ABSTRACT
Objective: This study compared functional outcomes and preoperative between cemented and uncemented bipolar hemiarthroplasty in patients older than 65 years with subcapital displaced femoral neck fracture
Methods: Fifty one patients with displaced femoral neck fracture were enrolled in this study. Twenty nine patients underwent uncemented bipolar hemiarthroplasty and 22 underwent cemented bipolar hemiarthroplasty. Physical examination and radiographs were performed at the first and sixth months after operation and results were recorded. The patients' pain and function were measured with Visual analogue Scale and with Harris Hip Score [HHS], respectively and then compared with each other
Results: The mean duration of follow up was 18.9 and 19.5 months in the cemented and uncemented groups, respectively. All patients were followed up for at least 6 months. Mean operation and bleeding times were longer in the cemented group compared to the uncemented group [P>0.05]. The mean pain score was significantly less in the cemented group compared to the uncemented group [P=0.001]. Hip functional outcome based on HHS was more in the cemented group [P= 0.001]. The intraoperative and postoperative complication rate was higher in the uncemented group [P<0.05]
Conclusion: Although higher rates of intraoperative bleeding and surgery time were seen with cemented bipolar hemiarthroplasty in older patients with femoral neck fracture compared to uncemented bipolar hemiarthroplasty, cemented bipolar hemiarthroplasty can cause less complications and improve patients' function in less time
ABSTRACT
Objective: Successful closure is a primary step of treatment in open fracture wounds. Delayed healing or complications can lead to increased treatment duration, costs and disability rates. The aim of this study was to compare Negative Pressure Wound Therapy [NPWT] and conventional wound dressings in patients with open fracture wounds
Methods: In a prospective randomized clinical trial study, 90 patients with open fractures that were referred for treatment were enrolled between February 2013 to March 2015. Patients were divided into two groups. Group I underwent NPWT and group II underwent conventional wound dressing. Then patients were followed up for one month. Within the one month, the number of dressing change varied based on the extent of the wound. Duration of wound healing, presence of infection and the number of hospitalization days in these patients were recorded and compared at the end of the study between the two groups. Questionnaires and check lists were used to collect data. Analysis was done with SPSS 20, paired sample T-test, and chi-square tests. P<0.05 was considered significant
Results: There was a significant difference between the rate of wound healing in the group one or NPWT group and group II [conventional wound dressings] P<0.05. There was no significant difference between two groups in incidence of infection [P=0.6]
Conclusion: Using NPWT expedites the healing process of extremity wounds. It is more economical and can be considered as a substitute for the treatment of extremity wounds
ABSTRACT
Background and Objective: Septic arthritis is a joint infection that causes metabolic and physiological disorders and if not diagnosed and treated on time can cause severe damage and disabilities. In this study, the effect of intravenous dexamethasone on septic arthritis, and the recovery process of the disease have been evaluated
Methods: In a non-randomized double blind clinical trial 60 patients assigned in two groups of 30 patients each were evaluated. After diagnosis of septic arthritis, group one received a dose of 0.15mg / kg / QD of dexamethasone and group two received the same amount of normal saline for four days
Then the patients were evaluated for treatment duration, inflammation and redness relief, joint movement and ESR and CRP levels
Results: After data collection they were compared with the X2 test, t-test, ANOVA and Mann-Whitney statistical test and were analyzed using SPSS18 software. Treatment duration was 3.27+/-1.04 days, joint movement was 50.67+/-9.7 degrees, inflammation and redness relief was seen after 4.1 +/-0.32 days, a decrease of 19.3+/-2.89 in ESR levels were seen and reduction in CRP levels showed a statistically significant difference [P < 0.05]
Conclusion: In patients with septic arthritis in addition to routine antibiotic therapy, receiving intravenous dexamethasone can reduce the clinical symptoms of the disease symptoms and also accelerate recovery and return to daily activities
ABSTRACT
