سال:1398 | دوره: | شماره: |تعداد مقالات:14

Background: The Single Assessment Numeric Evaluation (SANE) is a simple, one-question patient-reported outcome measure (PROM). We systematically reviewed correlations between SANE and more extensive PROMs. Methods: We identified studies with correlation coefficients between SANE and other shoulder, knee, and anklespecific PROMs. We calculated mean, median and range across studies and time points of data collection. Results: Eleven studies provided 14 correlations, six shoulder-specific PROMs in four studies, six knee-specific PROMs in six studies and two ankle specific PROMs in one study. The mean correlation comparing SANE and knee-specific PROMs was 0. 60 (SD 0. 24), median 0. 66, and range 0. 12 to 0. 88. Among studies comparing SANE and shoulderspecific PROMs mean correlation was 0. 59 (SD 0. 20), median 0. 62 and range 0. 20 to 0. 89. The mean correlation between SANE and ankle-specific PROMs was 0. 69 (SD 0. 17), median 0. 69 and range 0. 75 to 0. 81. Conclusion: There seems to be moderate correlation amongst PROMs, even those that are a single question. Future research might address whether patient reported outcome measure a common underlying construct even when they consist of a single question.

Background: Managing posterior glenoid wear and retroversion remains a challenge in shoulder arthroplasty. Correcting glenoid version through asymmetric reaming (AR) with placement of a standard glenoid component and the use of posteriorly augmented glenoid (PAG) components are two methods used to address this problem. Our objective is to report the radiographic outcomes of patients with posterior glenoid wear and/or retroversion treated with either approach. Methods: Patients with posterior glenoid wear and a minimum of 15 degrees of retroversion, treated with AR and standard glenoid component or with a PAG component (3 mm, 5 mm, or 7 mm posterior augmentation), were consecutively identified through retrospective chart review. Pre-operative axillary views were evaluated for version, humeral head subluxation in relation to scapular axis and to mid-glenoid face. Post-operative axillary views were reviewed to measure corrected inversion and humeral head subluxation. Results: There were 48 patients in the AR group and 49 patients in the PAG group. Version improved 6. 8 degrees in the AR group. In the PAG group, version improved 8. 8 degrees with 3 mm augment, 13. 4 degrees with 5 mm augment, and 12. 8 with 7 mm augments. There were significantly more central peg perforations in the 5 mm PAG group compared to other groups. The humeral head was re-centered within 6. 1% of normal in all groups except 7 mm augments. Conclusion: This study demonstrates that AR and PAGs have the ability to re-center the humeral head when utilized in patients with retroversion and posterior wear. Use of a PAG component may allow for greater correction of glenoid retroversion, however, there is an increased risk for central peg perforation with the specific implant utilized in this study. Long-term follow-up is ongoing and needed to understand the clinical implications of these findings.

Background: Femoral stem anteversion during hip arthroplasty is generally estimated by eye intraoperatively and has proven to be different from targeted values. This study aims to determine the accuracy of a novel technique using a digital protractor and a spirit level to improve surgeons’ estimation of stem anteversion. Methods: A prospective non-randomized study was conducted among 93 patients with femoral neck fracture who underwent cemented hemiarthroplasty via posterolateral approach. In the control group (N=62), five experienced surgeons assessed stem anteversion related to the posterior femoral condylar plane using visual estimation with a target angle of 15°-25° . In the study group (N=31), another two surgeons assessed stem anteversion with the same target angle by placing a digital protractor on the femoral stem inserter handle while the assistant held the leg in the truly vertical position, verified by a spirit level that was attached to the shin with cable ties. Stem anteversion was measured blind, postoperatively, on 2D-CT and compared with the intraoperative results. Results: The mean postoperative anteversion was 22. 4° (-4. 2° to 51. 3° , SD 11. 1° ) in the control group and 23. 0° (16. 0° to 29. 9° , SD 3. 6° ) in the study group (P=0. 810). The study group had more stems positioned in 15°-25° anteversion (71. 0% vs 32. 3%, P=0. 001) and the mean absolute value of surgeon error was-0. 2° (-5. 4° to 7. 0° , SD 3. 0° ). Twentyeight stems of the study group (90. 3%) had an error within 5° . Surgeon overestimation >5° was found in 1 hip (3. 2%) and underestimation >5° was found in 2 hips (6. 4%). Conclusion: Using a digital protractor and a spirit level was reliable with high accuracy and precision to improve the intraoperative estimation of cemented stem anteversion.

