Publications by authors named "Adel Ebrahimpour"

26 Publications

  • Page 1 of 1

Amputation as a Complication after Total Knee Replacement, is it a Real Concern to be Discussed?: A Systematic Review.

Arch Bone Jt Surg 2021 Jan;9(1):9-21

Orthopedic Research center, Mashhad university of Medical Sciences, Mashhad, Iran.

Total knee replacement (TKR) is a growing attractive treatment for a degenerative knee disease. However, there remain some certain devastating complications to be discussed with patients preoperatively, including limb amputation. This systematic review aimed to determine the rate of amputation following TKR. In this study, the literature was searched up to 2019. The papers were included in which knee amputation was reported following TKR. The primary search concluded the articles from EMBASE, SCOPUS, PubMed, Web of Science, MEDLINE, OvidSP, CINAHL, EBSCO, Web of Science™, and CENTRAL. After screening and excluding case reports, 40 papers were included in the present study. The present review showed that amputation is a real end result of knee replacements either in primary or revision knee arthroplasties, which needs to be discussed with patients for their decision-making. Prevalence of amputation in terms of failure or complications after TKR procedures was estimated between 0.1-10% in different studies , with 5.1% amputation rate in infected TKR and 0.025% amputation rate in primary TKR as a result of infection in our review. Deep infection was the main cause of amputation. Vascular complications and fractures associated with bone loss and compartment syndrome were other reasons for amputation.
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http://dx.doi.org/10.22038/abjs.2020.53892.2692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957107PMC
January 2021

Epidemiologic trend of mobile spine and sacrum chordoma: A National population-based study.

J Craniovertebr Junction Spine 2020 Jul-Sep;11(3):226-231. Epub 2020 Aug 14.

Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Chordoma is a rare sarcoma of the axial skeleton. The incidence of this tumor is different between races. To understand the epidemiologic characteristic and due to rarity of this pathology, large number of cases should be evaluated through national data registries.

Materials And Methods: All pathologically confirmed cases of chordoma were derived from the Iran National Cancer Registry. Descriptive analysis was performed to extract age-standardized and age-specific incidence rates. Data regarding tumor location and chordoma subtypes were derived and analyzed.

Results: One hundred twenty-two cases of chordoma including 80 male and 42 female were identified. One hundred seven cases of nonotherwise specified chordoma, 14 chondroid chordoma, and one dedifferentiated chordoma were detected. The age-standardized incidence rate (ASIR) of chordoma was 0.28. Chordoma of the sacrum composed 67.2% of cases. The mean survival time was 4.5 years.

Conclusion: Epidemiology characteristic of chordoma in Iran is similar to other studies; however, the total ASIR was lower and the incidence in sacrum is nearly twice respect to the mobile spine. While men affected by sacral chordoma in relatively older age, the female patients had higher mean age in case of mobile spine involvement. The survival rate of chordoma is significantly lower in comparison with other studies.
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http://dx.doi.org/10.4103/jcvjs.JCVJS_109_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546048PMC
August 2020

Reliability of Postoperative Radiographies in Ankle Fractures.

Arch Bone Jt Surg 2020 Sep;8(5):598-604

Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The accuracy of reduction of ankle fractures using postoperative plain radiographies (x-ray) remains widely controversial. Some authors have demonstrated that postoperative computed tomography (CT) scan can be useful for these patients. In current study, the efficacy of x-rays after fixation of ankle fractures was investigated based on the CT scan findings.

Methods: A total of 73 patients with ankle fractures who were subjected to open reduction internal fixation (ORIF) were enrolled. After surgery, if the reduction was acceptable based on the x-rays according to standard measurements, the patient was referred for CT scanning. Forty four patients were included in the study. Undesirable CT scan findings including malreduction of fragments or articular surfaces, device malpositioning, missed fractures, and undetected intra-articular fragments were documented.

Results: Undesirable CT findings were seen in 25 patients (56.8%). CT scan showed acceptable reduction without device malpositioning in 19 patients. The most prevalent findings in CT images were malreduction and device malpositioning in 17 and 16 patients, respectively. There was no abnormal finding in CT imaging of lateral malleolar fractures. In two thirds of the injured syndesmosis, device malpositioning, and malreduction were detected in CT scan.

