Journal of Research in Orthopedic Science
Year:2022 | Volume:9 | Issue:3|Papers Count:8

Background and Objectives: Dynamic knee valgus (DKV) is one of the faulty lower limb movements that cause increased patellofemoral joint stress and patellofemoral pain (PFP) occurrence. This systematic review investigates the effect of active and passive proximal interventions on DKV in patients with PFP. Methods: An online search was conducted in Cochrane Library, PubMed, Springer, Science Direct, and Scopus databases. The search was limited to the period of 2000 to 2022. The included articles were screened in three stages according to the eligibility criteria. The quality of articles was assessed based on the Downs and Black checklist and was then classified into three categories as follows in terms of quality: High, medium, and low. Results: Overall, 8 articles were included in this systematic review. Four articles were related to hip strengthening exercises, 2 articles to strengthening exercises combined with movement retraining, and 2 articles to brace and strap. In strengthening exercises, 2 articles did not demonstrate a significant effect in reducing DKV. In contrast, 2 articles reported a reduction in DKV after hip strengthening exercises. Two articles of strength training combined with movement retraining reported reductions in DKV. In the passive intervention, only 1 article reported a reduction in DKV.  Conclusion: Both active and passive proximal interventions have the potential to modify DKV and can be used in the prevention and treatment of PFP protocols; however, active interventions stimulate proprioception and facilitate muscle recruitment.

Background: Glomus tumors are benign perivascular neoplasms generally located in distal limbs, particularly in the nail bed, which present a classic triad including pain, tenderness, and cold hypersensitivity. This study described the epidemiologic characteristics, clinical presentation, diagnosis, management, and post-operative complications of glomus tumors. Methods: Medical profiles of patients with a glomus tumor who underwent surgical excision at Shafa Yahyaeian Hospital, Tehran, Iran, between 2009 and 2021, were retrospectively reviewed. ‎A senior hand surgeon at the same orthopedic center managed all patients with surgical excision. ‎The collected information included demographic characteristics, clinical presentation, tumor ‎characteristics, recurrence, and post-operative complications.‎ Results: The study included 38 females (76%) and 12 males (24%), with a mean age of 38.9±14.3 years (range: 16-75 years). The symptoms at presentation included pain (100%), local tenderness (98%), and ‎cold sensitivity (66%). In all patients, Hildreth’s test was positive. The mean symptom duration was 51.2±53.7 ‎months. Of 50 cases, 47 lesions (94%) were in the fingers. The subungual region was the most frequent site of finger involvement (n=35, 74.5%). At a mean follow-up of 6.4±4.5 years, tumors recurred in two patients (4%). Seven patients (14%) had surgical complications, including persistent pain (n=2), numbness (n=2), paresthesia (n=1), ‎limited range of motion (n=1), and nail separation (n=1).‎ Conclusion: Glomus tumors present as painful lesions, most commonly in the fingertips, and are generally associated with long ‎symptom duration. The lesions are more common in females. ‎Surgical excision is an efficient treatment for the local control of glomus tumors.

Background and Objectives: Degenerative cervical disease is one of the most common causes of referral to health centers and imposes a heavy burden on health systems. With the increase in life expectancy and the increase in the elderly population in Iran, similar to other countries, the prevalence of this disorder has increased significantly. This study investigates the demographic and radiological findings in patients with degenerative cervical disease who underwent surgery for the first time in Iran. Methods: In this cross-sectional study, the medical profiles of 301 patients with a definitive diagnosis of degenerative cervical disease who underwent surgery in Shafa yahyaeian Hospital in Tehran from 2010 to 2019 were reviewed. The demographic characteristics and radiographic findings of the patients were extracted by referring to the patient’s medical profiles using a checklist.  Results: The mean age of the patients was 51.12 ±11.2 years. A total of 202 (67.1%) were women. The mean body mass index was 27.1±3.11 kg/m2. A history of neck surgery was reported in 6% of patients. Meanwhile, 51.6% of patients had education higher than a diploma, more than half of the patients were employees, and in 147(48.8%) of the patients, the C5/C6 level was involved. C6/C7 and C4/C5 level involvement were 68(22.6%) and 56(18.6%), respectively. Conclusion: This study showed that the frequency of cervical discs in women was higher compared to men, especially in the fifth and sixth decades of life. Based on radiological findings, C5 and C6 were the most common levels of involvement. The prevalence of cervical disc disease was higher in people with higher education as well as employees than in other professions.

Background: Total hip arthroplasty (THA) is a highly successful orthopedic procedure, recognized as the gold standard for addressing advanced osteoarthritis, with a projected global increase in performed cases. Objectives: This study investigated the accuracy of cup positioning in patients undergoing THA using the anterolateral (AL) approach. Methods: This cross-sectional study included patients undergoing ALTHA at Shafa Yahyaiyan Hospital in Tehran, affiliated with the Iran University of Medical Sciences, from 2018 to 2023. Post-operative radiological evaluations were conducted, and anteversion and inclination were assessed using established protocols. A safe zone for cup orientation was defined with an inclination angle of 40±10° and anteversion angle of 15±10°. Results: Among 91 patients, the mean age was 51.14 years and 48 cases (52.7%) were male. Considering the safe zone for cup orientation, 69 patients (75.8%) fell within the inclination angle safe zone and 46(50.5%) were within the anteversion angle safe zone. However, no significant associations were found between age, gender, side of operation and the safe zones for anteversion and inclination. Conclusion: The results indicated that the AL approach, as performed by experienced surgeons, achieved favorable cup positioning in the majority of patients, regardless of age and gender.

