فهرست مطالب

Shafa Orthopedic Journal - Volume:5 Issue:1, 2018
  • Volume:5 Issue:1, 2018
  • تاریخ انتشار: 1397/01/08
  • تعداد عناوین: 7
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  • Hooman Shariatzadeh, Davod Jafari, Seyed Sajjad Jafari, Alireza Mirzaei * Page 1
    Context: Ulnar variance (UV) is attributed to the natural history of several wrist disorders. Thus, its reliable measurement is of considerable clinical importance. Several factors are proposed to affect the UV measures; the current study aimed at discussing these factors to further clarify their role in the evaluation of UV.
    Evidence Acquisition: The evidence of the current review was derived from literature published in English in PubMed to identify papers discussing the factors affecting UV measurement. The title and abstract of the articles published prior to October 2017 were checked. After the exclusion of non-relevant studies, 16 articles were found eligible for investigation.
    Results
    Based on the available evidence, the perpendicular technique is the most reliable method of UV assessment. Magnetic resonance imaging (MRI) is also reported as the best imaging method for UV measurement. Moreover, the most increase in UV is expected when the position changes from relaxed supination to pronation and grip status. It seems that aging affects UV, at least until maturity, with a shift toward less ulnar minus position. In addition, ulnar plus wrist position seems to be more frequent in females. Repetitive minor wrist trauma can also change wrist radiologic parameters, especially ulnar variance.
    Conclusions
    Among several potential factors affecting the UV, the role of some factors such as positioning, imaging, and measurement technique are well defined, while the role of some others such as age and gender needs further clarifications in future investigations.
    Keywords: Keywords: Ulnar Variance, Assessment, Techniques
  • Mehdi Moghtadaei, Hossein Farahini, Saead Enayati *, Mohsen Motalebi, Habib-O-Lah Gorgani Page 2
    Background
    Nowadays open meniscal repair approach is completely replaced by arthroscopic meniscal repair.
    Objectives
    The current study aimed at assessing the results of arthroscopic meniscal repair using the outside-in technique.
    Methods
    Patients diagnosed with meniscal tearing from 2008 to 2014 fulfilling the inclusion criteria were entered to the current cohort study. Outcomes of arthroscopic meniscal repair were assessed by 2 known questionnaires, IKDC (international knee documentation committee) and KOOS (knee injury and osteoarthritis outcome score), as well as magnetic resonance imaging (MRI) of knee.
    Results
    A total of 63 patients were assessed. The mean age and follow-up period were 28.8 ± 4.8 years and 44.3 ± 20.3 months, respectively; 82% of the subjects were male and 60.3% had injuries in both meniscus and anterior cruciate ligament (ACL); 76% of the patients had medial meniscal injury; 67% had posterior horn tear, and 56% had longitudinal meniscal tear. There was no significant association between age, gender, grade of tear, number of sutures, anatomic site of tear, and type of tear with the level of patient’s satisfaction. Patients with simultaneous reconstruction of ACL had significant difference compared with the ones with isolated meniscal injury. Grading of tear in MRI had no association with the better outcomes according to the questionnaires.
    Conclusions
    Arthroscopic meniscal repair using the outside-in technique yielded acceptable results.
    Keywords: Meniscus, Outside, in, IKDC, KOOS
  • Davood Jafari, Hooman Shariatzadeh, Farid Najd Mazhar, Reza Babaei *, Masoud Mirkazemi, Nazanin Ayazi Page 3
    Background
    Although carpal tunnel release (CTR) is accepted in severe cases of carpal tunnel syndrome (CTS), it is not clear if CTR overweighs the local steroid injection (LSI) in the treatment of patients with mild symptoms.
    Objectives
    Here, we compared the efficacy of LSI with CTR on improving signs and symptoms of mild to moderate CTS.
    Methods
    In a randomized clinical trial, we used the Boston carpal tunnel questionnaire (BCTQ) to evaluate the change of functional status scale (FSS) and symptom severity scale (SSS), in addition to the patients’ satisfaction, over a follow - up period of 6 months.
    Results
    In total, 68 patients (33 in the LSI and 35 in the CTR group), with the mean age of 45.8 ± 8.1 years and mean BMI of 30.5 ± 6.1 kg/m2 were included. The baseline clinic - demographic characteristics of the patients were not significantly different between the 2 study groups. Both treatments significantly improved the FSS (p = 0.002 for LSI and p = 0.001 for CTR) and SSS (p = 0.001 for both groups). However, no significant difference was observed between FSS (p = 0.36) and SSS (p = 0.29) of the 2 groups. Although the patients’ satisfaction was also not significantly different between the 2 groups, the number of completely satisfied patients was more in the LSI group.
    Conclusions
    Considering no significant difference between the outcome and satisfaction rate of patients treated with LSI or CTR, it can be concluded that both treatments are efficacious in the treatment of mild to moderate CTS, at least for a period of 6 months. However, the durability of treatments needs further evaluation.
