Comparison of surgical complications following hip hemiarthroplasty between the posterolateral and lateral approaches.

INTRODUCTION: Femur neck fractures are common fractures among the elderly. Hemiarthroplasty is a surgical choice for femur neck fractures in patients older than 70 years. This surgery is performed using two main methods: Posterolateral and Direct lateral. Here in this study, we aimed to evaluate and compare surgical and post-surgical complications of these two methods. MATERIALS AND METHODS: This retrospective study was performed on 154 patients with femur neck fractures between 2017-2021. All patients with femur neck fractures who had been under hemiarthroplasty entered this study. Data regarding complications such as dislocation, mortality, cause of mortality, repeated surgery and incidence of deep vein thrombosis (DVT) in both Posterolateral and Direct lateral surgical approaches were collected and analyzed. RESULTS: We indicated that there is no significant difference between the two surgical approaches regarding dislocation (P=0.06), mortality (P=0.598) and repeated operation (P=0.550). CONCLUSION: Taken together there are no significant differences between the two surgical approaches and we suggest that clinicians could decide based on their experiences and the clinical condition of patients.

Evaluation of femoral malrotation after intramedullary nailing.

BACKGROUND: Intramedullary nailing and closed reduction are one of the most important treatment strategies for femoral shaft fractures. Malrotation in the femoral shaft is a complication that requires exact investigations. Here we aimed to evaluate and report the outcomes of malrotation of femur in patients with femoral shaft fractures following antegrade intramedullary nailing. METHODS: In this cross-sectional study, 140 patients who had referred to Shahid-Beheshti Hospital in Abadan, Iran and had undergone antegrade intramedullary fixation for isolated femoral shaft fracture during a 6-year period from 2015 to 2021 were enrolled. Demographic information and disease-related information were collected. During operation, the patients were assessed clinically for malrotation of femur with 90° of the knee flection and with the hip in 0° flexion and then in the postoperative follow-up period, the patient was examined again and a computed tomography scan requested to identify the degree of malrotation of femur and the observers were unaware of the CT scan result at the time of the clinical examination. We also measured the amount of internal and external rotation while the patient in the lying supine position with 90° flexion in the knee and hip joint and lying prone position with hip extension. In CT imaging to determine the amount of malrotation of femur, the angle between a line drawn across the two femoral condyles in the posterior aspect and the femoral neck shows the amount of rotation. RESULTS: Degree of rotational deformity, less than 5°, 5 to 10° and 10 to 15° was less than 8.6%, 75.7% and 15.7% respectively and did not relate to age, sex, fracture location and activity of the patients (P>0.05). There was a strong linear correlation with the average predictive power between clinically detected torsional deformity in comparison with the CT detected torsional deformity (r=0.333 and P=0.005), which was stronger in women than men (r=0.336 in men and r=0.659 in women) (P<0.05). There was a strong linear correlation with the average predictive power between clinically detected torsional deformity in comparison with the CT detected torsional deformity was observed only in external malrotation of femur (r=0.541 and P=0.001). A poor inverse linear relationship was observed between clinically detected and CT detected torsional deformity with the age of the patients which the correlation of clinically detected was more than the CT detected (r in clinical examination =-0.285 and r in CT measurement =-0.246) (P<0.05). CONCLUSION: In this study, there was no femoral malrotation over 15° that was associated with clinical symptoms. However, a CT scan should be performed for accurate diagnosis and necessary measures but it does not seem necessary to perform in all patients.

Comparison of two different stems for total hip arthroplasty.

BACKGROUND: Total hip arthroplasty (THA) is the golden standard in treating severe osteoarthritis, which has not responded to conservative treatment. This study aimed to evaluate and compare the therapeutic results of THA using Short-stem and Standard-stem prostheses. METHODS: The study was a randomized clinical trial without a control group that was performed in 2020. A total number of 156 patients were recruited over three years. Patients were divided into two groups. The first group was treated with a Short-stem prosthesis and the second group was treated with a Standard-stem prosthesis. Patients were visited according to a schedule. At each visit, a control graph was prepared and the condition of the bone prosthesis and its position were examined. Also, the status of cane use and weightlifting were evaluated. Clinical signs such as pain, lameness, and the ability to climb stairs were assessed and recorded based on the Harris scale. Patients were also evaluated for surgical complications such as infection or limb length discrepancy. RESULTS: Data of 140 patients were analyzed. The mean age of patients was 60.2 ± 6.38 years. The amount of bleeding in the short-stem group was significantly lower than the standard-stem group (380.17 ml versus 430.13 ml, P = 0.001). In both groups, there was a significant increase in Harris score after the end of the study compared to before the operations. Furthermore, Harris's mean score was higher in the short-stem group compared to standard-stem group. However, these significant differences were observed only in the sixth week (P < 0.0001) and the third month (P < 0.0001). CONCLUSION: The use of Short-stem prosthesis in the short term can play a role in improving patient performance but in the long term evaluations, there is no apparent difference with the use of Standard-stem prostheses.

Outcomes of acromioclavicular joint dislocation using tightrope arthroscopy.

