Publications by authors named "Mohsen Mardani-Kivi"

45 Publications

Return to sports activity in the revision of anterior cruciate ligament reconstruction: A 2-6 Year follow-up study.

J Clin Orthop Trauma 2021 May 26;16:80-85. Epub 2020 Dec 26.

Department of Anatomical Sciences & Cell Biology, Mashhad University of Medical Sciences, Mashhad, Iran.

Introduction: and Objective: The risk of an anterior cruciate ligament (ACL) injury in young patients and those with sports activity is increasing. Regarding the need of athletes with ACL re-rupture to return to sports, ACL revision surgery has received great importance. This study was conducted to evaluate the outcome of ACL reconstruction revision surgery in athletes.

Method: In general, 62 patients with primary surgery and 62 patients with revision ACL surgery were investigated in this study. The study subjects were matched in terms of age, gender, involved leg, injury mechanism, sports group, time of surgery, and the degree of cartilage injury and ankle meniscus rupture. The studied variables included age, gender, body mass index (BMI), sports group, infection, meniscus injuries, chondral lesion, time to return to sports, quality of return to sports, range of motion, Lachman's test, and knee injury and osteoarthritis outcome score (KOOS), International Knee Documentation Committee score, Lysholm, and Marx scores. They were obtained through the information in the patients' medical records and the questionnaire filled out by the participants and the examiner's physician through the follow-ups. Then, the collected data were imported into the SPSS software and underwent analysis.

Results: The mean follow-up of patients was 49 months (in the range of 2-6 years). None of the patients had a chronic infection. The mean time to return to sports was 29.2 ± 3.2 and 35.3 ± 4.3 weeks in the primary surgery and revision surgery groups, respectively. In addition, 34 (54.8%) and 25 (40.3%) patients of the primary surgery and the revision surgery groups returned to the same level before injury, respectively. On the latest follow-up, the results of the Lachman test showed no significant difference between the two groups (P = 0.222) whereas Lysholm, IKDC, MARX, and KOOS scores on the latest follow-up in primary surgery were significantly higher than those of revision surgery (P < 0.001).

Conclusion: The rate of return to sports in revision surgery was 14.5% lower than that of primary surgery, and the average time of return to sports was six weeks. The rate of return to sports, similar to before the injury, was significantly lower in the revision group, females, the age group of over 25 years, and contact sports activity, and patients with a chondral lesion. All knee performance scores were also poorer in the revision surgery.
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http://dx.doi.org/10.1016/j.jcot.2020.12.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920088PMC
May 2021

Bilateral total knee arthroplasty: Simultaneous versus staging in the same or in twice hospitalization.

J Clin Orthop Trauma 2021 Mar 22;14:59-64. Epub 2020 Sep 22.

Department of Anatomical Sciences & Cell Biology, Mashhad University of Medical Sciences, Mashhad, Iran.

Background And Objective: Arthroplasty is the main treatment in patients with advanced knee osteoarthritis. In bilateral lesions, it is frequently performed in two simultaneous or separate surgical procedures. In this regard, the present study aimed to compare the results of knee arthroplasty in two joints simultaneously at two different times.

Method: In general, all 40-70 years old patients in need of complete bilateral total knee arthroplasty (BTKA) were enrolled in this descriptive cross-sectional study during 2009-2016. They were included in three groups of BTKA as simultaneously (n = 272), staging in the same hospitalization (146), and staging in different hospitalizations (245). To assess the quantitative and qualitative function of the knees, patients' knees were evaluated before the surgery, and one month, three months, and two years after the surgery using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Finally, hospitalization time, anesthesia duration, and medical costs were compared between the three groups.

Results: Based on the results, knee function improved based on WOMAC and KSS scales in all groups after arthroplasty although no significant differences were observed between the three groups. Patients' satisfaction in simultaneous BTKA was significantly higher compared to the other two groups ( = 0.013). Eventually, complications demonstrated no significant differences between the three groups except for pulmonary and cerebral embolism which were more prevalent in old patients with a high body mass index in the simultaneous BTKA group ( = 0.035 and  = 0.043, respectively).

Conclusion: Overall, simultaneous BTKA is a useful approach for reducing costs while increasing patients' function and satisfaction although it has certain complications such as embolism in older overweight patients.
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http://dx.doi.org/10.1016/j.jcot.2020.09.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920008PMC
March 2021

Return to sport activity after anterior cruciate ligament reconstruction: A 6-10 years follow-up.

J Clin Orthop Trauma 2020 May 19;11(Suppl 3):S319-S325. Epub 2019 Oct 19.

Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Nowadays, patients widely accept anterior cruciate ligament (ACL) reconstructive surgery. However, its long-term complications are still under investigation in athletes. Therefore, the aim of this study was to evaluate long-term ACL reconstruction especially in athletes.

Methods: A total of 426 patients with ACL injury were studied during 2008-2012. Demographic characteristics (gender, age, BMI), graft type, chondral lesion, osteoarthritis, meniscus tear, exercise activity, and pain intensity were noted. The effects of these factors on the return to sport activity after ACL reconstruction were also investigated. Lachman test, KT-1000, ACL quality of life (ACL-QOL), KOOS score, IKDC, and LKS were assessed at 2 years post-operation and at final follow-up. Repeated ACL rupture on the same and contralateral sides were also evaluated.Results: knee stability (based on Lachman and KT-1000), knee function (according to KOOS, LKS, and IKDC scores) and ACL-QOL were improved during the 2 years follow-up. The rate of return to sport activity similar to preinjury in patients was 64.08% in final follow-up. Chondral lesion was a limiting factor among the variables that affected the return to sport activity. It caused a return to sport activity similar to pre injury just in 21.24% of the patients. However, meniscus rupture did not affect return to sport activity similar to pre injury. Also, the rate of return to sport activity similar to pre injury was higher in men, patients under 30 years and those who had BMI of 20-25 kg/m. In final follow-up, risk of ACL rupture in the injured knee and contralateral knee was 4.22% and 10.57%, respectively.

