Sensitivity and specificity of ultrasound in the diagnosis of traumatic ankle injury.

BACKGROUND: This study was performed to determine the sensitivity and specificity of ultrasound in the diagnosis of traumatic ankle injury in comparison with magnetic resonance imaging (MRI). MATERIALS AND METHODS: This cross-sectional study was performed on 31 patients with soft-tissue injury or fracture, referring to the MRI imaging center of Alzahra and Kashani Hospitals in Isfahan from October 2018 to March 2019. After an MRI, an ultrasound of the affected ankle was performed for all patients. Sonography and MRI were performed by two radiologists who were blinded to the results of each other's reports. The sensitivity, specificity, positive predictive value, and negative predictive value of sonography were determined. RESULTS: In this study, 31 patients with ankle trauma were studied. The mean age of the patients was 30.73 ± 10.15 years; 32.3% were male and 67.7% were female. The sensitivity of ultrasound relative to MRI to detect damage to the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), and calcaneofibular ligament (CFL) was 66.67%, 50%, and 100%, respectively, and the corresponding specificity was 92.86%, 93.10%, and 93.10%, respectively. According to Kappa test, the agreement between ultrasound and MRI methods for detecting injury to ATFL (κ = 0.51), PTFL (κ = 0.35), and CFL (κ= 0.63) was statistically significant (P < 0.05). CONCLUSION: Ultrasound is an appropriate modality for the diagnosis of injuries to CFL and ATFL and has shown acceptable results for PTFL. It could be used as an alternative in cases where access to MRI is not available.

Comparison of dry needling and steroid injection in the treatment of plantar fasciitis: a single-blind randomized clinical trial.

INTRODUCTION: Plantar fasciitis is a common cause of heel pain. Considering different interventions which are applied for patients with plantar fasciitis, dry needling is proposed as a new modality of treatment recently. The aim of this study is to evaluate the effectiveness of dry needling versus steroid injection for plantar fasciitis. METHODS: Sixty-six patients were recruited to this single-blind clinical trial study. Participants were randomly allocated to receive 1 ml (40 mg) of Depo-Medrol (methylprednisolone acetate) or dry needling. They were followed up for 12 months and monitored for total perception of pain using the visual analogue scale (VAS), with data obtained in baseline and at three weeks, six weeks, three months, six months and one year after treatment. RESULTS: Mean VAS score before treatment was 6.96 ± 0.87 for the steroid group and 6.41 ± 0.83 for the dry-needling group (P value = 0.54). Steroid injection reduced VAS scores rapidly until three weeks after treatment compared with dry needling (0.32 ± 0.71 and 3.47 ± 1.32, respectively; P value < 0.001). However, patients who were underwent dry needling reported lower VAS scores at the end of follow-up compared with the steroid group (0.69 ± 0.93 and 2.09 ± 1.58, respectively; P value = 0.004). Over the long term, 82.3% and 17.6% of changes in pain were contributed to time since treatment and treatment method, respectively (P values < 0.001). CONCLUSIONS: Steroid injection can palliate plantar heel pain rapidly but dry needling can provide more satisfactory results for patients with plantar fasciitis in the long term.

Where does magnetic resonance imaging stand in the diagnosis of knee injuries?

BACKGROUND: The aim of this study was to determine the diagnostic value of magnetic resonance imaging (MRI) in the diagnosis of knee injuries. MATERIALS AND METHODS: Ninety-eight consecutive patients were enrolled in the study. In all patients, MRI and arthroscopy were performed and the results were compared. RESULTS: MRI was most sensitive in the detection of medial meniscus injuries, and the highest specificity and negative predictive value (NPV) were found in the detection of posterior cruciate ligament injuries. CONCLUSION: MRI is a valuable tool, and according to its high NPV, normal MRI can prevent unnecessary arthroscopic interventions.

Association between the procedure of tibiotalocalcaneal arthrodesis by hindfoot nailing and quality of life in Charcot's joint.

INTRODUCTION: Charcot arthropathy is a progressive disorder of the ankle and foot joints that can lead to foot deformity and instability. Surgical intervention is often necessary for deformity and ulcer management during the chronic phase. The device used for arthrodesis remains a challenge. METHODS: This clinical trial study included diabetic patients aged 40 years or older with Charcot foot. Lateral approach with lateral malleolar osteotomy was used to access the ankle joints and remove the cartilage. A small incision was made on the plantar aspect of the foot to pass an appropriately sized intramedullary nail. Demographic information, medical history, surgical details and Clinical data were collected at 2-week and 1-year follow-ups using the Ankle-Hindfoot Scale (AOFAS) score and the EuroQol 5-Dimensional 5-Level (EQ-5D-5L) health utility score. RESULTS: Twenty-six patients with a mean age of 63 ± 0.23 years were included in the study. The findings showed significant improvements in AOFAS questionnaire items related to pain score, length of the walk, walking surfaces, walking disorders, sagittal alignment, back leg alignment, sustainability, alignment and the total score (P value < 0.001). The EQ-5D-5L questionnaire also showed a significant improvement in the total score (P value = 0.002). CONCLUSION: This study provides evidence supporting the effectiveness of tibiotalocalcaneal arthrodesis by hindfoot nailing in diabetic patients with Charcot foot joints and demonstrated comparable and superior outcomes in terms of patient satisfaction and complication rate when compared to previous studies.

Extensile approach versus minimally invasive technique in management of calcaneus fractures.

