Background: Recent evidence supports the superiority of surgery over conservative treatment in the management of medial humeral epicondylar fractures (MHEF) with the displacement of more than 2 mm, regardless of other indications for surgical intervention.
Background: The sub-trochanteric (ST) fracture is relatively common. It does not have a single treatment but it can be repaired in a variety of ways. Objectives: The aim of this study was to compare the proximal femur locking compression plate (PFLCP) and intramedullary nailing in the treatment of ST fracture. Methods: This cross-sectional study was performed on 56 patients with ST fracture who referred to Firoozgar Hospital, Tehran, Iran, between January 2014 and December 2018. The patients were equally divided into two groups, PFLCP group and nailing group. The recovery and postoperative complications were evaluated by the Harris hip score (HHS). Results: Of the 56 eligible patients examined, 49 (87.5%) were male. The overall mean age was 42.7 ± 16.2 years. The status of the union was significantly better in the PFLCP group than in the nailing group (P = 0.038). The total mean HHS was 88.9 ± 14.1 with no significant difference between the two groups. The results of the logistic regression model showed that sex and age could significantly decrease the HHS. Thus, the HHS was influenced by female sex (OR = 0.851) and age of more than 60 (OR = 0.829). Conclusions: PFLCP provides an appropriate union, expedites the operation, and yields a very good HHS. Therefore, it can work even better than intramedullary nailing in some parameters, such as pain after the operation.
Introduction: Bizarre parosteal osteochondromatous proliferation (BPOP), also known as the Nora’s lesion, is a part of the spectrum of reactive lesions with a difficult diagnosis. To date, only limited number of Nora’s lesions have been reported in the literature. Here, we report a case of Nora’s lesion and discuss the differential diagnosis of the case. Case Presentation: A 34-year-old male that was referred to the hand clinic of our center with a painful lump at the dorsoulnar aspect of the first metacarpal bone of his left hand. The diagnosis of BPOP was suspected using its clinical and radiographic characteristics. Subsequently, excisional biopsy was performed and the extracted lesion was sent to the pathology for definitive diagnosis. The histopathologic evaluation confirmed the diagnosis of BPOP. One year follow-up of the patient showed no radiographic or clinical sign of recurrence. Conclusions: BPOP can be confused with malignant lesions such as parosteal osteosarcoma and chondrosarcoma. Thus care should be taken to combine the radiographic and pathologic information in the correct diagnosis of this lesion, especially when the BPOP presents with atypical features.
Femoral neck stress fractures are rare and encompass 5% of all stress fractures among the young people. The bilateral cases are very rare. Coxa vara deformity and morbid obesity are some of the predisposing factors for bilateral stress fractures. The decline of neck-shaft angle will result in an increase and concentration of stress force in femoral neck giving rise to fracture. This report introduced a 35-year-old man with severe coxa vara deformity with an angle of 100 neck-shaft who had a bilateral femoral neck stress fracture and severe obesity [body mass index (BMI) > 35 kg/m]. The femoral neck stress fracture was a tension-type occurred due to stress in coxa vara. Based on laboratory findings, his vitamin D deficiency was severe (8.9 ng/mL) but his PTH and phosphorus levels were normal. Regarding vitamin D deficiency and previous femoral deformity, the possibility of osteomalacia in adolescence period was raised. Bilateral valgus sub-trochanteric osteotomy and fixation with a dynamic hip screw (DHS) were performed. After three months, the patient restored his walking ability and weight bearing. Valgus sub-trochanteric osteotomy and fixation with DHS are useful methods in coxa vara deformity concomitant with stress fractures and can modify the neck-shaft angle.
Department of Orthopedics, Clinical Research Development Unit, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran Department of Orthopedics, Emam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran Mechanical Engineer, Bern, Switzerland Corresponding author: Department of Orthopedics, Clinical Research Development Unit, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran. Email: ali.tab.ms@gmail.com
Introduction: Gorham's disease is a rare enigmatic bone disorder associated with obscure osteolysis pattern, challenging diagnosis and treatment.Particularly, there is a high level of controversy regarding the diagnosis and strategy of treatment in the spinal involvement of Gorham's disease that is generally presented with a kind of spinal deformity.Case Presentation: Here, we report a case of Gorham's disease of the spine manifested with spinal cord complications and lacking any spinal deformity.The patient was managed through a two-stage spinal cord decompression technique.The symptoms were resolved afterward and five-year visits did not demonstrate any significant complication. Conclusion:This case reveals that the Gorham's disease of the spine could be presented with spinal cord complication alone.Accordingly, the strategy of treatment should be established based on the occurrence of spinal cord complications or magnitude of spinal deformity.
Introduction: Patellar dislocation is a relatively common injury. However, in rare circumstances along with dislocation of the patella, some types of fractures occur, making the treatment challenging and difficult.
Background: Long-term ionizing radiation exposure is a risk to young scoliosis patients. A new slot-scanning imaging system, “EOS imaging” has been shown, in patients with adolescent idiopathic scoliosis, to emit significantly lower levels of ionizing radiation. This is a single-center, preliminary report of radiographic assessment by a new system.
Castleman disease (CD) is a rare condition of a benign proliferation of lymph nodes with currently unknown etiology.A 21-yearold male patient referred to the institute with asymptomatic, slowly enlarging, soft tissue mass located on the medial part of the femoral region of his left thigh.Magnetic resonance imaging detected a heterogeneous mass of about 132 × 77 × 68 mm 3 in size, which was hypo-signal at T1 and hyper-signal at T2 sequences with central calcification and surrounded by hyperproliferative capillaries.The mass was completely excised through surgery and patient achieved complete remission.In pathologic evaluations, the specimen contained a fibrosclerotic lymph node with a partially distorted structure composed of small-sized mature lymphocytes in a hyper-vascularized stroma without the presence of neoplasia and malignant cells.Radiologic and histopathologic findings were suggestive of CD.The patient underwent surgery for excision of tumor and achieved complete remission without any complications.
