up and compared with the present situation. In Iran: resident selection method, period of residency training, working hours, daily notebook and medical services; mandatory in-training exams; the amount of supervision by the attending staff and mentors; From the six investigated countries, all but Russia had had almost similar orthopaedic residency training programmes. The major difference, however, were in the residency training years that were between 5 to 10 years, and the maximum allowable working hours which varied between 56 to 80 hours per week Orthopaedic residency training in Iran with the approval of the Ministry of Science, the Iranian Orthopaedic Residency Program was established in 1973, at Shafa Yahyaian Hospital simultaneously Shiraz University. The residency curriculum was formulated using the American Academy of Orthopaedics, as a framework. There were subtle differences. Though, i.e., the residency period in America is 5 years, but the Iranian program is 4 years. At its core the programs were equal in caliber, as evidenced by the exam results. The Iranian in-training exams used questions mailed from America. After completion, the exams were sent to the American Academy of Orthopaedics for evaluation. It was reported that the exam results were on par with the average American trained resident. The implementation of Curriculum of the Academy, at the Shafa Training Center, provided a solid foundation for several decades of growth and excellence in Orthopaedic Residency. In more recent years, however the absence of curriculum; the proper attending supervision in the educational centers; and the lack of supervision by regulatory institutions have caused a decline in the quality of the programs. The 4-year residency period has been reduced to 3.5 years. Proper record-keeping in "by books" for the number of surgeries a resident performs is not possible. Supervision of attending staff has gradually decreased to negligent levels. In all the programs examined, daily notebooks and attending supervision are paramount. In 2010, the Iranian Presidential Science Auditing Department audited the current state of the Orthopaedic Residency Program. It was reported that Orthopaedic residents were only taught 20% of the orthopaedic curriculum. In teaching hospitals, 80% of beds are filled with emergency patients. Contrary to the best practices, the staff imposes the emergency burden on the residents. We found only one residency training center that covers residents 24/7 (Shafa Yahyaian Training Center). In other cases, there is no proper supervision. There are a number of factors contributing to the decline and degradation of residency education: lack of supervision by the orthopaedic board; nonadherence of educational centers to the implementation of educational curriculum; lack of attending supervision; and also the emergence of fellowship programs.
Spine
mohammadreza chehrassan; Mohammadreza Shakeri; Farshad Nikouei
Abstract
Background: Congenital kyphosis is a spinal deformity resulting from disruption in the formation of the anterior part of the vertebrae on the sagittal plane during early fetal development. Understanding demographic trends and associated anomalies in affected individuals within specific regions and countries ...
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Background: Congenital kyphosis is a spinal deformity resulting from disruption in the formation of the anterior part of the vertebrae on the sagittal plane during early fetal development. Understanding demographic trends and associated anomalies in affected individuals within specific regions and countries is pivotal for tailoring more suitable treatment approaches within these patients.Methods: This retrospective cross-sectional study was conducted on 108 patients referred to Shafa Yahyaian Hospital in Tehran between 2010 and 2019. Demographic and radiological criteria were assessed in all patients who underwent surgery for congenital kyphosis at this hospital. Parameters such as age, gender, BMI, presence of cardiac, urogenital system, and spinal anomalies, kyphosis type, as well as Cobb's angle before and after surgery, were gathered, reviewed, and analyzed from patients' records.Results: Of the cohort, 74 patients were categorized as congenital kyphosis type 1, 21 as type 2, and 13 as type 3, encompassing 69 female (63.9%) and 39 male patients (36.1%). The mean age at the time of examination and symptom onset was 6.5 years, while the mean age at the time of surgery was 16.5 years. Notably, 38 patients exhibited a cardiac anomaly, 14 had genitourinary system anomalies, and 39 presented with spinal anomalies. A statistically significant correlation existed between the presence of a cardiac anomaly and the type of congenital kyphosis, with type one exhibiting a markedly higher incidence of cardiac anomalies compared to the other two types.Conclusion: The findings revealed a higher frequency of type 1 congenital kyphosis. Moreover, patients with type 3 congenital kyphosis underwent surgery at a significantly younger age than those with the other two types, potentially attributed to its higher progression rate. Spinal cord, cardiac, and genitourinary tract anomalies were respectively observed as the most prevalent anomalies among the patients.
