Seyed Mohammad Javad Mortazavi, MD.
Vol 5, No 1 (2019)
The vast majority of collected data in trauma patients can provide medical, economic and social information to guide the health care system for operating scheduled preventive programs to decrease the burden of trauma-related injuries. Also utilizing trauma registry’s data to compare with exiting international criteria in trauma care is another advantage. Analyzing the trauma mechanism based on registered data is the first step to clarify injuries' causes and construct primary preventive trauma injuries’ local or national programs. Over the years registered data will elucidate the morbidity and mortality causes to reprogramming health care systems' policies and planning. Therefore, conducting a national trauma registry system is an important issue to introduce to health care system as soon as possible.
Trauma to the pediatric’s elbow are common and may result in different types of injuries such as bony, cartilaginous or soft tissue injuries. Fall on an outstretched hand is the most common mechanism of injury that mostly may result in hyperextension or valgus load to the elbow [1,2].
Comparing with adults, pediatric elbow fractures have a higher incidence and variability in fracture patterns . 65 to 75% of all pediatric fractures are related to upper extremity. The most common is supracondylar humerus fracture followed by lateral condyle and medial epicondyle fractures .
Interpretation of pediatric elbow radiography needs a systematic approach to prevent misdiagnosis. In this study we explained a six-steps approach to an elbow radiography for better diagnosis of the injury.
The quality of radiography, identification of the presence and position of ossification centers, a search for effusion and localized soft tissue swelling, check the alignments, check the bone cortices and finally a focused search to avoid common mistakes based on the history and clinical examination of the patient are discussed in details.
A Genu Varum Correction: A Comparison of Conventional Open Wedge High Tibial Osteotomy versus Open Wedge Osteotomy with Sagittal Plane Cutting
Background: Open wedge high tibial osteotomy (OWHTO) is commonly utilized to correct genu varum. To decrease various complications of OWHTO, some modifications are needed.
Methods: In a parallel randomized controlled clinical trial, 42 patients were divided into two groups: conventional OWHTO (control group) and OWHTO with the cut in the sagittal plane or distal tubercle osteotomy (OWHTO/DTO) (intervention group). Evaluation of the following items was conducted pre- and post-operatively: Knee Society Score (KSS) questionnaire, incidence of postoperative complications, patellar height by Blackburne-Peel (BP) ratio and Insall-Salvati Index (ISI), posterior tibial slope (PTS), tibiofemoral angle (TFA), Q-angle, medial proximal tibial angle (MPTA), three joint alignment radiography, and union radiological parameters.
Results: The differences between preoperative and postoperative variables including the KSS, PTS, TFA, BP Index (BPI), ISI, MPTA, and Q-angle within the intervention and control groups were not statistically significant. In four cases (3 in the control group and 1 in the intervention group), the delayed union was observed but the complete union was achieved after a mean of 23 weeks. No nonunion was observed.
Conclusion: Our results showed equal effectiveness for OWHTO/DTO compared with the conventional OWHTO.
Tranexamic Acid Effectiveness on the Amount of Bleeding during Surgery and Surgeon’s Satisfaction in Intertrochanteric Fracture Fixation:A Randomized Clinical Trial
Background: The purpose of this double-blind randomized clinical trial study was the evaluation of intravenous tranexamic acid on hemorrhage volume during Surgery and surgeon's satisfaction in intertrochanteric fracture surgery.
Methods: A total of 62 intertrochanteric fractures (AO class 1 to 3) were randomly divided into two groups of 31. In the control group patients (69.2± 6.1 years old) treated with placebo and the intervention group receiving1gr tranexamic acid (69.7± 6.4) have exposed under the surgical operation by lateral approach and proximal femur’s plates., the amount of gauze and post operative blood losses measured with the amount of blood in the drain 48 hours after surgery. Also the hemoglobin levels compared before and after surgery. In the end, Surgeon satisfaction was measured by Likert scale.
Results: The amount of intraoperative bleeding in suctiondid not differ statistically between the arms (P-value = 0.465).Furthermore, the mean of gauze number in the intervention group was significantly lower than the control group (P-value <0.05). although the mean amount of blood in the drain 48 hours after surgery in the control group was higher than the intervention group B, but it was not statistically significant (P-value = 0.05). The mean of hemoglobin in the control group was significantly lower than group B (P-value <0.05).the proportion of patients in need of transfusion in the control group was significantly higher than the intervention group (P-value <0.005). Mean of satisfaction in the intervention group was significantly higher than the other arm (P-value <0.05).
