mani mahmoudi

Car accidents are one of the most common causes of traumatic mental disorders. This study was done to evaluate the symptoms of post-traumatic stress disorder (PTSD) in patients with lumbar spinal dislocation fractures caused by road accidents.

This case-control study was performed on 100 patients with lumbar spine dislocation fractures due to road accidents. After the seventh day, they were admitted to the orthopedic and trauma wards of Imam Khomeini Hospital in Sari. It was done six months after hospitalization. Data collected from 100 non-injured individuals using the Marmar and Weiss Revised Event Impact Questionnaire (Impact of Event Scale - Revised: IES-R) were compared.

There was no statistically significant relationship between PTSD and age, sex, marital status, education of the two groups. In all subscales related to the effect of the event, ie avoidance, disturbing thoughts, and over stimulation indices, the mean score of the participants in the case group was significantly higher than the mean scores of the individuals in the control group (P<0.05). The mean in case group was significantly higher than the mean in the control group (P<0.05).

The results of this study indicate the important role of road accidents in the formation of PTSD symptoms.

There is no concrete information about many aspects of femoral fracture, including its best management. We hypothesized that reporting the outcomes of patients managed with the same therapeutic algorithm would help the selection of best management strategies. 

In this study, we report the outcomes and complications of femoral head fracture in patients treated according to our therapeutic algorithm.

In a retrospective review of a prospectively collected orthopedic database, 41 patients with femoral head fractures were evaluated. Fractures were classified by the Pipkin classification system. The clinical outcome was assessed with the Harris Hip Score (HHS). In brief, our therapeutic algorithm included conservative treatment for the congruous joint of Pipkin type I and II, total hip arthroplasty for unfixable fractures of Pipkin type III, and IV, and fixation via three approaches otherwise (Smith-Peterson, Kocher, or surgical dislocation).

Of 41 cases, 34 cases (82.9%) had uncomplicated outcomes. The number of associated injuries was significantly more in patients with complicated outcomes (P=0.049). Avascular necrosis was the most common complication (n=5, 12.2%). Their Mean±SD HHS was 85.1±109. Accordingly, HHS scoring had poor, fair, good and excellent results in 4 (9.8%), 6 (14.6%), 13 (31.7%), and 17 (41.5%) patients, respectively. The mean HHS score was significantly lower in patients with complicated outcomes (P=0.007). The mean HHS score was not associated with types of fracture (P=0.071).  

The outcome of femoral head treatment was good to excellent in the majority of patients. However, patients who underwent total hip arthroplasty or had associated injuries are at higher risk of an inferior outcome.

Vascular thromboembolism is one of the major concerns of orthopedic surgeons after hip or knee replacement surgery. Although many thromboprophylactic drugs have been introduced, there is still no consensus over their efficacy and safety. Therefore, this study aimed to compare the efficacy and safety of oral rivaroxaban and aspirin administration and enoxaparin injections in patients undergoing knee or hip replacement.

Determination and comparison of the side effect and efficacy of Rivaroxaban and Enoxaparin after total hip or knee arthroplasty.

A total of 231 patients undergoing knee or hip replacement surgery were included in the study. Of them, 31 patients were excluded due to missing the follow-up. Of the remaining 200 patients, 42 low-risk and 158 moderate- to high-risk patients were identified, according to Caprini risk assessment model. Then, they were divided into three groups: aspirin (42 patients), enoxaparin (78 patients), and rivaroxaban (80 patients). Severe hemorrhage (hemoglobin reduction of more than 2 g/dL or requiring blood transfusion) was assessed after the first dose of medication until discharge through daily hemoglobin testing. Frequency of other side effects such as wound complications (ecchymosis, hematoma, and wound infection) and gastrointestinal or skin problems was recorded and compared by daily examination during the hospital stay and then in the future visits to the clinic up to 6 months in each group. Follow up visits were performed at weeks 6, 12, and 24.

No cases of deep vein thrombosis or pulmonary thromboembolism were observed in any of the study groups. There was no significant difference between the two groups in the number of major bleeding cases (P=0.39). Ecchymosis around the wound was significantly higher in the rivaroxaban group than in the enoxaparin group (33.8% vs. 23%). However, this difference was not statistically significant (P=0.06).

