فهرست مطالب

Shafa Orthopedic Journal - Volume:4 Issue:4, 2017
  • Volume:4 Issue:4, 2017
  • تاریخ انتشار: 1396/10/02
  • تعداد عناوین: 6
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  • Davod Jafari, Hooman Shariatzadeh, Ali Asghar Kousari *, Alireza Yousof Gomrokchi Page 1
    Background
    Perilunate fracture dislocation (PLFD) and perilunate dislocation (PLD) are wrist injuries, which are commonly missed. Meanwhile, the delay in the treatment of these injuries is leading to a more complicated situation. One of the acceptable treatments for old cases is open reduction and internal fixation.
    Objectives
    The purpose of this study was to determine the mid-term results of open reduction and internal fixation (ORIF) treatment for old unreduced perilunate injury that had been unreduced and untreated for a minimum of 6 weeks after injury.
    Methods
    Between 2011 and 2016, 12 patients with old PLFD and PLD, untreated for a minimum of 6 weeks after injury, were treated by ORIF. A retrospective review was performed with a minimum 12 months of follow-up. During the final follow up visit, the patients were evaluated for pain, range of motion, and grip strength. The MAYO wrist score was used for functional assessment. The patients were assessed using a validated Persian questionnaire Quick DASH score. Radiological outcomes were classified using the Herzberg classification.
    Results
    All of patients were males with a mean age of 25 years (18 to 32 years). Perilunate Fracture Dislocation injury was found in 7 cases and PLD in 5 cases. Mean time from injury to surgery was 14.3 weeks (6 to 26 weeks) and mean follow-up after the surgery was 33.5 months (12 to 60 months). The mean MAYO wrist score was 77.5 (55 to 85). According to the Mayo wrist score, 42% of patients (5 patients) had good, 50% (6 patients) had satisfactory, and 8% (1 patient) had poor results. The active range of flexion-extension averaged 107.5° (range 80 to 155°), and grip strength averaged 84% (range 53% to 100%) of the intact extremity. According to the Herzberg classification, 5 (42%) patients were radiologically located in group A and 7 (58%) in group B. Patients’ satisfaction rate based on the Persian Quick DASH score had an average of 12.5.
    Conclusions
    Open reduction and internal fixation is an appropriate treatment with acceptable functional and clinical results in old unreduced perilunate injuries up to 6 months after trauma.
    Keywords: Perilunate Fracture Dislocation, Perilunate Dislocation, Open Reduction, Internal Fixation
  • Burak Eren *, Feyza Karag, Ouml, Z. GUzey, Serkan Kiti?, Nezih, Ouml, Zkan, Cafer Korkut Page 2
    Background
    Infection is the most common complication of spinal surgeries. Surgical site infection (SSI) can result in high hospitalisation costs owing to prolonged hospital stays, repeated surgeries and an increase in the frequency of pseudoarthrosis.
    Objectives
    The purpose of this study was to identify the risk factors of SSI in patients treated with thoracolumbar posterior spinal instrumentation.
    Methods
    Inclusion criteria were treated by posterior thoracolumbar stabilization with transpedicular screw and posterolateral fusion in the neurosurgery clinic between March 2006 and June 2009. Overall, 260 consecutive patients were identified and 239 patients included in this study. Risk factors that may cause increase of rate of SSI were evaluated.
    Results
    There were 153 female and 86 male patients with 48.23 ± 16.77 year-old. In all patients, the SSI rate was 12.5% (n = 30). Ten out of these 30 patients (4.1%) had deep wound infections and 20 patients (8.4%) had superficial infections. The average duration of infection development was 13.26 ± 10.96 days. The most isolated bacteria was Staphylococcus aureus (n = 10). Trauma as primary diagnosis, diabetes mellitus and other concomitant chronic systemic diseases, long operation time, excess blood loss during operation and excess blood product transfusion, intraoperative dural injury and presence of additional operations after primary operation were risk factors in the development of SSI. Length of postoperative ICU stays was determined to be a significant risk factor also.
    Conclusions
    It is important to know the risk factors of the patient and the surgery to reduce the frequency of infection. The gold standard in infection control is to prevent development of SSI.
    Keywords: Surgical Site Infection, Spinal Infection, Posterior Instrumentation, Surgical Wound Infection, Spine Surgery, Infection Risk Factors
  • Farshad Nikouei, Ebrahim Ameri, Hassan Ghandhari *, Saeed Sabbaghan, Behrooz Givechian, Abouzar Azizi, Mehrdad Bahrabadi Page 3
    Background
    There are different classifications for adolescent idiopathic scoliosis (AIS), among which Lenke classification is the most recent and comprehensive method. It is 3 dimensional and treatment organized. In most previous studies, thoracic hypokyphosis was more common, but it may be different in many patients.
    Objectives
    The current study aimed at assessing the prevalence of thoracic hyperkyphosis in AIS for the first time in Iranian population.
    Methods
    The study was performed retrospectively on 242 patients with AIS treated surgically in the university hospital from 2009 to 2014. Three parameters were evaluated in each patient including the 6 curve types of Lenke classification, thoracic sagittal balance, and lumbar spine modifier.
    Results
    Adolescent idiopathic scoliosis was more common in female patients (83.5%). Type one curve was the most common type (48%). In lumbar spine modifier, type A was the most common (44%), similar to other studies. Hyperkyphosis was the most common type of thoracic sagittal balance (54%), which was in contrast to the original study by Lenke. The mean thoracic sagittal balance was hyperkyphosis in all Lenke types except type 5, which was normal. No relationship was found between the prevalence of thoracic kyphosis, and lumbar spine modifier, or the 6 types of Lenke classification.
