فهرست مطالب seyed hadi kalantar

Radial head and neck fractures are one of the common fractures of the elbow in adult patients. There are controversial in treatment of nondisplaced head and neck fracture. However, nonoperative treatment remain as a choice treatment of nondisplaced radial head fracture without motion block.

Case Report: 

we presented a 23 years-old patient who had bilateral nondisplaced radial head fracture. The Patients was managed with conservative treatment and early elbow range of motion. Finally, the patient had full range of motion without any pain in his both elbows.

Nonoperative treatment with early range of motion remain as a treatment for bilateral nondisplaced radial head fracture with acceptable outcome.

Transolecranon fracture is an unstable intra-articular injury in the elbow caused by high-energy trauma. Here, we introduce a medial humerus plate for severely comminuted transolecranon fracture.

 This article presents the case of a 29-year-old man who had a severely comminuted transolecranon fracture due to a motorcycle accident. A dorsal longitudinal approach was used in order to reach the fracture site. An olecranon anatomical plate and a medial humerus plate were applied for fixation, a new treatment method. The range of motion (ROM) was complete at a two-month follow-up, and the Mayo Elbow Performance Score (MEPS) was obtained 100 with no signs of complications.

Despite the several methods available for fixing transolecranon fractures, using the medial humerus plate, especially in severe comminution, can yield acceptable results. It should be considered in future studies to prove its efficacy in this type of fracture.

Correlation between Diabetes Mellitus (DM) and musculoskeletal problem has been established in many of the past studies. There are reports of high prevalence (up to 63%) of upper extremity impairment in diabetic patients. The main aim was to conduct a study to determine the prevalence of diabetes and prediabetes in patients with shoulder complaints. It may help the treating physician in managing patients with shoulder problems.

During a period of six months from February 2018 to August 2018, patients who consulted shoulder clinic with complain of shoulder pain were included in this cross sectional study. Eligible patients were enrolled after informed consent was obtained. A uniform checklist was completed for every patient. The key components of the checklist were: demographic data, fasting blood glucose(FBS), diagnosis, body mass index( BMI).Diagnosis of diabetes and prediabetes was done by FBS level( FBS between 100 to 126 considered prediabetes and more than 126 as diabetes.

564 eligible patients were enrolled in the study. Of the 564 patients, 18.8% had DM, 25.9% had pre-diabetes, and 55.3% had normal fasting blood glucose. A higher proportion of men had abnormal fasting glucose compared to women (54% and 33.9% respectively). There was no significant difference in blood glucose levels in respect to different shoulder pathologies (P = 0.191).

This study shows that population with shoulder complaint have a higher prevalence of DM than the normal population. This high proportion of patients with impaired blood glucose levels and shoulder pain necessitates further research in this course and advancement towards risk factors of DM. It is more important in community areas where routine screening of diabetes is not performed.

Patients with asymptomatic coronavirus disease 2019 (COVID-19) can transmit the disease to others.Since the trauma patients represent a portion of society and can be asymptomatic carriers of COVID-19, it is essential for medical staff to use precautions when managing all trauma patients with or without symptoms of COVID-19.

In this article, we discuss three patients with bone fractures who had no previous symptoms of COVID-19. Two cases were old patients with intertrochanteric fractures, and the other one was a young man with a distal clavicular fracture. All patients were diagnosed incidentally in the course of the admission.

Emergency room (ER) personnel and orthopedic surgeons should be aware of asymptomatic COVID-19 cases. It isimportant to use standard personal protective equipment (PPE) during the evaluation of all patients with orthopedic trauma toprevent disease spread.

Since the outbreak of the novel coronavirus disease-2019 (COVID-19) pandemics many orthopedic elective surgeries have been postponed all over the world. There are several guidelines for resuming elective surgeries during this crisis. In our center (Imam Khomeini hospital, Tehran, Iran), we resumed total joint arthroplasty (TJAs)surgeries using preoperative history taking and physical examination. Here, we report our experience.

From February 2020 to August 2020, we included 165 patients who underwent TJA [70 total hip arthroplasty (THA)and 95 total knee arthroplasty (TKA)] in Imam Khomeini hospital, a referral center for COVID-19.We followed each patient from the day of hospitalization to two weeks after discharge by telephone forclinical symptoms of COVID-19.

Only one patient became infected with COVID-19 a week after discharge from the hospital, and other patients did not show any sign or symptoms within two weeks after the discharge.

We recommend resuming the elective surgeries usinga careful physical examination and medical history for all patients, and in suspicious cases, referring to a specialized COVID-19 clinic for further investigation.

The novel coronavirus disease-2019 (COVID-19) has become a significant worldwide problem since January 2019. Hospitals have spent most of their time and logistics on patients with COVID-19. During this crisis, many healthcare providers have been infected with the disease, and occasionally, some wards and operating rooms were shut down as a result. Here, we explainour experience with the healthcare staff involvement with COVID-19in our hospital.