Foot and Ankle
Amirreza Vosoughi; Farzad Farokhi; Rohamroham Borazjani; zahra shayan; saeed solooki; Seyed Ali hashemi
Abstract
Background: Diagnosis of associated midfoot fractures in Lisfranc injuries is important for proper treatment. We aimed to describe frequency of different types of Lisfranc injuries in surgically treated cases and to find the accuracy of non-weight bearing radiographs to determine associated midfoot fractures.Methods: ...
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Background: Diagnosis of associated midfoot fractures in Lisfranc injuries is important for proper treatment. We aimed to describe frequency of different types of Lisfranc injuries in surgically treated cases and to find the accuracy of non-weight bearing radiographs to determine associated midfoot fractures.Methods: In a retrospective study, preoperative non-weight bearing plain radiographs and CT studies of 118 surgically treated Lisfranc injuries were evaluated by 2 orthopedic surgeons. The sensitivity and specificity of fleck sign, fractures of metatarsal bases, cuneiforms, navicular, and cuboid were calculated. Results: Among 118 patients with the mean age of 35.0±15.7 years, most were male (77.1%). The most common type was Myerson type B (44.1 %) followed by D2 (40.7%). Fractures of the second metatarsal base (87 patients, 73.7%), the fleck signs (85 patients, 72.0 %), and fractures of the third metatarsal base (65 patients, 55.0 %) were the three most frequent injuries. Oppositely, fractures of the fifth metatarsal base (5 patients, 4.3%), middle cuneiform (14 patients, 12.0%), and navicular (15 patients, 12.7%) were the three least common associated midfoot fractures. Plain radiographs could not show high sensitivity to distinguish associated midfoot fractures in Lisfranc injuries with the highest for the second metatarsal base fractures (78.2%). The maximum specificity was for fractures of the first metatarsal base (100%). Conclusions: Non-weight bearing radiographs of the foot cannot detect all associated midfoot fractures particularly fleck sign. Therefore, preoperative CT scan is highly recommended.
Hip
Ali Yeganeh; Amir Ebrahimzadeh Babaki; Sepideh Najafi Torbehbar
Abstract
Objectives: The prevalence of atypical femoral fractures in the elderly population is increasing worldwide, including in Iran. Left untreated, these fractures can lead to disability and reduced quality of life for patients.This study aims to evaluate surgical outcomes in patients with atypical femoral ...
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Objectives: The prevalence of atypical femoral fractures in the elderly population is increasing worldwide, including in Iran. Left untreated, these fractures can lead to disability and reduced quality of life for patients.This study aims to evaluate surgical outcomes in patients with atypical femoral fractures.Methods: This case-series study was conducted at Rasoul Akram Hospital on patients with atypical femoral fractures who underwent surgery from 2013 to 2020. Demographic and clinical information, including gender, age, fracture site, type of surgery, infection, and postoperative walking ability, as well as modified Harris Hip Score (HHS) and Numeric Rating Scale (NRS) scores, were collected at one month and one year after surgery.Results: Among the 30 participants in this study, 24 (80%) were female. The mean age of the patients was 68.66 ± 11.03 years. Of the patients, 46.7% underwent plate surgery, 26.7% had intramedullary nailing, and 26.7% underwent PFNA surgery. After surgery, 6 patients (20%) regained the ability to walk, 20 were able to walk with a cane or walker, and 4 could not walk. The NRS score of patients decreased by 2.80 ± 1.20 points after surgery, while the modified HHS score increased by 9.13 ± 22.56 (P value >0.05). After surgery, 13.3% of patients developed an infection. The type of surgery did not significantly affect patients' pelvic function or pain after surgery (P value> 0.05).Conclusion: The rate of complications and postoperative infections in surgeries for atypical femoral fractures is higher than for typical fractures, and the postoperative mobility and satisfaction of these patients are lower than usual.
Bio-mechanics
zahra hemati farsani; Amin Doolabi Telkabadi; Somayeh Momeni; Farzaneh Movaseghi
Abstract
Introduction& Purpose: Physical activity decreases at the beginning of adolescence, so organized physical activity at school plays an essential role in promoting the health and proper physical development of students. The purpose of this study was to investigate the effect of eight weeks of calisthenics ...
