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Journal Cover   Archives of Bone and Joint Surgery
  [4 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2345-4644 - ISSN (Online) 2345-461X
   Published by Mashhad University of Medical Sciences Homepage  [11 journals]
  • Sternocostoclavicular joint swelling- diagnosis of a neglected entity

    • Abstract: Purpose: Sternocostoclavicular joint swelling is an underdiagnosed, albeit important entity in the clinical practice. The present study was conducted in order to identify the incidence and common causes of the above entity.Method: Patients presenting to the Orthopaedic Clinic with a swelling of sterno-costo-clavicular joint, during the study period of two years were included, and detailed history was obtained from the patient. Baseline investigations (total and differential leukocyte count, ESR, CRP, X-ray and CT ) was performed. MRI,FNAC or joint aspiration was performed whenever clinically or radiologically indicated.Result: A total of 21 patients were enrolled in the study duration of 2 years. Patients mainly presented with both pain and swelling of the SCCJ with predominant right sided involvement. Osteoarthritis was the most frequent diagnosis followed by infections, primary bone/cartilage tumor and metastasis. Conclusion : Although most of the patients with a sterno-costo-clavicular joint swelling have a benign etiology, it is not wise to dismiss SCCJ swelling as degenerative changes. Serious conditions like septic arthritis or neoplasia, may masquerader with similar presentations as osteoarthritis. It would be therefore imperative to rule out all of these potentially life threatening conditions using thorough clinic-radiological workup.
      PubDate: Sun, 15 Mar 2015 20:30:00 +010
  • Is there any Correlation Between Patient Height and Patellar Tendon

    • Abstract: Background:A potential specific problem of patellar tendon graft in ACL reconstruction is the possibility of graft-tunnel mismatch which could be more problematic with anatomic ACL reconstruction where the femoral tunnel is placed low on the lateral wall of the lateral femoral condyle. The occasional occurrence of this mismatch raises the question that whether a correlation exists between patient height and patellar tendon length. The purpose of the present study was to measure patellar tendon length as an anthropometric finding and to evaluate whether a correlation exists between patient height and patellar tendon length.Methods:Intra-operative measurement of patellar tendon length was carried out in 267 consecutive patients during bone-patellar tendon-bone (BTB) graft ACL reconstruction. Patient age, gender, height were recorded. The patellar tendon measurements were done independently by two surgeons and the possible inter-observer errors were checked. The data were analyzed using the Pearson correlation.Results:The mean length of the patellar tendon was 46.4 ± 4.8 mm (Mean ± SD) with a range of 32–61 mm. The mean patient height was 177 ± 7 cm (Mean ± SD) with a range of 159–197 cm. A weak positive correlations were found between patient height and patellar tendon length (Pearson r = 0.24, P< .001). The linear regression equation for patellar tendon length (y, in millimeters) as a function of patient height (x, in centimeters) can be expressed as y=16.54 + 0.17x. Conclusions:Our study showed a weak correlation between patellar tendon length and patient height. This finding is in contrast to the usual measurements in human anthropometry in which taller individuals have normally longer tendons and ligaments. The graft-tunnel mismatch may be the result of this variation.
      PubDate: Sun, 15 Mar 2015 20:30:00 +010
  • An unusual case of a large hematorrachis associated with multi-level
           osteoporotic vertebral ...

    • Abstract: Spinal epidural haemorrhage may present as back pain associated with radicular symptoms and can be a catastrophic clinical scenario with progression to paraplegia or even sudden death. Being a rare entity, it needs a high index of clinical suspicion to diagnose this entity . Fractures have been documented as a cause of hematorrachis but such hematoma just extend to one or two vertebral segments. Large epidural hematomas are usually associated with conditions like bleeding diathesis, Arterio-venous malformations, plasma cell myeloma, non hodgkins lymphoma. Surgical management with immediate evacuation of hematoma is the usual line of management in patients with neuro deficits. Though rare, a monitored and careful conservative management can lead to recovery of neurological symptoms and resolution of the hematoma. We report a case of a very large post traumatic epidural hematorrchis extending to 11 vertebral segments that is from D3 to L1 vertebral bodies and had a Gradual spontaneous recovery.
      PubDate: Sun, 15 Mar 2015 20:30:00 +010
  • Evaluation of patient outcome and satisfaction after surgical treatment of
           adolescent ...

