فهرست مطالب

  • Volume:7 Issue: 2, 2020
  • تاریخ انتشار: 1399/04/14
  • تعداد عناوین: 8
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  • Hooman Shariatzadeh, Bijan Valiollahi, Mehdi Mohammadpour, Mohammadamin Haghbin* Pages 47-54
    Background

    Open reduction and internal fixation is the standard surgical treatment of calcaneal fractures. However, it is associated with a high rate of wound problems. 

    Objectives

    In this study, we evaluated the clinical and radiologic outcomes, as well as the wound complication rates of sinus tarsi minimally-invasive approach in the treatment of intra-articular calcaneus fracture.

    Methods

    In a retrospective study, 62 patients who were referred with an intra-articular calcaneus fracture and treated with a minimally-invasive sinus tarsi approach were included. The radiographic evaluations included the assessment of Bohler and Gissane angles before and after the surgery, as well as the height and length of the calcaneus. The clinical outcome was assessed with the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire.

    Results

    The Mean±SD age of the patients was 41.8±12.7 years. The Mean±SD follow-up of the patients was 21.3±10 ‎months. After 6  months, in  43 patients (69.3%) both Bohler’s and Gissane’s angles were significantly improved after the surgery (P=0.003 and P<0.001, respectively). The calcaneus height was significantly improved after the surgery (P=0.009), as well. The Mean±SD AOFAS score of the patients was found 79.6±7. Wound infection was seen in only 1 case (1.6%). Delayed wound healing occurred in 4 cases (6.4%). No other wound complication such as dehiscence and skin necrosis was recorded.

    Conclusion

    Minimally-invasive sinus tarsi approach is an efficacious procedure for the treatment of intra-articular calcaneus fracture with a minimized rate of wound complications.

    Keywords: Minimally invasive surgery, Calcaneus fracture, Sinus tarsi approach
  • Mahmood Jabalameli*, Sepehr Khosravi, Delaram Delbari, Abolfazl Bagheri Fard, Nariman Latifi Pages 55-60
    Background

    High Tibial Osteotomy (HTO) is an approved surgical technique for varus knee deformity. For open wedge HTO multiple fixation methods and devices have been used. Advantages and disadvantages of these methods and devices are reported in various studies. Few studies have been conducted on use and final outcome of correction of varus knee deformity by implementation of non locking plates and benefits of this method is not fully evaluated.

    Objectives

    To assess clinical and radiographic features of non-locking 4.5 millimeter L-buttress plate and T-buttress plate, which is used in open wedge High Tibial Osteotomy (HTO), and to find out whether this device is efficient enough or not.

    Methods

    This cross-sectional study was conducted on 39 patients with tibial deformity recruited from a referral orthopedic hospital in Iran. Patients’ information, including their baseline characteristics, Range of Motion (ROM) of the knee, comorbidities, time of weight-bearing, union time in x-ray, graft type, and time of follow-up were reported at two stages: before and after the operation. Radiographic images were taken from their legs in both stages. Although different surgeons operated on the cases, they all used the same method. After the surgery, they were checked up in 2, 6, 12, and 24 weeks and a second alignment view was taken from the patients.

    Results

    Thirty-nine patients underwent surgery for the correction of genu varus deformity and the follow-up time was between 6-48 months. There was no case of non-union and the ROM was perfectly restored in all the patients.

    Conclusion

    Although the rate of the success in the use of the locking plate in HTO is higher, the use of a 4.5-mm non-locking plate seems to have decent results, too; therefore, it could be used as an alternative yet functional fixation tool in HTO.

    Keywords: Varus deformity, 4.5 Non-locking plate, High tibial osteotomy, Open wedge
  • Akintayo Omojola*, Michael Akpochafor, Samuel Adeneye Pages 61-66
    Background

    The use of mini C-arm is required in many orthopedic surgeries as an image-guided tool. Studies have shown an unnecessarily high dose to patients if exposures are not properly optimized. Also, scatter radiation to personnel may increase the risk of cancer if an appropriate protective device is not used. 

    Objectives

    This study aims to determine the patient’s dose and scatter radiation to the surgeon, anesthetist, and scrub nurse. Also, a comparison will be made with other studies on this topic. 

