Vol 7, No 2 (2021)

Research Articles

  • XML | PDF | downloads: 183 | views: 646 | pages: 39-43


    Background: Non-operative management of valgus impacted femoral neck fracture leads to prolonged bed rest which may lead to deep vein thrombosis. The preferred method is the internal fixation because of pain control, enhanced mobilization, and better fracture healing but fails in older patients and individuals with medical comorbidities. The present study aims to assess the functional outcomes after the internal fixation or the non-operative management.


    Methods: A retrospective cohort study was conducted at a Level I trauma center from January 2013 to December 2019 on all patients with valgus-impacted femoral neck fractures [Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association Classification (AO/OTA 31-B1)]. Overall, 81 patients were managed operatively with three partially threaded, cannulated screws in a parallel configuration and 21 patients were managed non operatively with instant mobilization, physical therapy, and partial weight-bearing protocol.


    Results: 6 (28.0%) patients in the non-operative group and 3 (4.0%) cases in the operative group experienced fracture displacement (P < 0.001). 48 (59.2%) patients of the operative treatment group returned to baseline ambulatory function at 3 months, while this figure was 43.0% in the non-operative treatment group, not significantly different (P = 0.100). There was no significant difference in the mortality rates at one month and three months between the two groups (2 patients in each group, P = 0.140).


    Conclusion: The ideal treatment of valgus-impacted femoral neck fractures is still controversial. The main purpose in the treatment of hip fractures is to return the patient to functional level equal to the level he or she was before the fracture. Surgically treated patients had lower failure rates in comparison with the other group.

  • XML | PDF | downloads: 117 | views: 290 | pages: 44-7

    Background: Center of pressure (CoP) trajectory is one of the gait parameters that is widely used for clinical assessments. Moreover, the CoP trajectory could be adversely affected by anatomic and mechanical factors that involve foot function, which was shown to be correlated with musculoskeletal diseases. The aim of this study is to compare angle-associated parameters of gait in patients with different lumbar spinal disorders.


    Methods: The subjects suffered from the same levels of spine impairment, including patients with lumbar spinal stenosis (LSS) and lumbar intervertebral disc degeneration (LIDD) were recruited in this study. The spatio-temporal angular parameters associated with the CoP of the subjects during their gait were collected and examined. The measurements were used to calculate the CoP angle and symmetry angle (SA). Then the butterfly diagram (BD) intersection angle was introduced as a new potential parameter in gait assessment.


    Results: The results of the current study showed that CoPs and SAs did not vary between the two groups (P > 0.05). The BD intersection angle, however, indicated some variations between patients with LSS and LIDD (P < 0.05).


    Conclusion: While the results showed that CoP angles and SAs did not differ between the LSS and LIDD groups, it is hypothesized that such disorders that affect the gait could be reflected in the BD intersection angle. Therefore, the BD intersection angle is suggested as a clinical indicator in clarifying patients with lumbar spinal disorders.


  • XML | PDF | downloads: 113 | views: 186 | pages: 48-52

    Background: This study was aimed to evaluate the final results of surgical treatment (Latarjet procedure) in the recurrent anterior shoulder instability following episodes of tramadol-induced seizure.


    Methods: From January 2005 to March 2013, 47 patients with recurrent anterior shoulder dislocation after suffering a seizure episode following tramadol use underwent surgical procedure. There were 53 shoulders in 47 male patients (six had bilateral recurrent dislocations). The mean age of the patients at the time of operation was 24.7 years (ranging from 20 to 44 years). The average number of episodes of anterior shoulder dislocation before surgery was 16.


    Results: External rotation with the elbow at the side improved from 45.8 ± 9.3° (30°-60°) pre-operatively to 61.5 ± 7.8° (45°-90°) post-operatively (P < 0.001). Forward elevation also increased significantly post-operatively (P = 0.002). Mean pre-operative Rowe score was 28.41 ± 4.30 (30-85) which increased to 73.57 ± 8.40 post-operatively. The Western Ontario Shoulder Instability Index (WOSI) score decreased from 1352 ± 74 to 618 ± 46 (P < 0.0001).


    Conclusion: Correcting glenoid bone loss by Latarjet procedure combined, if necessary, with humeral head defect reconstruction could be a proper treatment method in patients experiencing recurrent anterior shoulder dislocation after idiosyncratic seizure reaction of tramadol.

