سال:1397 | دوره: | شماره: |تعداد مقالات:6

Background: Recently, opening-wedge high tibial osteotomy (HTO) has attracted much interest due to its advantages over closingwedgeHTO. However, it has been reported to influence the posterior tibial slope (PTS), potentiating the knee for subsequent complications. Objectives: This study aimed at evaluating: 1. How open-wedge HTO changes the PTS, and 2. how the PTS evaluation method influencesthe extent of the PTS change. Methods: Patients with genu varum deformity, who underwent HTO at the center of the current study were included. Tomofixplate or Podo plate with or without bone graft were used for fixation purposes. The pre-and post-operative assessment of the PTSwas performed using three different evaluation methods, including tibial anatomical axis (TAA), fibular anatomical axis (FAA) andposterior tibial cortex (PTC). Results: A total of 119 knees from 83 patients, with mean age of 31. 32 10. 1 years and mean follow-up of 3. 1 1. 9 years, were includedin this study. Medial compartmental osteoarthritis was the most frequent type of etiology. The pre-operative PTS was 13. 16, 13. 81 and11. 55 using the TAA, FAA and PTC method, respectively. The post-operative PTS was 12. 59, 12. 95 and 10. 77 using the TAA, FAA and PTCmethod, respectively. The change of PTS was not statistically significant using either methods. Conclusions: A negligible reduction of less than 1º was observed in the PTS of patients following opening-wedge HTO. The PTS assessmentwas not affected by the choice of evaluation method.

Introduction: The scaphocapitate fracture syndrome is a rare injury and refers to concomitant fractures of the scaphoid and capitatecarpal bones. It is a special type of perilunate fracture dislocation, accompanied with rotation of 90 or 180 degrees of thefractured proximal pole of the capitate bone. Case Presentation: A right-handed 23-year-old man was presented due to left wrist pain after falling down from great height. Hiswrist was swollen with severe pain, tenderness, and remarkable restriction of the range of motion. Plain X rays and CT scan revealedscaphoid waist fracture accompanied with capitate fracture and rotation of its proximal pole indicating scaphocapitate fracturesyndrome. The scaphoid and head of the capitate were reduced and fixed with headless Herbert screws and the injured lunotriquetralligament was repaired followed by immobilization of the wrist for 6 weeks. After removing the cast, the patient was referred tophysical therapy and finally achieved a painless wrist with acceptable range of motion and grip strength. Conclusions: Careful clinical examination and appropriate imaging are essential for diagnosis of this rare injury. Open reductionthrough posterior approach as well as anatomic reduction and fixation with headless compression screws and repairing the ligamentousinjuries can result in acceptable clinical and radiological outcomes.

Background: In the patients with osteoporotic vertebral compression fracture (OVCF) treated conservatively, significant progressionof the local kyphosis due to an impaired healing leads to reduction in the quality of life. Thus, it is of critical value to identifythe predictors of this major complication. Objectives: The current prospective cohort study aimed at evaluating the predictors of progression in the local kyphosis in a seriesof patients with acute OVCF undergoing conservative treatment. Methods: Eligible patients with OVCF were identified and local kyphosis progression was evaluated after four months of conservativetreatment. Demographic characteristics such as gender, age, and body mass index (BMI), as well as radiographic characteristicssuch as the location of fracture, bone mineral density (BMD), andserum25 (OH) vitaminDlevel were compared between the patientswith local kyphosis angle (LKA) progressed 30° (group A) and the patients with LKA remained < 30° (group B). Results: From a total of 60 patients with OVCF, LKA progressed  30° in 19 patients (31. 7%). The mean change of LKA was 16. 2°  7. 2° in group A and 1. 92°  2. 7° in group B (P < 0. 001). Higher age, lower BMI, and lower spinal BMD were significantly associatedwith LKA progression  30° (P = 0. 013, P < 0. 001, and P = 0. 037, respectively). The involvement of thoracolumbar junction (T11-L1)was more frequent in group A (P = 0. 049). Anterior cortical wall fracture was more frequent in group A as well (P = 0. 007). Afteradjustment of confounding factors, the association of LKA progression with the age, BMI, and the level of fractured vertebra stillremained significant. Conclusions: Significant progression of LKA following conservative treatment of OVCF is correlated with the level of fractured vertebra, BMI, and age of the patients. These factors could be used to select patients most benefit from conservative treatment.