Conclusion: Despite the recovery of patients after ACL reconstruction during long-term follow-up in athletes, return to sport activity similar to pre-injury in female, older peoples, overweight patients and athletes with chondral lesion were lower. However, these conditions do not apply to the meniscus rupture.
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http://dx.doi.org/10.1016/j.jcot.2019.09.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275270PMC
May 2020

Contralateral and siblings' knees are at higher risk of ACL tear for patients with a positive history of ACL tear.

Knee Surg Sports Traumatol Arthrosc 2020 Feb 14;28(2):622-628. Epub 2019 Nov 14.

Orthopedic Department, Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences, Parastar Ave., Rasht, Iran.

Purpose: Recent studies have shown that several genetic factors can cause susceptibility to anterior cruciate ligament (ACL) rupture. The aim of the present study was to evaluate certain underlying factors that increase the risk of ACL rupture.

Methods: Eight hundred thirty-six patients with ACL rupture who underwent ACL reconstructive surgery from 2010 to 2013 at an academic center completed a minimum of 5 years post-operation follow-up. The collected variables included sex, age, height, weight, exercise level, time interval between ACL rupture in the first knee and contralateral ACL rupture, dominant leg, side of the involved knee and sibling history of ACL rupture.

Results: The median follow-up duration was 6.5 (range: 5-8) years. Eighty-three patients (9.9%) had a contralateral ACL rupture, and 155 patients (18.5%) had siblings with a history of ACL rupture. The rate of contralateral ACL rupture was three times higher in women than in men and in patients with siblings with a history of ACL rupture than in those without such history. In addition, the risk of contralateral ACL rupture was higher in those younger than 30 years of age, those with a BMI of 20-25 kg/m and those who participated in regular sports activity. However, whether the involved knee was on the dominant or nondominant side had no effect on the incidence of contralateral ACL rupture. The results of the study showed that 69 (83.1%) of the contralateral ACL ruptures occurred within the first 2 years after the primary operation.

Conclusion: In a 5- to 8-year follow-up, one out of every ten patients had a contralateral ACL rupture, and two out of every ten patients had siblings with a history of ACL rupture. The findings suggest that having a sibling with a history of ACL rupture and being female are important risk factors for ACL rupture of the contralateral knee.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-019-05781-zDOI Listing
February 2020

Simultaneous arthroscopic ACL and PCL reconstruction using allograft Achilles tendon.

J Clin Orthop Trauma 2019 Oct 2;10(Suppl 1):S218-S221. Epub 2019 Jan 2.

Orthopedic Department, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Background: Multi-ligamentous injuries to the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) are uncommon but debilitating injuries. They mostly lead in functional disabilities and further surgeries.

Hypothesis: The aim of the present study was to evaluate the outcomes of simultaneous arthroscopic reconstruction of ACL and PCL using allograft Achilles tendon.

Study Design: Case-series study.

Materials And Methods: This study was performed on patients with combined ACL-PCL injuries which attended for treatment to a referral center from January 2010 to January 2014. All of them underwent simultaneous arthroscopic reconstruction of ACL and PCL using allograft Achilles tendon. Range of motion (flexion and extension loss), giving way, anterior and posterior knee stability, proximal tibia step off, subjective assessment of knee function and patients satisfaction were evaluated at 3, 6, 12, 24 months and final follow-up. Data were analyzed by SPSS version 21 with consideration of P < 0.05 as significant difference.

Results: Among 28 included patients, 21 patients (75%) were male. Mean age of patients was 30.86 ± 7.25 years (range: 18-49 years). The mean follow-up time was 35.7 ± 6.8 months (range: 26-50 months). Our results demonstrated that knee function, stability, and range of motion were improved along the follow-up periods. At final follow-up none of the patients had giving way and all of them were completely satisfied from the surgery.

Conclusion: Simultaneous reconstruction of injured cruciate ligaments using allograft Achilles tendon resulted in appropriate functional outcomes and acceptable range of motion.

Level Of Evidence: IV.
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http://dx.doi.org/10.1016/j.jcot.2019.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823795PMC
October 2019

Rotator cuff tear with concomitant long head of biceps tendon (LHBT) degeneration: what is the preferred choice? Open subpectoral versus arthroscopic intraarticular tenodesis.

J Orthop Traumatol 2019 Jul 5;20(1):26. Epub 2019 Jul 5.

Orthopedic Department, Guilan University of Medical Sciences, Parastar Ave, Poursina Hospital, P.O. Box: 4193713191, Rasht, Iran.

Background: Lesions associated with the biceps tendon are commonly detected during arthroscopic repair of rotator cuff tears. Acquiring a preferable technique to repair both cuff and long head of biceps tendon (LHBT) lesions was the aim of several recent studies. This study aimed to compare clinical and functional outcomes of open subpectoral versus arthroscopic intraarticular tenodesis in patients with repairable rotator cuff tear associated with LHBT degeneration.

Patients And Methods: In this randomized clinical trial, 60 eligible candidates for arthroscopic rotator cuff repair (mean age 55.7 ± 6.9 years) were allocated to a control group (open subpectoral, SP) or intervention group (intraarticular, IA). In the IA group, an anchor suture was used for both rotator cuff repair and LHBT tenodesis. In the SP group, after arthroscopic repair of the rotator cuff, subpectoral tenodesis of LHBT was performed using an interference screw. Patients were evaluated for 2 years follow-up regarding pain intensity using the visual analogue scale (VAS) and shoulder function using the Constant Score and Simple Shoulder Test.

Results: The two groups were similar with regard to demographic characteristics and preoperative evaluations (all P > 0.05). The functional status of both groups was improved, but not significantly differently so between the two groups (P = 0.1 and P = 0.4, respectively). Pain intensity decreased during the 2-year follow-up period, similarly so in the two groups. Patient satisfaction was also similar in the two groups.

Conclusion: Large and massive rotator cuff tears (tears > 3 cm) associated with LHBT pathologies benefited from intraarticular or subpectoral tenodesis similarly, with no differences in short- or mid-term results between these two techniques.

