Journal of Research in Orthopedic Science
Volume:10 Issue: 1, Feb 2023

Incidental dural tears are among the most critical complications in spine surgery. It may be identified either intraoperatively or postoperatively. Dural tears management is multifaceted, influenced by factors such as the location of the tear and actual conditions. Despite numerous techniques reported in the literature for dural tear repair, spine surgeons have no consensus on this matter. 

This narrative review explores existing articles and uses practical experience to propose an algorithmic approach for dural tears management. Additionally, this review evaluates other aspects of dural tears, including classification, risk factors, repair methods, the utility of drains, antibiotic prophylaxis, and dural tears in the context of vertebral fractures. 

By combining evidence-based recommendations with clinical expertise, this study seeks to provide a comprehensive understanding of dural tears in spine surgery and offer guidance for optimizing patient outcomes.

An algorithmic approach integrating evidence and clinical expertise can guide effective management of dural tears in spine surgery, improving patient outcomes.

Osteoporosis is a skeletal disorder characterized by reduced bone strength leading to an increased risk for fracture. Patients with osteoporotic fractures are at an increased risk for refracture. Understanding the crucial importance of preventing recurring fractures to maintain physical activity and improve the quality of life (QoL) for individuals with osteoporosis underscores the necessity of precisely examining the factors that contribute to these fractures. 

This study evaluates the prevalence and risk factors associated with recurrent osteoporotic fractures, emphasizing the critical importance of targeted interventions for fracture prevention and overall well-being.

This observational prospective cohort study focused on patients with osteoporosis-related fractures attending the Fracture Liaison Service (FLS) Clinic of Shafa Yahyaeian Orthopedic Hospital in Tehran City, Iran, from 2021 to 2023. The hospital is affiliated with Iran University of Medical Sciences. The census-based sampling method included all eligible patients with a history of osteoporotic fractures. Demographic and clinical information were collected.

Out of 1532 osteoporotic patients with a fracture history, 282(18.4%) experienced refractures between 2021 and 2023. Regression analysis demonstrated that higher age (P=0.005; OR=1.033) and female gender (P=0.010; OR=0.437) were the only factors significantly associated with refracture (R2=0.040). Fracture Recency evaluation indicated an mean interval of 2.8±2.5 (range: 0.5-12) years between the last two fractures. Furthermore, recurrent fractures after the index fracture occurred in 41% of patients during the first year.

The prevalence of refracture was 18.4%, with higher age and female gender as independent predictive factors. Notably, fracture recency was mainly observed in the first year.

Total knee arthroplasty (TKA) is an effective surgical procedure for alleviating pain and improving function in patients with severe knee osteoarthritis. However, significant intraoperative blood loss is a common concern, often necessitating blood transfusions and increasing the risk of complications. A tourniquet during TKA is a widely accepted technique to reduce blood loss and improve implant fixation, but it may lead to postoperative pain and restricted range of motion (ROM). 

This randomized clinical trial aimed to compare intraoperative blood loss, postoperative ROM, and pain in patients undergoing TKA with and without a tourniquet.

A total of 34 patients were randomized into two groups: 18 patients in the tourniquet group (TG) and 16 in the non-tourniquet group (NTG). Intraoperative blood loss, postoperative hemoglobin levels, ROM, thigh pain, and straight leg raise (SLR) were measured at multiple intervals postoperatively. 

The results showed that the TG group had significantly lower intraoperative blood loss (236.11 mL vs 531.25 mL, P<0.001) and higher postoperative hemoglobin levels than the NTG group. However, the TG group experienced significantly lower ROM on the first and second postoperative days (P<0.001) and reported greater thigh pain. By six months postoperatively, the two groups had no significant difference in ROM.

Using a tourniquet in TKA significantly reduces intraoperative blood loss but is associated with increased immediate postoperative pain and reduced early ROM. However, these adverse effects do not persist long-term. Individualized patient care and strategies to optimize tourniquet use are recommended to balance these outcomes.

Elbow fractures are among the most common injuries in children. While elbow fractures are rarely life-threatening, their significance lies in potential complications. Therefore, accurate and timely diagnosis and appropriate treatment are essential for elbow fractures. Identifying the frequency of pediatric visits with elbow injuries, categorized by fracture type and treatment method, is necessary for optimizing treatment planning.

This study addresses the knowledge gap regarding pediatric elbow injuries by investigating the frequency, fracture types, and treatment methods among children seeking medical attention at Shafa Yahyaiyan Orthopedic Hospital, Tehran, Iran.

This cross-sectional, descriptive study comprised children under 18 presenting to the Emergency Department of Shafa Yahyaiyan Orthopedic Hospital due to elbow injuries from September 20, 2020, to March 20, 2021. Demographic, clinical, and radiologic variables were collected using medical records. The statistical analysis was performed using the SPSS software, version 22, with a significance level set at 0.05.

A total of 507 pediatric cases with elbow injuries were analyzed, including 54% males. The average age of the cohort was 3.44±4.73 years. Pulled elbow emerged as the most common injury in 52% of cases. Among fractures, supracondylar humerus fractures had the highest prevalence. Closed reduction was the predominant intervention, followed by casting. There was no significant association between gender and injury type (P=0.211). However, a statistically significant relationship was identified between age and injury type (P=0.0001). 