    • Abstract: Background: Adolescent idiopathic scoliosis (AIS) causes several physical and mental problems. AIS adversely affects the patient satisfaction and quality of life. In current study, we investigated the patient outcome and satisfaction after surgical treatment of AIS using scoliosis research society-30 questionnaire (SRS-30).Materials and methods: There were 135 patients with AIS underwent surgical correction. Patients were followed at least for 2 years. Pre- and post-operatively, spinal x-rays were taken and Cobb's angles and coronal balance were compared.At last visit, patients completed SRS-30 questionnaire. The correlation between radiological outcomes and SRS-30 total score and patient satisfaction were investigated. Also, the correlations between satisfaction domain and other domains of SRS-30 were evaluated.Results: Cobb's angle and coronal balance improved significantly after the operation (p<0.001). The score of functional activity, pain, self-image/cosmesis, mental health and satisfaction were 26.7±4.3, 25.9±2.5, 33.3±5.2, 22.7±3.5 and 13.1±1.8 points, respectively. Also, the total SRS-30 score was 126.8±12.7 score. The rate of radiological correction was correlated positively with SRS-30 total score and satisfaction domain score (p<0.05). Also, the satisfaction score was correlated positively with self-image/cosmesis domain score (p<0.05).Conclusion: The greater radiological correction of the AIS results in higher SRS-30 total score and patient satisfaction. It seems that appearance and cosmesis is the more parameter affects the patient satisfaction with outcomes of surgical treatment.
      PubDate: Sun, 15 Mar 2015 20:30:00 +010
  • Two-stage nerve graft in severe scar: A time-course study in a rat model

    • Abstract: Purpose: The outcome of peripheral nerve repair is suboptimal in the presence of severe soft tissue injury and excessive scarring. This parallels the process in tendon reconstruction of the hand. Inspired with the advantages of two-stage technique in tendon grafting and with encouraging preliminary results, we aimed to investigate the two-stage nerve graft technique as an alternative method of secondary nerve repair.Methods: Thirty female rats (~200 g) were randomly distributed into two groups (n=15). A 15 mm gap was created in the sciatic nerve of all animals and an excessive extraneural scar was induced using the “mincing” method. In this method, a thin strip of muscle was removed, minced in a Petri dish and returned to the periphery of the nerve. In the two-stage nerve graft group, a silicone tube was interposed in the first stage. After 4 weeks, in the second stage, the silicone tube was removed and a median nerve autograft was interposed through the newly formed vascularized sheath. In the conventional graft group, two nerve ends were protected with silicone caps in the first stage. After 4 weeks the caps were removed and the median graft was interposed. Behavioral assessments were performed at 15th week after surgery with Withdrawal reflex latency (WRL) and Extensor Postural Thrust (EPT) and at the 3, 6 and 15-week time-points with TOA (Toe Out Angle). Masson trichrome staining method was used for histological assessments at the 15th week. Results: According to the EPT and WRL, two-stage nerve graft showed significant improvement (P=0.020 and P=0.017 respectively). The TOA showed no significant difference between the two groups. Total vascular index was significantly higher in the two-stage nerve graft group (P<0.001). Conclusion: Two-stage nerve graft using a silicone tube, enhances vascularity of the graft and improves functional recovery.
      PubDate: Sun, 15 Mar 2015 20:30:00 +010
  • A Pitfall of Pre-contoured Locking Compression Plate Fixation of Distal
           Humerus Fractures

    • Abstract: Anatomically precontoured locking plates are intended to facilitate the fixation of articular fractures and particularly those associated with osteoporosis. Fractures of the distal humerus are relatively uncommon injuries where operative intervention can be exceptionally challenging. The distal humeral trochlea provides a very narrow anatomical window through which to pass a fixed-angle locking screw, which must also avoid the olecranon, coronoid, and radial fossae. We describe 3 patients (ages 27, 49, and 73 years) with a bicolumnar fracture of the distal humerus where very short distal locking screws were used. Intra-articular screw placement was avoided but loss of fixation occurred in two patients and a third was treated with a prolonged period of immobilization. We postulate that fixed-angle screw trajectories may make it difficult for the surgeon to place screws of adequate length in this anatomically confined region, and may lead to insufficient distal fixation. Surgical tactics should include placement of as many screws as possible into the distal fragment, as long as possible, and that each screw pass through a plate without necessarily locking in.
      PubDate: Sun, 15 Mar 2015 20:30:00 +010
  • Childhood facial osteosracoma: a case report

