فهرست مطالب amirreza farhoud

Entrapment of the ulnar nerve in the cubital tunnel occurs as the second most common compression neuropathy of the upper limb. Although the usual etiology is idiopathic or following cubitus valgus, a compressing mass can be a rare ca use and should be considered in atypical presentation.

Case Report: 

A 45-year-old male patient presented with subacute onset of cubital tunnel syndrome that progressed rapidly and was associated with significant pain. An intra-canal ganglion cyst was found during surgical decompression of the ulnar nerve.

Diagnosis of intra-cubital canal mass should be considered when sudden onset and rapid progression of the cubital tunnel syndrome and dramatic pain coincide. Imaging modalities like ultrasound or magnetic resonance imaging (MRI) may be helpful to reach the correct diagnosis before the surgery.

Forearm nonunion is rare but a possible complication after standard treatment of the fracture of radius and ulna. The importance of precise restoration of length and anatomical relationship of both bones are among usual concerns. The situation is more complex when the infection is present in the union site. The several techniques have been applied to manage forearm nonunion consisting of osteosynthesis and using cancellous autograft, allograft, nonvascularized fibular graft, fibular flap, bone transport, induced membrane (Masquelet technique), and pedicled flap such as posterior interosseous and radial forearm bone flap (RFBF). Reviewing the recent studies focusing on treating forearm nonunion is the purpose of this review.

Sanctions have always been an obstacle for development, even in health and medical topics, since they aim to reduce acountry’s financial and economic power, and their impacts on medical and health systems in the objected country are inevitable. Inthis report, we are going to show the effect of sanctions on orthopedic surgeries in Iran.

In this study, we surveyed the opinion of 32 orthopedic surgeons about the effect of sanctions on orthopedic procedures.We evaluated surgeries routinely done in our referral centers in terms of the need for equipment and facilities.

In upper limb surgeries, the high cost of equipment has more frequency between answers although, in lower limbsurgeries, the changing method due to lack of facilities with worse results than the standard method has more frequency between answers. Both results indicate that sanctions made the feasibility of orthopedic surgeries more difficult.

We believe that several actions are needed to take place in the current situation by the international organizations tostop this unreasonable and illogical sanction, to prevent its devastating results.

Although there are various surgical methods for subungual glomus tumor treatment, there is no consensus on the optimal surgical approach.

We analyzed the outcomes of 15 patients treated with partial nail plate excision technique. The medial or lateral section of the nail plate was excised longitudinally based on the tumor location. After incision of the nail bed and tumor removal, the matrix was repaired carefully.

In this study, 15 people, including 11 men and four women, were studied. The mean onset of symptoms until diagnosis was 88 months. In the postoperative evaluation, the mean follow-up was 20 months. Two patients had recurrent tumors, and one had postoperative nail deformity.

Meticulous nail bed repair and complete tumor excision are key treatment points needed to prevent nail deformity and recurrence.

The fast-evolving pandemic of COVID-19 has forced clinicians to implement tele-health strategies in their routine practice. Social media provides unprecedented opportunities to transfer educational, monitoring, and individualizing data to the target populations. There have been numerous efforts on social media to use telerehabilitation approaches for patients and therapists. Question/

The purpose of this study was to explore and analysis the trend that hand therapists used for tele-rehabilitation approaches during the lock dawn period in Iran.

Scraping method was used to map out the tele-rehabilitation strategies that Iranian therapists have implemented for the hand and upper extremity injuries during the COVID-19 pandemic. Tele rehabilitation method was searched by relevant hashtags and direct contact with therapists. Extracted data were described and categorized by content analysis and thematic coding.

During lock dawn period, 27 records from 18 accounts were posted with relative tele rehabilitation content in Iran. Based on the content of extracted data four themes were conceptualized: Empowerment, informative, adaptive to new situations, and supportive approach. The content that were covered in the most posts were informative approach (40%).

