مجله جراحی استخوان و مفاصل ایران
سال نوزدهم شماره 3 (پیاپی 74، تابستان 1400)

Correlation between Diabetes Mellitus (DM) and musculoskeletal problem has been established in many of the past studies. There are reports of high prevalence (up to 63%) of upper extremity impairment in diabetic patients. The main aim was to conduct a study to determine the prevalence of diabetes and prediabetes in patients with shoulder complaints. It may help the treating physician in managing patients with shoulder problems.

During a period of six months from February 2018 to August 2018, patients who consulted shoulder clinic with complain of shoulder pain were included in this cross sectional study. Eligible patients were enrolled after informed consent was obtained. A uniform checklist was completed for every patient. The key components of the checklist were: demographic data, fasting blood glucose(FBS), diagnosis, body mass index( BMI).Diagnosis of diabetes and prediabetes was done by FBS level( FBS between 100 to 126 considered prediabetes and more than 126 as diabetes.

564 eligible patients were enrolled in the study. Of the 564 patients, 18.8% had DM, 25.9% had pre-diabetes, and 55.3% had normal fasting blood glucose. A higher proportion of men had abnormal fasting glucose compared to women (54% and 33.9% respectively). There was no significant difference in blood glucose levels in respect to different shoulder pathologies (P = 0.191).

This study shows that population with shoulder complaint have a higher prevalence of DM than the normal population. This high proportion of patients with impaired blood glucose levels and shoulder pain necessitates further research in this course and advancement towards risk factors of DM. It is more important in community areas where routine screening of diabetes is not performed.

Postoperative Deep Vein Thrombosis (DVT), a subtype of Venous Thromboembolism (VTE), is a significant preventable cause of morbidity and mortality worldwide. VTE is estimated to occur at a rate of one per 1,000 people per year, with DVT accounting for approximately two-thirds of these events. DVT continues to be a common complication of knee arthroscopy. The purpose of this study is to determine the prevalence of DVT in patients who have undergone arthroscopic knee surgery.

Patients over the age of 18 years who underwent arthroscopic knee surgery in a teaching hospital were evaluated for VTE clinically and via lower limb Doppler ultrasonography prior to, three days after, and four weeks after surgery. The incidence of DVT was determined and associated with risk factors such as age, sex, duration of immobility, and duration of surgery. Afterward, statistical analysis was performed on the data.

The prevalence of DVT was 3.1% in 318 patients undergone knee arthroscopy with a mean age of 34.31 years. The mean duration of surgery was 96.30 minutes across all patients. In 96.9% of patients, there was no evidence of DVT. Additionally, there was no significant association between DVT prevalence and gender, age, surgery type, duration of surgery, or presence of edema in patients (p = 0.551). The patients' mean duration of absolute rest was 61.89 hours. Absolute rest time was significantly longer in patients with positive DVT than in patients with negative DVT (p = 0.001).

While knee arthroscopy can be performed as an outpatient procedure, the risk of postoperative DVT is unknown. The incidence of DVT following arthroscopic knee surgery was 3.1% in this study, a necessary precondition for perioperative thromboprophylaxis.

Cervical spine injuries often cause disability and adversely affect the overall performance and life quality of people. Therefore, recognition of the damage and dysfunction of the cervical spine and biomechanical response to external stimuli is of paramount importance. Accordingly, finite element (FE) modeling can help researchers to access the internal stresses and strains in the bones, ligaments and soft tissues. The present study aimed to compare the biomechanical behavior of the cervical spine before and after trauma.

In this study, we developed a healthy model along with two different traumatic injuries of the cervical spine modeled by the FE method. The results of the models were compared under static loading. 

We estimated and evaluated three parameters of intervertebral rotation, facet joint force and intra-disc pressure by considering follower load. The results of the mentioned parameters were evaluated in the two traumatic injury models and the healthy model in flexion, extension, side bending and axial rotation movements at all levels.

According to the results, trauma modeling caused changes in the biomechanical behavior of the model, including decreased range of motion in the traumatic injury models, reduced intra-disc pressure and increased facet joint force. This structural disruption in this complex system caused abnormal behavior in various movements. According to the results, the lack of improvement of the biomechanical behavior of the model would cause spinal instability and could increase the probability of injuries in different segments of the lower cervical spine in the long term.

