فهرست مطالب mohammad javad dehghani firoozabadi

The deformity in the coronal plane is over-emphasized in the surgical management of adolescent idiopathic scoliosis (AIS), whereas the importance of the patient’s sagittal profile is generally neglected. Gold standard treatment in AIS consists of posterior instrumentation, deformity correction - through a reduction maneuver - and arthrodesis. The main focus in most reduction techniques is placed on the correction of deformity in the coronal and/or axial plane, worsening the patient’s sagittal profile.

This outcome analysis study aimed to investigate the surgical treatment of AIS patients with severe thoracic hypokyphosis (< 10) by adopting the posteromedial translation technique (PMT).

In this retrospective study, the data and records of the patients with minimum 2-year follow-ups were analyzed. Correction of the deformity was radiologically assessed based on Cobb’s angle, thoracic kyphosis, and apex translation. The Scoliosis Research Society 22-item questionnaire (SRS-22r) was used for clinical evaluation before and after the surgery.

A total of 11 AIS patients (8 females and 3 males) with hypokyphosis underwent operations by the PMT at Imam Khomeini Hospital Complex between 2000 and 2020. According to the results, 78% correction in the coronal plane and an average correction of 56° (P < 0.001) were obtained. As for the sagittal plane, 18.8° correction was recorded (75%) (P < 0.001). Scoliosis Research Society 22-item questionnaire subscale analysis showed a significant improvement in patients’ self-image (P = 0.035) and satisfaction (P = 0.043).

The management of hypokyphosis in AIS was challenging. The PMT facilitated the tri-planar deformity correction, including a restoration of the thoracic kyphosis in all patients. A significant improvement was observed in both the coronal and sagittal profiles of the patients.

“Sagittal balance” is defined by the anatomic relationship between the pelvis and the spine in the sagittal plane to keep the center of gravity over the feet. It is important to calculate the anatomical parameters of cervical, thoracic, lumbar, and spinopelvic regions and how any static and dynamic changes could affect the sagittal balance to understand the conditions necessary for such a balance. One of the effective changes in sagittal balance is aging, which leads to changes in spine parameters and further activation of compensatory mechanisms. Understanding the relationships between these parameters, especially in pathological cases, helps correct spine sagittal imbalance.

One of the most important objectives in the deformity correction surgery of spine is to achieve appropriate sagittal alignment, to improve patient outcome and reduce the risk of junctional failure. Intra-operative rod bending is crucial to achieve desired alignment.

Assessment of accuracy of rod bending by spine surgeons with or with-out template and/or correction.

Spine surgeons were asked to bend two rods; one in-situ on three-dimensional (3D) printed moulage, designed based on schematic representation of a patient with Kyphoscoliosis, the other rod was asked to bend with correction angles. The differences were measured and correlated with experience and specialty.

21 fellowship trained spine surgeons participated in this study, for in-situ rod, mean thoracic and lumbar bend were 65.2 (P = 0.033) and 49.3 (P = 0.077) degrees, respectively and for the correction rod, mean bend in thoracic and lumbar were 53.8 (P = 0.001) and 51.8 (P = 0.004) degrees, respectively, with significant difference from cut-off point. Each curve was over-bend and it was more pronounce in thoracic, both on in-situ and correction rods, 61.9 and 71.1 %, respectively. Level of experience showed positive correlation with degree of rod bending more than five years in thoracic in-situ bend (P = 0.003) and thoracic bend with correction (P = 0.004). Field of specialty showed positive correlation as well; with orthopedic in-situ bend (P = 0.002) and with correction (P = 0.003).

Spine surgeons tend to over-bend rods, when given target angles and when correction is needed. However, when provided with template, a 3D printed moulage in our study, accuracy of rod bending improved significantly.

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.

Warfare is an immense destruction of human life and infrastructure. Wide‑scale trauma is a gigantic problem, and the latest war trends are toward targeting more civilians. Injuries in war are multifactorial depending mostly on arms engaged. The objective of this study was to examine the characteristics of extremity injuries in the Iran–Iraq war. The important principle is recognizing injury types, mechanism of trauma, and factors influencing complications in extremity injuries of war.

In this retrospective study, we reviewed documents of 8437 patients who were transported and treated in Imam Khomeini Hospital, Tehran, during 8‑year Iran–Iraq war from 1980 to 1988. 7352 patients with physical injuries were selected as a sample. Data collection form included type, mechanism, and location of the injury, associated lesions, and the treatment given. Data were analyzed by descriptive statistics (frequency and mean) using SPSS software.

Medical archive review identified 8437 patients, 7352 sustaining physical trauma and 4926 among them had 6601 extremity injuries. Mean age of the patients sustaining extremity injury was 23 years. 74% (4885) of the injuries were caused by shrapnel fragments, 12% (792) were caused by bullets and rest 14% were due to various other causes. There were 53.9% (3561/6601) fractures among the total injuries, most commonly involving femur (19.9%). Fracture fixation with 66.3% (1394/2103) was the most common type of orthopedic treatment provided. In addition, 20.6% (1359/6601) injuries were related to arterial lesions and 32% (2112/6601) were accompanied with nerve damage.

Extremity injury is a major trauma in war zones and leads to high rate of morbidity; however, if appropriate care and timely assistance are provided, it has low risk of death. Understanding type, frequency, and mechanism of injury and factors influencing trauma is of extreme importance in appropriate management and avoiding unnecessary amputations.

Post-traumatic arthroplastyis associated with higher rates of complications and overall inferior outcome when compared with primary joint replacement. Literature revealed no precise guidelines on management of nonunion of Hoffa fracture. Hence, we tried to elicit a management protocol in such patients from literature perspective.