In spite of the urgent necessity for delivering care during the lockdown, the total number of the active therapists was very low. No documented method or platform was identified.

Total knee arthroplasty is considered as the treatment of choice for those with end stage hemophilic arthropathy.Compared to other patients undergoing TKA, these patients have specific features such as bleeding tendency, youngerage, pre-operative restricted range of motion (ROM), altered anatomy, and increased complications. This narrativereview of literature is going to investigate several issues regarding the TKA in hemophilic patients including indications,perioperative factor replacement, surgical challenges, postoperative rehabilitation, outcomes, and complications.Level of evidence: I

Context: While the clinical practice recommends field stabilization in trauma patients, in some situations, the speed of transport is crucial.

This study aimed to evaluate the association between emergency medical services (EMS) time intervals (response time [RT], scene time [ST], and transport time [TT]) and in‑hospital mortality in trauma patients in Tehran, the largest metropolis of Iran. Settings and Design: A prospective cohort study was conducted between May 2017 and April 2018.

All EMS operations related to trauma events in the Tehran city that were transferred to three targeted major trauma centers were included. Statistical Analysis: Logistic regression analysis was used to assess the relationship between EMS time intervals and other risk factors of trauma death.

A total of 14,372 trauma patients were included in the final analysis. In‑hospital mortality occurred in 225 (1.6%) patients. After adjustment for confounding variables, older age (odds ratio [OR] = 1.04/year), female gender (OR = 2.16), low Mechanism, Glasgow Coma Scale (GCS), age, and arterial pressure score (OR = 0.84 for each unit), low GCS (OR = 0.56 for each unit), longer ST (OR = 1.17/10 min), and longer TT (OR = 1.21/10 min) were found to be risk factors for death in trauma.

Our study showed that in‑hospital mortality of trauma patients correlated with longer EMS ST and TT, but the RT was not associated with mortality. Our results recommend that the EMS system should consider ST and TT rather than RT, as indexes of quality control in prehospital care of trauma patients.

Osteoid osteoma (OO) is a benign tumor that rarely occurs in carpal bones. Occurrence of OO in trapezoid is extremelyrare. We present a patient with OO of the trapezoid as 7th reported case around the world.

A 25-year-old man was referred to our clinic with a 12-month history of pain of his left wrist. He mentioned that hehad wrist pain during manual activity and the pain was increasing over time. He did not have history of trauma. He was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) before being referred to our clinic; however, it did not work. Examination showed tenderness over the dorsoradial side of the left wrist. Conventional radiographs of the wrist were normal. Computed tomography (CT) demonstrated a halo radiolucent osteoid tissue surrounded by a sclerotic tissue in left trapezoid. Magnetic resonance imaging (MRI) showed a focal hypointense lesion (nidus) in the trapezoid with 10 mm diameter. A focal increased uptake of 99mTc in his trapezoid was shown by bone scintigraphy. According to the clinical and imaging findings, we considered excisional biopsy with the diagnosis ofOO of trapezoid bone. Surgery was performed through a dorsal incision. We performed en bloc excision. Histopathological findings confirmed the diagnosis of OO. The patient got pain-free on postoperative day 3.

Carpal bones tumor such as OO should be considered in differential diagnosis of patients with chronic wrist pain.

During COVID-19 pandemia, orthopedic ward of Shariati Hospital continued its work as the refferral ward for trauma patients. As an educational center with undergrad and postgrad medical students, we were forced to acutely change our policies and the ward workflow in a way to limit the danger of disease transmission and continue education and giving medical service at the same time. Here we reported our strategies that were adopted in our center to continue educational process as efficient as possible.

COVID-19 has imposed an unusual effect on all aspects of medicine. Many elective measures have been canceled and medical facilities are reserved for this critical situation. Although a comprehensive approach is needed in entire fields of medicine to prevent spreading of corona virus and to protect the life of health care providers and patients, decreasing disabilities in orthopedic patients who are affected by trauma or those were in the process of rehabilitation, demands to apply some home-based or contact less policies. We assessed the available potentials that could be implemented easily for continuing the rehabilitation process of upper limb conditions because of significant role of this part of treatment, there.

