فهرست مطالب

Orthopedic Science - Volume:6 Issue: 4, 2019
  • Volume:6 Issue: 4, 2019
  • تاریخ انتشار: 1398/08/10
  • تعداد عناوین: 8
|
  • Omid Shahpari, Abolfazl Bagherifard, Mahmoud Jabalameli, Mohammad Rahbar, Hossein Hajitaghi Pages 1-6
    Background

    The preoperative identification of patients who might need constrained condylar knee (CCK) prosthesis in total knee arthroplasty (TKA), is essential to ensure the availability of equipment and to address the patients’ expectations accurately. 

    Objectives

    In this study, we aimed at investigating if the preoperative features of the patients can provide this data.

    Methods

    A total of 30 patients who underwent primary TKA for severe osteoarthritic genu varum deformity (varus angle ≥20º) were evaluated in this retrospective study. Prosthesis selection was based on preoperative and intraoperative information. Demographic data, preoperative correctability of the deformity, and intraoperative information, including the reduction osteotomy, soft-tissue release, and pie-crust technique, were retrospectively collected. Soft-tissue release was performed in a sequential manner in 3 steps.

    Results

    The study population included 4 males and 26 females with a mean±SD age of 64.6±8.7 years. A CCK prosthesis was used in 11 (36.7%) cases. A significant association was found between the preoperative correctability and the type of prosthesis. In other words, all CCK prostheses were used in patients who were preoperatively non-correctable (P<0.001). Also, the step of release was significantly associated with the type of prosthesis, and CCK prosthesis was used in all patients with step 3 release (P<0.001). Preoperative correctability was significantly related to the step of release, as well. It means that all deformities with step 3 release were preoperatively non-correctable (P=0.008).

    Keywords: The preoperative clinical evaluation of correctability could be used in the identification of patients who might need a CCK prosthesis
  • Hossein Akbari Aghdam, Azin Mohammad Salehi, Hamed Zandi Esfahani, Mohsen Heidari* Pages 7-12
    Background

    Primary malignant tumors, including rare tumors of the skeleton, are of concern. However, the unpredictable prognosis, morbidity, and mortality of these tumors have raised them as one of the health problems. 

    Objectives

    This study was designed to evaluate the epidemiological characteristics of these tumors in Isfahan province, Iran.

    Methods

    In this cross-sectional study, 489 patients with malignant bone and soft tissue tumors were enrolled from 2006 to 2016. Their data were available in Isfahan medical centers, and their diagnostic biopsies from their hospitals’ records were examined. The data were statistically analyzed using SPSS.

    Results

    The most common tumors were in the descending order: Osteosarcoma (15.1%), Ewing sarcoma (13.7%), chondrosarcoma (13.1%), fibrosarcoma and neurofibrosarcoma (10.8%), malignant fibrous histiocytoma (7.8%), synovial sarcoma (6.7%), liposarcoma (6.5%), dermatofibrosarcoma (3.3%), rhabdomyosarcoma (3.1%), and leiomyosarcoma (3.1%).  Other sarcomas comprised 16.8%. The highest prevalence of tumors was in Isfahan city.

    Conclusion

    This study was conducted for the first time in Isfahan Province to evaluate the epidemiological characteristics of malignant bone and soft tissue tumors. Our study results were similar to most studies conducted in different regions of the world. Considering the relatively high prevalence of malignant bone and soft tissue tumors in lower age groups, we recommend further studies in this area to manage this problem.

    Keywords: Primary, Bone tumor, Malignant, Epidemiology
  • Hooman Shariatzadeh, Farid Najd Mazhar, Hanon Sadony*, Nima Bagheri Pages 13-18
    Background

    Lunate morphology has been associated with several wrist pathologies. In this study, we aimed to find how lunate morphology (absence or presence of hamate facet) affects the severity of Kienböck disease.

    Objectives

    Evaluation of the relationship between lunate morphology and kienbocks disease. 

    Methods

    A total of 106 patients with stage IIIA or IIIB of Kienböck disease at initial presentation were included in this study. Modified Litchman classification system and standardized lateral radiographs were used for staging the Kienböck disease. Lunate morphology was investigated on plain radiograph and computed tomography scan or magnetic resonance imaging and was classified into type I (absence of hamate facet) and type II (presence of hamate facet).

    Results

    The mean±SD age of the patients was 33.5±9.2 years. Kienböck disease stage IIIA and IIIB were identified in 68 (64.2%) and 38 (35.8%), respectively. Hamate facet was present in 65 (61.3%) patients and absent 41 (38.7%) patients. A significant association was found between lunate morphology and stage of disease so that the number of patients with lunate type I was significantly more in stage IIIB and number of patients with lunate type II was significantly more in stage IIIA (p<0.001).

    Conclusion

    Lunate morphology is associated with the severity of Kienböck disease in patients initially presented with stage IIIA or IIIB. These associations could be implicated to prevent disease progression as well as to optimize the outcome of treatment.

    Keywords: Kienböck disease, Lunate morphology, Hamate facet
  • Farid Najd Mazhar, Hooman Shariatzadeh, Hanon Sadony*, Nima Bagheri, Hojatolah Ebrahimy Pages 19-24
    Background

    The optimal treatment of radial head component in the terrible triad injuries of the elbow is challenging. In this study, we compared the functional outcome and complication rates of radial head resection with radial head fixation in a terrible triad setting.

    Objectives

    Comparison of radial head resection with radial head fixation in terrible triad. 