Level Of Evidence: II.
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http://dx.doi.org/10.1186/s10195-019-0531-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611854PMC
July 2019

Double-plate fixation together with bridging bone grafting in nonunion of femoral supracondylar, subtrochanteric, and shaft fractures is an effective technique.

Musculoskelet Surg 2020 Aug 26;104(2):215-226. Epub 2019 Jun 26.

Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Purpose: The aims of the present study were to evaluate and report the therapeutic outcomes of double-plate fixation in combination with autogenous bridging bone grafting in treatment of nonunion fractures of femur.

Methods: In this retrospective case series study, 41 patients with nonunion fracture of femur who underwent surgery by double-plate fixation and autogenous bridging bone grafting in academic referral center from July 2010 to July 2015 were enrolled. Totally, 32 males and 9 females with mean age of 35 years were evaluated. They were evaluated for related risk factors, previous therapeutic methods, time interval between injury to nonunion surgery and surgery to full clinical and radiological union, duration of follow-up, levels of postoperative limb shortening, and movement limitations.

Results: Ten patients had open fractures and eight patients had infected nonunion in the femoral supracondylar, subtrochanteric, and shaft fractures. Nailing was the most common used method as the primary treatment of femoral shaft fractures. In addition, the mean follow-up time was 37 months. Full union was obtained even in infected cases. Deep vein thrombosis was found in one patient and pulmonary thromboembolism in another patient, and both patients were treated successfully. Moreover, limitations of articular movements were seen in seven patients.

Conclusion: Double-plate fixation in combination with bridging bone grafting is an effective method in the treatment of nonunion of femoral supracondylar, subtrochanteric, and shaft fractures even in the infected cases.
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http://dx.doi.org/10.1007/s12306-019-00615-0DOI Listing
August 2020

Wet-Cupping Is Effective on Persistent Nonspecific Low Back Pain: A Randomized Clinical Trial.

Chin J Integr Med 2019 Jul 27;25(7):502-506. Epub 2018 Nov 27.

Orthopedic Research Center, Rasht, Iran.

Objective: To compare the possible effects of wet-cupping therapy with conventional therapy on persistent nonspecific low back pain (PNSLBP).

Methods: In this randomized clinical trial, 180 participants with the mean age of 45±10 years old, who had been suffering from PNSLBP were randomly assigned to wet-cupping and conventional groups. The wet-cupping group was treated with two separate sessions (4 weeks in total) on the inter-scapular and sacrum area. In the conventional group, patients were conservatively treated using rest (6 weeks) and oral medications (3 weeks). The primary and the secondary outcome were the quantity of disability using Oswestry Disability Index (ODI), and pain intensity using Visual Analogue Scale (VAS), respectively.

Results: There was no significant difference in demographic characteristics (age, gender, and body mass index) between the two groups (P>0.05). Therapeutic effect of wet-cupping therapy was comparable to conventional treatment in the 1st month follow-up visits (P<0.05). The functional outcomes of wet-cupping at the 3rd and 6th month visits were significantly increased compared to the conventional group. Final ODI scores in the wet-cupping and conventional groups were 16.7 ± 5.7 and 22.3 ± 4.5, respectively (P<0.01).

Conclusion: Wet-cupping may be a proper method to decrease PNSLBP without any conventional treatment. The therapeutic effects of wet-cupping can be longer lasting than conventional therapy. (Registration No. IRCT2013021672741)).
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http://dx.doi.org/10.1007/s11655-018-2996-0DOI Listing
July 2019

A Comparison between Single and Double Tourniquet Technique in Distal Upper Limb Orthopedic Surgeries with Intravenous Regional Anesthesia.

Arch Bone Jt Surg 2018 Jan;6(1):63-70

Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Department, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Several studies have put an effort to minimize the tourniquet pain and complications after conventional double tourniquet intravenous regional anesthesia (IVRA). We expressed in our hypothesis that an upper arm single wide tourniquet (ST) may serve a better clinical efficacy rather than the conventional upper arm double tourniquet (DT) in distal upper extremity surgeries.

Methods: In this randomized controlled trial, 80 patients undergoing upper limb orthopedic surgeries were randomized into two groups. IVRA was administered using lidocaine in both groups. Tourniquet pain was recorded based on visual analogue scale (VAS). In case of pain (VAS>3) in the DT group, the proximal tourniquet was replaced with a distal tourniquet while fentanyl 50µg was injected in the ST group. The onset time of tourniquet pain, time to reach to maximum tourniquet pain and the amount of fentanyl consumption were compared between the two groups.

Results: No significant difference was seen in demographic characteristics. The onset time of tourniquet pain (VAS=1) in the ST group (26.9±13.2 min) was longer than that of the DT group (13.8±4.8 min) (). The median of time to reach to maximum tourniquet pain (VAS>3) in DT and ST groups were 25 and 40 minutes, respectively; indicating that the patients in ST group reached to pain level at a significantly later time (). The total opioid consumption in the DT group (61 µg) was significantly lower than the ST group (102 µg) (); however, both groups were similar regarding fentanyl consumption before 40 minutes of surgeries.

Conclusion: It seems that in upper limb orthopedic surgeries with less than 40-minute duration, a single tourniquet may serve as a proper alternative opposed to the conventional double tourniquet technique. II.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5799603PMC
January 2018

Intra-sheath versus extra-sheath ultrasound guided corticosteroid injection for trigger finger: a triple blinded randomized clinical trial.

Phys Sportsmed 2018 Feb 10;46(1):93-97. Epub 2017 Nov 10.

e General Practitioner, Guilan Road Trauma Research Center , Guilan University of Medical Sciences , Rasht , Iran.

Objective: The aim of this study is to compare clinical results of ultrasound-guided corticosteroid injection, intra-sheath versus extra-sheath of the finger flexor tendon.

Methods: A total of 166 patients with trigger finger were evaluated in a triple blind randomized clinical trial study. All the patients were injected with 1ml of 40mg/ml methyl prednisolone acetate, under the guidance of ultrasound. Half the patients were injected extra sheath, while the other half were injected intra sheath at the level of first annular pulley.