The COVID-19 disease is rapidly spreading around the world, affecting many countries and their healthcare systems.Like many other countries, Iran is struggling with the current situation. In this article, we aim to share our perspectiveson confronting obstacles mentioned above using appropriate hospital protocols during the COVID-19 crisis.We investigated and compared the number of referred patients to the emergency room, elective, and emergentorthopedic operations in our hospital, along with a number of residents and faculty participants in the morning reportsand virtual classes before and after the outbreak of COVID-19 in our hospital.The number of referred patients to the emergency room was significantly reduced; the number of orthopedic operationswas also decreased to almost zero in March 2020. Meanwhile, we managed to dismiss our residents and reducethe number of in-hospital morning reports and conferences. Instead, we designed virtual classes, and the number ofparticipants in our virtual classes grew to almost two-third of the whole participant. We also managed to fortify our virtualoffice system to reduce the number of in-hospital visits.Since our hospital had become a leading center for the treatment of COVID-19 patients, and the number of referredtrauma patients, elective, and trauma operations, along with educational activities, was reduced. There was also asignificant concern about the management of elective, trauma, and post-operative patients in this era. Orthopedicfaculty members needed to react to the current situation cautiously. We were able to manage the situation withconsideration of our educational path, along with the management of personal protective equipment (PPE), and theuse of communication technologies and specific protocols to overcome the obstacles mentioned above. Yet involvedour staff andWith orthopedic faculties active involvement at in-hospital activitie and establishment of hospital protocols consideringtechnological facilities and WHO guidelines, we can improve education, management of PPE, and both orthopedicelective and trauma patients.Level of evidence: IV

This study aimed to compare the efficacy of rescue blankets with conventional blankets in terms of preventing hypothermia in the pre-hospital setting.

In this randomized clinical trial, patients older than 18 years old with Cold Discomfort Scale (CDS) > 2, and those who were transferred to the emergency department (ED) by emergency medical service entered the study. Patients were randomly divided into two groups based on the type of transfer. In this regard, one group was transferred with rescue blankets and the other group was transferred with conventional blankets. The tympanic temperature in patients and CDS were recorded before the use of blanket (primary) and at the time of arrival in the ED (secondary).

Finally, 161 patients with the mean age of 45.31±19.8 years were included (63.4% were male). Totally, 88 cases (54.7%) were transferred with rescue blankets and 73 cases (45.3%) with conventional blankets. The mean of the primary tympanic temperatures in the rescue and conventional blanket groups were 36.20±0.84°C and 36.34±0.65°C, respectively (P=0.23). The mean of the primary CDS in rescue and conventional blanket groups were 6.55±1.95 and 5.89±2.29, respectively (P=0.05). Also, the mean of the secondary tympanic temperatures in the rescue and conventional blanket groups were 36.59±0.47°C and 36.76±0.48 °C, respectively (P=0.03). Besides, the mean of the secondary CDS in the rescue and conventional blanket groups were 2.64±2.80 and 2.41±1.29, respectively (P=0.48).

According to the results, there is no significant difference in the tympanic temperature and CDS of the patients transferred with the rescue blanket compared with the conventional blanket

Knowledge of epidemiological aspects can be a useful guide in determining the resources for better prevention and management of injuries. There are some performed studies on this topic in Iran, based on the limited hospital database. However, to the best of our knowledge, there is not any survey based on the pre-hospital database.

The purpose of this study was to assess baseline characteristics of the traumatic patients according to the records of Tehran Emergency Medical Service (EMS) Center to present descriptive statistics of their epidemiological features.