Background: Thoracolumbar spinal fractures include a range of injuries of various severities from simple apophyseal fractures to neurological injury and complex fractures associated with vertebral dislocation. The treatment of thoracolumbar fractures is challenging, especially due to the difficulty of evaluating the posterior ligamentous complex (PLC). The purpose of this study was to evaluate the diagnostic value of computed tomography (CT) scan in predicting PLC injuries in the patients with thoracolumbar spinal fractures referring to the referral center of spinal trauma in the east north of Iran in 2016. Methods: This retrospective study was conducted on patients with thoracolumbar injuries referring to Shahid Kamyab Hospital in Mashhad, east north of Iran, in 2016. The data were collected by entering the data of medical records into special forms. The classification of spinal fractures was accomplished using the AO Spine Classification System. Results: According to the results, 71 (71. 7%) patients were male, and the subjects had a mean age of 44. 6± 17. 7 years. The PLC injury was observed in 28 (28. 3%) patients. The PLC injury showed a significant relationship with facet joint widening, increased interspinous process distance, and spinous process avulsion fracture (P<0. 05). Conclusion: As the findings of this study indicated, the diagnostic results of PLC injury by means of CT scan was similar to those obtained by magnetic resonance imaging in patients with thoracolumbar spinal fractures.

Background: Distal humeral fractures accounts for approximately 2% of all fractures and nearly one-third of humeral fractures in adults. In this regard, Modified Tension Bind Wiring (MTBW) technique was used for the fixation of the distal humeral fractures type A2 and C1 (AO) to evaluate the early movement and complications of the patients. Methods: This study was conducted on 25 patients, who were subjected to open reduction and internal fixation using MTBW techniques, to evaluate the incidence of complications. Results: The mean age of the participants was 53. 7 years. Out of 25 patients, 16 cases had C1 and 6 individuals suffered from A2. The mean tourniquet time was 43 min. The mean union time was 12. 24 weeks and the mean duration of the follow-ups was 13. 72 months. The mean values for the lack of extension, flexion, and range of motion were 18o, 124o, and 106o, respectively. Wound haematoma and dehiscence were observed in two cases, who were treated after conservative treatment. During 15-90 days, there were no signs of neurapraxia injuries. The non-union of olecranon osteotomy site was seen in one case, who was treated by the MTBW technique. Since the range of motion was less than 100o in 4 patients, device removal was performed 6 months after the surgery when the range of motion was increased by nearly 12o. Moreover, patients were diagnozed with no serious complications, such as the nonunion of fracture site, malunions, and deep infection. The radiological examination of the patients revealed the success of their treatment. Conclusion: Based on the obtained results, it can be concluded that MTBW is an effective technique in fracture fixation, which allows gentle early motion. Moreover, this cost-effective technique decreased the surgery duration, tourniquet time, and damage caused by soft tissue stripping.

Background: Iliac osteotomies in adolescent patients may accompany graft related difficulties such as graft absorption and delayed union. A new modification of iliac osteotomies has been proposed to address these difficulties. Methods: A total of 24 consecutive hip joints in 21 juvenile or adolescent patients who were candidate for salter or triple pelvic osteotomy were included. A modification was performed to harvest a wedged bone graft based on a muscle pedicle of Tensor Fascia Lata and inserted at pelvic osteotomy site instead of a traditional graft technique. The hips were randomized into two groups. The traditional wedge graft was used in group 1, while the new modification was performed in group 2. The primary outcome of this study was duration of union. The secondary outcomes were Center Edge Angle (CE) Angle on pre-operation, immediately post-operation and at the end of follow-up. Results: Both groups were similar statistically regarding their age, gender, estimated blood loss and the duration of follow-up. However, significant differences were found in the time to complete union between the two groups (P=0. 03). CE angle decreased in both groups when comparing its last follow-up to its right postoperative values, but the decrease was significant only in group 1(P=0. 03). The type of surgery (Salter or TPO) had no significant effect on the average time to union. That shows faster union in pedicle graft group and less coverage loss during follow-up period than conventional graft patients. Conclusion: With the modification proposed, the healing at the osteotomy site was faster and the loss of correction, owing to the graft resorption, decreased. Using this pedicle wedge graft technique may improve the results of pelvic osteotomies in adolescent.

