The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian Speaking Patients with Knee Osteoarthritis.

BACKGROUND: Osteoarthritis of the knee is the most common chronic joint disease that involves middle aged and elderly persons. There are different clinical instruments to quantify the health status of patients with knee osteoarthritis and one example is the WOMAC score that has been translated and adapted into different languages. The purpose of this study was cultural adaptation, validation and reliability testing of the Persian version of the WOMAC index in Iranians with knee osteoarthritis. METHODS: We translated the original WOMAC questionnaire into Persian by the forward and backward technique, and then its psychometric study was done on 169 native Persian speaking patients with knee degenerative joint disease. Mean age of patients was 53.9 years. The SF-36 and KOOS were used to assess construct validity. RESULTS: Reliability testing resulted in a Cronbach's alpha of 0.917, showing the internal consistency of the questionnaire to be a reliable tool. Inter-correlation matrix among different scales of the Persian WOMAC index yielded a highly significant correlation between all subscales including stiffness, pain, and physical function. In terms of validity, Pearson`s correlation coefficient was significant between three domains of the WOMAC with PF, RP, BP, GH, VT, and PCS dimensions of the SF-36 health survey (P<0.005) and KOOS (P<0.0001) . CONCLUSIONS: The Persian WOMAC index is a valid and reliable patient- reported clinical instrument for knee osteoarthritis.

Evolution in diagnosis and treatment of Legg-Calve-Perthes disease.

Legg-Calvé-Perthes disease (LCPD) is an idiopathic osteonecrosis of the femoral head with variable complications and resultant deformity of the femoral head and osteoarthritis. Suggested risk factors are acetabular retroversion, obesity, latitude, hyperactivity, and coagulopathy. The most commonly applied classification is based on radiolucency in the lateral pillar of the femoral head, which is strongly correlated with the outcome. In the fragmentation stage of the disease involvement can be classified into three groups. After skeletal maturity, the outcome can be classified using the Stulberg classification based on the sphericity and congruence of the femoral head in relation to the acetabulum. The early goal of treatment is to prevent head deformation by weight transmitted forces during remodeling and ossification stages containment is the widely accepted principle of treatment. Although the Petrie cast still has a role in the short-term treatment of LCPD before and during the reossification stage, available data does not support additional benefits from braces during the course of LCPD.

The spinal cord injury quality-of-life-23 questionnaire, Iranian validation study.

BACKGROUND: The spinal cord injury quality-of-life questionnaire (SCIQL-23) is an instrument that has been developed for clinical follow-up as well health related quality-of-life (QOL) measurement in people with spinal cord injury (SCI). The purpose of this study was to assess the validity and reliability of the Persian version of SCIQL-23 in individuals with chronic SCI. MATERIALS AND METHODS: Medical outcomes study 36 item short-form health survey (SF-36) as well as the Persian version of the SCIQL-23 questionnaires applied to be used in 52 veterans with spinal cord injuries in the Orthopedic Research Center, Mashhad University of Medical Sciences from January 2011 to August 2011. Cronbach's alpha co-efficient computed to test the reliability of the survey. In order to assess the convergent validity the correlation of each item of the SCIQL-23 done with each dimension of the SF-36 by applying the Pearson correlation co-efficient. Independent samples t-test used to test power of discrimination. RESULTS: All of veterans were male and married. The mean age of individuals at the time of interview was 49.3 years (standard deviation = 7.9); in a range between 38 and 80 years. Most of them (88.5%) had incomplete paraplegia. Cronbach's alpha test revealed strong reliability in questions of SCI QOL (Total Cronbach's alpha = 0.764). A negative significant correlation occurred between physical function and functioning (FUNC) (r = -0.412**), bodily pain and problems related to injury (PROB) (r = -0.313*), vitality (VT) and mood state (MOOD) (r = -0.327*), social function and PROB (r = -0.309*), mental health (MH) and MOOD (r = -0.406**). Furthermore, the Mental component summary (MCS) of SF-36 had a negative significant correlation with MOOD (r = -0.312*). Similar to MCS, physical component summery (PCS) had a negative significant correlation with MOOD (r = -0.276*) in addition to FUNC (r = -0.324*) and PROB (r = -0.318*). Instead, GH (r = 0.455**), VT (r = 0.322*), MH (r = 0.276*) and PCS illustrated a positive significant correlation with global quality of life. CONCLUSION: The Persian version of the SCQL-23 discovered to be competent in terms of its valuable psychometric properties in assessing the QOL of SCI people by showing excellent internal consistency and no floor or ceiling effect.