    Keywords: Carpal Tunnel Syndrome, Carpal Tunnel Release, Local Steroid Injection
  • Mahmoud Jabalameli, Abolfazl Bagherifard, Hosseinali Hadi, Amin Yoosefzadeh, Hooman Yahyazadeh, Jafar Rezazadeh, Salman Ghaffari * Page 4
    Background
    Quadriceps tendon ruptures (QTR) are uncommon injuries of knee extensor mechanism. Although immediate repair is necessary to re-establish knee extensor continuity, favorable outcome of QTR reconstruction even several years after injury is reported.
    Objectives
    The outcome of acute and chronic QTR is rarely investigated. The current study aimed at evaluating the objective and subjective measures of outcome following the surgery of acute and chronic QTR.
    Methods
    A total of 6 QTR injuries, 3 acute and 3 chronic cases, in subjects with the mean age of 31.66 ± 12.7 years and mean follow-up of 4.3 ± 2.5 years were retrospectively evaluated. Pre- and post-operative subjective measures including international knee documentation committee (IKDC), modified Cincinnati knee scores, and objective measures including range of motion (ROM) and extension lag were used to evaluate the outcomes.
    Results
    ROM improvement was 36.6° in acute and 33.3° in chronic injuries. Extension lag improvement was 28.3° in acute and 26.7° in chronic injuries. IKDC improvement was 72.8 in acute and 62.4 in chronic injuries. Improvement of modified Cincinnati was 72.6 in acute and 64.7 in chronic injuries. No post-operative complications were observed in the studied series, while all cases re-established their pre-operative activity level.
    Conclusions
    According to the current study results, delayed repair of QTR injury adversely affected the outcome of surgery. Meanwhile, surgical reconstruction of chronic QTR is still warranted regarding the considerable post-surgical improvement of the outcome measures.
    Keywords: Quadriceps Tendon Rupture, Knee Extensor Mechanism, Chronic, Surgical Management, Outcome
  • Farid Najd Mazhar, Davod Jafari, Marzieh Nojoomi, Alireza Mirzaei *, Hamed Tayebi Page 5
    Background
    Proximal femur morphology determines the choice of cemented or uncemented Total Hip Arthroplasty (THR), and Dorr classification is widely used to type this characteristic. As a result, a considerable reliability for such typing system is expected.
    Objectives
    The current study aimed at assessing inter and intra-observer reliability of Dorr classification in proximal femur morphology.
    Methods
    A total of 50 standard hip radiographs from patients with trauma or THR candidates were evaluated by 6 observers, including 2 senior orthopedic residents, 2 orthopedic surgeons, and 2 hip fellowship-trained orthopedic surgeons, using the Dorr classification system. Subsequently, radiographs were re-numbered and re-evaluated, 6 weeks after the first review. Cohen’s Kappa statistic was used for statistical analysis of inter and intra-observer reliability.
    Results
    The mean intra-observer and inter-observer kappa value for the residents was 0.560 and 0.592, respectively. The mean intra-observer and inter-observer kappa value for the orthopedists was 0.566 and 0.540, respectively. The mean intra-observer and inter-observer kappa value for the hip fellowships was 0.477 and 0.490, respectively.
    Conclusions
    A minimum to moderate inter and intra-observer reliability of Dorr classification system was seen between the observers of the current study. These results suggest that the classification of the femur morphology is more challenging than previously described and characterization of a single Dorr type, especially in case of uncertainty between type B and C of Dorr might need reconsideration, in order to prevent its adverse effect on the patients’ outcome.
    Keywords: Total Hip Arthroplasty, Proximal Femur Morphology, Dorr Classification, Reliability
  • Pooria Hosseini *, Gregory Mundis, Kevin Yoo Page 6
    The authors report a rare case of recurrent tethered cord syndrome in the context of Ehlers Danlos Syndrome and mosaic trisomy chromosome 20 that was successfully treated by shortening vertebral column with a partial corpectomy. The patient was a 20-year-old female diagnosed with Ehlers Danlos type 3 and mosaic trisomy 20.Her lower extremities sensation and strength gradually deteriorated, and a clinical and radiographic diagnosis of tethered cord syndrome was made. She underwent three detethering surgeries, which all were complicated with retethering and arachnoid cyst formation. The massive amount of scar formation found on the third attempt at detethering surgery forced the surgeon to leave the spinal cord tethered and plan for spinal-shortening osteotomy. A T11 vertebral column resection shortened the spine by 20 mm and allowed gradual and significant recovery of lower limb neurological deficits. Authors reported this rare case in order to (a) propose the consideration of the spine-shortening osteotomy as the primary surgery in a tethered cord syndrome patient with a higher possibility of scar formation like Ehlers Danlos Syndrome (b) and to report a rare case of tethered cord syndrome in the context of Ehlers Danlos Syndrome with mosaic trisomy 20 and (c) raise the awareness of the possibility of unreported genetic association of Ehlers Danlos Syndrome with mosaic trisomy 20.
    Keywords: Recurrent Tethered Cord Syndrome, Spine, Shortening Osteotomy, Ehlers Danlos Syndrome, Mosaic Trisomy 20
  • Khodamorad Jamshidi *, Alireza Mirzaei Page 7