Background: The results of clinical studies have reported that Asian knee anatomical aspects are smaller than those of the Caucasian population. The purpose of this study was to investigate the morphometry of the proximal tibia in the standard resected surface of total knee arthroplasty (TKA). Methods: In this descriptive study, the anthropometric data of the proximal tibia were measured in 132 knees (80 males and 52 females) using magnetic resonance imaging in 2015. The collected data included anteroposterior (AP) length, mediolateral (ML) width, medial AP, lateral AP, and aspect ratio (ML/AP). The medial and lateral AP distance to bone center was calculated for symmetry analysis. The morphometric data were also compared with the same dimensions of four current tibial implants. Results: The mean age of the subjects was 38. 26± 11. 45 year (age range: 20-60 years). The mean AP length and mean ML width in the resected surface of the bone, as well as the mean aspect ratio (ML/AP) of tibial bone in all the subjects, were 46. 53± 4. 05 mm, 73. 36± 6. 86 mm, and 1. 58± 0. 11, respectively. The mean values of medial and lateral AP distance up to bone center were 13. 40± 6. 17 and 17. 09± 6. 83 mm, respectively, indicating asymmetric proximal tibia in the study population. Conclusion: The measurements of anatomic shapes and dimensions of the proximal tibia revealed that women have smaller dimensions than their male counterparts. Prostheses with smaller AP size tended to be undersized and larger AP size had a tendency towards overhang in the mediolateral dimension. The data and obtained results of this study can be used as guidance on designing tibial implant components suitable for TKA in the Iranian population.

Background: Multiligament knee injury (MLKI) is a complex orthopedic injury leading to the tear of at least two of the major knee ligaments. However, there is no consensus on the optimal management of this debilitating condition. Regarding this, the present study was performed to evaluate the outcomes of single-stage multiligament reconstruction surgery in patients with MLKI. Methods: This retrospective study was conducted on 41 consecutive MLKI patients who underwent surgical reconstruction. Objective evaluation of the outcome included active extension and flexion. Furthermore, the subjective evaluation of the outcome was accomplished using the Lysholm scoring scale and International Knee Documentation Committee (IKDC) form in Persian. Postoperative complications were also recorded for all patients. Results: The mean age of the participants was 31. 95± 7. 82 years. In addition, the mean follow-up period and the mean time interval between the injury and surgery were recorded as 36. 9± 17. 8 and 11. 5± 8. 9 months, respectively. The mean Lysholm and IKDC scores were obtained as 86. 9± 11. 5 and 70± 18. 7, respectively. The mean Lysholm and IKDC scores were not statistically different between the patients who underwent surgery less than 6 months after the injury and those subjected to reconstruction 6 months postinjury (P=0. 07 and P=0. 3, respectively). Seven patients showed postoperative restricted range of motion, which was resolved with physiotherapy. The only surgical complication was popliteal artery injury. Conclusion: As the findings indicated, the single-stage reconstruction of MLKI provided an acceptable outcome. However, several aspects of this reconstruction, such as the timing of the surgery, still remain to be resolved in future investigations.