    Methods

    In the present retrospective study, the outcome of terrible triad injury in 41 patients, in whom the radial head component was managed with either radial head resection (n=28) or open reduction and internal fixation (n=13), was compared. The subjective assessments of the outcome included visual analog scale (VAS) for pain, ‎the Mayo elbow performance score (MEPS), and the disabilities of the arm, shoulder, and ‎hand (DASH) score. The objective assessment of outcome included the evaluation of elbow range of motion (ROM) and elbow stability.

    Results

    The mean±SD age of the patients was 39.2±10.2 years. The demographic characteristics of the patients of the two study groups were not statistically different. The mean supination/pronation arc of motion was not significantly different between the two ‏study groups (P=0.11). The mean flexion/extension arc of motion was significantly more in the fixation group (P=0.001). The mean MEPS and DASH scores were not ‏significantly different between the study groups (P=0.22 and P=0.49, respectively). The mean ‏VAS was significantly more in the fixation group (P=0.04). All the elbows were stable at the last follow-up. The postoperative complications (arthrosis and heterotopic ossification) were considerably more in the resection group.

    Conclusion

    Although comparable at function, the present study favors the radial head fixation whenever possible to avoid the postoperative complications of radial head reaction.

    Keywords: Terrible triad, Radial head, Resection, Fixation
  • Bijan Valiollahi, Mostafa Salehpour, Hamidreza Bashari, Shoeib Majdi, Mehdi Mohammadpour* Pages 25-30

    Bisphosphonates, more particularly alendronate, are a popular category of drugs in the treatment of postmenopausal and corticosteroid-induced osteoporosis. The present study contends that the long-term consumption of bisphosphonates causes not only subtrochanteric and femoral shaft fractures but also pathological fractures at other musculoskeletal sites. This report presents a rare case of alendronate-induced pathological metatarsal fracture in a 59-year-old female with a history of cuboid fracture following a twisting with abnormal Bone Mineral Density (BMD) (T score: −3.5; lumbar spine and −2.6; proximal femur).

    Keywords: Atypical fracture, bisphosphonate, metatarsal
  • Khodakaram Rastegar, Misagh Eiji, Hasan Ghandhari, Naveed Nabizadeh, Milad Bahari, Omid Momen*, Ebrahim Ameri Pages 31-34
    Introduction

    Anterior Lumbar Meningoceles (MCs) are rare in the patient with Neurofibromatosis type 1 (NF1). Although spinal fusion with optimal resection of the meningocele might be indicated in these special cases, no report could completely describe a huge meningocele after posterior spinal instrumented fusion.

    Case Presentation

    Here we present a 23 years old woman with a history of NF-1 and ‬previous posterior spinal fusion, who was referred to the neurosurgery department because of abdominal pain and retroperitoneal mass secondary to large anterior lumbar MC. The MC was filling the retroperitoneal cavity and protruded to the anterior wall of abdomen. ‬‬‬‬‬As an elective procedure, reduction and closure of cyst was achieved through posterior approach. Postoperatively, the patient reported satisfactory relief of abdominal pain.

    Conclusion

    Lumbar anterior MC is rare in the patients with NF1. When surgical intervention is indicated, ‬reduction of cele should be considered.

    Keywords: Meningocele, Neurofibromatosis 1, Scoliosis
  • Ali Dastjerdi*, Omid Shahpari, Mahdi Mazloumi, Nafise Elahpour Pages 35-40
    Background

    Aneurysmal Bone Cysts (ABCs) are benign destructive tumors. Their diagnosis is sometimes challenging, and their treatment in unusual sites, especially in the pediatric age group is difficult, too. This study aims to support the paraclinical measures along proper consultation to approach the pelvic ABC.

    Methods

    We present a 9-year-old female who suffered from pain in the left hip 3 months before the referral. A pelvic mass was diagnosed and unfortunately misdiagnosed with an ovarian mass. It was led to a wrong operation with a wrong approach by a general surgeon and result in intra-operative bleeding and delay in diagnosis and treatment. the final diagnosis was massive ABC in the supra-acetabular area with extension to the ilium and pubic.

    Conclusion

    Pelvis is one of the most challenging sites for the diagnosis and treatment of bone tumors. Large ABC tumors in the hip are unusual and may be presented by non-specific signs and symptoms. Therefore complete clinical and radiological evaluations should be done before any attempt to surgically remove the pelvic mass. Prognosis is excellent if the pelvic mass remove wisely by an experienced hip surgeon.

    Keywords: Aneurysmal bone cysts, Bone tumor, Surgical treatment
  • Saeed Sabbaghan, Hasan Ghandhari*, Ebrahim Ameri, Naveed Nabizadeh, Saba Saberi, Omid Momen Pages 41-44

    Congenital kyphosis is a less common spinal malformation, which can progress and cause neurological deficits. The treatment of severe cases is complicated. There are several techniques of surgical intervention for the correction of kyphosis, but the selection of surgical methods is entirely dependent on the patient’s condition. This article reports a 14-year-old girl with severe congenital kyphosis, who underwent hemiepiphysiodesis at age 2. Last year, her neurological deterioration began and led to paraplegia over a couple of months. To treat her, we performed 2-stage multi-level vertebral column resection (Schwab type 6). First, she underwent anterior T12-L1-L2 complete corpectomy and cord decompression. Then, the resection of posterior elements from T12 to L2 and posterior fusion with instrumentation from T8 to L5 were performed. However, concerning this kind of severe deformity, we suggest using 3D planning, which facilitates the operation.

    Keywords: Congenital kyphosis, Anterior spinal fusion, Posterior vertebral column resection, Corpectomy