مجله جراحی استخوان و مفاصل ایران
سال هجدهم شماره 4 (پیاپی 71، پاییز 1399)

Nonunion is a serious complication following long-bone fracture that is known as a therapeutic challenge for surgeons and is associated with significant morbidity. It has been shown that osteogenesis stimulating factors combined with optimization of the mechanical environment could facilitate and accelerate nonunion healing. In this study, we aimed to treat nonunion using autologous bone marrow-derived mononuclear cell (BMDMC) aspirate as a source of osteoprogenitor cells combined with internal fixation.

From November 2010 to May 2013, 19 cases of nonunion were treated with bone marrow-derived mononuclear cell (BMDMC) grafting, that included 15 males and 4 females with an average age of 37.8 years (range, 18-81 years). The time from injury to therapy was 7 to 28 months, with an average of 13.4 months. At first, decortications were performed around the nonunion site to prepare a suitable bed for bone marrow grafting. Then, 2 ml of bone marrow concentrated cells was applied to the nonunion site in a mixture with partially demineralized cortical cancellous allograft chips. The healing rate in each patient was clinically and radiologically evaluated every 4 weeks.

Bone union was obtained in 18 of the 19 patients during 1.06 to 6 months with an average time of 3.5 months. No complications during anesthesia nor any infection, hematoma or chronic pain at the nonunion site were observed in any patient.

Transplantation of autologous BMDMC aspirate is a reasonable, effective and easy treatment option for tibial and femoral nonunion after internal fixation.

Total knee arthroplasty (TKA) is widely used as an effective treatment for end-stage osteoarthritis and other knee diseases to relieve pain and improve quality of life. While the benefits of TKA are reduced pain and an improved function there are also risks, such as hemorrhage, thromboembolic events, infection and the need for additional surgical procedures. Tranexamic acid (TXA) is effective in reduction of hemorrhage after such major surgical procedure. Abundant literature confirms that intravenous (IV) and intra-articular (IA) administration of tranexamic acid (TXA) reduces blood loss in total knee arthroplasty (TKA). 

Methods and Material:

The study is a retrospective cross-sectional study of 152 male and female patients aged 45 to 85 years who underwent Total knee replacement. They were divided into two groups.72 patients received tranexamic acid during the operation and 80 patients did not.Hemoglobin, transfused packed cell, hospital time, Visual analogue pain scale, Knee range of motion and cardiovascular accident were determined and compared between the two groups.

Comparing the result of hemoglobin drop, post op hemoglobin, transfused packed cell and hospital stay time showed significant difference between experimental and control group when pre op hemoglobin, range of motion, VAS score for pain measurement and cardiovascular effects were not significantly different.

We found that the administration of tranexamic acid can reduce the complications of knee replacement surgery due to bleeding, as well as decreasing the need for blood transfusion. In addition, the administration of tranexamic acid can reduce the length of hospital stay after knee replacement surgery; that in turn significantly reduces the cost of hospitalization.

Different medicines are utilized in giving nerve block. The different drugs are usually discussed concerning efficacy and persistence of pain relief. The present study aimed to compare the use of lidocaine alone with granisetron/lidocaine combination in terms of the efficacy and persistence of the analgesic effect, in the axillary block used in patients requiring elbow or below elbow surgery.

A double-blind randomized clinical trial was performed on 90 patients who were candidates for elbow surgery. In this regard, an ultrasonography-guided axillary block was performed by a linear transducer using a short-axis in-plane technique. The first group was given lidocaine, whereas the second group received granisetron/lidocaine combination. First, five mg/kg of lidocaine %0.5 was diluted to 40 ccs with 0.9% saline. In the first group, 40ml of lidocaine solution was injected after dipping the syringe in epinephrine. In the second group, 2 mg of granisetron was injected simultaneous with lidocaine solution.

In total, 90 patients entered the study and were divided into two equal groups of 45. The mean age of the patients was 34.48±9.0 years (18-58 years). 61 (67.8%) participants were male and 29 (32.2%) female. The onset time of sensory and motor block in the second group (granisetron/lidocaine combination) was significantly lower, compared to the lidocaine -alone group . Moreover, the continuity of sensory and motor block was significantly higher in the second group. Furthermore, the first analgesic requirement time was significantly lower in the granisetron/lidocaine combination group, compared to the lidocaine- alone group (P<0.001).

