فهرست مطالب

Journal of Research in Orthopedic Science
Volume:4 Issue: 1, Feb 2017

  • تاریخ انتشار: 1395/12/17
  • تعداد عناوین: 8
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  • Khodamorad Jamshidi, Alireza Mirzaei Page 1
    Context: Differentiation of low-grade chondrosarcoma (CS) from enchondroma (EC) is a clinical, radiological and pathological challenge. Considering its effect on the choice of therapeutic approach, this paper discusses the distinguishing criteria of low-grade CS and EC.
    Evidence Acquisition: Evidence of this article came from the result of more than 15500 surgeries of musculoskeletal tumors performed at our center during the previous 26 years, in addition to an inclusive literature review of related published articles.
    Results
    Pain is considered as the most distinguishing clinical criteria of low-grade CS from EC. Aggressive radiologic criteria including cortical destruction, cortical thickening, deep endosteal scalloping and periosteal reaction favor the presence of low-grade CS. Predominantly, intermediate signal on T1-weighted MRI, multilocular appearance on contrast-enhanced T1-weighted MRI, extensive gadolinium enhancement, and peri-tumoral edema could also favor low-grade CS. In addition, permeation of the bone marrow by cartilage and separation of cartilage lobules by fibrous bands could be regarded as the pathologic characteristics of low-grade CS.
    Conclusions
    Radiological evaluation is considered as the first line method in the distinction of low-grade CS and EC. In this regard, attention should be paid to the presence of aggressive radiological features.
    Keywords: Enchondroma, Low, Grade Chondrosarcoma, Differentiation Criteria
  • Davod Jafari, Samad Joudi, Payam Hassany Shariat Panahy Page 2
    Background
    The goal of treatment in displaced lateral condylar fracture is to achieve union without residual deformity. However, growth disturbance may occur despite initial anatomic reduction and secure fixation.
    Objectives
    The purpose of this study was to evaluate clinical and radiographic results and assess complications associated with the operative treatment of lateral condylar fractures in children.
    Methods
    A total of 73 pediatric patients under the age of 13 years, who were diagnosed with displaced lateral condylar fractures of the humerus and were treated with open reduction and internal fixation, were assessed from March 2011 to September 2015. The mean follow-up duration in these patients was 22 months (8 - 48 months). The clinical results were evaluated using the Hardcare scoring system. Also, anteroposterior and lateral radiographic views were assessed to identify the union process and presence of complications.
    Results
    The results of evaluation on 48 boys and 25 girls demonstrated that lateral condylar fractures of the humerus were more common in boys, aged 5-8 years (average: 57.1%). There was no significant relationship between complications and sex. However, according to the radiographic evaluation, while fractures in 71 (97.2%) patients were completely united without any complications, 2 (2.8%) patients experienced overgrowth of the lateral humeral condyle. Clinical evaluation demonstrated excellent and good outcomes in 68 and 5 patients, respectively. Also, evaluation of Hardcare scores revealed no significant relationship between complications and clinical outcomes.
    Conclusions
    The present results were in line with previous research regarding the absence of complications such as non-union, avascular necrosis, fishtail deformity, cubitus varus, cubitus valgus, and pain. The findings demonstrated that the acceptable treatment option for displaced and rotated fractures is open reduction and internal fixation. Furthermore, deformity did not affect the clinical outcomes of fractures.
    Keywords: Lateral Condylar Fractures of the Humerus (LCH), Union, Delayed Union, Overgrowth, Avascular Necrosis, Children
  • Farshad Nikouei, Hassan Ghandhari, Saeed Sabbaghan, Abdol Razzaqh Iri, Hossein Hamdollahzadeh, Ebrahim Ameri Page 3
    Research Article
    Background
    The identification of independent factors affecting the loss of lumbar lordosis can facilitate programmed surgery in adolescent idiopathic scoliosis (AIS) patients especially with considering the importance of sagittal characteristics.
