IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2009 | Volume:7 | Issue:3 (28)|Papers Count:9

Background: Prior to 1980 decade, surgical ideas and facts were mainly based on the individual surgeon’s experience and the collective judgment of groups of surgeons. In the 1980’s the concept of “Evidence Based Medicine” became popular suggesting that all surgical practices must be based on evidence and not experience. According to the widespread publication of medical articles nowadays, the question often arises about the dependability and strength of the evidence. We are reporting the level of evidence (LOE) of articles published in the Journal of the Iranian Orthopaedic Association between 1995 and 2008.Methods: All the articles published in the Iranian Journal of Orthopaedic Surgery (1995-2008) were studied separately by 5 groups of physicians. The level of evidence rating system was based on the Journal of Bone and Joint Surgery, which classifies articles into therapeutic, prognostic, diagnostic and economic subgroups. The articles are subsequently divided into five levels in accordance with the defined levels of evidence.Results: Over half of the articles (54%) were therapeutic, 9% diagnostic, 35% prognostic and 2% economic. Overall 2% were placed as level I, 8% level II, 5% level III, 84% level IV and 1% level V.Conclusion: Therapeutic and prognostic articles and evidence level IV were the most common types observable in the articles published in the Iranian Journal of Orthopaedic Surgery. Furthermore, level I to III articles in this journal had increased over 3.5 times between 1995 and 2008.

Background: Clubfoot is a common congenital deformity in babies occurring in 1 in 1000 live births. The more accepted procedure in the past was surgery in severe cases. Ponseti technique is a non-surgical treatment method. We are exploring our early results in a small group of children with this method of manipulation and casting.Methods: We reviewed 24 patients (32 feet) with idiopathic clubfoot who were initially treated with ponseti method. The severity of deformity were classified according to the Pirani score system, before and after of correction phase. Pirani severity score and result was used in a 9 months (4-14 months) average follow-up.Results: Initial correction was achieved in 31 patients (96.8%). The patients, average of Pirani score before correction was 5.53 and after correction was 0.09 (p<0.05). Tenotomy was done in 21 patients (65.62%).Conclusion: Our study supports the use of ponseti method for the initial treatment of clubfoot deformity. Longer follow-up will be necessary to assess the risk of recurrence.

Background: The aim of this study was an assessment of patients with adolescent idiopathic scoliosis (AIS) treated by short anterior fusion of the thoracolumbar/lumbar curve.Methods: In a retrospective study, 12 consecutive patients with Lenke 5 type AIS treated by short segment anterior spinal fusion during 2002-2005, were evaluated. The Cobb angles of major and minor curves, upper and lower end instrumented vertebrae angulation, disc angulation below the lower end instrumented vertebrae, apical vertebral angulation and translation, sagittal Cobb angles were assessed preoperatively, 4 days post operatively and at the last follow-up. Patients' satisfaction was assessed by SRS-30 questionnaire.Results: The correction of main curve cobb angle was 66.7%. The unfused thoracic curve improved to 50.2% that was comparable with flexibility data. In the major curve, there were an improvement of 92% in the apical vertebral rotation, 74% apical vertebral translation, 75% upper end instrumented vertebra angulation, 79% lower end instrumented vertebra angulation, and 92% correction of disc angulation below the lower instrumented vertebra. There were no significant changes in thoracic kyphosis or lumbar lordosis. The average SRS-30 at the last follow-up was 116 points.Conclusion: We conclude that short segment anterior selective fusion with anterior instrumentation of the thoraco lumbar/ lumbar curve in Lenke 5 scoliosis with a thoracic curve bending to 25o or less, results in a satisfactory correction and a well balanced spine.

Background: Rotator cuff muscles are the milestone of shoulder function. Tear of the rotator cuff could result in shoulder pain and deterioration of the function. The purpose of this study was to evaluate the outcome of arthroscopically repaired large and massive rotator cuff tears in short term.Methods: Fifity one consecutive patients (41 males, 10 females) with average age of 49 years old (38-62 y/o) who had arthroscopically repairable large or massive tears during a 3 year period in two hospitals in Tehran were included in the study. Ten of these patients were lost to follow-up and were excluded from the study. The remaining 41 were the focus of this study.Results: 28 patients had large tears and 13 had massive tears. Follow-up averaged 25 months (range, 12 to 48 months).Based on the University of California Los Angeles shoulder rating (UCLA), 88% of patients had good or excellent outcomes. Although 5 patients were considered failures based on the UCLA score, 98% of patients were satisfied with the result. Only 1 of these failures underwent a second operation for revision repair. There was no significant difference in final scores when comparing the massive tears with the entire group. The preoperative scores however for massive tears were lower than the large tears.Conclusion: Arthroscopic management of large and massive of rotator cuff tears results in good or excellent outcomes comparable to reported outcomes following open repair.

Background: Antifibrinolytic drugs are used to minimize the potential risks of bleeding and blood transfusion. Studies showed the effect of tranexamic acid on decreasing blood loss in cemented THA. We would like to report its effect on cement less hip arthroplasty.Methods: A prospective double blind randomized controlled study was conducted on 64 candidates for cementless THA under epidural anesthesia between 2006 and 2008. The patients were randomly divided into study and control groups.32 patients received tranexamic acid (15 mg/kg) and 32 received normal saline immediately before surgery.Results: The comparison of two groups showed less drop in 6 hour (p=0.035) and 24 hour (p=0.043) post-operative hemoglobin levels, less intra-operative bleeding (p=0.024), and less need for allogenic blood transfusion (p=0.017) in the tranexamic acid group. Although the mean of 6 and 24 hour hematocrit level was higher and hospital stay was shorter in the tranexamic acid group, but the differences were not significant.Conclusion: administration of tranexamic acid before cementless THA under epidural anesthesia can reduce intraoperative and post-operative bleeding as well as need for blood transfusion.

Background: Delivery of high quality services to the patients requires continuous refreshment with up-to-date information. This study was aimed at investigating the search behavior of Iranian orthopaedic surgeons in obtaining new information in their fields.Methods: During the 16th Annual Iranian Orthopaedic Association Meeting, questionnaires related to study were distributed among the participants. The questions were mainly related to: What source is commonly used for solving clinical problems? How often new journals of the field are utilized? What scientific route is used to increase personal information on subjects of specific interest? 178 orthopaedic surgeons completed the form.Results: The orthopaedic textbooks were the most common source on information used by the clinical problem cases.Orthopaedic seminars and conferences were the next common source followed by the journals. Direct one to one information seeking form colleagues were a very usual practice for specific clinical problem solving.45% would use internet for new orthopaeic knowledge updating.Conclusion: Internet and online services are not commonly used for knowledge updating by the orthopaedic group that we studied.

Congenital Knee fusion-whether as an isolated lesion or in association with other anomalies-is a relatively rare condition.This is a report of such a case without growth plate around the fused knee, who underwent leg equalization procedure.

Traumatic dislocation of lisfranc joint is relatively rare. There have been many different subtypes and variations in this injury. We would like to report a variation of this injury in a 40 years old man who had lisfranc dislocation with simultaneous dislocations of first and second metatorsophalangeal joints. A two-year follow-up has been done.