Conclusion: Despite acceptable postoperative x-rays, a considerable number of patients with ankle fractures had inappropriate reduction or undesirable findings in their postoperative CT scan. It seems necessary to use CT scan after ORIF of ankle fractures in order to examine the accuracy of reduction. Further validation of postoperative CT scan in ankle fracture surgery should be investigated.
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http://dx.doi.org/10.22038/abjs.2020.43134.2173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547165PMC
September 2020

Efficacy of single high-molecular-weight versus triple low-molecular-weight hyaluronic acid intra-articular injection among knee osteoarthritis patients.

BMC Musculoskelet Disord 2020 Aug 15;21(1):550. Epub 2020 Aug 15.

Orthopedic surgery Department, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, School of Medicine, No. 1998734383, Velenjak, Tehran, Iran.

Background: To compare intra-articular (IA) knee injections of a cross-linked high-molecular-weight hyaluronic acid (HMW-HA) with a linear low-molecular weight HA (LMW-HA) in terms of pain and functional improvement among knee osteoarthritis (OA) patients.

Methods: In this single-blinded RCT, the patients were randomly divided into two groups for HA injections. The first group received an HMW-HA (Arthromac) injection, while the other received three weekly LMW-HA (Hyalgan) injections. Pain and function were assessed using the outcome measures including WOMAC, Lequesne and VAS indices, once prior to injection, as well as 2 and 6 months after injections.

Results: A total of 90 patients were included. There was no significant difference in baseline characteristics including age and sex between the two groups. Our analysis showed that total WOMAC, Lequesne and VAS mean scores remarkably improved at both follow-up time-points compared to the baseline measurements (p < 0.001). There was no significant superiority between the two therapeutic protocols according to our outcome measures at any time-point of follow-up. The only except was about the improvement in WOMAC stiffness subscale that was significantly higher in LMW-HA group compared to HMW-HA (p = 0.021). Moreover, no significant difference was observed in minor complications and injection-induced pain scores between the two groups.

Conclusion: This study proved that a single HMW-HA injection is as effective as multiple injections of LMW-HA counterparts in periods of 2 and 6 months follow-up. This study protocol was registered in Iranian database of RCTs (IRCT; www.irct.ir ) with the trial registration number IRCT20130523013442N24 and registration date 2018-07-13.
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http://dx.doi.org/10.1186/s12891-020-03577-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429877PMC
August 2020

The Survival and Incidence Rate of Ewing Sarcoma; a National Population-based Study in Iran (2008-2015).

Arch Bone Jt Surg 2020 May;8(3):391-399

Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The effect of race and ethnicity on some kind of malignant bone tumors including Ewing sarcoma has been proven in different studies. In order to evaluate the latter, national cancer registries may help to increase understanding about potential cancer causes, prevention and control strategies, and apply these findings to control health problems among populations with similar characteristics.

Methods: A national population-based cancer registry study based on all patients affected by Ewing Sarcoma was registered in the Iran National Cancer Registry (INCR) between 2008 and 2015 was designed. Demographic data of microscopically confirmed cases of bone Ewing sarcoma were registered. Patients with Ewing sarcoma were divided in groups to describe the primary site of the tumor (including axial or appendicular bones) and analyzed. In order to analyze the survival rate, randomized selection of the patient through the INCR data-base was performed.

Results: A total of 678 cases of malignant Ewing sarcoma of the bone were identified through the INCR. The mean age of Ewing sarcoma in Iran was 21.53 years. Nearly half of patients were observed at the age group of 15-24. The total crude incidence rate of Ewing sarcoma was 1.29 in 1 million. The mean 5 year survival rate was 47%. The Mean survival rate for study population was 5.53.

Conclusion: The crude incidence rate of Ewing sarcoma in Iran is relatively lower with respect to other registries. The majority of patients are in 15-25 years group and shows affection by Ewing sarcoma in an older age. Socioeconomic factors had direct influence on survival rate.
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http://dx.doi.org/10.22038/abjs.2020.44095.2206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358229PMC
May 2020

Fracture Surgery in Known COVID-19 Infected Patients: What Are the Challenges?

Arch Bone Jt Surg 2020 May;8(3):378-382

Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Surgery in the time of COVID-19 pandemic is a challenging issue while treatment of affected fracture patients is inevitable. The present study summarizes the challenges that an orthopedic surgeon is confronting during the surgical treatment of fracture patients with concomitant COVID-19 infection.

Methods: Demographic and fracture related data of 13 fracture patients with concomitant COVID-19 infection who were treated with surgery was collected from three trauma centers in Tehran and Kermanshah cities from 21, February 2020 to April 3, 2020.

