Journal of Research in Orthopedic Science
Year:2017 | Volume:4 | Issue:4|Papers Count:6

Background: Orthopedic disorders of children are regularly managed by both general and pediatric orthopedists, practically, withvarious diagnostic and therapeutic approaches. Objectives: The purpose of this study was to compare these two groups of surgeons regarding consensus and viewpoint variety onBlount’ s disease and malalignment syndrome. Methods: A nine-item questionnaire was designed and different choices were provided for each question to cover the main managementstrategies. Forty surgeons in two groups of general orthopedic surgeons (GOS) (n = 20) and pediatric orthopedic surgeons(POS) (n = 20) participated in the study and they were asked to choose answers by an electronic keypad. Statistical analysis wasperformed with Chi-square and Fisher’ s exact tests. Results: For unimproved Blount’ s disease after one-year application of leg brace, 85% of POS vs. 31% of GOS tended to performosteotomy, mostly with pin and cast fixation. In case of recurrence, re-osteotomy and temporary hemiepiphysiodesis were mostpopular. For further work-up of typical Blount lesion in X-ray, 73% of POS and 36% of GOS would perform an MRI. For a child withasymptomatic torsional malalignment syndrome, 75% of POS and 78% of GOS voted against surgery; while, for a symptomatic patient, femoral and tibial osteotomy was the choice. Conclusions: Disagreements among orthopedic surgeons imply inadequacy of level-1 evidence. More comprehensive investigationsare necessary to elucidate the situation.

Background: Perilunate fracture dislocation (PLFD) and perilunate dislocation (PLD) are wrist injuries, which are commonlymissed. Meanwhile, the delay in the treatment of these injuries is leading to a more complicated situation. One of the acceptabletreatments for old cases is open reduction and internal fixation. Objectives: The purpose of this study was to determine the mid-term results of open reduction and internal fixation (ORIF) treatmentfor old unreduced perilunate injury that had been unreduced and untreated for a minimum of 6 weeks after injury. Methods: Between 2011 and 2016, 12 patients with old PLFD and PLD, untreated for a minimum of 6 weeks after injury, were treatedby ORIF. A retrospective review was performed with a minimum 12 months of follow-up. During the final follow up visit, the patientswere evaluated for pain, range of motion, and grip strength. TheMAYO wrist score was used for functional assessment. The patientswere assessed using a validated Persian questionnaire Quick DASH score. Radiological outcomes were classified using the Herzbergclassification. Results: All of patients were males with a mean age of 25 years (18 to 32 years). Perilunate Fracture Dislocation injury was found in 7cases and PLD in 5 cases. Mean time from injury to surgery was 14. 3 weeks (6 to 26 weeks) and mean follow-up after the surgery was33. 5 months (12 to 60 months). The mean MAYO wrist score was 77. 5 (55 to 85). According to the Mayo wrist score, 42% of patients(5 patients) had good, 50% (6 patients) had satisfactory, and 8% (1 patient) had poor results. The active range of flexion-extensionaveraged 107. 5° (range 80 to 155° ), and grip strength averaged 84% (range 53% to 100%) of the intact extremity. According to theHerzberg classification, 5 (42%) patients were radiologically located in group A and 7 (58%) in group B. Patients’ satisfaction ratebased on the Persian Quick DASH score had an average of 12. 5. Conclusions: Open reduction and internal fixation is an appropriate treatment with acceptable functional and clinical results inold unreduced perilunate injuries up to 6 months after trauma.

Background: Infection is the most common complication of spinal surgeries. Surgical site infection (SSI) can result in high hospitalisationcosts owing to prolonged hospital stays, repeated surgeries and an increase in the frequency of pseudoarthrosis. Objectives: The purpose of this study was to identify the risk factors of SSI in patients treated with thoracolumbar posterior spinalinstrumentation. Methods: Inclusion criteria were treated by posterior thoracolumbar stabilization with transpedicular screw and posterolateralfusion in the neurosurgery clinic between March 2006 and June 2009. Overall, 260 consecutive patients were identified and 239patients included in this study. Risk factors that may cause increase of rate of SSI were evaluated. Results: There were 153 female and 86 male patients with 48. 23  16. 77 year-old. In all patients, the SSI rate was 12. 5% (n = 30). Tenout of these 30 patients (4. 1%) had deep wound infections and 20 patients (8. 4%) had superficial infections. The average duration ofinfection development was 13. 26 10. 96 days. The most isolated bacteria was Staphylococcus aureus (n = 10). Trauma as primary diagnosis, diabetes mellitus and other concomitant chronic systemic diseases, long operation time, excess blood loss during operationand excess blood product transfusion, intraoperative dural injury and presence of additional operations after primary operationwere risk factors in the development of SSI. Length of postoperative ICU stays was determined to be a significant risk factor also. Conclusions: It is important to know the risk factors of the patient and the surgery to reduce the frequency of infection. The goldstandard in infection control is to prevent development of SSI.

