mohammad taghi peivandi

Context: 

Congenital scoliosis is a difficult condition for orthopedic surgeons. There are some influencing factors to choose the best treatment option for scoliosis. 

Patients with congenital scoliosis may encounter different anomalies. There exist various surgical techniques with different indications. 

Electronic databases, such as Google Scholar, PubMed, and Scopus were searched for congenital scoliosis. Articles published from 1928 to 2020 were searched. A narrative review was conducted by focusing on treatment options.

Different methods are presented in the literature that consists of operative and nonoperative approaches. Nonoperative treatment methods are seldom a final choice. They are used to postpone the final surgery. There are different methods of surgeries in the literature; the best treatment strategy concerns the patients’ condition and the surgeon’s preference. 

The critical issue in the management of congenital scoliosis is to diagnose these patients’ curves before severe progression, i.e. mandatory to achieve desirable results. Usually, a course of nonoperative treatment can be started, but only to postpone the final surgery. The preferred surgical treatment depends on the type of congenital scoliosis and the age of the patient. The treatment of congenital scoliosis should be a multidisciplinary approach due to concomitant morbidity in these patients.

Nonunion is a serious complication following long-bone fracture that is known as a therapeutic challenge for surgeons and is associated with significant morbidity. It has been shown that osteogenesis stimulating factors combined with optimization of the mechanical environment could facilitate and accelerate nonunion healing. In this study, we aimed to treat nonunion using autologous bone marrow-derived mononuclear cell (BMDMC) aspirate as a source of osteoprogenitor cells combined with internal fixation.

From November 2010 to May 2013, 19 cases of nonunion were treated with bone marrow-derived mononuclear cell (BMDMC) grafting, that included 15 males and 4 females with an average age of 37.8 years (range, 18-81 years). The time from injury to therapy was 7 to 28 months, with an average of 13.4 months. At first, decortications were performed around the nonunion site to prepare a suitable bed for bone marrow grafting. Then, 2 ml of bone marrow concentrated cells was applied to the nonunion site in a mixture with partially demineralized cortical cancellous allograft chips. The healing rate in each patient was clinically and radiologically evaluated every 4 weeks.

Bone union was obtained in 18 of the 19 patients during 1.06 to 6 months with an average time of 3.5 months. No complications during anesthesia nor any infection, hematoma or chronic pain at the nonunion site were observed in any patient.

Transplantation of autologous BMDMC aspirate is a reasonable, effective and easy treatment option for tibial and femoral nonunion after internal fixation.

The aim of this study was to investigate the prevalence of Hepatitis B(HBV),Hepatitis C( HCV),and Human immunodeficiency virus(HIV)in a large trauma center in northeast of Iran.

In a descriptive cross sectional study, 27252 consecutive patients admitted in a trauma hospital in Mashhad, Iran during March 2012 to March 2017 who required surgery for their traumatic injuries were screened for the presence of Hepatitis B surface antigen (HBsAg), anti HCV Ab and anti HIV Ab.

In 926 patients at least one of the serologic tests was positive, showing an incidence of 3.3% seropositivity among study population. HBsAg was positive in 523 patients (1.9%), HCV Ab in 388 (1.4%) and HIV Ab in 15 patients (0.05%) respectively. 19 patients (0.06%) were simultaneously infected by more than one virus.

The results of this study demonstrate that seroprevalence of blood born-pathogens among trauma patients, especially HCV and HIV, are higher than general population and it emphasized that health care workers in trauma centers must adhere to standard precautions to prevent viral transmission.