Results: The two groups were comparable in baseline characteristics (age, gender, dominant hand, involved hand and finger, and the symptoms duration). No significant difference was observed in the two groups with regards to Quinnell grading. In the final visit, 94% of patients from each group were symptom free.

Conclusion: Results of corticosteroid injection intra-sheath or extra-sheath of the finger flexor tendon under ultrasound guidance in patients with trigger finger are comparably alike. Extra-sheath injection at the level of A1 pulley is as effective as an Intra-sheath administration.
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http://dx.doi.org/10.1080/00913847.2018.1400897DOI Listing
February 2018

Anatomical Repair of Stener-like Lesion of Medial Collateral Ligament: A case Series and Technical Note.

Arch Bone Jt Surg 2017 Jul;5(4):255-258

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

Medial collateral ligament tears usually will be treated through non-surgical methods, but, in some cases such as those with tears at the distal insertion where the reduction could be blocked by the pes anserine tendons (Stener-like lesion), surgery will be performed. Here, we present a surgical technique in such cases. In this retrospective case series, we describe six patients diagnosed with Stener-like lesion based on clinical evaluation and imaging results. In the one-year follow-up visit, there was no complaining of pain or joint instability and full range of motion and negative valgus stress test were reported in all cases. The results showed this surgical technique is a useful and safe treatment approach in such cases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592368PMC
July 2017

Is Spinal Anesthesia with Low Dose Lidocaine Better than Sevoflorane Anesthesia in Patients Undergoing Hip Fracture Surgery.

Arch Bone Jt Surg 2017 Jul;5(4):226-230

Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran.

Background: To evaluate general anesthesia with sevoflurane vs spinal anesthesia with low dose lidocaine 5% on hemodynamics changes in patients undergoing hip fracture surgery.

Methods: In this randomized double blind trial 100 patients (50 patients in each group) older than 60 years under hip surgery were randomized in general anesthesia with sevoflurane and spinal anesthesia with lidocaine 5%. Hemodynamic changes including mean arterial pressure (MAP) and heart rate, blood loss, pain severity, nausea and vomiting and opioids consumption were compared in two groups.

Results: During surgery, difference between two groups regarding changes in mean arterial pressure was not significant, but the changes in heart rate were significantly different. Mean arterial pressure changes during recovery between two groups were significantly different. But there was no significant difference in heart rate changes. Bleeding in the sevoflurane group was significantly more than spinal group (513.ml vs. 365 ml). Moreover, AS Score, opioid consumption, and the nausea and vomiting in spinal anesthesia group was significantly lower than the sevoflurane group.

Conclusion: We showed that general anesthesia with sevoflurane and spinal anesthesia with low dose lidocaine 5% have comparable effects on hemodynamics changes in patients undergoing hip fracture surgery. However postoperative pain score, vomiting and morphine consumption in patients with spinal anesthesia were lower than general anesthesia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592363PMC
July 2017

Does Tranexamic Acid Reduce Bleeding during Femoral Fracture Operation?

Arch Bone Jt Surg 2017 Mar;5(2):103-108

Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Poursina hospital, Rasht, Iran.

Background: Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead to postoperative acute anemia and some other complications. Tranexamic acid (TA) is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusion requirements during some elective surgeries. The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA) on intraoperative blood loss and a subsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting.

Methods: Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullary nailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. Group I, the intervention group with eighteen patients received 15 mg/kg (TA) via intravenous infusion before surgical incision. Patients in the placebo group received an identical volume of normal saline. Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobin change as well as transfusion rates and volumes were compared between the two groups.

Results: Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups, respectively (P=0.570). Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group (5.6%) compared to the placebo group (30%) (P=0.06). No significant difference in The Allowable Blood Loss during the surgery was found between the two groups (P=0.894).

Conclusion: Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion during traumatic femoral fracture operation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410741PMC
March 2017

Predicting the Hamstring Tendon Diameter Using Anthropometric Parameters.

Arch Bone Jt Surg 2016 Oct;4(4):314-317

Guilan Road Trauma Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran.

Background: Despite the importance of hamstring tendon autograft, one major disadvantage in applying this technique in the surgical reconstruction of anterior cruciate ligament is individual variability in the tendon diameter. Hence, the purpose of the present study was to use anthropometric parameters such as gender, height and body mass index to predict 4-strand (quadruple) hamstring tendons (gracilis and 2-strand semitendinosus tendons).

Methods: This is a cross-sectional study conducted on all consecutive patients who underwent arthroscopic ACL reconstruction between 2013 and 2015. The anthropometric variables (age, gender, height, and body mass index) were recorded. The quadruple hamstring tendon (gracilis and semitendinosus) autografts were measured using sizing cylinders. The relationship between these parameters was statistically determined using the Pearson Spearman test and linear regression test.

Results: The mean age of the 178 patients eligible for the study was 29.58±9.93 (118 males and 60 females). The mean hamstring tendon diameter was 7.8±0.7 mm, the mean for males was 7.9±0.6 and for females 7.8±9 mm (=0.0001). There were significant correlations between the mean hamstring tendon diameter with BMI (Pearson correlation=0.375, R=0.380, and =0.0001), height (Pearson correlation=0.441, R=0.121, and =0.0001), and weight (Pearson correlation=0.528, R= -0.104 and =0.0001). However, patient's age and genderwerenot found to be a predictor of the size of the hamstring tendon diameter.

Conclusion: Based on findings from this study weight, height, body mass index, and the length of the tendon may be predictors of the hamstring tendon diameter for anterior cruciate ligamentreconstruction. These findings could be used in preoperative planning of patients undergoing ACL reconstruction surgery to estimate the size of the graft and select of the appropriate type of graft.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100445PMC
October 2016

Comparison of Indirect MR Arthrography With Conventional MRI in the Diagnosis of Knee Pathologies in Patients With Knee Pain.

Trauma Mon 2016 May 20;21(2):e20718. Epub 2016 Mar 20.

Student Research Committee, Guilan University of Medical Sciences, Rasht, IR Iran.

