Ali Yeganeh, Hossein Farahini, Mikaiel Hajializade, Shadi Abdollahi Kordkandi, Reza Amiri, Mani Mahmoudi, Seyed Mani Mahdavi, Mehdi Moghtadaei,
Volume 7, Issue 3 (8-2020)
Abstract
Background: There is no concrete information about many aspects of femoral fracture, including its best management. We hypothesized that reporting the outcomes of patients managed with the same therapeutic algorithm would help the selection of best management strategies.
Objectives: In this study, we report the outcomes and complications of femoral head fracture in patients treated according to our therapeutic algorithm.
Methods: In a retrospective review of a prospectively collected orthopedic database, 41 patients with femoral head fractures were evaluated. Fractures were classified by the Pipkin classification system. The clinical outcome was assessed with the Harris Hip Score (HHS). In brief, our therapeutic algorithm included conservative treatment for the congruous joint of Pipkin type I and II, total hip arthroplasty for unfixable fractures of Pipkin type III, and IV, and fixation via three approaches otherwise (Smith-Peterson, Kocher, or surgical dislocation).
Results: Of 41 cases, 34 cases (82.9%) had uncomplicated outcomes. The number of associated injuries was significantly more in patients with complicated outcomes (P=0.049). Avascular necrosis was the most common complication (n=5, 12.2%). Their Mean±SD HHS was 85.1±109. Accordingly, HHS scoring had poor, fair, good and excellent results in 4 (9.8%), 6 (14.6%), 13 (31.7%), and 17 (41.5%) patients, respectively. The mean HHS score was significantly lower in patients with complicated outcomes (P=0.007). The mean HHS score was not associated with types of fracture (P=0.071).
Conclusion: The outcome of femoral head treatment was good to excellent in the majority of patients. However, patients who underwent total hip arthroplasty or had associated injuries are at higher risk of an inferior outcome.
Kaveh Gharanizadeh, Abolfazl Bagherifard, Mansour Abolghasemian, Hamedreza Ahmadizadeh, Shadi Abdollahi, Shabnam Bayat,
Volume 7, Issue 4 (11-2020)
Abstract
Background: Several pelvic osteotomy techniques are introduced for the treatment of Developmental Dysplasia of the Hip (DDH). However, there is no agreement on the optimal pelvic osteotomy in DDH. Thus, this study aimed to compare the outcomes of Pemberton Osteotomy (PO) and the Kalamchi Modification of Salter Osteotomy (KMSO).
Objectives: Comparison of pemberton osteotomy and kalamchi modification of salter osteotomy in the treatment of developmental dysplasia of the hip.
Methods: In a retrospective study, radiographic and clinical outcomes as well as surgical complications were compared between the patients who underwent unilateral DDH surgery using either KMSO or PO. The radiographic measures included the assessment of the acetabular index and the Shenton line. The clinical results of the osteotomies were evaluated by McKay’s criteria modified by Berkeley et al. Also, Kalamchi and MacEwen’s classification was used for the assessment of avascular necrosis.
Results: The characteristic features of the patients, such as age and follow-up time, were statistically comparable between the two study groups. One year after the surgery, the Shenton line was intact in 55 patients (84.6%) of the KMSO group and 40 patients (88.9%) of the PO group (P=0.52). The Mean±SD value of the acetabular index was 21.1±5.1 and 20.7±3.9 in the KMSO and PO groups, respectively (P=0.13). Besides, the McKay’s clinical criteria were respectively excellent, good, and fair in 44, 16, and 5 patients (67.7%, 24.6%, and 7.7%, respectively) of the KMSO group, and 31, 12, and 2 patients (70%, 26.6%, and 4.4%, respectively) of the PO group (P=0.4). Moreover, the number of postoperative avascular necrosis did not significantly differ between the two study groups.
Conclusion: The PO and KMSO techniques are equally safe and effective osteotomies in the treatment of DDH and can be used interchangeably.
Kaveh Gharanizadeh, Hamed Tayyebi, Abbas Esmaeli, Maziar Rajei, Mohamadreza Heidarikhoo, Mehdi Siahpoosh,
Volume 8, Issue 2 (5-2021)
Abstract
Background: Femoral neck fracture nonunion is a frequent and challenging complication, with several surgical options.