    • Abstract: Osteosarcoma (OS) is the eighth common cancer of childhood. OS incidence is 4 cases in one million in children younger than 14. Facial OS incidence is estimated between 8% and 10% of OS cases. The main etiology of OS is unknown, but various predisposing factors are proposed such as radiation, radiotherapy, some benign bone diseases like Paget’s disease or fibrous dysplasia. 5 year survival of OS is 68% and it decreases in older ages. Positive history of radiotherapy is the main predisposing factor for childhood OS. There is some evidence about the x ray induced mutation in genomic DNA which leads to osteosarcoma. In the present paper we present a 19 month girl with a mass located in inferior margin of the left cheek and orbit. Our introduced case was unique with regard to its young age and gender. Moreover, the tumor was located in an uncommon site and her disease was progressive and resistant.
      PubDate: Sun, 15 Mar 2015 20:30:00 +010
  • Adult degenerative scoliosis with spinal stenosis treated with stand-alone
           cage via an extreme ...

    • Abstract: We report the case of a 73-year-old female with severe degenerative scoliosis and back and leg pain that was successfully treated with stand- alone cages via an extreme lateral transpsoas approach. This patient had declined open surgery and instrumentation due to her advanced age concerns about potential side effects.We report the case of a 73-year-old female with severe degenerative scoliosis and back and leg pain that was successfully treated with stand- alone cages via an extreme lateral transpsoas approach. This patient had declined open surgery and instrumentation due to her advanced age concerns about potential side effects.We report the case of a 73-year-old female with severe degenerative scoliosis and back and leg pain that was successfully treated with stand- alone cages via an extreme lateral transpsoas approach. This patient had declined open surgery and instrumentation due to her advanced age concerns about potential side effects.We report the case of a 73-year-old female with severe degenerative scoliosis and back and leg pain that was successfully treated with stand- alone cages via an extreme lateral transpsoas approach. This patient had declined open surgery and instrumentation due to her advanced age concerns about potential side effects.
      PubDate: Sun, 15 Mar 2015 20:30:00 +010
  • Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament
           Reconstruction: Case ...

    • Abstract: Abstract:Purpose: Complications following anterior cruciate ligament (ACL) revision reconstruction occur in 1.8-24% of procedures. One of the rare and devastating complications following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture. We present a rare case of femoral condyle fracture that has occurred intraoperative during revision of ACL reconstruction.Case presentation: A 35 year old male soccer player with history of ACL tear 1 year ago that underwent endoscopic arthroscopic ACL reconstruction with endobutton technique and functioned well till another twisting injury caused ACL re-rupture. Revision of ACL reconstruction was performed using the same tunnels in both femur and tibia and after failing the graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. Patient referred to our knee clinic and we decided to operate him in two stages, first fixation of the fracture and performing ACL re-revision after fracture healing.Discussion: Pre-operative planning with three dimensional CT scan to assess detailed information of tunnel position will help the surgeon for placing the tunnel in the best place. Not inserting multiple guide pins , keeping the safe distance from the posterior cortex and pay more attention during the graft tensioning specially in revision surgeries are all small points that will reduce the risk of fracture during the revision of ACL reconstruction. Conclusions: Careful attention to preoperative planning and surgical technique is the mystery of success.
      PubDate: Fri, 06 Feb 2015 20:30:00 +010
  • Review on the Prevention of Periprosthetic Joint Infection

    • Abstract: Prosthetic joint infection (PJI) is a calamitous complication with high morbidity and substantial cost. The reported incidence is low but it is probably underestimated due to the difficulty in diagnosis. PJI has challenged the orthopaedic community for several years and despite all the advances in this field, it is still a real concern with immense impact on patients, and the healthcare system. Eradication of infection can be very difficult. Therefore, prevention remains the ultimate goal. The medical community has executed many practices with the intention to prevent infection and treat it effectively when it encounters. Numerous factors can predispose patients to PJI. Identifying the host risk factors, patients’ health modification, proper wound care, and optimizing operative room environment remain some of the core fundamental steps that can help minimizing the overall incidence of infection. In this review we have summarized the effective prevention strategies along with the recommendations of a recent International Consensus Meeting on Surgical Site and Periprosthetic Joint Infection.
      PubDate: Fri, 06 Feb 2015 20:30:00 +010
  • A Survey of severity and distribution of musculoskeletal pain in the
           Multiple Sclerosis ...

