فهرست مطالب

Shafa Orthopedic Journal - Volume:5 Issue:2, 2018
  • Volume:5 Issue:2, 2018
  • تاریخ انتشار: 1397/03/13
  • تعداد عناوین: 6
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  • Abolfazl Bagherifard, Azade Amini Kadijani, Hooman Yahyazadeh, Jafar Rezazadeh, Masoud Mirkazemi, Alireza Mirzaei * Page 1
    Background
    The degree of patient’s suffering in association with radiological evidence of osteoarthritis (OA) determines the time point of surgery. Thus, a more clear understanding of the association between clinical and radiological symptoms of OA is necessary.
    Objectives
    Here we aim to evaluate how clinical and radiographic symptoms of patients are associated with each other in an Iranian Knee OA population.
    Methods
    In a cross - sectional study, patients with knee OA were recruited. The diagnosis of OA was made using the criteria of American College of Rheumatology (ACR) Classification. Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) was used as an indicator of self-reported disability. The Kellgren - Lawrence index was used for OA grading.
    Results
    A total of 96 OA patients, including 77 females and 19 males, with a mean age of 53.27 ± 10 years, were included. The OA was graded as I, II, III, and IV in 28, 35, 19, and 14 patients, respectively. The mean WOMAC score was 55.2 ± 20.5, ranging from 6.3 to 100. The WOMAC score was not significantly correlated with the grade of OA (p = 0.1, r = - 0.188). When we stratified the patients based on their gender, a strong correlation was observed between WOMAC scores and OA grade in male patients (p
    Conclusions
    Self - reported disability is associated with radiographic symptoms in male patients with knee OA, but not in females. Hence, the orthopedic surgeons should consider this discrepancy in their decision - making process to decide appropriately about the choice of therapy.
    Keywords: Osteoarthritis, Clinical Symptoms, Radiographic Symptoms
  • Davod Jafari, Hooman Shariatzadeh, Farid Najd Mazhar *, Sajjad Jafari, Poria Tabrizian Page 2
    Background
    While there is consensus about the treatment of acutely presented displaced lateral condyle fracture (LCF) of distal humerus in children by open reduction and internal fixation, treatment for lately presented LCF remained challenging due to contradictory results of treatments and paucity of studies in this field.
    Objectives
    The aim of this study was to report the clinical and radiological results of open reduction and internal fixation for the treatment of lately presented LCF of distal humerus in children.
    Methods
    Prospectively we studied the clinical and radiographical results of open reduction and internal fixation of 8 patients from 12 cases. These cases had a delayed presentation of more than 3 weeks from injury among those who were referred to our center from 2011 to 2017. We evaluated the range of motion, alterations in carrying angle, presence of prominent deformity, presence of arthritic or neurological symptoms, and finally nonunion or avascular necrosis of the lateral condyle. For assessment of the treatment results we used the Hardacre criteria.
    Results
    A total of 8 patients, including 7 males and 1 female with mean age of 5.2 years (2.5 - 8) bearing time delay from injury to the surgery of 32.4 days (22 - 48), underwent surgical treatment. The mean follow up was 21 months (8 - 54). The main reason for referring to the clinic consisted of palpable mass followed by decreased range of motion. All patients achieved satisfactory union. Of the patients, 2 suffered from complications; 1 patient experienced avascular necrosis of the lateral condyle and the other was complicated by carrying angle abnormality. According to the Hardacre criteria, 6 patients achieved excellent results and 2 patients, with mentioned major complications, obtained fair results.
    Conclusions
    Open reduction and internal fixation of lately presented lateral condyle fracture of distal humerus can result in excellent functional and radiological results in most of the patients.
    Keywords: Lateral Condyle Fractures, Children, Delayed Presentation, Open Reduction, Internal Fixation
  • Ahmadreza Afshar, Ali Tabrizi *, Kosar Fathalizadeh, Sasan Hejazi, Azim Rezamand, Majid Vafaie Page 3
    Background
    Fanconi anemia is the most common hereditary aplastic anemia characterized by progressive bone marrow deficiency, congenital anomalies, and an increased risk for leukemia. Skeletal deformity is one of the primary manifestations before diagnosis and hematological disorder.
    Methods
    This study presents a perspective of Fanconi anemia at its concomitant skeletal anomalies at a sub - national level in northwestern Iran. Between 2000 and 2017, all records were collected in 3 provinces of northwest Iran.
    Results
    Overall, 64 patients (38 female (59.4%) and 26 male (40.6%)) with Fanconi anemia in 3 provinces of northwestern of Iran were identified. The mean age at the time of diagnosis was 6.6 ± 4.8 years. Thirty - seven (57.8%) patients had skeletal deformity in their upper or lower limbs. The 3 most common anomalies, included microcephaly in 29 (45.3%), short stature in 27 (42.2%), and thumb anomalies in 22 (34.2%) patients. The association of the thumb anomalies with microcephaly and short stature was a significant association between them (Chi - square test, p value 0.03; Odds Ratio 3.1 in 95% confidence interval 1.07 to 9.2). Fourteen (21.9%) patients among the 37 patients with skeletal deformities sustained surgeries before the diagnosis of the disease.
