فهرست مطالب yousef fallah

Osteoporosis, referred to as a " silent epidemic," is a skeletal disease with decreased bone density. This problem has no symptoms, but the most common result is fracture. According to the reported result, this disorder in Iran is more than 4% in men and more than 7% in women, while in the age of over 50 years, this statistic is significant and reaches more than 10% in both sexes. Considering this problem and the need to predict the conditions to change and treat it, it was decided to investigate this study of osteoporosis in people in a tertiary trauma center.

In this study, 113 patients over 65 year old age admitted to the emergency room of Sina Hospital were examined by and subjected to BMD osteoporosis examination, and also the demographic examinations of the patients were recorded through interviews and examination of hospital records, and were finally subjected to statistical analysis

The age of the examined patients was 75.8 years and 67.3% were in the group over 70 years old. 44.2% of the studied population were women and 57.8% were men. 31 patients (27.4%) had a history of fracture. Alcohol consumption and smoking were reported in 3.5% and 31.9% of cases, respectively. In addition, there are 6 patients (3.5 percent) taking drugs on bone density, which in some cases were from the corticosteroid group.The fracture status of the patients was in 61 cases (54%) in the lower limb and in 52 cases (46%) in the upper limb. A total of 76 patients (67.3%) have osteoporosis

This study found that about two-thirds of the patients who suffer limb fractures in old age have osteoporosis.

Oxygen ozone gas mixture as a newly prescribed substance became popular among clinicians to relieve low back pain in discogenic patients as an alternative method rather than surgery. It is believed multiple metabolic pathways intervein within its site of action with nucleus pulposus. We developed this study to uncover whether this combination could be helpful in the middle Eastern population or not.

 In the present randomized clinical trial study, we included 40 patients with L1 to S1 disc herniation based on MRI verification within years 2018-2019 who did not respond to 6 weeks of physiotherapy. All patients were followed with a mean time of 12 weeks after injection, and pain VAS score and SF-36 score were performed for all patients. The severity of disc herniations was evaluated by a spine surgeon within the Michigan State University (MSU) classification frame.

Nine out of 40 patients were unexpectedly excluded during our study due to their absence for follow-up. The present study showed that the mean distribution of the patient’s sex, age, BMI, smoking was not contrasting between the two groups (p>0.05). The current study represented two groups were identical regarding Lumbosacral segment involvement during 12 weeks of our survey (p>0.05). SF-36 score graphical inclination was equivalent in both intervention and control groups. The mean VAS score was primarily decreased after two weeks in the intervention group in comparison with the control group, but it failed to thrive in the following weeks and was raised afterward. On the other hand mean VAS score for the control group (6.1; 95% CI: 5.4-6.8) proceeded with a steady slope notably lower than the intervention group (7.5; 95% CI: 6.9-8.2; P<0.001).

In conclusion, referring to statistical outcomes inferred from our study, we understood oxygen-ozone mixture injection is not beneficial in patients with low back pain.

Hemicorporectomy is a life-saving operation to maintain the survival of patients with severe and irreversible pelvis and lower extremities injuries. In the typical procedure, removing lower extremities and pelvic viscera in the two stages might result in hemodynamic instability, intraoperative and postoperative morbidities, and more deficient patients' survival. In this study, we aim to describe our experience with a new technique for one-stage hemicorporectomy, which minimizes surgical time and intraoperative bleeding.

Case Report: 

A 77-year-old male patient with lower limb gangrene after previous vascular surgery for an abdominal aortic aneurysm in an unstable situation underwent hemicorporectomy in one step.

We believe that achieving a one-step procedure, especially in non-malignant cases or in the absence of severe trauma lesions, may be a viable option in emergency surgery cases or hemodynamic instability. However, there is still a need to modify the single-stage surgical technique in later experiments.

Complex regional pain syndrome (CRPS) is an important common complication after surgical treatment for distal radius fracture. Recognition of the related factors is important to reduce the burden of the problem. Herein, the contributing factors for CRPS after distal radius fracture surgery are studied.

In this cross-sectional comparative study, 250 patients admitted to the orthopedics ward in Sina Hospital in Tehran, Iran, from 2017 to 2020, were enrolled. The contributing factors for CRPS after distal radius fracture surgery were determined in them.

The CRPS was seen in 17 cases (6.8%). 9 percent of male and 1.9 percent of female patients were diagnosed with CRPS. This showed a significant difference in the Fisher test (P = 0.028). The mean pain severity by Visual Analogue Scale (VAS) was higher in CRPS cases, that showed a significant difference by the Mann-Whitney test (P = 0.001).

According to the obtained results, it may be concluded that CRPS was seen in seven percent of patients under surgery for distal radius fracture and was related to the male gender and higher pain severity.

Dislocation of total hip arthroplasty (THA) needs prompt intervention and reduction either closed or open. It is unusual to left THA dislocated. Hence in this study, the outcomes of neglected prosthesis after THA were determined.

