IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2022 | Volume:20 | Issue:3 (78)|Papers Count:8

Background: Distal radius fractures are among the most common fractures. They can happen at any age group, and there are several treatment options and several classification systems for these fractures. One of these classifications is that of Fernandez. In this study, we evaluated the results of treatment of distal radius fractures by bridging external fixator and percutaneous pinning. Methods: In a cross-sectional study, 72 patients with Fernandez type 3, 4 and 5 that underwent external fixation and percutaneous pinning for comminuted distal radius fractures were followed and assessed after 3 and 6 months. Results: The 72 patients had mean age of 44. 2 years. 55% were male. The most common cause of fractures was vehicle accidents. 4 cases of malunion, 4 radial nerve injuries, 2 fixator loosening and 6 cases of infection were encountered. Conclusion: External fixator supplemented by percutaneous pinning is an efficient technique for treatment of unstable distal radius fractures. It has low rate of complication and high rate of patient's satisfaction.

Background: Moderate intensity continuous training (MICT) has been reported as an effective exercise on bone metabolism. However, very few studies have focused on high-intensity interval training (HIIT). The aim of this study was to investigate and compare the effects of HIIT and MICT training on bone density in middle-aged rats. Methods: 30 male Wistar rats (16 weeks old) were randomly divided into three groups: control, MICT and HIIT. Both test groups completed 8 weeks (5 sessions per week) of treadmill training in which the HIIT group performed 10 sessions of running at a speed of 35-47 m/min with a 2-minute active recovery, and the HIIT group ran continuously for 10-45 minutes at a speed of 15-20 meters per minute. The body composition and bone mineral density in the whole body were evaluated through Dual Xray absorptiometry (DXA) at the beginning and after the intervention. The data was analyzed using SPSS software and one-way analysis of variance and Tukey's post hoc tests. Results: After 8 weeks of intervention, BMD of the whole body and femur increased significantly in both groups (p0≥, 0. 05), although the observed change was greater in the HIIT group (p≥, 0. 05). In addition, in the case of BMD of the lumbar vertebra, no significant difference was observed between all three groups after the intervention (p≤, 0. 05). Conclusion: These findings show that a period of HIIT and MICT training can improve bone density in middle-aged rats and compared to MICT, HIIT had more benefits on bone density.

Background: Ankle arthrodesis is one of the major surgeries for the treatment of advanced osteoarthritis of the ankle joint. There are various techniques available for ankle arthrodesis and each technique has unique advantages and disadvantages. The aim of the present study was to evaluate the results of ankle arthrodesis with two this different approaches. Methods: The medical records of the patients who were admitted for ankle arthrodesis and treated by a single surgeon from January 2015 to January 2020 were reviewed. The patients were recalled for re-evaluation after a mean follow-up of 19 months. Functional outcomes were assessed using validated AOFAS Ankle-Hind foot score, Manchester-Oxford Foot Questionnaire (MOXFQ) and visual analog scale (VAS) score for pain. The collected data were recorded in a pre-designed checklist and then analyzed using SPSS software. Results: A total of 32 patients, 18 men and 14 women with a mean age of 46. 7 years were included in the study. 67. 6% had history of ankle fractures. Anterior approach was used in 24 patients, 75%, and the rest of the patients had surgery with lateral approach (25%). The most common instrument for arthrodesis was concomitant use of plate and screws in 18 patients (56%). Union occurred in 28 patients (87. 5%) within 11. 1 weeks after the surgery. The AOFAS score increased significantly and MOXFQ and VAS scores decreased significantly following the surgery (p<0. 001 for each). Advanced age and intramedullary nail were related to prolonged time to union (p<0. 05). Surgical approaches (either anterior or lateral) had no association with AOFAS, MOXFQ, and VAS scores. Non-union was seen in 4 patients (12. 5%) and deep infection in 3 patients (9. 3%) after ankle arthrodesis. Conclusion: The study results showed that, this surgery could improve patients’,pain and function with relatively low post-operative complications.

Background: Postoperative pain following total hip arthroplasty (THA) impacts patients' rehabilitation and quality of life. Although gabapentin has been widely used for pain control, its effectiveness in hip arthroplasty is not well established. The aim of our systematic review is to evaluate the effect of gabapentin on postoperative pain after THA. Methods: A systematic search was conducted in three databases: MEDLINE, PsycINFO, and Embase, through OVID, using the keywords gabapentin, pain, and hip arthroplasty, with no restrictions on language or publication date. To evaluate the quality of the articles, the Cochrane Collaboration tool was used. Results: Five studies, including 728 patients, were included in our systematic review. Gabapentin 600 mg was used in three and 1200 mg in two studies. The results of these studies showed that gabapentin had no significant effect on pain or morphine consumption after THA. Besides, gabapentin use was associated with side effects such as rash, nausea, headache, vomiting, and pruritus. Conclusion: Gabapentin does not decrease pain or morphine consumption after THA. However, future studies with a larger sample size and longer follow-up period are required.