    Objectives
    This study aimed to investigate the factors affecting the amount of the loss of lumbar lordosis in surgical treatment of the patients with AIS using segmental instrumentation.
    Methods
    In this study which was conducted in three years, 91 AIS patients who underwent segmental instrumentation were studied and 63 patients remained in the study according to the inclusion criteria. All patients’ information was recorded on admission in separate forms and radiography results were coded and archived before the surgery for more evaluation. All patients were subject to standing whole spine radiograph again 12 months after the surgery. Ultimately, the information was put into predetermined forms and was used for a statistical analysis after the completion of forms.
    Results
    The mean age of the patients was 15.62 ± 3.09 years. The mean preoperative lumbar lordosis was 45.25 ± 12.17 degrees and the mean preoperative thoracic kyphosis was 41.54 ± 16.31 degrees. The mean postoperative lumbar lordosis was 34.37 ± 10.26 degrees. The mean postoperative thoracic kyphosis was obtained 26.56 ± 9.17. The mean surgical correction of thoracic kyphotic deformity and lumbar lordosis were correlated with each other with the correlation coefficient of 0.71 (P
    Conclusions
    Considering the findings of this study, the most important factor affecting the amount of post-operative loss of lumbar lordosis in segmental instrumentation in AIS patients is the amount of the correction of thoracic kyphosis. So that, the greater the amount of the correction of thoracic kyphosis, the more the loss of lumbar lordosis. Men, also, have a more loss of lumbar lordosis.
    Keywords: Lumbar Lordosis, Thoracic Kyphosis, Segmental Instrumentation
  • Davod Jafari, Ali Ajvadi Page 4
    Background
    The value of external fixation in complex hand injuries is well established. Expenses and technical difficulties of commercial mini external fixator sets have led to the innovation of handmade external fixators. These fixators are used as versatile facilities to treat certain hand fractures. Usually, these structures are made by k-wires crossed filled with cement plastic tube. However, these fixators have multiple deficiencies that should be addressed.
    Objectives
    In this study, we described in detail the surgical technique of a handmade concrete like mini external fixator and report its clinical use and results.
    Methods
    Our handmade external fixator was applied for 52 patients with 56 fractures. Only 5% of the fractures were closed, non-comminuted extra-articular, and the other 51 fractures were more complex injuries. The mean follow up time was 9.3 months. At the end of the follow up, radiologic and functional assessment (DASH: Disability of arm, shoulder and hand and TAM: Total active motion) was evaluated.
    Results
    All 56 fractures were united completely. None of the cases experienced pin loosening or reduction loss. Of the fractures, 8.9% malunited due to fracture complexity. The mean dash score was 3.76. TAM was excellent in 45% of the fractures; it was good in 7% and fair in 4%.
    Conclusions
    This type of handmade external fixator is simple, lightweight, and cheap. Furthermore, all implements are readily available in most operating fields. The probability of loosening has been greatly diminished because of the concrete like structure. Easy and fast assembly and good clinical and functional results are the other advantages of this technique. Due to the less complication and benefits, this technique could be used for many phalangeal and metacarpal fractures with confidence.
    Keywords: Mini External Fixator, Handmade, Phalangeal Fracture, Metacarpal Fracture
  • Hassan Ghandhari, Saeed Sabbaghan, Farshad Nikouei, Farhad Rahbarian, Hamed Tayebi, Ebrahim Ameri Page 5
    Background
    Disfiguring complications of adolescent idiopathic scoliosis (AIS) could significantly affect the patients’ satisfaction. In this regard, shoulder imbalance has recently received much attention in spite of its poorly understood challenge.
    Objectives
    While the majority of previous studies have attempted to explore preoperative determinants of postoperative shoulder imbalance, in this study we aimed to investigate the factors correlated with the preoperative shoulder imbalance.
