Vol 4, No 3 (2018)


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    The popularity of AO method among the surgeons, and organization of Iranian chapter of AO Alumni Association, were well known and not possible to be ignored, but It was necessary to find a way to have trauma training as before and holding events and courses under the umbrella of a scientific Association. So the Persian Orthopaedic Trauma Association (POTA) was founded in 2002. The association has focused on training and proper treatment of all kinds of traumas related to extremities and spine. In this regard, we are in close relations with professionals for scientific exchanges. Some of the activities of POTA are seasonal scientific meeting, scientific events in different provinces of the country, nursing orthopaedic workshop, POTA board and ATLS and PH-TLS training classes. POTA is one of the associated society of EFFORT (European Federation of the national association of Orthopaedic and Traumatology) and has started to do the same aim with DKOU (German Congress of Orthopaedics and Traumatology). POTA has begun publishing a magazine titled "the Journal of Orthopedic and Spine Trauma (JOSTrauma)" that aims at trauma-related issues especially in developing countries.

Research Articles

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    Background: Intertrochanteric fracture in elderly patients is a frequent problem and is becoming more prominent as the proportion of this injury increases. The ideal treatment for an unstable intertrochanteric femoral fracture in senile osteoporotic patients remains controversial.
    Methods: Seventy-five patients (over 70 years of age) with unstable intertrochanteric fractures were randomized into three groups and treated with three different procedures including long-stem bipolar hemiarthroplasty, proximal femoral nail (PFN), and dynamic hip screw (DHS). Estimated blood loss, duration of the operation, time of full weight-bearing, and Harris Hip Score (HHS) were determined for each patient. 
    Results: Surgical time was longer in hemiarthroplasty group, but the HHS and time from surgery to mobilization in these patients were significantly superior to the two other groups. PFN group had the lowest bleeding volume during surgery. Revision surgery was lower in hemiarthroplasty compared to the internal fixation, although it was not statistically significant.
    Conclusions: In elderly patients with an unstable intertrochanteric femoral fracture who cannot tolerate long immobilization time, primary long distal fitting bipolar hemiarthroplasty is a valid treatment option for faster mobilization, good clinical efficacy, and satisfactory functional outcome.


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    Background: This study was conducted to develop a modified, parsimonious, faster to produce, easier to implement, and patient-specific drill guide template and also to examine if such a modification might affect the accuracy.
    Methods: On two cadaveric spines, using reverse engineering, the orientation of pedicles, and safe corridors for pedicle screws were determined. A drill template was designed with a surface that was the inverse of the posterior vertebral surface. The drill template was manufactured using a rapid prototyping technique. To decrease the costs, the cervical spine corresponding prototypes were not manufactured. In contrary to previous studies, to preserve the stability from the posterior element, the templates were designed in such a way that removing interspinous and supraspinous ligaments were not necessary. The accuracy was evaluated by computed tomography (CT) images and classified into three grades of 0: correct placement, 1: malposition by less than a half screw diameter, and 2: malposition by more than a half screw diameter.
    Results: Of 20 positions available, we inserted 19 screws, because the trajectory of one of the patient-specific drill guide templates was misdirected. The overall accuracy rate for cervical pedicle screw (CPS) placement was 84.2% (16 of 19). Safely inserted screws, combining the grades 0 and 1 categories, were as high as 100%. We observed no “unsafe screw placement”.
    Conclusions: The total cost and the latency period before the operation was reduced and the interspinous and supraspinous ligaments were preserved. Good applicability and high accuracy was obtained for subaxial CPS (SCPS) insertion.


Educational Corner

Case Report

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    Background: Post-traumatic arthroplasty is associated with higher rates of complications and overall inferior outcomes when compared with primary joint replacement. The literature revealed no precise guidelines on the management of nonunion of Hoffa fracture. Hence, we tried to elicit a management protocol in such patients from the literature perspective.
    Case Presentation: A 62-year-old patient survived a car accident with a distal femoral fracture in the coronal plane (Hoffa fracture) and was treated with open reduction and internal fixation (ORIF). Three years later, the patient developed nonunion with post-traumatic arthritis (PTA). Owing to joint degeneration and poor bone quality, the patient was treated with total knee arthroplasty (TKA). One year follow-up showed excellent outcomes.
    Conclusions: Inpatient with healthy joint surface and good bone density, treatment of choice should be ORIF and in those with joint degeneration and low bone stock, arthroplasty is a better choice.



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    Background: Collagen VI (COLVI) dysfunction results in a combination of connective tissue and muscular disorders. Spinal involvement and development of scoliosis precede loss of ambulation and respiratory deterioration in these patients. Therefore, spinal deformity correction surgery is warranted to preserve ambulation and respiratory function.
    Case Presentation: A twelve-year-old girl presented with progressive scoliosis accompanying respiratory deterioration, sitting imbalance, and wheelchair-bound. The patient demonstrated an array of overlapping phenotypes related to COLVI dysfunction, including developmental delay, muscular dystrophy (MD), fatty replacement of skeletal muscles, and reduced bone mineral density to mention few. Patient was diagnosed with COLVI dysfunction caused by COLVI alpha 2 (COL6A2) gene mutation. She had severe phenotype expression similar to Ullrich congenital MD (UCMD). A Cobb angle of 85 degrees and thoracic kyphosis of 40 degrees were recorded. Surgical correction was performed in the form of spinal fusion from T4 to S1 in addition to multiple level vertebral osteotomies.
    Conclusions: Respiratory distress and ambulatory problems are life-endangering events in these patients. As the disease progresses and respiratory distress increases, anesthesia becomes more difficult and the risk of surgery increases. Therefore, early intervention for correction of scoliosis is warranted to support the quality of life. Surgical time has to be kept as short as possible to minimize blood loss in these patients.


  • XML | PDF | downloads: 103 | views: 115 | pages: 65-68

    Background: Distal femoral fractures are not common among all fractures and the incidence rises with age. While this kind of fracture is usually caused by low-energy trauma in the elderly, there are many known fracture patterns. We encountered a new pattern of fracture in a middle-aged man.
    Case Presentation: A 56-year-old obese man presented to our hospital with direct trauma from a motor car accident. We encountered a bizarre pattern of distal femoral fracture, which was a biplanar unicondylar fracture in the medial condyle of the femur through physeal remnant. This fracture was similar to the pattern of Salter-Harris type III fracture and unicondylar type of T-type simple articular epiphyseal fracture in Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification (type 43.C1.3). The fracture was fixed with two 7.3mm cannulated screws.
    Conclusions: A direct trauma to the distal femur can result in different fracture patterns. In our case, a fracture through physeal remnant of the distal femur has occurred in a morbidly obese patient with radiographic signs of osteoarthritis (OA). We hypothesize that the conduction of axial and anterior to posterior forces through the weak epiphyseal line in a patient can cause a new pattern of fracture similar to AO/OTA type 43.C1.3.