Vol 3, No 4 (2017)

Research Articles

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    Background: One of the most important issues in the orthopedic surgery, especially pediatric orthopedic surgery, is to prevent or reduce bleeding during the operating time. The goal of local hemostasis is to prevent or blockade the flow of blood from a disrupted vessel that has been incised or transected.
    Objectives: The aim of this study was to compare the effects of standard (monopolar) and bipolar electrocauterization during the pediatric orthopedic surgery.
    Methods: In this study, 60 patients were enrolled for the pediatric orthopedic surgery and classified into two groups. Group I included 30 patients undergoing hemostasis with standard electrocautery and group II comprised 30 patients undergoing hemostasis with bipolar electrocautery. The intraoperative bleeding was measured with sterile absorbent gauze. Every gauze could absorb 20 mL of blood. Then, bleeding was compared between the groups.
    Results: The average amount of blood loss and operating time was 134.6 ± 0.04 mL and 140.9 ± 0.02 minutes in group I and 133.4 ± 0.07 mL and 140.2 ± 5 minutes in group II, respectively. Thus, there was no significant difference between the two groups (P = 0.65 and 0.70, respectively).
    Conclusions: There was no significant difference in blood loss and operating time between patients in groups I and II. Therefore, the use of monopolar and bipolar cauterization in the pediatric hip surgery has the same effects on blood loss and operating time.

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    Tibia is one of the most common fractured long bone, which occurs most often in young people following high-energy trauma. Gold standard treatment of tibial diaphysis fractures is currently intramedullary nailing. In this study, we intend to examine the results of treatment of tibia diaphysis fractures with intramedullary interlocking nail without use of imaging (C-Arm) during surgery. In this cross-sectional study, 43 patients (36 males and 7 females with an average age of 31 years) were included, 40% were open fractures and 60% were closed. Just postoperatively, 12% of the cases had a problem with length and placement of nail and screws. A total of 18% had rotational deformity (78% less than 5 degrees) and 5% had only mild varus or apex anterior deformity. In cases where imaging during surgery is not possible for any reason, the use of intramedullary nailing along with distal jig could be performed for tibial shaft fractures.

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    Background: Pedicle screw instrumentation is one of the most commonly used forms of stabilization. Achieving solid screw fixation within the bone presents a significant challenge to spinal surgeons. Although pure pullout is not the mode of failure seen in clinical situations, pullout testing is thought to be a good predictor of pedicle screw fixation strength for spinal fusion.
    Objectives: To investigate the effects of varying lengths and thread depths of pedicle screws, as well as its insertion angle relative to the sagittal line on pullout strength, and stiffness of the pedicle screws and adjacent bone.
    Methods: Six fresh-frozen bovine lumbar vertebrae (L5) were examined. Pedicle screws with the lengths of 35, 40, and 45 mm, and the pedicle screws with thread depths of 0.9, 1.1, and 1.15 mm were inserted in pedicles by an orthopedic surgeon. Axial pullout tests were performed by a pullout apparatus and force-displacement curves were plotted.
    Results: The 45 mm length screw showed the maximum pullout strength (1746 N) and stiffness (564.7 N/mm) in the case of constant thread depth of 0.9 mm. The 1.15 mm thread depth screw showed the maximum pullout strength (1719 N) and stiffness (646.4 N/mm) in the case of constant length of 40 mm, and the screw insertion angle of 25° resulted in maximum pullout strength (1251 N) and stiffness (249.6 N/mm) in the case of constant thread depth of 0.9 mm and constant length of 35 mm.
    Conclusions: Increasing the length and the thread depth of the screws leads to an increase in the pullout strength, as well as the bone-screw construct stiffness. Pedicle screw pullout strength and the bone-screw construct stiffness were also affected by the insertion angle of the screw. There are other factors such as the insertion technique employed by the surgeon, and bone mineral density, which affect the pullout strength.

Case Report

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    Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic disease that is mostly reported in the spinal column with or without extraspinal involvement. DISH is often asymptomatic, but in case of progressive symptoms such as dysphagia, surgery may be required. Not only coexistence of DISH and ossification of posterior longitudinal ligament (OPLL) is uncommon, but also dysphagia as a presenting symptom in these patients is quite rare. To our knowledge, there are merely few such cases have been reported in the literature. In this study, we present the case of a 30-year-old man with the chief compliant of progressive dysphagia. After evaluation, diagnoses of DISH and OPLL were established, due to poor response to conservative treatment, the patient was managed surgically and favorable results were achieved.

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    Vertebral hemangiomas are common neoplasms of the spine and usually considered benign. They are usually asymptomatic and incidentally detected. A rare subset of them, referred to as aggressive hemangiomas, can be symptomatic presented with pain and neurological symptoms. The current study presented a case of a 27-year-old female with a four-month history of pain in thoracic spine and neurological involvement of the lower limbs for three weeks before the visit. Further investigations with computed tomography (CT) scan and magnetic resonance imaging (MRI) showed aggressive hemangioma in T4 vertebra with cord compression. The patient underwent laminectomy of T4, posterior fixation of T2-T6 and vertebroplasty. Final pathologic diagnosis after surgery confirmed the diagnosis of vertebral hemangioma. One month after surgery, the patient's motor symptoms and three months later, sensory symptoms were resolved.