Hasan Ghandhari, Farshad Nikouei, Ebrahim Ameri, Mansour Karimi, Mohammadreza Shakeri,
Volume 7, Issue 3 (8-2020)
Abstract
Background: Severe angular kyphosis is one of the uncommon etiologies of compressive myelopathy and hence, many aspects of this myelopathy are unknown.
Objectives: In this study, we report a series of 12 patients with compressive myelopathy in severe angular kyphosis, as well as the result of surgical treatment in these patients.
Methods: In a retrospective study, we included 12 patients with the progressive or sudden onset of paraplegia caused by severe angular kyphosis. The neurological status of the patients was evaluated with the American Spinal Injury Association (ASIA) typing system before the operation and at four time points after the operation (1 day, 1 week, 6 months, 1 year). The main surgical interventions included anterior corpectomy, anterior spinal fusion, and posterior spinal fusion with or without instrumentation and with or without decompression.
Results: The Mean±SD age of the patients was 41.9±16.4 years, ranging from 14 to 59 years. The etiology of myelopathy was congenital kyphosis in 10 patients (83.3%). The Mean±SD duration of paralysis was 6.4±6.6 months. The Mean±SD percentage of cord thinning at the apex was 61.7±17.5%. Bowel or bladder dysfunction was present in 6 patients (50%) before the surgery that was resolved in 5 patients after the surgery. One year after the surgery, the ASIA typing was improved in 9 patients (75%) and remained the same as preoperative status in 3 patients (25%).
Conclusion: Surgical decompression corrects the neurological symptoms in the majority of cases with compressive myelopathy caused by severe angular kyphosis.
Hossein Akbari Aghdam, Mohammad Dehghani, Parisa Karimi,
Volume 8, Issue 2 (5-2021)
Abstract
Background: In this article, the prevalence of recurrent anterior dislocation of the shoulder and the effect of factors such as age, occupation, primary cause and gender on it have been investigated.
Objectives: This study aimed to investigate the factors related to the frequency of recurrent anterior shoulder dislocation in clients of the Orthopedic Ward of Kashani Hospital, Isfahan City, Iran, in 2017-2018.
Methods: The present research is a cross-sectional study. The study population comprised all patients with traumatic and anterior shoulder dislocation referred to Kashani Hospital during 2017-2018. The sampling method in the present study was census. The patients were asked by phone or in person after their presence about the recurrences of dislocations between the beginning of 2017 and the end of 2018. The obtained data were analyzed in SPSS version 25.
Results: Out of 256 patients, 22% had a recurrence of dislocation. The recurrence rate of dislocation in less than 20 years patients was 40%, and in 20 to 40 years was 63%. The highest recurrence rate of dislocation was reported in the age group of 20 to 40 years in the present study. Based on the present study results, the recurrence rate of dislocation in the age-group of 20-40 years was significantly higher than in other groups. There was no significant relationship between gender and recurrence of dislocation in the subjects (P>0.05). Significance was observed in the primary cause and type of occupation in recurrence of dislocation (P<0.05).
Conclusion: The recurrence rate of dislocation in the patients who suffered from dislocations for the first time was 22%. Based on the results, the rate of recurrence of dislocation in the present study was lower than the rate of recurrence of dislocation in similar studies.
Mohsen Mardani-Kivi, Ardeshir Shirangi, Aryan Mardani-Kivi, Zahra Haghparast Ghadim-Limudahi, Amin Izadi,
Volume 8, Issue 2 (5-2021)
Abstract
Background: Choose a proper therapeutic approach for various shoulder joint involvements is still a significant challenge.
Objectives: The study aimed to assess the knowledge and attitude of orthopedic surgeons in managing patients with shoulder problems.
Methods: In a cross-sectional survey, a questionnaire consisted of 2 different parts was directly presented to orthopedic surgeons. Part 1 investigated the experience of shoulder surgeries, and part 2 evaluated their knowledge and attitude toward 4 patients with different scenarios.