Background: The prevention of surgical site infection is one of the most concerning issues in operating rooms. Surgical gowns are worn as one of the intraoperative strategies for infection prevention. The present study investigated whether the gowns remained sterile during the surgical procedure. Furthermore, this study examined which parts of the surgical gown were more prone to contamination. Methods: The sterility of the gowns was investigated during eight total joint arthroplasties all of which were performed by four surgeons. The samples were taken from the arms and frontal part of the sterile gowns pre-and postoperatively. In the anterior surface of the gown, the sampling was initiated at a strip with 50 cm height from the ground followed by the strips with 15 cm distances from caudal to cephalad. Furthermore, the frontal part of the gown was divided into three parts in relation to the operating room table. Finally, the contamination rate was evaluated in each part. A semiquantitative method was used for the analysis of bacterial culture. Results: Before the operation, there were four samples tested positive for bacterial culture (1. 06%). All of these samples were taken from the most proximal strip near the neckline. After the surgery, the rate of contamination in the strips on the frontal part of the gown was reported as 3. 1% to 53%. Based on the operating table, the contamination rate was 35. 9%, 8. 9%, and 47. 3% in the distal, middle, and proximal parts of the gown, respectively. The contamination rate at the elbow crease was 23%, and at 5 and 10 cm above the creases were 24% and 36%, respectively. Conclusion: The high rate of gown contamination during the operation is concerning. However, part of the gown that was in contact with the operating room table remained clean most of the time. More safe strategies should be used for infection prevention in operating rooms.

Background: Lumbosacral orthosis (LSO) is commonly used for the treatment of back pain. The clinical and mechanical effectiveness of this device has been repeatedly investigated in several studies; however, its sensorimotor effectiveness has been rarely considered. Regarding this, the aim of the current study was to investigate the effect of a non-extensible LSO on postural stability (as a construct of sensorimotor function) in patients with nonspecific chronic low back pain (LBP). Methods: This preliminary study was conducted on 17 patients with nonspecific chronic LBP using a single-group quasi-experimental design. Postural stability was measured while the participants were placed in a quiet standing position, under the combined conditions of base of support (rigid and foam surface), visual input (open eyes and closed eyes), and LSO (with and without orthosis). Results: The findings demonstrated that wearing orthosis during the most challenging postural task (i. e., blindfolded while standing on a foam surface) significantly reduced postural sway parameters related to the position and displacement of the center of pressure (COP; the sway area and sway amplitude in the anteroposterior direction; P<0. 001). However, the use of this device had no significant effect on COP velocity. Conclusion: As the findings of the present study indicated, the use of a non-extensible LSO decreased the COP displacement; however, it did not affect the COP velocity. Therefore, our data could not utterly support the effectiveness of non-extensible LSO on postural stability as a construct of sensorimotor function. Postural control is an appropriate indicator for assessing the global functioning of the sensorimotor system due to its dependence upon the interaction between the neural and musculoskeletal systems. Consequently, further studies are needed to elucidate the positive effects of LSO on the aspects of sensorimotor function.

Background: Motorcyclists are among the most vulnerable groups of road accident victims, who are prone to a growing mortality rate due to the constant rise in the number of accidents. This study was performed to investigate the injury patterns among motorcyclist trauma patients admitted to Kamyab Hospital, the largest trauma center affiliated with Mashhad Univercity of Medical Sciences, Mashhad, Iran, due to an accident. Methods: This cross-sectional study was conducted on motorcyclists referred to our hospital due to accidents from August 23, 2014 to August 22, 2016 to receive treatment. After the accurate examination of the collected data and correction of the potential errors, they were subjected to analysis. The gathered data included the demographic variables, injury pattern, accident time, and accident type. Data analysis was performed in Stata Software, version 12. Results: A total of 4, 205 motorcycle accident cases were hospitalized (14% of all cases were hospitalized during the two-year study period). The mean age of the patients was 30 years, and 88% of them were male (a male to female ratio of 7. 3). Car-and pedestrian-motorcycle collisions were the most common causes of injury that accounted for 68% and 22% of the cases, respectively. The head was the most commonly injured site of the body; in this regard, 59. 7% of the admitted patients and 85. 4% of total death cases had a head injury. In addition, 67% of the target population received trauma in more than two parts of their body. The elbow, arm, and hip were the least regions involved. Conclusion: Motorcycle accidents cause severe physical injuries to the patients’ body. Head injury was the most common type of trauma, leading to a wide range of disabilities. Therefore, the use of crash helmets and avoidance of dangerous driving behaviors will remarkably decrease such trauma.

