فهرست مطالب خشایار صاحب اختیاری

One of the common operations for lower limb mal-alignment below 50 years of age is proximal tibial osteotomy. In the open wedge technique، the superficial medial collateral ligament (MCL) usually needs to be released. This study seeks to evaluate the results of open wedge high tibial osteotomy with or without releasing MCL. In a prospective clinical trial، 59 patients with symptomatic genu varum between 16-50 years of age who were candidates of tibial osteotomy were divided into open wedge surgery with (30 patients، 40 knees) or without MCL release (29 patients، 36 knees). The outcome was studied comparing the stability in valgus، pattelar height slope of tibial plateau، and also the knee score (KSS) in a 17. 4 months (3-24 months) follow-up. The patients from MCL preserving group، with mean age of 26. 7±9 improved their scores of 53. 5±15. 2 to 81. 9±13. 4. The cases from MCL-releasing group with mean age of 25. 5±8. 4 improved the score of 52. 4±14. 6 to 65. 4+17. 8. The rates of surgical complication and valgus instability were lower in MCL preserving ones، but tibial slope remained unchanged in either group. Both techniques lead to an improvement in the KSS score; however it was more significant in MCL preserving group with lower complication and without valgus instability.

Scaphoid fractures are the most common fractures of the wrist. This study compared the outcomes of two surgical internal fixation techniques، using either Herbert screws (HS group) or multiple pins (MP group)، in the treatment of scaphoid fractures. This cross-sectional study was performed on 41 patients (23 in HS and 18 in MP groups) with unilateral scaphoid fractures from September 2009 to September 2011. All patients were followed-up two weeks post-surgery، every month for six months، and then every year after one year. Degree of fracture healing، measured level of pain using Visual Analog Scale (VAS)، range of motion، hand grip strength of affected limb vs. healthy limb، Quick DASH score (QD) and also Mayo Modified Wrist Score (MMWS) were recorded. In December 2012، all patients presented to the Orthopedic Clinic for their final follow-up visit where all data was recorded once more. Mean patient follow-up time was 24. 34 ± 8. 70 months (range: 11-34). Mean scaphoid fracture healing times for the HS and MP group were 14. 61 ± 3. 88 and 14. 39 ± 4. 27 weeks، respectively. No statistically significant difference was found between both groups after comparing mean levels of pain using VAS، ROM of wrist during flexion and extension، hand grip strength expressed as percentage of normal، QD، and MMWS. The level of patients'' content using VAS was 9. 5 for HS and 9. 0 for MP groups. The use of multiple pins for the internal fixation of scaphoid fractures proves to be a viable treatment option compared to Herbert Screws، due to decreased cost and increased availability.

Cementless total hip arthroplasty is an accepted alternative in young patients، but in older individuals، its use is still controversial. To evaluate the clinical and radiological outcome of cementless hip replacement in patients aged 65 years or older using proximally tapered femoral stem implants. In this cross- sectional study، 162 patients (173 hips) with a mean age of 69. 38±3. 8 years (range 65-80 years) who were candidates for and underwent cementless total hip replacement with polyethylene-metal and were followed up for 3-7 years. were entered “Harris Hip Score” (HHS) was applied to assess the functional outcomes. All the patients were screened for early complications (thrombophlebitis of the lower extremity، early dislocation، hematoma، surgical site infection)، and late complications (aseptic loosening، dislocation، osteolysis، and need for revision) at 3 and 6 weeks، 3 and 6 months، 1 year post-surgery، and annually thereafter. Patients were followed for an average of 5. 5 years (range 3. 1-7. 3 years). Six hips (3. 5%) experienced early-onset complications (1 case of hematoma، 2 cases of symptomatic thrombophlebitis، and 3 cases of premature hip joint dislocation)، and 2 cases (1. 1%) of delayed-onset dislocation. Not case of aseptic loosening or osteolysis was observed. Mean pre-operative “Harris Hip Score”، was 54. 3 and increased significantly to 84. 6، and 87. 8، on immediate and latest follow up visits، respectively. Cementless total hip arthroplasty، in elderly patients، i. e، 65 years and older، using new generation proximally tapered prosthetic femoral implants، and wear resistant acetabular cups with polyethylene inserts، is a low risk surgery with satisfactory results in short to moderate follow up study.

