IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2019 | Volume:17 | Issue:4 (67)|Papers Count:6

In my experience Guest Speakers have three tasks, they need to be somewhat interesting, a little funny, and not too long. Hopefully, I will achieve these goals. The talk is Skeptic Driven Innovation. I have no disclosures and really no claim to innovation. But I have always had an interest in business innovation and in the qualities that enhance one company’ s success over another. In business it is clearly understood that the status quo kills companies and those enterprises that challenge the status quo often improve their products or even develop new industries. . .

PURPOSE: We sought to determine the incidence, extent, and prognostic factors for physeal growth resumption after partial physeal bar resection. METHODS: We performed a retrospective chart review of all patients treated between 1981-2017 by lower extremity physeal bar resection. All radiographic images were reviewed from preoperatively until cessation of affected physeal growth, subsequent surgery, or skeletal maturity. RESULTS: Eighty-nine patients met inclusion criteria (26 distal femora, 49 proximal tibiae (including 40 infantile Blount patients), 14 distal tibiae). Thirty-seven (42%) had at least two years’ normal growth (defined as “ successful” ), 13 (15%) showed less than two years’ growth (“ partial” ), and 39 (44%) had no growth (“ failure” ) after resection surgery. 56% of the “ successful” and “ partial” groups required subsequent surgery compared to 100% of the “ failure” group. The use of methylmethacrylate (CranioplasticTM) as interpositional material was superior to autologous fat (p <0. 01). Anatomic type of bar (peripheral, central, linear), physis affected, patient age, and etiology were not prognostic. CONCLUSIONS: Approximately 40% of patients demonstrated useful resumption of growth after partial physeal bar resection. With the exception of interpositional material, other demographic variables were not prognostic. These RESULTS: should be considered when determining whether physeal bar resection surgery is warranted in individual patients. Advanced 3-D imaging reconstruction preoperatively, imaging confirmation of complete bar resection, markers to detect and monitor growth, and periodic radiographic follow up until cessation of growth or maturity should be incorporated in a standardized treatment regimen. LEVEL OF EVIDENCE: Level 3.

Background: About 80% of the population will experience back pain in their lifetime; however, although many patients have low back pain associated with disc degeneration, the exact course of degeneration is still unclear. The disc degeneration disorder has affected one-third of the worldchr('39')s young population. During degeneration, the disc undergoes morphological and biochemical changes, which in turn alter the tissue hydration, permeability, and ultimately the load-bearing capacity of the disc. Therefore, the finite element model, designed to study the relationship between frequent loading and disk degeneration, must be able to analyze the complex loading in the in-vivo conditions. The aim of this study was to construct and update models of finite element components with the prolastic properties so that different quasi-static loads could be investigated by presenting a personalized model in different individuals and applied in clinical studies to simulate the daily biomechanical behavior for accurate diagnosis and treatment. Method: This study simulated three different modes of finite element modeling, including axial symmetry Method: , parametric model and precision model with poroelastic mechanical properties and its RESULTS: were compared with experimental in-vivo experiments. RESULTS: To validate the constructed models, the RESULTS: of three different quasi-static creep experiments were performed, including short-term creep, long-term creep and creep under regular daily activities, the RESULTS: of which predicted changes. The RESULTS: predicted height changes, axial displacement of the spine and the intradiscal pressure of the nucleus. Conclusion: All the proposed RESULTS: indicated that the models presented in quasi-statistic behavior predicted acceptable RESULTS: and have sufficient validity to be examined in other quasi-statistic experiments. Therefore, it is possible to take a step forward in examining the RESULTS: of clinical activities in determining the process of intervertebral disc degeneration.

Background: Spinal fusion is a surgical Method: to treat degenerative diseases of the spine. We studied the effect of bone graft soaked with zolendronic acid (ZA) on spinal fusion. Method: 60 patients with degenerative disease, scheduled for spinal fusion were randomly divided into 2 equal groups, receiving either local bone graft or local bone graft plus topical zoledronic acid. The cases were studied with visual analogue scale (VAS), Oswestry low back disability questionnaire, and radiographic bone bridge formation with a 12-months follow-up. RESULTS: 57 patients completed the study: 27 patients in “ control group” and 30 patients in “ case group” . VAS Score was significantly lower in case group in comparison with control one after 12 months (P value: 0. 00). In the point of Oswestry low back disability questionnaire score(ODI)score the mean score was decreased significantly in “ case group” in comparison with “ control group” (P value =0. 006). Radiographic grades A or B bone bridging was more frequently observed in Zoledronic acid group at 12 months post-operation compared with the control group (p value=0. 00). Conclusion: This study demonstrates that addition of Zolendronic Acid to bone grafting in the spinal fusion of elderly people increases the fusion rate and is associated with better clinical and functional outcome.

Background: The aim of this study was to investigate the prevalence of Hepatitis B(HBV), Hepatitis C( HCV), and Human immunodeficiency virus(HIV)in a large trauma center in northeast of Iran. METHODS: In a descriptive cross sectional study, 27252 consecutive patients admitted in a trauma hospital in Mashhad, Iran during March 2012 to March 2017 who required surgery for their traumatic injuries were screened for the presence of Hepatitis B surface antigen (HBsAg), anti HCV Ab and anti HIV Ab. RESULTS: In 926 patients at least one of the serologic tests was positive, showing an incidence of 3. 3% seropositivity among study population. HBsAg was positive in 523 patients (1. 9%), HCV Ab in 388 (1. 4%) and HIV Ab in 15 patients (0. 05%) respectively. 19 patients (0. 06%) were simultaneously infected by more than one virus. Conclusion: The RESULTS: of this study demonstrate that seroprevalence of blood born-pathogens among trauma patients, especially HCV and HIV, are higher than general population and it emphasized that health care workers in trauma centers must adhere to standard precautions to prevent viral transmission.

Background: The use of autograft hamstring tendons for ACL reconstruction has increased due to measurable outcomes such as decreased donor site morbidity and improved fixation METHOD: S: . Final graft diameter is effective in reducing the chance of graft re-tearing. Anthropometric parameters such as age, gender, height, weight, Body Mass Index (BMI) and thigh circumferencehave been reported to be of predictive value in a variety of studies but there is poor consensus agreement. MRI based radiologic assessments also needs radiologic workstation and special software. This study investigated the relationship between pre-operative semitendinosus tendon diameter measured by MRI and intra-operative final graftconstruct diameter. METHODS: Adult patientsconfirmed to have anterior cruciate ligament(ACL)rupture by positive physical test and 1. 5 Tesla quality magnetic resonance imaging(MRI), who were candidates for autograft ACL reconstruction entered the study. Those with previous history of ACL surgery or candidates for allograft or bone patellar bone graft reconstruction were excluded. The MRI images of the patients were uploaded into Infinitesoftware. Joint level was determined first in coronal plane and then by using cross linking option the axial joint level was defined. Using cursor and ruler tools the maximum diameters of semitendinosus tendon was measured at the joint line, and two spaces (SPs) proximal and distal to it. Semitendinosus and final graft construct diameters were measured intraoperatively. SPSS software was used to analyze the data to find possible correlations. RESULTS: TheSemitendinosustendon graft diameter over 3. 4 millimeters at two spaces distal to joint line on axial MRI cut well correlated to intra-operative final graft construct diameterof over 8 millimeters. Conclusion: The proposed measurement techniqueis a reliable option to assist the surgeonsfor pre-operative prediction of graft size in hamstring autograft reconstruction.