Background: The aim of this study was to compare corticosteroid injection and corticosteroid injection with needle release (Pie-crusting) method in the treatment of plantar fasciitis in patients with heel pain. Methods: The present study is a randomized clinical trial. The study population included patients with heel pain who had referred to a teaching center with plantar fasciitis for treatment during the years 2020-2019. The patients were randomly divided into two groups: corticosteroid injection and corticosteroid injection plus Pie-crusting method. The patients were visited again in the third (T1), sixth (T2), twelfth (T3) and twenty-fourth (T4) weeks post treatment, and the severity of pain and ankle and foot score (AOFAS) were determined at each visit. The data of this study were analyzed with SPSSv. 24 software. Results: 89 patients (46 in steroid injection group and 43 in "pie-crusting" group) were examined. Patients in the two groups were similar in terms of age, sex and body mass index. The two groups showed a significant difference in terms of VAS of pain only in the T4. The AOFAS in the T2 (p=0. 039), in the T3 (p>0. 001), in the T4 (p>0. 001) statistically significant differences were reported. Comparing the angle of inclination of the calcaneus, there was no statistically significant difference between the two groups in the T4. Conclusion: The results of this research showed good results in use of combination of corticosteroid therapy and "pie-crusting surgery" for plantar fasciitis.

Background: The purpose of this study is to investigate the results of surgical treatment for hallux rigidus using the Weil osteotomy method in grade III patients with this disease. Methods: This quasi-experimental study involved a single-group intervention "before and after" the surgery. The research population consisted of patients with grade 3 hallux rigidus. The data collection tool used in this study was a checklist based on clinical examinations that evaluated joint movement in both plantar and lateral directions, as well as the Visual Analog Scale (VAS) to measure pain. The range of motion and pain level of the metatarsophalangeal (MTP) join were investigated and recorded before the operation and 1, 3, and 6 months after the operation. All this information was entered into SPSS software version 26. Results: The study groups included 8 (22. 9%) male and 27 (77. 1%) female patients, with an average age of 77. 1 ±,12. 17 years. The amount of pain decreased significantly (P=0. 00) at the one-month and three-month follow-ups after the intervention, and the amount of passive movement of the joint in the plantar directions significantly increased from one month to three months after the intervention (P=0. 00). 17 patients (48. 6%) took up to two weeks after surgery, 10 patients (28. 6%) between two to four weeks, and 8 patients (22. 9%) more than one month to recover the mobility. The average joint space of the patients after the operation in plain radiography was 3. 6 ±,0. 46. Conclusion: : The Weil osteotomy surgery in hallux rigidus patients showed a significant decrease in pain level, and also a significant increase in joint motion and improvement in the average joint space in short term.

Background: Essex-Lopresti injury (ELI) is one of the rare injuries of the elbow area, which includes fracture of radius head, disruption in the interosseous membrane of the forearm (IOM), and distal radio-ulnar joint dislocation. This happens as a result of transverse pressure on the elbow and forearm when falling down or when high energy is applied. Methods: In this study, we introduced a 40-year-old patient who suffered both bone forearm fracture in addition to the above injuries. First, the patient underwent both bone forearm ORIF surgery, and then fixation of radius head and distal radio-ulnar joint reduction and fixation. Results: After six months, the patient has 20 degrees of motion limitation only in the pronation state, and the joint’, s motion range in other joints is complete. Conclusion: In general, the Essex-Lopresti injury (ELI) is one of the rare hand injuries that are difficult to diagnose with simple radiographs and requires great care.

Background: To improve the education of orthopaedic residents and enhance patient care in the Iran's healthcare system, it is necessary to gather information about the current status of scientific, practical, and research-based education for residents. Methods: The research project initially focused on examining the executive curriculum in 14 centers affiliated with 6 different medical universities. Subsequently, an investigation was conducted into human resources, infrastructure, operating room facilities, educational and research outcomes, as well as the regular implementation of practical examinations to evaluate the performance of residents during their residency years. All the aforementioned aspects were covered using a comprehensive questionnaire, which was distributed via the "Formafzar. com" website as a link to the heads of departments in these centers by the Iranian Orthopaedic Association. The relationship between facilities and equipment and passing the future specialized orthopaedic board examination was also evaluated. Results: Among the examined centers, only 20% adhered to the criteria of Iran educational curriculum in all aspects of human resources, education, and research. Conclusion: a regular evaluation of teaching methods used by international centers and the national curriculum is necessary for orthopaedic training centers in Iran. Additionally, regulatory systems should monitor the training process of orthopaedic residents to standardize services, equipment, and educational programs in the country.