Iliac Pedicle Wedge Graft as a New Modification for Iliac Osteotomies in Young Adolescents: A Single-blind Randomized Clinical Trial.

BACKGROUND: Iliac osteotomies in adolescent patients may accompany graft related difficulties such as graft absorption and delayed union. A new modification of iliac osteotomies has been proposed to address these difficulties. METHODS: A total of 24 consecutive hip joints in 21 juvenile or adolescent patients who were candidate for salter or triple pelvic osteotomy were included. A modification was performed to harvest a wedged bone graft based on a muscle pedicle of Tensor Fascia Lata and inserted at pelvic osteotomy site instead of a traditional graft technique. The hips were randomized into two groups. The traditional wedge graft was used in group 1, while the new modification was performed in group 2. The primary outcome of this study was duration of union. The secondary outcomes were Center Edge Angle (CE) Angle on pre-operation, immediately post-operation and at the end of follow-up. RESULTS: Both groups were similar statistically regarding their age, gender , estimated blood loss and the duration of follow-up. However, significant differences were found in the time to complete union between the two groups (P=0.03). CE angle decreased in both groups when comparing its last follow-up to its right postoperative values, but the decrease was significant only in group 1(P=0.03). The type of surgery (Salter or TPO) had no significant effect on the average time to union. That shows faster union in pedicle graft group and less coverage loss during follow-up period than conventional graft patients. CONCLUSION: With the modification proposed , the healing at the osteotomy site was faster and the loss of correction, owing to the graft resorption, decreased. Using this pedicle wedge graft technique may improve the results of pelvic osteotomies in adolescent.

Evaluation of early postoperative ocular pain after photorefractive keratectomy and corneal crosslinking.

PURPOSE: To evaluate and compare early postoperative pain after photorefractive keratectomy (PRK) and corneal crosslinking (CXL). SETTING: Khatam-al-Anbia Eye Hospital, Mashhad, Iran. DESIGN: Prospective case series. METHODS: The PRK group included patients with simple refractive errors whereas the CXL group included patients with clinical keratoconus. The groups were compared regarding the level of pain based on the visual analogue scale (VAS), verbal rating scale (VRS), and Wong-Baker FACES pain rating scale immediately after surgery, 6 hours postoperatively, and 1, 3, and 7 days postoperatively. The epithelial defect size was measured at 6 hours after surgery and 1 day and 3 days after surgery in both groups. RESULTS: The study comprised 68 patients (34 patients in the PRK group and 34 patients in the CXL group). The epithelial defect size was significantly smaller in the CXL group than in the PRK group (P < .001); however, the amount of pain was significantly higher after CXL than after PRK based on VAS and VRS (P = .04 and P = .019, respectively). In the FACES scaling system, the pain score was also higher in the CXL group than in the PRK group. However, the difference was not statistically significant. No intraoperative or postoperative complications were observed during follow-up. CONCLUSIONS: The epithelial defect healing rate was statistically significantly faster in the CXL group than in the PRK group. However, the level of pain was greater in the CXL group, suggesting that postsurgical pain might be influenced by other factors than the epithelial defect.

Foot scan assessment of metatarsus adductus: A useful adjunct to Bleck's classification.

To determine the severity of metatarsus adductus (MA) comparing with Bleck's classification as a commonly acceptable method for assessing MA, static foot scan has been used. In this cross-sectional descriptive research study, 100 subjects were equally divided into four groups according to Bleck's classification. The feet were scanned and MA severity (MAS) index was measured on the obtained foot scan images. The MAS index was the ratio of the transverse deviation of the forefoot from the lateral border heel line to the width of the ball of the foot. The mean of the MAS index in normal, mild, moderate, and severe MA was 0.02±0.02, 0.1±0.01, 0.159±0.03, and 0.216±0.025, respectively. The difference of MAS index between each group was significant (p<0.001). The mean of MAS index in 4 groups was consistent with Bleck's classification, with a significant increase from normal to severe MA (p<0.05). Since the results of this method are consistent with Bleck's classification and this novel foot scan assessment appears to be more objective than Bleck's classification, the authors recommend this method to be used in examination of patients with MA. However, further studies should be conducted to define interobserver and intraobserver reliability. LEVEL OF EVIDENCE: III.