Seyed Mohammad Javad Mortazavi, MD.
Vol 5, No 2 (2019)
Background: Intramedullary nailing (IM nailing) is the standard of care for the treatment of most diaphyseal lower extremity fractures. A few studies have assessed and compared the infection rate following reamed and unreamed IM nailing in open long bone fractures. In the present study, we attempted to compare the infection rate between two procedures in open fractures of tibia. Methods: In this prospective study, we included consecutive patients suffering from open fractures of tibia (Gustilo subtypes II or IIIA) who required IM nailing. Patients younger than 16 years old, other Gustilo types (I, IIIB, and IIIC), fractures reaching to the tibial plateau articular surface, and simultaneous fractures of other bones in the extremity were excluded. All patients were followed up for one year to assess the postoperative infection rate.
Results: Of 59 patients, 37 underwent reamed IM nailing and 22 underwent unreamed IM nailing. In reamed group, 4 cases (10.8%) experienced an infection requiring reoperation and antibiotic therapy, while in the unreamed group, it was 5 cases (22.7%). The difference between the groups was not statistically significant.
Conclusion: Reamed and unreamed IM nailing procedures for fractures of tibia have similar outcome regarding long-term postoperative infections that require reoperation and antibiotic therapy.
The Effect of Body Mass Index, Age, Weight, and Psychosocial Status on Bone Mineral Density in Postmenopausal Women on Hemodialysis
Background: Decreased bone mass, often measured using bone mineral density (BMD) is frequently seen in patients with end-stage renal disease (ESRD) undergoing hemodialysis. It may cause serious bone health problems such as fractures. Several risk factors of low bone mass in the patients on hemodialysis have been proposed including age and body mass index (BMI). Our current study explored the relationship between BMI, age, sociodemographic status, and BMD among postmenopausal women on hemodialysis.
Methods: This study enrolled postmenopausal women on hemodialysis whose bone densitometry was checked and assessed with the age, BMI, and social status. Statistical analysis was performed in SPSS software.
Results: Sixty participants with a mean ± standard deviation (SD) of age of 57.00 ± 10.63 years were enrolled. After adjustment of sex and age, normal-weight women had 2 times the prevalence of low bone density compared to the obese women [prevalence ratio (PR) = 2, 95% confidence interval (CI): 1.4–2.8]. For osteoporosis, the PR was also twice higher for the women with normal BMI (PR = 2, 95% CI: 1.3-2.8) and 1.6 times higher for the overweight group than the women in the obese group (PR = 1.6, 95% CI: 1.3-2.4).
Conclusion: Among the women on hemodialysis, obese women have lower prevalence of osteoporosis than normal-weight cases
Don’t Do This Case Report: Do Not Do This Case Report: Recurrence of Knee Flexion Contracture after Extension Osteotomy in Congenital Patellar Dislocation: The Importance of a Thorough Patient Evaluation
Background: Congenital patellar dislocation (CPD) is a rare disorder which presents with hypoplastic and irreducible patellae. It is accompanied by flexion contracture of the knee joint, genu valgum, and external tibial rotation.
Case Report: A seven-year-old girl with CPD who was misdiagnosed as having cerebral palsy (CP) crouch gait and underwent distalfemoral extension osteotomy (DFEO) without paying attention to the dislocated patellae, is presented. Recurrence ensued, and the patient was referred for further evaluation. After a second surgery to address the dislocated patellae, the flexion contracture andgait pattern improved significantly.
Conclusion: The case underscores the importance of a systematic, thorough physical examination, without which uncommon diagnoses will be overlooked, exposing the patient to further morbidity and complications.
Background: Asymmetric bilateral hip dislocation is a rare condition and the association with bilateral femoral head fracture makes it even more rare. We report a patient with asymmetric bilateral hip fracture – dislocation and our management and therapeutic approach.
Case Report: A 28-year-old male sustained motor vehicle accident and presented asymmetric bilateral hip fracture-dislocation. In the initial step close reduction was performed and in the following step the patient underwent bilateral open reduction and fixation of femoral head fragment by screws. The results were satisfactory after 5 year follow-up.
Conclusion: Although rare, paradoxical femoral head fracture should be considered in patients with hip dislocation. Our management and therapeutic approach seems to be appropriate for this case and is suggested in similar cases.
Polytrauma describes the condition of a child subjected to multiple traumatic injuries and can be a life-threatening condition. Approximately 30% of children with severe trauma die because of inadequate initial assessment. To reduce the rate of mortality and morbidity, it is essential to know the primary and then the secondary survey of the patient. The first hour (the “golden hour”) after injury is the most critical in influencing the rates of survival from the injuries. Initial resuscitation follows the Advanced Trauma Life Support (ATLS) or Pediatric Advanced Life Support (PALS) protocols (ABCDE), Airway, Breathing, Circulation, Disability (neurologic), Exposure (Extremities). Urine catheter is mandatory too.After the management of the patient in the first survey and stability of the vital signs, the team and the physician can start their second survey. It includes a complete history and a complete and serial examination from head to toe. With Ecchymosis on the abdominal wall, abdominal injury is suspected. Taking radiographs and other imaging according to physical exam are included in the second survey too. Taking a pelvic and chest and bed side lateral neck radiograph is mandatory.
Scapholunate instability is the most common cause of carpal instability. The entity is often missed in practise. If diagnosed early, it may be repairable. However, the later it is diagnosed, the more complicated and difficult the management would be. In this paper we aimed at reviewing the main concepts of the carpal instability and delineating the wide management options of scapholunate interosseous ligament injury discussed in the literature.
Femoral neck fracture is a global public health problem with 1.5 million hip fractures per year worldwide. However, there is no current consensus on the choice of ideal treatment. In this study, we aimed to answer the questions of when to choose internal fixation and arthroplasty, whether to do total hip arthroplasty or hemiarthroplasty, whether to use cemented or uncemented prosthesis, and whether to use a bipolar or unipolar design for hemiarthroplasty. We also discussed the complications associated with each method. We attempted to discuss these issues based on the latest literature and also presented the protocol of our institute in each subject.