فهرست مطالب amirreza sadeghifar

Genu varum is a type of knee deformity. In this deformity lower limb mechanical axis, moves inward to the knee centre. In genu varum mechanical axis usually lies through the medial of the knee joint. In this deformity, the patient's lower limbs become bow shape. One of the best techniques for genu varum correction is high tibial osteotomy that this procedure can change some index include posterior tibial slope (PTS), and insall-salvati index (ISI).

Our study was a cross-sectional study performed on patients with genu varum before and after a step cut of the high tibia osteotomy. The method of examining the posterior tibia slope was that before and after the high tibia osteotomy by Step Cut-MCL sparing method, a simple radiographic image in true lateral view (True lateral) was taken from the knee of patients. The significance level of P Value <0.05 was considered.

In this study 21 patients ( 11 male and 10 female ) were enrolled. Mean age was 36.19 ± 10.17 year-old. Mean PTS pre operation was 11.48 ± 1.94 degrees and post operation was 11.48 ± 2.15 degrees.

In our study, PTS increased after HTO that this increase was not statistically significant difference between men and women. In addition, we showed that this increase did not have significant relationship with age and BMI. In the present study, Insall-Salvati index showed no significant difference before and after the treatment.

Obesity is a growing epidemic in developed countries. Which lead to increase the percentage of obese people in the orthopedic trauma population and concern patients postoperative period. Lower extremity long-bone fractures are among the most common fractures and are associated with significant complications, prolonged hospitalization, and a heavy financial burden on the community health network. In this cohort study, all patients with lower extremity long-bone fractures treated in Bahonar Hospital in Kerman were included using the simple sampling method and divided into two groups based on BMI (BMI greater than or equal to 30 were considered obese, and people with a BMI less than 30 as non-obese) and followed for one year after treatment. Our study was conducted on two groups, each including 65 people, of obese and non-obese people with lower extremity fractures. In statistical studies, no significant difference was found between the obese and non-obese groups in terms of underlying disease (P = 0.1), fracture site (P = 0.13), open or closed fracture (P = 0.283), type of surgery (P = 0.217), and fracture complications (P = 0.699).There is no significant relationship between the complications of lower extremity long bone fractures of obese and non-obese people; it seems that mostly systemic complications should be considered in obese people after fractures. Finally, considering the differences between the results of this and similar studies and genetic and ethnic differences in other parts of Iran, further studies in this field with larger sample sizes in different geographical locations are recommended.

Although surgical techniques have been improving, preoperative anxiety is still a challenge in preoperative care and is known as an expected response experienced by patients waiting to undergo surgery. The present study aimed to compare preoperative anxiety levels in three educational hospitals in Kerman.

This cross‑sectional study was conducted in three educational hospitals in Kerman, Iran, from December 2017 to May 2018. The participants were 100 patients from each hospital (300 patients in sum) who were selected through the convenience sampling method. Sampling was not restricted to sex and type of surgery. The 40‑item Spielberger State‑Trait Anxiety Inventory was administered to the patients to assess the level of preoperative anxiety experienced by them. Bivariate linear regression models were used to compare the preoperative state anxiety levels based on the patients’ demographic information. A multivariate linear regression model was used to determine the predictors of preoperative state anxiety.

The participants were 149 males and 151 females with a mean age of 36.38 (12.75) years (age range: 12–79 years). Almost two‑third of the patients showed upper‑middle symptoms of state anxiety (n = 197, 65.7%) followed by upper‑middle symptoms of trait anxiety (40% and 49.3%, respectively). There was a significant relationship between the patient’s sex and state anxiety (P = 0.05) and also between trait anxiety and state anxiety (P ≤ 0.001). It was shown that train anxiety could predict state anxiety before surgery (B: 0.53, 95% confidence interval: 0.44, 0.62; P ≤ 0.001).

