Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 4 2024 12 30 149 151 Alireza Nankali Orthopaedic Subspeciality Research Center (OSRC), Tehran university of Medical Science, Tehran, Iran Maryam Sabouri Orthopaedic Subspeciality Research Center (OSRC), Tehran university of Medical Science, Tehran, Iran Hediye Gholamshahi Orthopaedic Subspeciality Research Center (OSRC), Tehran university of Medical Science, Tehran, Iran, 2. Surgical Research Society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran 2023 11 27 2024 12 21 Postoperative pain plays a key role in patients’ satisfaction. Since opioids may cause dependence and have a high abuse rate, non- opioid drugs such as duloxetine are being investigated for their effect in this matter. This review investigated the pharmacokinetics and the effects of duloxetine on postoperative pain after orthopedic surgeries. Duloxetine is a dual serotonin and norepinephrine reuptake inhibitor that causes a synergistic effect and can help manage postoperative pain. For this cause, it is prescribed as 60 mg per day. There have been studies in recent years proving its effectiveness both in total hip and knee arthroplasties and elective surgeries. The collective data show that duloxetine can be used for postoperative pain management, and with minimal side effects, it can lower opioid usage and dependence. However, considering duloxetine side effects including gastrointestinal (GI) disturbances (nausea, constipation), dry mouth, and loss of appetite, and the limitations of current literature, further studies need to be conducted. https://jost.tums.ac.ir/index.php/jost/article/view/551 https://jost.tums.ac.ir/index.php/jost/article/download/551/387

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 4 2024 12 30 152 4 Mohammad Karimi Full Professor of Orthotics and Prosthetics,shiraz university of medical sciences 2024 06 05 2024 12 21 Background: According to the Hueter-Volkmann law, there is asymmetry in the loads applied to the spinal structure on the convex and concave sides, which can increase the severity of scoliosis and its progression. The purpose of this review was to examine the asymmetry of vertebrae in subjects with scoliosis and explore how this theory can be utilized to enhance the effectiveness of braces in controlling and reducing scoliosis curves. A search was conducted in databases such as Google Scholar, PubMed, and ISI Web of Knowledge using keywords like Hueter-Volkmann law and asymmetry in relation to scoliosis. While there were limited studies on the asymmetry of vertebrae in individuals with scoliosis, the findings indicated significant differences in the height of vertebrae and discs between the concave and convex sides. Additionally, the degree of asymmetry was found to be correlated with the severity of scoliosis. It appears that the design of scoliotic braces is influenced by the Hueter-Volkmann law. It is recommended that new brace designs be developed based on the principles of this law to minimize the impact of gravity on the spine. https://jost.tums.ac.ir/index.php/jost/article/view/597 https://jost.tums.ac.ir/index.php/jost/article/download/597/388

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 4 2024 12 30 155 9 Ahmadreza Mirbolook 1. Associate Professor of orthopedic surgery, Department of Orthopedic, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Masoomeh Raoufi 2. Assistant Professor of Radiology, Department of Radiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Yeganeh Yousefifar 3. Department of Radiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mobin Forghan 4. Department of orthopedic surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Fakhari Student Research Committee, Arak University of Medical Sciences, Arak, Iran Mohammadreza Bozorgmanesh Tehran University of Medical Sciences 2023 08 20 2024 12 21 Background: Occipitocervical fusion (OCF) is a rare and often challenging surgical procedure. Several methods have been introduced to obtain the best measures for occipitocervical alignment. The mandible-C2 angle was first introduced in 2020. In this study, we aimed to evaluate the out-of-sample validity of these measures. Methods: We retrospectively studied 274 lateral cervical radiographs of patients aged 1 to 87 years with no cervical pathology evident on X-ray. A board-certified radiologist and a second-year radiology resident performed the measurements on five specific angles as suggested by Bellabarba. The five angles measured consisted of: 1) anterior C2 body/anterior mandible angle (AB/AM), 2) anterior C2 body/posterior mandible angle (AB/PM), 3) posterior C2 body/anterior mandible angle (PB/AM), 4) posterior C2 body/posterior mandible angle (PB/PM), and 5) occipito-C2 angle (OC2A). Results: Inter-rater correlation data were calculated for single and average measures. The inter-rater agreement for individual angle measures of O-C2A, AB/AM, AB/PM, PB/AM, and PB/PM were 0.49, 0.11, 0.25, 0.33, and 0.49, respectively. The intraclass correlation coefficient (ICC) for average measures of O-C2A, AB/AM, AB/PM, PB/AM, and PB/PM were 0.66, 0.20, 0.40, 0.50, and 0.66, respectively. Conclusion: Our study did not find statistically significant evidence to confirm that these angles were dependable indicators of occipitocervical alignment, except for the PB/PM angle, which showed a validity comparable to our reference angle. https://jost.tums.ac.ir/index.php/jost/article/view/527 https://jost.tums.ac.ir/index.php/jost/article/download/527/389

