سال:1398 | دوره: | شماره: |تعداد مقالات:7

One of the most important causes of disability and death in developing countries is trauma-related injuries and motor vehicle accidents. In 2016, the World Health Organization (WHO) reported approximately 15, 932 road traffic deaths in Iran, with the motorcyclist and pedestrian injuries being the leading causes (1). Therefore, all trauma information must be acquired first and ultimately interpreted and analyzed to improve decision management and macro policy making. In the United States, as an increasing need, trauma specialists and medical services developed a trauma registry. Primarily, their effort was focused on the evaluation of trauma care in patients and trauma wards. The secondary goal was the utilization of documented data as a source of health surveillance. In recent decades, modern registry systems were developed based on electronic data collection and use of information technology, and had successfully recorded data in primary high-turnover trauma centers (2)...

Scaphoid fracture can cause serious complications and its diagnosis and treatment approaches are still contentious. Tenderness of anatomical snuffbox (ASB), longitudinal compression (LC) of the thumb, and scaphoid tubercle (ST) tenderness are very sensitive tests for clinical diagnosis of scaphoid factures all together. Previous studies recommend taking four standard views of the wrist for non-displaced scaphoid fractures diagnosis. Magnetic resonance imaging (MRI), computed tomography scan (CT scan), bone scintigraphy, and ultrasound are used for triage of suspected scaphoid fractures. MRI has the highest sensitivity and specificity. CT scan images captured in planes by the long axis of the scaphoid guide the diagnosis of nondisplaced scaphoid fracture. Displaced fractures need surgical treatment, but the best way of treating a nondisplaced fracture is controversial. Same results have been determined using a short arm or long arm cast for treatment of nondisplaced scaphoid fractures as well as similar outcomes with or without a thumb-spica component to the cast. Wrist position immobilization did not affect the rate of nonunion, wrist flexion, pain, or grip strength. Percutaneous screw fixation can shorten return to work time. CT scan and MRI both can be applied for assessment of union of fracture during follow-up period. This study aims to review the literature on challenges about clinical and radiologic diagnosis of nondisplaced scaphoid fractures and also present concepts about definite management of nondisplaced and minimally-displaced scaphoid waist fractures.

Pediatric elbow traumas are common and may be cause of different types of injuries such as soft tissue, bony, or cartilage injuries. Fall on an outstretched hand is the most common mechanism of injury that results in hyperextension or valgus load to the elbow (1, 2). Compared with adults, higher incidence and variability of elbow fracture patterns in pediatrics make these injuries difficult to recognize (3). Almost 70% of all pediatric fractures are related to upper extremity. Supracondylar humerus fracture is most common. The second and third common fractures are lateral humeral condyle and medial humeral epicondyle fractures (4)...

Background: Open wedge high tibial osteotomy (OWHTO) is commonly utilized to correct genu varum. To decrease various complications of OWHTO, some modifications are needed. Methods: In a parallel randomized controlled clinical trial, 42 patients were divided into two groups: conventional OWHTO (control group) and OWHTO with the cut in the sagittal plane or distal tubercle osteotomy (OWHTO/DTO) (intervention group). Evaluation of the following items was conducted pre-and post-operatively: Knee Society Score (KSS) questionnaire, incidence of postoperative complications, patellar height by Blackburne-Peel (BP) ratio and Insall-Salvati Index (ISI), posterior tibial slope (PTS), tibiofemoral angle (TFA), Q-angle, medial proximal tibial angle (MPTA), three joint alignment radiography, and union radiological parameters. Results: The differences between preoperative and postoperative variables including the KSS, PTS, TFA, BP Index (BPI), ISI, MPTA, and Q-angle within the intervention and control groups were not statistically significant. In four cases (3 in the control group and 1 in the intervention group), the delayed union was observed but the complete union was achieved after a mean of 23 weeks. No nonunion was observed. Conclusion: Our results showed equal effectiveness for OWHTO/DTO compared with the conventional OWHTO.

