Vol 2, No 4 (2016)

Research Articles

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    Background: One of the most important factors in the fracture healing is the intracellular production of prostaglandins by osteoblast cells. Nonsteroidal anti-inflammatory drugs (NSAIDs) exert their effects through inhibition of prostaglandin synthesis. NSAIDs are widely used in orthopedic practices and their effect on bone healing is not fully understood yet.
    Objectives: The current study aimed at examining the effects of indomethacin and meloxicam on tibia fracture union in rats.MethodsThe current study was conducted on 60 male rats. Mid-shaft tibia fracture was induced in rats using bone-breaker device. The animals were randomly divided into 3 groups; a control group that received distilled water and 2 other groups that received indomethacin and meloxicam respectively for 28 days. At the end of weeks 1, 2, 4, 8 and 12, four rats were randomly sacrificed from each group, and histological evaluation, measurement of the calcium, phosphorus, and alkaline phosphatase plasma levels, as well as radiographic examinations were performed on them.
    Results: After 4 weeks, a thin layer of woven bone was observed in the vast spaces of the bone marrow in the fracture area in the control group. In the meloxicam group in the week 4, the formation of immature blades of bone was observed, which were less organized and more irregular. In the indomethacin group in the week 4, new bone formation was less immature and more areas of cartilage were still observed. In the radiographic evaluations, delayed union in indomethacin and meloxicam groups was observed, which was more significant in the indomethacin group.
    Conclusions: Indomethacin and meloxicam had impact on the process of bone repair and delayed union in both groups of drugs. This delayed union was more significant in non-selective NSAIDs (COX-I and = II inhibitors) rather than selective NSAIDs (COX-II inhibitor).

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    Objectives: Fractures are prevalent injuries in children. Forearm fractures include 25% of children fractures. Although low level of 25 (OH) vitamin D3 is related with less bone density and more risk of fractures due to osteoporosis in adults, not enough data are available on the relationship between decreased levels of 25 (OH) vitamin D3 and the risk of forearm fracture in children.
    Methods: The current observational, analytic study included 30 children within the age range of 2 to 15 years with the verified fracture of both forearm bones. The recorded data included age, gender, the broken hand, and the educational status of parents. Moreover, the levels of serum 25-hydroxy vitamin D3, calcium, and phosphorus were measured in all subjects. The normal children (n = 54) without the history of fracture were considered as controls.
    Results: The case group consisted of 21 males (70%) and 9 females (30%) and control group included 28 males (51.9%) and 26 females (48.1%). The mean age of the children with and without forearm fractures was 6.8 ± 3.17 and 6.96 ± 3.57 years, respectively. There were no significant differences between the groups in terms of gender, age, the broken hand, and father’s education (P > 0.05). Serum 25 (OH) vitamin D3 level was 17.22 ± 13.42 ng/mL for the case group and 17.88 ± 11.21 ng/mL for the control group. These levels for serum calcium and phosphorus were 9.88 ± 0.44 and 5.02 ± 0.56 mg/dL for the cases, and 9.64 ± 0.44 and 4.72 ± 0.72 mg/dL for the controls, respectively (P > 0.05).
    Conclusions: The results of the current study showed no relationship between the levels of serum vitamin D, calcium, and phosphorus as well as age, gender, broken hand, and parents` educational status and fracture of both bones of forearm. Larger studies with more variables are recommended.

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    Background: Calculation of the risk of instability and malunion in patients with distal radius fracture and choosing treatment based on this risk percentage is a new method that can greatly help surgeons in decision-making. In this study, we have tried to make a comparison between treatment decision-making based on prediction of the risk of instability and experience of orthopedic surgeons for management of this fracture.
    Methods: Recorded information of 69 patients with extra-articular distal radius fracture diagnosis was examined. Radiographs and age of each patient were submitted to two orthopedic surgery professors and they were asked to express their opinion about surgical or non-surgical treatment for each patient based on their own personal habit. The risk of instability was calculated for each patient and surgical or non-surgical treatment for each patient was proposed based on this risk percentage with cut-off point of 70%. Then, the treatment proposed by each surgeon was compared with the treatment proposed based on the calculated risk of instability.
    Results: The study demonstrated that treatment decision-making for distal radius fracture according to the risk of instability with cut-off point of 70% (this is surgery for fractures with instability risk of more than 70% versus non-surgical intervention for cases with risk of less than 70%) is not significantly and reliably consistent with the opinions of two orthopedic surgeons who had the experience of confronting this fracture.
    Conclusions: Prediction of the risk of instability for management of distal radius fracture needs to be validated through further studies before being used as the decisive factor for management of this fracture. Colleagues are invited to assess the outcomes of using the risk of instability more accurately with further studies. It is suggested to be more prudent and perform more evaluations when the risk of instability calculation with cut-off point of 70% is used to choose the appropriate treatment.