This cross-sectional study was conducted retrospectively, using Tehran EMS center data registry. All traumatic patients examined by EMS in Tehran, Iran following call to emergency medical dispatcher were included. By reviewing the EMS technicians’ mission forms, required data were extracted. The mission form contains information such as age, sex, injured location, damage mechanism, accident location (home, workplace, street), time of call, the outcome of the patient's ambulance mission and the results of the assessment of the technician, etc.

Totally, 56612 injured cases with the mean age of 33.1±15.6 years were examined by EMS during one-year study period of whom 80.4% were male. Crude Incidence Rate was 10.5 and 2.5 per 1000 in male and female, respectively. Traffic accident and then fall were the two most prevalent mechanism of injuries. All types of injuries were significantly more prevalent in males (P<0.001). Most injuries were in winter season with 15570 cases (27.5%). Car accident was prevalent in winter and other injuries were significantly prevalent in spring (P<0.001). The most frequent places of injuries occurred on main roads and streets (55.7%). All of the road-related injuries was prevalent in winter, whereas injuries in other places were prevalent in spring (P<0.001). Most of the cases (78.3%) were transferred to the health centers, but 20.7% did not consent to treatment and transmission. Only 222 cases (0.4%) died, that 95% was due to traffic accident. there was a significant relationship between the number of injured organs and the death; So that the highest death rate occurred for those with more than 5 injured organs (P <0.001).

Based on the findings, traffic accident was the most frequent cause of trauma that led to visiting a traumatic patient by an EMS technician in Tehran, Iran. Injuries in all age groups were more prevalent in males, and the involvement of 5 or more injured organ had a significant relationship with mortality.

The earthquake is one of the most natural catastrophic crises that can cause a lot of casualties. Considering an earthquake-prone country, Iran is ranked as one of the world's most dangerous countries In this article, we describe the actions taken by emergency medical service (EMS) after the earthquake in Kermanshah, Varzaghan, and Bam and compared the strengths and weaknesses of the emergency response program and the limitations and challenges of this system in dealing with these major crises. This study is a cross-sectional study that compares some of the information and findings related to three earthquakes that occurred in Iran, including Bam, Varzaghan and Sarpol-e-Zahab earthquakes. The data reported in the present article is descriptive and is based on various independent sources such as National Emergency Operation Center, Local Emergency Operations Center (EOC), the EMS of the country, the World Health Organization, the United Nations, the statistics website, the Forensic Data website, the International Institute of Seismology and Earthquake Engineering, conferences and personal interviews. To ensure the credibility of the information, the authors reported data that had been verified by two or more sources. The characteristics of the geographic area of the 3 earthquakes has been described. Post-earthquake response activities were described in details in subheadings including rapid warning and response, surge capacity plan, rapid response teams, emergency medical teams, increasing the capacity of health facilities, increasing transfer capacity, and handling, transportation and distribution of injuries. In the recent earthquake, had been occurred in Sarpol-e-Zahab, the health response of the country was largely satisfactory. The existence of structures such as EOC at various levels, the unified incident command system, emergency operations plan, and Medical Care Monitoring Center are among the most important reasons for satisfactory performance.

This is a report on simultaneous dislocation of the left shoulder and elbow resulting in a 16 years old boy. Bipolar dislocation of Luxatio Erecta and posterior dislocation of the elbow is extremely rare. After clinical examinations (attention to pain, swelling, and deformity of the shoulder and elbow joints and neurovascular examinations), the necessary radiography was performed for the patient at the level of his tolerance: AP of the shoulder and side imaging of the elbow. Closed reduction was carried out with emergency maneuvers, followed by physiotherapy. Good result was obtained in the 6 weeks follow-up the examination of the adjacent joints of a dislocated limb is an important issue and must be emphasized.

