The outcome measure of proximal humerus fracture treated by open reduction and internal fixation with proximal humerus internal locking system based on oxford shoulder score.

Objective: Proximal humerus fractures became one of the most prevalent upper extremity fractures during recent decades. The use of scoring systems has been taken under consideration to estimate the surveillance, prognosis, and post-operative outcomes. During this study, we investigated the outcome measure of proximal humerus fracture treated by open reduction and internal fixation (ORIF) with plate based on oxford shoulder score (OSS). Furthermore, we tried to propose a new classification system for OSS that could be of prognostic value. Methods: Patients with proximal humerus fracture treated by open reduction enrolled in the study. Persian version of the OSS was completed by the patients. Data were analyzed using SPSS-22. Results: Forty-four patients including 24 women and 20 men were assessed. The mean age was 54.61 (SD ± 19.371) years. The use of a spoon and fork at the same time had the best score and hanging the clothes up in a wardrobe with the operated hand had the worst score in the questionnaire. Comparison of OSS and number of physiotherapy session showed that patients with best outcome had least number of physiotherapy's session, but it was not statistically significant. Conclusion: OSS is useful to evaluate the function of the traumatized shoulder. We suggest classifying the OSS score into three range groups, good (total score 12-28), moderate (total score 29-44), and bad (total scores 45-60).

A Newly Modified Salter Osteotomy Technique for Treatment of Developmental Dysplasia of Hip That Is Associated with Decrease in Pressure on Femoral Head and Triradiate Cartilage.

BACKGROUND AND PURPOSE: The Salter innominate osteotomy has been an effective method to treat the developmental dysplasia of hip (DDH) over the past decades; however, several postoperative complications and deficiencies were reported. In this study, we evaluated outcome of a newly modified Salter osteotomy in patients presenting with DDH. METHODS: We reviewed retrospectively 76 patients (90 hips) with DDH aged ≥ 18 months, who underwent open reduction and a modified osteotomy by a single surgeon. The distal osteotomy segment of pelvis was shifted anterolaterally in the amount of osteotomy cross-section, but not downwards. The mean age at surgery was 2 years and 11 months (1.5 to 16 years). Femoral shortening was conducted when necessary. The duration of operation varied between 60 and 90 minutes. The mean follow-up was 4 years and one month (range 15 months to 7 years and 9 months). All patients were followed up both clinically (based on the modified MacKay criteria) and radiologically (based on the modified Severin criteria). RESULTS: Clinically, 94.5% of hips had excellent and good results at final follow-up, and only 5.5% had a fair condition. Radiographically, at the final follow-up 77.8% of hips were grade IA (excellent), 12.2% were grade IB, 6.7% were grade II, and 3.3% were grade III (fair). The preoperative mean acetabular index was 47.85° (41° to 59), which decreased to 17.16° (13° to 22°) immediately after the surgery (p<0.0001) and progressed to 11.24° (7° to 19°) at the final follow-up (p<0.0001). The mean initial postoperative center-edge angle was 30.3° (25° to 42°) significantly improved to 39.1 (31° to 56°) at the final follow-up (p<0.0001). Avascular necrosis of femoral head occurred in 4.4% of hips (4 patients). CONCLUSION: The results show that our modified Salter osteotomy is safe and associated with significant benefit for the management of patients suffering from DDH.

Osteoarticular manifestations of human brucellosis: A review.

Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac (up to 80%) and spinal joints (up to 54%) are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single- or multi-focal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging (MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications (antibiotics) and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.