The results of the present study confirmed the presence of preoperative anxiety in a sample of Iranian patients. Although the anxiety scores were not very high, organizing intervention and training programs to control and reduce preoperative anxiety among patients seems essential.

Femoral shaft fracture is the most prevalent major orthopedic injury in children. Usually, we use two methods for spica casting for femoral shaft fractures. This survey aimed two compare them.
This single-blind randomized clinical trial study was performed on the 35 2- to 6-years-old patients with isolated and non-complicate femoral shaft fracture referred to Shahid Bahonar hospital, Kerman, Iran. All the patients were followed for 6 months. 17 patients were treated with type 1 method (90/90 casting) and 18 ones underwent type 2 method (45/45 casting). Patient was examined in regard of limb length, angular deformity, muscle power, neurovascular lesion, compartment syndrome, and dermal injury. After opening the cast, a researcher-made questionnaire about the child's activities was completed by parents.
Findings: In all the patients in both groups, after maximum of 8 weeks, union was completed. The average difficulty in moving around independently was 5.77 ± 2.41 and 8.05 ± 1.43 in 45/45 and 90/90 groups, respectively, with a significant difference (P = 0.002). The average difficulty rate of leaving family residence or was 5.77 ± 2.94 and 8.00 ± 1.76 in 45/45 and 90/90 groups, respectively, which was statistically different (P = 0.011).
Based on the results of the present study, it seems that the child is more comfortable with 45/45 spica cast.

Frozen shoulder is a common condition, characterized by pain and restriction in shoulder movements. Different non-surgical and surgical methods are used to overcome this condition. Given the high prevalence of frozen shoulder among the working class in communities, re-empowerment is essential for individuals to return to their daily activities. Considering the contradictory results reported by previous research, further investigations are required in this area. Therefore, this study aimed to evaluate the clinical findings of arthroscopic release in treatment of primary frozen shoulder.
This cross-sectional study was performed on all patients with primary frozen shoulder, referring to Bahonar and Shafa hospitals of Kerman, Iran. These patients were candidates for surgery due to unsuccessful supportive treatment. First, American shoulder and elbow surgeons (ASES) assessment form (score: 0 - 100) and simple shoulder test (SST) (a 12-item questionnaire) were completed before surgery. Then, all the patients underwent arthroscopic release and examinations. The assessment forms were completed again 3 and 12 months after surgery.
Overall, 15 patients with the mean age of 50.57 ± 12.01 years were included in this study. There was asignificant difference in the mean score of SST before (10.24±0.98) and after (10.99±1.05) surgery (p=0.034). In addition, patients’ performance at 12-month follow-up significantly improved compared to the 3-month follow-up (P = 0.014). There was a significant difference in the mean scores of ASES test before and after surgery (P = 0.007). In addition, the mean score of ASES test was higher at 12-month follow-up compared to the three-month follow-up (P = 0.019).
Arthroscopic release could help relieve pain and improve the range of shoulder movements in patients. Moreover, it could help patients return to their daily activities and regain their productivity. In fact, this technique facilitates simultaneous diagnosis and treatment of shoulder joint problems.

Tibia and femur fractures are among the most common fractures and intramedullary nailing is the standarad treatment. This study was performed to determine the best preoperative method for estimating the intramedullary nail length.
In a cross sectional study, 82 patients with tibia and 25 patients with femur shaft fracture were studied in a training center of Kerman-Iran. The estimated preoperative intramedullary nail length and the length of used nail at operation were compared. The measurment methods for femur fractures were greatrer trochanter-patella, greater trochanter-lateral epicondyle and olecranon-fithe finegr tip; and for tibia fractures were medial malleolus-tuberosity, intact leg radiogram and olecranon fifth metacarp were assessed. Data was assesed by statistical methods.
Almost all of the examined methods showed "good" interobserver and intraobserver reliability. In femur fracture, the greater to patella method showed the best ICC (0.876) and the lowest SEM (0.777). In tibia fracture, best ICC (0.860) and the lowest SEM (0.602) were for medial malleolus tubercle method. For femur fractures, 64% of the measurements in greater to patella, 93% in olecranon fifth finger, 100% of greater to epicondyle methods; and for tibia fractures 40.9% in medial malleolus tubercle, 37.3% of olecranon metacarp and 65.06% of radiogram method were larger than the nail used at operation.
The best method for estimation of nial length was medial malleolus to tuberosity for tibia fractures, and greater to patella method for femur fractures; however none of the examined methods was found completely suitable.