The knee is the most commonly injured joint by adolescent athletes. Since there is almost no published study reporting the type and frequency of knee injuries among Iranian athletes، this study is sought to fill the mentioned gap. This study aimed to determine the epidemiology of knee injuries among the patients presented to Sports Medicine Committee of Guilan Province from 2010 to 2012. Of the 2035 patients، 1409 injuries (69. 2%) were associated with the knee joint. 68. 1% of those patients were men and 31. 6% were women. After recording the demographic characteristics and physical examination، plain antero-posterior and lateral radiographs were performed، if necessary، and in the suspected diagnosis، further evaluation such as MRI and arthroscopy were performed. ACL tear was the most common cause of internal knee injuries (44. 7%)، followed by medial meniscus (23. 5%) and lateral meniscus (21. 6%). Almost half of the patients were between the ages of 20-29 (43%). Despite the smaller number of women، the rate of ACL tears was significantly higher in them than that in men. The most common sports associated with internal knee injuries were soccer/futsal (56%) and martial arts (31%). The highest risk for ACL injury in male and female athletes was observed while performing soccer (66%) and martial arts (89%)، respectively. Knowledge of the epidemiology and specific pattern of injury of the knee joint during sports may help prevent، diagnose، and treat knee joint injuries. Conflict of interest: non declared

With rapidly growing literature in the medical sciences being printed internationally, as well as in Iran, the need for citing references accurately has increased in importance. Accurate documentation, not only helps the proficiency of the citing author in a certain subject, but also reveals both journal's and author’s credibility and knowledge. This study aims to assess the rate and severity of improper citation practices in articles published by The Journal of Guilan University of Medical Sciences In this cross-sectional study, 9153 references in 531 articles published in 42 issues from year 2000 to 2011 have been evaluated. From each research article, three randomly selected references (1593 references) were checked for citation errors. Out of 531 research articles, 102 instances (19.2%) were found not to allude to the referenced citation, and 127 articles (23.9%) were not cited in the appropriate accepted format. Overall, 959 references (60.2%), were found to have some degree of error. After improving instructions for authors in 2005, and the creation of e-journal and electronic library in 2008, significant decrease of errors were found (both P<0.001). Additionally, as more years passed by, a significant decrease in the amount and severity of citation errors was noted (P<0.001). Although accuracy of writing references in The Journal of Guilan University of Medical Sciences improved significantly, referencing problems still exist. Utilizing the benefits modern technologies, requesting a copy of the first page of all cited references, and stressing the importance of a trustworthy bibliography, may decrease the citation errors.

Over 150 different surgical techniques for treatment of anterior shoulder instability has been suggested that there is no consensus in the orthopedics. This study seeks to compare treatment outcomes of arthroscopic Bankart lesion repair methods with Bristow - Latarjet open surgical technique in patients with anterior shoulder instability. In this cross-sectional study all patients with recurrent shoulder dislocation from 2009-2011 was divided into two groups, arthroscopic Bankart treatment (28 cases) and open Bristow - Latarjet (26 cases) that all were treated by one orthopedic surgeon. Patients were visited in 2,4,6,8 weeks also in the third and sixth month post-op. The visual analog scale (VAS) for patient satisfaction and Walsch-duplay and Rowe score for functional outcomes of treatment were used in six months follow up. These three criteria were analyzed again after recalling the patients. Mean age of 54 patients was 29.46±9.16 years and mean follow-up duration was 23.28 ± 6.2 months. Scores of patients in both groups were not statistically different after analyzing the functional outcomes of treatment by Walsch-duplay and Rowe score after six months and final follow-up. Scores of patients by Walsch-duplay measurement in arthroscopic Bankart and Bristow-Latarjet groups were 98.03±4.37 and 97.88±4.51 respectively and by Rowe index were 97.32±5.52 vs. 97.88±4.51at final follow-up. No recurrence was observed in both groups in final follow up. Patient satisfaction in Bankart and operation groups were 9.4 ±0.68 and 9.47±0.58 (p = 0.69). In anterior shoulder instability, minimally invasive Arthroscopic Bankart procedures almost equal to open Bristow-Latarjet method with regards to shoulder stability, recurrence rate, and range of motion.

The Valvular mechanism and associated intra-articular lesions has shifted therapeutic approach for Baker’s cyst towards arthroscopic technique.

The aims of this study include determining the frequency of accompanying intra-articular lesions as well as comparing the outcomes of treating popliteal cyst with arthroscopy and open surgery.