Results: All patients were male with mean age of 38.6±19.5 years. Eight patients had high energy fracture and seven patients had multiple fractures and trauma. Wrist and hand were the common sites of fracture following hip and pelvis. The mean interval time period between the diagnosis of COVID-19 infection and surgery was 2.3±1.5 days. Before surgery, all patients except one had been admitted to the corona dedicated wards, while two patients were admitted to the intensive care unit (ICU). One of the ICU admitted patients died. All the 12 alive patients remained in home isolation after discharge.

Conclusion: Fracture surgery in COVID-19 patients has many challenges such as lack of medical resources, delay of surgery, medial staff fear, and patient isolation. However, a multidisciplinary approach using all potential hospital resources would lead to successful operation and acceptable outcome.
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http://dx.doi.org/10.22038/abjs.2020.47899.2372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358239PMC
May 2020

Platelet-Rich Plasma-Derived Growth Factor vs Hyaluronic Acid Injection in the Individuals with Knee Osteoarthritis: A One Year Randomized Clinical Trial.

J Pain Res 2020 8;13:1699-1711. Epub 2020 Jul 8.

Physical Medicine and Rehabilitation Research Center, Clinical Research Development Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: In this study, we aimed at performing a comparison between intra-articular injections of PRP-derived growth factor (PGRF) and hyaluronic acid regarding their effect on pain and patient's function in knee osteoarthritis, as well as their safety profiles.

Methods: During our single-masked randomized clinical trial, the candidates with symptomatic knee osteoarthritis received two intra-articular injections of PRGF with 3 weeks apart or received three weekly injections of HA. The mean improvements from before treatment until the second, sixth, and twelfth months post-intervention in scores obtained by visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index were our primary outcomes.

Results: A total of 102 candidates were finally included in the study. Patients' mean age was 57.08±7.3 years old in the PRGF group compared to the mean age of 58.63±7.09 years old in HA patients. In the PRGF group, total WOMAC index decreased from 41.96±11.71 to 27.10±12.3 (P = 0.02), and from 39.71±10.4 to 32.41±11.8 in the HA group after 12 months (P > 0.05). Regarding the Lequesne index, pain, ADL, and global scores significantly decreased after 12 months in the PRGF group compared to the HA group (P<0.001). There was also a meaningful higher rate of satisfaction in the PRGF group compared to the HA group after 12 months of treatment (P<0.001).

Conclusion: Besides significantly higher satisfaction belonging to the PRGF group, there was a statistically significant improvement in VAS score and global, pain, and ADL score of Lequesne by passing 12 months from injection in PRGF compared to HA.
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http://dx.doi.org/10.2147/JPR.S210715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354951PMC
July 2020

Management of Spine Trauma in COVID-19 Pandemic: A Preliminary Report.

Arch Bone Jt Surg 2020 Apr;8(Suppl 1):270-276

Functional Neurosurgery Research Center, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: COVID-19 was first identified in Iran in February 2020 and since then it spread rapidly through all over the country and soon after that it was reported as a pandemic. The current study presents a preliminary report of spine trauma management during COVID-19 pandemic.

Methods: A cross sectional study was designed to evaluate patients admitted for vertebral fractures with diagnosis of COVID-19 infection on February and March 2020. Analysis was made based on clinical and laboratory data along with the imaging findings from chest HRCT.

Results: Seven patients with spine trauma including five males and two females ranging from 14 to 59 years were diagnosed for COVID-19 infection through CT-scan findings. Except one, all other patients were asymptomatic for COVID-19 at the time of admission. In three cases the COVID diagnosis was made the day after arrival and in others after 10, 14 and 35 days. Five patients were treated surgically among whom four were admitted to ICU soon after the surgery. The mean ICU stay for operated patients were eight days and the mean hospital stay was 22.6 days.

Conclusion: Proper diagnosis of COVID-19 is the keystone to protect both patients and health care providers. During the pandemic all admitted patients should be screened for COVID-19 infection. Unnecessary procedures for spine trauma patients should be avoided in order to reduce complications related to surgery and to preserve ICU beds.
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http://dx.doi.org/10.22038/abjs.2020.47882.2368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296594PMC
April 2020

Bioreactor cultivation condition for engineered bone tissue: Effect of various bioreactor designs on extra cellular matrix synthesis.

J Biomed Mater Res A 2020 08 3;108(8):1662-1672. Epub 2020 Apr 3.

Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Dynamic-based systems are bio-designed in order to mimic the micro-environments of the bone tissue. There is limited direct comparison between perfusion and perfusion-rotation forces in designing a bioreactor. Hence, in current study, we aimed to compare given bioreactors for bone regeneration. Two types of bioreactors including rotating & perfusion and perfusion bioreactors were designed. Mesenchymal stem cells derived from buccal fat pad were loaded on a gelatin/β-Tricalcium phosphate scaffold. Cell-scaffold constructs were subjected to different treatment condition and place in either of the bioreactors. Effect of different dynamic conditions on cellular behavior including cell proliferation, cell adhesion, and osteogenic differentiation were assessed. Osteogenic assessment of scaffolds after 24 days revealed that rotating & perfusion bioreactor led to significantly higher expression of OCN and RUNX2 genes and also greater amount of ALP and collagen I protein production compared to static groups and perfusion bioreactor. Observation of cellular sheets which filled the scaffold porosities in SEM images, approved the better cell responses to rotating & perfusion forces of the bioreactor. The outcomes demonstrated that rotating & perfusion bioreactor action on bone regeneration is much preferable than perfusion bioreactor. Therefore, it seems that exertion of multi-stimuli is more effective for bone engineering.
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http://dx.doi.org/10.1002/jbm.a.36932DOI Listing
August 2020

Chromic phosphate-32 colloid radiosynovectomy for the treatment of haemophilic synovitis: A long-term follow-up study.

Haemophilia 2020 Jan 3;26(1):136-141. Epub 2019 Dec 3.

Joint Reconstruction Research Centre, Tehran University of Medical Sciences, Tehran, Iran.

Aim: We previously reported the outcome of chromic phosphate-32( P) colloid synoviorthesis in 53 haemophilic patients with an average follow-up of 31 months. The purpose of the present study was the long-term follow-up of the same cohort on both clinical and radiographic features.

Materials: Nine patients failed to attend the recall appointment. The mean follow-up for the remaining 44 patients (52 procedures) was 15 years (range, 14.6-15.5). The mean age at the time of reassessment was 31 years (range, 18-43).

Results: The haemarthrosis frequency was not statistically significant at the latest follow-up years compared with 31 months (0.8 vs 0.4 per week, P = .3). There was no significant change in the clinical severity of haemophilic arthropathy (P = .5). Most of the treated joints still are in stage III of Fernandez-Palazzi and Caviglia classification. There was a trend towards the radiologic deterioration of arthritis with nearly 50% of patients at Arnold-Hilgartner Stage V. 13% of patients underwent a total knee arthroplasty (TKA). The age at which the initial radiosynovectomy was performed was significantly higher in patients who had a TKA than those who had not (22 vs 15 years, P < .002).

Conclusion: The bleeding control effect of 32P on the target joint remains over time; however, it did not appear to halt the progression of radiographic changes in haemophiliacs. It could delay the need for TKA if it performs at the right time.
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http://dx.doi.org/10.1111/hae.13879DOI Listing
January 2020

Intraosseous Lipoma of Calcaneus, Rare Cause of Chronic Calcaneal Pain: A Case Report.

Arch Bone Jt Surg 2019 Sep;7(5):469-473

Department of Orthopedics, Alborz University of Medical Sciences, Karaj, Iran.

Intraosseous lipoma is a rare, benign primary tumor occurring in the bone. Herein, we reported a 45-year-old man with chronic right posterior heel pain. In this study, the man was treated conservatively due to plantar fasciitis. During a one-month follow-up visit, the patient had no symptoms of relief in the right heel pain. Initially, calcaneal X-ray was taken, which revealed an expansile unicameral lytic lesion with central calcification on the right calcaneus. Moreover, computed tomography scan revealed an expansile lytic lesion on the right calcaneus. The diagnosis was confirmed as calcaneal lipoma in magnetic resonance imaging. The patient underwent curettage and autogenous iliac crest corticocancellous bone graft under general anesthesia. In a 3-month postoperative follow-up, the patient returned to full ambulation. Postoperative radiographs demonstrated continued remodeling and healing of the graft site. The purpose of this article was to increase awareness among clinicians about the existence of this rare cause of calcaneal pain.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802544PMC
September 2019

Minimally Invasive Repair of Acute Achilles Tendon Rupture Using Gift Box Technique.

Arch Bone Jt Surg 2019 Sep;7(5):429-434

Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: This study aimed to introduce a modified technique for minimally invasive Achilles tendon (AT) rupture repair using gift box sutures. The preliminary clinical and functional outcomes were investigated among a number of patients.