Background and Carpal tunnel syndrome is one of the most common causes of orthopedic referrals. Today, many surgeons tend to perform minimally incision surgery (MIS). This study was conducted to compare the results of open surgery and MIS by Smillie knife.
In this prospective study, 72 patients (98 surgeries) with carpal tunnel syndrome were randomly divided into two groups of open surgery (n= 46) and MIS by Smillie knife (n= 52). Clinical improvements were investigated in both groups according to the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Electrodiagnostic improvement, duration of surgery, length of incision, and complications were compared between the two groups using paired-sample t-test, independent t-test, and Chi-square test.
Paresthesia resolved immediately after surgery, except in two cases in open surgery group and one case in MIS group. After the surgeries, no difference was seen in electrodiagnostic parameters between the two groups. The number of individuals with pain was significantly lower in MIS group in week two and six after the surgery (P=0.035 and P=0.011 respectively). The Boston score showed no significant difference between the two groups after three months but after six months the score was significantly different in MIS group (P=0.515 and P=0.029 respectively). One patient in open surgery group suffered wound dehiscence after removal of sutures.
MIS is associated with quicker clinical improvements and because patients receive no anesthesia, it is superior to classic surgery.

Frozen shoulder is a painful condition in which surgery may be helpful in case of failure of conservative treatment. In this prospective study we tried to compare two common methods of surgical treatment.
Between 2011 and 2012, 54 patients with frozen shoulder were treated by one of the two methods of arthroscopic release and manipulation under anesthesia. The variables studied were postoperative pain, American Shoulder and Elbow Surgeons (ASES) and Simple shoulder test (SST) scores, range of motion in different directions and pain in the last follow up.
Findings: All the patients in the two groups had significant improvement in comparison to preoperative scores at the least follow up of one year. The difference between the two groups was not significant in internal rotation, forward flexion and pain in the last follow up, but among the other variables, the arthroscopy group showed more improvement. No statistically significant association was found among the variables and diabetes, age, dominant limb involvement and sex.
Based upon the findings of the present study it seems that both manipulation under anesthesia and arthroscopic release are effective treatments for frozen shoulder.

Distal leg, ankle and foot injuries are relatively common; and because of lack of soft tissue and poor blood supply in these areas, one of the common problems in these patients is soft tissue necrosis. Exposed orthopedic implants can be used as open reduction internal fixator (ORIF) in these regions.
During 2013-2014, 14 patients (11 men and 3 women) with a mean age of 30 years were enrolled the study in the Department of Plastic and Reconstructive Surgery, Shafa Hospital, Kerman, Iran. All the patients were referred from the Department of Orthopedic Surgery because of exposed orthopedic implants. The minimum and maximum size of the defects was 3 × 5 and 11 × 15 cm, respectively. 7 defects were in distal leg, 3 in foot, 2 in ankle and 2 in distal leg and ankle together. After measuring the defect, sural flap based on sural artery and nerve was prepared and transferred with a rotation of 180 degrees to the defect site over the exposed orthopedic implants, before the separation.
In all 14 patients, the healing was complete. In 2 cases, we had to remove the prostheses because of infection and in 3 cases, partial necrosis was seen; and in 4 cases, a hypertrophic scar was seen in donor site and a neurosensorial deficit was seen in the sural nerve sensory areas. But in all of them, the sural flap was successful and there was no need to replace this flap to another one.
Due to the good clinical results, sural flap can be a viable alternative to cover the exposed prostheses of distal leg, ankle and foot.

