Seyed Mohammad Javad Mortazavi, MD.
Vol 8, No 1 (2022)
Femoroacetabular impingement (FAI) could cause early osteoarthritis in patients. It is important to diagnosis this condition in the early stages to avoid osteoarthritis. The radiological x-ray is one of the main methods to diagnose FAI. There are many radiological signs which help orthopedic surgeons to diagnose FAI in the pelvic x-ray. Recent studies revealed many new signs for diagnosis and in the present concept article, we try to review all the radiological signs of the FAI in the pelvic and hip x-ray.
The Role of Tranexamic Acid in Reducing Blood Loss Following Total Joint Arthroplasty: A Review Article
Total Joint Arthroplasty (TJA) is a major surgery performed for patients who suffer from severe joint destruction. It is so important to reduce the blood loss in the TJA surgery to decrease the infection rate, falling, and other complications following the surgery. Many methods could reduce blood loss, such as mechanical methods and chemical methods. Tranexamic acid (TXA) is a chemical method to reduce blood loss in surgery. There are numerous methods of administration of TXA in the literature, such as intravenous (IV), intra-articular, and a combination of intra-articular and -venous methods. In the present review article, we review the studies that compared the efficacy of each method of the TXA administration.
Evaluation of Bone Mineral Density in Patients Undergoing Total Hip Arthroplasty and Total Knee Arthroplasty
Background: Osteoarthritis and osteoporosis are the most prevalent musculoskeletal disorders (MSDs) in middle aged and elderly individuals and affect their quality of life (QOL). The presence of both these disorders is rarely reported in an individual patient. This study was conducted with the aim to assess this association using Dual-energy X-ray absorptiometry (DEXA) as a measure of bone mineral density (BMD) in patients undergoing hip and knee arthroplasty.
Methods: Between August 2015 and August 2018, 71 patients were selected as the study participants. The inclusion criteria included age of higher than 50 years and presence of primary or secondary arthritic conditions. The exclusion criteria were age of below 50 years, prolonged steroid intake (3 months), metabolic disease, and performance of arthroplasty for the management of fractures. Results: The incidence rate of osteoporosis was found to be higher in higher age groups of patients undergoing arthroplasty. Furthermore, there was no statistical difference in the T-scores with respect to the sex of the patients.
Conclusion: Osteoarthritis and osteoporosis can occur simultaneously in an individual. The development of osteoarthritis does not prevent the development of generalized osteoporosis in an individual patient.
Background: The posterior cruciate ligament (PCL) presents commonly as avulsion fractures from the tibial attachment site. Isolated tears of the PCL can be caused by a fall on the flexed knee or dashboard injury in road traffic accident. Such a mechanism (the upper tibia driven posteriorly with the knee flexed) may produce PCL disruption as the only clinically detectable instability. For the PCL avulsion fractures fixation, there are various methods available like closed reduction and internal fixation (CRIF), open reduction and internal fixation (ORIF), and arthroscopic fixation. This study was performed to assess the result of PCL avulsion fracture managed with ORIF with cannulated cancellous screw.
Methods: We performed ORIF using cannulated cancellous screws with the posterior approach in 11 patients with isolated PCL tibial avulsion injuries. The minimum follow-up period was 6 months. The results were assessed radiologically and clinically. The spectrum of outcomes following PCL tibial avulsion fracture were measure using the Lysholm knee scoring system and range of motion (ROM) of the knee joint.
Results: 63.6, 27.3, and 9.1 percent of the cases had excellent, good, and moderate fracture healing, respectively.
Conclusion: PCL tibial avulsion fractures managed with open reduction with cannulated cancellous screw fixation yields good functional outcome with less complications.
Background: Sanctions have always been an obstacle for development, even in health and medical topics, since they aim to reduce a country’s financial and economic power, and their impacts on medical and health systems in the objected country are inevitable. In this report, we are going to show the effect of sanctions on orthopedic surgeries in Iran.
Methods: In this study, we surveyed the opinion of 32 orthopedic surgeons about the effect of sanctions on orthopedic procedures.
We evaluated surgeries routinely done in our referral centers in terms of the need for equipment and facilities.
Results: In upper limb surgeries, the high cost of equipment has more frequency between answers although, in lower limb surgeries, the changing method due to lack of facilities with worse results than the standard method has more frequency between answers. Both results indicate that sanctions made the feasibility of orthopedic surgeries more difficult.
Conclusion: We believe that several actions are needed to take place in the current situation by the international organizations to stop this unreasonable and illogical sanction, to prevent its devastating results.
Background: Due to traumatic events, patients with acetabular fractures are vulnerable to rupture of the peritoneum and abdominal hernia in the fracture site. Infection and thromboembolic events are the two most common complications of this situation.
Case Report: In the current report, we present a 63 year-old woman with a traffic accident that was diagnosed with multiple fractures of posterior and anterior walls and anterior column of the right acetabulum associated with femoral head protrusion to the fracture site. Furthermore, the right posterior iliac wing fracture and mild subluxation of the right sacroiliac (SI) joint were observed in the pelvic computed tomography (CT) scan. During the Stoppa surgical approach, small intestine penetration and peritoneum were observed and immediately treated by the surgical team. Our case was later diagnosed with pulmonary thromboembolism and recovered successfully, and no infectious complications were observed.
Conclusion: We suggest that bowel entrapment be considered in blunt traumatic events, and antibiotics and anti-coagulants be used in similar cases.
Background: Despite improvement in technology and decision-making, misdiagnosis or delayed diagnosis of cervical spine injuries in trauma patients can cause severe irreparable neurological damage.
Case Report: We present here a 56-year-old man, with a history of old bilateral C4-C5 dislocation who, contrarily to classically described unfavorable results of cranial traction in patients with older than 3 weeks cervical injury, underwent optimal reduction under cranial traction for four days and surgical intervention with an anterior surgical approach.
Conclusion: Relatively high incidence of missed cervical spine injuries in polytrauma patients illustrates that proper clinical examination, use of designed protocols for clearance of cervical trauma, and accurate interpretation of radiological imaging can sometimes be neglected.