Methods: In a consecutive case series study, 24 patients with acute AT rupture underwent modified minimally invasive AT repair using two mini-incisions and gift box sutures. The patients were followed up for 24 months. The AT rupture score (ATRS) and the American Orthopedic Foot and Ankle Society (AOFAS) measure score were obtained from all patients. The other measured variables included pain intensity and satisfaction using a visual analog scale (VAS), calf atrophy, the range of sagittal ankle motion, development of wound complications, sural nerve injury, and re-rupture.

Results: After two years, the mean scores of AOFAS and ATRS were obtained at 83±4 and 81.9±6.3, respectively. Approximately 87.5 % of the patients regained their previous level of activity. The mean VAS score was 7.7±0.9 regarding the satisfaction with the outcomes. Moreover, isokinetic testing of plantar flexion and dorsiflexion strength were 82.7±5.8 and 87.7±4.1%, respectively, compared to those of the normal side. The calf atrophy was not statistically significant. In total, five patients reported pain during their activities. The range of operated ankle motion decreased significantly, compared to that of the other side; however, the differences were not significant functionally. There was no patient with wound complications, nerve injury, or complaint about problem with footwear.

Conclusion: Minimally invasive repair of acute AT rupture using two mini-incisions and gift box sutures offers good functional and clinical outcomes without wound complications which can be usually observed following open repair of AT ruptures.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802554PMC
September 2019

Outcomes of Ultrasound-Guided Gastrocnemius Injection With Botulinum Toxin for Chronic Plantar Fasciitis.

Foot Ankle Int 2020 01 5;41(1):63-68. Epub 2019 Oct 5.

Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The objective of this study was to determine whether the injection of botulinum toxin A (BTA) in the medial head of the gastrocnemius muscle could yield improvements in function and disability in patients with chronic plantar fasciitis with follow-up 12 months after treatment.

Methods: Thirty-two patients with chronic plantar fasciitis were included in the study and randomly allocated to the BTA and placebo groups. The visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scores were used to evaluate pain levels pre- and postinjection as well as function of the foot, respectively. Patients were also asked to rate their treatment satisfaction 1 year after injection. The range of dorsiflexion was measured before and 12 months after the injection.

Results: At the 12-month follow-up, the mean VAS decreased from 7.8 to 4 in the placebo group and from 8 to 0.33 in the BTA group. Furthermore, the mean AOFAS scores increased from 48.4 to 65.3 in the placebo group and from 45.5 to 90.6 in the BTA group. The postinjection scores in the BTA group were significantly higher than those in the placebo group ( < .001). Patient satisfaction in the BTA group was higher than that in the placebo group at the 12-month follow-up.

Conclusion: In patients with chronic plantar fasciitis, the use of BTA had a positive effect on improvement in pain and foot function 1 year after treatment.

Level Of Evidence: Level I, prospective randomized controlled trial.
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http://dx.doi.org/10.1177/1071100719875220DOI Listing
January 2020

Patient Satisfaction Following Total Knee Arthroplasty: Comparison of Short-Term Results in Rheumatoid Arthritis and Osteoarthritis.

Arch Bone Jt Surg 2019 Jan;7(1):61-66

Taleghani hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Due to the obvious differences in the natural course of rheumatoid arthritis (RA) and osteoarthritis (OA), different functional outcomes might be expected after Total Knee Arthroplasty (TKA) in these distinct patients. Although several studies have reported the objective outcome of TKA in RA and OA patients, few studies have compared post-operative patient-satisfaction levels.

Methods: In this clinical cohort study 171 patients (RA: n=33, OA: n=138) who underwent TKA with posterior stabilizing knee prosthesis were included. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS) were used to evaluate and compare patients' satisfaction 6 and 12 months after TKA relative to their preoperative state and to make an assessment between two groups.

Results: Both of patient-reported scoring systems showed a statistically significant improvement for OA and RA patients at 6 and 12 months after surgery, relative to their preoperative scores. The results of the OKS and KOOS did not show statistically significant improvement from 6 to 12 months n RA patients. Unlike RA group, OKS and KOOS revealed further improvement between 6 and 12 months for the osteoarthritic patients.

Conclusion: OA patients had continuous improvement in their satisfaction in the first year after TKA with a gentle upward curve. In contrast, in RA patients, recovery was faster and greater in the first six months after surgery and slowed down in the second six months. Patient-reported outcome scores were not significantly different between two groups at the end of the first year.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372268PMC
January 2019

Skin Complications of Orthopedic Procedures and Devices.

Iran J Public Health 2018 Dec;47(12):1937-1944

Kassir Dermatology, Dallas, Texas, USA.