    Conclusions
    A combination of the thumb anomalies and microcephaly should alert the physician to investigate further for a probable existence of Fanconi anemia.
    Keywords: Congenital Anomalies, Fanconi Anemia, Microcephaly, Short Stature, Thumb Anomalies, Skeletal Anomalies
  • Seyed Amir Mahlisha Kazemi Shishavan, Ali Tabrizi * Page 4
    Introduction
    Skeletal involvements are less reported in tuberculosis and even less likely observed in fingers. Fingers are rarely involved in adults and it often has been reported in children under 5 years old. Most likely, a recent condition in adult patients is required to provoke reactivation of bacilli lodged in the bone during the original mycobacteremia of primary infection.
    Case Presentation
    In this report, a 31 - year - old female patient, suffered from detached extensor tendon due to the fourth finger trauma, was diagnosed as a Mallet finger and treated by closed percutaneous pining is introduced. The patient had chronic swelling and progressive pain in the same finger for six months after treatment. The common anti - inflammatory and antibiotic therapy was not successful. Radiographic images of the ring finger demonstrated erosion and irregularity of the articular surfaces around the distal interphalangeal join (DIP). She expressed a history of untreated cough and exposure to people with tuberculosis. A positive tuberculosis (TB) skin test was determined with more than 10mm induration. Treatment with anti-tuberculosis medication regimen was successful and continued for 12 months.
    Conclusions
    Skeletal tuberculosis should always be considered by physicians in endemic areas. A slow progression of the disease in skeletal involvement and lack of clinical suspicion can lead to misdiagnosis. Using anti - tuberclusis medications for an appropriate period is effective in the disease control and treatment of patients.
    Keywords: Dactylitis, Lytic Lesion, Tuberculosis
  • Mahmood Jabalameli, Hooman Shariatzadeh, Reza Babaei * Page 5
    Introduction
    Coronal plane Fractures of the femoral condyle are known as Hoffa fractures. Although isolated posterior Hoffa fractures of medial femoral condyle have been rarely reported, no reports are available regarding the anterior fracture of this type. Here, we report a large isolated anterior osteoarticular fracture of the medial femoral condyle.
    Case Presentation
    A 16 - year - old girl with a traumatic open joint injury of the right knee caused by a car - to - pedestrian accident was referred to our emergency department for further evaluation. A physical examination of the knee revealed effusion and limited knee range of motion. While no obvious fracture was detectable on plain radiographs of the knee, a large anterior osteoarticular fracture of the medial femoral condyle was observed in computed tomography (CT), which was detached from the medial condyle. The fracture was managed with open reduction and internal fixation. Eight weeks after the surgery, the patient retrieved the full knee motions and the complete union of the fracture was observed. No complication was reported by the patient at a follow-up period of 12 months.
    Conclusions
    In cases with knee tenderness and/or effusion and normal plain radiographs, whenever there is a discrepancy between plain radiographs and clinical symptoms of the patient, a further evaluation of the knee with a CT scan and/or MRI is necessary to avoid missing a Hoffa fracture, which could be successfully treated if timely diagnosed.
    Keywords: Isolated Hoffa Fracture, Femur, Medial Condyle
  • Abolfazl Bagherifard, Mahmood Jabalameli, Jafar Rezazadeh*, Salman Ghaffari, Pouria Tabrizian Page 6
    Introduction
    Consumption of anabolic - androgenic steroids (AAS) is described as a major factor in tendon weakening process. The reports of bilateral quadriceps tendon rupture (QTR) following the AAS consumption are very rare. The current study described a case of simultaneous bilateral QTR following a low - energy trauma in a body builder with the history of ASS consumption.
    Case Presentation
    A 32 - year - old male body builder was referred to under study center with a history of falling down from the stairs nearly 2 weeks earlier. Magnetic resonance imaging (MRI) showed QTR in both knees from superior pole of patella. He denied any major trauma to explain the recent problem. Thus, the QTR was attributed to a low - energy trauma. While ruling out the tendon weakening conditions promptly, the history of oral and intramuscular consumption of AAS was noted. The patient was operated to repair QTR. At the last follow-up session, he was able to actively straighten his legs. The consumption of AAS was discontinued afterward.
    Conclusions
    Consumption of AAS by athletes has considerably increased during the last few decades. An appropriate warning of orthopedic surgeons regarding AAS side effects is necessary in order to recognize the predisposing factor of tendon rupture in similar circumstances and address the case properly.
    Keywords: Quadriceps Tendon Rupture, Anabolic, Androgenic Steroids, Athletes