Seyed Mohammad Javad Mortazavi, MD.
Vol 8, No 2 (2022)
The spine, pelvis, and hip are three anatomic structures that tightly interact to create spinopelvic mobility and harmony. Orthopaedic surgeons, both spine and hip specialists, must have a complete awareness of this concept. Recently, the literature has placed great emphasis on paying attention to these parameters in the preoperative planning of the total hip arthroplasty (THA). We could distinguish between balanced and unbalanced pelvis and spine with spinopelvic parameters and therefore, we could diagnose the spinopelvic stiffness that is important in preventing complications following THA. This review briefly introduces the importance of spinopelvic parameters and their critical role in THA outcome. Treatment algorithms are also provided based on the most recent studies.
The skeletal system has a high healing capacity. A nonunion fracture occurs when the natural course of bone healing is impaired. Numerous local and systemic factors participate in the development of a nonunion fracture. Patients with diabetes mellitus (DM), smoking history, obesity, and malnutrition are at risk for nonunion. Moreover, the major local risk factors for impaired bone healing are malalignment, infection, mechanical stability, and tissue loss. In this brief review, we discuss the definition, epidemiology, and diagnosis of nonunion. We further explain the major contributing factors which must be considered in patient selection for nonunion revision surgeries.
Evaluating the Effect of Double Plating Fixation with Bone Graft in Nonunion of Femoral and Tibial Fractures after Primary Surgery
Background: Several treatment approaches are now considered to manage tibial and femoral shaft nonunion after primary surgeries. Double-locking plates with channel bone grafting technology are treatments that surgeons could choose. We aimed to describe our experiences in evaluating the union of bone for these patients after using double-locking plates with channel bone grafting with serial examinations and radiologic studies.
Methods: This case study was conducted on 33 patients consisting of 20 femoral nonunion and 13 tibial nonunion cases. They underwent double plate fixation with bone grafting at Sina Hospital, Tehran, Iran, from 2015 to 2020. They were monitored for an average of 60 months after surgery.
Results: Union was achieved in all the patients in a mean of 10.03 months (range: 8-18 months). During patients’ follow-up, no plate and screw breakage, device loosening, deformity, and infection were seen. No additional surgery was needed for any of our patients. Conclusion: There are various treatment options for nonunion of long bones. This study described the double plating approach for treating femoral and tibial shaft nonunion. The technique of double plate fixation and bone grafting had reasonable union rates in long bone nonunion. The present case series analysis also shows that it is more beneficial to manipulate this promising method for long bone nonunion whenever possible.
Mortality Rate and Quality of Life in Patients with Intertrochanteric Fractures Treated with Dynamic Hip Screw
Background: Intertrochanteric (IT) fracture is one of the most common fractures in adults. Dynamic hip screw (DHS) surgery is a surgical procedure for IT fracture treatment. This study evaluated the mortality rate and quality of life (QOL) among these patients one year after the surgery.
Methods: This cohort study was conducted on 110 patients with IT fractures treated with DHS from 2017 to 2019. A questionnaire was completed for each patient before, during, and after surgery. Preoperative information included demographics, height, weight, body mass index (BMI), smoking, diabetes, variables such as IT fracture classification, injury mechanism, lateral wall, and the American Society of Anesthesiologists (ASA) comorbidity classification. Tip-apex distance (TAD), nail position at the femoral head, and the amount of bleeding during the operation were achieved during and immediately after the surgery. The mortality rate was determined one year after the surgery, and the surviving patients were assessed by the 36-Item Short Form Survey (SF-36) questionnaire.
Results: The mortality rate among patients who underwent DHS was 31.81%. There was no significant difference between living and dead patients regarding demographic information, surgical techniques, and comorbidities. There was no association between patients regarding the average of all areas of physical, mental, and overall health and gender. There was no significant relationship between the mean of physical and mental health with the duration of hospital stay and the amount of bleeding during surgery. A history of diabetes, high blood pressure, and smoking in these patients was not associated with mortality and QOL.
Conclusion: The patient’s age is the most important risk factor for mortality after the DHS surgery.
The Effect of Augmentative Plating for the Treatment of Nonunion of Femoral Shaft Fractures after Intramedullary Nailing: A Case Series
Background: Several treatment approaches are now considered to manage femoral nonunion following intramedullary (IM) nailing. Augmentation plating over a maintained IM nail was a successful treatment for femur fracture nonunion in recent years. We aimed to describe our experiences in evaluating the union of bone for these patients after plate augmentation with serial examinations and radiologic studies.
