مجله جراحی استخوان و مفاصل ایران
سال شانزدهم شماره 1 (پیاپی 60، زمستان 1396)

Knee osteoarthritis is one of the most important causes of disability in elderly. Increasing age is associated with increased knee osteoarthritis. The average population age is increasing. In the next 30 years, Iran will enter the club of countries with the 30% of the population aged over 65. The cost of osteoarthritis treatment accounts for a significant amount of each country’s GDP. Knee osteoarthritis is caused by an imbalance between the destruction and repair of articular cartilage under the influence of several risk factors such as trauma, excessive use, and genetic predisposition. Overweight and joint disorders apply an increased load to the specific points of the knee. This overload creates a tissue response, which provides the conditions for the occurrence of osteoarthritis. No cure has been found for knee osteoarthritis so far. Although joint replacement (knee arthroplasty) at this point is the best solution, its survival and durability is not permanent. Some patients are not suitable for surgery; some are reluctant to have surgery, and finally, the cost of surgery is high. Treating knee osteoarthritis without joint replacement is another method to deal with this problem. Through extensive studies and review of medical literature, The American Academy of Orthopaedic Surgeons has prepared the Guideline for Non-Arthroplasty Treatment of Knee Osteoarthritis. This Guideline brings the promise of quality of life equal to the surgical approach. The Academy recommends its use to all orthopaedic surgeons and also calls for an assessment of the outcome studies. Nonarthroplasty treatment of knee osteoarthritis is a simple and inexpensive treatment method. The majority of patients will benefit from this treatment. We all need to set up centers to treat patients according to the academy Guideline with special interest on recording outcomes.

  Low back pain is one of the most common problems that force individuals to seek medical care. Since surgery is the last treatment strategy, predicting the process of conducting surgical procedures seems beneficial and somehow crucial. In this regard, the first step is having a validated biomechanical model based on the anatomical parameters of patients’ lumbar spine. Despite the impressive progress in this field, there is still a need to designing a model that could include important anatomical parameters and be applicable in terms of clinical applications. This study aimed to develop the personalized spinal finite element model with 23 anatomical parameters. The initial data was extracted from the radiology picture of the average healthy volunteers and was designed in Catia software. Afterwards, the finite element model was analyzed in Abaqus, and results of the range of motion of motionsegments in movements of flexion, extension and left and right lateral bending were verified based on the results of experimental studies present in the literature. In order to observe the application of the patient-specific spinal parametric model, a model of a patient after spinal fusion was presented. Moreover, results of the range of motion of the motion segments and intradiscal pressure were compared to the healthy model. Since acceptable results were obtained at each step, it is possible to predict the result of spinal fusion and compare the biomechanical results in case of decreased or increased fusion level by developing a parametric parient-specific model for each patient, which can be an effective achievement for clinical fields.

Unstable ankle fractures are a common presentation and operative intervention has proven to improve patient outcomes. Each stage of patient management can have an impact on patient length of stay and clinical outcome. The aim of the present study is to assess how we manage the patient at each stage from their presentation right through to discharge, and if/how variation in practice differed significantly. From April 2017 to December 2017, in the Heart of England NHS Foundation Trust (HEFT), we retrospectively analysed the data of 49 patients with a diagnosis of an unstable ankle fracture. The patient journey was assessed from presentation to the Emergency Department (ED) right through to discharge. Post-operative notes were also reviewed. Data was obtained through our Trauma Audit and Research Network (TARN). 49 patients had surgical fixation for their ankle fracture. Whilst in the ED, less than 50% of the patients had a radiographic diagnosis of an ankle fracture within 30 minutes of arrival.25 patients were admitted to the ward within 4 hours, with some patients having to wait more than 9 hours.27 patients (more than 50%) had their surgery within 2 days after being admitted, in comparison to 6 patients who had to wait more than 6 days for their operation. The former were found to have shorter hospital length of stay post-operatively.47 out of the 49 patients were given chemical thromboprophylaxis, all patients were advised to not weight bear for a minimum of 6 weeks, and no post-operative morbidity or mortality was encountered. We found an association between early ankle fracture fixation, and reduced post-operative hospital Length of Stay (LOS).

Mitchell osteotomy is one of first metatarsal distal corrective osteotomies for hallux valgus deformity. The purpose of this study was to evaluate the outcome of Mitchellosteotomy. Eighteen patients underwent Mitchell corrective osteotomy using screw fixation for hallux valgus deformities from 2011 to 2015 were included. Clinical outcome was assessed using American Orthopedic Foot and Ankle Score, Hallux metatarsophalangeal-interphalangeal scale, (AOFAS Hallux), visual analogue score, and changes in hallux valgus and intermetatarsal angles based on standard weight-bearing radiographs, at least one year after surgery. About 95 % of patients were completely satisfied. Mean of AOFAS score was 86.7 at final follow-up. The mean of changes in intermetatarsal and hallux valgus angles were 5.6 ± 3.1 and 17.0 ± 5.2 respectively. Pain of the cases based on visual analogue score decreased from 5.8 ± 0.8 preoperatively to 1.3 ± 1.2 postoperatively. There were no deep infections, non::union:: or osteonecrosis of first metatarsal head. Mitchell corrective osteotomy with screw fixation could bea simple and effective procedure to correct hallux valgus deformity with high levels of patient satisfaction.

congenital foot deformities are among the most common congenital abnormalities causing morbidities, disturbing the normal gait and affecting patients’ quality of life. The aim of our study was to find out the prevalence of such abnormalities in neonates born at a referral center in northern Iran. This study was a descriptive cross-sectional study on the neonates born in Imam Khomeini hospital of Sari in a two-year period. The variables considered in our study were gestational age at the time of delivery, medical conditions complicating the pregnancy including diabetes, chronic hypertension, obstetrical complications like olygohydramnios, polyhydramnios, and malpresentations, mothers' age, chronic diabetes, hypertension, mothers' addiction, sex and birth weight of the newborn, history of having a child with congenital limb anomaly and the type of delivery. Photography of newborns' feet was taken on first day of birth to be assessed by an orthopaedic surgeon. In addition, the babies were examined the day after birth by one of the two neonatologists and the suspicious cases were referred to the orthopedic surgeon. Statistical analysis was performed by SPSS software. From 2025 neonates studied, 210(10.4%) calcaneovalgus, 7 (0.3%) clubfoot, 156(7%) cases of ''PesVarus'', 22 cases of (1.1%) metatarsus adductus, and 1 case of polydactyl were recognized. Among all variables, only mothers' age and cigarette smoking during pregnancy had association with congenital foot abnormalities. The most prevalent congenital abnormalities in our study was Pes Calcaneovalgus and a positional mild ''Pes Varus''. The low rate of club foot, polydactyly and metatarsus adductus are notable,

Acrometastasis or metastasis distal to elbow and/or knee is a very rare event. A 31 y/o female, a known case of breast cancer for 3 years presented with a swollen 4th right finger. Radiographs and then biopsy showed separate metastases to middle and distal phalanges, an extremely rare event. She was managed with ray amputation. Four months later she developed a second metastasis, this time to her left tibia, again a rare site for metastasis, that was managed by closed intramedullary nailing. Sadly, she died of pulmonary metastasis, 9 months after her hand event. Acrometastasis is a rare finding and predicts a short survival.