As a referral tertiary center, Imam Khomeini Hospital (Tehran, Iran) has 4,200 health-care workers (HCWs). From February 20, 2020 to August 21, 2020, we investigated the hospital database for COVID-19 involvement among the staff.

During the study period, 973 (23%) hospital HCWs were detected with COVID-19, 378 (9%) of whom were involved between June 21 and July 21, 2020. In the orthopedic department, 20 of 43 (46%) HCWs were infected with COVID-19.

We believe that the increase in the incidence of the disease and higher risk of exposure is a highly noticeable factor which should be addressed by the administrative health officials.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the largest global healthcare crisis of the last century since its emergence in December 2019. As more of the condition’s chronicity became evident and the government policies changed, the unlocking of the orthopedic wards seemed necessary. In this study, we decided to share our experience regarding the unlocking of our orthopedic ward in the largest tertiary referral hospital of Iran and to explain its negative and positive consequences.

This observational study was done in Imam Khomeini Hospital Complex, Tehran, Iran, from April to August 2020. We extracted the data regarding the number of elective/trauma operations, emergency patients, and morning report sessions attendance from our registry database. The data were analyzed and plotted using Microsoft Excel 365.

The mean weekly number of orthopedic operations decreased from 50 for elective and 30 for trauma operations in January 2020 to almost zero for both in late March and early April 2020 [the first coronavirus disease 2019 (COVID-19) peak]. Following the department unlocking, the mean weekly elective and trauma operations returned to 50 and 20 by mid-June, respectively. The mean weekly orthopedic emergency visits followed the same order with decrease from 50 to almost zero in late March and increase to 70 in mid-June. However, by the beginning of the second wave, it decreased to almost 38 in early July and further to 28 in late July bythe end of the second wave.

The unlocking of the orthopedic department in a tertiary referral hospital during the COVID-19 pandemic is possible, provided that there is a set of protocols for patient care in the ward, emergency room (ER), operating room (OR), and clinic during the pandemic.

Total knee arthroplasty (TKA) can cause excessive blood loss requiring allogenic transfusions.Tranexamic acid (TXA) has been increasingly used for lowering blood loss. The present study aimed to comparethe efficacy of intravenous (IV) and intra-articular (IA) administrations of TXA in TKA patients who receive aspirin aschemoprophylaxis and uses no drain post-operative.

In this prospective randomized clinical trial, 49 TKA patients were intravenously given 15 mg/kg dose ofTXA, and 49 patients intraarticularly received 15 mg/kg of TXA. Demographic information, pre-operative and postoperativehemoglobin values of the patients were used for assessing total perioperative blood loss by GOOD &NADLER formulae.

There was not any significant difference between the IV TXA and IA TXA groups concerning blood loss(P=0.102). However, the decrease in hemoglobin level at 48 hours post-operation compared to the preoperativelevel in the IV TXA group was significantly higher than that in the IA TXA group (-2.3 ±0.8 vs. -1.9 ±1.0 g/dL;P=0.038). No blood transfusion was needed, and the deep venous thrombosis and pulmonary embolization werenot observed in either of the groups (P>0.05).

Our study showed that during TKA, the IA TXA is equally safe and effective as its IV infusion concerningdecreased blood loss and adverse effects. The use of TXA during TKA is safe for patients who receive less potentchemoprophylaxis agents such as aspirin.Level of evidence: I

The COVID-19 disease is rapidly spreading around the world, affecting many countries and their healthcare systems.Like many other countries, Iran is struggling with the current situation. In this article, we aim to share our perspectiveson confronting obstacles mentioned above using appropriate hospital protocols during the COVID-19 crisis.We investigated and compared the number of referred patients to the emergency room, elective, and emergentorthopedic operations in our hospital, along with a number of residents and faculty participants in the morning reportsand virtual classes before and after the outbreak of COVID-19 in our hospital.The number of referred patients to the emergency room was significantly reduced; the number of orthopedic operationswas also decreased to almost zero in March 2020. Meanwhile, we managed to dismiss our residents and reducethe number of in-hospital morning reports and conferences. Instead, we designed virtual classes, and the number ofparticipants in our virtual classes grew to almost two-third of the whole participant. We also managed to fortify our virtualoffice system to reduce the number of in-hospital visits.Since our hospital had become a leading center for the treatment of COVID-19 patients, and the number of referredtrauma patients, elective, and trauma operations, along with educational activities, was reduced. There was also asignificant concern about the management of elective, trauma, and post-operative patients in this era. Orthopedicfaculty members needed to react to the current situation cautiously. We were able to manage the situation withconsideration of our educational path, along with the management of personal protective equipment (PPE), and theuse of communication technologies and specific protocols to overcome the obstacles mentioned above. Yet involvedour staff andWith orthopedic faculties active involvement at in-hospital activitie and establishment of hospital protocols consideringtechnological facilities and WHO guidelines, we can improve education, management of PPE, and both orthopedicelective and trauma patients.Level of evidence: IV