Hallux valgus deformity is a common chronic problem with a reported prevalence of 28.4% and its chief complaint is pain. Thus far, different surgical procedures with their proposed indications have been introduced. This study compared three current procedures, namely the chevron and scarf osteotomies and the McBride procedure. This retrospective cohort was conducted at the Ahvaz University of Medical Sciences on 44 patients with moderate hallux valgus deformity from 2010 and 2013. All of the patients underwent one of the three procedures [chevron, scarf or McBride]. Preoperative and follow up radiographies were evaluated in terms of hallux valgus and intermetatarsal angle correction. The Foot and Ankle Disability Index was filled out to assess the functional outcome and the Visual Analogue Scale was used to evaluate pain. Also, satisfaction, aesthetics and the rate of recurrence was evaluated. Hallux valgus angle and intermetatarsal angle correction were significantly higher in scarf, but not in chevron and McBride. However, from amongst the three procedures, there was no significant difference in terms of the Foot and Ankle Disability Index score, aesthetics, satisfaction level, pain score and recurrence rate. Considering that scarf osteotomy had better results in this study, we think that scarf osteotomy can be considered as a first choice for the treatment of moderate hallux valgus deformity
ABSTRACT
Fat embolism syndrome symptoms is due to the presence of free fat globules originates from bone marrow and deposit in parenchyma of the lung, brain, and other organs and in most cases is particularly due to long bones, or pelvic fractures and can be accompanied by considerable complications and mortality. The aim of this research is to evaluate effect of early fixation of femoral fractures on preventing of fat emboli. In a double blind nonrandomized clinical trial study 174 patients with femoral fractures enrolled in four groups and in the first 12 hours after fracture occurrence were treated as below Group I: included 53 patients were treated by means of open reduction and internal fixation with screws and plate. Group II: included 46 patients were treated by means of skeletal traction. Group III: included 33 patients that were not treated by means of any methods of fracture fixation. Group IV: included 42 patients were treated by means of interlocking intramedullary nailing. With use of Chi-square, ANOVA and Tukey post hoc test there were significant differences among groups [p=0.003]. 11 patients in all groups and in Group A, any patients, in Group B, four patients [7.8%] in group three, six patients [18.1%] in group four, one patient had fat embolism syndrome [4.2%]. The main point in the prevention of fat embolism syndrome is stabilization of fracture site of long bones as soon as possible
ABSTRACT
Objective: Knee arthroscopy is a painful procedure which if untreated will cause intensive and prolonged pain that may prevent rehabilitation of patients. This study was designed to compare the analgesic effects of different opioids in the early post operative period in comparison to control group
Methodology: One hundred forty patients were prospectively assigned to four groups randomly. After arthroscopic menisectomy all patients received an intraarticular injection containing 9.5 ml bupivacaine 0.5% with 1:200000 epinephrine in a 10 ml syringe. The remainder of syringe was filled with one of the study solutions. Group I: 5mg methadone, group II: 5mg morphine, group III: 5 ml normal saline, group IV: 50 mg meperidine. At three stages in the ealy post operative period the need for analgesics was recorded. A statistical comparison was done afterwards
Results: In morphine group [group II], the analgesic usage in hospitalized and outpatients compared with other groups was significantly low [P < 0.05]
Conclusion: Morphine in comparison to meperidine or methadone is more beneficial in reducing pain or analgesic need when is added to bupivacain injection following arthroscopic menisectomy
ABSTRACT
Treatment of open tibial fractures is an orthopedic challenge. Interlocking nailing is one of the accepted forms of treatment in these fractures. Two accepted methods of nailing are unreamed and reamed which have been largely used in closed fractures of the tibia but their use in open tibial fractures is still challenging. In this randomized clinical trial, we treated open tibial fractures using these methods and compared the results. Between May 2008 until September 2010 we treated 119 healthy young patients with open tibial fractures [types I, II, IIIA] by two methods of interlocking nailing. We chose the type of nailing using random table of numbers. The age of the patients was between 20 to 45 years. One hundred and six male and thirteen female patients were in two groups. Parameters including type of open fracture, length of operation, amount of blood loss during operation, superficial and deep infection, mean union time, need for dynamization and bone graft, nail and screw breakage in two respective groups were compared and the data analyzed using SPSS 13 and T-test and the P value of less than 0.05 considered as significant difference. Fifty-eight and sixty-one patients were treated in unreamed and reamed groups respectively. The time of operation was 54 minutes in unreamed and 71 minutes in reamed group with significant difference [P= 0.023]. Superficial infection was seen more in reamed group in comparison with unreamed group [P=0.01] but for deep infection there was no significant difference between two groups. [P=0.31]. Screw breakage was seen more in unreamed group in comparison with reamed group with significant difference [P=0.026]. There was not any case of nail breakage in two groups. The time to complete union was similar in both groups. Unreamed and reamed interlocking nailing can be used in open tibial fractures types I, II and IIIA with quite similar rates of success.
