احمدرضا میربلوک

 Various drugs are used as adjuvants to improve the quality of supraclavicular block method. 

 This study aims to investigate the effect of adding dexmedetomidine to lidocaine in the supraclavicular block method in patients candidate for upper extremity surgery.

 This double-blind randomized controlled clinical trial was conducted on 61 patients candidate for upper extremity fracture surgery receiving the supraclavicular block method from 2017 to 2018. They were randomly divided into two groups of lidocaine-normal saline (30 mL of 1.5% lidocaine plus normal saline) and lidocaine-dexmedetomidine (30 mL of 1.5% lidocaine plus 1 μg/kg of dexmedetomidine). The supraclavicular block characteristics and intraoperative hemodynamic changes were measured.

 There was no statistically significant difference between the two groups regarding the demographic factors. The mean age of patients was 43.09±10.92 years, and most of them were male. The mean onset time of sensory-motor blockade was faster and the duration of sensory-motor blockade and analgesia were longer in the lidocaine-dexmedetomidine group than in the other group. These differences were statistically significant. There was significant differences in hemodynamic parameters among nine assessment times in each group and between the two groups.

 Adding dexmedetomidine to lidocaine in the supraclavicular block method accelerates the blockade onset and increases the duration of blockade and analgesia after surgery without causing any considerable side effects.

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.

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.

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).

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.

Regenerative medicine is a field of medicine that uses the body’s ability in healing the tissues or damaged body parts. This area is extensively used in orthopedics, specifically in the treatment of disc destructive diseases, as well as injuries and inflammation of the tendons, joints, and ligaments. The most commonly used product in this field is platelet-rich plasma (PRP). In this research, we reviewed human clinical studies conducted to evaluate the role of PRP in spinal diseases.

Malnutrition is the cause of many problems in orthopedic patients. In this study، we aimed to determine the prevalence of malnutrition in patients who were hospitalized for ten days.

Control the potential damage caused by malnutrition in orthopedic patients

This is a cross-sectional study in which the prevalence of malnutrition in patients admitted to the Poursina hospital during the year 2011 was determined. A researcher -made questionnaire was formulated for each patient and their features were recorded on the first day of hospitalization، then، on the same day and the tenth day of hospitalization in these patients by nutritional tests، and lymphocyte count and serum albumin levels، were evaluated as well. Upon data collection، they were entered into SPSS version 16.

Of the 377 patients admitted to the orthopedic ward on the first day، 99 patients with malnutrition were recorded that reached to 81 cases on the tenth day. Malnutrition rate in open fractures increased in day 10 of hospitalization but reduced during the same period in closed fractures (P<0،005). Most of the malnourished patients had fracture of the femur. In patients with fractures of the femur، pelvis and multiple injuries، unlike other fracture sites، an increased incidence or severity of malnutrition during 10 days hospitalization was seen.

Due to the negative impact of malnutrition on patient improvement and orthopedic complications، dietary control is essential in these patients.

Backgroud: Most pediatric open long bone fractures are the results of high energy trauma، and can lead to complications. The aim of this study is to compare the results of two commonly used operative techniques for tibial or femoral fractures; namely external fixator and flexible intrameduly rods.

In this clinical series، 42 children with 45 femoral or tibail open fractures from 2009 to 2011 who were treated by either external fixator (EF) (24 cases) or TEN (21 cases) were compared. In few cases combination of TEN and pin were used for more stability. The patients were evaluated and compared for infection، nonunion، malunion and refracture.

Bony union in the EF group was achieved in 3. 8 months and in TEN group in 3. 6 months (p≥. 05). In each group، 2 fracture-site infections without any evidence of osteomyelitis was obsereved. Five pin site infection in EF group needed changing the pin site. In TEN group early nail removal was necessary because of painful bursitis in one case at nail insertion site. There were 4 femoral refractures in EF group after frame removal. In 10 patients with TEN and extra pin no symptom or problem was seen.

In our study EF was effective as a definitive treatment. Flexible intramedullary nails were also effective and their results were similar to those of EF. Combination of TEN and pin caused more stability without any symptoms.