paniz motaghi

Genu recurvatum associated with Osgood-Schlatter disease (OSD) has been reported in several studies. In this report, we describe a rare complication of a case of OSD with flexion contracture (tfighat is the exact opposite of the knee deformity classically associated with OSD) and increased posterior tibial slope.In the current article, we report a 14-year-old case of OSD referred to our center with a fixed knee flexion contracture. Radiographic evaluation revealed a tibial slope of 25 degrees. There was no limb length discrepancy. Bracing that was prescribed in the primary centerbefore referring to us was not successful in treating this deformity. He underwent anterior tibial tubercle epiphysiodesis surgery. After a year, the flexion contracture of the patient was significantly reduced. The tibial slope decreased by 12 degrees and reached 13 degrees.The present report suggests that OSD may affect the posterior tibial slope and lead to knee flexion contracture. Surgical epiphysiodesis can correct the deformity.Level of evidence: IV

Autogenous arteriovenous fistulas (AVFs) are the recommended type of vascular access for hemodialysis (HD). Nonetheless, the precise outcome of Proximal Radial Artery Arteriovenous (PRAAVF), as well as its risk of failure and complication, has yet to be determined.

In the current single-center, by retrospective analysis of prospectively collected data, we compared the outcome of Brachial Artery AVF (BAAVF) and Proximal Radial Artery Arteriovenous (PRAAVF) in end-stage renal disease (ESRD) patients who were referred to our center between 2010 to 2018. The outcome of the fistula was routinely assessed for all patients at least two years after the surgery. All data were analyzed in SPSS software (version 16). The success rate for each procedure was reported as a percentage. The Chi-square test was used to compare the success rate between the groups.

A total of 146 patients (86 males, and 60 females) with a mean age of 55.79±17.03 years were included in the study. The results demonstrated that men and women did not significantly differ in the success rate of PRAAVF (P=0.076). The PRAAVF showed a significantly higher success rate in the 30-39 age range (P=0.03). The success rate of BCAVF did not display a significant difference between different age and gender groups (P> 0.05 for both). The success rate of PRAAVF was lower in both diabetic patients and smokers, as compared to that in healthy individuals (P=0.032 and P=0.001, respectively). None of the patients who underwent PRAAVF implementation had steal syndrome (as compared to the 2.8% rate of steal syndrome following BAAVF implementation)

As evidenced by the obtained results, PRAAVFs, which are associated with a very low risk of ischemic steal syndrome, can be regarded as safe and suitable vascular access. Accordingly, when it is anatomically feasible, PRAAVFs should be preferred over BAAVFs due to their superior clinical outcomes.

A preferred surgical approach to distal femur intra-articular fractures is still controversial. 

In the current study, we assessed the outcome and complications of three different surgical techniques, including screw fixation, Retrograde Intramedullary Nailing (RIN), and Locking Compression Plate (LCP). 

A total of 63 patients with distal femur intra-articular fractures were included in this retrospective study. AO/OTA fracture and dislocation classification was used to categorize patients. Type B fractures were treated with screw fixation and type C fractures were treated using LCP and RIN. Outcome measures, including the knee range of motion (ROM) and pain level, were 

The mean±SD age of patients was 36.7±15.7 years. The fracture types B and C were detected in 22 (32.4%) and 46 (67.6%) patients. The mean follow-up period was 27.2±15.9 months. Mild knee pain was the only complication of screw fixation that was observed in 21% of patients. LCP was associated with some complications, including pain (19.4%), infection (9.7%), limited ROM (47.4%), malunion (47.4%), and nonunion (6.5%). RIN was also associated with several complications, including pain (44.4%), infection (11.1%), limited ROM (33.3%), and malunion (41.2%). A comparison of the outcome in matched fracture types of LCP and RIN groups revealed no superiority of each technique. 

Screw fixation alone results in a satisfactory outcome in the treatment of type B distal femur intra-articular fractures. LCP and RIN are associated with a variety of complications with no superiority over each other.

Blood loss during and immediately after total knee arthroplasty (TKA) is among the most challengingconcerns. It has been demonstrated that Tranexamic acid (TXA) can help to reduce perioperative blood loss. TXAcan be used as an oral, topical or intravenous injection. Many studies evaluated the effectiveness of each route ofadministration but few works on a comparison between them. The current study aimed to compare the effectivenessof intravenous injection versus topical use of TXA in reducing perioperative blood loss after primary total kneearthroplasty.

Eighty-five patients who were a candidate for total knee arthroplasty were randomized into two groups:one group received Intravenous injection of 15 mg/kg TXA, 10 min before tourniquet inflation while the other groupreceived 1 g diluted TXA during wound closure. The postoperative blood loss was estimated by measuring thewhole drain output and also hemoglobin (HB) drops. Both groups compared based on the need for allogenic bloodtransfusion and also thromboembolic events.

Patients who received topical TXA had a higher total drain output (P<0.0001) compared to intravenousinjection. The hemoglobin drop also was more in the topical group although it was marginally significant (P=0.05).

Intravenous injection of TXA is more effective in reducing postoperative blood loss after primary TKAcompared to topical administration.Level of evidence: I

Humerus fractures include 5% to 8% of total fractures. Non-union and delayed union of GT (GT) fractures is uncommon; however they present a challenge to the orthopedic surgeons. Significant controversy surrounds optimal treatment of neglected fractures. The purpose of this article was to perform a comparative study to evaluate the outcomes
of open reduction and internal fixation (ORIF) of neglected GT fractures.
We retrospectively evaluated the results of surgical intervention in 12 patients with displaced nonunion of GT fractures who were referred to our center. Before and minimally 25 months after surgery ROM, muscle forces, Constant Shoulder Score (Constant-Murley score) (CSS), Visual Analogue Scale (VAS), Activities of Daily Living (ADL) Score and American Shoulder and Elbow Surgeons (ASES) Score were all recorded. Additionally, the results were compared with undamaged shoulder.
Between March 2006 and January 2013, 12 patients underwent surgical intervention and followed for 36.2 months in average. All fractures healed. Anatomic reduction achieved only in 6 cases with no report of avascular necrosis or infection. All ROMs and muscle forces increased significantly (Mean Forward Flexion: 49.16 to 153.3, Mean Internal Rotation: 3 to 9, Mean External Rotation: -5 to 27.5) (P value ORIF for neglected and displaced GT fractures has satisfactory functional outcomes, despite of non-anatomical reduction of the fracture.