A comparative study on treatment outcomes of bandage and casting in non-displaced extra-articular fracture of distal radius: A clinical trial study.

<b>Background:</b> Some therapeutic methods for treating non-displaced extra-articular fracture (NDEA) of distal radius are sometimes met with controversy in their selection. We explored and compared two such methods - bandaging and casting - for this study. <br><b>Methods:</b> This prospective randomized clinical trial was conducted during 2015 on patients (n = 62) with an NDEA fracture of the distal radius. Patients were randomly assigned to either the casting (n = 32) or bandage (n = 30) group to receive the respective fracture-repair procedure. Follow-up contact was made during the first, second, third, and sixth weeks after treatment. The Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire was completed and the visual analog scale (VAS) for measuring pain was assessed. All patients underwent an X-ray radiographic assessment to evaluate any potential complications. <br><b>Results:</b> At the end of the study, 30 patients in the bandage group and 32 in the casting group finished the study. Statistical analyses indicated the bandage group exhibited a significantly higher mean DASH score than the casting group during the first week. This higher mean score decreased enough during the second week that, by the third week, the casting group scored higher. During the sixth and final week of study, the two groups showed no significant difference in DASH value. No significant differences between the two groups was evident in the VAS scores obtained during all follow-up assessments. Patients in the bandage group were able to return to work sooner than those in the casting group; their cost of treatment was lower, too. <br><b>Conclusion:</b> Bandage is the more appropriate treatment option for NDEA fractures of distal radius.

Risk factors associated with diabetic foot ulcer-free survival in patients with diabetes.

AIMS: This study was done to assess the risk factors associated with diabetic foot ulcer-free survival in patients with diabetes. MATERIALS AND METHODS: Based on a prospective cohort study, ADFC (Ahvaz Diabetic Foot Cohort) study, carried out in a university hospital, all of the patients with diabetes were followed up for new diabetic foot ulcer (DFU). The time of ulcer development was final outcome during two years in the present study. To analyze the data, the variables were first evaluated by univariate analysis. Subsequently variables with P value <0.2 were tested in multivariate analysis, using backward elimination multiple Cox regression. RESULTS: From among 605 eligible patients of ADFC study, 566 patients without foot ulcer were included for a 2- years follow-up. Thirty subjects (5.3%) developed DFU during the study course none of whom underwent amputation. The DFU-free survival rate was 0.945 over two years of follow-up. In final multivariate Cox regression analysis, the variables which remained in the model and had a statistically significant relationship with time to develop foot ulcer were: dyslipidemia, history of DFU or amputation, nephropathy callus formation in the feet and diabetes duration. Foot deformity and patients' training about self-care of their feet were statistically borderline significant. CONCLUSIONS: The DFU-free survival rate was 0.945 over two years of follow-up. In this study, independent risk factors associated with ulcer-free survival in diabetic foot patients were dyslipidemia, prior history of DFU or amputation, diabetic nephropathy, callus formation in the feet and diabetes duration.

Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)-Two-Year Follow-Up Study.

AIM/INTRODUCTION: This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU). MATERIALS AND METHODS: In this prospective cohort study in a university hospital, all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with P value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression. RESULTS: Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89-8.02). After analysis, previous history of DFU or amputation [OR = 9.65, 95% CI (2.13-43.78), P value = 0.003], insulin usage [OR = 5.78, 95% CI (2.37-14.07), P value < 0.01], gender [OR = 3.23, 95% CI (1.33-7.83), P value = 0.01], distal neuropathy [OR = 3.37, 95% CI (1.40-8.09), P value = 0.007], and foot deformity [OR = 3.02, 95% CI (1.10-8.29), P value = 0.032] had a statistically significant relationship with DFU incidence. CONCLUSION: Our data showed that the average annual DFU incidence is about 2.8%. Independent risk factors of DFU development were previous history of DFU or amputation, insulin consumption, gender, distal neuropathy, and foot deformity. These findings provide support for a multifactorial etiology for DFU.

Prevalence and related risk factors of diabetic foot ulcer in Ahvaz, south west of Iran.