Background: The purpose of this study was to evaluate the effect of intravenous tranexamic acid (TXA) on the blood loss volume during surgery and surgeon's satisfaction in intertrochanteric fracture surgery. Methods: A total of 62 patients with intertrochanteric fracture were involved in the study and accidentally categorized into two groups. In the control or first group, patients were medicated with placebo (age: 69. 2 ± 6. 1 years old) and in the second group or intervention, they received 1 g injection of TXA (age: 69. 7 ± 6. 4 years old). Intraoperative bleeding was measured by the amount of blood in the suction bottle and amount of gauze utilized and postoperative blood loss was measured by the amount of blood in the drain 48 hours after surgery. Also, hemoglobin (Hb) levels were compared before and after surgery. In the end, the surgeon’ s satisfaction was measured by Likert scale. Results: The difference in the amount of intra-operative bleeding was significant between the groups (P < 0. 050). The mean number of utilized gauze in the intervention group was meaningfully less than the placebo group (P < 0. 050). The mean Hb in the control group was considerably inferior to the intervention group (P < 0. 050). The respect of patients in need of transfusion in the placebo group was outstandingly superior to the intervention group (P < 0. 005). Surgeon satisfaction in the intervention group was considerably greater than the control group (P < 0. 050). Conclusion: The use of intravenous TXA during intertrochanteric fracture surgery can reduce hemorrhage during surgery, reduce the need for blood products, and finally improve the surgeon’ s satisfaction.

Background: The aim of this study was to report the effectiveness of intra-articular injection of hypertonic saline in pain reduction and functional improvement in patients with knee osteoarthritis (OA). Methods: Patients with knee pain and dysfunction who fulfilled the American College of Rheumatology criteria and whose illness was sub-acute or chronic were enrolled. We performed a single intra-articular injection of 5 cc of hypertonic (5%) saline solution. Measured outcomes were Visual Analogue Scale (VAS) score and Knee Injury and Osteoarthritis Outcome Score (KOOS) evaluated before and 1 month after intervention. Results: A total of 28 patients with mean age of 66. 3 years were surveyed. Overall, study participants reported clinically and statistically significant reduction in VAS and KOOS subscales for symptoms, pain, function, daily living, sports, recreational activities, and quality of life in one month of follow-up with respect to the patients’ mean baseline scores (by 24. 47%, 42. 74%, 54. 96%, 43. 78%, and 63. 63%, respectively). Although obese patients [body mass index (BMI) ≥ 30 kg/m2] showed less improvement in terms of pain, sports, and quality of life subscales of KOOS, compared with non-obese patients (BMI < 30 kg/m2); VAS score difference was not significant. Conclusion: Intra-articular injection of hypertonic saline yields a statistically and clinically significant short-term pain reduction and functional improvement of patients with knee OA.

Background: Surgical treatment of basicervical femoral neck fractures, which are biomechanically similar to intertrochanteric fractures, is an internal fixation by dynamic hip screw (DHS) and anti-rotation screw. Since one of the remarkable complications of this surgical procedure is device failure, we aimed to make a comparison between bipolar hemiarthroplasty and the DHS plate fixation in elderly patients with basicervical femoral neck fracture. Methods: In this randomized controlled clinical trial study, 60 patients with femoral neck fractures were randomly divided into two groups of DHS fixation (control group, n = 30) and bipolar hemiarthroplasty (intervention group, n = 30). Harris Hip Score (HHS) questionnaire and the Visual Analogue Scale (VAS) for pain assessment were used for functional evaluations. Postoperative complications were evaluated at 6 months and one year postoperatively. Results: The mean age was 73. 95 ± 9. 85 years in the hemiarthroplasty group and 74. 22 ± 7. 85 years in the internal fixation group. Three patients in the internal fixation group and 6 patients in the hemiarthroplasty group were excluded. HHS in 6 months and one year after surgery in the intervention group was dramatically higher than the control group. There were no noticeable changes in VAS scores between the two groups. Two cases of device failure happened in the control group. Conclusions: It seems that bipolar hemiarthroplasty is more effective than internal fixation by DHS plate in improving the patient’ s quality of life, considering higher HHS scores, earlier patient mobilization, shorter hospital stay, lower device failure rate, and lower revision rate.