Objectives: Laterallumbarinterbody fusion (LLIF) is increasingly being utilized in isolation to achieve a large surface-area interbodyfusion with an indirect decompression for spinal stenosis. This retrospective chart review was done to determine the viability ofperforming stand-alone (SA) LLIF. Methods: Forty-nine patients at least 18 years of age with minimum one-year follow-up at a single institution underwent SA-LLIFusing minimally invasive surgery (MIS) approach without further posterior surgery between 2011 and 2015. One to five-level fusionswere included. Retrospective review of surgical outcomesandradiographic parameters were examined preoperatively, acutely postoperativelyand at 1 year postoperatively. Results: Forty-nine patients (102 spinal segments) underwent SA-LLIF. Fusion levels ranged from one to five with a mean of 2. 1  2. 1. Mean blood loss was 68  63. 2cc and mean surgical time was 143. 4  66. 5 minutes. Fifty-seven percent had undergone priorspine surgery unrelated to their index procedure. Complication rate was 38. 9% and reoperation rate was 20. 4%. No difference incomplication rates was noted between constructs with three or more levels fused versus less than three levels fused. At one-year, significant improvement was noted with pelvic tilt, pelvic incidence, and lumbar lordosis. Conclusions: SA-LLIF is an optional MIS treatment of stable degenerative disc disease and spinal stenosis, with good one-year correctionand maintenance of radiographic parameters. With complication rate of 38. 9% and reoperation rate of 20. 4%, true benefitof forgoing posterior supplemental fixation may be questioned.

Introduction: Despite its low prevalence, giant cell tumor of tendon sheath (GCTTS) is considered as one of the most commonbenign tumors in the hand. GCTTS mostly affects tendon sheaths and finger joints; however, its presence in the wrist and Guyoncanal is scarcely reported. Case Presentation: In this report, we describe the case of a 32-year-old female with signs and symptoms of ulnar tunnel syndromein her right hand while the MRI illustrated a soft tissue mass in the Guyon canal. Excisional biopsy was performed, confirming thediagnosis of GCTTS. Conclusions: This report proposes the consideration of GCTTS as a differential diagnosis in patients suffering from ulnar tunnelsyndrome. In addition, it could be concluded that an excisional biopsy might be considered as a therapeutic and diagnostic methodin this disease.

Background: Recently, minimally invasive surgical (MIS) techniques havebecomemorecommonin orthopedics and traumatologypractice. MIS techniques may also reduce complications in the treatment of tibial plateau fractures (TPFs). Objectives: The aim of this study was to compare the radiological and functional outcomes of TPF, treated by MIS techniques andthe conventional approach (open reduction and internal fixation). Methods: The patients were divided into two groups, receiving either MIS (group A) or conventional treatment (group B). Eachgroup consisted of 20 patients. The mean age of patients was 46. 8 2. 85 years in group A and 50. 3 2. 41 years in group B. Incisionhealingcomplications were classified based on severity. Functional outcomes were evaluated using the Lysholm scale in the firstyear. Results: Complete healing without incision-healing complicationswasreported in all patients from group A, whereas nine incisionhealingcomplications were found in group B (P < 0. 001). The mean Lysholm scores of patients in group A and group B were 81. 8 1. 72 and 76. 3 2. 27, respectively (P = 0. 06). Also, the mean fracture union time in group A and group B was 9. 55 0. 46 and 10. 25 0. 71, respectively (P = 0. 41). Conclusions: Widespread use of MIS can be promoted in order to reduce incision-healing complications in TPF. However, furtherprospective studies with a larger sample size are needed to confirm our results.