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 4 2024 12 30 174 6 Aidin Arabzadeh 1 Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Hossein Azaditalab M.D. Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Hesam Alitaleshi MD, Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mohammad Abbaszadeh Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2024 02 11 2024 12 21 Background: Freeman-Burian syndrome (FBS) is a rare genetic disorder characterized by facial deformities, arthrogryposis, and difficulties in orthopedic management. Case Report: A case study of a nine-month-old female patient with FBS is presented, who exhibited facial abnormalities and contractures of the hands and feet. Non-operative treatment, including stretching, massage, and splinting, was initially advised. At nine months, bilateral Achilles tenotomy was performed under local anesthesia due to anesthetic risks. Serial casting and bracing were used to maintain the correction. Conclusion: The authors recommend prompt treatment, especially with non-operative methods, and early training of parents in non-operative therapy for optimal results, as multiple surgeries and anesthetic complications can lead to suboptimal outcomes. Massage, stretching, and achieving stable plantigrade feet are crucial for independent walking in patients with FBS. https://jost.tums.ac.ir/index.php/jost/article/view/568 https://jost.tums.ac.ir/index.php/jost/article/download/568/393

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 4 2024 12 30 160 5 Mohsen Sabermoghaddamranjbar Departement of anesthesiology, school of medicine, Mashhad University of Medical Sciences, Mashhad, Iran Saeid Jamalie Bastami Departement of anesthesiology, school of medicine, Mashhad University of Medical Sciences, Mashhad, Iran Alireza Sharifian Attar Departement of anesthesiology, school of medicine, Mashhad University of Medical Sciences, Mashhad, Iran Seyed-Hossein Khademi Departement of anesthesiology, school of medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mohammad Alipour Departement of anesthesiology, school of medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mahdieh Samei Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Omid Shahpari Orthopedics Surgeon, Orthopaedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran 2024 05 09 Background: The objective of this study was to assess the effect of adding a very low dose of naloxone to a remifentanil infusion on postoperative pain in patients undergoing hip replacement surgery in the lateral position. Methods: This randomized clinical trial involved 80 patients who underwent hip replacement surgery under general anesthesia and were randomly assigned into two groups through block randomization: group 1 received remifentanil at a dose of 0.3 μg/kg/minute, while group 2 received remifentanil at a dose of 0.3 μg/kg/minute with a very low dose of naloxone administered at 0.05 μg/kg/hour following injection. Postoperative pain [measured using the visual analog scale (VAS)], drowsiness caused by narcotics and analgesics in recovery, and the duration of getting out of bed were all monitored and recorded in the ward. Results: The median [interquartile range (IQR)] of time to administration of the first sedative drug was 0 (0, 4) hours in the control group and 4 (0, 4) hours in the intervention group. The difference between the groups was statistically significant (P < 0.0001). The frequency of pain after surgery at 0, 4, and 8 hours was significantly different between the control and intervention groups (P = 0.003, P < 0.0001, and P = 0.021, respectively). Conclusion: Based on the results, we recommend using a very low dose of naloxone along with remifentanil infusion in patients undergoing complete hip replacement surgery to reduce their pain and the need for painkillers. https://jost.tums.ac.ir/index.php/jost/article/view/591 https://jost.tums.ac.ir/index.php/jost/article/download/591/390

