JOURNAL OF ORTHOPEDIC AND SPINE TRAUMA
Year:2019 | Volume:5 | Issue:2|Papers Count:7

Background: Intramedullary nailing (IM nailing) is the standard of care for the treatment of most diaphyseal lower extremity fractures. A few studies have assessed and compared the infection rate following reamed and unreamed IM nailing in open long bone fractures. In the present study, we attempted to compare the infection rate between two procedures in open fractures of tibia. Methods: In this prospective study, we included consecutive patients suffering from open fractures of tibia (Gustilo subtypes II or IIIA) who required IM nailing. Patients younger than 16 years old, other Gustilo types (I, IIIB, and IIIC), fractures reaching to the tibial plateau articular surface, and simultaneous fractures of other bones in the extremity were excluded. All patients were followed up for one year to assess the postoperative infection rate. Results: Of 59 patients, 37 underwent reamed IM nailing and 22 underwent unreamed IM nailing. In reamed group, 4 cases (10. 8%) experienced an infection requiring reoperation and antibiotic therapy, while in the unreamed group, it was 5 cases (22. 7%). The difference between the groups was not statistically significant. Conclusion: Reamed and unreamed IM nailing procedures for fractures of tibia have similar outcome regarding long-term postoperative infections that require reoperation and antibiotic therapy.

Background: Decreased bone mass, often measured using bone mineral density (BMD) is frequently seen in patients with end-stage renal disease (ESRD) undergoing hemodialysis. It may cause serious bone health problems such as fractures. Several risk factors of low bone mass in the patients on hemodialysis have been proposed including age and body mass index (BMI). Our current study explored the relationship between BMI, age, sociodemographic status, and BMD among postmenopausal women on hemodialysis. Methods: This study enrolled postmenopausal women on hemodialysis whose bone densitometry was checked and assessed with the age, BMI, and social status. Statistical analysis was performed in SPSS software. Results: Sixty participants with a mean ± standard deviation (SD) of age of 57. 00 ± 10. 63 years were enrolled. After adjustment of sex and age, normal-weight women had 2 times the prevalence of low bone density compared to the obese women [prevalence ratio (PR) = 2, 95% confidence interval (CI): 1. 4– 2. 8]. For osteoporosis, the PR was also twice higher for the women with normal BMI (PR = 2, 95% CI: 1. 3-2. 8) and 1. 6 times higher for the overweight group than the women in the obese group (PR = 1. 6, 95% CI: 1. 3-2. 4). Conclusion: Among the women on hemodialysis, obese women have lower prevalence of osteoporosis than normal-weight cases.

Polytrauma indicates a condition in which a patient is affected by several serious injuries. This condition can threaten life of a child. These injuries normally involve two or more crucial parts of body. Falling from height and motor accident are the two most common causes of pediatric multiple trauma. Around 30% of children with serious trauma die because of inadequate primitive assessment. To reduce the rate of mortality and morbidity, it is essential to know the primary and then the secondary survey of the patient (1)...

Regarding carpal instability, the most frequent etiology is scapholunate interosseous ligament (SLIL) (1, 2). It happens mostly when the wrist is in extension, supination, and ulnar deviation (3). Due to the difficulty in diagnosing the entity, the exact epidemiology of the injury is not known (4). Also, the injury is commonly misinterpreted as a wrist sprain by patients (2). Forty-three percent of intraarticular (IA) distal radius fractures (5) and 5% of wrist sprains are accompanied with scapholunate (SL) dissociation (2, 6). Therefore, it should be considered as a possible diagnosis in the presence of wrist trauma (1)...

A 19-year-old woman came to our clinic with a femoral neck fracture (Figure 1). What is your stepwise approach to choose the appropriate treatment, i. e., internal fixation or arthroplasty? Hip fracture is considered a global public health issue, as nearly 1. 5 million hip fractures occur worldwide annually. It is anticipated that 3. 9 million hip fractures will occur worldwide in 2050 per year, more than 700, 000 of which will be in the United States (US). Hip fractures in the elderly are associated with diminished mobility, conspicuous loss of independence, increased morbidity, and mortality (1). Therefore, hip fractures are a public health concern, particularly with the aging population, and must be surveyed and treated accurately...

Background: Congenital patellar dislocation (CPD) is a rare disorder which presents with hypoplastic and irreducible patellae. It is accompanied by flexion contracture of the knee joint, genu valgum, and external tibial rotation. Case Report: A seven-year-old girl with CPD who was misdiagnosed as having cerebral palsy (CP) crouch gait and underwent distal femoral extension osteotomy (DFEO) without paying attention to the dislocated patellae, is presented. Recurrence ensued, and the patient was referred for further evaluation. After a second surgery to address the dislocated patellae, the flexion contracture and gait pattern improved significantly. Conclusion: The case underscores the importance of a systematic, thorough physical examination, without which uncommon diagnoses will be overlooked, exposing the patient to further morbidity and complications.

Background: Asymmetric bilateral hip dislocation is a rare condition, especially when it is accompanied by a bilateral femoral head fracture. Case Report: A 28-year-old man who sustained a motor vehicle accident, was presented to the our center (Imam Khomeini Hospital Complex) with asymmetric bilateral hip fracture-dislocation. In the initial step, closed reduction was performed, followed by bilateral open reduction and fixation of the femoral head fragment by screws. The results were satisfactory after 5 years of follow-up. Conclusion: Although rare, paradoxical femoral head fracture should be considered in patients with hip dislocation. We recommend our therapeutic approach in a similar situation.