فهرست مطالب

Shafa Orthopedic Journal - Volume:6 Issue:2, 2019
  • Volume:6 Issue:2, 2019
  • تاریخ انتشار: 1398/02/07
  • تعداد عناوین: 8
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  • Fardin Mirzatolooei, Ali Tabrizi *, Amir Nematollahi, Maryam Sadat Mokarram Page 1
    Background
    Bleeding is the most common post-operative complication of knee arthroplasty. Arthroplasty systems with posterior cruciate ligaments potentially affected the amount of postoperative bleeding due to a lower need for bone cutting.
    Objectives
    In this study, two types of prosthesis, including preserving and not preserving posterior cruciate ligament (PCL), were compared in terms of post-operative bleeding.
    Methods
    In the current cohort study, 100 patients participated in this study and were divided to two groups: 50 patients were treated by using posterior stabilized (PS) system and 50 patients were treated through the Wright cruciate retaining (CR) system with a medial pivot mechanism. Blood loss during surgery and hemoglobin and hematocrit levels were measured for three days after surgery.
    Results
    In the first group, the amount of collected blood through the drainage tube in first group was 261.87 cc and in the second group this was 225.86 cc, (P = 0.42). After three days the mean drop in hemoglobin in PS group was 2.69 g/dL and in the CR group, this was 2.77 g/dL (P = 0.741). Hemoglobin declined on the second day after surgery, to approximately 3.5 g/dL and 2.74 g/dL for the PS and CR group, respectively, and was significantly higher in the PS group (P = 0.003), and the blood loss in the two groups of nPS and CR were 92 cc and 71 cc, respectively (P = 0.003). The mean blood transfusion per patient in the PS group was 1.2 unit, which was significantly higher than the CR group with mean of 0.78 unit per patient (P = 0.012).
    Conclusions
    The PS system (Zimmer company product) leads to greater bleeding during the three days, which increased the need for blood transfusion. Consequently, the type of implanted prosthesis could influence the amount of bleeding. In certain circumstances, prevention of postoperative bleeding is crucial, and prostheses can be most beneficial to reduce the amount of acute bleeding in the patient.
    Keywords: Arthroplasty, Knee, Arthroplasty Prosthesis, Bleeding
  • Hasan Ghandhari , Farshad Nikouei , Saeed Sabbaghan , Maryam Ameri Mahabadi , Mona Ziaei , Behrooz Givehchian *, Farshad Safdari Page 2
    Background
    There are many unanswered questions about the characteristics and mechanism of the lumbosacral scoliotic list (LSL). In the current study, the pattern of LSL, the level of maximal opened disc space (take-off) in addition to the relationship between the location of disc herniation (DH) on magnetic resonance imaging (MRI) and LSL direction on radiographs, were investigated.
    Methods
    A total of 37 patients, with extruded lumbar DH and LSL, were included in the current study. The following variables were measured on standing anteroposterior and lateral lumbar x-rays: LSL (from L1 to L5), the take-off level, and the coronal shift (the distance between the plumb line from T12 spinous process to the central sacral vertical line). The direction of LSL was recorded as the bending side of the patient opposite to the convexity of the curve. The location of DH was determined as right, left, or central on an MRI.
    Results
    The magnitude of the LSL curve averaged 9.9° ± 6.9°. Regarding the right or left herniation, the list occurred mostly toward the opposite side of the herniation direction (P = 0.04). There was no significant matching between the location of herniation and the take-off segment (P = 0.391); however, in 67.6% of patients with L4 - L5 or L5 - S1 herniation, the take-off point occurred one segment above the involved levels. The take-off was found only at L3 - L4 or L4 - L5 levels in all the patients.
    Conclusions
    LSL usually occurs on the opposite side of the herniation location. Furthermore, take-off is found in L3 - L4 or L4 - L5 segments in most of the patients with LSL. It seems that LSL curve characters are not affected by the level of herniation.
    Keywords: Disc Herniation, Lumbar Spine, Lumbosacral List, Coronal Shift
  • Burt Yaszay *, Nima Kabirian , Gregory M. Mundis , Carrie E. Bartley , Jeff Pawelek , Behrooz A. Akbarnia Page 3
    Background
    Long-term ionizing radiation exposure is a risk to young scoliosis patients. A new slot-scanning imaging system, “EOS imaging” has been shown, in patients with adolescent idiopathic scoliosis, to emit significantly lower levels of ionizing radiation. This is a single-center, preliminary report of radiographic assessment by a new system.
    Methods
    Thirty-eight patients with early onset scoliosis (EOS) who had spine radiographs (antero-posterior, lateral or bending) were included. Patients were divided into two groups: (1) conventional radiography (CR) and (2) EOS-imaging. Patients’s demographics and total annual radiation (TAR) doses were calculated. The mean TAR dose per patient was compared to annual background radiation estimated by Radiological Society of North America (2.4 mSv). The mean radiation dose for anteroposterior and lateral spine film with the EOS imaging system was reported as 0.12 and 0.19 mSv per the manufacturer.
    Results
    There were 25 patients in the CR and 18 patients in the EOS-imaging group. Five patients had films from both CR and EOS-imaging on different occasions. Mean follow-up of the entire cohort from the first spine x-ray was 1.3 years (0.3 - 2 years). The mean TAR dose per patient was 10.2 mSv (3.3 - 20.3) and 1.3 (0.6 - 2.2) for CR and EOS-imaging groups, respectively. The mean TAR was 4.25× (CR) and 0.54× (EOS-imaging) that of annual background radiation. The mean age of patients at the first spine X-ray within the study period was 4.1 years (0.11 - 9.2) in CR and 7.6 year (3.3 - 10.5) in the EOS-imaging group.