Results: The surgeons were divided into 2 groups: shoulder surgeons (n=17) and general orthopedic surgeons (n=192). The first scenario is about a 21-year-old male with first anterior shoulder dislocation. In this scenario, shoulder surgeons chose surgical intervention more than general surgeons (88.21% vs 33.54%, P<0.05). The second scenario presents a 55-year-old male with shoulder osteoarthritis and complete and repairable rupture of supraspinatus and rupture of the long head of the biceps tendon. Shoulder surgeons chose total shoulder arthroplasty (43.8%) and arthroscopic rotator cuff repair (37.5%). But, only 21.87% of general orthopedic surgeons choose these two items together. The third scenario is a 65-year-old male with supraspinatus and infraspinatus tendon rupture. Sixteen of 17 shoulder surgeons answered this case, and 100% chose surgical interventions (62.5% arthroscopic and 37.5% open repair). On the other hand, 180 general surgeons of 192 answered this case scenario, and only 41.11% chose surgical treatment. The fourth scenario presents a 52-year-old female with refractor adhesive capsulitis. Arthroscopic capsular release and manipulation was the most frequent answer among shoulder surgeons compared to general surgeons (64.71% vs 31.38%).
Conclusion: It seems that an advanced course of shoulder surgeries is necessary to improve the knowledge of general orthopedic surgeons about shoulder diseases and treatment choices.
Mohsen Mardani-Kivi, Mahmoud Karimi Mobarakeh, Ehsan Kazemnejad Leili, Zahra Haghparast Ghadim-Limudahi,
Volume 8, Issue 3 (8-2021)
Abstract
Background: There are several methods like Kirschner wire, suture fixation, different plaque and etc. for surgical treatment of Neer’s type-II fractures of distal end of clavicle.
Objectives: Due to lack of gold standard in treatment of fractures of distal end of clavicle, this study was conducted to compare therapeutic outcomes of tension band wire (TBW) and suture fixation (SF) in treatment of this type of fractures.
Methods: This retrospective cross sectional-analytic study was performed on patient with confirmed unilateral unstable Neer’s type-II fracture of distal end of clavicle. Based on surgeon preferred protocol for fixation of fractures, for patients from 21 September 2010 to 20 March 2013 pin and wire were used (TBW group) and patients from 21 March 2013 to 23 September 2015, were enrolled as SF group. Demographic information were recorded separately for both groups. All patients were evaluated and scored based on constant score, VAS, symptomatic hardware, loss of reduction in 3 and 6 months and final visit after surgery.
Results: Among 85 patients, 41 and 44 patients were allocated in TBW and SF groups respectively. Mean of follow-up time was 36.7 months. Our findings showed that both groups in three follow-up periods were similar with regard to shoulder function based on constant score, VAS score, loss of reduction, and nonunion. But SF group had lesser symptomatic hardware rather than TBW group (P=0.001).
Conclusion: Although the results of pain intensity and function were similar in two groups, existence of symptomatic hardware and need of hardware removal in TBW method are weak points which should be considered.
Ali Asghar Norasteh, Hamid Zolghadr,
Volume 9, Issue 2 (5-2022)
Abstract
Background: Understanding the relationships between exercise and performance tests is crucial for the sports rehabilitation expert.
Objectives: To comprehensively review functional tests and their reliability for return to sport (RTS) after shoulder injuries.
Methods: During this research, a comprehensive review of the functional tests for RTS after shoulder injuries was performed by searching the Web of Science, PEDro, Google Scholar, PubMed, ScienceDirect, SCOPUS, and CINAHL databases with the keywords shoulder RTS, return to play, upper limb and shoulder functional tests from 2000 to June 2021. English was used in this search. After gathering the research results, first, the titles and then the summary of the research papers were studied. If the research papers meet the inclusion and exclusion criteria, their results will be utilized in the study of review otherwise they will be excluded.
Results: When searching the texts, 123 research papers were found, after deleting 11 identical titles, 112 abstracts were chosen for review. After analyzing the abstracts, 79 research papers were removed and 33 research papers were selected for full study. After reviewing the full-text research papers, 21 research papers were removed and 12 research papers were selected from among the research papers that were very closely related to the subject under study. Many functional tests exist, but few have been studied to evaluate the RTS after a shoulder injury.