    Methods

    A phantom was designed to simulate a patient on the operating table to produce scatter radiation. In the same vein, a mobile mini C-arm unit was positioned with the x-ray tube beneath the head and the image receptor above the operating table. Measurements were made with a measuring tape from the central axis to the position of the surgeon, anesthetist, and scrub nurse. The Entrance Surface Dose (ESD) was determined by placing the electronic dosimeter at the surface of the phantom to estimate the patient dose. Similarly, each personnel dose/dose rate from the central axis was determined using a similar detector. 

    Results

    The total average time for most orthopedic surgeries in the studied facility was 3.3 minutes. The estimated ESD to the patient was 25.03 µSv and the scatter radiation per patient reaching the simulated anesthetist, scrub nurse, and surgeon was, 3.75, 3.59, and 7.72 µSv, respectively. The estimated dose values per year to anesthetist, scrub nurse, and surgeon were 390, 373.36, and 802 µSv, respectively. 

    Conclusion

    The personnel recommended limit dose rate was <20000 µSv/y. The technical factor used and total exposure time from this study could have affected the radiation dose. This study showed that personnel was safe even without the use of lead apron. Nevertheless, the use of an appropriate protective device should be encouraged to ensure safety.

    Keywords: Simulation, Orthopedic, Radiation dose, Exposure, Personnel, Protective device, Entrance surface dose
  • Ali Andalib, Hossein Akbari Aghdam*, Emran Ahmadi Pages 67-72
    Background

    Trauma and traumatic injuries are the most common causes of disabilities among the young population in developing countries. Besides morbidity and mortality, traumatic injuries can significantly decrease the quality of life and life expectancy of the victims.

    Objectives

    Traumatic Spinal Cord Injury (TSCI) is an acute, traumatic lesion of the spinal cord. It usually produces economic problems that can emotionally and psychologically affect the patients. This study aims to evaluate spinal column fractures and TSCI in Iran.

    Methods

    In this study, we evaluated all of the cases diagnosed with TSCIs between 2012 and 2018. A total of 1014 patients were included in our study. Prevalence of spinal column fractures was evaluated and the percentage of each type of fractures was extracted. The need for surgery and the percentage of TSCI were also evaluated.

    Results

    The most common cause of trauma was vehicle and road accidents (83.4%) followed by falling (12.7%). A total of 21 patients (2.1%) died due to injuries. The incidence of TSCI among patients with traumatic spinal column fractures were 62 cases (6.1%). Also, 67.7% of patients with TSCI underwent surgery. Furthermore, we found that the lumbar area received the highest incidence of TSCI (38.3% of all TSCIs) followed by thoracic spine fractures (27.4% of all TSCIs). Also thoracic and cervical spine fractures were mostly associated with mortality compared with other sites of spine fractures (47.6% and 38.1% of all mortalities, respectively).

    Conclusion

    In our study, most cases (83.4%) were injured by road accidents which indicates the low safety of vehicles and roads in Iran. Epidemiological features of spinal column injuries and TSCI vary among different societies due to different causes. So far, this study is the first one to evaluate different spine fractures and TSCI and other associated factors in the Iranian population.The results indicate a high incidence of thoracic and lumbar fractures and a higher mortality rate in thoracic and cervical fractures.

    Keywords: Spinal cord injury, Epidemiology, Spinal column fractures
  • Zahra Yahoueian, Mona Najaf Najafi, Reza Habibzadeh Shojaie, Seyed MohammadAta Sharifi Dalooei, Hamid Hejrati, Ali Parsa, Farzad Omidi Kashani* Pages 73-78
    Background

    The widespread use of social networks among students seems to provide an appropriate opportunity to track the effects of the media on their educational capabilities. 

    Objectives

    We aimed to investigate the effect of virtual education (via Telegram messaging service during six months) on the knowledge of orthopedic residents of Mashhad University of Medical Sciences in the field of spine surgery.

    Methods

    This quasi-experiment study was conducted on 25 orthopedic residents with an Mean±SD age of 31.4±4.1 years. During a 6-month training course, 85 educational spinal cases were presented in the form of riddles, video questions, or case presentations and were discussed among orthopedic residents. Before and after the intervention, a reliable and valid exam comprising 70 multiple choice questions about different topics of spinal surgery was taken to evaluate the level of students’ knowledge. We used the annual residency promotion exam to compare the correlation coefficients obtained by Fischer exact test, paired t test, and independent t test for statistical analysis. 

