فهرست مطالب

  • Volume:2 Issue:3, 2015
  • تاریخ انتشار: 1394/09/28
  • تعداد عناوین: 8
|
  • Seyed Hossein Vahid Tari, Ebrahim Ameri Mahabadi, Hasan Ghandehari, Farshad Nikouei*, Ramin Javaheri, Farshad Safdari Page 1
    Background
    Recently, several authors have demonstrated the importance of sagittal spinopelvic alignment in patients with adolescent idiopathic scoliosis (AIS).
    Objectives
    In the current study, we investigated the preoperative spinal and pelvic sagittal parameters in the abovementioned patients. Patients and
    Methods
    There were 50 consecutive patients with AIS (16 males and 34 females) in the current prospective study. In addition to the measurement of main scoliotic curve on posteroanterior X-rays, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis (TK) were measured on lateral X-rays. Finally, the correlations between these parameters were investigated. We also compared the sagittal parameters between patients with main thoracic scoliosis (Lenke type I) and thoracolumbar/lumbar scoliosis (Lenke type V).
    Results
    Main scoliotic curve (MSC) was correlated with TK and PT. LL was correlated positively with PI and SS. Negative correlation was found between SS and PI. The sagittal parameters were the same in patients with Lenke type I and Lenke type V scoliosis. In addition, MSC and LL were significantly greater in patients with thoracolumbar/lumbar scoliosis, while TK was significantly greater in patients with main thoracic scoliosis. In the main thoracic group, MSC and TK were positively and PI was negatively correlated with PT. LL and SS had a positive correlation.
    Conclusions
    PI has a constant magnitude and is correlated with SS and LL. Postoperatively, pelvis can compensate for any change in LL. Therefore, the LL within fusion must be imposed in lordosis to the extent that the below fusion segments can compensate for intrafusion hypo/hyper lordosis to prevent the pelvis to compensate for hypo/hyper lordosis. This can result in a normal or near normal postoperative sagittal alignment. The authors recommend the surgeons to perform exact preoperative planning including the sagittal alignment of the pelvis in addition to spinal alignment.
    Keywords: Adolescent Idiopathic Scoliosis, Sagittal, Alignment, Spinal Deformity
  • Abolfazl Bagherifard, Mahmoud Jabalameli, Kaveh Gharanizadeh, Ali Jahansooz, Faeze Abbasi, Milad Haji Agha Bozorgi, Hooman Yahyazadeh* Page 2
    Background
    There is significant evidence of hip and knee kinematic influence on each other. In some studies, hip restricted range of motion is a risk factor of anterior cruciate ligament (ACL) tear.
    Objectives
    This study was designed to compare hip range of motion in physical examination between non-contact ACL injured patients with normal population. Patients and
    Methods
    One hundred and forty patients with arthroscopically confirmed primary ACL ruptures were evaluated to assess their hip range of motion; these findings were compared with a control group of 100 patients with non ACL injury.
    Results
    All parameters of hip range of motion (internal rotation, abduction and adduction) except external rotation were decreased significantly in ACL injured group compared with control group. Patients with sum of internal and external rotation lower than 80° had an increased odds ratio of having ACL injuries (OR = 2.64; 95% CI, 1.4 to 4.7).
    Conclusions
    There was an association between non-contact ACL rupture and decreased hip range of motions including internal rotation, abduction and adduction as well as sum of internal and external rotation. Therefore, it may be possible to use hip physical exam finding as a predictor of ACL rupture.
    Keywords: Anterior Cruciate Ligament, Tear, Motion, Knee
  • Farid Najd Mazhar*, Hooman Shariatzadeh, Ali Dianat, Davod Jafari Page 3
    Background
    Focal fibrocartilaginous dysplasia (FFCD) is a benign lesion and has been reported as a cause of tibia vara in proximal tibia and distal of the femur. It is rare in upper extremity and few cases have been reported in the ulna and radius.
    Objectives
    The aim of the study was to review and report the clinical course, radiographic presentation and treatment results of three cases of FFCD in the distal radius. Patients and
    Methods
    We reviewed the medical records, imaging files, intraoperative anatomical findings and treatment complications of three cases of FFCD in distal radius. All patients underwent tethering fibrotic band resection with lengthening of extensor tendons in one case and distal radius corrective osteotomy in another one.
    Results
    All three patients were male with a mean age of 21.3 (11 - 36) months. The mean follow-up period was 28 months. Clinical and radiographic examinations in patients who underwent tethering band resection without osteotomy showed considerable remodeling. Nonunion, multiple surgeries and deformity were the complications in patient who received osteotomy as a part of treatment.
    Conclusions
    The natural history of distal radius FFCD is not clear. Until receiving enough evidences regarding the natural history of this rare lesion, we can recommend the least invasive treatment for the lesion, which is the resection of the fibrous band.
