فهرست مطالب

  • Volume:7 Issue: 3, 2020
  • تاریخ انتشار: 1399/06/30
  • تعداد عناوین: 8
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  • Hasan Ghandhari, Farshad Nikouei, Ebrahim Ameri, Mansour Karimi, Mohammadreza Shakeri * Pages 97-104
    Background

    Severe angular kyphosis is one of the uncommon etiologies of compressive myelopathy and hence, many aspects of this myelopathy are unknown. 

    Objectives

    In this study, we report a series of 12 patients with compressive myelopathy in severe angular kyphosis, as well as the result of surgical treatment in these patients.

    Methods

    In a retrospective study, we included 12 patients with the progressive or sudden onset of paraplegia caused by severe angular kyphosis. The neurological status of the patients was evaluated with the American Spinal Injury Association (ASIA) typing system before the operation and at four time points after the operation (1 day, 1 week, 6 months, 1 year). The main surgical interventions included anterior corpectomy, anterior spinal fusion, and posterior spinal fusion with or without instrumentation and with or without decompression.

    Results

    The Mean±SD age of the patients was 41.9±16.4 years, ranging from 14 to 59 years. The etiology of myelopathy was congenital kyphosis in 10 patients (83.3%). The Mean±SD duration of paralysis was 6.4±6.6 months. The Mean±SD percentage of cord thinning at the apex was 61.7±17.5%. Bowel or bladder dysfunction was present in 6 patients (50%) before the surgery that was resolved in 5 patients after the surgery. One year after the surgery, the ASIA typing was improved in 9 patients (75%) and remained the same as preoperative status in 3 patients (25%).

    Conclusion

    Surgical decompression corrects the neurological symptoms in the majority of cases with compressive myelopathy caused by severe angular kyphosis.

    Keywords: Compressive myelopathy, Kyphosis, Neurological symptoms
  • Ali Yeganeh, Hossein Farahini, Mikaiel Hajializade, Shadi Abdollahi Kordkandi, Reza Amiri, Mani Mahmoudi, Seyed Mani Mahdavi, Mehdi Moghtadaei* Pages 105-114
    Background

    There is no concrete information about many aspects of femoral fracture, including its best management. We hypothesized that reporting the outcomes of patients managed with the same therapeutic algorithm would help the selection of best management strategies. 

    Objectives

    In this study, we report the outcomes and complications of femoral head fracture in patients treated according to our therapeutic algorithm.

    Methods

    In a retrospective review of a prospectively collected orthopedic database, 41 patients with femoral head fractures were evaluated. Fractures were classified by the Pipkin classification system. The clinical outcome was assessed with the Harris Hip Score (HHS). In brief, our therapeutic algorithm included conservative treatment for the congruous joint of Pipkin type I and II, total hip arthroplasty for unfixable fractures of Pipkin type III, and IV, and fixation via three approaches otherwise (Smith-Peterson, Kocher, or surgical dislocation).

    Results

    Of 41 cases, 34 cases (82.9%) had uncomplicated outcomes. The number of associated injuries was significantly more in patients with complicated outcomes (P=0.049). Avascular necrosis was the most common complication (n=5, 12.2%). Their Mean±SD HHS was 85.1±109. Accordingly, HHS scoring had poor, fair, good and excellent results in 4 (9.8%), 6 (14.6%), 13 (31.7%), and 17 (41.5%) patients, respectively. The mean HHS score was significantly lower in patients with complicated outcomes (P=0.007). The mean HHS score was not associated with types of fracture (P=0.071).  

    Conclusion

    The outcome of femoral head treatment was good to excellent in the majority of patients. However, patients who underwent total hip arthroplasty or had associated injuries are at higher risk of an inferior outcome.

    Keywords: Femoral head fracture, Total hip arthroplasty, Avascular necrosis, Pipkin classification
  • Pramod Valsalam*, Ibad Sha I, Ajin Edwin Pages 115-120
    Background

    The diagnosis of ACL tear is aided by clinical tests and imaging evaluation with MRI. The main clinical tests include Lachman, Anterior Drawer  and Pivot shift test. A newer clinical test called lever test was proposed recently with higher sensitivity compared to traditional tests.