Case Report

  • XML | PDF | downloads: 90 | views: 139 | pages: 61-3

    Background: Revision surgery of spine can be a complex procedure and has known complications. It involves hardware revision, removal of scar/callus tissue, realignment of sagittal balance, and anterior augmentation. However, through this report, we aim to demonstrate that a stand-alone rod augmentation at the failure site without removal of scar/callus tissue and/or anterior fixation can achieve excellent results in select cases.


    Case Report: A 66-year-old woman underwent L2 pedicle subtraction osteotomy (PSO) + T9-iliac fixation for fixed sagittal imbalance and osteoporotic collapse of L3. One year later, she developed progressive axial lumbar pain and difficulty in mobilization. The patient was diagnosed with pseudoarthrosis and instrumentation failure and underwent revision spine surgery with stand-alone rod augmentation. She had an uneventful rehabilitation and showed complete radiographic union and excellent clinical outcome in the 2-year follow-up.


    Conclusion: Stand-alone rod augmentation can provide stable posterior construct to prevent future pseudoarthrosis and/or instrumentation failure after revision spine surgery in selected cases. Anterior augmentation or resection dural scar tissue or dissection through callus tissue is not always necessary.


  • XML | PDF | downloads: 114 | views: 185 | pages: 64-6

    Background: Among all joint dislocations, dislocations of the shoulder are the most common. Although posterior shoulder dislocation is infrequent, it is more common following seizures. Trauma, electrocution, and seizures can cause bilateral shoulder dislocation. Anterior shoulder dislocations can be accompaniment by greater tuberosity (GT) fractures, Bankart fractures, and other complications such as rotator cuff tears and neuro-vascular injuries.


    Case Report: This article describes a 19-year-old boy who suffered from bilateral anterior shoulder dislocation due to an episode of generalized seizure, which happened after taking tramadol.


    Conclusion: Any sign of shoulder pain in a patient who has experienced a generalized tonic-clonic seizure should warrant full radiographic evaluation to prevent the complications.

  • XML | PDF | downloads: 122 | views: 245 | pages: 67-70

    Background: Retained surgical items (RSIs) are not very common in the orthopedic surgery. Here, we are reporting a case of a sponge pad left in the femoral canal for 22 years. We could not find any other reported case of retained surgical sponge in the femoral canal and that is what makes this case report unique.


    Case Report: The patient was a 42 year-old man who underwent surgery for the fixation of a fractured femur 22 years ago. In August 2020, this patient was seen complaining about pain at the surgical site. The assessments revealed a sponge pad retained in the femoral canal, which was removed by surgery. The union of fractured bone did not take place in the first surgery, so after 6 months a second surgery was performed and the dynamic compression plate (DCP) placed was successfully replaced with an intramedullary nail.


    Conclusion: The surgeon could not detect the pad 22 years ago and the patient had no significant symptoms all this time. The most important take-away lesson of this paper is that retention of surgical pads could also occur with correct gauze counting, so detection and prevention protocols for RSIs must be taken seriously.

  • XML | PDF | downloads: 92 | views: 204 | pages: 71-3

    Background: Nonunion and pseudoarthrosis formation following scapular spine fracture is a rare condition and is limited only to case reports. Some authors reported its association with rotator cuff impingement. Standard treatment is not defined well as the condition is rare.


    Case Report: Our patient was a 61-year-old man with painful nonunion in addition to cuff impingement. Surgical treatment by open reduction, internal fixation with reconstruction plate and tension band wiring, along with bone grafting led to fracture union, as well as complete resolution of the rotator cuff tendinopathy.


    Conclusion: Surgical fixation seems to be the best choice in treating scapular spine pseudoarthrosis. The first attempt should be the best, so we took an aggressive approach by the use of plating, tension band wiring, and bone grafting altogether.

  • XML | PDF | downloads: 92 | views: 143 | pages: 74-6

    Background: Osteoid osteoma is a benign osteogenic tumor affecting adolescents and young adults. It is managed using different treatment options. The lesions located around the lesser trochanter is rare and the management of these lesions is troublesome. Here, we report a case of an osteoid osteoma in the lesser trochanteric region, managed with a minimally invasive surgical excision of the lesion.


    Case Report: In a 14-year-old girl patient with nocturnal left thigh pain from 2 years before, conservative treatment with administration of non-steroidal anti-inflammatory drugs (NSAIDs) was not effective, and symptoms were refractory to medication. The day after surgery the patient was pain-free.


    Conclusion: The surgical management of osteoid osteoma in the region of the lesser trochanter is troublesome. The minimally invasive surgical excision of the lesion using CT-guided percutaneous drilling and resection of the osteoid osteoma is a safe, simple, cost-benefit, and effective technique.