    • Abstract: Background: Pain is a common phenomenon in patients with Multiple Sclerosis (MS) and is associated with many symptoms and problems.Aim: this study designed to investigation severity and distribution of musculoskeletal pain in MS patients. Methods: In this cross-sectional study, 115 members of the Mazandaran MS Association with confirmed MS were randomly collected. The patients were asked to fill in Numerical Rating Score and Nodric questionnaires, respectively. The data was analyzed by SPSS 16. Results: The mean age of the participants was 30.43±5.86 years and 88 cases (76.5%) were female. The mean disease duration was 26.34±24.32 months. 87.8% of the cases were experiencing pain at the time of study. The mean pain severity and worst pain experienced were 3.75±2.25 and 5.73±2.12, respectively. The most common pain sites were: knees (55.7%), wrist (43.5%) and neck (41.7%). Women experience higher prevalence of shoulder, upper back and ankle pain (P<0.05). In 62 cases (53.91%) MS interfered with daily functioning at least for a time. The prevalence of upper back and neck pain were higher in cases with shorter disease duration (P<0.05).Discussion: Pain was very common in patients with MS and not relevant to sex or age. In the majority of the cases more than 1 limb was involved and the prevalence of pain in lower limbs was higher, especially in knees. In females the prevalence of pain in shoulders, upper back and ankle was higher compared to males. Also, neck and upper-back pain can be found in the early stages of the disease.
      PubDate: Fri, 06 Feb 2015 20:30:00 +010
  • Giant Cell Tumor of Tendon Sheath

    • Abstract: Background:  Giant cell tumor of tendon sheath (GCTTS) is often thought of as a volar finger mass. We hypothesized that GCTTS are equally common on the dorsal and volar aspects of the hand. In addition, we hypothesized that there are no factors associated with the location (volar versus dorsal) and largest measured dimension of a GCTTS.  Methods:  A total of 126 patients with a pathological diagnosis of a GCTTS of the hand or finger were reviewed. Basic emographic and GCTTS specific information was obtained. Bivariable analyses were used to assess predicting factors for location (volar or dorsal side) and largest measured diameter of a GCTTS.  Results:  Seventy-two tumors (57%) were on the volar side of the hand, 47 (37%) were dorsal, 6 (4.8%) were both dorsal and volar, and one was midaxial (0.79%). The most common site of a GCTTS was the index finger (30%). There were no factors significantly associated with the location (volar or dorsal, n=119) of the GCTTS. There were also no factors significantly associated with a larger diameter of a GCTTS.  Conclusions:  A GCTTS was more frequently seen on the volar aspect of the hand. No significant factors associated with the location or an increased size of a GCTTS were found in this study.
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • Surgical Procedures of the Elbow: A Nationwide Cross-Sectional
           Observational Study in the ...

    • Abstract: Background:  Elbow surgery is shared by several subspecialties. We were curious about the most common elbow surgeries and their corresponding diagnoses in the United States.   Methods:  We used the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS) data gathered in 2006-databases that together provide an estimate of all inpatient and ambulatory surgical care in the US.  Results:  An estimated 150,000 elbow surgeries were performed in the US in 2006, 75% in an outpatient setting. The most frequent diagnosis treated operative was enthesopathy (e.g. lateral epicondylitis) and it was treated with several different procedures. More than three quarters of all elbow surgeries treated enthesopathy, cubital tunnel syndrome, or fracture (radial head in particular). Arthroscopy and arthroplasty accounted for less than 10% of all elbow surgeries.  Conclusions:  Elbow surgery in the United States primarily addresses enthesopathies such as tennis elbow, cubital tunnel syndrome, and trauma. It is notable that some of the most common elbow surgeries (those that address enthesopathy and radial head fracture) are some of the most variably utilized and debated.
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • Evidence-Based ACL Reconstruction

    • Abstract: There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL)reconstruction. The purpose of this article is to answer the following questions: 1) Bone patellar tendon bone (BPTB) reconstruction or hamstring reconstruction (HR); 2) Double bundle or single bundle; 3) Allograft or authograft; 4) Early or late reconstruction; 5) Rate of return to sports after ACL reconstruction; 6) Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE) search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analysesfocused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II) of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years.
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • Tranexamic Acid in Total Joint Arthroplasty: Efficacy and Safety

    • PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • Doctor Shoja-ad-Din Sheikholeslamzadeh and his Achievements

    • Abstract: Doctor Shoja-ad-Din Sheikholeslamzadeh (also known as Dr. Sheikh) (1931-2014) was an outstanding orthopedic surgeon. He is credited for the establishment of the Iranian Association of Rehabilitation, Shafa Yahyaian Hospital as an Orthopedic and Rehabilitation Center, the Social Welfare Organization, Iran’s emergency dispatch center (115) and many other major projects that led to the upgrading of health care services in Iran. He also served as the Minister of Social Welfare and Minister of Health and Welfare before the Islamic revolution. The history of modern health care management and modern orthopedic surgery in Iran are indebted to the great leadership and executive abilities of Dr. Sheikh
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • Better Survival of Total Knee Replacement in Patients Older Than 70 Years:
           A Prospective Study ...

    • Abstract:  Background: Modern knee designs have popularized its use in younger patients due to its better performance. There remains uncertainty whether higher demands of these patients can affect implant survivorship.    Purpose: To assess whether modern knee designs have provided similar results in patients younger than 70 years versus older patients. Methods: We included 203 consecutive patients (236 knees) who underwent knee replacement for osteoarthritis with a mean follow-up of 11.4 years (range: 8.8 to 12). The mean age was 70 years (range: 31 to 85). Knee replacements were stratified into two groups: 109 were younger than 70 years and 127 were older than 70 years (70 years of age is the mandatory retirement age). Results: There were no significant pre-operative differences between groups with regards to knee alignment, alpha or beta angles, knee score or function score. Fourteen implants were radiographically loose at last follow up visit. Groups were matched in terms of demographic data. We found that patients older than 70 years had significantly better mean survivorship at 12 years. (97% vs. 88%; P=0.010). Patients under 70 years presented with a higher rate of polyethylene wear which was further associated with radiolucent lines in the femur and tibia as well as the presence of osteolysis. There was also an association between migration and presence of osteolysis. Conclusions: Patients over 70 years old undergoing cemented total knee replacement for osteoarthritis showed better implant survivorship versus patients under 70 years old.
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • Biomechanical Comparison Between Bashti Bone Plug Technique and
           Biodegradable Screw for ...

    • Abstract:   Background: Ligament reconstruction is a common procedure in orthopedic surgery. Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. Purposes: We sought to introduce our new technique of Bashti bone plug for fixation of soft tissue graft in anterior cruciate ligament (ACL) reconstruction and to compare its biomechanical features with conventional absorbable interference screw technique in a bovine model. Methods: Twenty pairs of bovine knees were harvested after death. Soft tissue was removed and the Achilles tendon was harvested to be used as an ACL graft. It was secured into the bone tunnel on the tibial side via two different methods: Bashti Bone Plug technique and conventional screw method. Biomechanical strength was measured using 200 N and 300 N cyclic loading on the graft. Pull out strength was also tested until the graft fails. Results: No graft failure was observed after 200 N and 300 N cyclic loading in either fixation methods. When testing for pull out failure, 21 tendons (53%) were torn and 19 tendons (48%) slipped out. No fixation failure occurred, which did not reveal a significant difference between the bone plug or interference screw group (P=0.11). The mean pull out force until failure of the graft was 496±66 N in the screw group and 503±67 N in the bone plug group (P=0.76). Conclusions: Our suggested fixation technique of Bashti bone plug is a native, cheap, and feasible method that provides comparable biomechanical strength with interference screw when soft tissue fixation was attempted in bovine model.
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • The Results of Biplanar Distal Femoral Osteotomy; A Case Series Study

    • Abstract: Background:  Distal femur wedge osteotomies for varus or valgus alignment of the lower extremity could be done in either uniplanar or biplanar fashion.Union time and stability of the osteotomy site has been considered important in this anatomic region. In this study, clinical and radiographic findings of biplane distal femur osteotomy were reported. Methods: Clinical, functional, and radiological findings of eight patients (10 knees)underwent biplane distal femur osteotomy were evaluated. Visual analogue score (VAS) and Lysholm-Tegner knee score were used for the assessment of pain and function before and three months after surgery. Results:  In this study, eight patients were included. All patients were female. The mean age was 28±6.3. The mean pre-operativemechanical anglewas 8.7±2.2˚and the post-operativeangle was 1.4±0.53˚ in patients with valgus alignment whileit was 7.0±1.0˚preoperatively and 0.66±1.2˚ postoperatively in patients with varus alignment. The mean lateral distal femoral angle (LDFA)was 85±8.0˚ before surgery and was 88±1.3˚ after surgery. According to Lysholm- Tegner knee score, in the post-operative visit, sixknees were good and four were excellent. The mean union time was 9.2±2.3 weeks.   Conclusions:  Biplane distal femur osteotomy is a reliable technique that creates larger surfaces and more stability at the osteotomy site with further rapid union. 
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • Stage IE Primary Bone Lymphoma:Limb Salvage for Local Recurrence