Conclusion: Functional tests can assist in estimating when an athlete will RTS or exercise without restrictions. Therefore, according to the results of the current research, functional tests can be an effective tool to assess RTS after shoulder injuries, but due to the limitations and lack of information in this area, further studies are required to be conducted. Therefore, caution should be taken and a general rule should not be drawn for all shoulder injuries.
Hiva Mohammadian, Seyed Nima Taheri, Shervin Lashgari, Mohammad Soleimani,
Volume 9, Issue 2 (5-2022)
Abstract
Although medial epicondyle fractures are responsible for 12% of pediatric elbow fractures, they rarely occur concurrently with a capitellar fracture, and the treatment approach and indications are controversial. According to the case report (CARE) guidelines, here we present a case of the medial epicondyle and capitellar fractures with elbow dislocation in a 4-year-old girl who underwent K-wire fixation and splint application. After four months of follow-up, the patient showed good results and a full range of motion. Open reduction and internal fixation may be reasonable options for medial epicondyle and concomitant capitellar fractures using the medial and lateral approaches. We suggest using K-wires, especially in the pediatric population.
Prof Morteza Nakhaei Amroodi, Dr Mansour Karimi, Dr Alireza Mojani, Dr Mohammadreza Bahaeddini, Prof Hasan Ghandehari, Dr Khatere Mokhtari, Dr Pouria Tabrizian,
Volume 10, Issue 1 (2-2023)
Abstract
Background: Elbow fractures are among the most common injuries in children. While elbow fractures are rarely life-threatening, their significance lies in potential complications. Therefore, accurate and timely diagnosis and appropriate treatment are essential for elbow fractures. Identifying the frequency of pediatric visits with elbow injuries, categorized by fracture type and treatment method, is necessary for optimizing treatment planning.
Objectives: This study addresses the knowledge gap regarding pediatric elbow injuries by investigating the frequency, fracture types, and treatment methods among children seeking medical attention at Shafa Yahyaiyan Orthopedic Hospital, Tehran, Iran.
Methods: This cross-sectional, descriptive study comprised children under 18 presenting to the Emergency Department of Shafa Yahyaiyan Orthopedic Hospital due to elbow injuries from September 20, 2020, to March 20, 2021. Demographic, clinical, and radiologic variables were collected using medical records. The statistical analysis was performed using the SPSS software, version 22, with a significance level set at 0.05.
Results: A total of 507 pediatric cases with elbow injuries were analyzed, including 54% males. The average age of the cohort was 3.44±4.73 years. Pulled elbow emerged as the most common injury in 52% of cases. Among fractures, supracondylar humerus fractures had the highest prevalence. Closed reduction was the predominant intervention, followed by casting. There was no significant association between gender and injury type (P=0.211). However, a statistically significant relationship was identified between age and injury type (P=0.0001).
Conclusion: This study revealed that pulled elbow and supracondylar humerus fractures were the most common injuries, with the closed reduction being the predominant treatment method. While gender did not significantly correlate with injury type, age showed a noteworthy association, indicating an increased risk with advancing age.
Morteza Nakhaei Amroodi, Mohammadreza Bahaeddini, Saeedreza Amiri, Mansour Karimi, Khatere Mokhtari, Pouria Tabrizian,
Volume 10, Issue 2 (5-2023)
Abstract
A thorough review of the available scientific works related to the use of gene therapy to address orthopedic disorders was performed. This review highlights the considerable promise of gene therapy in transforming clinical practice in this domain. Orthopedic conditions, including a range of problems, such as spinal fusion failure, disc degeneration, fractures, segmental bone defects, bone tumors, joint disorders, soft-tissue injuries, genetic disorders, and nerve and muscle disorders, often pose significant challenges for traditional surgical or medical treatments. Consequently, a concerted effort has been made to explore gene therapy as a viable alternative. This innovative approach has made significant progress, although several hurdles must be addressed before widespread clinical application in humans. However, gene therapy has considerable potential as a promising treatment option for orthopedic disorders in the 21st century. As gene transfer techniques continue to advance, the potential applications of gene therapy for orthopedic disorders are expected to expand significantly.