Conclusion: The evaluation of intravenous tranexamic acid duringintertrochanteric fracture surgery can reduce hemorrhage volume during Surgery, reduce the need ofblood products’ transfusionand finally improve surgeon satisfaction.
The Effectiveness of Intra-Articular Injection of Hypertonic Saline in Pain Control and Function of Patients with Knee Osteoarthritis
Background: To report the effectiveness of intra-articular injection of hypertonic saline in pain reduction and function improvement of patients with knee osteoarthritis.
Methods: Patients with knee pain and dysfunction who fulfilled the American College of Rheumatology criteria and whose illness was sub-acute or chronic were enrolled. We performed a single Intra-articular injection of 5cc of hypertonic saline solution 5%. Measured outcomes were Visual Analogue Scale (VAS) score and Knee injury and osteoarthritis outcome score (KOOS) evaluated before and 1 month after intervention.
Results: a total of 28 patients with mean age of 66.3 years were surveyed. Overall, study participants reported clinically and statistically significant reduction in VAS and KOOS subscales for symptoms, pain, function, daily living, sports, recreational activities and quality of life in one month of follow-up with respect to the patients’ mean baseline scores which were reduced by 24.47%, 42.74%, 54.96%, 43.78% and 63.63%, respectively (P-value<0.05 for all comparisons). Although obese patients (BMI≥30 kg/m2) showed less improvement in terms of pain, sports and quality of life subscales of KOOS subscales, compared with non-obese patients (BMI<30 kg/m2), VAS scale difference was not significant.
Conclusions: Intra-articular injection of hypertonic saline yields a statistically and clinically significant short-term pain reduction and functional improvement of patients with knee osteoarthritis.
A Comparison of Bipolar Hemiarthroplasty versus Dynamic Hip Screw Fixation of Basicervical Femoral Neck Fractures
Background: Surgical treatment of basicervical femoral neck fractures, which is biomechanically similar to intertrochanteric fractures, is an internal fixation by DHS and anti-rotation screw. Since devise failure is one of the most noticeable complications of these surgical procedures, this study aimed to compare the bipolar Hemi-arthroplasty with DHS plate internal fixation in elderly patients with a basicervical femoral neck fracture.
Methods: This is a randomized controlled clinical trial in which 60 patients with femoral neck fractures were divided into two groups of 30 control (DHS fixation) and intervention (Bipolar hemiarthroplasty) randomly. Functional evaluation was completed by the HHS questionnaire and VAS scale for pain assessment, postoperative complications at 6 months and one year postoperatively. Data were analyzed using Stata software.
Findings: The overall mean age in the control group was 73.95± 9.85 and in the intervention group 74.22±7.85 years. Three patients in the intervention group and 6 patients in the control group were excluded. HHS in Sixth months and one year after surgery were significantly higher in the bipolar group compared to the DHS group(p-value<0.0003and p-value < 0.0097). there were no significant differences in VAS between the two groups (p-value<0.4557 and p-value < 0.4578).The rate of device failure in the control group was 2 cases.
Conclusion: Overall, the results of this study show that bipolar hemiarthroplasty surgery is more effective than internal fixation by DHS plate in improving the patients' quality of life based on the HHS scores, and the lower failure rate as well as diminishing of the reoperation rate.
Scaphoid fracture can cause serious complications and its diagnosis and treatment approaches are still contentious. Tenderness of anatomical snuffbox (ASB), longitudinal compression (LC) of the thumb, and scaphoid tubercle (ST) tenderness are very sensitive tests for clinical diagnosis of scaphoid factures all together. Previous studies recommend taking four standard views of the wrist for non-displaced scaphoid fractures diagnosis. Magnetic resonance imaging (MRI), computed tomography scan (CT scan), bone scintigraphy, and ultrasound are used for triage of suspected scaphoid fractures. MRI has the highest sensitivity and specificity. CT scan images captured in planes by the long axis of the scaphoid guide the diagnosis of nondisplaced scaphoid fracture. Displaced fractures need surgical treatment, but the best way of treating a nondisplaced fracture is controversial. Same results have been determined using a short arm or long arm cast for treatment of nondisplaced scaphoid fractures as well as similar outcomes with or without a thumb-spica component to the cast. Wrist position immobilization did not affect the rate of nonunion, wrist flexion, pain, or grip strength. Percutaneous screw fixation can shorten return to work time. CT scan and MRI both can be applied for assessment of union of fracture during follow-up period. This study aims to review the literature on challenges about clinical and radiologic diagnosis of nondisplaced scaphoid fractures and also present concepts about definite management of nondisplaced and minimally-displaced scaphoid waist fractures.