Background: Knee pain is a common problem in the general population. In order to determine the extent of the injury and the appropriate treatment, MRI provides the most accurate imaging method. This may be done through conventional MRI techniques or by injecting a contrast material (MR arthrography).

Objectives: The purpose of this study was to compare the diagnostic value of these two methods.

Patients And Methods: The study involved the diagnostic evaluation on 60 patients with knee pain who received treatment over the course of a one-year period. Referred patients were randomly divided into two groups: indirect MR arthrography was performed on one group, and conventional MRI was performed on the other group. Both groups then underwent arthroscopy. The results from both groups were compared with the arthroscopic findings.

Results: In all of the pathologies studied, the sensitivity, specificity, and the positive and negative predictive values were evaluated. A high rate of accuracy was found between MR arthrography and arthroscopy (P < 0.05) for all knee injuries, however a similar rate of accuracy between conventional MRI and arthroscopy was only seen in patients with damage to the posterior cruciate ligament (PCL), the tibio-femoral articular cartilage, and patella chondromalacia (P < 0.05). The highest rate of accuracy was seen in cases where indirect MR arthrography was used for the diagnosis of anterior cruciate ligament (ACL) damage (K = 1).

Conclusions: Our results have shown that indirect MR arthrography had greater diagnostic accuracy in regards to the sensitivity, specificity, and positive and negative predictive values than conventional MRI in knee pathologies.
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http://dx.doi.org/10.5812/traumamon.20718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003469PMC
May 2016

Rotator Cuff Repair: Is there any role for acromioplasty?

Phys Sportsmed 2016 Sep 5;44(3):274-7. Epub 2016 Aug 5.

c Orthopedic Research Center , Guilan University of Medical Sciences , Rasht , Guilan , Iran.

Objectives: Acromioplasty has been one of the most common techniques amongst orthopedic surgeries in the past decade. However, its efficacy in arthroscopic surgeries of rotator cuff repair is still debatable. The purpose of this study is to compare the arthroscopic rotator cuff repair with or without acromioplasty in patients with complete rotator cuff tear.

Methods: In this prospective cohort study, patients with complete rotator cuff tear (acromion type II or III Bigliani) and a history of failure to the conservative treatment for at least 6 months were evaluated for eligibility. Patients, based on the time interval, were placed in one of two groups: arthroscopic rotator cuff repair with (RCR-A group) and without acromioplasty (RCR group). Patients were assessed for two years in term of pain intensity by VAS criteria and shoulder functional status by Quick-DASH, Constant score and simple shoulder test criteria.

Results: In the baseline assessment, RCR-A group (34 patients) and RCR group (33 patients) were similar. Comparing patients in two groups in relation to SST, Quick-DASH and VAS scores preoperatively showed there is no significant difference between the two groups. The SST, Quick-DASH and VAS scores improved significantly in both groups at both the 6-month and 2-year follow-ups (all P < 0.001). The extent of progress in the functional scores was similar in both groups (P > 0.05).

Conclusion: Arthroscopic rotator cuff repair without acromioplasty may be as reliable and useful as conventional rotator cuff repair with acromioplasty. Thus, acromioplasty cannot be recommended as a routine technique in every rotator cuff repair.
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http://dx.doi.org/10.1080/00913847.2016.1216717DOI Listing
September 2016

Calcitonin effects on shoulder adhesive capsulitis.

Eur J Orthop Surg Traumatol 2016 Aug 8;26(6):575-80. Epub 2016 Jul 8.

Poursina Hospital, Orthopedic Department of Guilan University of Medical Sciences, Parastar Ave., Rasht, Iran.

Introduction: Adhesive capsulitis (frozen shoulder) is a relatively prevalent disease of shoulder and affects soft tissue of glenohumeral joint. Signs include painful restricted motion and disability of the patient in daily activities. Calcitonin is a thyroid hormone, and its effectiveness has been demonstrated in painful conditions. The presents study aims to evaluate the effect of calcitonin in treating shoulder adhesive capsulitis.

Method: This double-blinded randomized clinical trial was conducted on 64 patients suffering from shoulder adhesive capsulitis. The intervention and control groups were given intranasal calcitonin and placebo for 6 weeks, respectively. For both groups, physiotherapy and non-steroidal anti-inflammatory drugs were administered correspondingly. The patients were evaluated pre- and post-treatment for shoulder pain and shoulder range of motion (ROM). Shoulder functional outcome (secondary outcome) was evaluated using Disability of Arm, Shoulder, and Hand, Shoulder Pain and Disability Index, and Health Assessment Questionnaire disability criteria.

Results: The mean age of patients in calcitonin and control group was 52.4 ± 4.6 and 53.2 ± 4.9, respectively. Demographic characteristics and pre-treatment scores were similar in both groups (all P > 0.05). In post-treatment follow-up, shoulder pain, ROM, and the patients' functional scores were significantly improved in both groups (P < 0.001); however, the improvement in calcitonin group was more effective than that of placebo group.

Conclusion: Intranasal calcitonin spray could be an additional safe alternative in shoulder adhesive capsulitis with regard to the efficiency in alleviating pain and improving functional outcome.

Level Of Evidence: II.
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http://dx.doi.org/10.1007/s00590-016-1816-5DOI Listing
August 2016

Hamstring tendon autograft versus fresh-frozen tibialis posterior allograft in primary arthroscopic anterior cruciate ligament reconstruction: a retrospective cohort study with three to six years follow-up.

Int Orthop 2016 Sep 18;40(9):1905-11. Epub 2016 Mar 18.

Orthopaedic Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Selection of various grafts for anterior cruciate ligament (ACL) reconstructions have been employed in order to improve on stability and function of the knee. This study aimed to compare stability and function of the knee after ACL arthroscopic reconstruction by single-loop tibialis posterior (TP) allograft and four-strand hamstring tendon (HT) autograft.

Materials And Methods: The retrospective cohort study included 104 patients in the TP group matched with 118 patients in the HT group in terms of demographic characteristics, associated meniscus injury, subjective and objective knee characteristics. All patients were followed up for at least three years with regards to mentioned criteria and time of return to former activities.