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 4 2024 12 30 170 3 EN Alireza Moharrami Joint Reconstruction Research Center, Tehran University of Medical Sciences Mohammad Mirahmadi Eraghi Joint Reconstruction Research Center, Tehran University of Medical Sciences Shahabaldin Beheshti Fard Joint Reconstruction Research Center, Tehran University of Medical Sciences Ali Asadifar Resident of Radiology, Department of Radiology, Afzalipour Faculity of Medicine, Kerman University of Medical Scineces, Kerman, Iran, Ali Salehi Resident of Radiology, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Sadulla Sharifpour Orthopedic Surgeon, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran SM Javad Mortazavi Joint Reconstruction Research Center, Tehran University of Medical Sciences 2023 06 06 2024 12 21 Low back pain (LBP) is a significant issue in both clinical and public health settings, resulting in high healthcare and social costs. While knee joint pain is more prevalent than hip joint pain, standing posture is influenced not only by spinal alignment but also by hip and knee joint alignment. The knee and spine are interconnected anatomically, and degenerative changes in one area could often cause discomfort in the entire axis, leading to what is known as "knee-spine syndrome". LBP is a common condition associated with knee pain and can significantly affect the results of total knee arthroplasty (TKA). Surgeons need to consider knee-spine syndrome before any surgical intervention in patients with knee or back pain and explain it to the patients before the surgery. https://jost.tums.ac.ir/index.php/jost/article/view/503 https://jost.tums.ac.ir/index.php/jost/article/download/503/392

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 4 2024 12 30 177 9 EN Reza Kamrani Professor , Department of Orthopedics, Shariati Hospital Tehran University of Medical Sciences, Tehran, Iran Hossein Azaditalab MD, Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Hesam Alitaleshi MD, Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Mohammad Abbaszadeh MD, Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran 2024 02 13 2024 12 21 Background: Garre’s sclerosing osteomyelitis (GSO) is a rare chronic inflammatory condition characterized by sclerosis and thickening of bone cortices with mandibular affection in children and young adults. It involves periosteal reactions without abscess formation in young adults. Treatment typically includes analgesics and antibiotics, with surgery for non-responders. In this study, we report a rare case of GSO of the upper extremity involving radius and ulna bones. Case Report: A young man with a history of forearm trauma treated by a bonesetter developed worsening pain and swelling over two years. At age 34, he underwent debridement for chronic osteomyelitis, followed by four additional surgeries. In 2004, a non- vascularized fibular graft was applied, achieving union, but persistent pain led to further interventions. By 2011, lab tests showed increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and the lesion had recurred, necessitating resection and a free vascularized fibular graft. In 2013, after irrigation and debridement, the Masquelet technique was utilized. Four years post-surgery, the patient reports no pain or symptoms. Conclusion: On the basis of this case, we suggest that iournal> Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 9 1 2023 07 29 38 40 EN Abbas Abdoli Tafti Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Ali Salmani School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2022 05 15 2023 07 29 Background: Trochlea fracture usually happens with other fractures such as capitellum fracture or medial or lateral condyle fracture and isolated trochlea fracture is very rare because of its location and there are only a few cases of isolated trochlea fracture that have been reported. Case Report: We present here a 40-year-old man who suffered from an isolated trochlea fracture due to falling from three meters height on his flexed left elbow. After examination, imaging, and setting up a plan for surgery, the patient's fragment was fixed with two Herbert screws through anterior approach and after five years of follow-up which was the longest follow-up that had been reported, the patient’s elbow range of motion was 5° to full flexion with Mayo Elbow Performance Index (MEPI) of 85/100 and Disabilities of Arm, Shoulder, and Hand (DASH) score of 13.6/100. Conclusion: Isolated trochlea fracture is very rare, and it is best treated with open reduction and secure internal fixation using anterior or medial approaches. https://jost.tums.ac.ir/index.php/jost/article/view/394 https://jost.tums.ac.ir/index.php/jost/article/download/394/304

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 9 1 2023 07 29 31 4 Mohammad Sadeghian