Background and Diabetic foot ulcer is a complication of type 2 diabetes. Various factors, such as changes in the level of cytokines (especially IL-1β) can interfere with the development of diabetic foot ulcer. Several factors affect the level of IL-1β levels, including the rate of neurotransmitter, especially dopamine and its receptors. The aim of this study was to investigate the changes in IL-1β and dopamine DRD2 receptor in peripheral blood mononuclear cells (PBMCs) in diabetic foot ulcers.
In a cross sectional comparative study, peripheral blood samples were collected from 31 subjects with diabetic foot ulcer, 29 without ulcer, and 25 healthy individuals (control). Total mRNA was extracted from PBMCs and cDNA was synthesized to study the DRD2 and il-1β gene expression variations by real time PCR. Concentration of il-1β was also investigated in sera.
Significant decrease was seen in gene expression and sera concentration of il-1β in PBMCs in diabetic patients with foot ulcer. There was also a significant reduction in the expression of DRD2 receptor gene in patients with and without foot ulcer.
Reduction of IL-1β expression seems to be related to changes in the expression of DRD2 receptor gene. Therefore, after supplementary studies, reducing the expression of DRD2 could be regarded as a prognostic factor and as an effective factor in the spread of diabetic foot ulcer.

Osteoid osteoma (OO) is a benign osteoblastic neoplasm, mostly occurring in long bones of lower extremity. Its manifestation in unusual locations can be a diagnostic challenge and distressing for patients. OO in carpal bones is uncommon; its occurrence in triquetrum is even more so.

This study reports on a nineteen-year-old female with history of wrist pain for 4 years. She had sustained trauma to the same wrist before commencing of pain. Patient's pain was unresponsive to conservative treatments. Her routine x-rays were mostly interpreted as normal and obtaining further imaging helped us in diagnosis of OO of triquetrum. Surgical resection of the nidus was performed.

Manifestation of OO in small carpal bones may not be typical; identifying the lesion or nidus could be challenging. Whatever unusual the location or presentation of such lesions may be, obtaining advanced imaging can be of significant help; therefore, we suggest clinicians to have low threshold in ordering advanced imaging specifically in patients suffering from chronic pain. Also, persistent history of nocturnal pain is a sign which is worth attention

Tibia is one of the most common fractured long bone, which occurs most often in young people following high-energy trauma. Gold standard treatment of tibial diaphysis fractures is currently intramedullary nailing. In this study, we intend to examine the results of treatment of tibia diaphysis fractures with intramedullary interlocking nail without use of imaging (C-Arm) during surgery. In this cross-sectional study, 43 patients (36 males and 7 females with an average age of 31 years) were included, 40% were open fractures and 60% were closed. Just postoperatively, 12% of the cases had a problem with length and placement of nail and screws. A total of 18% had rotational deformity (78% less than 5 degrees) and 5% had only mild varus or apex anterior deformity. In cases where imaging during surgery is not possible for any reason, the use of intramedullary nailing along with distal jig could be performed for tibial shaft fractures.

This study aims to investigate the pattern of Musculoskeletal and soft tissue injuries in a series of referred patients in a tertiary medical center and review previous reports in the literature.
In this study, we recorded musculoskeletal injuries of the victims, following the Kermanshah earthquake on November 12, 2017, with a total number of 38. All patients were admitted to the Imam Khomeini Hospital. Injury type, site of injury, gender, age, complications, mortality, and treatment modality were recorded for each case.
Among 38 patients, 18 were male (47%) and 20 were female (53%). The mean age was 37 ± 21.6 years. Most of them were aged between 18 and 65 (71.1%). Lower extremities were involved more than the upper (37% versus 24%) and distal limb involvement was more than the proximal (57.3% versus 43.7%). One patient died due to necrotizing fasciitis and septic shock after femoral shaft open fracture. Two patients developed compartment syndrome and underwent fasciotomy complications by skin necrosis and infection.
Soft tissue injuries and fractures are the most common injuries following the earthquakes, hence orthopedic surgeries play a vital role in disasters. Despite patients overload and emergency situation in natural disasters like earthquakes, it is crucial to have a stepwise and evidence based approach for each patient. For the patients with open fractures referred to a tertiary center, careful contamination assessment even in the previously managed wounds is highly recommended, especially for those with early wound closure. Early fasciotomy in the crush syndrome is not beneficial as it has adverse effects such as skin necrosis and infection.