This is a prospective study on 45 patients referred with symptoms of pain، swelling، and limited range of motion in knees and underwent arthroscopy with a diagnosis of Baker’s cyst confirmed by clinical examination and sonography. The accompanying intra-articular lesions were documented and treated and، whenever possible، the cyst’s valve was removed (26 cases). Otherwise، the cyst would be excised by open surgery (19 cases). On arthroscopy، we used the anterolateral and anteromedial portals to treat accompanying lesions، and the additional posteromedial portal for removing cyst’s valve. We recorded and analyzed the patients’ demographic characteristics، associated lesions and rate of reduction of symptoms (using Rauschning and Lindgren scale) before and three months after surgery. One year after surgery، recurrence was studied through sonography.

The arthroscopic group consisted of 11 women and 15 men (mean age: 48. 27±8. 27years) and 8 women and 11 men (mean age: 48. 63±9. 15 years) were in open surgery group. They all had at least one intra-articular lesion. The most frequent associated lesion was medial meniscus tear (75. 6%)، followed by sinovitis and chondral lesions. In both groups، the patients recovered considerably after three months (p<0. 0001); in both modes of therapy symptoms were reduced almost equally (P=0. 74) and no case of recurrence after one year was found.

The results suggest that arthroscopic treatment of intra-articular pathologies may result in lower rate of recurrence for popliteal cyst. In case the valve is found and removed and the cyst is extracted through its entry into the knee، it is then not necessary to excise the cyst by open surgery.

Congenital unilateral absence of pectoralis muscles in combination with ipsilateral brachysyndactyly is the most acceptable definition of Poland syndrome. This very rare syndrome has been reported in association with various malignancies and deformities including cardiovascular anomalies. To our knowledge, pulmonary stenosis associated with Poland's syndrome has not been described previously in literature, and there are a few articles about atrial septal defect (ASD) in combination with this syndrome either. We present the first report of Poland syndrome associated with pulmonary valve stenosis and another case of Poland syndrome with ASD. We discuss common etiologic factors of this rare syndrome. Case history: Case one: The first patient is a 23 month old boy with Poland syndrome presentation such as absence of pectoralis major of right hemi-thorax, nipple and subcutaneous hypoplasia and ipsilateral brachysyndactyly. On physical examination, we found a systolic ejection sound in auscultation so that a complete cardiac evaluation was performed. Pulmonary stenosis with 7mm diameter was detected by Color-Doppler echocardiography. Case two: The second patient is a 5 year old girl presenting typical Poland syndrome clinical manifestation. She has congenital right pectoralis major agenesis, Right upper position of nipple and areola was compared to left hemi-thorax, and an ipsilateral hypoplastic hand with syndactyly and short fingers. The 2-dimentional echocardiogram revealed that she is suffering from an Ostium Secundum ASD. Although Poland syndrome is a rare congenital one, it is associated with numerous anomalies and malignancies in the reported articles. The two mentioned cases are the samples of cardiac anomalies associated with this very unique syndrome. According to critical situation of cardiovascular problems, performing a complete cardiovascular evaluation in addition to common medical-surgical treatments seems to be essential for patients with Poland syndrome.

Brown tumor is an osteolytic lesion caused by excessive production of parathyroid hormone. We present a 20 year old man with symptoms of severe muscle weakness and multiple fractures of shoulder and hip that the Brown tumor was observed in most of his bones

Cementless total hip replacement is an accepted alternative to total hip replacement with cement in younger patients، but it remains controversial for elderly patients. This study evaluated the functional results and complications of cemented and cementless methods in old patients. In this cross-sectional study، all the patients aged 65 years or older who had been hospitalized for total replacement of hip joint because of femoral neck fracture or osteoarthritis of hip were studied during a 3-year period in three educational hospitals in Iran. «Harris hip score» was used to assess the functional consequences. The early complications -thrombophlebitis of lower limbs، dislocation، hematoma and infection - and late complications - aseptic loosening، dislocation، and reoperation، were documented. 209 eligible patients، including 96 (45. 9%) cemented and 113 (54%) cementless were studied. Patients were followed for a mean period of 5 years and 2 months (51-82 months). The overall rate of early complication was 8 cases (3. 8%): five in the cemented and three in cementless group، respectively. Late complications were seen in two cases -one loosening in cemented group and one dislocation in cementless group. The final Harris hip score at the final follow-up was 84. 01±4. 71 in cemented and 85±5. 02 in the cementless groups (p≥. 05). Cementless hip replacement can have a satisfactory functional result like cemented hip replacement procedure in the elderly patients over 65 years of age.

