فهرست مطالب reza tavakoli darestani

Shoulder pain is a common orthopedic complaint, with rotator cuff tear (RCT) and impingement syndrome as prevalent causes. The critical shoulder angle (CSA), the angle between the glenoid and acromion, has been implicated in the development of RCT. However, comprehensive evaluations of CSA in Iranian patients with impingement syndrome and RCT are lacking.
This case-control study assessed CSA in patients with RCT and impingement syndrome. Patients presenting with severe shoulder pain between 2019 and 2021 were included, with CSA measurements taken from anterior-posterior radiographs. Diagnostic performance was evaluated. The control group comprised patients with other shoulder pathologies.
Of 135 patients, those with RCT exhibited significantly higher CSA values (37.3) compared to the impingement syndrome group (30.25) and control group (29.9). CSA showed high sensitivity (100%) and specificity in diagnosing RCT at a cut-off value 35.1. In diagnosing impingement syndrome, CSA demonstrated a sensitivity of 60% and specificity of 66.7% at a cut-off of 30.25.
CSA emerged as a promising diagnostic tool for RCT, with its value exceeding the critical threshold. This finding aligns with international studies, suggesting the utility of CSA in the Iranian context. The study provides valuable insights into the diagnostic potential of CSA, particularly in the differentiation of shoulder pathologies within the Iranian population.
As assessed through radiographs, the critical shoulder angle is a reliable diagnostic measure to identify RCT and distinguish it from impingement syndrome. This research contributes to understanding shoulder pathologies in the Iranian population, emphasizing the clinical significance of CSA as a predictor for RCT.

Displaced acetabular fractures are complex injuries that necessitate precise surgical intervention. Obturator nerve injuries occur in approximately 2% of cases. The modified Stoppa approach, offering enhanced exposure of the quadrilateral plate, has gained attraction as an alternative technique for anterior acetabular fractures. However, its proximity to the obturator nerve poses a risk of iatrogenic injury. This study aimed to investigate the incidence of nerve injuries and functional outcomes in patients undergoing the modified Stoppa approach for traumatic acetabular fractures. This retrospective study involved 86 patients with anterior column fractures, whose data were prospectively collected. The fractures were treated using the modified Stoppa approach. Exclusion criteria were pathological fractures, alternative surgical approaches, prior nerve injuries, hip issues, refusal to participate, or inadequate follow-up. Data collection involved pre-operative imaging, thorough post-operative neurological assessments, and post-operative radiographic evaluation. Functional outcomes were assessed using the Harris Hip Score (HHS). Most patients were male (n=54) with a mean age of 40±17.3 years. Post-operative infection occurred in six cases, with resolution in four through antibiotics and two necessitating device removal. Obturator nerve damage was detected in 14 patients, comprising nine traumatic and five iatrogenic cases. During the follow-up, symptoms improved in all patients, except for the four patients with iatrogenic nerve damage. Traumatic nerve injuries generally heal naturally over time. In contrast, iatrogenic injuries have a less optimistic prognosis, potentially resulting in lasting neurological deficits. Level of evidence: III

 Medial malleolar stress fractures are rare injuries resulting from excessive and repetitive stress loads on bone. The incidence rate of these stress fractures varies from 0.6% to 4.1% of all stress fractures and has been almost exclusively reported in athletes. Typical clinical presentation is a gradual onset of pain and tenderness at the medial malleolus site with a history of long-term physical activity. 

Presentation: 

A 60-year-old postmenopausal woman with a gradual onset of pain and point tenderness over the medial malleolus and a history of daily walking for several months.

Diagnosis:

 The initial anterior-posterior and lateral plain radiographs were normal. After the initial conservative medication therapy failed, magnetic resonance imaging (MRI) was obtained. It demonstrated a vertical linear zone of decreased signal intensity originating between the tibial plafond and the medial malleolar junction, which suggested medial malleolar stress fracture. 

Intervention: 

We started treatment with a short leg cast and non-weight bearing for six weeks that failed; open reduction and internal fixation were performed under general anesthesia. 

Outcomes:

 Six months postoperatively, the pain entirely resolved, and the patient returned to her regular daily physical activity and conducted plain radiographs demonstrating complete union, and no complications occurred.

 Medial malleolar stress fractures are rare injuries and might be misdiagnosed due to normal initial radiographs. They must be considered in those with gradual onset of pain and point tenderness of medial malleolus, especially with a history of long-term physical activity. Early diagnosis and surgical intervention lead to faster healing and a return to physical activity

Clinical decision-making for treating anterior shoulder instability relies on accurate glenoid bone loss quantification precision. This study aimed to assess the accuracy of the axial view of a 2-D CT scan compared with arthroscopy to measure glenoid bone loss following 3-D CT scanning.