BACKGROUND: Based on different treatment outcomes and different treatment methods for acromioclavicular dislocation, we decided to evaluate the treatment outcomes of acromioclavicular joint dislocation using tightrope arthroscopy. METHODS: This retrospective cross-sectional study was performed on patients with acromioclavicular joint dislocation referred to Alzahra Hospital in Isfahan and Abadan-Iran from 2015 to 2017. Information that was assessed included age, sex, type of dislocation (Figure 1), duration of injury, cause of injury, complications such as osteoarthritis, changes in the distance between the joints, as well as the American Shoulder and Elbow Surgeons Shoulder Score (ASES) were collected after 6 months of surgery. RESULTS: There was a significant relationship between horizontal change instability and type of injury that 9 cases (60%) of type 5 of injury and 0 of type 3 had horizontal change instability (P=0.01). There was a reverse significant correlation between ASES score and duration of injury (r=-0.58, P=0.01). CONCLUSION: Acromioclavicular joint dislocations could successfully be treated with the TightRope system. We also showed that patient's pain and functions are diversely correlated with injury durations.

Platelet-rich plasma or extracorporeal shockwave therapy for plantar fasciitis.

BACKGROUND: Plantar fasciitis is a common cause of plantar pain which is prevalent among adults. Conservative tractions, invasive injections, shock therapies and also surgical procedures are known as beneficial methods in non-responsive cases. Here we evaluated and compared the injection of platelet rich plasma (PRP) and usage of extracorporeal shockwave therapy (ESWT) in pain reduction in patients with chronic plantar fasciitis. METHODS: This is a randomized clinical trial that was performed in 2017-2020 on patients with chronic plantar fasciitis who did not respond to conservative therapies. A total number of 110 patients with plantar fasciitis were entered based on inclusion and exclusion criteria. Patients were then divided into two groups. The pain of patients was measured using visual analogue scale (VAS) before interventions. The first group underwent PRP injections while the second group underwent ESWT using Shock Master 500. Patients were visited 2, 4, 8, 12, 16, and 24 weeks after interventions and the pain scores were noted using VAS. RESULTS: Data of 104 patients were analyzed. Initial VAS scores of patients were also analyzed. These data indicated no significant differences between the pains of patients before interventions (P = 0.413). Pain evaluations in 2, 4, 8, 12, 16, and 24 weeks after interventions with controlling age and sex showed significantly reduced VAS scores in both groups after interventions (P = 0.002). We should also note that pain in the PRP group reduced more than ESWT group and this difference was also significant (P = 0.001). CONCLUSION: Here we showed that PRP injections and ESWT are both beneficial in pain amelioration in patients with chronic plantar fasciitis. We also indicated that PRP injections were associated with better pain reduction results compared to ESWT.

Outcomes of patients with humerus fracture under treatment with PHILOS plate.

BACKGROUND: Based on the contradictory results about the effect of an intramedullary nail in the treatment of humeral shaft fracture, in this study, we aim to evaluate the outcomes of patients with humeral fracture treated with PHILOS plaque. METHODS: In this cross-sectional study, which was performed to evaluate the recovery rate of patients with humeral fracture treated with PHILOS plaque referred to Shahid Beheshti Hospital in Abadan-Iran during 2015-2019. Constant Shoulder Score was evaluated six months and one year after the operation. RESULTS: The mean constant shoulder score was increased significantly after 1 year compared to 6 months (P<0.001). The means of constant shoulder score 6 months in type 4 of fracture was significantly higher than type 3 of fracture (P=0.03) but there was no significant relationship between the means of constant shoulder score 1 year after surgery and type of fracture. CONCLUSION: We suggest that orthopedic surgeons should pay more attention to the usage of PHILOS plate in patients with humerus fractures especially the type 4 fracture.

Comparison of opponensplasty techniques in isolated low median nerve palsy.

BACKGROUND: Thumb opposition is a critical operation of thumb. Median nerve palsy interferes with a large number of ordinary activities such as opposition. Opponensplasty for low median nerve injury is performed with various techniques. The purpose of this study is to compare tendon transfer techniques of Riordan and Burckhalter. METHODS: This study was a clinical trial performed on 120 patients who underwent Opponensplasty. Patients with traumatic low nerve palsy were divided into two equal groups of Riordan and Burckhalter operation. Demographic information, functional status, Kapandji score, and Pulp pinching method were recorded and compared for all patients 3 months and 8 months after surgery. FINDINGS: Performance status, Kapandji score and Pulp pinching tests showed significant improvements in both groups after surgeries. The changes in pressure between the thumb and fifth finger were significantly greater in the Burckhalter method compared with Riordan method (P<0.05). The incidence of complications was significantly higher in the Riordan group (P=0.01). CONCLUSION: According to the present study, there was no differences between Burckhalter and Riordan methods in terms of opposition recovery, although Burckhalter's opponensplasty had better therapeutic results. Postoperative complications were also less in the Burckhalter method.

Treatment of unstable extra-articular distal radius fractures using locked volar plating and percutaneous pinning without external fixation.