Background: Open hamstring lengthening (oHSL) is commonly performed to decrease knee contracture and improve gait and posture for children with spastic diplegia. Furthermore, percutaneous hamstring lengthening (pHSL) is also gaining popularity as an alternative to the open approach. This study aimed to compare the results of pHSL versus oHSL and to determine the efficacy and safety of the percutaneous approach. Methods: This retrospective included 54 patients (108 knees) with spastic diplegia operated for flexed knee gait with either open or percutaneous HSL. The mean age of the participants at the time of surgery was 10. 3± 1. 7 years (age range: 5-25 years) for the open and 8. 5± 1. 5 years (age range: 7-23 years) for the percutaneous group. Overall, 29 and 25 children were subjected to oHSL and pHSL, respectively. Results: The mean durations of follow-up were 19. 1 months (range: 12-49 months) and 18. 3 months (range: 14-45 months) for oHSL and pHSL groups, respectively. In the open group, the mean of preoperative popliteal angle decreased from 64. 3± 3. 6 to 28. 4± 4. 3 (P<0. 001), and in the percutaneous group from 63. 8± 2. 7 to 29. 5± 2. 3 (P<0. 001). The obtained results revealed no significant differences between the two approaches leading to a similar improvement among the investigated patients (P=0. 83). Although the Gross Motor Function Class Score improved significantly within each group (P<0. 001); this improvement was insignificant between the groups (P=0. 88). The mean of hospital stay for the percutaneous group was 1. 6 days (range: 1-3 days) compared to 3. 6 days (range: 2-6 days) for the open group, which indicated a significant difference (P=0. 001). The mean values of total cost were $333 and $473 in the percutaneous group and open group (P=0. 001), respectively. There was no significant difference between the groups regarding the complication rate (P=0. 85). Conclusion: Percutaneous HSL is a safe, easy, rapid, and brief procedure that is as effective as the open technique for children with spastic diplegia in a short period of time. However, it is essential to examine the effects of this approach during longer follow-ups to generalize the findings of the current study.

Ceramic bearing surfaces are being increasingly used in young patients undergoing total hip arthroplasty. However, failures have been reported including fractures even with the newer third generation ceramics. The recommended treatment for fracture of ceramic bearing surfaces is complete synovectomy and revision total hip arthroplasty. However, disappointing results have also been reported with this approach. The residual ceramic particles may lead to complications. We report a fatal case of cobalt toxicity leading to cardiomyopathy secondary to the catastrophic failure of a Cobalt-Chrome femoral head, which followed the revision of a fractured ceramic-on-ceramic total hip arthroplasty.

Background: To date, little has been published comparing the structure and requirements of orthopedic training programs across multiple countries. The goal of this study was to summarize and compare the characteristics of orthopedic training programs in the U. S. A., U. K., Canada, Australia, Germany, India, China, Saudi Arabia, Russia and Iran. Methods: We communicated with responders using a predetermined questionnaire regarding the national orthopedic training program requirements in each respondent’ s home country. Specific items of interest included the following: the structure of the residency program, the time required to become an orthopedic surgeon, whether there is a log book, whether there is a final examination prior to becoming an orthopedic surgeon, the type and extent of faculty supervision, and the nature of national in-training written exams and assessment methods. Questionnaire data were augmented by reviewing each country’ s publicly accessible residency training documents that are available on the web and visiting the official website of the main orthopedic association of each country. Results: The syllabi consist of three elements: clinical knowledge, clinical skills, and professional skills. The skill of today’ s trainees predicts the quality of future orthopedic surgeons. The European Board of Orthopedics and Traumatology (EBOT) exam throughout the European Union countries should function as the European board examination in orthopedics. We must standardize many educational procedures worldwide in the same way we standardized patient safety. Conclusion: Considering the world’ s cultural and political diversity, the world is nearly unified in regards to orthopedics. The procedures (structure of the residency programs, duration of the residency programs, selection procedures, using a log book, continuous assessment and final examination) must be standardized worldwide, as implemented for patient safety. To achieve this goal, we must access and evaluate more information on the residency programs in different countries and their needs by questioning them regarding what they need and what we can do for them to make a difference.