فهرست مطالب amir sobhani eraghi

The inconsistent results of different studies regarding the prevalence of joint hypermobility (JH) or joint laxity in children and adolescents made us conduct a meta‑analysis on the prevalence of JH in this age group.

We searched electronic databases including Trip, Scopus, Medline, Embase, PubMed, and Google Scholar; some Iranian databases including Iran Medex and Magiran; and Scientific Information Database to find studies in which the prevalence of JH in children and adolescents had been reported since January 1990 to April 2017. In this process, two researchers evaluated the articles separately while they were not aware of each other’s method, and they extracted and matched the information.

Necessary data of twenty studies (15,097 boys and 6048 girls) were entered into this meta‑analysis. The age range in these studies was 3–19 years. According to the meta‑analysis conducted on the twenty studies, it was determined that the total prevalence of JH among children and adolescents was 34.1% (95% confidence interval [CI]: 33.3%–34.8%). Based on the results obtained from the studies, a significant heterogeneity (I2 index equals to 99,415 and P ≤ 0.001) was shown, so we used random‑effects model; moreover, the overall assessment of studies showed a statistically significant publication bias (P = 0.02). In total, the prevalence in girls was equal to 32.5% (95% CI: 31.4%–33.7%), and in boys, it was equal to 18.1% (95% CI: 17.2%–19.1%).

According to this meta‑analysis, studies showed high heterogeneity, and the prevalence of JH in children and adolescents around the world was equal to 34.1% (95% CI: 33.3%–34.8%) in total, whereas it was higher in girls and lower in older ages. Level of evidence: 1.

Anterior interosseous nerve (AIN) palsy after proximal humeral fracture is very rare syndrome. This report presents a 21-year-old man with axillary nerve and AIN palsy following a proximal humeral fracture. The fracture was treated with open reduction and internal fixation, and nerve palsy was treated conservatively. At 6-month follow-up, proximal humeral and distal radius fractures had a complete union. There was no subluxation of the humeral head, due to complete deltoid muscle recovery. Range of motion of the shoulders was complete and symmetric. FPL, index FDP and deltoid muscles had full strength. EMG revealed complete recovery of the axillary nerve and AIN injury.

Combined injuries of Mid-shaft clavicle fracture and Acromioclavicular (AC) joint dislocation are rare, and only a few cases have been reported. Several treatment options including surgical, conservative and hybrid approach have been described. Yet, there is no consensus regarding the optimal management approach for this injury.

Here we reported a case of Mid-shaft clavicle fracture with associated type IV AC joint dislocation in a 29-year-old male following a cycling accident.

Both parts of the injury were fixed surgically. Meanwhile, the patient did not follow the postoperative protocol and started the heavy sports activities one month after the surgery.

The patient showed up 6weeks after the surgery with slightly uncorrected AC joint. However, he was satisfied with the results and accordingly no intervention was done for the correction of the AC joint. 

Our case reveals the importance of adherence to the postoperative protocol in this combined and challenging injury and we recommend surgical fixation for such injury.

 

Orthopedic procedures on areas of the body where tourniquet application is not possible, such as the shoulder, is usually accompanied by significant bleeding in addition to a higher need for blood transfusion. Therefore, packed cell units are generally reserved prior to these kinds of procedures, however, not all of those are transfused during surgery. The waste of unused blood units takes a lot of money, time, and energy of the blood bank staff. In this study, we evaluated the average blood units reserved and consumed for elective shoulder surgeries to determine the C/T ratio (crossmatch/transfusion).

In this cross-sectional study, all recorded cases of elective shoulder surgeries between 2015 and 2017 were investigated through our hospital blood bank registry. The number of reserved blood units and transfused blood units (packed cell) for each surgical operation were recorded in the checklist. Finally, the average number of reserved and consumed blood units were determined using the SPSS v.16 software.

In this work, 157 patients with a mean age of 36 ± 19.6 years were studied, of which 66.9% were male. The average number of reserved blood units was 1.5 ± 0.586 and the mean number of injected blood units were 0.216 ± 0.672. In addition, the average number of injected blood units in the men's group was significantly higher; this difference was statistically significant.

Considering the ratio of reserved blood units to the injected ones, this ratio, on shoulder surgeries at our hospital in Tehran, was within the normal range

This case report presents an open subtrochanteric fracture in a premature low birth weight newborn, which was treated with intramedullary Kirschner wire.

A neonate with left open subtrochanteric fracture was referred to the orthopedics department of the current study. Pavlik harness was applied yet treatment failed; therefore, an intramedullary Kirschner wire was applied.

