مجله جراحی استخوان و مفاصل ایران
سال هجدهم شماره 1 (پیاپی 68، زمستان 1398)

Correct-level surgery is one of the most important concerns in the treatment of patients with adolescent idiopathic scoliosis (AIS). Variations in vertebral number can potentially result in wrong-level surgery. It is possible that the incidence and type of these variations be affected by different factors such as ethnicity. In the current retrospective study, the prevalence of these variations in Iranian AIS patients was investigated.  

Between 2012 to 2017, spinal fusion was performed for the treatment of AIS in 125 patients. The thoracic and lumbar vertebrae were enumerated on posteroanterior radiographs. The first thoracic vertebra was the one attached to the first pair of ribs. Enumeration was continued in a caudal direction. The lumbar level initiated just below the last vertebra with a pair of associated ribs.

Abnormal vertebral enumeration was found in 18 patients (14.4%). The prevalence of abnormal lumbar enumeration was higher than thoracic vertebrae (10.4% versus 4%). Eleven thoracic vertebrae were found in 5 patients (4%). Four lumbar vertebrae were found in eleven patients (8.8%). There were two patients with six lumbar vertebrae (1.6%). There was no patient with abnormal enumeration of both thoracic and lumbar vertebrae.

The current study showed a relatively high rate of atypical number of thoracic and lumbar vertebrae in Iranian AIS patients. It is necessary to enumerate the vertebrae on the basis of an organized protocol preoperatively to prevent wrong-level surgery in AIS patients.

Nowadays, bone grafts are used in veterinary and human orthopedic to stimulate fracture healing, accelerate joint connection, and healing of bone defects. In this study, we carried out the radiological and histopathological evaluation of the effects of nano-hydroxyapatite concurrent with bone marrow treatment on rabbit fracture repair.

This experimental study was performed in the spring and summer of 2019 on 20 male New Zealand white rabbits (12-month-old, weight=2 kg). The samples were randomly divided into four groups, and bone segments were removed from the radius. In the first group (n=5) (control), the bone defect remained empty and no substance was injected. Meanwhile, the defects in the second, third, and fourth groups (sample size of five in each group) were filled with nano-hydroxyapatite, bone marrow, and combination of nano-hydroxyapatite and bone marrow. Radiographs of the radius in each rabbit were taken at 2nd, 4th, 6th, and 8th post-operative weeks, and bone biopsy was performed in the eighth week for histopathological assessment. In addition, the radiographs and samples were evaluated in terms of union, ossification activity, and re-forming.

In this study, there was a significant difference among the groups in the second, fourth, sixth, and eight weeks regarding radiographical assessments (P<0.05). However, the difference was more evident in the sixth week, when a significant difference was found between the nano-hydroxyapatite group and a combination of bone marrow and nano-hydroxyapatite group (P=0.02). In this regard, the latter had a better performance, compared to the former. In histopathological evaluation, the group of a combination of nano-hydroxyapatite and bone marrow showed higher ossification activities, compared to the control group.

According to the results of the study, the group of a combination of nano-hydroxyapatite and bone marrow had a better function in terms of bone healing, compared to the other two groups. Therefore, it is suggested that the method be applied to larger animal samples to confirm its clinical implications.

Total knee arthroplasty (TKA) is one of the most common orthopedic surgeries in the world. The use of tourniquet is recommended by some surgeons around the world. However, the evidence of its usefulness in replacing the knee is still uncertain. In the present study, we assessed the effect of using tourniquet in reducing bleeding during and after operation and the amount of transfusion requirement in TKA surgery.

Methods and Materials:

Patients referred to Imam Reza and Tabriz universal hospitals for TKA surgery in case of absence of hemorrhagic diseases and non-use of anticoagulants were included in this study. In this study, 8 (25.8%) males and 23 (74.2%) females were present with an average age of 63.6 ± 7.86 with a minimum age of 52 years and a maximum age of 81 years. Patientschr('39') Randomization applied considering balanced mean age and body mass index (BMI). In the first group after the patientchr('39')s preparation and induction of anesthesia, the tourniquet was considered and surgery was performed and the tourniquet was released immediately after the cement was inserted. In the second group after the patientchr('39')s preparation and induction of anesthesia, tourniquet was not used until cementation and after that again deflated. All surgical procedures were performed by the same and experienced surgical team using spinal epidural anesthesia. The standard surgical procedure was considered by surgeons.

23 (74.2%) patients did not need blood transfusion, and 8 (25.8%) patients needed transfusion. The average duration of surgery was 75.81 ± 26.3 minutes with a minimum duration of 30 minutes and a maximum of 125 minutes. The mean preoperative HB level was 12.66 ± 1.67, which was 11.09 ± 1.62 after surgery.

In conclusion, the use of tourniquet in patients undergoing TKA surgery reduces the duration of surgery but does not significantly affect hemoglobin maintenance after surgery. In other words, the use of tourniquet does not have an effect on reducing the need for blood transfusion.

The foot quickly becomes a problem in diabetics, so itchr('39')s important to diagnose problems and treat them early. One of these problems is the Charcot foots. Charcot problem is a type of deformity in the joint, also called neuropathic arthropathy. Because of this problem, the foot is removed from its natural axis. To compensate for this abnormality, the surgeon removes some of the bone and places the other bones of the foot next to each other so that the foot returns to its normal position. To stabilize the bones next to each other, stabilizers such as plates on the two common surfaces of the medial and plantar or intramedullary nails are required. This study examines the biomechanical behavior of these three methods. One of the purpose of this study was to model and simulate as close as possible to the actual anatomy of the position of the study site. For this purpose, the images recorded by CT- Scan method were used by a 40-year-old woman and were transferred to mimics software to complete the geometric model. Then, the model was subjected to biomechanical analysis in abaqus19.0 software. By comparing the types of structures studied, in the nail model, more stress on the implant and less stress on the bone were observed. The plantar plate method is closer to the foot without implants in terms of maximum stress and is more suitable in this regard.

The aim of present study was to examine the prevalence of sport injuries in 14th sports and cultural Olympiad of Iranian universities and higher education institutes for male and female students.

The present study is the retrospective-descriptive and cross sectional study. Statistical population of this study was all of the students who injured in 14th sports and cultural Olympiad of Iranian universities and higher education institutes for male and female students. The daily incidence of injuries was collected using injury report form, completed by team physicians.

A total of 1430 injuries were documented, consisting of 535 injuries in female and 895 in male students. The most common types of injuries were muscle cramp, knee and finger injuries respectively. Most of the injuries of male participants were from the following: Basketball 14 types, handball 12 types, futsal and free-style wrestling 14 types. For the female students the common types of injuries were in: Handball 12 types, volleyball 9 types, and karate 7 types.

These findings are useful to medical staff to cover the competition and also to design prevention strategies to minimize injury.

Intertrochanteric fracture is one of the most common fractures in elderly due to poor bone stock. The treatment of choice in these patients is surgery but choosing the proper method is very important. If this fracture occurs in a femur that has already undergone surgery, the treatment challenges are more. The patient reported in this study is an 80-yaer old woman who underwent open reduction and internal fixation (ORIF) with plate because of right femoral shaft fracture 20 years ago, and the fracture was completely healed. This patient suffered an intertrochanteric fracture on the same side following the fall and was referred to our center, who treated by remove of the previous plate of the femoral shaft and close reduction and internal fixation of the intertrochanteric fracture with long gamma nail in one stage. According to our information, no similar case with this management has been reported in the literature so far.