    Results

    The Mean±SD score of the assistants’ knowledge in the pretest and post-test exams were 42.8±6 and 45.2±9.2 (out of a total score of 70). Despite the obvious increase, the values were not statistically significant (P=0.09, t=-1.7). The intervention was associated with an increase in the level of knowledge in 17 residents (68%) while in 8 (32%), this 6-month virtual training course has had no significant effect. In this regard, age, marital status, housing, activity level, or level of residency (from the first to fourth year) had no significant relationship with knowledge improvement. 

    Conclusion

    virtual spinal education for six months using the social network of Telegram could improve the level of knowledge in most orthopedic residents, although the observed difference was not statistically significant.

    Keywords: Education, Spine surgery, Telegram, Virtual training
  • Sayed Abdulla Jami, Shi Jiandang* Pages 79-86
    Background

    Chondrosarcoma is one of the common malignant bone tumors and is characterized by thin tumors. The cells produce tumor cartilage. It occur usually 3rd decade of life, affected more men than women.

    Objectives

    To perform alternate surgical procedures for remove tumor and obtain fully forearm functionality by reconstruction. 

    Methods

    A patient affected by a rare proximal radius chondrosarcoma bone tumor and it became malignant (grade III). Resection the tumor along with chemotherapy and radiotherapy was done. Surgical treatments are mainly recommended for most types of chondrosarcoma treatment. However, the treatment of chondrosarcoma clinically and surgically is controversial due to different techniques.

    Results

    Patients was fully recovered with excellent wrist and elbow joint functionality. Reconstruction of bones were fused by the support of metallic implants. There was no tumor recurrence occur during post-operative follow-up period.

    Conclusion

    Chondrosarcoma of bone generally has an excellent prognosis when optimal diagnosed and treated by an experienced team of specialists. Its clinical treatment is always challenging due to of the rarity of these lesions and few institutions having enough patients to study about it.

    Keywords: Resection, Reconstruction, Rare proximal, Radius, Malignant, Chondrosarcoma
  • Hamidreza Dehghani, Mehryar Khadem*, Milad Bahari Pages 87-92

    A ganglion cyst is a small sac of fluid that forms over a joint or tendon (tissue that connects muscle to bone). A 23-year-old woman, right hand dominant, and Laboratory expert, was referred with a 1-year history of a lump in the anterior aspect of her elbow associated with altered sensation in the anterolateral aspect of her left hand. Her elbow was painful and the mass progressive increased in size during the last 1.5 months. There was no history of trauma, injections or manipulation. The patient had no symptoms of fever, ulcers, or numbness. On physical examination, there was a tendered mass about 4 cm in diameter in the anterior aspect of the elbow. X-ray was normal and MRI confirmed a mass along with a radiocapitellar capsule. The cyst and radial nerve were explored through an anterolateral curved incision, with ligation of the radial recurrent vessels. The cyst was on the capsule of the radiocapitellar joint and posterior to the interosseous nerve at the proximal fibers on the edge of the supinator muscle. The cyst was identified as a ganglion clinically, and excised completely. Pathology finding  confirmed it. The lateral elbow pain disappeared immediately after surgery, with no neurological deficit. The patient returned to work after 1 month.

    Keywords: Elbow, Ganglion cyst, Case report
  • Ali Tabrizi*, Ahamdreza Afshar, Hassan Taleb Pages 93-96
    Introduction

    Radial neck fracture is one of the rare traumas in the upper extremity among the children accounting for 5%-10% of the pediatric elbow injuries. The valgus strain-induced radial neck displacement often ranges from 10° to 90. Rotational displacement with 180° rotation is very rare. 

    Case Presentation

    In this case report, we present a 6-year-old child who had radial neck fracture with 180 rotation and joint surface tilt toward the distal direction after falling on her outstretched hand. The close reduction was conducted under the fluoroscopic guide and the radial neck-shaft was restored with 15 angulation. The elbow was immobilized by a long forearm cast for 3 weeks. Based on conventional radiography taken after 3 weeks, a complete union was achieved. Six-month follow-up showed no radial growth disturbance and radial head avascular necrosis. 

    Conclusions

    The radial head could be displaced in the form of 180° rotation during the radial neck fracture. In this regard, careful attention to the joint surface is important to minimize the lateral displacements or angulation and to avoid any misdiagnosis. The closed reduction was a successful treatment and caused no complications.

    Keywords: Fracture dislocation, Radial neck fracture, Radial head fracture