Background: The inflammatory response following trauma is the possible pathophysiology of complex regional pain syndrome (CRPS) I, caused by the release of pro-inflammatory factors and neuropeptides. Vitamins C and D are two antioxidants that can effectively prevent the occurrence of CRPS I. Objectives: The primary aim of this study was to compare the effectiveness of vitamins C and D in preventing the occurrence of CRPS following the fixation of distal radius fractures. Methods: The study was performed from January 1, 2018 to the end of December 2019. Patients who had fractured distal radius were candidates for external fixation and PCP. The patients were divided into three groups: 1) Receiving 500 mg of vitamin C daily for 50 days, 2) Receiving an oral dose of vitamin D of 5000 IU weekly for 50 days, and 3) Receiving no complementary medicine (control group).  Results: Of the 150 fractures, 62 type C3, 56 type C2, and 32 type C1 were observed, constituting 41.3%, 37.3%, and 21.3% of the total. During the two follow-up sessions, CRPS occurred in 28 patients (18.7%). Among the 28 patients mentioned, 14 patients (50%) belonged to group C, 8 patients (28.6%) belonged to group B, and 6 patients (21.4%) belonged to group A.  Conclusion: The use of vitamins C and D reduced the incidence of CRPS in patients with distal radius fractures. Also, the use of these vitamins was significantly effective in improving CRPS and reducing pain and ROM limitation.

Background and Objectives: Intertrochanteric fracture is a prevalent condition among the elderly that affects many people annually in both health and financial status. Type A2 intertrochanteric fracture is treated with surgical internal fixation either through a cephalomedullary nail (CMN) or a dynamic hip screw (DHS). This study compares radiological and clinical outcomes of CMN and DHS devices in patients with type A2 intertrochanteric fractures. Methods: In this retrospective cohort study, hospitalized patients with A2 intertrochanteric fracture who were treated with either CMN or DHS devices from 2014 to 2023 were included in the study. All participants were assessed retrospectively regarding radiological outcomes (nonunion, varus malunion, and femoral medialization percentage) clinical outcomes, and incidence of pulmonary thromboembolism and deep vein thrombosis.  Results: A total number of 194 patients were included in the study. The patients who were operated on with DHS showed a better result regarding the incidence of varus malunion compared to CMN (P=0.009), while the incidence of nonunion and union failure, and percentage of femoral medialization showed no significant difference between groups. Despite a comparable total score of modified Harris hip score in both groups (P=0.669), DHS surgery had a better outcome in the walking distance status component (P=0.043). Conclusion: Despite better outcomes of DHS surgery regarding the incidence of varus malunion and walking distance status, other outcomes of both groups did not show a significant difference. However, more prospective studies with multiple systematic follow-ups and radiographs are needed to confirm these findings.

Background and Objectives: Acquired local hypertrichosis occurs unilaterally in the same organ, causing asymmetry and beauty-related issues. This study investigates the prevalence of hypertrichosis after the casting of limb fractures, addressing patient concerns, preventive measures, and timely treatment. Methods: In this prospective cohort study, 82 patients who were hospitalized in the orthopedic department of Hazrat Rasul Akram educational, research and treatment complex in 2019 and required limb casting due to fractures or trauma were included. Demographic and clinical information of the patients were collected through interviews or by consulting the patient’s clinical file. The severity of the trauma and the presence of hypertrichosis were also determined by clinical examination. Results: Out of a total of 82 participants in the study, 41(50%) were male and 41(50%) were female. The mean age was 41.04±22.14 years. The mean duration of casting was 4.65±1.02 weeks. Meanwhile, 80(97.6%) people had undergone plaster casting once; however, 43 people (52.4%) had minor fractures. The most commonly injured site was the distal tibia, accounting for 30.48% of cases. The patients with hypertrichosis and patients without hypertrichosis were the two study groups, and the mean age in each group was significantly different from the other (P=0.0001); however, no other significant relationships or differences were discovered (P>0.05). Conclusion: The incidence of hypertrichosis in Iranian society is 8.5%, which is slightly lower compared to other societies. Younger patients in Iran are more susceptible to developing hypertrichosis after limb casting of broken limbs.

Neglected knee dislocations are rare. There is no agreement on the best treatment for these injuries. In this report, we present a case of old knee dislocation treated with open reduction and proximal tibial traction pin. After open reduction and extensive soft-tissue release, the complete reduction was not achieved. Therefore, we used a proximal tibial traction pin to gradually obtain a complete reduction via ‎traction weight change.‎ We did no ligamentous repair. One year after the operation, the patient had an acceptable radiographic reduction and satisfactory clinical outcomes. We recommend the proximal tibial traction pin as a valuable alternative in the treatment of neglected ‎knee dislocation. In addition to its promising outcomes, the traction pin is much less expensive than the already-used devices. Moreover, the introduced procedure makes the future conversion to total knee arthroplasty (TKA) more feasible, which is considered a significant concern in such ‎patients.