The pin wasmaintained for 6 weeks and fracture healing was confirmed by a radiograph. Follow up after 18months showed complete healing, no limb length discrepancy, and normal gait.

In some patients, traditional methods, such as traction, cast, and Pavlik harness cannot be used. Intramedullary Kirschner wire insertion could be an alternative treatment option.

Primary non-Hodgkin’s lymphoma of the bone (PLB) represents about 3% - 5% of all extranodal non-Hodgkin’s lymphoma (NHL) cases and 7% of primary bone tumors. It may occur at any age. The peak incidence for PLB is in the fifth and sixth decades of life, and it has a slight male predominance. The most commonly affected sites are the long bones. A palpable mass due to soft tissue extension of the bony disease is seen in almost half of all cases.
We report the case of an NHL (diffuse large B-cell lymphoma) in the talus bone of a 17-year-old boy who was referred to our center in 2011 - 2012, which had an odd presentation. The patient’s first diagnosis was a simple ankle sprain, and he underwent conservative treatment. Given the patient’s deteriorating symptoms, further paraclinical evaluations were conducted, and fracture of the talus was diagnosed, which was thought to be a cause of further osteonecrosis. Finally, because of lack of pain relief and due to MRI images, the suspicion of malignancy was raised. Open biopsy of the talus showed NHL (diffuse large B-cell lymphoma).
The present case is interesting because it expresses how such lesions can be met with diagnostic confusion.

Rotational deformity after intramedullary nailing is a well-known complication. Femoral malrotation is the most common form of malunion but it is underrecognized in part because of the difficulty in accurately assessing rotation as well as the variation that exists in normal anatomy. The aim of this study was to evaluate femoral malrotation following intramedullary nailing of the femur. We studied 70 patients who had referred to Imam Khomeini Hospital and had undergone antegrade intramedullary fixation for isolated femoral shaft fracture during 3-year period from 2008 to 2011. Inclusion criteria including isolated femoral shaft fracture that had undergone antegrade intramedullary nailing. Exclusion criteria including spontaneous ipsilateral tibial fracture or pelvic fracture، contralateral femoral fracture، femoral fracture that had fixed using plate or external fixator or retrograde intramedullary nailing. During operation، the patients were assessed clinically for rotational deformity and then in the postoperative follow-up period، degree of rotation was identified with CT scan. Postoperative computed tomography measurements of rotation were compared with the opposite side. There were 70 patients، 56 men and 14 women. The average age of the patients was 28. 21±14. 39 patients (55/7%) had external rotation and 31 patients (44/3%) had internal rotation. The mean of malrotation degree in physical examination was 4/67 and The mean of malrotation degree in CT scan was 7. Degree of malrotation deformity، less of 5º، 5 to 10º and 10 to 15º was less of 8. 6%، 75. 7% and 15. 7% respectively. Degree of malrotation didn’t relate to age، sex، fracture location and activity of the patients (P> 0. 05). Rotational deformity in 28% of the patients was equal to more 15º. This complication didn’t relate to fracture location. The patients with external rotation deformity had more symptoms than the patients with internal rotational deformity but there isn’t significant relation in this study.

Septic arthritis of the hip in children has multiple sequelae and may result in severe disability. Significant morbidity can be prevented by early recognition and treatment. The authors reviewed 13 children with 14 hips with sequelae of septic arthritis of the hip. All of children had history of hip septic arthritis before age of 4 years. Six were male subjects، and 7 were female subjects. We evaluated the history، clinical findings and radiographs of all children who had been treated at the Imam Khomeini hospital between 1986 and 2001 for septic arthritis of the hip. Final results of operations in patients include range of motion، presence or absence pain، joint stability، limb-length discrepancy were assessed. Three hips had mild pain in usual daily activities and one patient with cerebral palsy experienced hip instability. Most of patients (80%) had flexion contracture about 10-15 degrees. Final results showed average limb length discrepancy was about 2. 8 cm. Septic arthritis of the hip in children may result in a spectrum of residual problems and the significant complications can be averted by early detection and treatment. Treatment in younger age cause better outcome.

Hutchinson-Gilford progeria syndrome (HGPS) is a rare premature ageing disorder that is characterized by accelerated degenerative changes of the cutaneous, musculoskeletal and cardiovascular systems. Mean age at diagnosis is 2.9 years and generally leading to death at approximately 13 years of age due to myocardial infarction or stroke. Orthopedic manifestations of HGPS are multiple and shoulder dislocation is a rare skeletal trauma in progeria syndrome. Our patient had simultaneous shoulder and hip dislocation associated with a low energy trauma. This subject has not been reported. Treatment accomplished as close reduction under general anesthesia and immobilization.