    Objectives

    To investigate the sensitivity, specificity and other statistical parameters of newly proposed  lever test for ACL injury along with other established tests, Lachman test, Anterior Drawer test and Pivot Shift test.

    Methods

    242 patients consecutive patients with a complaint of knee pain  were included in the study over a period of 4 years between ages of 18 to 50 years. They were evaluated with clinical tests Lever test, Lachman test, Anterior Drawer test and Pivot Shift test without anaesthesia and under anaesthesia. Results of diagnostic arthroscopy was taken as gold standard.

    Results

    A total of 242 consecutive subjects were eligible during the study period, of which 182 were males while the remaining 60 were females. Compared to gold standard, without anaesthesia the lever test had a sensitivity of 85.57%, specificity of 25.00%, PPV of 82.18%, NPV of 30.00%, and accuracy of 73.55%. Similarly regarding other tests the sensitivity and specificity without anaesthesia were, Lachman test sensitivity of 93.81%, specificity of 20.83%, PPV of 82.73%, NPV of 45.45%, and accuracy of 79.34%, Anterior Drawer test sensitivity of 80.41%, specificity of 33.33%, PPV of 82.98%, NPV of 29.63%, and accuracy of 71.07%, Pivot Shift test sensitivity of 40.21%, specificity of 91.67%, PPV of 80.17%, NPV of 95.12%, and accuracy of 50.41%.  The results under anaesthesia compared to arthroscopy findings were Lever Test Lachman Anterior Drawer Pivot Shift Accuracy, % 77.69, 79.34, 71.90, 80.99 Sensitivity, % 91.75, 98.97, 93.81, 98.97, Specificity, % 20.83, 36.33, 20.83, 58.33 PPV, % 82.41, 81.36, 58.33, 87.95 NPV, % 38.46, 66.67, 39, 36.84.

    Conclusion

     The lever test needs to be studied extensively considering multiple variables like correlation with BMI, position of wrist, partial injuries and also interobserver variations before it gets standardized into routine examination.

    Keywords: Anterior cruciate ligament, Diagnosis, Knee, Lachman test, Lever test, Sensitivity, Specificity
  • Hamidreza Yazdi, Mohammad Taher Ghaderi *, Alireza Yousof Gomrokchi, Parham Pezeshk Pages 121-128
    Background

    Diaphyseal tibial fractures are the most frequent bone fractures in the body and are usually treated with intramedullary nailing method. However, this approach is responsible for 41% of the rotational deviation. 

    Objectives

    This study aimed to provide a radiographic evaluation method to determine tibial malrotation in closed fixation of tibia bone fractures during or after the operation.

    Methods

    This study was conducted in a university hospital from May 2015 to March 2016. All patients referring to the hospital with the complaints of minor trauma around the ankle and knee requiring radiographic evaluation of both joints were enrolled in the study. The inclusion criteria included being 20 and 50 years old; having normal axial, sagittal, and coronal lower limb alignment; lacking previous lower limb injury (such as fractures of the tibia or fibula), ankle or knee sprain; not having previous lower limb surgery, metabolic or congenital bone diseases, or malignancy. In all cases, a standard Anteroposterior (AP) radiograph of the knee was taken, and then, without changing the limb position or image setting, an AP radiograph of the ankle was obtained. The overlap between the distal tibia and fibula was measured in the PACS program environment.  

    Results

    Fifty cases were included in this study. The Mean±SD ages of males and females were 29.08±2.49 years and 31.46±2.04 years, respectively. The range of distal tibia-fibula overlap one centimeter above the tibiotalar joint line was 7.81 to 9.09 mm (confidence interval of 95%), and its percentage to the fibula shaft width at the same level was 49.43% to 54.35%.

    Conclusion

    According to the results, distal tibia-fibula overlap when the knee is in the true AP position, regardless of the side and gender, is 7.81 to 9.09 mm or 49.43% to 54.35%.