The standard method for repair of an injured peripheal nerve is epineural repair with separate sutures. Herein we describe a method in which the nerve is sutured with continous sutures. In fact this method has not been utilized for nerve repair previously and our purpose was to compare it to the standard method. If it proved to be successful it would replace the standard method in certain circumstances. The proposal of the clinical trial was given a reference number form the ethics comitee. 25 dogs in which the scaitic nerve was cut by a sharp blade under genaeral anesthesia were divided randomly into three groups: control (5 dogs), repair of sciatic nerve with simple sutures (10) and repair with continous sutures (10). In the control group the nerve was not repaired at all. After 6 weeks the dogs were killed and the nerve was studied by light and electronic microscopes. The amount of consumed suture material, time of repair, myelin thickness and axon diiameter were examined. Ultrastructural studies were performed to assess degeneration and regeneration findings. Time of repair and the amount of consumed suture material were significantly lower in the continous group (P<0.001). No difference was found with regard to light microscopy findings and regeneration was confirmed by electron microscopy in the continous group. The method described in the present study, provided a result similar to the standard method. Though undobtfully it has some limitations, can replace the standard method in many circumstances.

There have been investigations on the effect of absence or presence of Palmaris longus tendon on pinch and grip strength of the hand. In the same way the effect of presence of fifth superficial flexor digitorum on grip strength of the hand has been investigated. The aim of the present study was to assess the combined effect of these anatomical variations on pinch and grip strength.
In a cross sectional study, 1046 hands in 523 volunteers were enrolled. Each hand was assessed for the presence or absence of palmaris longus tendon and also variations of fifth superficial flexor digitorum function. Then the grip and pinch power of the hands were measured with Jammar Dynamometer.
Presence or absence of Palmaris longus had no effect on grip strength of the individuals. In the same way, variations of fifth superficial flexor digitorum function had no effect on the grip and pinch strengths. But the positive and statistically significant effect of presence of palmaris longus on pinch strength (25.38 in hands with palmaris present v/s 24.43 in hands without it) was evident (p=.03). Grip and pinch powers were higher in men compared to women (p Based upon the findings of the present study, it seems that absence of palmaris longus tendon is associated with a reduction in pinch strength, but has no effect on grip strength and the variations of fifth superficial flexor digitorum have no effect on pinch and grip strengths.

Acute acromioclavicular (AC) joint dislocation is common in shoulder injuries. Considering the biomechanics of this joint, the use of a treatment method, which can restore joint physiology and biomechanics to the extent possible, is important. This study aimed to compare the treatment of acute AC joint dislocation by screw fixation with and without ligament reconstruction. In the present study, 28 patients with AC joint dislocation type 4, 5, and 6, were randomly treated with either coracoclavicular screw fixation with ligamentous reconstruction or screw fixation without ligament reconstruction. Screws were removed after 8 weeks. The follow-up period lasted for 2 months. The simple shoulder test (SST), disabilities of the arm, shoulder, and hand (DASH) score, and the University of California-Los Angeles (UCLA) shoulder scale were conducted using specific questionnaires. Based on the SST, mean shoulder function was better in the ligament reconstruction group compared to the group without ligament reconstruction (P = 0.028). The result of the UCLA shoulder scale indicate a significantly better returning to original and natural function of the AC joint in the ligament reconstruction group than the other group (P = 0.012). DASH score indicated a significantly lower disability rate in the group that underwent ligament reconstruction than the other group (P = 0.001). The results suggest that ligament reconstruction in the Ac joint significantly increases the rate of returning to normal function, joint stability, and normal joint physiology.