This study revealed that pulled elbow and supracondylar humerus fractures were the most common injuries, with the closed reduction being the predominant treatment method. While gender did not significantly correlate with injury type, age showed a noteworthy association, indicating an increased risk with advancing age.

Reducing pain is the most important goal of total knee arthroplasty (TKA). 

The present study aimed to evaluate the effect of systemic corticosteroids on pain control after TKA.

The present study was performed as a randomized controlled clinical trial study on 75 patients. Patients were randomly assigned to three groups (n=25): the dexamethasone (Dex) group received Dex 8 mg/IV at three times (24 mg), the Met group received methylprednisolone  (Met)125 mg/IV, and the control group received isotonic fluid IV (placebo). Primary outcomes included knee nausea, vomiting, and pain 4, 12, and 24 hours after surgery. The pain was assessed using the visual analog scale. Also, patients’ performance indices were evaluated based on the Western Ontario and McMaster universities osteoarthritis (WOMAC) index after surgery.

The mean scores of pain, 4, 12, and 24 h after surgery in the Dex and Met groups were significantly lower than the placebo group (P<0.001). The mean score of WOMAC and subscales in the Dex, Met, and placebo groups was not significantly different. Postoperative nausea was reduced significantly in the Dex group (P=0.002).

This study shows that administering 24 mg Dex or 125 mg Met significantly reduces pain and nausea 6, 12, and 24 hours after TKA. The effect of Met is significantly less than Dex in controlling pain and nausea. In contrast, Dex and Met had no impact on improvement based on the WOMAC index in patients after TKA.

In carpal tunnel syndrome (CTS) surgery, standard incisions to release the median nerve often leave scars that can cause cosmetic concerns, such as hypertrophic scarring or wrist flexion contracture. Previous studies have explored the benefits of mattress sutures in various surgical contexts, such as meniscus and rotator cuff ruptures.

The present study compared the scars of single interrupted and horizontal mattress sutures in median nerve open surgery.

This randomized controlled trial included 60 hands with CTS treated at Rasoul-Akram, Kasra, and Moheb-Kosar hospitals, Tehran, Iran from September 2020 to October 2021. Patients were randomly assigned to two groups: Group 1 (30 hands) received single interrupted sutures, and group 2 (30 hands) received horizontal mattress sutures. Scar characteristics, including height, width, and color, were assessed six months after surgery.

The sample comprised 84.3% female patients, with a mean age of 59.75±11.54 years. The right hand was involved in 61.6% of cases. No significant preoperative demographic differences were noted between the groups (P>0.05). Six months after the surgery, the horizontal mattress group had significantly lower scar widths (2.17±0.13 cm, P=0.012) and heights (P=0.021) than the single interrupted group. No significant difference was found in hyperpigmentation (P=0.098).

Horizontal mattress sutures resulted in significantly smaller and less noticeable scars than single interrupted sutures in median nerve release surgery. This technique may offer fewer complications and better cosmetic outcomes for CTS patients.

Osteoarthritis (OA) is a degenerative joint disorder causing pain and disability. The present treatments are inadequate to improve the underlying pathogenesis of OA. Melatonin, because of its chondroprotective, anti-inflammatory, and antioxidant properties, may have a role in the management of OA. Duloxetine is presumed to modulate pain through serotonergic and noradrenergic pathways. In the present study, as a first study, melatonin has been compared with duloxetine for its efficacy in reducing OA-related knee pain.

This randomized controlled trial (RCT) study involved 60 knee OA patients treated at Imam Hossein Hospital in Tehran, Iran. Participants were randomly assigned to receive either melatonin, 3-10 mg per day, or duloxetine, 60-120 mg per day. The primary outcome measure was the 3-month change in the Western Ontario and McMaster universities OA index (WOMAC) score.

Compared to the duloxetine group, a reduction in the total WOMAC score was noted in the melatonin group (P=0.001 and P=0.09, respectively). Changes in WOMAC pain score were significant in both groups (P=0.0001). Additionally, the need for naproxen for breakthrough pain was significantly lower in the melatonin group (318.33±16 mg vs 810±35 mg with a P<0.001).

Melatonin is more potent than duloxetine in pain reduction and functional improvement in patients with knee OA. Considering the ability of melatonin to reduce the usage of nonsteroidal anti-inflammatory drugs, melatonin may be a safer agent for managing pain in OA.

Tenosynovial chondromatosis is an extremely rare, extra-articular variant of synovial chondromatosis. It is often mistakenly considered a cartilage or soft tissue tumor. This condition primarily affects the tendon sheath, commonly in the hands or feet. It typically presents as a gradually enlarging soft tissue mass that may be painful or restrict joint movement. In its early stages, plain radiographs may not show any abnormalities. This report discusses a case featuring a multinodular proliferation of cartilage, bone erosion, and a periosteal reaction located deep in the flexor tendons of the index finger.