Percutaneous vertebroplasty in iranian patients with osteoporotic vertebral fractures

Osteoporotic compression vertebral fractures are common clinical problems. In those with refractory fractures, percutaneous cement augmentation has been suggested. The aim of this study was to evaluate the functional outcome of percutaneous vertebroplasty in Iranian patients with refractory Osteoporotic fractures. We retrospectively studied 37 Osteoporotic fractures in 28 patients [6 men and 22 women], who had been treated with vertebroplasty from August 2009 to June 2012. The mean follow-up period was 12.1 +/- 3.6 [range: 6-42 months]. The patients' states were assessed by the visual analogue scale and short form-36 questionnaire. Student t test was used to analyze the pre- and postoperative data. The mean age of the patients was 71.6 +/- 6.1 [range: 50 to 91 years] and the most common fractured vertebrae were L1 and T12, There were five patients with two levels of vertebral fractures and two with three levels. Vertebroplasty could improve the scores for pain and quality of life from preoperative 7.6 +/- 1.4 and 44.8 +/- 7.6 to 1.8 +/- 0.4 and 74.1 +/- 5.3 at four weeks after surgery. At the last follow-up visit, this improvement continued with no significant decline. The most common complication was cement leakage [32.4% per vertebra], wherein all of of the patients were clinically asymptomatic. Adjacent vertebral fracture occurred in six cases. By understanding the risks, we propose vertebroplasty in Iranian patients with refractory Osteoporotic vertebral fracture. If correctly performed, this procedure can significantly improve the pain and quality of life in these elderly Osteoporotic patients

Carpal tunnel release in diabetic and non-diabetic patients

Carpal tunnel syndrome [CTS] is a compression neuropathy that causes paresthesia, pain or numbness in the territory of median nerve. The aim of this study is to compare the open surgery outcome and patients' satisfaction in carpal tunnel syndrome among diabetic and non-diabetic patients. In a retrospective cohort study from April 2011 to June 2012, patients suffered from carpal tunnel syndrome at least 6 months, without response to conservative treatment, who had the inclusion and exclusion criteria, were evaluated by the usage of MHQ and WHOQOL-BREEF tests, one month before surgery and three months after that. Carpal tunnel decompression surgery was performed by two surgeons, experienced in hand surgery, which used the same surgical method. Statistical analysis was performed by SPSS 19.0, 24 of patient [34,2%] were male and 46 [65.8%] were female and there was no significant difference between two groups [P>0.05]. MHQ total score before and after surgery was respectively 50.22 +/- 7.13 and 63.49 +/- 11.28 and this difference was significant [P<0.05]. In WHOQOF-BREEF parameters, physical parameters [36.81 +/- 19.8 vs. 55.30 +/- 24.36] and psychological parameters [41.64 +/- 14,77 vs. 61.24 +/- 19.9] improved significantly after surgery. The outcome of carpal tunnel syndrome open surgery is good in both men and women, but diabetes has a negative impact on surgery outcome in short term

Migration of a broken steinman pin into the posterior compartment of the leg 12 years after total hip arthroplasty

This report is on a migration of a Steinman pin into the posterior com Department of the calf. It was used to fix a greater trochanteric osteotomy in a total hip arthroplasty. The puzzling note is how this metal piece passed through the anterolateral compartment of the thigh to the posterior compartment of the calf. According to our literature review, migration of fixation pins through the knee joint is an extremely rare occurrence and could be missed by an inattentive physician

[Legg-Calve-Perthes treatments and relation between type of treatment and duration of the disease]

Legg-Calve-Perthes disease is one of the most common disabling diseases of childhood and if not managed appropriately is truly disabling. Severity of disease and duration of disease onset are main determinants of choosing treatment strategy of either conservative management or surgical treatment. This study was designed to determine Legg-Calve-Perthes treatments and relation between type of treatment and duration of the disease. This descriptive study was carried out on 50 patients with Legg-Calve-Perthes disease admitted in Ghaem Hospital in Mashhad, North East of Iran from 1995-2005. According to age of patients and severity of disease, the subjects allocated to conservative [11 patients] and surgical treatment [39 patients]. Clinical improvement signs include pain reduction, range of joints motion, which were evaluate by physical examination and taking medical history of patients. In conservative group, only 4 patients assumed to be successfully treated with mean age of 7.25 years and the mean interval between disease onset and beginning of treatment was 2.25 months. Surgical group had mean age of 10.85 years and mean interval between onset of disease and initiation of treatment was 18 months. Conservative group showed less sever form of disease [lateral pillar group A and group B with age less than 8 years], but patients treated surgically were more severely involved [lateral pillar group B with age more than 8 years and group C]. This study showed that age and severity of disease [lateral pillar classification] are main elements in treatment strategy [choosing conservative VS surgical treatment]. The interval between onset of disease and onset of treatment strongly affects treatment success

[Patella femoral joint pain due to degenerative joint disease, conservative and surgical treatment]

Degenerative joint disease in patella femoral joint causes disabling pain in knee motion. When conservative treatment fails, surgery is indicated. In advanced stage those operations that release the stresses on the patella femoral joint by correcting the biomechanics of the joint may be more useful for patients. In this study, we analyzed the clinical outcomes following conservative methods and surgical treatment with tibial tuberosity transfer. Fifty patients, who had severe patella femoral arthritis, after true clinical and radiographic evaluation, were treated with conservative methods. For those patients that did not have improvement after three months and were agree with surgical treatment, tibial tuberosity transfer was done. Patients were followed for one year and were asked about decrease of pain and improvement in daily living function. Altogether, 12 patients [24%] had improvement with conservative methods and in 34 patients after conservative treatment failure who agreed to have surgical treatment had 13 acceptable results [38.2%]. In advanced DJD of patella femoral joint, patients not responding to conservative treatment, may have surgical treatment. Anterior transfer of tibial tuberosity can be considered as a last choice of surgery before TKA and can be accepted and considered

[Intramuscular haemangioma of the forearm with radial and ulnar periosteal reaction [Report of one case]]

We present a rare case of intramuscular Haemangioma of the forearm with periosteal reaction of radius and ulna. A 38-year-old female presented with a tumefaction in distal and dorsoulnar side of the right forearm. She had 1.5 years history of tumor which was painful during resent 2 months. Plain x-ray and MRI was done and the diagnosis of Haemangioma was proved by open biopsy. The tumor plus periosteal reaction and enlarged bone was respected. After 4 years follow-up no recurrence was seen