Tibia fractures are the most common long bone fracture. Due to minimal soft tissue and its blood supply, inadequate treatment of injuries could be a major cause of morbidity and disability. The intramedullary nail is the preferred method of treatment; however, despite all previous studies, no accurate method to measure nail length prior to surgery exists as yet. Due to the importance of this issue in stability and alignment and reduction of operation time, in this study, we compared several methods of measuring tibia nail length. This was a cross-sectional study in which the nail length was estimated using different methods such as X-ray of the opposite leg, tubercle-medial malleolar distance (TMD), and olecranon to fifth metacarpal distance. In addition, the length of the tibia canal was measured using a metal rod during the surgery. Subsequently, the obtained results were compared. None of the studied methods showed a significant difference between the estimation and the length of used nail. However, the results from the combination of the two methods of olecranon to fifth metacarpal and X-ray of the opposite leg had the closest correlation with the length of used nail. The aim of this study was to determine the best method of preoperative estimation of the length tibia canal for the reduction of operative time and better fracture fixation. Among these methods, the combination of olecranon to fifth metacarpal and opposite leg X-ray showed the strongest correlation.

Knee osteoarthritis is a common etiology of disability in older age group. There are evidences suggesting that varus or valgus deformity can be from distal of femur، proximal of tibia or because of ligamentous laxity. Osteotomy in incorrect location may create zigzag deformity and may contribute to increase risk of osteoarthritis. The objective of this study was to find the correct location of deformity in genuevarum or genuevalgum. We studied 40 patients with knee deformity at a mean age of 27. 4 years (19-38)، prospectively. Standing 3-point view radiographs were obtained on each patient، and the limb axis was determined. The data on limb malalignment was analyzed statistically. In 94. 5% of cases the location of varus deformity was proximal of tibia and in 5. 5% in distal of femur، the best location of osteotomy. Our study also revealed multiple factors contributing to varus deformity، i. e. distal femur in 67. 5%of cases، proximal tibia deformity in 92. 5% of cases and ligamentous laxity in 77. 5%. Varus knee deformity can be from proximal tibia، distal femur or knee laxity. Before any corrective surgery one must clarify location of deformity

Simultaneous fractures of the femoral neck and shaft are not common injuries, though they cannot be considered rare. Herein, we report our experience with a patient with bilateral occurance of this injury. Up to the best of our knowkedge this is the first case reported in literature in which correct diagnosis was made initially. Both femurs were fixed using broad 4.5 mm dynamic compression plate and both necks were fixed using 6.5 mm cannulated screws. Femur fixation on one side was converted to retrograde nailing because of plate failure. Both neck fractures healed uneventfully. In spite of rarity of concomitant fractures of femoral neck and shaft, this injury must be approached carefully demanding especial attention and careful device selection.

The glenohumeral joint becomes dislocated more than any other major joint because it maintains a wide range of motion and its stability is inherently weak. The most common complication following acute initial shoulder dislocation is recurrent dislocation or chronic instability. Imbalance of strength and range of motion in individuals with anterior dislocation can be a contributing factor in recurrent dislocation as well. This case-control study consisted of 24 individuals with a mean age of 24.29±4.33 years, and a mean dislocation rate of 5.37±3.62 times. Isometric cuff strength was measured using a handheld dynamometer and for range of motion, the Leighton flexometer was used in internal and external rotational motions of both upper extremities. Independent t-test was used for data analysis. The internal and external range of motion of the injured glenohumeral joint was lower than the uninjured joint (P<0.001). Similarly, the internal and external rotation strength of the injured joint was lower than the uninjured joint (P<0.001). According to previous data, imbalance of strength and range of motion in individuals with anterior shoulder dislocation can be a contributing factor in long-term disability and increased recurrent dislocation and our finding confirm decreased range of motion and strength in our patients. Hence, proper exercise and rehabilitation plans need to be developed for those suffering from this complication.

