Age and Sex Standardized Prevalence of Corneal Opacity and Its Determinants; Tehran Geriatric Eye Study (TGES).

Background: We aimed to determine the age and sex standardized prevalence of corneal opacity and its determinants. Methods: The Tehran Geriatric Eye Study (TGES) is a population-based cross-sectional study conducted on 3791 subjects aged above 60 yr in Tehran, Iran (2019) selected using stratified random cluster sampling. After sampling, all subjects underwent complete ophthalmic, optometric, and eye examinations. Results: The 3310 participated in the study, of whom the data of 3284 were analyzed. The age and sex standardized prevalence with 95% confidence interval (CI) of corneal opacity in at least one eye, both eyes, and one eye was 9.58% (95% CI: 8.50 to 10.79), 5.52% (95% CI: 4.71 to 6.45), and 4.07% (95% CI: 3.35 to 4.94), respectively. The mean uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) according to LogMar were worse in subjects with corneal opacity (both P<0.001). According to multiple logistic regression analysis, male sex (OR: 1.98; P: 0.003), age>80 yr (OR: 2.05; P: 0.004), and lack of insurance coverage (OR: 1.87; P: 0.004) increased the odds and high school education (OR: 0.68; P: 0.003) reduced the odds of corneal opacity. Among the study variables, sex was the most important determinant of corneal opacity (standardized beta: 0.126). Conclusion: This study found a high prevalence of corneal opacity in the geriatric population. Considering the increasing trend of population aging in Iran, attention should be paid to prioritizing public health policies to estimate resources required for providing comprehensive corneal services and improving geriatric eye health.

Entire posterior process talus fracture: a report of two cases.

The complex anatomy of the posterior process of the talus includes the medial and lateral tubercles extending from the talar body. Review of the current literature indicates that fracture of the entire posterior process of the talus is a rare injury. Two patients presented to our emergency department after motor vehicle accidents, and both were diagnosed with entire posterior process talus fractures. After evaluation of each patient, treatment of each was undertaken by means of open reduction and internal fixation via the posteromedial approach to fracture. Headless screws were used to fixate the reduced posterior tubercle in each case. Based on our experience with the patients described in this report, open reduction and internal fixation appear to be suitable methods of treatment for complete posterior process fractures of the talus.

Are hospitalized patients with fragile fractures managed properly in relation to underlying osteoporosis?

BACKGROUND: Osteoporotic fractures are an important reason of morbidity and mortality in the elderly population and impose huge economic burden on health services. There have been major advances in the treatment of osteoporosis, and many steps can be taken to prevent or even reduce the risk of fractures. Orthopedic surgeons manage most of these fractures and are often the only clinician seen by the patient. METHODS: We performed a survey of 515 patients with osteoporotic fractures who were admitted to 3 level I trauma hospitals in Tehran, Iran. Patients were evaluated with a questionnaire to determine whether orthopedic surgeons informed their patients about aspects of osteoporosis other than their fracture, and if appropriate, evaluation and treatment for osteoporosis were initiated. The questionnaires were completed in 2 years (mean) from their admissions. RESULTS: Only 10.5% patients reported that they had been told by an orthopedic surgeon that they had osteoporosis. Only 3.3% had bone mineral density appointments. Few had received treatment for osteoporosis-only 8.2% of patients had been treated with calcium and vitamin D, and 3.5% with a bisphosphonate. DISCUSSION: We believe that the majority of the orthopedic surgeons lacked sufficient training in osteoporosis; therefore, engaging other providers in their healthcare system can create a pathway for the assessment and treatment of osteoporosis, to guarantee the patient the best care.

Knowledge of orthopaedic surgeons in managing patients with fragility fracture.

PURPOSE: Fragility fractures represent a major health problem, as they cause deformity, disability and increased mortality rates. Orthopaedic surgeons should identify patients with fragility fractures and manage their osteoporosis in order to reduce the risk of future fracture; therefore, orthopaedic surgeons' knowledge about managing fragile fracture should be evaluated. METHODS: A questionnaire was administered to 2,910 orthopaedic surgeons to address the respondents' knowledge. The questions covered the topics of diagnosis, treatment and approach to a patient with a fragility fracture. The data-collection period for this survey spanned one year. RESULTS: There were 2,021 orthopaedic surgeons who participated in this study. Less than 10% of the respondents included bone mass densitometry (BMD) when evaluating patients with fragile fractures 32% prescribed proper dosage of calcium and vitamin D; approximately 30% would refer if falling from a height was suspected. CONCLUSIONS: The majority of orthopaedic surgeons questioned lacked knowledge of fragility fracture management. This is reflected by limited knowledge of osteoporosis assessment and treatment in most areas. An appropriate method should be created to manage patients with fragility fractures to guarantee the patient the best possible care.

Pin and plate fixation in complex distal humerus fractures: surgical technique and results.

PURPOSE: Complex distal humerus fractures are difficult to fix by conventional methods, especially in comminuted low distal humerus fractures. We propose a technique using small diameter K-wires and a plate on the humeral shaft. METHODS: Between May 2007 and March 2009, 19 patients with poor bone quality showing comminuted or low distal humerus fractures involving the articular surface were referred to our institution and were primarily treated by this technique that we called "pin and plate fixation". We have reviewed all the cases treated by this method. RESULTS: The average age was 46 years. All of the patients were followed up for a mean of 12 months and had a good range of motion (the average total arc of flexion-extension was 99°); the average Disabilities of the Arm, Shoulder and Hand (DASH) score was 18 points. The Mayo Elbow Performance Index was measured and the mean score was 88 in our patients. CONCLUSIONS: In this study, a technique has been evaluated for the treatment of complex distal humerus fractures. We recommend this technique in comminuted, osteoporotic or low distal humerus fractures in which other fixation methods seem difficult or even impossible.

Treatment of Kienböck disease by lunate core decompression.

PURPOSE: Kienböck disease is characterized by avascular necrosis of the lunate bone, which is usually progressive without treatment. This study examined lunate core decompression for its treatment potential. METHODS: We surgically treated 20 patients with stage 1 to 3b Kienböck disease with lunate core decompression. We evaluated pain, range of motion, functional disability, and radiographic indices in these patients at baseline and 5 years after surgery. RESULTS: The mean age of the patients was 29 years; 16 were men. Ten patients had Lichtman stage 1 disease, 6 had stage 2 disease, 3 had stage 3a, and 1 had stage 3b disease. Range of motion scores showed meaningful improvement. Two patients did not improve with this technique and were revised with radial shortening procedures. CONCLUSIONS: Lunate core decompression is a simple surgical procedure that is effective in the treatment of Kienböck disease. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.