INTRODUCTION: One of the most common fractions is distal radius fracture, and various treatments have been suggested for this. The purpose of this study, is comparison of Open reduction and internal fixation by using a locked volar plating compared to percutaneous pinning by cast immobilization under the elbow in patients less than 60 years with good bone density that had unstable extra-articular distal radius fracture or UDRF. METHODS: This study was clinical trial. 88 patients with closed UDRF who were referred for surgical treatment entered the study. Patients were randomized into two groups: group 1 had open reduction and internal fixation by using a locked volar plating and the other group had percutaneous pinning by cast immobilization surgeries. Amount of pain [by using Visual analog scale or VAS] and functional results of two methods were compared 3 and 12 month after surgeries. FINDINGS: The intensity of pain was higher in the pinning group 3 and 12 month after treatment (P=0.001 and P=0.390 respectively). The range of motions in the plating group was significantly better (P<0.001). There was a significant difference in performing daily activities 3 month after treatment between the two groups, but a significant limitation in daily activities, observed 12 months after surgery in pinning group (P=0.004). CONCLUSION: Bone fixation, using locked volar plating, can be a better modality with regard to postsurgical pain and also the wrist range of motion than percutaneous pinning with cast immobilization in patients younger than 60 years sustaining unstable, closed extra-articular, distal radius fracture.

Clinical Outcomes of Intramedullary and Extramedullary Fixation in Unstable Intertrochanteric Fractures: A Randomized Clinical Trial.

BACKGROUND: The best method for repairing intertrochanteric fractures is still controversial. The fixation methods include extramedullary (EM) and intramedullary (IM). Studies that compare IM and EM fixations for unstable hip fractures are rare. In this study, our goal was to compare the efficacy of EM and IM fixation in treatment of unstable intertrochanteric fractures. METHODS: A total of 113 patients with unstable intertrochanteric were randomized in this cohort study between March 2016 and June 2018 in trauma center of Kashani and Alzahra Hospitals, Isfahan, Iran. The patients were followed for a period of 12 months with sequential clinical and imaging evaluations. Baseline data were recorded at the time of injury. Radiographs were evaluated immediately post-operatively and at the scheduled follow-up intervals. RESULTS: A total of 20 of patients were excluded during the study and finally 93 patients (43 males and 50 females) with mean age of 62.74±16.4 completed the follow-up sessions. Mann-Whitney test indicated a significant difference in tip-apex distance between the two groups. While the two groups were homogeneous in the baseline LEM score, it was not significantly different between two groups after 1 and 3 months of surgery as well. However, the LEM score was significantly higher in IM group after 6 and 12 months of surgery. CONCLUSION: According to our findings, IM nails (such as the cephalomedullary nail) afforded more advantages over EM devices (such as the DHS and DCS) in the treatment of unstable intertrochanteric fractures. Our results indicated that the final LEM scores as well as the time to union were better in IM fixation group.

A survey on prognosis of anterior cruciate ligament (ACL) reconstruction surgeries following fixed loop and adjustable loop methods.

BACKGROUND: Anterior cruciate ligament (ACL) rupture is an important disease in the younger population and especially professional athletes followed by trauma. There are different surgical methods for repairing ACL rupture each having their own prognosis rates. Here in this study, we investigated and compared results of ACL reconstruction after the fixed loop and adjustable loop surgical procedure in patients with ACL rupture. METHODS: In this study, we evaluated 60 patients with ACL rupture and divided them into two groups each containing 30 patients. Fixed loop and adjustable loop ACL repair were performed for each group. Data regarding knee society score, static laxity, and joint range of motion (ROM), patient's satisfaction and returning to normal daily activities were collected and compared between two groups after 6 months follow up using SPSS software. RESULTS: We showed that there was no significant difference between two groups of patients regarding investigated factors (P>0.05). No surgical site infections were also observed during the study. CONCLUSION: Both fixed loop and adjustable loop grafting procedures for ACL repair indicate beneficial results and are effective in patients with ACL rupture. We suggest that orthopedic surgeons could use each of these methods according to their own experience and the patient's condition. There are no significant differences between these two methods in the prognosis of patients.

Clinical presentation of carpal tunnel syndrome with different severity: a cross sectional study.

Background: Carpal tunnel syndrome is a common neuropathy in the hand which presented with pain and paresthesia in the hands and the wrists. The aim of our study was evaluated clinical symptoms of patients with different severity of CTS. Methods: This study is a cross-sectional study was performed on 40 patients referred to Emam khomeyni Hospital in Tehran from 2017 to late 2019 with symptoms of CTS and have been diagnosed with a definite diagnosis. Results: A positive significant correlation was between severity of CTS and age, and reverse significant correlation was between severity of CTS with duration of symptoms. There were significant relationships between severity of CTS and shaking or ringing the hands symptoms, weakness or atrophy of the flexion test and reverse phalen test (P < 0.05). Conclusion: Clinical symptoms of CTS can be diagnosing different severity of disease, so considering of symptoms can plays a predominant role in the diagnosis of the disease.