This study was performed from March 2019 to February 2020 on patients who presented to the shoulder clinic of a referral teaching hospital in Tehran, Iran. Eighteen patients with at least one history of unilateral anterior shoulder dislocation without shoulder surgery participated in the study. Before surgery, the qualified participants had their injured and uninjured shoulders CT scanned. The Griffiths index was used to estimate the size of glenoid bone loss in CT scan imaging. Subsequently, the affected shoulders were arthroscopically evaluated, and glenoid bone loss was measured using a standard probe.

Among the 18 participants, glenoid bone loss was underestimated for 11 patients (61.1%) in CT scans compared to arthroscopy. The mean ± SD of glenoid bone loss percentage on CT scan (9.5% ± 4.9%) was significantly lower than on arthroscopy (11.7% ± 3.9%, p = 0.04). Nevertheless, Pearson’s correlation showed a significantly moderate correlation (r = 0.55, p = 0.01) between arthroscopic and CT scan measurements of glenoid bone loss.

Our findings indicate that glenoid bone loss width measurement via the axial view of a CT scan should not be considered a reliable method to measure glenoid bone loss.

In this article, a 75‑year‑old patient with pain in left knee and restricted range of motion following total knee arthroplasty (TKA) is presented. Serological evaluation and aspiration of knee joint suggested a fungal prosthetic joint infection. After the diagnosis was confirmed, treatment started with antifungal drugs, removing prosthesis, exhaustive debridement, and revision of TKA after efficient antifungal treatment. At one‑year follow‑up, she has a painless motion range of 10 to 90 degrees, and there was no recurrence of infection observed.

 Stress fractures develop when a bone cannot remodel in response to a repetitive force. They are less frequent in the upper extremities, and the coronoid process is an infrequent site for stress fractures. Coronoid stress fractures present with pain and tenderness of the elbow, which is exacerbated by full extension of the elbow.

A 24-year-old boxer man was admitted to the hospital after complaining of pain in the anterior part of his elbow for seven months. Physical examination revealed exacerbation of the pain during hyper-extension positions and training, tenderness of the elbow at the anterior region, and decreased range of motion. Coronoid stress fractures should be considered in athletes, especially gymnasts with chronic elbow pain. Initial treatment is conservative management of the pain. If the conventional treatment fails, fixation of the fragment with a surgical approach and subsequent rehabilitation must be performed.

Osteoid osteoma is a moderately common bone lesion, accounting for 10-12% of benign bone tumors (1, 2). It primarily affects young people in their first two decades of life, with the majority of cases occurring between the ages of 5 and 30 (3). Men are 2-4 times more likely to be affected than women (4). The tumor can develop in almost any bone in the body; however, in more than 70% of cases, the long bones are the source of the tumor, with the femur and tibia being the most frequently affected (50-60%). The diaphysis or metaphysics of long bones are the most common sites for osteoid osteomas. With a frequency of around 10-13%, epiphyseal and intra-articular locations are deemed rare, with the hip being the most common site (4-7). Other less impacted areas include the ankle, elbow, wrist, and knee. When a lesion develops at the extremity of long bones, near or inside the joint, in a bone confined by the capsule, very close to it, and to the synovia, it is classified as intra-articular (3). This condition's etiology remains unclear and the incidence of a familial occurrence is exceptionally unlikely. Cytogenetic modifications such as the deletion of chromosome 22q have been identified in cases of osteoid osteoma, although further research is needed to definitively relate this individual to a clonal mutation (8, 9).

Also known as intravascular papillary endothelial hyperplasia, Masson’s tumor is a relatively rare soft‑tissue vascular tumor that usually arises in the hand. Felon is an abscess formation in the distal phalanx that usually occurs following a penetrating microtrauma. We present a 30‑year‑old patient who was referred to our clinic with a palpable mass in the distal phalanx of the index finger after a needle stick injury. At first, the lesion was treated as a felon but finally and after treatment failure, a complete reevaluation revealed the lesion to be a Masson’s tumor of the distal phalanx

In the elderly, proximal humerus fractures are not unusual. The treatment of these injuries are often complicated. This study aimed to evaluate the effect of deltoid tuberosity index on the outcome of proximal humeral fractures treated with a locking plate. One hundred consecutive patients with displaced fractures of the proximal humerus had open-reduction and internal fixation using a locking plate. The patients were divided into two main groups (low density group) DTI<1.4 and DTI>1.4 (normal density group) and at the end of the study, treatment and failure were assessed in the two groups. In this study, 100 patients with proximal humeral fracture who were candidates for locking plating surgery were evaluated. The mean of DTI in all patients was 1.48 with a minimum of 1.10 and a maximum of 2.20. Based on the Pearson correlation coefficient, with increasing age, the constant score decreased in the studied patients, which was statistically significant (r=-0.216, p-value = 0.031). Also, in patients with DTI less than 1.4 and more than 1.4, the Constant score was 73.02 and 77.88, respectively. This difference was not statistically significant (p-value=0.054). There was a statistically significant relationship between Constant Score, DTI and patients' gender (p-value≤0.05). While there was no statistically significant relationship between fracture type and constant score. Pearson correlation coefficient between DTI and age of patients was -0.30, which decreased with increasing age of patients. This was statistically significant (r=-0.30, p-value=0.003). The results of this study show that the deltoid tuberosity index can be effective on proximal humoral fracture surgery treated with locking plating.