    Conclusions
    Our study shows the TAR dose per patient from EOS imaging systems are lower than conventional systems and can be utilized for patients as young as 3 years old. This study suggests that the use of this new system can reduce TAR dose in EOS patients; however, a larger cohort with longer follow-up is needed to critically examine this statement.
    Keywords: EOS Imaging, Early Onset Scoliosis, Radiation
  • Karim Pisoude , Omid Elahifar , Mohammad Bagher Sohrabi , Javad Khajemozafari * Page 4
    Background
    The sub-trochanteric (ST) fracture is relatively common. It does not have a single treatment but it can be repaired in a variety of ways.
    Objectives
    The aim of this study was to compare the proximal femur locking compression plate (PFLCP) and intramedullary nailing in the treatment of ST fracture.
    Methods
    This cross-sectional study was performed on 56 patients with ST fracture who referred to Firoozgar Hospital, Tehran, Iran, between January 2014 and December 2018. The patients were equally divided into two groups, PFLCP group and nailing group. The recovery and postoperative complications were evaluated by the Harris hip score (HHS).
    Results
    Of the 56 eligible patients examined, 49 (87.5%) were male. The overall mean age was 42.7 ± 16.2 years. The status of the union was significantly better in the PFLCP group than in the nailing group (P = 0.038). The total mean HHS was 88.9 ± 14.1 with no significant difference between the two groups. The results of the logistic regression model showed that sex and age could significantly decrease the HHS. Thus, the HHS was influenced by female sex (OR = 0.851) and age of more than 60 (OR = 0.829).
    Conclusions
    PFLCP provides an appropriate union, expedites the operation, and yields a very good HHS. Therefore, it can work even better than intramedullary nailing in some parameters, such as pain after the operation.
    Keywords: Proximal Femur Locking Compression Plate, Intramedullary Nailing, Subtrochanteric Fracture, Complications, Harris Hip Score
  • Ali Tabrizi *, Mohsen Mehdizadeh Page 5
    Femoral neck stress fractures are rare and encompass 5% of all stress fractures among the young people. The bilateral cases are very rare. Coxa vara deformity and morbid obesity are some of the predisposing factors for bilateral stress fractures. The decline of neck-shaft angle will result in an increase and concentration of stress force in femoral neck giving rise to fracture. This report introduced a 35-year-old man with severe coxa vara deformity with an angle of 100 neck-shaft who had a bilateral femoral neck stress fracture and severe obesity [body mass index (BMI) > 35 kg/m2]. The femoral neck stress fracture was a tension-type occurred due to stress in coxa vara. Based on laboratory findings, his vitamin D deficiency was severe (8.9 ng/mL) but his PTH and phosphorus levels were normal. Regarding vitamin D deficiency and previous femoral deformity, the possibility of osteomalacia in adolescence period was raised. Bilateral valgus sub-trochanteric osteotomy and fixation with a dynamic hip screw (DHS) were performed. After three months, the patient restored his walking ability and weight bearing. Valgus sub-trochanteric osteotomy and fixation with DHS are useful methods in coxa vara deformity concomitant with stress fractures and can modify the neck-shaft angle.
    Keywords: Stress Fractures, Coxa Vara, Obesity, Osteomalacia, Valgus Osteotomy
  • Hamidreza Yazdi , Alireza Yousof Gomrokchi *, Mohammad Reza Sarshar , Omid Elahifar , Sara Sohrabi Page 6
    Introduction
    Patellar dislocation is a relatively common injury. However, in rare circumstances along with dislocation of the patella, some types of fractures occur, making the treatment challenging and difficult.
    Case Presentation
    We report a 28-year-old man with dislocation of the patella, simultaneous Hoffa fracture, and incarcerated patella in lateral femur condyle fracture due to a serious motorcycle accident.
    Conclusions
    Generally, patellar dislocation can be reduced with open reduction or close reduction. There are some indications for open reduction of the patellar dislocation in the literature. We are going to introduce a new indication of open reduction for patellar dislocation and the clinical picture, diagnosis, pathogenesis, and treatment are discussed. Finally, the literature is reviewed based on previous studies.
    Keywords: Patellar Dislocation, Incarceration, Distal Femur Fracture
  • Sam H Sami , Milad Haji Agha Bozorgi *, Mehryar Khadem Page 7
    Castleman disease (CD) is a rare condition of a benign proliferation of lymph nodes with currently unknown etiology. A 21-year-old male patient referred to the institute with asymptomatic, slowly enlarging, soft tissue mass located on the medial part of the femoral region of his left thigh. Magnetic resonance imaging detected a heterogeneous mass of about 132 × 77 × 68 mm3 in size, which was hypo-signal at T1 and hyper-signal at T2 sequences with central calcification and surrounded by hyperproliferative capillaries. The mass was completely excised through surgery and patient achieved complete remission. In pathologic evaluations, the specimen contained a fibrosclerotic lymph node with a partially distorted structure composed of small-sized mature lymphocytes in a hyper-vascularized stroma without the presence of neoplasia and malignant cells. Radiologic and histopathologic findings were suggestive of CD. The patient underwent surgery for excision of tumor and achieved complete remission without any complications.
    Keywords: Castleman Disease, Extranodal Castleman, Femoral Mass, Benign Lymphadenopathy
  • Ali Tabrizi *, Mohammad Javad Shariyate , Sajjad Zakeralhoseini Page 8