A 62-year-old patient survived a car accident with distal femoral fracture in coronal plane (Hoffa fracture) and was treated with open reduction and internal fixation (ORIF). Three years later, the patient developed nonunion with post-traumatic arthritis (PTA). Owing to joint degeneration and poor bone quality, patient was treated with total knee arthroplasty (TKA). One year follow-up showed excellent outcome.

In patient with healthy joint surface and good bone density, treatment of choice should be ORIF and in those with joint degeneration and low bone stock, arthroplasty is a better choice.

Distal femoral fractures are not common among all fractures and the incidence rises with age. While this kind of fracture is usually caused by low-energy trauma in the elderly, there are many known fracture patterns. We encountered a new pattern of fracture in a middle-aged man.

A 56-year-old obese man presented to our hospital with direct trauma from a motor car accident. We encountered a bizarre pattern of distal femoral fracture, which was a biplanar unicondylar fracture in medial condyle of the femur through physeal remnant. This fracture was similar to the pattern of Salter-Harris type III fracture and unicondylar type of T-type simple articular epiphyseal fracture in Association for Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification (type 43.C1.3). The fracture was fixed with two 7.3mm cannulated screws.

A direct trauma to the distal femur can result in different fracture patterns. In our case, a fracture through physeal remnant of distal femur has been occurred in a morbidly obese patient withradiographic signs of osteoarthritis (OA). We hypothesize that the conduction of axial and anterior to posterior forces through the weak epiphyseal line in a patient can cause a new pattern of fracture similar to AO/OTA type 43.C1.3.

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

Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic disease that is mostly reported in the spinal column with or without extraspinal involvement. DISH is often asymptomatic, but in case of progressive symptoms such as dysphagia, surgery may be required. Not only coexistence of DISH and ossification of posterior longitudinal ligament (OPLL) is uncommon, but also dysphagia as a presenting symptom in these patients is quite rare. To our knowledge, there are merely few such cases have been reported in the literature. In this study, we present the case of a 30-year-old man with the chief compliant of progressive dysphagia. After evaluation, diagnoses of DISH and OPLL were established, due to poor response to conservative treatment, the patient was managed surgically and favorable results were achieved.

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.

Periprosthetic fracture, after total knee arthroplasty, is one of the most common reasons of revision arthroplasty and periprosthetic fracture of the patella has been shown to be very rare. Literature review has shown no reports of periproshtetic fracture of the patella around tumor endoprosthesis. Only 1 study has discussed management of open periprosthetic fractures of the patella as this type of fracture is extremely rare.
We report a particular open periprosthetic fracture of the patella around a tumor endoprosthesis in a 60 years old female, that was treated with irrigation and debridement and tension band wiring and 3 month of follow up showed satisfactory range of motion with no extension lag.
Despite the fact that operative management of periprosthetic fractures of the patella has a high rate of complications and poor outcome, it can be considered for patients with open periprosthetic fractures of the patella, especially when the extensor mechanism is compromised.

ACL tearing is one of the most common sport injuries. For its reconstruction, different grafts including autograft and allograft are used. In term of complications, postoperative improvement, daily activity, and quality of life comparing allograft and autograft are the preferred method, with minimum complications and maximum effectiveness.
The method of this study was a prospective randomized study. A total of 38 patients were selected who only have a tear in their ACL and no other associated ligament injury. These 38 patients have been put into 2 groups by random computerized selection and their group has been advising them in closed pockets. Finally, 18 patients were in the allograft division and 20 in the autograft. In the beginning, a physical examination was done as well as a IKDC objective, Lysholm, level of activity, KOOS, and quality of life scoring forms have been filled for all patients before the operation process. Then patients have been operated by the standard arthroscopic method. Graft fixation in the femur bone has been done by the endo-button and in the tibia bone by interference screws (Smith and nephew). In the next step, the above-mentioned scoring forms were filled after 3 months, 6 months, and 1 year after operation. In addition, required physical examinations were done again. In this period of time, the patients have been under exact observation regarding related complications.
All mentioned scoring forms and pivot shift test, Lachman test, and ADT showed significant improvements in patient postoperative period. Lysholm (P = 0.07), IKDC objective (P = 0.8), level of activity (P = 0.9), and KOOS (P = 0.15) represented that there are no statically differences between 2 autograft and allograft groups. Infection risk in both groups has been almost same (P = 0.3).
All findings clarify that short term result was equal in 2 groups.

Traditional external fixation used for open or soft tissue compromised tibial distal metaphyseal fractures is used both as a temporizing or definitive treatment to minimize more traumas to the soft tissue, but it has its own shortcomings such as joint spanning and bulky construct. Lower profile locked plates used as external fixation may overcome such problems.
A series of 16 open or with soft tissue compromised tibial distal metaphyseal fractures were treated using locking plate as a definitive external fixator. Time to union, nonunion, malunion, device failure, function for the knee and ankle, and deep and pin tract infections were evaluated.
All fractures healed without any complications (nonunion, malunion, device failure, or infections including deep and pin tracts). The mean time of fracture healing was 18 weeks (ranged 12 to 26). After walking with full weight-bearing for 1 month, the patients underwent plate removal. The mean hospital for special surgery (HSS) score was 89 (ranged 84 to 100) and 95 (ranged 91 to 100), and the mean American orthopaedic foot and ankle society (AOFAS) score was 93 (ranged 89 to 100) and 95 (ranged 92 to 100) at 4 weeks postoperatively and final follow-up (mean period of 16 months).
Application of the locking plate as an external fixator for definitive treatment of distal tibial fractures had the advantages of traditional external fixators and at the same time overcame its shortcomings due to its low-profile frame; therefore, it was more acceptable to patients and Joint-sparing frame gave the opportunity for early range of motion and function exercise. It was a safe and reliable technique with minimal complications and excellent outcomes.