Brief Report

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    Background: Frozen shoulder is a common condition, characterized by pain and restriction in shoulder movements. Different non-surgical and surgical methods are used to overcome this condition. Given the high prevalence of frozen shoulder among the working class in communities, re-empowerment is essential for individuals to return to their daily activities. Considering the contradictory results reported by previous research, further investigations are required in this area. Therefore, this study aimed to evaluate the clinical findings of arthroscopic release in treatment of primary frozen shoulder.
    Methods: This cross-sectional study was performed on all patients with primary frozen shoulder, referring to Bahonar and Shafa hospitals of Kerman, Iran. These patients were candidates for surgery due to unsuccessful supportive treatment. First, American shoulder and elbow surgeons (ASES) assessment form (score: 0 - 100) and simple shoulder test (SST) (a 12-item questionnaire) were completed before surgery. Then, all the patients underwent arthroscopic release and examinations. The assessment forms were completed again 3 and 12 months after surgery.
    Results: Overall, 15 patients with the mean age of 50.57 ± 12.01 years were included in this study. There was asignificant difference in the mean score of SST before (10.24±0.98) and after (10.99±1.05) surgery (p=0.034). In addition, patients’ performance at 12-month follow-up significantly improved compared to the 3-month follow-up (P = 0.014). There was a significant difference in the mean scores of ASES test before and after surgery (P = 0.007). In addition, the mean score of ASES test was higher at 12-month follow-up compared to the three-month follow-up (P = 0.019).
    Conclusions: Arthroscopic release could help relieve pain and improve the range of shoulder movements in patients. Moreover, it could help patients return to their daily activities and regain their productivity. In fact, this technique facilitates simultaneous diagnosis and treatment of shoulder joint problems.

Case Report

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    Introduction: Pubis osteomyelitis is a rare bone infection disease. The clinical manifestations of this disease are highly misleading. The symptoms are non-specific and the patients feel pain in their pelvis and have difficulties in walking. The risk factors for this disease are pelvic and urological surgeries.
    Case Presentation: In this report, a 40-year-old female with suprapubic fistula secretion 6 months after reconstructive surgery for bladder prolapse was introduced. In fistulectomy surgery, pelvic pubis osteomyelitis was identified and treated by curettage and debridement. In microorganism culture of the samples, Staphylococcus epidermidis was the result, which was resistant to methicillin.
    Conclusions: Antibiotic treatment is not enough for pubic osteomyelitis. Curettage and jet lavage surgeries are suggested. Closing the possible route by the urogenital tract is of great importance in controlling the disease.

Review Article

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    The purpose of this study was to assess the current concepts of the application of transexamic acid (TXA) in total hip arthroplasty. Perioperative blood loss in patients who undergo hip arthroplasty is a serious problem. Most patients are old and their cardiovascular system cannot easily tolerate hypovolemia. A literature review of 25 papers on TXA use in hip arthroplasty, to assess efficacy and cost-effectiveness of TXA, as well as the risk of thrombotic events may be useful. Our literature review is based on searching TXA and hip arthroplasty related articles in PubMed, Scopus, and Google Scholar. We focused on large meta-analysis articles and randomized clinical trials. Current concepts recommend routine application of TXA in hip arthroplasty, if no contraindications exist.

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    Distal femur fracture is a critical fracture. It affects knee joint, which needs a wide range of motion. On the other hand, it is a weight bearing joint and needs stability for tolerating the weight of body. For achieving better results, it is necessary to have preoperative planning. It needs high quality radiography and a CT scan. Locking plates has good results in distal femoral fracture fixation. There are some pitfalls in reduction and fixation of distal femoral fractures. At-tention to details is the key for success in these fractures.