The aim of the present study was to compare two methods of plating and intramedullary nailing in treatmant of closed noncomminuted tibia fractures with intact fibulae. Utimately 69 patients were followed for at least one year. The patients were randomly devided into two groups of plating and intramedullary nailing and operated on. One case of nonunion and one case of superficial infection occurred in the intramedullary group. One of the patients in the intramedullary group developed late deep infection in the screws location (in both cases p>.05). In both of the groups the tibia fractures reached union in about 4 months, though the intramedulary group had underwent more operations for union achievement (dynamization in 4, 12.1%, p≥.05). The need for implant removal was not statistically significant in the two groups (p≥.05). Of the other variables, the diffence between the two groups was statistically significant only with regard to their complaints of the limb and the number of individuals with knee pain (p<.001). It seems that both methods are suitable for closed noncomminuted isolated tibia fractures, but the patients with intramedullary nails, probably will need more operations to achieve union and probably will have more complaint of limb pain.

Rotator cuff tear is one of the major causes of shoulder pain and disability especially in over 60 year old age people. The problems with arthroscopic repair and also failure to repair with strong and valuable sutures in massive tears have increased the trend towards open surgery. This study was done to assess repair of rotator cuff tear by open surgery. In this cross-sectional study, 14 candidates (8 female, 6 male) for rotator cuff surgery, were assessed for shoulder function by the use of ASES and SST scoring systems, before and after surgery, by the same observing orthopaedic surgeon. Mean age of patients was 57.94±14.04 years old. The mean SST score before surgery and 6 and 9 months after surgery were 10.17, 10.67 and 10.81, respetively; with a significant post-operative improvement (p=.026). The mean ASES score before surgery, 6 and 9 months post surgery were 42.82, 47.95 and 57.43, respectively; showing significant improvement after surgery (p=.025). The open surgical repair of rotator cuff tear is effective and shoulder function improves and pain decreases significantly. This is with the technique of constructing a surface, rather than making a trough, and also using of interoseous suture rather than anchor suture.

Retained gauze after surgery is an uncommon error and it may be associated with many complications. We are reporting our case to call attention to the fact that retained gauze may become symptomatic even after a very long interval. Herein we report on a patient who developed infection and fistula with discharge from this error 35 years after a surgery for femur fracture and insertion of a IM nail. The diagnosis was easily made because of a marker in the gauze. Removal of the gauze and irrigation and debridement of the wound in two stages led to complete recovery of the patient as was shown in the 1 year follow up. Retained gauze after surgery is a preventable complication and may be asymptomatic for a very long period, but can become a complication post-operatively at any time. Hence, if diagnosed immediately after the surgery or at any other time, the gauze should be removed.

Diagnosis of carpal tunnel syndrome is based on clinical findings and these findings are used to confirm the diagnosis. Sonography is also a noninvasive method for diagnosis of carpal tunnel syndrome. The purpose of this study was to investigate the role of sonography and electrodiagnostic studies in diagnosis of this syndrome. In a prospective study، 76 hands with diagnosis of carpal tunnel syndrome (study group) were compared with 80 hands (control group) in a training hospital in Kerman-Iran. In both groups the diameter of median nerve was measured by sonography and electrodiagnostic studies were performed only on the study group. The study group، post surgery، was followed up for 6 months and the DASH preoperative functional scoring was compared with post operative scores. The difference between the diameters of the median nerve measured by sonography (p=. 0001); and also the difference between before and after-operation Dash Score in the patient group (p=. 001) were statistically significant. Sonography was 95% sensitive and 93% specific for the diagnosis of carpal tunnel syndrome. A weak correlation was found between the severity of the disease in electrodiagnostic studies and sonography (p<. 01، r=. 38). No correlation was proved between the sonographic or electrodiagnostic findings and Dash score before and after the operation (p≥. 05). sonography might be a suitable module for the diagnosis of carpal tunnel syndrome، but there were no correlation between its findings or electrodiagnostic findings and functional scores. Whether or not sonography could be substitute for electerodiagnostic tests، will need further investigation.