Sever disease is a common cause of heel pain in growing adolescents. The aim of this study to prevalence of Sever’s diseasein children in age 5to15 referred to Poursina hospital during 2015-2014

This study designed as descriptive-cross sectional study on 88 children 5 to 15 years admitted to Poursina Hospital in 2015-2014, who had a definite diagnosis of sever disease with regard to clinical symptoms and specialist physician diagnosis were identified. These patients had no evidence of fracture or tumor or deformity in the distal to the leg, infection, reactive arthritis, and rheumatoid arthritis during the past 12 months. Patient demographic and contextual information such as age, sex, height, weight, and patient records were recorded from the patient and the patient family. Then data were analyzed, using SPSS, version 21.

Sever disease prevalence in the study period was observed 1/86. The mean age of patients was 10.28 ± 3.92 years. The highest percentage of patients with sever disease in children aged 5 to 15 were males (76.1%). In this study, 100 percent of patients with sever and painful limitation of dorsiflexion and gastrocnemius soleus equines foot / soleus. In this study Chi-square test showed that the gastrocnemius / soleus and professional sports history statistically significant correlation (P=0.0001).

Severe disease is more common in 5 to 15 year old male children doing professional sports, but further research is needed.

In medical researches, health has always been regarded as one of the main issues. In sports, particularly martial arts, which are associated with higher rates of injuries, health is of higher significance. Accordingly, more researches and scientific reviews are required for the identification and recognition of physical injuries. Various studies have been performed on sports injuries, most of which used statistical methods and qualitative approaches. Due to the importance of the issue, a more comprehensive approach is required for the systematic and scientific identification of sports injuries of the joints and body organs of martial arts athletes. In this study, for identifying martial arts injuries, we used a managerial decision-making method based on the principles of mathematical modeling. The advantage of this method is that based on pairwise comparison and using the diagnoses of the professionals and orthopedic specialists, causes and interactions can be identified. Therefore, this method can identify the injuries affecting the organs and joints and determine their susceptibility and importance.

Most reports on the underlying problem of complete hip replacement are related to its loosening. Several important factors such as the implant features, the replacement process, the use and amount of bone cement, and the patient's lifestyle affect the loosening. The aim of this study was to provide an analysis of the dynamic stresses and strains at the interface between the bone and the implant in different phases of walking in order to determine and develop biomechanical parameters of loosening.

A two-dimensional model including femur and its artificial joint has been used in numerical simulation with ADINA software based on finite element method. There is a dynamic load applied to the joint head corresponding to the normal walking cycle of a person with 75 kg weight.

The results show a difference between stress and strain in the medial and lateral edge of the bone-implant interface, which indicates a risk area for loosening. The amount of strain difference at the interface with about 1.6% and stress reaches about 5.7 MPa.

The greatest strain difference occurred in the lowest area of the implant stem, which indicates the possible occurrence of separation in implant loosening. This information can also be used in surgical strategies for hip replacement and is also important for optimal mechanical design of the implant.

There are some relatively definite indications for fixing these problems which can be as the surgery with Osteotomy and the deformation and making the bone fixed in new location. There are so many techniques in this field with respect to the surgery and the kind of osteotomy, and with respect to the kind and fixation tool.Genovalgum is usually a disorder in femur distal and this point can be repaired by osteotomy. From the past, the blade plate is an attractive option for the fixation which can be harder than newer methods like lockable blade-plates for the younger surgeons. In this research, our goal was to present a new design of blade plate for more easiness in tool installation and test the finite element for making sure of the effectiveness of the new tool. The goal of this research is to design a modular sample of blade plate and the biomechanical comparison of these two states in the finite element form. In this research, the biomechanical behavior of these two methods with pseudo-static loading on the made model in the finite element software.

The CT-Scan images were transformed to Mimics software. Then, the model under biomechanical analysis was placed in abaqus19.0 software in pseudo-static form. The bone was considered as orthotropic and stainless-steel implant.

In the comparison of the tension of blade plate and bone, the tension on the blade-plate and bone has been reduced in modular blade plate which is possibly related to the energy waste in the connection of blade and plate. The strain of modular blade plate is significantly less than the older blade plates, but the strain of the bone without orthosis is much more similar to the previous blade plate with respect to the strain of the bone

Primary Epithelioid Hemangioendothelioma (EHE) of spine is an extremely rare malignant vascular neoplasm with unpredictable outcome. As a malignant tumor, total resection offers the best possible disease -free survival, while the location poses difficult technical problems .

A 38-year-old man with a large tumor of T10 vertebra was investigated, had biopsy-confirmed diagnosis of EHE, and underwent simultaneous anterior and posterior resection and reconstruction with anterior strut grafting and posteriorly instrumented fusion.

The patient has had good a post-operative course with no neurological damage and no recurrence found in the one-year follow-up .

EHE of thoracic spine is a rare finding and a well-planned total surgical excision can produce a good outcome.