Vol 3, No 1 (2017)

Research Articles

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    Background: Bone bruise is a signal change in marrow that can be the result of edema, bleeding, or trabecular bone fractures. Analysis of the exact location of bone bruise can specify the injury pattern, trace the mechanism of injury, and contribute to a better understanding of the internal structural lesions in knees and concomitant injuries. The current study aimed to find a relationship between occurrence, location, and severity of pain and bone bruise.
    Methods: The current analytical case study was conducted on 22 patients with the isolated bone bruise associated with acute traumatic knee. The patients were asked to grade the severity of pain according to the visual analogue scale (VAS) from 1 to 10. To calculate the volume of bone bruise by magnetic resonance imaging (MRI), the 3 dimensional vectors A × B × C were used. The image analysis software was employed to determine the intensity of bone bruise in the coronal plane in pixel, and the scale of severity of pain was analyzed statistically by the location of bone bruise.
    Results: The mean pain scores among male (n = 20) and female (n = 2) patients were 4.40 ± 1.56 and 7 ± 2.82, respectively. The statistical tests showed no significant relationship between the age of patients and severity of pain (P < 0.05). The results of the current study showed no significant relationship between the location of bone bruise and that of severe pain. The average of bone bruise volume in the patients was 8.12 ± 8.77 cm2 and the mean score of pain was 4.63 ± 1.78, having a significant relationship with each other. In addition, the mean severity score of bone bruise was 42.47 ± 176.40 pixels and the mean pain score was 4.63 ± 1.78, having a significant correlation with each other (P = 0.03, r = 0.8). The tests showed that the severity of pain increased by increasing the intensity of bone bruise.
    Conclusions: According to the findings of the present study, the severity of acute bone edema had the highest effect on increasing the severity of pain.

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    Floating hip refers to concomitant fracture of the acetabulum, pelvis, and femur. We report the cases, our approach, as well as short-term results from 2008 to 2016. There were a total of 11 cases. The most prevalent pelvis fracture type were Tile type C and the most acetabulum fractures were both column fracture. The most femoral side fractures were per-throchantrric fractures (head, neck, intertrochanteric fracture). In most cases, fixation started from the pelvis, acetabulum, and then the femur. There were 5 complications (45%) (1 DVT, 2 nonunion, and 2 AVN). There were 3 cases, which end to THA in the follow up period. It seems this combination of fractures needs special attention.

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    Background: As the population is getting older, the recent increasing rate of total knee replacement has raised some doubts over its potential outcomes. Physical therapy or home-based exercise has been regarded as the prerequisites for excellent outcomes after primary total knee arthroplasty. However, comparison of physiotherapy exercise with home exercise program after primary TKA has not been addressed.
    Methods: The present study compared the impacts of physiotherapy protocol with those of home-base exercise after TKA. In this regard, a post-operative clinical evaluation was conducted on 2,250-member groups of patients. The mean ages of physiotherapy and home-based exercises groups were 65 ± 1 and 61 ± 6, respectively.
    Results: The clinical and statistical analyses indicated the effective improvements in functional results and quality of life parameters. All OKS, WOMAC, and KOOS approximately assessed the same improvement in both group. The 6-minutes walk distance improved about 12% in both groups. Baseline measurements through 4 years of follow-up revealed considerable and equal improvements in both groups.
    Conclusions: It was concluded that there were no significant differences between the 2 groups. After primary total knee arthroplasty, the improvement of patients following a home exercise program was similar to improvement of the patient completing a regular physical therapy. However, further researches are required.

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    Background: Traditional external fixation used for open or soft tissue compromised tibial distal metaphyseal fractures is used both as a temporizing or definitive treatment to minimize more traumas to the soft tissue, but it has its own shortcomings such as joint spanning and bulky construct. Lower profile locked plates used as external fixation may overcome such problems.
    Methods: A series of 16 open or with soft tissue compromised tibial distal metaphyseal fractures were treated using locking plate as a definitive external fixator. Time to union, nonunion, malunion, device failure, function for the knee and ankle, and deep and pin tract infections were evaluated.
    Results: All fractures healed without any complications (nonunion, malunion, device failure, or infections including deep and pin tracts). The mean time of fracture healing was 18 weeks (ranged 12 to 26). After walking with full weight-bearing for 1 month, the patients underwent plate removal. The mean hospital for special surgery (HSS) score was 89 (ranged 84 to 100) and 95 (ranged 91 to 100), and the mean American orthopaedic foot and ankle society (AOFAS) score was 93 (ranged 89 to 100) and 95 (ranged 92 to 100) at 4 weeks postoperatively and final follow-up (mean period of 16 months).
    Conclusions: Application of the locking plate as an external fixator for definitive treatment of distal tibial fractures had the advantages of traditional external fixators and at the same time overcame its shortcomings due to its low-profile frame; therefore, it was more acceptable to patients and Joint-sparing frame gave the opportunity for early range of motion and function exercise. It was a safe and reliable technique with minimal complications and excellent outcomes.

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    Background: Complex regional pain syndrome (CRPS) is a common complication in orthopedic surgeries. The present study aimed at evaluating the effect of calcitonin in the treatment of patients with CRPS.
    Methods: In this clinical trial study, 30 CRPS patients were randomly divided into 2 groups: 16 patients were only treated with physiotherapy and 14 with physiotherapy and calcitonin spray. They were matched according to age, sex, and type of fractures. Changes in range of motion, swelling, and pain were compared between the 2 groups after the fourth month.
    Results: No significant difference was obtained between the 2 groups in motion range amelioration and swelling decrease. However, the patients in physiotherapy and calcitonin group had less pain than the control group. No significant difference was found between the 2 groups in pain after the first and second months of treatment. However, patients’ pain showed a significant difference at the end of the third and fourth months (44.3 ± 10.5 vs. 56.7 ± 13.8) (P = 0.01). There was no side effect in calcitonin group.
    Conclusions: The use of calcitonin spray with physical therapy efficiently reduced CRPS patients’ pain. It also reduced the need for analgesic consumption. However, it did not affect the functional outcome.

Case Report

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    Osteoid Osteoma is the most common benign bone tumor often observed in long bones. Ribs involvement is very rare. In spinal involvement, it usually can cause painful scoliosis often seen in posterior component of spinal vertebral. A 15 year-old female with painful scoliosis, whose brace treatment was unsuccessful, is presented. In imaging investigations, her CT scan showed lytic lesions in the posterior of the seventh rib. She had a 30-degree painful scoliosis with right concave curve. Posterior part of the rib containing tumoral lesion was removed. Histopathological investigations showed a woven bone. Osteoid Osteoma was confirmed and the patient’s pain was resolved several days after the surgery. Follow-up in 3 month after the surgery showed that the curve of spinal deformity was completely resolved. Rib osteoid osteoma can cause painful scoliosis in young people, and surgical excision can be a successful treatment. It seems that application of brace had no impact on reducing the patient’s symptoms.