Vol 3, No 2 (2017)

Research Articles

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    Background: ACL tearing is one of the most common sport injuries. For its reconstruction, different grafts including autograft and allograft are used. In term of complications, postoperative improvement, daily activity, and quality of life comparing allograft and autograft are the preferred method, with minimum complications and maximum effectiveness.
    Methods: The method of this study was a prospective randomized study. A total of 38 patients were selected who only have a tear in their ACL and no other associated ligament injury. These 38 patients have been put into 2 groups by random computerized selection and their group has been advising them in closed pockets. Finally, 18 patients were in the allograft division and 20 in the autograft. In the beginning, a physical examination was done as well as a IKDC objective, Lysholm, level of activity, KOOS, and quality of life scoring forms have been filled for all patients before the operation process. Then patients have been operated by the standard arthroscopic method. Graft fixation in the femur bone has been done by the endo-button and in the tibia bone by interference screws (Smith and nephew). In the next step, the above-mentioned scoring forms were filled after 3 months, 6 months, and 1 year after operation. In addition, required physical examinations were done again. In this period of time, the patients have been under exact observation regarding related complications.
    Results: All mentioned scoring forms and pivot shift test, Lachman test, and ADT showed significant improvements in patient postoperative period. Lysholm (P = 0.07), IKDC objective (P = 0.8), level of activity (P = 0.9), and KOOS (P = 0.15) represented that there are no statically differences between 2 autograft and allograft groups. Infection risk in both groups has been almost same (P = 0.3).
    Conclusions: All findings clarify that short term result was equal in 2 groups.

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    Objectives: This study aims to investigate the pattern of Musculoskeletal and soft tissue injuries in a series of referred patients in a tertiary medical center and review previous reports in the literature.
    Methods: In this study, we recorded musculoskeletal injuries of the victims, following the Kermanshah earthquake on November 12, 2017, with a total number of 38. All patients were admitted to the Imam Khomeini Hospital. Injury type, site of injury, gender, age, complications, mortality, and treatment modality were recorded for each case.
    Results: Among 38 patients, 18 were male (47%) and 20 were female (53%). The mean age was 37 ± 21.6 years. Most of them were aged between 18 and 65 (71.1%). Lower extremities were involved more than the upper (37% versus 24%) and distal limb involvement was more than the proximal (57.3% versus 43.7%). One patient died due to necrotizing fasciitis and septic shock after femoral shaft open fracture. Two patients developed compartment syndrome and underwent fasciotomy complications by skin necrosis and infection.
    Conclusions: Soft tissue injuries and fractures are the most common injuries following the earthquakes, hence orthopedic surgeries play a vital role in disasters. Despite patients overload and emergency situation in natural disasters like earthquakes, it is crucial to have a stepwise and evidence based approach for each patient. For the patients with open fractures referred to a tertiary center, careful contamination assessment even in the previously managed wounds is highly recommended, especially for those with early wound closure. Early fasciotomy in the crush syndrome is not beneficial as it has adverse effects such as skin necrosis and infection.


Case Report

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    Introduction: Periprosthetic fracture, after total knee arthroplasty, is one of the most common reasons of revision arthroplasty and periprosthetic fracture of the patella has been shown to be very rare. Literature review has shown no reports of periproshtetic fracture of the patella around tumor endoprosthesis. Only 1 study has discussed management of open periprosthetic fractures of the patella as this type of fracture is extremely rare.
    Case Presentation: We report a particular open periprosthetic fracture of the patella around a tumor endoprosthesis in a 60 years old female, that was treated with irrigation and debridement and tension band wiring and 3 month of follow up showed satisfactory range of motion with no extension lag.
    Conclusions: Despite the fact that operative management of periprosthetic fractures of the patella has a high rate of complications and poor outcome, it can be considered for patients with open periprosthetic fractures of the patella, especially when the extensor mechanism is compromised.

Review Article

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    Background: Thoracolumbar fractures are the most common traumatic fractures of the spinal column. They result from a compression load without the associated shear, rotational, or translational components. Although neurological compression and spine instability are the recognized indications for surgery, it is unclear which approach should be used to stabilize the spine. Short-segment (SS) stabilization involves the upper and lower levels of the fractured vertebra, while use of more extended instrumentations is defined as long-segment (LS) stabilization. The SS stabilization is the most common approach; nevertheless, its superiority to LS stabilization is not clear yet.
    Objectives: The aim of the present study was to conduct a review of the literature to find evidence supporting SS or LS posterior stabilization.
    Methods: A review of the English literature was conducted to select prospective, randomized studies, comparing the effectiveness of stabilization with short and long pedicle screws for thoracolumbar burst fractures in adults.
    Results: Three studies were selected, including a total of 89 patients. Overall, 40 patients were treated with SS stabilization and 49 with LS stabilization. No significant difference was found between the groups in terms of preoperative and postoperative parameters, as the level of correction was quite similar. However, the measured parameters were significantly different in the follow-up, indicating a major loss of correction in the SS stabilization group.
    Conclusions: Based on small-scale studies, a major loss of correction is associated with posterior SS stabilization. However, larger studies are needed to confirm this finding and to verify differences in the clinical outcomes.