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Introduction& Purpose: Physical activity decreases at the beginning of adolescence, so organized physical activity at school plays an essential role in promoting the health and proper physical development of students. The purpose of this study was to investigate the effect of eight weeks of calisthenics training on core stability, muscle strength, static balance and trunk proprioception of male teenagers. Methods: In this semi-experimental study with a pre-test-post-test design, 40 male high school students aged 15 to 18 in Zavareh city were selected as a sample and randomly divided into two groups: calisthenics training (n=20) and control (n=20). The experimental group received calisthenics training for eight weeks, three times per week, for 60 minutes each session. Before and after the eight-weeks training, static balance, core stability, muscle strength and trunk proprioception were measured using the Stroke balance test, McGill test, chest press, leg press, rowing and error rate of the trunk reconstruction angle at 45° respectively. Results: The results of the independent t- test showed that eight weeks of calisthenics training increased the amount of static balance (p<0.0001), trunk proprioception (p<0.0001), core stability in trunk flexion (p<0.0001), and muscle strength in the rowing and leg press test (p<0.05) significantly. Conclusion: Overall, the findings from the present study suggest that following an 8-week participation in calisthenics training, trunk proprioception, core stability in flexion, muscle strength and static balance improved in teenagers, therefore, this type of exercises can be used along with other types of exercises or as a suitable alternative in schools.
Knee
soroosh naghdi; mahmud karimi mobarake; amirreza sadeghifar; mohamad sheibani; salman azarsina; peyman mohammadhosseiniazar
Abstract
Introduction:Genu varum is a type of knee deformity. In this deformity lower limb mechanical axis, moves inward to the knee centre. In genu varum mechanical axis usually lies through the medial of the knee joint. In this deformity, the patient's lower limbs become bow shape. One of the best techniques ...
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Introduction:Genu varum is a type of knee deformity. In this deformity lower limb mechanical axis, moves inward to the knee centre. In genu varum mechanical axis usually lies through the medial of the knee joint. In this deformity, the patient's lower limbs become bow shape. One of the best techniques for genu varum correction is high tibial osteotomy that this procedure can change some index include posterior tibial slope (PTS), and insall-salvati index (ISI).Method:Our study was a cross-sectional study performed on patients with genu varum before and after a step cut of the high tibia osteotomy. The method of examining the posterior tibia slope was that before and after the high tibia osteotomy by Step Cut-MCL sparing method, a simple radiographic image in true lateral view (True lateral) was taken from the knee of patients. The significance level of P Value <0.05 was considered. Result:In this study 21 patients ( 11 male and 10 female ) were enrolled. Mean age was 36.19 ± 10.17 year-old. Mean PTS pre operation was 11.48 ± 1.94 degrees and post operation was 11.48 ± 2.15 degrees. Conclusion:In our study, PTS increased after HTO that this increase was not statistically significant difference between men and women. In addition, we showed that this increase did not have significant relationship with age and BMI. In the present study, Insall-Salvati index showed no significant difference before and after the treatment.
General
Yousef Fallah; mohammadreza golbakhsh; babak Siavashi; parham talebian; mohammad soleimani; seyyed hossein shafiei
Abstract
Background: Osteoporosis, referred to as a " silent epidemic," is a skeletal disease with decreased bone density. This problem has no symptoms, but the most common result is fracture. According to the reported result, this disorder in Iran is more than 4% in men and more than 7% in women, while in the ...
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Background: Osteoporosis, referred to as a " silent epidemic," is a skeletal disease with decreased bone density. This problem has no symptoms, but the most common result is fracture. According to the reported result, this disorder in Iran is more than 4% in men and more than 7% in women, while in the age of over 50 years, this statistic is significant and reaches more than 10% in both sexes. Considering this problem and the need to predict the conditions to change and treat it, it was decided to investigate this study of osteoporosis in people in a tertiary trauma center.Materials and methods: In this study, 113 patients over 65 year old age admitted to the emergency room of Sina Hospital were examined by and subjected to BMD osteoporosis examination, and also the demographic examinations of the patients were recorded through interviews and examination of hospital records, and were finally subjected to statistical analysisFindings: The age of the examined patients was 75.8 years and 67.3% were in the group over 70 years old. 44.2% of the studied population were women and 57.8% were men. 31 patients (27.4%) had a history of fracture. Alcohol consumption and smoking were reported in 3.5% and 31.9% of cases, respectively. In addition, there are 6 patients (3.5 percent) taking drugs on bone density, which in some cases were from the corticosteroid group.The fracture status of the patients was in 61 cases (54%) in the lower limb and in 52 cases (46%) in the upper limb. A total of 76 patients (67.3%) have osteoporosisConclusion: This study found that about two-thirds of the patients who suffer limb fractures in old age have osteoporosis.