Objectives: The present study reported the outcome of valgus osteotomy for treating femoral neck nonunion in patients aged <65 years.
Methods: This case series research included young patients who underwent valgus osteotomy for treating femoral neck nonunion or device failure of the index surgery. The fixation of the osteotomy site was performed using either a dynamic hip screw or a fixed angle blade. The union of the neck and osteotomy site (subtrochanteric region) was evaluated by monitoring callus formation in the postoperative radiographs. Limb length discrepancy, Pauwels’ angle, and the neck-shaft angle were evaluated before the surgery and at the last follow-up. Postoperative complications were extracted from the explored patients’ profiles.
Results: Twenty patients with a Mean±SD age of 27.2±10.8 years were examined in this study. The Mean±SD follow-up time of the patients was 6.1±3.9 years. The femoral neck was united in 18 patients in a Mean±SD period of 5.1±2.3 months. The Mean±SD limb length discrepancy was measured as 1.3±0.8 cm before and 0.5±0.7 cm after the osteotomy. The Mean±SD Pauwels’ angle was calculated as 65.5±16.9º before and 32.4±16.2º after the osteotomy. The Mean±SD neck-shaft angle was computed to be 121.9±22.8º before and 144.5±17.7º after the osteotomy. Revision surgery was performed for 6 (30%) patients. This measure included device removal in 4 and total hip arthroplasty in 2 patient.
Conclusion: Valgus osteotomy is a safe and efficient technique for managing femoral neck nonunion. Therefore, this approach is suggested as a good alternative for total hip arthroplasty, particularly in young and active patients.
Ali Yeganeh, Alireza Ghaznavi, Amer Karimpour, Seyedehsan Daneshmand, Shayan Amiri,
Volume 8, Issue 4 (11-2021)
Abstract
Regarding the fact that lateral compression is usually not the underlying mechanism of fracture, Locked pubic symphysis is a very rare injury. At most times it can be managed with closed reduction method; however, open reduction with or without internal fixation may sometimes be required. In rare cases, osteotomy is the only choice. Urethral or bladder damage can occasionally be found. In this study, we presented a case of locked pubic symphysis with failed closed reduction who underwent successful open reduction with internal fixation.
Kaveh Gharanizadeh, Karim Pisoudeh, Mahmoodreza Sarikhani, Amir Aminian, Mohammadreza Bahaeddini,
Volume 9, Issue 3 (8-2022)
Abstract
Background: Total hip arthroplasty (THA) is a highly successful orthopedic procedure, recognized as the gold standard for addressing advanced osteoarthritis, with a projected global increase in performed cases.
Objectives: This study investigated the accuracy of cup positioning in patients undergoing THA using the anterolateral (AL) approach.
Methods: This cross-sectional study included patients undergoing ALTHA at Shafa Yahyaiyan Hospital in Tehran, affiliated with the Iran University of Medical Sciences, from 2018 to 2023. Post-operative radiological evaluations were conducted, and anteversion and inclination were assessed using established protocols. A safe zone for cup orientation was defined with an inclination angle of 40±10° and anteversion angle of 15±10°.
Results: Among 91 patients, the mean age was 51.14 years and 48 cases (52.7%) were male. Considering the safe zone for cup orientation, 69 patients (75.8%) fell within the inclination angle safe zone and 46(50.5%) were within the anteversion angle safe zone. However, no significant associations were found between age, gender, side of operation and the safe zones for anteversion and inclination.
Conclusion: The results indicated that the AL approach, as performed by experienced surgeons, achieved favorable cup positioning in the majority of patients, regardless of age and gender.
Parsa Amirlou, Amir Aminian,
Volume 9, Issue 3 (8-2022)
Abstract
Background and Objectives: Intertrochanteric fracture is a prevalent condition among the elderly that affects many people annually in both health and financial status. Type A2 intertrochanteric fracture is treated with surgical internal fixation either through a cephalomedullary nail (CMN) or a dynamic hip screw (DHS). This study compares radiological and clinical outcomes of CMN and DHS devices in patients with type A2 intertrochanteric fractures.