Dissertations could be evaluated from two views; studied subjects and citations. With regard to importance and necessity of presenting citations in students dissertations or articles present study seeks to evaluate the citations of medical and dental students'' dissertations in order to find the effector factors on their quality in the last 5 years. In this sectional-analytical study all medical and dental students'' dissertations which have been written between years 2006 and 2011 (425 cases) were included. First 10 references of each dissertation (4233 cases) were selected. All evaluated citations were graded into 5 groups: excellent، good، fair، poor and very poor. The only acceptable and error-free group was «excellent» and others had errors to some degree and were unacceptable. A checklist was used for the study and gathered information was analyzed by SPSS ver. 19. From all dissertations، 26. 8% were medical and 73. 2% were dental. All dental and 98. 1% of medical dissertations had clinical supervisors. The mean half-life of references were more than 5 years in 86% of dental and 70. 7% of medical dissertations (P<0. 001). Dissertations'' grade were increased by increment in their scores but this correlation was statistically weak in dental (P=0. 043) and had no significant in medical group (P=0. 321). 10% of medical and 7. 9% of dental dissertations gained excellent grade (P=0. 007). Weak or no significant correlation between references'' counts، half-lives and grades with dissertations'' score demonstrated the inattention to accuracy of citation from students، supervisors and review board.

Entrapment of flexor pollicis longus at the level of A1 pulley is the most common cause of snapping or painful thumb upon flexion and extension motion; the so called which is called «Trigger Thumb». The aim of this study is to assess the efficacy of sonographically-guided intra tendon sheath corticosteroid injection in the management of trigger thumb. In a prospective study 104 patients (7 males، 97 females، 112 trigger thumbs) with the mean age of 52. 11±7. 63 who had trigger thumb underwent intra flexor sheath corticosteroid injection under the guide of ultrasound in a 2 year period in Rasht-Iran. Improvement was measured using the «Quinnell» grading system before and in intervals after 3 and 6 weeks; 3، 6 and 12 months after injection. From the 112 thumbs، 15 (13. 4%) required reinjection and/or surgery. Twelve (80%) of these 15 thumbs were simply re-injected، 2 (13. 3%) underwent surgery without re-injection but because of no improvement، underwent surgery. Reduction in Quinnell grade after the first injection was significant (p<. 0001). One year after the first injection، 111 of 112 thumbs (99. 1%) were symptom-free. Sonographically guided intra flexor sheath corticosteroid injectionis an effective method in the management of trigger thumb and would reduce the need for surgical release.

Progress in high-contrast ultrasound technology in recent years brought more attention to its rule in the diagnosis of carpal tunnel syndrome (CTS). The aim of this study is to evaluate the diagnostic value of sonography in the diagnosis of CTS and its relationship with disease severity.

In this prospective study، 100 patients who had unilateral upper extremity involvement were studied. All patients were initially undergone electro diagnostic test and the test was assumed as the gold standard. Afterwards the cross-sectional area and anteroposterior diameter of the median nerve in the carpal tunnel inlet and outlet and the thickness of the flexor retinaculum were measured by ultrasound in all patients. Relationships between ultrasound and electro diagnostic findings were evaluated using SPSS software ver. 19th.

Patients included 84 women and 16 men in the age range 19 to 72 years (mean age 44. 43 ± 12. 05 years). Among the criteria evaluated، the proximal and distal cross sectional area of the nerve showed significant correlation with disease diagnosis (P= 0. 018 and P= 0. 022 respectively). In addition، significant relationship was found between mentioned two criteria and the severity of the disease (P<0. 05 both). The best cut-off point at the proximal cross sectional area was 9. 45 mm2 in which the sensitivity was 78. 9%، specificity was 82. 8%، positive predictive value was 91. 8% and negative predictive value was 61. 5%.

The present study indicated that evaluating the cross sectional area of the median nerve using ultrasound at the carpal tunnel inlet is useful in diagnosing CTS. According to its high sensitivity، specificity and positive predictive value، it is not only useful in diagnosing suspected patients but also can be useful in screening the population at risk.