    Keywords: Radiographic method, Tibial rotation, Tibial malrotation, Tibial fracture fixation
  • Ali Yeganeh, Mehdi Moghtadaei, Amir Sobhani, Mehdi Abbasi, Habib-O-Lah Gorgani, Babak Otoukesh*, Shayan Amiri Pages 129-134
    Background

    Despite the advances in the methods of treating femoral neck fractures, treating some types of these fractures is still challenging. Therefore, understanding these fractures, their treatments, and the ways to control their complications are necessary for the orthopedists. 

    Objectives

    In this study, we evaluate patients with acute femoral neck fractures with respect to the type of fractures and complications.

    Methods

    In a 4-year cross-sectional study, the patients with acute femoral neck fractures who were admitted to Rasoul Akram Hospital were selected. Anatomical features and the type of fracture were determined by using plain radiography and CT scan. Fractures were classified according to the Garden classification. The patients were also evaluated for any postoperative complications for at least 6 months.

    Results

    A total of 124 patients were enrolled. The Mean±SD age of the patients was 64.9±12.7 years and 87 (74.4%) were male. Based on the Garden classification, 7 fractures (5.9%) belonged to type I, 10 fractures (8.5%) to type II, 48 fractures (41%) to type III, and 52 fractures (44.4%) to type IV. Avascular necrosis in 28 cases (23.9%), non-union in 14 cases (12%), and claudication and pain in 35 cases (29.9%) were noted. The mean age of patients was different between fracture groups (P=0.01). 

    Conclusion

    Our results showed that most of the patients with femoral neck fractures admitted to Rasoul Akram Hospital were associated with displacement. In this study, the most common complications were pain and claudication, avascular necrosis of the femoral head, and nonunion. In sum, further displacement of the fracture will result in more complications.

    Keywords: Osteonecrosis, Femoral neck fracture, Classification, Fractures, Malunion
  • Hamidreza Dehghani Nazhvani, Sam Bemani Lirgeshasi, Milad Bahari* Pages 135-140

    Isolated fractures of the trapezoid are very rare. Of all of the fractures of the carpus, the most common happens for the scaphoid, which represents 68.2% of all carpal fractures. In contrast, trapezoid fractures represent 0.4% of all carpal injuries. We present a rare case of a trapezoid fracture associated with a scaphoid fracture that was successfully treated with percutaneous fixation with a headless cannulated compression screw and the patient had a full functional recovery.

    Keywords: Trapezoid, Scaphoid, Fracture, Carpal, Wrist, Hand surgery
  • Farid Najdmazhar, Tina Shooshtarizadeh, Seyed Matin Sadat Kiaei* Pages 141-146

    Synovial Sarcoma (SS) is a rare and aggressive sarcoma that usually occurs around the knee joint; it rarely involves the hand. Joint involvement by SS is extremely rare. We report a case of wrist intraarticular SS presenting with chronic wrist pain. The patient underwent surgical excision alongside with local radiotherapy and chemotherapy. After 24 months of follow up, there was no recurrence or metastasis. Intraarticular SS should be in a differential diagnosis list of chronic wrist pain even though it is extremely rare.

    Keywords: Intraarticular, Synovial sarcoma, Wrist pain, Hand
  • Salman Ghaffari, Mehran Razavipour, Parastoo Mohammad Amini* Pages 147-152


    McCune Albright syndrome (MAS) is characterized by endocrinopathies, café-au-lait spots, and fibrous dysplasia. Bisphosphonates are the most prescribed treatment for reducing the pain and their long-term use has been associated with atypical fractures of cortical bones like femur in patients. We present a 23-year-old girl diagnosed with MAS. She had an atypical mid-shaft left femoral fracture during simple walking. She had a history of long-term use of Alendronate. Because of the narrow medullary canal instead of the intramedullary nail, We used 14 holes hybrid locking plate for the lateral aspect of the thigh to fix the fracture and 5 holes dynamic compression Plate in the anterior surface to double fix it, reducing the probability of device failure. With double plate fixation and discontinuation of alendronate five months after surgery complete :union: achieved

    Keywords: Atypical Femoral Fracture in McCune-Albright Syndrome