    • Abstract: Background:   Primary bone lymphoma or non-Hodgkin lymphoma of bone is a rare disease. There are only a few case series of stage IE of this condition in medical literature. The aim of this study is to determine the rate of survival   for stage IE after combined modality treatment, the rate of local recurrence, and the results of limb salvage in cases   of local recurrence.     Methods:   We collected data from 61 patients with histologically confirmed PBL treated at the Musculoskeletal   Oncology Department of our hospital from 2000 to 2010. Retrospective evaluation included demographics, symptoms, tumor locations, outcomes of surgical treatment for local recurrence and survival rates. Results:   All patients received Combined Modality Therapy. Overall,five year survival was 89% and five year disease free survival rate was 78%. Local recurrence occurred in 6 patients during follow up period, which was treated surgically     by wide excision and reconstruction. The mean follow-up for the local recurrence group was 36(24-54) months and mortality rate in this group was 17%. Conclusions:   Combined Modality Therapy for stage IE primary bone lymphomaresults in good survival rate. In case   of local recurrence, wide excision and reconstruction improves the outcomes.
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • Short Form-McGill Pain Questionnaire-2 (SF-MPQ-2): A Cross-Cultural
           Adaptation and Validation ...

    • Abstract:   Background: We aimed to develop and validate the Persian version of Short Form McGill Pain Questionnaire-2 (SF-MPQ-2) in patients with knee osteoarthritis. Methods: Translation and back translation was performed using Beaton’s guideline. After a consensus has achieved on the Persian version of SF-MPQ-2, it was administered to 30 patients with knee osteoarthritis in a pilot study. Then, we enrolled 100 patients with knee osteoarthritis to fill the final SF-MPQ-2 as well as SF-36 and WOMAC questionnaires. Forty-three patients returned 3 days after the initial visit to fill the Persian SF-MPQ-2 for the second time. Construct validity was tested by Pearson’s correlation coefficient between subscales of SF-MPQ-2 and subscales of SF-36 and WOMAC. Internal consistency for total and subscales was calculated by Cronbach’s alpha and reliability between test retest was performed using Intraclass correlation coefficient (ICC). Results: ICC for subscales of SF-MPQ-2 ranged from 0.73 to 0.90. The ICC for total SF-MPQ-2 was 0.90. Cronbach’s alpha for subscales was 0.65-0.74 at the first visit and 0.58-0.81 at the second visit. Cronbach’s alpha for the total questionnaire was 0.88 and 0.91 at the first and second visit, respectively. Pearson’s correlation coefficient was highly significant when comparing subscales specifically with WOMAC (r=-0.47 to -0.61; P<0.001). Interscale correlation between subscales of SF-MPQ-2 was significant as well (r: 0.43-0.88, P<0.001). Conclusions: Persian SF-MPQ-2 showed excellent reliability and good to excellent internal consistency throughout the questionnaire. It is a valid and reliable instrument for measuring the pain intensity and applicable in osteoarthritic pain assessment.
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • Prediction of Mortality in Hip Fracture Patients:Role of Routine Blood

    • Abstract:  Methods: In a retrospective descriptive study, medical records of 204 hip fractured patients with the age of 60 or older who were admitted to the Department of Orthopedics was considered regarding routine laboratory tests. Predictive values of these tests were assessed using receiver operating characteristic curve (ROC).  Results: The incidence of death due to hip fracture was 24%. The mortality rate was significantly increased with age > 65 (OR= 15). There was no significant difference between mortality in regards to gender. High plasma BUN (more than 20 mg/dl) and creatinine (more than 1.3 mg/dl) significantly increased the chance of mortality. [OR= 3.0 and OR=2.5 for BUN and creatinine, respectively]. Patients’ mortality did not show any correlation with sodium and potassium plasma levels and blood hemoglobin. Conclusions: There is direct correlation between plasma levels of BUN and creatinine and 3-month mortality after hip fractures. Patients with high plasma levels of BUN were three times more likely to die than those with normal BUN. Also, patients with high plasma creatinine levels were 2.5 times more likely to die than those who had normal values. Mortality was also associated with increasing age but did not vary with gender. Patients aging more than 65 were 15 times more likely to die following a hip fracture than those with younger age.
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • The Zarit Caregiver Burden Interview Short Form (ZBI-12) in spouses of
           Veterans with Chronic ...