The concomitant use of granisetron with lidocaine improved all pain indicators and  also led to faster and more continuous sensory and motor blocks .

Nowadays, bone grafts are used in both veterinary and human orthopaedics to stimulate fracture healing and to accelerate the restoration of bone defects. Autografts are still a high standard for comparing different bone-building stimuli. Autografts not only include healing stimulants but also contains cells that do not stimulate immune responses and do not transmit infectious diseases. However, bone grafting is not without side effects such as pain, infection, fracture, blood loss and increased surgical stages, besides the amount of bone removed is limited.Tarantula cubensis venom has an anti-inflammatory and re-epithelialization effect in bovine wound healing on the 14th day; it also plays a role in infection prevention since Theranekron can alter the process of inflammation. This study aims to examine the effect of hydroalcoholic extract of tarantula cubensis on the distal radius fracture healing in rabbits

This study was conducted on 20 male rabbits, in four study groups of five rabbits. A bone se was extracted from the distal radius. The first group was administrated with one microgram per kilogram of Theranekron injection at the site of the bone defection. The second and third (or negative control) groups were administrated with normal saline injection and no substance (no intervention), respectively. Lastly, the fourth group (or autograft group), the extracted bone segment was returned in its place, and the skin and muscles were sutured. Lateral view radiographs images were taken from rabbits on days of 14, 28, 42 and 56 after surgery.On the eighth week, a bone biopsy was performed to evaluate histopathology. Radiographs and biopsies were statistically examined for fusion rate, ossification activity and remodelling.

Both Theranekron and autograft group had similar behaviour and outperformed the normal saline and negative control group; therefore it is concluded that hydroalcoholic extract of tarantula cubensis was effective in distal radius fracture healing.

Knee osteoarthritis is one of the common diseases in humans and due to its increasing spread, early diagnosis of this disease is very important. Consideration of cartilage volume in knee osteoarthritis studies from radiological images is very necessary. The aim of this study is to help improve the diagnosis of knee osteoarthritis with the help of artificial intelligence and image processing techniques.

This is a diagnostic study that has been evaluated on 957 MRI images. Images were collected from Tehran Hospital database, such that 111 samples were related to healthy individuals and 48 samples to people with knee osteoarthritis. In this study, in order to diagnose osteoarthritis automatically, a new method called “image distinguishing and teaching it to artificial neural network”,using MATLAB software was used. MRI images were received and after pre-processing they were processed to diagnose osteoarthritis conditions with the help of artificial neural networks.

Experiments show acceptable performance of the proposed method, such that using this technique the diagnose of knee osteoarthritis was possible, with 93% accuracy.

the proposed model can be used in screening plans in order to identify people in danger of developing osteoarthritis and can serve as doctor assistants.

Introduction Spinal fractures are up to four times more common in patients with AS than the general population. Fractures in this population have a high incidence of neurologic complications, with spinal cord injury at initial presentation. The vast majority of these injuries are 3-column injuries resulting in an unstable spine. The diagnosis unfortunately, can frequently be missed or delayed. The mortality rate ranges from 18 to 32% in various series 1-4

Traumatic dislocation of the hip is rare in children. Complications occur in cases with associated injuries and delayed treatment. Treatment options are limited in case of avascular necrosis. In this paper, we present the case of a 6-year-old girl who was unable to walk for the last 3 months. She had a traumatic hip dislocation at the age of 18 months, which was treated with a 48-hour delay. With the diagnosis of femoral head AVN, a femoral head reduction osteotomy was planned. 3D-models were printed, and the surgery was simulated on the models. The patient is now walking painless and with minimal limp. A femoral head reduction osteotomy, with some small modification, can be performed in children as young as 6-years old. 3D-modeling is a great addition to the tools a surgeon can use, in the preoperative planning of difficult osteotomies, as well as education of the residents and fellows.

Total hip Arthroplasty (THA) is an advanced surgical modality, which reduces hip pain resulting from destruction or degenerative change. THA may be associated with complications, such as instability. Instability is the second common reason for revision surgery. The etiology of instability can be factors like prosthetic malposition, impingement, and low soft tissue tension around the hip and also polyethylene wear. In this paper, we will review the common causes of instability following THA in various phases, and suggest the strategies to prevent instability following THA.