mohammadjavad shariyate

Avascular necrosis(AVN) of multiple carpal bones is a very rare condition. This case report presents a patient with concomitant AVN of the lunate and proximal pole of the scaphoid that had led to severe joint space narrowing and degenerative arthritis in the radiocarpal and distal radioulnar joints (DRUJs). She was known to have thalassemia minor hemoglobinopathy. Wrist arthrodesis and distal ulna hemiresection‑interposition arthroplasty (Bowers technique) for a DRUJ were offered and performed. The patient was satisfied with the clinical outcomes.

We hypothesized that there is no difference in the perceived pain and disability when the tennis elbow symptoms recur after a CSI. Consequently, we secondarily aimed to assess the approximate time from CSI until symptom recurrence. Moreover, we aimed to evaluate factors associated with the time to recurrence.

This cross-sectional study was performed during 2018-2019. We enrolled 50 consecutive patients who presented with the recurrence of tennis elbow symptoms and had a history of a single CSI for this condition. We asked the patients to rate the perceived pain and disability by filling the QuickDASH twice, including one by recalling pain and function before the CSI and one for the recent recurrent symptoms to assess the patient’s perceived pain and disability at the two-time points. 

There was a significant difference in perceived pain VAS and disability QuickDASH between pre-injection and recurrence, showing that the patient’s perceived pain and disability were greater when recurred (P<0.001). The mean time between CSI and recurrence of symptoms was 6 (4-7) months, which is shorter than the expected spontaneous resolution of tennis elbow (> 1 year) to offer other invasive treatments. Time to recurrence had no significant association with sex, age, side, education, occupation, pre-injection VAS score, pre-injection QuickDASH, or symptom duration using a linear regression model.

Although CSI seems to relieve or mask the pain in the short term, there is a considerable chance of recurrence, and patients may perceive more significant pain and disability that may lead to subsequent injection or precocious surgery. Time is an effective treatment for this illness. Shared decision-making is paramount, and patients have to be counseled regarding the natural history and expected prognosis of different treatments. Level of evidence: IV

The novel coronavirus-induced infection (COVID-19) was declared a pandemic by the World Health Organization onMarch 11, 2020. Iran is one of the countries with a high incidence of COVID-19 infection.Data on three patients with fragility hip fracture and COVID-19 infection were collected from one hospital located inBadrud, Isfahan, Iran, from March 1, 2010, to March 30, 2020. All patients were elderly and had fracture induced by fallfrom standing height.All patients (n=3) were admitted with fragility hip fracture due to low energy trauma. The most common symptoms wereweakness and fatigue. Positive C-reactive protein (CRP) and Leukopenia were the most common abnormal laboratoryevaluations. According to the results, two patients underwent surgical treatment, and one patient had negative reversetranscription-CRP; however, all of them underwent medical treatment for COVID-19 infection.There is a possible relationship between COVID-19 infection and fragility hip fracture in elderly patients. It could beinduced by fatigue and weakness due to COVID-19 disease. COVOID-19 infection should be considered in elderlypatients with fragility hip fracture during the coronavirus pandemic.Level of evidence: IV

Pseudoaneurysm, accompanied by penetrating trauma in the forearm, is rarely reported. Considering that clinical examination is not standard in these cases, clinical suspicion and application of suitable diagnostic modalities would be promising and helpful. Most of these patients were referred to the emergency units but were not correctly diagnosed. 

In this report, we present a 22-year-old patient with increasing pain because of a stab wound to forearm 10 days after the first referral to the emergency unit. A pseudoaneurysm was suspected in posterior interosseous of the radial artery because of the persistent pain and palpation of mass. 

The results of bedside ultrasound in the emergency unit and CT angiography revealed pseudoaneurysm in posterior interosseous of the radial artery. The surgical treatment was the resection of the lesion and posterior interosseous ligature. All symptoms of the patient were resolved in a 2-months follow-up. Post-traumatic upper extremity pseudoaneurysm can show its signs and symptoms after a long time.

Gorham-Stout syndrome is a rare disease, which results in spontaneous bone resorption. Failure to proper diagnosis of this syndrome can lead to unnecessary bone surgeries. A 13 years old girl with right hip pain, limping, and proximal femur lytic lesions underwent three surgeries without the exact diagnosis. Surgical curettage, bone graft, and internal fixation failed miserably. According to the imaging studies and the biopsy results of bone lesions that showed lymphangiomatosis, accompanied by skin and spleen lesions, a rare presentation of the Gorham-Stout syndrome was diagnosed. Bisphosphonate treatment provides a significant recovery in her symptoms and imaging studies confirmed bone improvement.

Meniscus plays an important role in weight‑bearing and energy absorption. Moreover, its function is optimal to maintain joint stability and congruous. Treatments for meniscus damage or meniscus tear include open or arthroscopic repair and meniscectomy. One of the most important factors that influence patients’ recovery outcome is restoration technique. The purpose of this study was to compare the strength of recently new method of meniscus repair, submeniscal horizontal sutures, and single vertical loop suturing techniques in meniscus repair.

An experimental study was conducted to study 12 ruptured medial meniscuses of bulls, which were divided into two groups of six meniscuses equally. In this study, submeniscal horizontal and vertical loop suturing techniques were compared based on their resistance to tensile forces and the stability of repaired gaps.

In this study, submeniscal horizontal and vertical loop knots were 104.3 ± 12.5 N and 110.7 ± 16.4 N, respectively. No significant difference was found between the two groups. To measure the stability of the gap, 95.4 ± 8.7 N tensile force was applied to submeniscal and 124.6 ± 11.7 N to vertical loop techniques. There was significantly different in gap stability between horizontal and vertical loop techniques in meniscal repair (P = 0.02).

The results of this study indicate that knot resistance in submeniscal horizontal is similar to vertical loop resistance. The stability of the restored gap in vertical loop technique is more than submeniscal horizontal techniques. Vertical loop causes greater stability against tensile force.

Neurofibroma is a rare benign tumor that often originates from peripheral nerve sheath. The solitary type can be seen in middle-aged people. Hyalinization is a rare phenomenon that can be observed in fibrous tumors.
In this report, a 46-year-old male patient with a hard mass in proximal femoral is presented. He had central necrosis in the initial imaging studies. The mass was painful and caused signs of local anesthetic for the patient. Extensive hyalinization was observed in the central part of the mass in histopathological studies. S100 protein was widely positive, but CD34 and bcl2 were negative. No necrosis was observed.
The extensive central hyalinization is very rare in fibrous tumors and is observed for the first time in neurofibroma. Hyalizination in the work up prior to surgical treatment led to misdiagnosis of the radiologist and the surgeon. Detailed pathological examination is very important to definitive diagnosis.

Osteoid Osteoma is the most common benign bone tumor often observed in long bones. Ribs involvement is very rare. In spinal involvement, it usually can cause painful scoliosis often seen in posterior component of spinal vertebral. A 15 year-old female with painful scoliosis, whose brace treatment was unsuccessful, is presented. In imaging investigations, her CT scan showed lytic lesions in the posterior of the seventh rib. She had a 30-degree painful scoliosis with right concave curve. Posterior part of the rib containing tumoral lesion was removed. Histopathological investigations showed a woven bone. Osteoid Osteoma was confirmed and the patient’s pain was resolved several days after the surgery. Follow-up in 3 month after the surgery showed that the curve of spinal deformity was completely resolved. Rib osteoid osteoma can cause painful scoliosis in young people, and surgical excision can be a successful treatment. It seems that application of brace had no impact on reducing the patient’s symptoms.