Background: Complex regional pain syndrome (CRPS) is a chronic syndrome of pain usually caused by an initiating noxious eventin the periphery. Carpal tunnel release (CTR) surgery has been known to associate with the development of CRPS. Objectives: The incidence rate of CRPShasbeenattributed to the differences in ethnicandsocioeconomicbackgroundof the cohort. Here, we aimed at evaluating the incidence of CRPS after CTR surgery in Iranian population for the first time. Methods: In a prospective study, a total of 106 patients with carpal tunnel syndrome (CTS), who underwent CTR surgery, were includedin this cohort. The patients’ medical records were evaluated and the incidence of CRPS after CTR surgery was assessed accordingly. Visual analogue scale (VAS) was used to subjectively evaluate the pain level in each CRPS patient. Results: In this study, 7 (6. 6%) cases of postoperative CRPS including 1 (14. 2%) male and 6 (85. 8%) females were identified at a meanfollow-up period of 6. 1  2. 4 months, ranging from 2 to 7 months. The mean age of CRPS cases was 49. 5  10. 6, ranging from 31 to74 years. In 2 patients the dominant hand and in 5 patients nondominant hand were involved. The mean preoperative VAS was 2. 9, ranging from 2 to 4, which increased to 8. 1 in CRPS patients, ranging from 7 to 9. Conclusions: CRPS could be seen frequently following the CTR surgery, giving rise to a pain level of significantly higher than theinitial pain level. Consequently, the patients should be informed of this potential adverse consequence of CTR surgery, especiallythose having the risk factors of this condition including gender, age, and hand dominancy.

Background: There are different classifications for adolescent idiopathic scoliosis (AIS), among which Lenke classification is themost recent and comprehensive method. It is 3 dimensional and treatment organized. In most previous studies, thoracic hypokyphosiswas more common, but it may be different in many patients. Objectives: The current study aimed at assessing the prevalence of thoracic hyperkyphosis in AIS for the first time in Iranian population. Methods: The study was performed retrospectively on 242 patients with AIS treated surgically in the university hospital from 2009to 2014. Three parameters were evaluated in each patient including the 6 curve types of Lenke classification, thoracic sagittal balance, and lumbar spine modifier. Results: Adolescent idiopathic scoliosis was more common in female patients (83. 5%). Type one curve was the most common type(48%). In lumbar spine modifier, type A was the most common (44%), similar to other studies. Hyperkyphosis was the most commontype of thoracic sagittal balance (54%), which was in contrast to the original study by Lenke. The mean thoracic sagittal balance washyperkyphosis in all Lenke types except type 5, which was normal. No relationship was found between the prevalence of thoracickyphosis, and lumbar spine modifier, or the 6 types of Lenke classification. Conclusions: The frequency of different types of curves in Iranian population was the same as that of the original article by Lenkeexcept that in the current study more thoracic hyperkyphosis was observed than hypokyphosis in the population.

Background: Ischemic neuropathy is a major complication in patients undergoing hemodialysis (HD) with arteriovenous (AV)fistula. Objectives: The aim of this study was to investigate the relationship between cubital tunnel syndrome and chronic HD via forearmAV fistula. Methods: All HD patients with forearm AV fistulas, who were referred to the hemodialysis ward of Rasoul-e-Akram and Hasheminejadhospitals from February 2014 to February 2015 and met the inclusion criteria, were enrolled in the study. They were asked aboutulnar neuropathy symptoms and were under physical examination and electrophysiological studies for cubital tunnel syndromeat the time of recruitment and 1-year follow-up. Results: A total of 90 HD patients were included in the study. The mean age of the participants was 53. 65  17. 89 years (range, 22-86 years), and 53 (59%) patients were male. Cubital tunnel syndrome was not detected in the patients. There was a significantdifference in tingling and muscle weakness of the hand and forearm under chronic HD via forearm AV fistulas (P < 0. 05). Therewas no significant relationship between chronic HD via forearm AV fistula and neurological symptoms, including pain and muscleatrophy of the hand and forearm (P > 0. 05). Conclusions: This research concludes that chronic HD via forearm AV fistula does not lead to cubital tunnel syndrome in HD patients.