    Keywords: Complication, Distal, Radius, Treatment, Focal Fibrocartilaginous Dysplasia
  • Abolfazl Bagherifard, Mahmood Jabalameli, Ali Jahansouz*, Hooman Yahyazadeh, Hosein Karimi Heris, Mahsa Khezri, Parham Nikraftar, Ramin Bozorgmehr, Tahmineh Mokhtari Page 5
    Background
    Platelet-rich plasma (PRP) is plasma of enriched platelets with high concentration of platelet granules and growth factors. The platelet growth factors have a great potential of wound and connective tissue healing used to treat cartilage lesions and retarding the progression of knee osteoarthritis.
    Objectives
    This study was designed to evaluate PRP injection results in knee osteoarthritis. Patients and
    Methods
    This was a case-series study of 39 patients and all of them had three injections of PRP for the involved knee (every two weeks) and they were followed up at two weeks, two months and six months post-injection of PRP. All included patients filled the WOMAC (western Ontario and Mcmaster universities arthritis index) standardized and translated to our national language and culture. We analyzed the collected scores of before initiation of PRP injections, the second week, the second month and the sixth month after injections into the knees.
    Results
    Thirty-nine patients with a mean age of 55.24 ± 9.27 years (ranged 40 to 83) were evaluated in this study. Six patients (15.4%) were male and 33 patients (84.6%) female. There were significant differences in WOMAC score of patients in two months and six months after injection of PRP compared to before injection.
    Conclusions
    PRP had a great clinical improvement in short-term follow-up for early stages of knee osteoarthritis.
    Keywords: Arthritis, Platelet, Rich Plasma, Knee, Osteoarthritis
  • Hormoz Zahiri, Christopher Zahiri, Mansour Eghbali* Page 6
    Background
    Idiopathic osteoarthritis of the trapeziometacarpal (TMC) joint is common. Spontaneous attenuation of either the anterior oblique ligament (Beak ligament) or the dorsoradial ligament has been reported as the cause of the joint laxity, resulting in subsequent wear and tear of the articular cartilages. So far, no cause has been reported for the spontaneous attenuation of these key supporting ligaments of the TMC joint and no effective method of prevention or treatment has been reported for the early stages of the condition.
    Objectives
    The authors reported a conservative method for the prevention as well as reversal of the early stages of the joint instability before the process of wear and tear sets in and the condition progresses towards osteoarthritis.
    Materials And Methods
    A retrospective study was performed on 17 patients with early stages of idiopathic TMC joint osteoarthritis. The patients were treated through a conservative management protocol with an average follow-up of 28.4 months. The protocol consisted of performing specifically devised isometric exercises and a functional abduction brace.
    Results
    The result of the conservative treatment was postural correction of the thumb, anatomical stability of the TMC joint and resolution of the symptoms as well as findings including pain, swelling and joint dorsoradial translation. The mean pain score of the patients was 3.6 before the treatment was begun and was zero after the treatment was completed.
    Conclusions
    The presented conservative method is recommended for either prevention or reversal of the early stages of TMC joint instability before the osteoarthritic changes set in.
    Keywords: Trapeziometacarpal Joint, Osteoarthritis, Conservative Treatments, Prevention
  • Javad Parvizi*, Mohammad Ghazavi Page 7
    Context: There is a need to find the situations that Vancomycin should be used as antibiotic prophylaxis in hip and knee arthroplasty. There are also situations that might need different antibiotic prophylaxis protocol; such as abnormal urinary screening test or indwelling urinary catheter and previous joint infection. Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on periprosthetic joint infection (PJI) reviewed English literature for relevant articles. 62 of 221 articles were relevant to the six following questions regarding perioperative antibiotic prophylaxis to prevent PJI.
    Results
    Vancomycin should be considered for patients who are current Methicillin resistant Staphylococcus aureus (MRSA) carriers or have anaphylactic allergy to penicillins. Routine use of vancomycin for preoperative prophylaxis is not recommended. Routine prophylactic use of dual antibiotics is not recommended. The presence of urinary tract symptoms should trigger urinary screening prior to total joint arthroplasty (TJA). Asymptomatic patients with bacteriuria may safely undergo TJA provided that routine prophylactic antibiotics are administered. Patients with acute urinary tract infections (UTI) need to be treated prior to elective arthroplasty. The type of preoperative antibiotic administered to a patient with prior septic arthritis or PJI should cover the previous infecting organism of the same joint. In these patients, we recommend the use of antibiotic-impregnated cement, if a cemented component is utilized. There is no evidence to support the continued use of postoperative antibiotics when urinary catheter or surgical drains are in place. Urinary catheters and surgical drains should be removed as soon as safely possible.
    Conclusions
    Recommendations for choice of perioperative antibiotic prophylaxis in hip and knee arthroplasty were provided based on evidences in the literature and consensus of expert delegates from consensus meeting.
    Keywords: Infection, Periprosthetic, Joints, Arthroplasty
  • Hooman Shariatzadeh* Page 8