Methods: In this retrospective cohort study, hospitalized patients with A2 intertrochanteric fracture who were treated with either CMN or DHS devices from 2014 to 2023 were included in the study. All participants were assessed retrospectively regarding radiological outcomes (nonunion, varus malunion, and femoral medialization percentage) clinical outcomes, and incidence of pulmonary thromboembolism and deep vein thrombosis.
Results: A total number of 194 patients were included in the study. The patients who were operated on with DHS showed a better result regarding the incidence of varus malunion compared to CMN (P=0.009), while the incidence of nonunion and union failure, and percentage of femoral medialization showed no significant difference between groups. Despite a comparable total score of modified Harris hip score in both groups (P=0.669), DHS surgery had a better outcome in the walking distance status component (P=0.043).
Conclusion: Despite better outcomes of DHS surgery regarding the incidence of varus malunion and walking distance status, other outcomes of both groups did not show a significant difference. However, more prospective studies with multiple systematic follow-ups and radiographs are needed to confirm these findings.
Dr Mohammad Ali Tahririan, Dr Hossein Akbari Aghdam, Seyed Ashkan Salehi, Dr Mohammad Shahsavan, Dr Ashkan Jalili, Ms Farnaz Jokar,
Volume 9, Issue 4 (11-2022)
Abstract
Background: This study aims to investigate early and delayed mortality rates and hospitalization duration among patients with delayed and early femoral intertrochanteric fractures.
Objectives: To compare short and long-term mortality rates and hospitalization duration between intertrochanteric fracture patients receiving early and delayed surgical treatment.
Methods: In this cross-sectional study demographic data, underlying disease history, pre-surgery hospitalization duration, surgery duration, and post-surgery hospitalization duration were extracted from patient files. Patients were divided into two groups with and without delay in surgery. Patients’ mortality rates were divided according to the time elapsed after the operation. They were divided into short-term and long-term categories. Data were analyzed using SPSS software, version 26.
Results: No significant difference was observed between the two groups in terms of age and sex distribution, but the frequency of underlying disease was significantly higher in the delayed surgery group (P<0.001). Also, mean hospital stay duration (P<0.001), surgery duration (P<0.001), short-term mortality (P=0.01) and long-term death (P<0.001) were significantly higher in the delayed surgery group.
Conclusion: Delayed surgery correlates with increased early and late mortality rates and prolonged hospital stay among patients with intertrochanteric femoral fractures.
Dr Karim Pisoudeh, Dr Sohail Gravandi,
Volume 9, Issue 4 (11-2022)
Abstract
Background and Objectives: The treatment methods for Legg-Calvé-Perthes disease (LCPD) patients with Herring C involvement scores are divided into two categories: Non-surgical treatments, including pain relief and physical therapy, braces or casts; and surgical treatments, including all types of femoral head containment surgeries. Although many researchers agree with conservative treatment, some also declare that surgery can be effective in improving the clinical results of group C patients. This study’s goals include examining clinical results, osteoarthritis status based on Tonnis classification, and Stulberg deformity degree of patients with LCPD with Herring C involvement scores, who underwent various types of containment surgery.
Methods: In this study, 18 patients (19 hips) diagnosed as Herring group C involvement LCPD underwent one type of containment surgery, including femoral varus osteotomy, femoral valgus osteotomy, Salter osteotomy, Ganz osteotomy, and triple innominate osteotomy. Participants who met the inclusion criteria were examined in terms of demographic-biometric information (age, follow-up period, gender, operated side, body mass index) and clinical-radiographic information, including range of motion, lower limb discrepancy (LLD), limping, Trendelenberg test, tenderness, classification of osteoarthritis based on Tonnis classification, Merle d’Aubigne-Postel score, and Stulberg classification.
Results: The mean patients’ current age and age at surgery were 13.9±3.3 and 8.3±2 years, respectively, and the mean follow-up period was 5.7±2.8 years. Two hips belonged to one female patient (10.5%), and 18 hips belonged to 18 male patients (89.5%). The left side was more frequently involved (57.9%), and the mean body mass index was 21.3 kg/m2. In the post-operation clinical results examination, significant differences were observed in only 3 variables: Range of motion in abduction (P<0.001), external rotation (P=0.042), and extension (P=0.037). Tonnis osteoarthritis class also improved significantly after surgery (P=0.029). The mean post-op Merle score of patients was 17.3. Regarding post-op Stulberg class, the highest frequency was related to class 2 with 42.1% (8 people) and no patient was placed in class 5.