Massive bone allograft is an option in cases of limb preservation and reconstruction after massive benign and malignant bone tumor resection. The purpose of this study was to analyze the outcome of these procedures at Imam Reza Hospital, Mashhad University of Medical Sciences.
In this study, 113 cases have been presented. Eleven cases were excluded (patients has a traumatic defect or they passed away before the completion of the study’s two-year follow up period). Each patient completed a questionnaire, went through a physical examination and, if indicated, X-ray information was collected. The patients were divided into three groups: chemotherapy, chemotherapy plus radiation therapy, and no-adjuvant-therapy.
Fifty-four cases were male and the mean age was 24.5±5.39. The number of cases and indications for surgery were: 33 cases of aggressive benign tumors or low grade malignant bone tumors (large bone defects) including 16 germ cell tumors, eight aneurysmal bone cysts, five low grade osteosarcomas, and four chondrosarcomas. Another 69 cases were high-grade malignant bone tumors including 42 osteosarcomas, 21 Ewing’s sarcoma, and six other high grade osteosarcomas. Patients were divided into three groups: the first group received no adjuvant therapy, the second group received chemotherapy, and the third group received chemotherapy plus radiotherapy. The location of tumors were as follows: eight cases in the pelvic bone, 12 in the proximal femur, 18 in the femoral shaft, 36 in the distal femur, 12 in the proximal tibia, and 16 in the humeral bone. The 12 cases of proximal femoral defects were reconstructed by allograft composite prosthesis, 18 diaphyseal defects with intercalary allograft, and 36 distal femoral defects were reconstructed using osteoarticular allograft. The rate of deep infection was 7:8% (eight patients) and in this regard, we found a significant difference among the three groups, such that most cases of infection occurred in the adjuvant chemotherapy plus radiation therapy group. Allograft fracture occurred in six patients and prevalence was the same in all groups. Only in six cases of radio-chemotherapy nonunion occurred, so we used autogenous bone graft for union. Local recurrence was observed in six patients: three belonged to the adjuvant chemotherapy group and the other three were in the chemo-radiotherapy group; no significant difference was observed between these two groups. However, there was a significant difference between these two and the group that received no adjuvant therapy. Also, there were 11 cases of metastases and Restriction of knee joint motion occurred in 48 cases of osteo-cartilaginous grafts of the distal femur and proximal tibia.
Although structural allograft is an appropriate choice in limb reconstruction after massive resection of involved tissues in malignant and invasive bone tumors, the risk of complications such as nonunion and infection in massive allograft increases in cases of adjuvant (chemotherapy and radiotherapy) modalities of treatment. Whereas the rate of tumor recurrence, metastasis, and restrictions in range of motion during a short term follow up after implantation showed no significant difference among the evaluated groups. Consequently, further attention and constant periodic visits of the patients and checking for local recurrence and distant metastasis should be done after surgery.

In the absence of microvascular replantation or in crash injury cases in which obtaining an acceptable function is not possible, amputation of the injured finger seems to be the best treatment modality. Some studies recommended leech therapy for this kind of injury after vascular repair to decrease venous congestion. In this case report, the authors presented a case of leech therapy after near total amputation of the fingers. A 25-year-old patient was admitted following a sawing injury with crashed bundles of the third, fourth and fifth fingers. Microvascular surgery was not performed because of crush injury. After a simple repair and pin fixation, the patient was treated using leech therapy. The result was satisfactory. The third and fourth fingers were salvaged. It seems that in cases where a small part of the skin is still attached to the amputated part, even with complete crash of both bundles, leech therapy can help salvage the amputated fingers.

Calcaneus has the most fracture prevalence among tarsal bones. About 3/4 of calcaneal fractures are intra-articular fractures with displacement. The majority of calcaneal fractures occur in 21 - 35 year old young men, and that are mostly active people, these fractures cause complete disability for 15 months. Moreover, inappropriate treatment leads to lots of social and economical damages.. In this study we compared the incidence and the severity of peroneal tenosynovitis as a complication of non-operative and operative treatment of intra-articular calcaneal fractures. In this study, some other complications of this fracture were also analyzed and the prevalence of the complication was higher in non-operated patients..Patients and A total of 140 patients with intra-articular calcaneal fracture were analyzed prospectively. These patients were divided into 2 groups: operated group and non-operated group.. In non-operated group (56 patients), 22 patients were complicated by peroneal tenosynovitis. In operated group (84 patients), 8 patients had the same complication. Statistical analysis revealed that the prevalence, and the severity of this complication in the mentioned groups had a meaningful difference. The results in operated group were much better than the non-operated one.. Although some of the orthopedic surgeons are not interested to manage these fractures surgically and most of them treat these cases conservatively (casting, etc.), in most displaced intra-articular calcaneal fractures, surgical treatment is the method of choice. Moreover, in non-surgical treatment the prevalence of these complications among the patients is more and as a result, inevitable social, occupational and familial damages occur..