Pathology
Abdolrasoul Namjou; Masoud Zare; Mostafa Noorbakhsh; farnaz sadat Samsam Shariat; Reza Moradi kalamoee
Abstract
Purpose of Review: Tendinopathy, also called tendinitis, is a common issue in musculoskeletal consultations. Tendon healing is inferior to normal due to low metabolic rate and poor vascularity. R. damascena has anti-inflammatory, antioxidant, and healing effects. This study aims to investigate R. damascene's ...
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Purpose of Review: Tendinopathy, also called tendinitis, is a common issue in musculoskeletal consultations. Tendon healing is inferior to normal due to low metabolic rate and poor vascularity. R. damascena has anti-inflammatory, antioxidant, and healing effects. This study aims to investigate R. damascene's effects on Achilles tendon injury using histopathology and biomechanical evaluations.Materials/Methods: Wistar rats were divided into seven groups, including a control group and three groups with tendinitis, that were given different doses of Hydroalcoholic Extract of R. damascene (HERD) (250, 500, 1000 mg/kg) intraperitoneally. Dexamethasone and Vitamin E were used in the reference groups. The Achilles tendon was injured, and the extract was administered for 20 days. Histopathological assessment and antioxidant activity were determined by serum malondialdehyde levels and ferric-reducing antioxidant power assays on days 10 and 20.Results: Different dosages of HERD, particularly 1000 mg, improved inflammatory intensity, angiogenesis, fibroplasia, and complete tendon regeneration on the 10th and 20th days after the injury, while also reducing unsaturated fatty acid peroxidation and increasing the whole serum's antioxidant capacity on the 20th day.Conclusions: After a thorough review, it can be concluded that HERD is an effective anti-inflammatory agent and analgesic for preventing and treating tendinitis. Furthermore, it has been deemed safe and well-tolerated, making it a promising option for those seeking relief from the symptoms of tendinitis.
Joints
Ziba Alizadeh; roshanak baghaei roudsary; akbar bighlarian
Abstract
Introduction: Knee osteoarthritis often causes disability due to the pain it causes and affects a person's quality of life.The purpose of this study is to investigate the effect of ankle-foot-orthosis with and without lateral wedge on pain, function and displacement of the center of pressure in patients ...
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Introduction: Knee osteoarthritis often causes disability due to the pain it causes and affects a person's quality of life.The purpose of this study is to investigate the effect of ankle-foot-orthosis with and without lateral wedge on pain, function and displacement of the center of pressure in patients with the medial compartment knee osteoarthritis.Methodology: The research method was quasi-experimental with a pre-test and post-test design. This study was conducted on patients with medial compartment knee osteoarthritis in the age range of to years as available sampling. Demographic information and Womac questionnaire were completed and the displacement of the center of pressure in the internal-external plane was recorded by the Kistler force plate device, in three situations: bare feet, ankle-foot orthosis with lateral wedge and ankle-foot orthosis without lateral wedge. The obtained data were analyzed using SPSS software. Shapiro-Wilk test was used to check the conformity of distribution of quantitative variables with normal distribution. According to the normality (p>0.05), variance analysis tests, multiple comparisons and generalized linear models were used for data analysis.Results: patients participating in this study were examined in three situations, and the pain of the patients in the state of using the orthosis with the lateral wedge was significantly reduced (p=), the function of the patients was better in the state of using the orthosis with the lateral wedge. (p=), but the displacement of the center of pressure in the case of using the orthosis without wedge had a significant decrease (p=).Conclusion: the use of an orthosis with an lateral wedge was effective in improving pain and function, but the use of an orthosis without an wedge led to a reduction in the displacement of the center of pressure in the internal-external plane. Therefore, it will probably reduce the knee adduction moment.