    Conclusions
    The frequency of different types of curves in Iranian population was the same as that of the original article by Lenke except that in the current study more thoracic hyperkyphosis was observed than hypokyphosis in the population.
    Keywords: Adolescent Idiopathic Scoliosis, Thoracic Hyperkyphosis, Lumbar Spine Modifier
  • Shayan Tavabi, Alireza Pahlevansabbagh, Hossein Farahini, Mohsen Motalebi *, Marzieh Nojomi Page 4
    Background
    Ischemic neuropathy is a major complication in patients undergoing hemodialysis (HD) with arteriovenous (AV) fistula.
    Objectives
    The aim of this study was to investigate the relationship between cubital tunnel syndrome and chronic HD via forearm AV fistula.
    Methods
    All HD patients with forearm AV fistulas, who were referred to the hemodialysis ward of Rasoul-e-Akram and Hasheminejad hospitals from February 2014 to February 2015 and met the inclusion criteria, were enrolled in the study. They were asked about ulnar neuropathy symptoms and were under physical examination and electrophysiological studies for cubital tunnel syndrome at the time of recruitment and 1-year follow-up.
    Results
    A total of 90 HD patients were included in the study. The mean age of the participants was 53.65 ± 17.89 years (range, 22 - 86 years), and 53 (59%) patients were male. Cubital tunnel syndrome was not detected in the patients. There was a significant difference in tingling and muscle weakness of the hand and forearm under chronic HD via forearm AV fistulas (P 0.05).
    Conclusions
    This research concludes that chronic HD via forearm AV fistula does not lead to cubital tunnel syndrome in HD patients.
    Keywords: Cubital Tunnel Syndrome, Forearm Arteriovenous Fistulas, Hemodialysis
  • Ramin Haj Zargarbashi, Hirbod Nasiri Bonaki, Shayan Abdollah Zadegan, Mohammad Hossein Nabian*, Reza Abdi, Amirreza Vafaee Page 5
    Background
    Orthopedic disorders of children are regularly managed by both general and pediatric orthopedists, practically, with various diagnostic and therapeutic approaches.
    Objectives
    The purpose of this study was to compare these two groups of surgeons regarding consensus and viewpoint variety on Blount’s disease and malalignment syndrome.
    Methods
    A nine-item questionnaire was designed and different choices were provided for each question to cover the main management strategies. Forty surgeons in two groups of general orthopedic surgeons (GOS) (n = 20) and pediatric orthopedic surgeons (POS) (n = 20) participated in the study and they were asked to choose answers by an electronic keypad. Statistical analysis was performed with Chi-square and Fisher’s exact tests.
    Results
    For unimproved Blount’s disease after one-year application of leg brace, 85% of POS vs. 31% of GOS tended to perform osteotomy, mostly with pin and cast fixation. In case of recurrence, re-osteotomy and temporary hemiepiphysiodesis were most popular. For further work-up of typical Blount lesion in X-ray, 73% of POS and 36% of GOS would perform an MRI. For a child with asymptomatic torsional malalignment syndrome, 75% of POS and 78% of GOS voted against surgery; while, for a symptomatic patient, femoral and tibial osteotomy was the choice.
    Conclusions
    Disagreements among orthopedic surgeons imply inadequacy of level-1 evidence. More comprehensive investigations are necessary to elucidate the situation.
    Keywords: Blount Disease, Consensus, Pediatrics, Torsional Malalignment Syndrome
  • Hooman Shariatzadeh, Mohammad Mujeb Mohseni * Page 6
    Background
    Complex regional pain syndrome (CRPS) is a chronic syndrome of pain usually caused by an initiating noxious event in the periphery. Carpal tunnel release (CTR) surgery has been known to associate with the development of CRPS.
    Objectives
    The incidence rate of CRPS has been attributed to the differences in ethnic and socioeconomic background of the cohort. Here, we aimed at evaluating the incidence of CRPS after CTR surgery in Iranian population for the first time.
    Methods
    In a prospective study, a total of 106 patients with carpal tunnel syndrome (CTS), who underwent CTR surgery, were included in this cohort. The patients’ medical records were evaluated and the incidence of CRPS after CTR surgery was assessed accordingly. Visual analogue scale (VAS) was used to subjectively evaluate the pain level in each CRPS patient.
    Results
    In this study, 7 (6.6%) cases of postoperative CRPS including 1 (14.2%) male and 6 (85.8%) females were identified at a mean follow-up period of 6.1 ± 2.4 months, ranging from 2 to 7 months. The mean age of CRPS cases was 49.5 ± 10.6, ranging from 31 to 74 years. In 2 patients the dominant hand and in 5 patients nondominant hand were involved. The mean preoperative VAS was 2.9, ranging from 2 to 4, which increased to 8.1 in CRPS patients, ranging from 7 to 9.
    Conclusions
    CRPS could be seen frequently following the CTR surgery, giving rise to a pain level of significantly higher than the initial pain level. Consequently, the patients should be informed of this potential adverse consequence of CTR surgery, especially those having the risk factors of this condition including gender, age, and hand dominancy.
    Keywords: Complex Regional Pain Syndrome, Carpal Tunnel Release, Incidence