Clinical Results of Percutaneous Fixation of Pelvic and Acetabular Fractures: A Minimally Invasive Internal Fixation Technique.

BACKGROUND: The pelvic ring fractures (PRF) and acetabular fractures (AF) are among the major orthopedic injuries associated with high rates of morbidity and mortality. Open surgical stabilization is the standard treatment for the majority of these complications. Percutaneous minimally invasive surgical stabilization of the fractures has become an accepted treatment method for the past several years. This study investigated the outcomes of percutaneous fixation of pelvic and acetabular fractures. METHODS: Totally, 143 patients with PRF or AF of whom 95 cases were males underwent percutaneous fixation between February 2015 and September 2016. All the operations were performed by a single surgeon in a supine position and under C-arm fluoroscopy visualization. The patients were followed up for one year. RESULTS: All the fractures healed in all of the patients within the first postoperative three months. The patients could bear weight completely on both lower limbs. Out of 143 patients, 133 cases could get back to their preoperative work (93%). The mean amount of intraoperative blood loss was 29±19 cc. Of the total patients, seven cases required oral analgesics because of moderate pain (4.9%). The means of operation time and length of incision were 32±8 min and 3.2±2.4 cm, respectively. There was one screw back out and one deep infection. No neurovascular injury was reported in this study. CONCLUSION: Closed reduction and percutaneous minimally invasive screw fixation for a pelvic ring or acetabular fractures is a useful surgical treatment option with low complication rates. LEVEL OF EVIDENCE: IV.

Do the Concentration and Volume of Local Anesthetics Affect the Onset and Success of Infraclavicular Anesthesia?

BACKGROUND: Although local anesthesia is a suitable method for upper limb surgeries, there is debate regarding the effects of appropriate dosing. OBJECTIVES: In the current study, we investigated the effects of the concentration and volume of a local anesthetic on the beginning and quality of anesthesia during upper limb orthopedic surgeries. PATIENTS AND METHODS: This double-blinded, randomized, clinical trial was conducted on 60 patients aged between 18 and 85 years candidated for upper limb orthopedic operations. The patients were equally and randomly distributed into two groups (n = 30). Under ultrasound imaging guidance, the first group received 7 mL of 2% lidocaine and the second group 10 mL of 1.3% lidocaine into the brachial plexus cords. The onset of block and the level of sensory and motor block were documented for each nerve territory. RESULTS: The onset of sensory and motor block was significantly shorter in the 1.3% lidocaine group than in the 2% lidocaine group (P ≤ 0.05). The success rate of sensory and motor block was not different. The quality (completeness) of sensory block for the musculocutaneous nerve and that of motor block for the radial nerve were significantly better in the 1.3% lidocaine group than in the 2% lidocaine group. CONCLUSIONS: The volume of the injected anesthetic accelerated the onset of sensory and motor block without affecting the rate of success in our patients.

Investigation of the asporin gene polymorphism as a risk factor for knee osteoarthritis in Iran.

Osteoarthritis (OA) is a degenerative disease of the joints characterized by degradation of the hyaline articular cartilage and remodeling of the subchondral bone with sclerosis. The asporin (ASPN) gene encodes a cartilage extracellular protein belonging to the small leucine-rich proteoglycan family. Polymorphisms in the aspartic acid (D) repeat region in the second exon of this gene, which consist of GAT repeats, are associated with OA susceptibility. The D14 allele, which contains 14 D-repeats, is associated with increased OA susceptibility in the Japanese and the Han Chinese but is not an important factor in OA etiology among Caucasians, though the D15 allele is a risk allele for the Greek population. To examine the possibility of this controversial association, we explored the effect of ASPN on Iranians with knee OA. The D-repeat polymorphism was genotyped in 100 knee OA patients and 100 controls, and the allelic association of the D-repeat was examined. Our data suggest that the D15 allele could be considered a risk allele significant only for women (P = .045, odds ratio = 1.73, 95% confidence interval [CI] = 1.01-2.94) in the Iranian population. This association is in part similar to that found for the Greek population.

Efficacy of anti-interleukin-2 receptor antibody (daclizumab) in reducing the incidence of acute rejection after renal transplantation.

BACKGROUND: Acute rejection remains a major problem in renal transplantation and represents one of the most important causes of chronic allograft dysfunction and late graft loss. Daclizumab is a genetically engineered human IgG1 monoclonal antibody that binds specifically to the α chain of the interleukin-2 receptor, and may thus reduce the risk of rejection after renal transplantation. OBJECTIVES: The aim of this study was to examine the effect of daclizumab induction therapy combined with a triple immunosuppressive protocol including prednisolone,cyclosporine microemulsion (CsA), and mycophenolate mofetil (MMF), in reducing the incidence of acute rejection in recipients of living unrelated donor kidneys. PATIENTS AND METHODS: In this historical cohort study, 43 adult recipients of their first kidney allograft received daclizumab (three 1 mg/kg doses administered every 2 weeks) with triple immunosuppressive therapy (steroids, CsA, and MMF). This group was compared to 43 first-time graft recipients who received maintenance triple immunosuppressive therapy comprising steroids, CsA, and MMF. The end point was the incidence of biopsy confirmed acute rejection within 6 months after transplantation. RESULTS: At 6 months, 5 (11.6%) of the patients in the daclizumab group had biopsy-proven rejections, as compared to 14 (32.5%) in the control group (P = 0.017). The sex and the age of recipients had no impact on the incidence of acute rejection episodes in the two groups. CONCLUSIONS: Adding interleukin-2 receptor antibody (daclizumab) to maintenance triple immunosuppressive therapy (prednisolone, CsA, and MMF) reduces the incidence of acute rejection episodes at 6 months in first-time transplant recipients of living unrelated donor.