In this case series study, 15 neglected cases of total hips which had been left unreduced for long time (more than 3 months) were assessed. Cause of postponing reduction, femoral side and acetabular side defects, approach and type of revised prosthesis, Harris hip score(HHS), and other complications were studied.

The results in this study demonstrated that financial issues were the cause of delayed attempt for treatment in 5 cases and the other 10 cases had delay for treatment, because they searched for a specialist to accept performing an operating on them.There were some acetabular side and femoral side defects. By Paprosky classification, in femoral side, there were 6 defects: four type 2, one type 3A, and one 3B.In acetabular side, there were 10 defects (three type 1, one type 2a, three type 2b, one type 3a, and two type 3b). In one developmental dysplasia of the hip (DDH) case, previous osteotomy site was revised (distal segment rotated and then refixed)

Totally, according to the obtained results, it may be concluded thatoutcomes were relatively good in neglected prosthesis cases after THA. However, recognition of high-risk cases and reduction of delay time may improve the outcomes.

Shoulder pain and neck pain affect respectively 25% and 43% of the population. The aim of this clinical study is to assess the proportion, correct diagnosis, and treatment of hypertension (HTN) in patients with pain in the neck, shoulder, and upper extremity.

300 patients with complaints of neck, shoulder, or upper extremity pain without trauma or infection were studied from January 2015 to December 2017. After taking the history and examination, the blood pressure of these patients was recorded. Laboratory tests, x-ray, and magnetic resonance imaging (MRI) of the neck and affected shoulder joint were requested. Antihypertensive and symptomatic treatments were prescribed for patients with HTN. In the next visits, new history and examination, including the range of motion (ROM) of neck, shoulder, and upper extremity, blood pressure, and the results of laboratory tests, and images were checked. The final data were analyzed using chi-square test in SPSS software.

The Prevalence of HTN in patients in the age groups of 20-30, 31-60, and above 60 years were 21%, 44%, and 56 %, respectively. Neck, shoulder, and upper extremity pain and motion improved significantly after antihypertensive and symptomatic treatment in patients with HTN.

HTN is the most common cause of neck, shoulder, and upper extremity pain in the adults and older patients referring to a physician. Thus, checking blood pressure by a physician or specialist is recommended for adults or older patients with neck, shoulder, or upper extremity pain. Antihypertensive and symptomatic treatments must be prescribed for nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen-codeine and corticosteroids should be prohibited for the patients with HTN.

Intraosseous stab wounds are extremely rare. Only a few cases have been reported in the upper extremity.

Case Report: 

In this report, we presented a case of stab wound to the right shoulder with penetration to the scapula. The patient was successfully managed in a team-based approach. During a 12-month follow-up, he showed no abnormality in passive and active movements or physical examination.

Relying on the physical examinations and paraclinical studies may be an appropriate substitution for exploration surgery when possible iatrogenic injuries may affect the patient's quality of life.

This study was conducted to develop a modified, parsimonious, faster to produce, easier to implement, and patient-specific drill guide template and also to examine if such a modification might affect the accuracy.

On two cadaveric spines, using reverse engineering, the orientation of pedicles and safe corridors for pedicle screw were determined. A drill template was designed with a surface that was the inverse of the posterior vertebral surface. The drill template was manufactured using rapid prototyping technique. To decrease the costs, the cervical spine corresponding prototypes were not manufactured. In contrary to previous studies, to preserve the stability from posterior element, the templates were designed in such a way that removing interspinous and supraspinous ligaments was not necessary. The accuracy was evaluated by computed tomography (CT) images and classified into three grades of 0: correct placement, 1: malposition by less than a half screw diameter, and 2: malposition by more than a half screw diameter.

Of 20 positions available, we inserted 19 screws, because the trajectory of one of the patient-specific drill guide templates was misdirected. The overall accuracy rate for cervical pedicle screw (CPS) placement was 84.2% (16 of 19). Safely inserted screws, combining the grades 0 and 1 categories, were as high as 100%. We observed no “unsafe screw placement”.

The total cost and the latency period before the operation was reduced and the interspinous and supraspinous ligaments were preserved. A good applicability and high accuracy was obtained for subaxial CPS (SCPS) insertion.

Open bone grafting has been the standard procedure for treatment of scaphoid nonunion. Arthroscopic bone grafting and fixation is a minimally invasive method, which is effective as open procedure with minimal complications.
The purpose of this study was to assess the results of arthroscopic treatment by refreshing and bone grafting on clinical wrist function and radiographic outcome in patients with stable scaphoid nonunion.
Patients and Between June 2012 and May 2014, 17 patients received arthroscopic refreshing and bone grafting for treatment of stable waist scaphoid nonunion. The mean follow-up was 13 months (ranged 6 - 18 months).
The mean flexion/extension of the wrist was 72 degrees (ranged 50 - 160 degrees) compared with the pre-operation 53 degrees (ranged 35 - 160 degrees) (P Arthroscopic treatment of stable scaphoid nonunion is an effective alternative to the conventional treatment of stable Scaphoid nonunion.