Background: Knowledge of skin complications and contributing factors in orthopedic patients is important for design and development of preventive approaches. Therefore, this study was designed to assess skin complications in orthopedic patients.

Methods: In this case-series study, 126 orthopedic patients referred to Rasoul-e-Akram and Bahman hospitals from 2012 to 2016 with skin complications were analyzed. The adverse effects were assessed with respect to type and contributing factors. Fisher's exact test, Chi-square, and independent sample t-test were performed to assess the associations between skin complications and other variables.

Results: Skin complications in orthopedic patients included infections in 33 (26.1%) cases and hypersensitivity reactions in 88 (40%) cases. In total, 66 (55%) cases of fracture and 35 (29.2%) cases of cellulitis were detected, while the remaining cases involved complications such as disc herniation, nerve involvement, and osteoarthritis-related arthroplasty. Severe reactions presenting as toxic epidermal necrolysis were observed in 3 patients, 2 of whom died eventually. Age and gender were not related to the type of skin complications (>0.05).

Conclusion: Complications due to orthopedic treatments were not common. However, since the disease may become fatal on certain occasions, patients should receive more attention from physicians and nurses.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379618PMC
December 2018

The Outcomes of Pilon Fracture Treatment: Primary Open Reduction and Internal Fixation Versus Two-stage Approach.

Arch Bone Jt Surg 2018 Sep;6(5):412-419

Research performed at Taleghani hospital, shahid beheshti medical university, Tehran, Iran.

Background: Pilon fracture is one of the challenging injuries in orthopedic surgery. Associated soft tissue injury is an important factor in choosing treatment options. Two major methods of treatment are considered as one-stage open reduction internal fixation (ORIF) and two-stage treatment (primary external fixation and secondary ORIF). The latter is most accepted in literature. In the current study, we compared the results of these two methods.

Methods: In a retrospective study, 41 patients were assigned to two groups containing one-stage primary ORIF (21 patients) group, and two-stage group included external fixation and secondary ORIF (20 patients). The rate of infection (superficial or deep infection, osteomyelitis), malunion, nonunion, duration of hospital stay, neurovascular injury, pain intensity, and patients' satisfaction with AOFAS score, were compared between the two groups.

Results: There was no significant difference between the two groups in measured variables except hospital stay which was significantly longer for the two-stage group.

Conclusion: Based on our findings, we recommend using one stage ORIF for a patient with Pilon fractures type C and Tscherne 1, 2 if the patient is planned to be operated on during the first 24 hours after the injury.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168224PMC
September 2018

The Relationship between Plasma Levels of Interleukin-6, Multiple Organ Dysfunction and Mortality in Orthopedic Patients.

Iran J Immunol 2018 Jun;15(2):156-164

Taleghani Hospital, Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran.

Background: Interleukin 6 (IL-6) functions as both a pro-inflammatory cytokine and an anti-inflammatory cytokine.

Objective: To evaluate the levels of IL-6 in patients with multiple organ dysfunction syndrome (MODS).

Methods: Level of IL-6 was assessed and recorded for 14 days subsequent to the injury in 161 multiple trauma patients. MODS were diagnosed using Marshal Score. Injury Severity Scoring (ISS) was measured for all patients.

Results: The results of this study indicated that there was a significant relationship between the level of IL-6 and ISS on the first and second days post trauma (P=0.0001). The high level of IL-6 on the second day post trauma was associated with high mortality rate.

Conclusion: Our study suggests the second day as the golden time for measuring the serum levels of IL-6. These findings warn us to take more health care actions in patients with higher serum levels of IL-6 on the second day.
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http://dx.doi.org/IJIv15i2A8DOI Listing
June 2018

Foot scan assessment of metatarsus adductus: A useful adjunct to Bleck's classification.

Foot (Edinb) 2018 Mar 22;34:74-77. Epub 2017 Nov 22.

Shahid Beheshti University of Medical Sciences, Iran. Electronic address:

To determine the severity of metatarsus adductus (MA) comparing with Bleck's classification as a commonly acceptable method for assessing MA, static foot scan has been used. In this cross-sectional descriptive research study, 100 subjects were equally divided into four groups according to Bleck's classification. The feet were scanned and MA severity (MAS) index was measured on the obtained foot scan images. The MAS index was the ratio of the transverse deviation of the forefoot from the lateral border heel line to the width of the ball of the foot. The mean of the MAS index in normal, mild, moderate, and severe MA was 0.02±0.02, 0.1±0.01, 0.159±0.03, and 0.216±0.025, respectively. The difference of MAS index between each group was significant (p<0.001). The mean of MAS index in 4 groups was consistent with Bleck's classification, with a significant increase from normal to severe MA (p<0.05). Since the results of this method are consistent with Bleck's classification and this novel foot scan assessment appears to be more objective than Bleck's classification, the authors recommend this method to be used in examination of patients with MA. However, further studies should be conducted to define interobserver and intraobserver reliability.