Dr Morteza Nakhaei Amroodi, Dr Khatere Mokhtari, Dr Mojtaba Baniasadi, Dr Saeedreza Amiri, Dr Mansour Karimi, Dr Pouria Tabrizian,
Volume 10, Issue 3 (8-2023)
Abstract
The intricate orchestration of cell types and developmental processes in multicellular organisms hinges upon signaling pathways, such as Wnt, which play a pivotal role in embryonic development and adult tissue homeostasis. Over the past four decades, significant efforts have been made to elucidate the complexities of the Wnt signaling pathway and its diverse physiological functions. Wnt signaling has emerged as a crucial regulator in orthopedic contexts, particularly in fracture healing and osteoarthritis. This review delves into the intricate involvement of the Wnt pathway in these orthopedic conditions and explores its impact on bone formation, chondrogenesis, and joint pathologies. Moreover, it examines the therapeutic potential of targeting Wnt signaling in the treatment of osteoporosis, highlighting the promising avenues opened by advancements in understanding rare bone disorders, such as sclerosteosis and van Buchem disease. By elucidating the multifaceted roles of Wnt signaling in orthopedic health and disease, this review offers insights into potential therapeutic strategies to enhance fracture healing, mitigate osteoarthritis progression, and address bone-related disorders.
Niki Tadayon, Farsad Biglari, Azadeh Hakakzadeh, Meisam Jafari Kafiabadi, Seyed Mohammad Reza Kalantar-Motamedi,
Volume 10, Issue 3 (8-2023)
Abstract
Thoracic outlet syndrome (TOS) is a well-known compressive neurovasculopathy with various anatomical etiologies. Neurogenic TOS (nTOS) is the most common type of this syndrome, accounting for over 95% of all cases. Conservative treatment plays a significant role in the management of nTOS. However, there are many controversies regarding this theme. Therefore, the optimal treatment method remains unclear. Herein, a narrative review was conducted to gather recent data on the available conservative treatment methods for the management of nTOS.
Dr. Morteza Nakhaei Amroodi, Dr. Pouria Tabrizian, Dr. Mojtaba Baniasadi, Dr. Mohammadreza Bahaeddini, Dr. Farzaneh Merdowsi, Dr. Khatere Mokhtari, Dr. Babak Roshanravan, Dr. Saeed Amiri,
Volume 10, Issue 4 (11-2023)
Abstract
Background: The acromioclavicular joint (ACJ) connects the clavicle and scapula, ensuring shoulder girdle coordination. In subacute injuries, acromioclavicular and coracoclavicular ligaments retain healing potential and often require surgical treatment to repair the tissue. The clavicular hook plate, fixed to the back of the ACJ after reduction, prevents redislocation.
Objectives: This study aims to investigate the suitability of hook plate surgery without ligament reconstruction in patients with subacute ACJ.
Methods: A retrospective cohort study was conducted on 38 patients with subacute ACJ injuries treated with a hook plate without reconstruction. Demographic data, injuries, timing of surgery, and infection history were collected. Eligible patients were contacted for final assessment.
Results: Most patients were men (86.84%), with a mean age of 41 years. Surgery was predominantly on the dominant hand (63.16%). The mean shoulder range of motion (ROM) was 157.89° for forward flexion, 153.95° for abduction, and 50.79° for external rotation. The highest pain was in the first six weeks (70%). Over 80% of the patients had no post-surgery infection, and 97% did not require re-surgery. No significant statistical relationship was found between pain intensity and other variables (P>0.05). Men reported clinically higher pain levels. Younger patients (<45 years) had significantly better ROM (P<0.05).
Conclusion: The present study showed that hook plate fixation was effective for subacute ACJ injuries, with better outcomes in patients ≤45 years old.