Methods: This was a case study on 21 patients who had a nonunion or delayed union of the femoral shaft fracture (FSF) after IM nailing. After initial intervention, they were monitored for 20.4 months (range: 12-72 months).
Results: A closed IM nail was used in 18 patients, while the other three patients were shown as non-IM nail cases with a dynamic hip screw (DHS) in one patient, an external fixator in one other patient, and plate fixation in another one that was planned for augmentation plating. After plating, appropriate union appeared in all patients. Fracture union took an average of 7 months ranging from 3 to 12 months.
Conclusion: Augmentation plating for treating FSF nonunion with leaving the nail in place results in excellent and favorable clinical outcomes with the radiographic recovery of the nonunion site in all of the cases with no complication.
Multifocal Unicameral Bone Cysts in a Middle-Aged Patient Treated with Three Different Methods: A Rare Case Report
Background: Primarily diagnosed in the first two decades of life, unicameral bone cysts (UBCs) are benign cystic lesions of the bone. More than 90% of UBCs are located in the proximal femur or proximal humerus of skeletally immature patients, however in this case report we report a middle-aged patient with multiple lesions in unusual sites.
Case Report: A 42-year-old patient presented to our institute with multiple bony lesions in the right and left tibias, proximal radius, ulna, and the second metacarpus. The lesions were later pathologically proven to be UBCs. A multimodality treatment approach was selected including decompression-only, extended curettage, bone grafting, and prophylactic fixation based on the lesion size and anatomic location. All these methods proved to be effective with no disease relapse and complete radiographic obliteration of the cavities.
Conclusion: UBCs could occur in much older patients than generally believed and the proper method of treatment should be
individualized based on the lesion’s characteristics.
Background: In case of a stab wound to the lower cervical region and upper dorsal region, many organs are prone to damage, including the lung, heart, pericardium, any of the vessels in the thoracic cage, the esophagus or trachea, thoracic duct, and even spinal cord.
Case Report: A 19 year-old patient arrived at the emergency department with swollen and painful upper dorsal region between the internal border of the left scapula and T2 vertebra. The patient had a history of a street fight with a stab wound on the corresponding area. Nothing abnormal was found on physical examination, and the patient was stable without any neuroglial deficit. Radiographic imaging demonstrated a foreign body lodged near the vertebra. The patient underwent an operation surgery, and the foreign body was removed without any serious complications. The foreign body was the blade of the stab, which was broken and hidden under soft tissue.
Conclusion: According to guidelines for a stab wound to the thoracic, a chest x-ray and exploration of the area must be performed, which were missed in the present case and potentially could lead to serious complications given multiple vital organs in that anatomical region.
Surgical Treatment of Chronic Traumatic Rupture of the Flexor Digitorum Profundus Tendon in a 9-Years-Old Female: A Case Report a case report
Background: Flexor tendon rupture is a common traumatic event that is treated with surgery. Delay in reconstruction can reduce the chances of successful treatment even the surgeon is forced to choose fuse surgery.
Case Report: The study case was a 9-year-old girl who presented after months of traumatic injury with severe deformity of index finger and shortened flexor digitorum profundus (FDP). Although there was no suitable tendon, a plantaris tendon graft was prepared from her left leg. After one year, the range of motion (ROM) in the left hand was normal beyond expectation.
Conclusion: Single-stage tendon graft repair surgery even in chronic cases with shortened tendon and severe deformity is a good method which is recommended for similar patients, especially in children.
Intrapelvic Migration of Dynamic Hip Screw Postoperatively Leading to Total Hip Arthroplasty: A Case Report
Background: This study aimed to present a rare case of a failed dynamic hip screw (DHS) used for fixation of intertrochanteric fracture sliding into the pelvis and to review the most common causes of DHS failure in order to prevent this from happening in the future.
Case Report: A 68-year-old woman was referred to the orthopedics clinic with left hip pain and limping from 6 months ago. In our evaluation, she had DHS failure and intrapelvic protrusion.
Conclusion: There have been several aspects of the previously described DHS failure. We performed a two-stage total hip arthroplasty (THA) for the patient with a good one-year follow-up in the present case.
No abstract is available.