Results: The mean (range) age of TP (88 males and 16 females) and HT (99 males and 19 females) groups was 34.4 (19-48) and 36.9 (20-51) years, respectively. Median (range) follow-up durations were 55 (37-71) and 56 (36-72) months, respectively. No significant differences were observed post-operatively, regarding subjective and objective evaluations. Additionally, time duration for return to former activity was similar in both groups. Post-operative paresthesia and numbness of medial aspect of the calf were observed for two months in eight patients of the HT group which persisted to the final visit in one case. No similar symptom was seen in the TP group.

Conclusion: In arthroscopic ACL reconstruction, fresh frozen doubled TP allograft compared to HT autograft was equally effective in restoring function and stability of knee, permitting return to former activities.

Level Of Evidence: Retrospective comparative, Level III.
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http://dx.doi.org/10.1007/s00264-016-3164-9DOI Listing
September 2016

A Survey on Transfusion Status in Orthopedic Surgery at a Trauma Center.

Arch Bone Jt Surg 2016 Jan;4(1):70-4

Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Increased costs and mortality associated with inappropriate blood transfusions have led to investigations about blood request and blood transfusion techniques. We investigated the transfusion status in patients who underwent orthopedic surgery in Poursina Hospital (Rasht, Iran) to optimizing blood usage and determine if a scheduled transfusion program for every orthopedic surgery could improve blood transfusion management.

Method: In this descriptive-prospective study, all orthopedic surgeries in Poursina Hospital, Rasht, between April to June 2013 were reviewed. All patient information was recorded, including: demographics, type of surgery, hemoglobin level, cross-match test, duration of surgery, and blood loss, and transfusion. Based on the one-way ANOVA and independent samples test analysis, cross-match to transfusion ratio and transfusion possibility, the transfusion index, and maximal surgical blood order schedule were calculated to determine blood transfusion status.

Results: Among 872 selected orthopedic surgery candidates, 318 of them were cross-matched and among those, 114 patients received a blood transfusion. In this study, the cross-match to transfusion ratio was 6.4, transfusion possibility 36.47%, transfusion index 0.6, and maximal surgical blood order schedule 0.9.

Conclusion: We found that blood ordering was moderately higher than the standard; so it is highly recommended to focus on the knowledge of evidence based on transfusion and standard guidelines for blood transfusion to avoid over-ordering.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733240PMC
January 2016

How Much are Emergency Medicine Specialists' Decisions Reliable in the Diagnosis and Treatment of Pediatric Fractures?

Arch Bone Jt Surg 2016 Jan;4(1):60-4

Guilan Road Trauma Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Background: Considering the importance of an early diagnosis and proper decision-making in regards to the treatment of pediatric distal radius and elbow fractures, this study examines emergency medicine specialists' accuracy in the diagnosis and treatment of these patients.

Methods: From 2012 and 2013, children less than 14 years old who were referred to an academic hospital emergency department with elbow or distal radius fractures were enrolled. Initially, patients were examined by an emergency medicine specialist and then they were referred to an orthopedic surgeon. Type of fracture and the proposed treatment of two specialists were compared.

Results: In total, there were 108 patients (54 patients in each group) with a mean age of 8.1±3.3 years. Identical diagnosis in 48 cases (88.9%) of distal radius and 36 cases (66.7%) of elbow trauma were observed. We found a difference between diagnosis of the two specialists in diagnosing lateral condyle of the humerus fracture in the elbow group and growth plate fracture in the distal radius fracture group, but the differences were not significant. Among 108 patients, 70 patients (64.8%) received identical treatment.

Conclusion: Although the emergency medicine specialists responded similarly to the orthopedic specialists in the diagnosis of pediatric distal radius and elbow fractures, diagnosis of more complicated fractures such as lateral condylar humoral fractures, distal radius growth plate and for choosing the proper treatment option, merits further education.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733238PMC
January 2016

Treatment Outcome of Intramedullary Fixation with a Locked Rigid Nail in Humeral Shaft Fractures.

Arch Bone Jt Surg 2016 Jan;4(1):47-51

Department of Orthopedic Surgery, Pursina Hospital, Guilan University of Medical Sciences, Rasht, Iran.

Background: The aim of this study was to determine the treatment outcome of humeral shaft fractures with a locked rigid intramedullary nail in patients indicated for surgical treatment.

Methods: In this descriptive-cross sectional study, all patients were followed up for one, six, and 18 months post operatively. The Short Form Questionnaire (SF-36) and Constant Shoulder Score were applied.

Results: Of 78 included patients (mean age: 35), one patient had a soft tissue infection, one had secondary radial nerve palsy, eight had non-union, one had elbow limited range of motion in extension, and three patients had decreased shoulder range of motion. The Constant Shoulder Score and Short Form Questionnaire Score (SF-36) increased in all patients, although aged women showed lower improvement.

Conclusion: Intramedullary nail fixation in the humeral shaft fracture may be associated with high rates of non-union.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733235PMC
January 2016

Oxford Shoulder Score: A Cross-Cultural Adaptation and Validation Study of the Persian Version in Iran.

Iran J Med Sci 2015 Sep;40(5):404-10

Assistant Professor, Mashhad University of Medical Sciences, Mashhad, Iran ; Research Fellow, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

Background: Oxford shoulder score is a specific 12-item patient-reported tool for evaluation of patients with inflammatory and degenerative disorders of the shoulder. Since its introduction, it has been translated and culturally adapted in some Western and Eastern countries. The aim of this study was to translate the Oxford Shoulder Score (OSS) in Persian and to test its validity and reliability in Persian speaking population in Iran.

Methods: One hundred patients with degenerative or inflammatory shoulder problem participated in the survey in 2012. All patients completed the Persian version of OSS, Persian DASH and the SF-36 for testing validity. Randomly, 37 patients filled out the Persian OSS again three days after the initial visit to assess the reliability of the questionnaire.

Results: Cronbach's alpha coefficient was 0.93. The intraclass correlation coefficient was 0.93. In terms of validity, there was a significant correlation between the Persian OSS and DASH and SF-36 scores (P < 0.001).