The efficacy and safety of rivaroxaban and enoxaparin drugs are comparable. Although ecchymosis was seen after using rivaroxaban rather than enoxaparin, rivaroxaban is orally administered and costs less for the patient and the health system. So, its use as a thromboprophylactic drug of choice following hip and knee arthroplasty surgery is still recommended.

Femoral Neck Fracture (FNF) is prevalent in young people. It is mostly due to high-energy trauma and creates many challenges in surgical repair. A few patients with hip fractures can fully recover from the injury and act independently in their daily activities. In this study, we evaluated the results of FNF operation in patients younger than 60 years. 

This study was conducted to evaluate the outcome of femoral neck surgery in young patients and comparison the complications according to types of surgery ,age,delay and type of FNF fracture. 

This study was a retrospective-prospective descriptive and analytical study on patients 15 to 60 years old with FNF from 2013 to 2017. The surgical efficacy and its results were evaluated using the Harris Hip Scale (HHS). The obtained data were analyzed in SPSS version V. 24. 

The Mean±SD age of 53 study patients was 42.07±12.5 years. The Mean±SD femoral neck shortening was 7.05±5.42 mm, and the HHS score was 82.7±6.9. Avascular Necrosis (AVN) was seen in 10 (18.9%), malunion in 11 (20.8%), nonunion in 1 (1.9%)  and failure in 3 (5.7%) patients. Eight patients had reoperation procedures. The type of fracture, delay in surgery, type of operation, and the shortening of the femoral neck were predictive factors of postoperative complications (P<0.05). 

According to this study, reducing the delay for surgery, increasing anatomic reduction, and preventing the shortening of the femoral neck can improve the quality of life, reduce complications, and decrease the economic burden.

Background and purpose: Missed detection of some major trauma in the context of multiple trauma remains a persistent problem in both clinical aspects and forensic medicine. This study aimed at investigating the prevalence of missed injuries in patients with major trauma. This prospective cross-sectional study was done in all multiple trauma patients (7-28 years of age) admitted to emergency, orthopedic, and surgical departments in Sari Imam Khomeini Hospital, 2016. Data was collected using a checklist to study the demographic information (age and gender), mechanism of injury, time of injury, the type of trauma, and treatment interventions. SPSS V19 was used for data analysis. The patients were 82% males. The frequency of missed injury was 5.8%, including clavicles, metacarpal, scaphoid, acetabulum, femoral neck, intertrochanteric, heels, Lisfranc, and ankle fractures, and hip dislocation. The results indicated a relationship between the frequency of missed injuries and older ages, more trauma, male patients, blunt trauma, and higher level of consciousness
(P= 0.034). Also, in 44.4% of the cases, identifying the damage led to changing the non-surgical treatment to surgical treatment. Tertiary surveys in multiple trauma patients could be of great benefit in identifying missed injuries and eventually cause better patient management.

Infectious diseases are major public health problems, among which blood-borne ones are the most important infections. Patients who undergo orthopedic surgery are at higher risk of transmitting infectious diseases from and to others, due to repeated blood examinations and injection, drains secretion and receiving blood products. Accordingly, in this study we determined prevalence of Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) and human immunodeficiency Virus (HIV) infections in patients who underwent surgery in a general training hospital. In this cross-sectional study the prevalence of HBV, HCV, and HIV infections was determined among 320 patients under orthopedic trauma surgeries in a general training hospital in Tehran, Iran from 2009 to 2011. Associations of these rates with age, gender, marital status, residence location, substance abuse history, hospital admission history, previous surgery, blood transfusion, dentistry procedures, and previous medical history were also assessed. A total of 320 patients (290 male, 30 female) were studied. Ten patients (3.2%) had at least one of these three infections. Totally 10 patients (3.2%), 2 subjects (0.6%), and 8 patients (2.5%) had HCV, HIV, and HBV infections, respectively. None of the evaluated variables had significant relationship with HCV, HBV, and HIV infections (p> 0.05). According to the obtained results, routine use of diagnostic tests for infectious disease such as HIV and viral hepatitis is recommended and should be considered before orthopedic operations.