Magnetic resonance imaging (MRI) of the wrist joint is a useful method in the diagnosis of triangular fibrocartilage complex (TFCC), ligaments and tendons, peripheral nerves, cartilage and carpal tunnel syndrome. However, the evaluation of these small anatomical structures is a topic of investigation. In some instances, the diagnostic indices of MRI in tears and other lesions of cartilage and ligamentous structures are relatively low, so the protocols should be optimized..
In this study, we aim to compare new MRI protocols of 3D T2SPACE, PD BLADE and T2 BLADE with the conventional protocols, including T2 FSE, PD FSE, and T1 FSE in case of signal intensity..
Patients and Twenty patients with a history of wrist trauma or suspected wrist lesions were referred by orthopedic hand surgeons and enrolled into the study. All the protocols were carried out on all patients and the images were assessed quantitatively by measurement of signal to noise ratio (SNR) and contrast to noise ratio (CNR). Then, these parameters were compared between different protocols. SPSS ver.18 was used for the statistical analyses..
SNR of the cartilage, TFCC on 3D T2SPACE and T1 FSE was better than other sequences (P High-resolution MR images of the wrist using 3D T2SPACE, PD BLADE and T2 BLADE were superior to those using conventional sequences quantitatively. High-SNR and CNR MR imaging with SPACE and BLADE would be a promising method to diagnose wrist lesions..

Lunate fracture is a rare injury. Most reports are associated with other wrist injuries such as perilunate dislocation and distal radius fracture. Isolated lunate fracture has been reported even more rarely. The choice of treatment and outcomes are consequently undetermined.

In this case report we will describe a lunate avulsion fracture as an isolated injury after a fall from nine meters treated operatively by excision of the comminuted avulsed fragment. After 33 months of follow-up radiographs showed no sign of degenerative joint disorder on simple X-ray, but slight Volar Intercalated Segment Instability (VISI) by a capitolunate angle of 26 degrees was noted. Clinically, the patient was pain free near full wrist and forearm range of motion and could perform his previous vocational and recreational tasks without any limitations.

Despite apparently good short and mid-term clinical outcome, slight volar intercalated segment instability after 33 months of follow-up revealed that lunotriquetral ligament function was probably lost, which led to static instability. This ligament injury may be missed primarily. Excision of the avulsed osteochondral fragment should be the last option of treatment and most attempts should be tried to fix and/or restore the normal anatomy of ligamentous structure.

Osteomalacia represents a risk factor for hip fracture (HF), which is one of the most common and costly injuries in elderly.
This study was performed to determine the frequency of histopathologic and laboratory osteomalacia in elderly patients with HF.
Patients and Totally, 87 patients with HF, admitted to Imam Khomeini hospital, Tehran, Iran, from 2005 to 2006, were studied. Laboratory investigations included serum calcium, phosphorus, alkaline phosphatase (ALP), albumin and 25-hydroxy vitamin D3 [25 (OH) D3]. Open biopsy from ipsilateral iliac crest was performed during the same surgery.
The average age was 78.06 ± 8.4 years. Bone biopsy showed osteomalacia in eight patients (9.2%), hypocalcaemia in 42.5%, hypophosphatemia in 17.2%, hypoalbuminemia in 66.6% and 25 (OH) D3 deficiencies in 66.6%. Concomitant hypophosphatemia and hypovitaminosis [25 (OH) D3 Elderly patients with femoral neck or intertrochanteric fractures may have osteomalacia, as a treatable cause for osteopenia, and laboratory tests may not be precise criteria for diagnosis in HF patients.