Conclusion: The Persian version of the OSS proved to be a valid, reliable, and reproducible tool as demonstrated by high Cronbach's alpha and Pearson's correlation coefficients. The Persian transcript of OSS is administrable to Persian speaking patients with shoulder condition and it is understandable by them.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567599PMC
September 2015

Association of Soccer and Genu Varum in Adolescents.

Trauma Mon 2015 May 25;20(2):e17184. Epub 2015 May 25.

Student Research Committee, Guilan University of Medical Sciences, Rasht, IR Iran.

Background: Genu varum is a physical deformity marked by bowing of the leg. One of the risk factors of this musculoskeletal alignment is stress on the knee joint such as with exercise.

Objectives: Since the evaluation of genu varum has not been widely studies, this study was conducted to examine the association between genu varum and playing soccer.

Materials And Methods: Between Septembers 2010-2012, 750 soccer players and 750 non-soccer players 10-18 years of age were included in the study. A questionnaire of data including age, height, weight, body mass index (BMI), years of soccer participation, the average time of playing soccer per week, previous trauma to the lower limbs, history of any fractures of the knee, previous hospitalizations, and the distance of joint lines between the knees was assessed for all subjects. Chi-square, student t-test, and one-way ANOVA were used for statistical analysis by SPSS v.19.0 software. In all tests, a P value of less than 0.05 was construed as statistically significant.

Results: Both soccer players and controls had genu varum. However, the incidence of genu varum was higher in the soccer players (P = 0.0001) and it was more prevalent in the 16-18 year age group (P = 0.0001). The results revealed a statistically significant association between the degree of practices and the prevalence of genu varum (P = 0.0001). Moreover, previous trauma to the knees and practicing in load-bearing sports led to an increase in the degree of genu varum (P = 0.0001).

Conclusions: There was a higher incidence of genu varum in soccer players than in control adolescents; the stress and load imposed on the knee joint led to more severe genu varum.
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http://dx.doi.org/10.5812/traumamon.17184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4538725PMC
May 2015

Treatment Outcomes of Corticosteroid Injection and Extracorporeal Shock Wave Therapy as Two Primary Therapeutic Methods for Acute Plantar Fasciitis: A Prospective Randomized Clinical Trial.

J Foot Ankle Surg 2015 Nov-Dec;54(6):1047-52. Epub 2015 Jul 26.

General Practitioner and Researcher, Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran.

The outcome of corticosteroid injection (CSI) and extracorporeal shock wave therapy (ESWT) as primary treatment of acute plantar fasciitis has been debated. The purpose of the present study was to evaluate and compare the therapeutic effects of CSI and ESWT in patients with acute (<6-week duration) symptomatic plantar fasciitis. Of the 116 eligible patients, 68 were randomized to 2 equal groups of 34 patients, each undergoing either ESWT or CSI. The ESWT method included 2000 impulses with energy of 0.15 mJ/mm(2) and a total energy flux density of 900 mJ/mm(2) for 3 consecutive sessions at 1-week intervals. In the CSI group, 40 mg of methyl prednisolone acetate plus 1 mL of lidocaine 2% was injected into the maximal tenderness point at the inframedial calcaneal tuberosity. The success and recurrence rates and pain intensity measured using the visual analog scale, were recorded and compared at the 3-month follow-up visit. The pain intensity had reduced significantly in all patients undergoing either technique. However, the value and trend of pain reduction in the CSI group was significantly greater than those in the ESWT group (p < .0001). In the ESWT and CSI groups, 19 (55.9%) and 5 (14.7%) patients experienced treatment failure, respectively. Age, gender, body mass index, and recurrence rate were similar between the 2 groups (p > .05). Both ESWT and CSI can be used as the primary and/or initial treatment option for treating patients with acute plantar fasciitis; however, the CSI technique had better therapeutic outcomes.
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http://dx.doi.org/10.1053/j.jfas.2015.04.026DOI Listing
August 2016

Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature.

Arch Bone Jt Surg 2015 Apr;3(2):137-40

Sohrab Keyhani MD Orthopedic Department, Akhtar Hospital, Shahid-Beheshti University of Medical Sciences, Tehran, Iran.

A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture. A 35-year old male soccer player with a history of ACL tear from one year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages first fixation of the fracture and then ACL re-revision after fracture healing was complete. Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468616PMC
April 2015

Arthroscopic Meniscal Repair: "Modified Outside-In Technique".

Arch Bone Jt Surg 2015 Apr;3(2):104-8

Sohrab Keyhani MD Mohammad Reza Abbasian MD Nasim Siatiri MD Ali Sarvi MD Ali Akbar Esmailiejah MD Department of Orthopedic Surgery, Akhtar Hospital, Shahid Beheshti University of medical sciences, Tehran, Iran.

Background: Despite the introduction of different techniques for meniscal repair, no single procedure is superior in all situations. The new method for meniscal repair named "modified outside-in technique" aims to achieve higher primary fixation strength by an alternative suture technique as well as avoid disadvantages of outside-in, inside-out, and all-inside suture procedures. Additionally, the mid-term results of surgically treated patients with meniscal injuries by our new technique were evaluated.

Methods: The current prospective study included 66 patients who underwent meniscal repair by the modified outside-in technique. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form was completed pre- and post-operatively. At final follow-up, Lysholm score was completed and patients were questioned about their return to previous sport activities. Clinical success was defined as lack of swelling and joint line tenderness, absence of locking, negative McMurray test and no need for meniscectomy. Patients' satisfaction was evaluated using the visual analogue scale (VAS). Patients were followed for 26±1.7 months.

Results: Clinical success was achieved in 61 patients (92.4%) and 5 candidates required meniscectomy (7.6%). IKDC Subjective Knee Evaluation Form score increased significantly from 54.2±12.7 preoperatively to 90.8±15.6 postoperatively (P<0.001). Lysholm score was excellent and good in 49 (80.3%) patients and fair in 12 (19.7%). Patients' satisfaction averaged at 8.35±1 (6-10). Neurovascular injury, synovitis and other knot-related complications were not reported.