Conclusion: In addition to improving the range of motion, surgery reduces Tonnis osteoarthritis classification and Stulberg grade in LCPD Herring C patients.
Amir Aminian, Mohammadreza Bahaediniv, Mehdi Komijani,
Volume 10, Issue 3 (8-2023)
Abstract
Background: Acetabular fractures are common traumatic injuries globally, posing challenges owing to their complex nature and difficulties in achieving precise anatomical reduction. Total hip arthroplasty (THA) is a valuable treatment for posttraumatic osteoarthritis secondary to these fractures; however, outcomes can vary based on initial fracture management, and optimal strategies remain debatable.
Objectives: This study evaluates THA outcomes in patients with previous acetabular fractures managed with open reduction and internal fixation (ORIF).
Methods: We conducted a retrospective review of patients who underwent THA for posttraumatic osteoarthritis following acetabular fractures managed with ORIF. The inclusion criteria comprised osteoarthritis graded ≥III according to the Kellgren-Lawrence classification and a minimum two-year follow-up. Clinical outcomes were assessed using the Harris hip score (HHS).
Results: Sixty-eight patients who underwent THA after ORIF for acetabular fractures were included (mean age 52.5±13.8 years). Preoperative HHS improved significantly from 41.4±9.9 to 83.1±10.4 at the final follow-up (P<0.001). Postoperative complications occurred in 54.4%, with 11.8% requiring revision THA.
Conclusion: THA for posttraumatic osteoarthritis following acetabular fractures, particularly in patients managed with ORIF, shows significant clinical improvement but has a high complication rate.
Karim Pisoudeh, Hosein Hamadiyan, Mehrzad Solooki, Esmail Asan,
Volume 10, Issue 3 (8-2023)
Abstract
Background: Femoral neck fractures present a considerable challenge for surgeons in the field. This study focuses on a critical issue in understanding the occurrence of treatment failure among individuals who underwent surgical fixation for femoral neck fractures.
Objectives: This study aims to evaluate the prevalence of treatment failure and identify associated risk factors in patients with non-displaced femoral neck fractures who underwent this procedure.
Methods: Data were gathered from individuals with non-displaced femoral neck fractures who received internal fixation from 2011 to 2022, ensuring a minimum follow-up period of one year. Treatment failure was evaluated based on these data. The gathered data were documented using SPSS software, version 22 and examined using descriptive statistics, including percentage, frequency, and Mean±SD. Statistical analysis was conducted using inferential tests, such as the t-test, chi-square test, and Fisher’s exact test. P≤0.05 was considered.
Results: Data were analyzed on 60 individuals, with a mean age of 50.25±16.94 years. Of the total, 44 men (73.3%) participated. One individual (1.7%) experienced avascular necrosis (AVN), while 7(11.7%) experienced nonunion. Seven patients (11.7%) experienced treatment failure, including AVN, which was also associated with nonunion. Six cases (10%) were advanced to total hip replacement surgery.
Conclusion: The results of this study indicate that the fixation of non-displaced femoral neck fractures has a combined incidence of nonunion and AVN at around 12%. It is advisable to consistently follow-up with patients and monitor risk factors after surgery to minimize complications and enable quicker identification of those impacted.
Karim Pisoudeh, Khatere Mokhtari, Siamak Kazemi,
Volume 10, Issue 4 (11-2023)
Abstract
Recent advancements in imaging technologies have significantly improved the diagnosis and management of hip disorders, particularly in older adults. Accurate diagnosis remains challenging due to the complex nature of hip pain, often involving referred pain from other regions. While conventional imaging methods, such as x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) continue to be essential, innovations, such as three-dimensional (3D) imaging, dynamic imaging, low-dose systems, and artificial intelligence (AI)-based analysis are transforming the field. AI, particularly deep learning, enhances diagnostic precision, in detecting non-displaced hip fractures. Additionally, molecular imaging techniques, such as positron emission tomography (PET)/CT and PET/MRI offer valuable insights into metabolic changes, while nanotechnology aids in early detection. Despite these advancements, challenges, such as accessibility, cost, and clinical integration persist. This review highlights these innovations and their potential to shape future hip disorder diagnostics.