Intertrochanteric fractures, which are one type of hip fracture, have been considered as amajor public health issue in many nations. This study was carried out with the aim of comparing the rateof fusion between patients with intertrochanteric fractures treated with short sliding and non-slidingGamma nail implants.

This is a retrospective cross-sectional study performed in 2018 and2019, and 47 patients with intertrochanteric fractures, who referred to Imam Hussein Hospital, andwere treated using either sliding or non-sliding gamma nail implants were compared. The rates of bonefusion, fused union, and bone repairments were all assessed using radiography 1, 3, 7 and 12 monthsafter the operation.

In the current survey, 68.6% of cases were treated with non-sliding gammanail implants, while 31.4% were treated with sliding gamma nail implants. The mean period of bonefusion was 4.5 months in patients with non-sliding gamma nail implants and 5.5 months in patientswith sliding gamma nail implants. In patients treated with sliding gamma nail implants, treatment of28.5% of patients failed, and in the group of patients treated with non-sliding gamma nail, treatmentfailure was reported in 12.5% of patients. In addition, mean postoperative Harris Hip Score (HHS) in thegroup treated with non-sliding gamma nail implants was significantly higher than the group treatedwith sliding gamma nail implants (P = 0.002).

Based on the findings of the present study,it seems that treatment with short non-sliding gamma nail implants is a better method compared totreatment with sliding gamma nail implants.

Conjugated linoleic acid (CLA) has been shown to positively influence calcium and bone metabolism in experimental animals and cell culture, but there are limited human data available. The study consisted of a double-blind, placebo-controlled trial in which 76 healthy post-menopausal women (aged 55.1) were randomly assigned to receive daily either four capsules of CLA G80 containing 3.2 g isomer blend (50:50% cis-9, trans-11:trans-10, cis-12 isomers) or four capsules containing high oleic sunflower oil as placebo for 12 weeks. Urine and blood samples were collected at weeks 0 and 12 and were analyzed for biomarkers of calcium and bone metabolism and inflammatory markers (TNF-α and IL-6). Subjects completed 3-day dietary records during the trial in weeks 0 (baseline), 6, and 12. Supplementation with 3.2 g CLA isomer blend (50:50% cis-9, trans-11:trans-10, cis-12 isomers) for 12 weeks had no significant effects on markers of bone formation (serum osteocalcin, bone-specific alkaline phosphatase) or bone resorption (urine C-telopeptide-related fraction of type 1 collagen degradation products), PTH, urinary calcium, urinary creatinine and CTP to creatinine ratio. Serum interlukine-6 did not change significantly over 12 weeks in postmenopausal women. ‍ Under the conditions tested in this double-blind, placebo-controlled trial in postmenopausal women, 3.2 g CLA isomer blend (50:50% cis-9, trans-11:trans-10, cis-12 isomers) did not affect markers of bone metabolism and calcium.

It was suggested that the direction of incision for medial hamstring tendons harvesting influences the incidence of injury to the infrapatellar branch of the saphenous nerve (IPBSN), a common complication following arthroscopically-assisted anterior cruciate ligament reconstruction (ACLR).. The main purpose of current study was to compare the incidence of IPBSN injury between vertical and oblique incisions utilizing electrophysiological evaluation..Patients and There were 60 patients underwent arthroscopically-assisted ACLR assigned to two equal vertical or oblique incision groups, randomly. One year postoperatively, the patients were electrophysiologically examined to detect whether IPBSN is injured. The Lysholm score was completed. The patients'' satisfaction with surgical outcomes determined utilizing visual analogue scale (VAS). Finally, two groups were compared and the effect of IPBSN injury on function and satisfaction was investigated.. The incidence of IPBSN injury was higher in the vertical group (4 patients vs. 10 patients), but the difference was not statistically significant. The mean of Lysholm and VAS scores were the same. Also, the mean of Lysholm score was the same in patients with and without IPBSN injury. However, patients without IPBSN injury were more satisfied (8.9 ± 9 vs. 7.4 ± 1.1; P < 0.001).. IPBSN injury is a common complication following arthroscopically-assisted ACLR and, if not significant, oblique direction of the incision is associated with decreased incidence of the injury. IPBSN injury has no effect on the function but because of the disturbance with patients'' satisfaction, authors believe the oblique incision is preferable to avoid the nerve injury during medial hamstring tendons harvesting..