Conclusions: The modified outside-in technique has satisfactory functional and clinical outcomes. We believe that this procedure is associated with better clinical and biomechanical results; however, complementary studies should be performed to draw a firm conclusion in this regard.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464318PMC
April 2015

Effect of obesity on arthroscopic treatment of anterolateral impingement syndrome of the ankle.

J Foot Ankle Surg 2015 Jan-Feb;54(1):13-6. Epub 2014 Oct 24.

Medical Student, Student Research Center, Guilan University of Medical Sciences, Rasht, Iran.

The present case series study was performed to evaluate the effect of obesity on the arthroscopic findings and the functional outcome after arthroscopic treatment of anterolateral impingement syndrome of the ankle. The study was conducted on 36 patients (26 were classified as obese [body mass index ≥30 kg/m(2)] and 10 as not obese [body mass index <25 kg/m(2)]) who had previously undergone arthroscopic treatment of anterolateral impingement syndrome of the ankle. The arthroscopic findings and demographic features were recorded. The patients were examined postoperatively at 6 and 12 months postoperatively, and AOFAS scores were obtained. Our data showed that obese patients had the same arthroscopic findings as nonobese patients, except for chondral lesions. At 1 year of follow-up after performing arthroscopy, the presence of obesity had no effect on the functional outcome of arthroscopic treatment of anterolateral impingement syndrome of the ankle.Obesity has no effect on the effectiveness of arthroscopic treatment.
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http://dx.doi.org/10.1053/j.jfas.2014.09.005DOI Listing
August 2015

Hemodynamic and Arterial Blood Gas Parameters during Cemented Hip Hemiarthroplasty in Elderly Patients.

Arch Bone Jt Surg 2014 Sep 15;2(3):163-7. Epub 2014 Sep 15.

Mehran Soleimanha MD, Ahmad Reza Mirbolook MD, Mohsen Mardani-Kivi MD, Department of Orthopedics, Guilan University of Medical Science, Rasht, Iran.

Background: Patients undergoing cemented hip hemiarthroplasty may develop bone cement implantation syndrome (BCIS) which is a leading cause of intraoperative complications. The purpose of this study was to evaluate cardiovascular changes during cemented hip hemiarthroplasty in elderly patients.

Methods: Cemented hip hemiarthroplasty was performed on 72 patients with femoral neck fracture. All patients were catheterized with a radial artery catheter to assess mean arterial pressure (MAP) and arterial blood gas (ABG) in these time points: just before cementation, just after cementation (0th), 5 min (5th) and 10 min (10th) after cementation, and at the end of surgery (END). Also, systolic and diastolic blood pressure (SBP & DBP), heart rate and any arrhythmia or cardiac arrest was evaluated.

Results: Seventy-two patients (33 females, 39 males; mean age: 66.8±7 years) were evaluated. All parameters changed during cementation with a significant drop in MAP, SBP, and DBP immediately after cementation and pH and base excess decreased significantly (P<0.001) with no changes in O2 saturation. Mean heart rate rose until the 5th and then decreased dramatically with no bradycardia presentation. During cementation, 12 patients showed arrhythmia, but no cardiac-arrest was observed.

Conclusions: Under strict observation of a anesthesiology care team, hemiarthroplasty can be a safe method for femoral neck fracture in elderly osteoporotic patients without severe cardiopulmonary compromise.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225020PMC
September 2014

Snow Catastrophe Conditions: What is its Impact on Orthopedic Injuries?

Arch Bone Jt Surg 2014 Jun 15;2(2):111-3. Epub 2014 Jun 15.

Mohsen Mardani-Kivi MD, Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Iran places sixth amongst high risk natural disaster countries and Guilan province of Iran shoulders a large amount of socio-economic burden due to snow catastrophes. The more knowledge of circumstances we have, the more efficient our future encounters will be.

Methods: In this retrospective study, of all of the patients admitted to Poursina Hospital due to snow and ice related trauma in the first two weeks of February 2014, 306 cases were found eligible for entry into the present study.

Results: Of the 306 eligible patients (383 injuries), there were 175 men (57.2%) and 131 women (42.8%). Most patients suffered from orthopedic injuries (81%) and the most common fractures were distal radius fractures in the upper extremities and hip fractures in the lower extremities. Slipping was the most common and motor vehicle accidents had the rarest injury mechanisms. It was shown that the frequency of injuries were higher on icy days (67.6%) than snowy days (32.4%).

Conclusions: Snow crises may lead to increased risk of slipping and falling situations, especially on icy days. The peak of injury rates is a few days after snowfall with the most common injury being distal radius fracture. Providing essential instructions and supporting resource allocation to better handle such catastrophes may improve outcomes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151451PMC
June 2014

Achilles tendon repair, a modified technique.

Arch Bone Jt Surg 2013 Dec 15;1(2):86-9. Epub 2013 Dec 15.

Sohrab Keyhani MD, Department of Orthopedic Surgery, Akhtar Hospital Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Wound complications following open repair for acute Achilles tendon ruptures (AATR) remain the subject of significant debate. The aim of this study is to investigate the effects of covering repaired AATR using well-nourished connective tissues (paratenon and deep fascia) to avoid complications after open repair.

Methods: In this case series study, open repair was performed for 32 active young patients with AATR. After the tendon was repaired, the deep fascia and paratenon was used to cover the Achilles tendon. Patients were followed for two years and any wound complication was recorded. During the last visit, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score was completed for all patients. Calf circumference and ankle range of motion were measured and compared with the contralateral side. Patients were asked about returning to previous sports activities and limitations with footwear.

Results: Only, one patient developed deep wound infection (3%). None of the patients had any discomfort around the operation area, limitation with footwear, sural nerve injury, re-rupture, and skin adhesion. The AOFAS score averaged 92.5±6. Two patients (7%) were unable to return to previous sports activities because of moderate pain in heavy physical exercises. The calf circumference and ankle ROM were similar between healthy and operated sides.

Conclusion: The present study showed that fascial envelope for full covering of the repaired Achilles tendon may help to prevent the occurrence of wound complications.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151419PMC
December 2013