Level Of Evidence: III.
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http://dx.doi.org/10.1016/j.foot.2017.11.007DOI Listing
March 2018

Comparative investigation of percutaneous plating and intramedullary nailing effects on IL-6 production in patients with tibia shaft fracture.

Acta Orthop Traumatol Turc 2017 Dec 6;51(6):478-481. Epub 2017 Nov 6.

Department of Orthopaedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Objective: The aim of this study was to analyze the effect of intramedullary nailing (IMN), open plating and percutaneous plating on the induction of IL-6 in patients with tibia fractures.

Methods: A total of 30 patients with tibia shaft fracture underwent either intramedullary nailing (IMN, n = 15; 14 males and 1 female; mean age: 32.1 ± 15.6), ORIF plating (n = 8; 5 males and 3 females; mean age: 60.0 ± 17.8), or percutaneous plating (n = 7; 6 males and 1 female; mean age: 43.1 ± 21.4). Serum IL-6 cytokine levels were measured prior to, and 6 and 24 h after the surgery, using a special ELISA kit.

Results: The IL-6 concentration increased to peak levels at 6 h in both IMN and percutaneous plating groups, and at 24 h in ORIF plating group (p < 0.001). The mean IL-6 concentration of percutaneous plating group was significantly lower than that of the IMN group at 6 h following the surgery (p = 0.022). In addition, the mean IL-6 concentration of ORIF plating group was significantly higher than that of the percutaneous plating group at 24 h post operation (p = 0.009).

Conclusion: Our results suggest that percutaneous plating compared to the IMN has lower effects on IL-6 production in patients with tibia fracture.

Level Of Evidence: Level III, therapeutic study.
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http://dx.doi.org/10.1016/j.aott.2017.09.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197449PMC
December 2017

Comparison of patellar versus hamstring tendon autografts in arthroscopic anterior cruciate ligament reconstruction: A 6-month follow-up of a randomized clinical trial.

J Res Med Sci 2017 26;22:105. Epub 2017 Sep 26.

Iran University of Medical Sciences, Tehran, Iran.

Background: The purpose of this study was to compare the outcomes of anterior cruciate ligament (ACL) reconstruction using the patellar versus hamstring tendon (HT) autograft.

Materials And Methods: In this randomized clinical trial, fifty patients undergoing arthroscopic ACL reconstruction were randomized into two equal groups: Those treated with either autogenous patellar tendon grafts (PT group) or HT group grafts. All patients were reviewed immediately after surgery, at 6 and 12 weeks after surgery, and then at 6 months using the International Knee Documentation Committee evaluation form. Infection, severity of pain (visual analog scale), duration of rehabilitation, and clinical and magnetic resonance imaging (MRI) findings were assessed at the 6-month follow-up. Positive pivot shift and Lachman test were considered clinical signs and symptoms of treatment failure. In addition, the absence of the ACL or transverse ACL rather than the posterior oblique ligament is an MRI finding that indicates treatment failure.

Results: Comparing changes in pain and range of motion (ROM) in patients first and 6 months after therapy show that pain had been relief significantly ( < 0.001) and ROM dramatically changes ( < 0.001). The average rehabilitation period in the PT group was 13.2 ± 2.08 weeks whereas in the HT group, it was 9.28 ± 2.26 weeks. A significant difference was seen between the two groups in terms of the rehabilitation period ( < 0.001). No significant difference was found in the normal ROM between the groups ( = 0.32). When the pain severity was considered, a significant difference was found between the PT group and the HT group ( < 0.001). The HT group patients had less knee pain than did the PT group patients. No significant difference in infection rates was seen between two groups ( = 0.66).

Conclusion: Considering the better outcomes of HT reconstructions for the two parameters of pain severity and rehabilitation period, we consider HTs to be the ideal graft choice for ACL reconstructions.
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http://dx.doi.org/10.4103/jrms.JRMS_939_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629835PMC
September 2017

High Tibial Osteotomy: A Systematic Review and Current Concept.

Arch Bone Jt Surg 2016 Jun;4(3):204-12

Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.