ABSTRACT
There have been a few reports on outcome after operative treatment of the adult diaphyseal forearm fractures. The aim of this study was to evaluate the clinical and radiographic outcome after open reduction and internal fixation of the forearm diaphyseal fractures by Dynamic Compression Plate [DCP]. We prospectively investigated the clinical and Radiographic outcome for 47 adult patients with 77 forearm shaft fractures including 10 Radius, 7 ulna and 30 [66] both bones. The study group included 35 males, and 12 females. Patients were treated by open reduction and internal fixation with small DCP and followed up for 12 months. Time to union, Rate of union, complications and outcome were assessed according to the modified system of Price and Daruwalla score. Out of 77 fractures 75 [97.4%] had united at a mean time of 15.4 weeks [range 11- 21 weeks]. There was two superficial infection that healed by debridement and antibiotics, and one deep infection which caused to delayed union and underwent reoperation including change of implant and bone graft. Two radial nerve injuries occurred after operation for radius fracture. Full recovery in one and partial in another patient was observed after 6 months. Excellent and good results were seen in 20 [66.7%] and 10 [33.3%] of the patients with both bone fractures. In radius excellent and good results were seen in 8 [80%] and 2 [20%] patients respectively. In ulna excellent and fair results were observed in 85.7% [n=6] and 14.3% [n=1] of the patients. Outcome of adults forearm shaft fractures with conventional 3.5 mm DCP was associated with a high rate of success. The results with this type of plate are comparable with the newer and more expensive implants
ABSTRACT
Low back pain [LBP] and radicular leg pain [RLP] are among the most common types of pain in human beings. Although magnetic resonance imaging [MRI] is very sensitive for diagnosis of discopathy, some factors, such as overestimation of pathology, expensiveness, unavailability, and using it for patients with cardiac pacemaker or metal foreign bodies, limit the utility. The present study is designed to evaluate the efficacy of computed tomography scan [CTS] in patients with disc herniation in each level of lumbar spine versus MRI findings at the same level. In a prospective trial, 100 consecutive patients with LBP and RLP and signs and symptoms of discopathy referred to our private clinic from September 2004 to April 2005 were studied. CTS and MRI and their data were compared level by level; i.e. CTS of the patients analyzed according to clinical signs and symptoms and compared with MRI at the same level in axial view. Thirty-two patients had clinically S1 root signs and symptoms, in all of them CTS and MRI showed disc herniation at L5/S1 level in axial view. For L5/S1 level, positive predictive value [PPV] of CTS was 100%. In upper lumbar region, CTS findings were less reliable than MRI. CTS showed the pathology at 14.2% of upper lumbar, 27.2% at L3/L4 and 46.3% at L4/L5. In nine cases with more than one level involved, CTS confirmed the diagnosis in 11.1% of the cases. MRI is the gold standard for diagnosis of lumbar disc herniation, but CTS is sensitive in 100% for L5/S1, 68% for L4/L5, 60% for L3/L4, 0% for upper lumbar discopathies and finally 78% for multilevel involvement. Therefore, the higher the level of disc herniation is, the lower the sensitivity of CTS
Subject(s)
Humans , Male , Female , Radiculopathy/diagnostic imaging , Tomography, X-Ray Computed , Magnetic Resonance Imaging , Sensitivity and Specificity , Decision Making , Intervertebral Disc DisplacementABSTRACT
Background and aim: the rate of mortality in an intensive care unit [ICU] is one of the most important criteria for evaluation of a hospital. In this article the moralities of the ICU of Kashani General Hospital of Shahrekord from 23 Sept 1998, until 23 Sep 2001 have been analyzed
Method: a cross-sectional survey was performed on all the patients admitted to the ICU during this period
Results: in this period 296 patients were admitted and 79 patients [27.9%] died. 35.8% of the patients were females, 60.5% were males and 3.7% were neonates. The main reasons of mortality were respiratory failure [37.9%] and brain trauma [27.8%].There was no difference between the times of death during 24 hours. Most of the patients were expired or discharged from the ICU during the first four days. Mortality was more prevalent in the patients older than 55 years and in neonates
Conclusion: more attention during the first four days of the admission to the ICU is necessary