Clinical outcome of en-block resection and reconstruction with nonvascularized fibular autograft for the treatment of giant cell tumor of distal radius.

BACKGROUND: Although giant cell tumor (GCT) is considered to be a primary benign bone tumor, its aggressive behavior makes its diagnosis and treatment, difficult and challenging. This is especially true in distal radius where GCT appears to be more aggressive and difficult to control locally. We report our clinical outcome of en-block resection and reconstruction with non-vascularized fibular autograft in 15 patients with distal radius GCT. MATERIALS AND METHODS: We retrospectively reviewed 15 patients with GCT (Grade 2 and 3) of distal radius who were treated with en-block resection and non-vascularized fibular autograft. Five of 15 were recurrent GCT treated initially with extended curettage; local adjuvant therapy and filling the cavity with cement or bone graft. We followed the patients for mean 7.2 years post operation (range: 4-11 years). Patients were evaluated post operation with clinical examination, plain radiography of distal radius and chest X-ray and/or computed tomography scan. Furthermore pain, function, range of motion and grip strength of the affected limb were evaluated and mMayo wrist score was assessed. RESULTS: A total of 11 patients were women and 4 were men. Mean age of patients was 29 years (range: 19-48). We had no lung metastasis and bony recurrence occurred in one patient (6.6%). Nearly 53.3% of patients had excellent or good functional wrist score, 80% of the patients were free of pain or had only occasional pain and 80% of patients returned to work. Mean range of motion of the wrist was 77° of flexion-extension and mean grip strength was 70% of the normal hand. CONCLUSION: En-block resection of distal radius GCT and reconstruction with non-vascularized fibular autograft is an effective technique for treatment in local control of the tumor and preserving function of the limb.

Quality of life and the related factors in spouses of veterans with chronic spinal cord injury.

BACKGROUND: The quality of life (QOL) of caregivers of individuals with chronic spinal cord injuries may be affected by several factors. Moreover, this issue is yet to be documented fully in the literature. The purpose of this study was to evaluate the health related quality of life of spouses who act as primary caregivers of veterans with chronic spinal cord injuries in Iran. METHODS: The study consisted of 72 wives of 72 veterans who were categorized as spinal cord injured patients based on the American Spinal Injury Association (ASIA) classification. Health related quality of life was assessed by the Short Form (SF-36) Health Survey. Pearson's correlation was carried out to find any correlation between demographic variables with SF-36 dimensions. To find the effect of the factors like age, employment status, duration of care giving, education, presence or absence of knee osteoarthritis, and mechanical back pain on different domains of the SF-36 health survey, Multivariate analysis of variance (MANOVA) was used. RESULTS: The mean age of the participants was 44.7 years. According to the ASIA classification 88.9% and 11.1% of the veterans were paraplegic and tetraplegic respectively. Fifty percent of them had a complete injury (ASIA A) and 85% of the spouses were exclusive care givers. All of the SF-36 scores of the spouses were significantly lower than the normal population. Pearson's correlation demonstrated a negative significant correlation between both age and duration of caring with the PF domain. The number of children had a negative correlation with RE and VT. CONCLUSION: The burden of caregiving can impact the QOL of caregivers and cause health problems. These problems can cause limitations for caregiver spouses and it can lead to a decrease in the quality of given care.

Bilateral One-half Spica Cast After Open Reduction and Pelvic Osteotomy in the Developmental Dislocation of the Hip.

BACKGROUND: The prevalence of DDH ranges from 1 per1000 to 3.4 per 100 live- births. One- and-one-half hip spica cast is the conventional technique of immobilization after the open reduction with or without osteotomy. OBJECTIVES: In this study, we evaluated the preference of bilateral one-half spica cast over the one-and-one-half spica cast. MATERIALS AND METHODS: Eight hips in five patients with developmental dislocation of the hip have undergone open reduction. Salter osteotomy, Pemberton osteotomy and femoral shortening were done on two, two and six hips, respectively. Bilateral one-half spica cast with trochanteric molding was applied for all of the hips. RESULTS: The patients' age ranged from 1.5 to 7 years old. The only complications consisted of two osteonecrosis of the head and one superficial infection. No dislocation, graft displacement, nonunion and device failure was occurred. CONCLUSIONS: Bilateral one-half spica cast is sufficient after the open reduction with or without osteotomy in DDH patients and we can substitute the bilateral one-half spica cast above the knee cast for the conventional one and one-half spica cast.