    • Abstract: Background:  To test the psychometric properties of the Persian version of Zarit Burden Interview (ZBI-12) in the Iranian opulation.  Methods: After translating and cultural adaptation of the questionnaire into Persian, 100 caregiver spouses of Iran-Iraq war (1980-88) veterans with chronic spinal cord injury who live in the city of Mashhad, Iran, invited to participate in the study. The Persian version of ZBI-12 accompanied with the Persian SF-36 was completed by the caregivers to test validity of the Persian ZBI-12.A Pearson`s correlation coefficient was calculated for validity testing.In order to assess reliability of the Persian ZBI-12, we administered the ZBI-12 randomly in 48 caregiver spouses again 3 days later. Results:  Generally, the internal consistency of the questionnaire was found to be strong (Cronbach’s alpha 0.77). Intercorrelationmatrix between the different domains of ZBI-12 at test-retest was 0.78. The results revealed that majority of questions the Persian ZBI_12 have a significant correlation to each other. In terms of validity, our results showed that there is significant correlations between some domains of the Persian version the Short Form Health Survey -36 with the Persian Zarit Burden Interview such as Q1 with Role Physical (P=0.03),General Health (P=0.034),Social Functional (0.037), Mental Health (0.023) and Q3 with Physical Function (P=0.001),Viltality (0.002), Socil Function (0.001).  Conclusions:  Our findings suggest that the Zarit Burden Interview Persian version is both a valid and reliable instrument for measuring the burden of caregivers of individuals with chronic spinal cord injury.
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • Motor Aphasia as a Rare Presentation of Fat Embolism Syndrome; A Case

    • Abstract:   Fat embolism syndrome is a clinical diagnosis, and diagnostic procedures are not specific. In every trauma patient, Fat embolism syndrome has to be considered as a possibility and supportive treatment should begin as soon as possible. The authors reported a rare case of Fat embolism syndrome whose only neurological symptom was motor aphasia. A young man sustained comminuted femoral shaft fracture following an accident presented dyspnea, motor aphasia and petechial rash. The Po2 and O2 Saturation were 53 and 91.1%. The body temperature was 38.5 °C. The hemoglobin decreased from 12.9 to 8.7 and platelet from 121000 to 84000 mg/dl. The pulse rate was 120 bpm. The CT scan and MRI were normal. Fat embolism syndrome was diagnosed according to both Gurd and Schonfeld criteria ruling out other possible causes. Patient recovered completely. Although rare, focal neurological symptoms and motor aphasia should be kept in mind as a part of diagnostic criteria.
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
  • Chronic Osteomyelitis in the Femoral Midshaft Following Arthroscopic ACL

    • Abstract:   A 25 year-old man presented with pain, swelling, and intermittent drainage from distal lateral aspect of his left knee three months after undergoing isolated ACL reconstruction with arthroscopic hamstring autograft and endobottom technique. His surgeon at that time tried to eliminate the pathology through arthroscopic wash out in two attempts. However, the pain, edema, and discharge recurred after a year of being symptom free. The patient underwent imaging assessment and anteroposterior and lateral radiographs demonstrated a sclerotic area beneath the femoral condoyle in femoral tunnel and a fusiform sclerotic area in the lateral aspect of femoral midshaft. Magnetic Resonance Imaging revealed necrotic tissue with bone edema consistent with the sclerotic area in radiographs indicating micro abscesses and osteomyelitis. A diagnosis of femoral chronic osteomyelitis was made and the patient underwent arthroscopic drainage and washout, followed by open surgery for diaphysial femoral osteomyelitis. Rehabilitation was started and after six months the patient returned to his work .
      PubDate: Wed, 31 Dec 2014 20:30:00 +010
School of Mathematical and Computer Sciences
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