High tibia osteotomy is a common procedure in orthopedic surgery. A precise overview on indications, patients selection, pre-operative planning, surgical technique, methods of fixation, and complications have been presented. This paper focused on the points that should be considered to achieve good long-term outcomes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969364PMC
June 2016

Outcome Assessment of Operative Treatment of Humeral Shaft Fractures by Antegrade Unreamed Humeral Nailing (UHN).

Indian J Surg 2015 Jun 29;77(3):186-90. Epub 2012 Sep 29.

Shahid Beheshti University of Medical Sciences, Velenjak St, Tehran, Iran.

The purpose of this study was to assess the outcome of humeral shaft fractures treated with Unreamed Humeral Nailing (UHN) system. Fixation of the humeral shaft fractures in this study was performed by minimal incision UHN system, without using its distal locking properties. Forty one patients were treated this way. Functional status of shoulder and elbow were evaluated using Society of the American Shoulder and Elbow Surgery (SASES) scoring system. During follow up period, no superficial or deep infections were observed. Mean union time was 13 weeks. Shoulder and elbow functions using SASES scale were excellent or good in 93 % of the patients. Complications included delayed union in 3(7.3 %), nonunion in 2(4.8 %) and radial nerve palsy in 1(2.4 %). Antegrade unreamed humeral Nailing is an acceptable, safe and reliable treatment for humeral shaft fractures.
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http://dx.doi.org/10.1007/s12262-012-0756-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522247PMC
June 2015

Early clinical results of arthroscopic remplissage in patients with anterior shoulder instability with engaging hill-sachs lesion in iran.

Arch Bone Jt Surg 2014 Mar 15;2(1):43-6. Epub 2014 Mar 15.

Hamid Reza Aslani MD, Zohreh Zafarani MD, Adel Ebrahimpour MD, Shahin Salehi MD, Shahid-Beheshti University of Medical Sciences Tehran, Iran.

Background: To assess the outcome of the remplissage arthroscopic surgical method in patients with anterior shoulder dislocation associated with Hill-Sachs lesion.

Methods: Ten patients with anterior shoulder dislocations and Hill-Sachs lesions were entered into this study and were operated on by the remplissage arthroscopic surgical method. They were followed up 22 months after surgery in order to evaluate the outcome of the treatment, including recurrence of dislocation and motion limitation.

Results: During the internal follow up period, no case of recurrence was found. Motion limitation during the follow up period was not significant (internal rotation limitation=5°±1°, and external rotation limitation=4°±1°).

Conclusions: Our findings suggest that the remplissage arthroscopic surgical method is an acceptable, safe and reliable treatment for anterior shoulder dislocation with engaging Hill-Sachs lesion.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151427PMC
March 2014

Spontaneous radial nerve palsy subsequent to non-traumatic neuroma.

Trauma Mon 2013 Sep 13;18(2):98-100. Epub 2013 Aug 13.

Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

Introduction: Spontaneous radial palsy is a not rare finding in hand clinics. The anatomy of the radial nerve renders it prone to pressure paralysis as often called "Saturday night palsy". This problem is a transient nerve lesion and an acute one but the case presented here is very unusual in that it seems this entity can also occur as an acute on chronic situation with neuroma formation.

Case Presentation: A 61 year-old man presented with the chief complaint of inability to extend the wrist and the fingers of the left hand which began suddenly the night before admission, following a three-week history of pain, numbness and tingling sensation of the affected extremity. He had no history of trauma to the extremity. Electromyography revealed a severe conductive defect of the left radial nerve with significant axonal loss at the upper arm. Surgical exploration identified a neuroma of the radial nerve measuring 1.5 cm in length as the cause of the paralysis. The neuroma was removed and an end-to-end nerve coaption was performed.

Conclusions: Complete recovery of the hand and finger extension was achieved in nine months.
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http://dx.doi.org/10.5812/traumamon.9851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860672PMC
September 2013

Intraosseous ganglion cyst of the lunate.

Trauma Mon 2012 Jan 15;16(4):198-200. Epub 2012 Jan 15.

Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.

Intraosseous ganglia can affect the carpal bones of the hand and must be considered in the differential diagnosis of wrist pain. A 38-year-old female presented with a 14-month history of left wrist pain and a radiolucent cystic lesion was seen computed tomography (CT) scanning. Characteristic radiographic findings of a cyst in association with a fine sclerotic rim was apparent. We report an unusual presentation of a ganglion cyst in the lunate bone with excellent treatment outcome.
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http://dx.doi.org/10.5812/kowsar.22517464.2705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3989574PMC
January 2012