Appropriate treatment of acromioclavicular joint dislocation is controversial. Acroplate fixation is one of the most common treatment methods of acromioclavicular joint (ACJ) dislocation. Based on the risk of re-dislocation after Acroplate fixation, we assumed that combined fixation with an Acroplate and a coracoclavicular screw helps improve the outcome.. The main purpose of the current study was to compare the outcome of ACJ dislocation treated with an Acroplate alone and in combination with coracoclavicular screw..Patients and This study was carried out on 40 patients with ACJ dislocation types III to VI who were divided randomly into two equal groups: Acroplate group (P) and Acroplate in combination with coracoclavicular screw group (P + S). The screws were extracted 3-6 months postoperatively. The patients were followed for 1 year and Imatani’s score was calculated. Finally, the data were compared between the groups.. The mean Imatani’s score was significantly higher in P + S group (83.4 ± 14.1) than P group (81.2 ± 10.3) (P < 0.001). The mean duration of surgery was the same in the two groups (59.8 ± 9.4 minutes in group P V.s 64.3 ± 10.9 minutes in group P + S; P = 0.169). There were no cases of re-dislocation, degenerative changes and ossification and all patients returned to their previous jobs or sporting activities.. Using a coracoclavicular screw combined with an Acroplate can improve the patients’ function after ACJ disruption without any significant increase in surgical duration. Authors recommend this technique in the fixation of ACJ dislocation..

Osteoarthritis (OA) is the most common rheumatologic disorder and the knee is the most involved joint. There are several medications suggested to treat knee OA، each of them has some advantages and disadvantages. The goal of the current study was to compare the effect of piascledine and diclofenac on pain and function of the patients with knee OA. In this clinical trial، 60 patients with knee OA were randomly divided into two groups: piascledine (300 mg daily) and diclofenac (25 mg three times a day). Patients were treated for 8 weeks. WOMAC score was completed for each patient، and pain was measured using VAS pre- and post-medication. The mean WOMAC score was 53. 7±3. 1 in piascledine group and 54. 2±2. 9 in diclofenac group before treatment; which increased to 64. 3±4. 1 and 62±4. 4 after treatment، respectively. The mean WOMAC score was significantly higher in the piascledine group (P<0. 05). The mean of VAS in piascledine and diclofenac group was 6. 5±2. 2 and 7. 1±2. 1 pre-medication which decreased to 4. 2±1. 1 and 4. 5±1. 4 post-medication، respectively. There was a statistically significant difference between the two groups after treatment in the means of VAS. No side effect seen in neither of the groups. Due to improvement in WOMAC score and better patient compliance because of once daily intake، piascledine can be an efficient substitute to NSAIDs in treatment of knee OA.

Acetabular fractures are a common problem among young males. An acetabular fracture with disruption of the joint surface, if untreated, will rapidly lead to post-traumatic osteoarthritis. Proper reduction and internal fixation depend on accurate classification and the quality of imaging.

We present an unusual form of acetabular fracture, which is not included in the conventional classification (Judet and Letournel) ; this occurred in a middle-aged male who was operatively treated without any complications. In this case due to posterior extension of the fracture into the SI joint and concomitant anterior column fracture in the area above the acetabular dome, no portion of the acetabular anterior surface remained connected to the innominate bone.

We recognized this type of fracture and treated it similarly to both column fractures. We recommend that the classification of acetabular fractures be modified to include this type of fracture.

Gorham’s disease is a rare musculoskeletal disease which causes progressive osteolysis and is characterized by massive bone destruction due to proliferation of vascular elements along with a great number of osteoclasts. The etiology of the disease is unknown. Gorham’s disease is essentially rare in the forearm bones. As far as we know, only 2 cases of Gorham’s disease of the forearm have been reported with 1 of them in the radius and the other starting in the radius and spreading to the lower portion of the humerus.

This case report shows that Gorham’s disease may affect the ulna primarily and spread to adjacent bones despite the fact that there are no such reports in the literature.

Gorham’s disease has several manifestations as primary bone involvement. As in this rare case the ulna may be affected first and then the disease may spread to adjacent bones. More studies are needed to better recognize the behavior of this rare disease.

Two patients with iatrogenic femoral neck fracture following intramedullary fixation of the diaphyseal fractures are reported. This is a rare complication of intramedullary nailing (IMN)، has poor prognosis and is preventable. It seems that choosing the piriformis fossa as the entry point، increased neck-shaft angle (coxa valga) and excessive nail insertion increased the risk of the iatrogenic neck fracture.