    Methods
    A total of 72 AIS patients with no previous history of corrective surgery took part in this study. The study sample comprised 63 females and 9 males with the mean age of 15.72 ± 3.08 years, ranging from 11 to 26 years. Shoulder imbalance parameters including T1 tilt, first rib angle (FRA), and clavicle angle (CA) were assessed and their correlation with radiographic characteristics of the curves and patients’ demographic data including age and sex was evaluated.
    Results
    T1 tilt was more severe in males (mean -8.2°) than females (mean -2.8°) (P = 0.04). Moreover, a significant correlation was found between age and FRA (P = 0.04). A significant correlation was also observed between main thoracic (MT) curve size and all the three parameters of shoulder imbalance (P
    Conclusions
    According to our results, in AIS, pre-operative radiographic shoulder imbalance could be affected by some curve parameters including MT and kyphosis size and demographic characteristics of patients including age and gender.
    Keywords: Adolescent Idiopathic Scoliosis, Shoulder Imbalance, Pre-Operative Determinants
  • Mahmoud Jabalameli, Hosseinali Hadi, Vahid Behshad, Tohid Safaei, Ali Shahsavari Pour, Salman Ghaffari Page 6
    Introduction
    The knee is the most commonly affected joint in the pigmented villonodular synovitis (PVNS). If misdiagnosed or mismanaged, PVNS, especially the diffused form can destroy joints and can result in terminal degenerative joint disease.
    Case Presentation
    We report 3 cases of diffuse form of PVNS with grade 3 osteoarhtritis that IS treated by total synovectomy and total knee arthroplasty (TKA). The mean duration of the follow-up was 46.5 (9, 11, 120) months. In 2 cases, staged posterior then anterior synovectomy and TKA were done with excellent results. In 1 case, simultaneous synovectomy and TKA was performed with hematoma formation postoperatively and quadriceps tendon rupture 10 weeks later with fair final result.
    Conclusions
    TKA in PVNS is a challenging procedure. We recommend open posterior synovectomy then anterior synovectomy and TKA in 2 separate operations. Quadriceps mechanism must be protected during synovectomy.
    Keywords: Pigmented Villonodular Synovitis, Total Knee Arthroplasty, Synovectomy
  • Hooman Shariatzadeh, Bahman Hosseini Page 7
    Introduction
    Avulsion of extensor carpi radialis brevis (ECRB) insertion from dorsal base of the third metacarpal with or without bony chips is rarely reported.
    Case Presentation
    The current study reported the case of a young male that after falling down the stairs, referred to emergency room with dorsal wrist pain and weakness in wrist extension, and the lateral X-ray showed a bone fragment of dorsal capitate, but the computed tomography (CT) scan proved that the fragment was detached from the third metacarpal base. Then, with the diagnosis of ECRB avulsion fracture of its metacarpal base, the patient was operated and the fragment and accompanying tendon were fixed with 3 k-wires to its anatomic location and after 6 weeks of casting the pins were removed and at 6 months post-operation the range of motion and strength were the same as those of contralateral side.
    Conclusions
    ECRB avulsion is a rare condition, and its diagnosis can be difficult, and it should be in differential diagnosis of wrist trauma with tenderness on the base of the third metacarpal bone.
    Keywords: Extensor Carpi Radialis Brevis, Avulsion Fracture, Third Metacarpal, Tendon
  • Tina Shooshtarizadeh, Mehdi Mohammadpour Page 8
    Introduction
    Nerve sheath myxoma (NSM) is a rare benign neoplasm of nerve sheath origin with Schwann cell differentiation. NSM and neurothekeoma were considered one single phenomenon in the past.
    Case Presentation
    A 28-year-old woman presented to our hospital clinic with pain and a fixed firm mass in the proximal phalanx of the right second finger. Excisional biopsy was performed and histological examination revealed NSM.
    Conclusions
    Based on the findings, NSM should be considered in the differential diagnosis of firm and tender masses in the upper extremities of young adults.
    Keywords: Nerve Sheath Myxoma, Finger, Neurothekeoma