A damaged orthopedic implant in the body can cause problems for the patient and disrupt the therapeutic process. This study investigates various factors for orthopedic implant failures in patients with traumatic lower limb fractures who referred to a trauma center in Mashhad, Iran. This was a prospective study of 23 patients referred to Kamyab University Hospital with failed orthopedic implants in 2009. We included any patient with an orthopedic device previously implanted secondary to a traumatic lower limb fracture who later presented to Kamyab University Hospital because of a failed implant.For all patients, a thorough history was taken and the necessary investigations that included radiographic studies were performed. We investigated the quality of the failed devices by chemical analysis, metal hardness testing and metallography. The results were statistically analyzed. The mean age of the patients was 33 ± 19 years. There were 19 (82.5%) male and 4 (17.4%) female patients. In 14 (60.9%) cases, there were failed femoral implants and 9 (39.1%) cases had failed implants for tibial fractures. We compared the implants against ASTM standards. According to chemical analysis, all internally produced devices and one of the leading international brands were within the expected standard. However, in 3 cases chemical analysis showed a deviation from the standards. These were manufactured by “miscellaneous” companies. In one (4.3%) case the device failure was iatrogenic, in 14 (60.9%) it was due to faulty implants and in 8 (34.8%) cases, the patients were non-compliant with instructions. Hardness testing was satisfactory in all cases and metallographic studies showed good quality for the leading international brands, satisfactory quality for the internally produced devices and poor quality for the miscellaneous devices. The implants classified as miscellaneous were of poor quality. Thus, we cannot recommend their use in orthopedic surgeries. We recommend using credible, known brands.

Distal radius fracture is among the most common fractures of the long bones that are seen in all age groups. Presence of different treatment protocols explains the challenge and controversy in treatment. In a clinical trial study on 100 patients with stable extra articular distal radius fractures 50 cases were randomly treated with short and 50 with long arm casts in a one year period in three training hospitals in Mashhad-Iran. All the long casts were changed to short casts in the forth week and all the casts discontinued in the sixth week and the patients assessed for the elbow range of motion forearm supination-pronation union malunion the patient satisfaction and distal radioulnar joint stability in the 6th and 18th weeks after treatment. The severity of fractures in both groups was similar. We didn’t find any case of nonunion unacceptable malunion regional pain syndrome carpal tunnel syndrome or compartment syndrome. All the patients with short arm cast were satisfied in contrast to the other group. Range of motion had been better saved in short arm cast and in younger patients. This study shows that the effectiveness of short arm cast is the same as long arm cast; the complications are fewer than long arm cast and the patient's satisfaction is better in short arm cast. So we suggest closed reduction and short arm cast for the treatment of stable extraarticular A2 type of OTA distal radius fractures.

Surgical wound infection is the most serious complication after surgical treatment and the second most common etiology in nosocomial infection. Nutritional status of the patients is one of the risk factors for surgical site infection (SSI). This study aims at investigating the relationship between the serum albumin level and pre-operative anemia with surgical site infection in patients with open tibial fracture. In a prospective study 56 patients with open tibia fractures were studied in a teaching hospital in Mashhad-Iran. At the time of admission serum albumin level hemoglobin and anthropometric values were measured. Surgical site infection during a one-year follow-up was recorded. The results were analyzed using statistical tests. Nineteen patients (%33.9) were complicated by infection. The odd ration was 1.83 (p=.032) for anemia 2.35 (p=. 018) for hypoalbuminemia and 3.53 (p=.002) for type of open fracture. This study showed that SSI is a problem of great significance in orthopaedic tibia open fracture surgeries. It also showed that hypoalbuminemia and anemia before surgery resulted in a higher SSI occurrence in the patients.

Treatment of the femural shaft fracture is imporoving. The aim of this study was to compare the outcome of Dynamic Compression Plating (DCP) and intramedullary nailing in the femural shaft fracture. This clinical trial study was done in orthopedic department of Shahid Kamyab Hospital in Mashhad – Iran during 2002-03. 40 patients with open fracture of femur divided into two groups. One group was treated by dynamic compression plate and the other group by intramedullay nailing. Follow-up time was 9-14 months. Out of 40 patients, 75% were male. The time of clinical and radiological bone union was the same in both groups. There was 4 implant failure in the plate group (P<0.05). There was one deep infection in the intramedullary nailing group. This study showed that there is no difference between plate and intramedullary nailing group according time of bone union. But because of 4 implant failure in DCP groups, intramedullary nailing is recommended for femural shaft fracture.