AIMS: The aim of this study was to evaluate the prevalence of diabetic foot ulcer and its related risk factors. MATERIALS AND METHODS: In this descriptive cross-sectional study, 605 patients with diabetes were evaluated in July 2014. A checklist was used to obtain demographic data, diabetes related data, past medical history, and physical examination data. RESULTS: The prevalence of diabetic foot ulcer was 6.4% (95% CI: 4.64-8.73). Seventeen cases of them were female (4.9%). In univariate analysis, the following variables had statistically significant relationship with DFU prevalence: diabetes duration, educational level, 10 g monofilament sensation, Ankle Brachial Index (ABI) and Body Mass Index (BMI). Patients' age, glycemic control and smoking did not show any significant relationship with DFU. After logistic regression analysis, the patients with decreased 10 g monofilament sensation had DFU more than patients with normal sensation (OR = 8.84, 95% CI: 3.5-22.3). Abnormal ABI increased the odds of DFU (OR = 5.6, 95% CI: 1.3-24.18). The DFU prevalence in patients with diabetes duration of 11-20 years, was more than patients with ≤5 years (OR = 3.8, 95% CI: 1.33-10.8).The odds of DFU development in educated patients compared with illiterate patients was 0.27(95% CI: 0.12-0.57). BMI had a significant relationship with DFU prevalence. The odds in overweight patients was 0.259(95% CI: 0.108-0.623) and in obese patients was 0.263 (95% CI: 0.1-0.687). CONCLUSION: The prevalence of DFU was 6.4% in this study. Final associated risk factors of DFU were decreased 10 g monofilament sensation, abnormal ABI, diabetes duration, educational level and BMI.

The Comparison of Results of Treatment of Midshaft Clavicle Fracture between Operative Treatment with Plate and Non-Operative Treatment.

BACKGROUND: Clavicle fractures are common and usually heal without complications. In this study, we evaluated the outcomes of non-operative versus operative management of displaced fractures. METHODS: In a prospective clinical trial study, sixty-five patients with displaced clavicle mid-shaft fractures were non-randomly divided in two treatment groups. The first group underwent non-operative treatment with figure of 8 bandage (30 patients), and the other underwent operative treatment with plate fixation (35 patients). Figure of 8 bandage and 3.5 millimeter DCP plate with at least six cortical screws were used in non-operative and operative groups respectively. We followed up all patients at weeks 2, 6 and 12, and at month sixth. In addition to clinical examination and x-ray evaluation, we assessed satisfaction, DASH and Constant Shoulder Score for each individual. RESULTS: The average durations of union were 19.3 and 24.4 weeks in operative and non-operative groups respectively (P=0.006). Satisfaction with operative treatment was 74.3% and with non-operative treatment was 66.7%, showing no significant difference (P=0.500). The non-union rate was 5.7% in the operative group and 13.3% in the non-operative group (P=0.518). A significant difference between the two groups in terms of DASH and Constant Shoulder Scores after the six-month follow-up was not found (P=0.352). CONCLUSIONS: According to our results, we recommend operative treatment in mid-shaft clavicle fractures only when there is a definitive indication.

Comparing the effect of Glucosamine and Glucosamine With Alendronate in Symptomatic Relieve of Degenerative Knee Joint Disease: A Double- blind Randomized Clinical Trial Study.

BACKGROUND: Degenerative Joint Disease (DJD) is the most common joint disease in human beings. Previous studies have explained that glucosamine is preferred as placebo and in efficacy compared with NSAID's in treatment of patients' knee osteoarthritis. Alendronate was used to treat osteoporotic patients and its efficacy was established. OBJECTIVES: The aim of this study was to compare the efficacy of administration of glucosamine alone and its combination with alendronate in osteoarthritis of the knee. PATIENTS AND METHODS: The study included 130 patients with osteoarthritis who randomly received glucosamine alone (group II) (500mg TDS), or combination of glucosamine (500mg TDS) and alendronate (70mg weekly) (group I) for 12 weeks. Patients were evaluated on 1, 3, 6 and 12 weeks after beginning the treatment to evaluate efficacy of each treatment. RESULTS: Statistically, there was no significant difference in pain index (P > 0.05) but in the two groups the mean of pain index decreased in a similar fashion. The stiffness index in combination treatment group (group I) decreased more than glucosamine group (group II) (P < 0.05). The function of joints in combination treatment group (group I) improved after 12weeks. The bone mineral density (BMD) at 12weeks in combination therapy group improved. CONCLUSIONS: Combination therapy of glucosamine and alendronate indicated significant improvement of stiffness, function, BMD of osteoarthritis compared with glucosamine alone but there was no statistically significant decrease in pain index. It can be concluded that the combination of glucosamine and alendronate provide better and more rapid improvement in patients with osteoarthritis.