Background: There are many unanswered questions about the characteristics and mechanism of the lumbosacral scoliotic list (LSL). In the current study, the pattern of LSL, the level of maximal opened disc space (take-off) in addition to the relationship between the location of disc herniation (DH) on magnetic resonance imaging (MRI) and LSL direction on radiographs, were investigated. Methods: A total of 37 patients, with extruded lumbar DH and LSL, were included in the current study. The following variables were measured on standing anteroposterior and lateral lumbar x-rays: LSL (from L1 to L5), the take-off level, and the coronal shift (the distance between the plumb line from T12 spinous process to the central sacral vertical line). The direction of LSL was recorded as the bending side of the patient opposite to the convexity of the curve. The location of DH was determined as right, left, or central on an MRI. Results: The magnitude of the LSL curve averaged 9.9°±6.9°. Regarding the right or left herniation, the list occurred mostly toward the opposite side of the herniation direction (P = 0.04). There was no significant matching between the location of herniation and the take-off segment (P = 0.391); however, in 67.6% of patients with L4 L5 or L5 S1 herniation, the take-off point occurred one segment above the involved levels. The take-off was found only at L3 L4 or L4 L5 levels in all the patients. Conclusions: LSL usually occurs on the opposite side of the herniation location. Furthermore, take-off is found in L3 L4 or L4 L5 segments in most of the patients with LSL. It seems that LSL curve characters are not affected by the level of herniation.
Background: Treatment of Monteggia fracture-dislocations can become quite complicated when the diagnosis is delayed. Objectives: We report the outcome of open reduction and ulnar osteotomy with annular ligament repair or reconstruction in pediatric patients with neglected Monteggia fracture-dislocation. Methods: In a retrospective study, pediatric patients with neglected Monteggia fracture-dislocation who underwent open reduction and ulnar osteotomy with annular ligament repair or reconstruction were included. The radiologic evaluations included the assessment of the union of the osteotomy site and elbow joint degenerative changes or peri-articular ossifications. The clinical evaluation of outcomes included the range of motion (ROM) and the Kim elbow performance score (KEPS). Results: A total number of seven patients with pediatric Monteggia fracture-dislocations and the mean age of 6.6 ± 2.7 years were evaluated. The mean delayed time from injury to surgery was 53.3 ± 31.4 days. The mean follow-up of the patients was 30.8 ± 25.5 months. The mean flexion arc, supination, and pronation were 137.9°, 72.1°, and 65.7°, respectively. Flexion contracture was present in two cases only. The mean KEPS of the patients was 96.4 ± 6.3. Accordingly, the outcome was excellent in six (85.7%) patients and good in one (14.3%). One ulnar nonunion and one heterotopic ossification were recorded as post-operative complications. No case of subluxation, dislocation, or degenerative joint disease was seen in our series. Conclusions: Radial head reduction and ulnar osteotomy with annular ligament reconstruction result in acceptable radiologic and clinical outcomes in the management of neglected pediatric Monteggia fracture-dislocation.
Background: Application of fix-bearing-(FB) or mobile-bearing (MB) total knee arthroplasty (TKA) is an area of controversy. Introduction of mobile-bearing implants has become an appealing option for some surgeons leading to more favorable structural and weight-bearing outcomes in TKA; however, the beneficial long-term outcome is still unclear.
Background: Elbow stiffness is a debilitating condition with different etiologies including trauma, head injury, and burns, which seriously interferes with the patient's daily activities.Objectives: Here, we aimed to report the outcome of elbow release surgery in patients with elbow stiffness caused by different etiologies.Methods: In a retrospective study, the outcome of surgery was evaluated in 18 patients with elbow stiffness.The indication for surgery was the functional loss of elbow range of motion that failed at least six months of conservative management.Elbow range of motion was evaluated before and after the surgery.Mayo elbow performance score (MEPS) was used to assess elbow function at the final follow-up session. Results:The mean follow-up period of the patients was 4.5 ± 2.6 years, ranging from 2 to 10 years.The etiology of stiffness was trauma in 11 cases, central nervous system injury in six patients, and burns in one patient.The mean pre-operative supination, pronation, and flexion arc improved by 15.3°, 20.9°, and 62.2°at the final follow-up evaluation, respectively (P = 0.028, P = 0.008, and P < 0.001, respectively).The mean MEPS of the patients was 85 ± 9.1, ranging from 65 to 95.According to the MEPS scores, the functional outcome was excellent in 8 (44.4%) patients, good in 7 (38.9%)patients, and fair in 3 (16.7%)patients. Conclusions:The release of stiff elbow could be regarded as an effective treatment that provides an acceptable gain in the range of motion and considerable improvement of elbow function.
Background: Femoral nonunion is an important complication, which can occur after intramedullary nailing and it requires surgical intervention. Plate augmentation over intramedullary nail is emerging as an acceptable option with satisfactory results for femoral nonunion.
Background: Bleeding is the most common post-operative complication of knee arthroplasty. Arthroplasty systems with posterior cruciate ligaments potentially affected the amount of postoperative bleeding due to a lower need for bone cutting.
Sciatic Nerve Compression Due to Proximal Femoral Solitary Osteochondroma: A Case Report and Literature Review
Graft Inclination Angle is Associated with the Outcome of the Anterior Cruciate Ligament Reconstruction
Successful Spine-Shortening Osteotomy for Recurrent Tethered Cord Syndrome in a Patient with Ehlers-Danlos Type III and Mosaic Trisomy 20: A Case Report
