رحمت الله جوکار

Degenerative hip joint of diseases can cause physical inability and pain in patients. Hip arthroplasty is a standard and successful method for improving quality of life and reducing the cost of treatment for these patients. A number of surgical approaches to the hip joint exist, include direct anterior, lateral and posterior. Considering to efforts for evaluating the functional problems of these patients, the aim of this study is to comparison the functional results of the lateral and posterior procedure in hip arthroplasty, in order to determine the preferred method with the best functional results.

A total of 50 patients then randomly are divided into two groups: first lateral classical method and second Classic posterior. Patient demographic information, history of preoperative disease and postoperative complications were collected. The patients were assessed with the Harris Hip Score (HHS) at 6 month follow-up visit to evaluate functional outcome. The results of treatment patients were evaluated in 1 and 6 months after the surgery.

HHS index in the lateral and posterior groups 99.2 and 99.2 was reported respectively at 6 months after the intervention there was no statistically significant difference between the two groups. Also, the mean range of motation score in the lateral and posterior groups 298 And 299 Was reported respectively at 6 months after the intervention that there was no statistically significant difference between the two groups.

The findings of this study showed that there is no significant difference between the results of two methods of lateral and posterior surgery.

Intravenous regional anesthesia is a simple and reliable method for surgeries of the lower extremities.  The purpose of this study was to compare the effect of regional intravenous anesthesia with spinal anesthesia on foot surgeries.

This study was conducted as a randomized clinical trial on 60 patients undergoing foot surgery in two similar groups. In this account, the intervention group received intravenous regional anesthesia with 40 mililitre of lidocaine (0.5%) and the control group underwent spinal anesthesia with marcaine (0.5%). Duration of analgesia, duration of postoperative analgesia after opening the tourniquet, recovery time, postoperative pain intensity based on Visual Analogue Scale (VAS), blood pressure, heart rate during the surgery and recovery period, and other complications such as nausea, vomiting and headache were assessed in both groups.

The two groups did not differ in age and sex. The mean duration of analgesia in the spinal group was 121.13±17.30 minutes and in the intravenous anesthesia group was 49.50±5.14 minutes (P<0.001). The mean duration of analgesia after opening the tourniquet was 72.17± 15.29 minutes in the control group and 11.17± 6.22 minutes in the intervention group (P<0.001). The mean recovery time in the control group was 26.83± 4.82 and in the intervention group was 13.10±3.20 min (P<0.001). One hour postoperative pain score was 2.3 ± 0.31 in the control group and 7.1± 0.20 in the intervention group (P<0.001).  Hypotension, bradycardia, nausea and vomiting, dizziness, and headache were more incidental in the spinal group than in the intravenous anesthesia group (P<0.001).

In short-term foot surgeries, intravenous regional anesthesia is more appropriate than intra-spinal

Supracondylar fracture of the humerus is common in children and various surgical procedures are used to manage this condition. This study was conducted to compare the treatment results of open surgical approaches; external (lateral) and posterior access.

This cross-sectional study was performed in 200 children (younger than 10 years of age) with supracondylar fractures of the arm attending Babol Shahid Beheshti Hospital (2014-2018) who underwent open surgery using either lateral or posterior approach. Radiographic examination and some factors such as age, sex, cause of fracture, type of fracture, fracture side, and range of motion of elbow joint were compared between the two groups at week eight after the surgeries.

Among the patients, 98 (48.8%) underwent surgery with lateral approach and 102 (51.2%) underwent posterior approach. There were no significant differences between the two groups in age, sex, fracture side, and the predominance of the involved arm (P<0.05). We observed no significant differences between the range of motion, bearing angle, flexion and extension of the injured side. Clinical and radiological variables in injured and healthy hands in the external approach showed that range of motion (152.45±3.27 vs. 143.61±4.50), carrying angle (11.98±1.72 vs. 11.44±2.75), and flexion (141.91±3.30 vs. 134.35±4.85) and extension (10.60±1.69 vs. 9±2.35) of the elbow were lower in the injured hand (P<0.001). In comparing the clinical and radiological variables between the injured and healthy hand in the posterior approach, it was found that the range of motion (152.78±3.64 vs. 144.39±4.39), carrying angle (12.4±1.47 vs. 11.62±1.83), and flexion (142.54±3.33 vs. 135.41±4.36) and extension (10.14±1.81 vs.  8.89±2.07) of the elbow were lower in the injured hand (P<0.001).

The study showed no significant differences between external and posterior approaches in treatment of supracondylar fractures of the arm.

Femoral neck fracture is associated with a high rate of side effects, especially in young people, who are usually affected by severe energy shocks. Results after injury depend on some factors, including displacement, fragility, bleeding rate, proper placement, and stable and strong fixation. The aim of this study was to compare dynamic hip screw (DHS) or multiple cannulated screws (MCS) in fractures of the femoral neck base.

In this cross-sectional study, 78 patients with femoral neck fracture were treated by internal fixation: MCS (n= 26) and DHS (n= 52) in Babol Shahid Beheshti Hospital, 2016-2018. Complications, including pain and lameness, infection, avascular necrosis (AVN), and nonunion were investigated in both groups. The visual analog scale (VAS) score and Harris Hip Score (HHS) were also compared between the two groups.

Mean ages of the patients in MCS group and DHS group were 54.19 ± 23.35 and 58.50 ± 21.06 years, respectively. In patients treated by MCS, infection, AVN, no welding, and pain and lameness were seen in 3, 2, 3, and 6 patients, respectively, while these complication were observed in 1, 1, 1, and 4 patients in the DHS group, respectively. The rate of complications were not found to be significantly different between the two group (P>0.05). The mean VAS score was significantly lower in the DHS group compared to that in the MCS group (P<0.05). The HHS scores were not significantly different between the two groups (P<0.05).

According to this study, MCS is more appropriate in the treatment of femoral neck fractures due to less bleeding and shorter operation time.

Diabetes Mellitus is a prevalent disease worldwide and foot ulcer is one of the serious complications of chronic uncontrolled diabetes which could lead to various complications such as amputation of the extremity if left untreated. Total contact casting (TCC) is the gold standard in treatment of neuropathic and neuro ischemic diabetic foot ulcers (DFU) on which less emphasize is seen on routine medical practice. The aim of this study was to emphasize on healing effect of this off-loading method and to study the possible influence of variants on the healing rate of this technique. In this cohort study, 92 diabetic patients with complaint of plantar foot ulcer grade 0, 1 and 2 according to Wagner classification had participated in Shahid Beheshti Hospital, Babol City, Iran, from March 2014 to February 2016. The demographic and biochemical information along with dimensions of foot ulcers were carefully recorded. After the primary cleansing, surgical debridement and dressing, TCC was applied on foot by the specialist and they were requested to return weekly for changing the TCC and re-evaluation of ulcers. The healing rate was calculated as decline in ulcer surface area per week. 92 patients of study sample with mean age of 63.9±10.56 year consisted of 76 patients with DM type 2 with BMI of 31.16±3.8 kg/m² and 58 male patients. The average healing rate of ulcers treated with TCC was 0.406 ±0.168 cm²/week. The duration of diabetes on average was 17.23±6.93 years. Most of the patients (n=45) had an ulcer on the forefoot and the healing rate of midfoot ulcers was slower. The average amount of baseline HbA1c was 8.2±0.19%. There was no relation between smoking history (P=0.94) and anti-diabetic regimen used by patients (P=0.754) with the healing rate. The healing rate is slower in elderly patients and those with longer duration of diabetes. So in these two groups, TCC is to be applied for a longer duration in order to achieve complete healing.