BACKGROUND: Calcaneus fracture is one of the important fractures in orthopedic surgery. Here we aimed to investigate and compare the extensile approach and minimally invasive technique in patients with calcaneus fractures. METHODS: This is a randomized clinical trial that was performed in 2019 in Kashani and Alzahra hospitals in Isfahan, Iran. The study population consisted of 30 patients with intraarticular calcaneus fractures. Thirty patients were divided into two groups. In the first group, surgery was performed using the minimally invasive technique and in the second group, the extensile approach was performed. Patients were followed for 12 months. Data regarding the duration of surgery, Boehler and Gisan angles, quality of joint reduction, subtalar joint movement, the incidence of soft-tissue complications and pain of the patients were measured and compare between two groups. RESULTS: A total number of 30 patients entered the study and were divided into two groups each containing 15 patients. The duration of operation in the extensile approach group was significantly higher than the minimally invasive group (P = 0.03). The severity of pain and mean Boehler angle were significantly higher in the minimally invasive group than in the extensile approach group (P = 0.001 and P = 0.002 respectively). The quality of reduction was also significantly better in the extensile approach group than minimally invasive (P = 0.01) but the extensile approach group had more soft tissue complications than the minimally invasive group (P = 0.006). CONCLUSION: Extensile approach was associated with lower pain, lower Boehler angle and better quality of reduction compared to minimally invasive technique but also higher operation duration and surgical site complications. We suggest that the extensile approach should be used in patients with calcaneus fractures with attention to possible complications.

Assessment of Open-Wedge High Tibial Osteotomy Plus Tibial Tubercle Osteotomy: A Novel Approach for Genu Varum Treatment.

BACKGROUND: Lower extremity genu varum is a common deformity leading to imbalanced weight distribution on the knee joint and eventually significant disabilities due to medial compartment joint osteoarthritis. This study was aimed to assess the efficacy of a novel technique of high tibial open wedge osteotomy plus tubercle osteotomy in a follow-up study. MATERIALS AND METHODS: This is a prospective census cross-sectional study conducted on 146 patients with the history of genu varus undergone high tibial open-wedge osteotomy and tubercle osteotomy since 2011. The study population was followed within 6 months regarding tibial slope angle and medial proximal tibial angle alterations and operation-related complications, including venous phlebitis, nerve, and arterial injury, deep and superficial infection, mal-, non- and delayed-union. RESULTS: 146 patients with the mean age of 25.66 ± 4.23 years, and predominance of male gender (60.3%) were evaluated. Mean of tibia slope and MPTA before the surgical procedure was 9.38 ± 0.85 and 79.45 ± 2.11 that turned to 7.10 ± 0.84 and 89.74 ± 1.52 postoperatively, respectively (P < 0.001). Arterial and peroneal nerve injury was not detected in any of the cases. Deep-vein phlebitis, superficial infection, and delayed-union, malunion, and nonunion were presented in 2.05%, 1.36%, and 2.05%, respectively. CONCLUSION: Outcomes of this study showed significant improvement in the tibia slope angle and MPTA postoperatively. Surgical-associated complications were negligible and rehabilitated by performing appropriate medical/surgical approaches. Considering the number of assessed population, HTO plus tubercle osteotomy seems an acceptable approach for genu varum treatment.

Modified Camitz versus BRAND Procedures for the Treatment of Severe Carpal Tunnel Syndrome: A Comparative Trial Study.

BACKGROUND: Carpal tunnel syndrome (CTS) is characterized by complications such as pain, paresthesia, and numbness in the fingers. There are some surgical therapies for the management of severe carpal tunnel, but differences exist between the treatments available for creating the opposition. The current study was conducted to compare the effect of modified Camitz and BRAND techniques on thumb opposition in patients with severe CTS. METHODS: A total of 40 patients with severe CTS who were candidates for opponensplasty were enrolled in this clinical trial study at Alzahra and Kashani hospitals, Isfahan, Iran, from 2014 to 2018. The patients were divided into two groups of modified Camitz and BRAND. Quick DASH-9 and Kapandji scores as well as pulp and side pinch and pronation angle were assessed before and after the surgeries. RESULTS: Quick DASH-9 score, Kapandji score, pulp and side pinch and pronation angle significantly improved post-operatively (P=0.0XXX, P=0.0XXX, P=0.0XXX, P=0.0XXX, and P=0.0XXX, respectively). But, no significant differences were seen in the mentioned variables between both groups pre and post-operative (P>0.05, for all the studied variables). No postsurgical complications were seen in any of the groups. CONCLUSION: The findings of the present study demonstrated that, both Modified Camitz and BRAND techniques are effective and safe techniques, yielding high improvements, but no serious complications. Both techniques can be considered for treatment of patients with severe CTS.

Herpes zoster segmental paresis in an immunocompromised breast cancer woman.

Herpes zoster is an infectious disease with neurological complications caused by reactivation of varicella zoster virus in dorsal root ganglia of spinal cord which is also known as "Shingles." Suppression of immune system is the major predisposing factor for reactivation of latent virus. Disease is mainly characterized by rash, vesicles and pain along one or more dermatomes which are innervated from one or more spinal nerve roots. Complications may be present after a while despite of patient treatment. Motor involvement is included. Some previous studies showed segmental zoster paresis as a rare complication, a few weeks after first presentation, among immunocompetent individuals. We present post herpetic motor involvement of C5 and C6 in a 59-year-old woman who underwent chemotherapy and radiotherapy due to breast cancer, manifesting left upper limb weakness and paresis, 6 months after left partial mastectomy. Segmental paresis of zoster virus should be considered as a cause of motor impairment in an immunocompromised person suffering from shingles.

Scaphoid nonunion fracture and results of the modified Matti-Russe technique.

BACKGROUND: The best treatment for scaphoid nonunion fractures is still controversial. The main aim of this study was to determine the results of the modified Matti-Russe method of surgery on scaphoid nonunion. MATERIALS AND METHODS: In this prospective interventional study, 30 patients with nonunion scaphoid fracture recruited from clinics of the Isfahan University of Medical Sciences between October 2007 and March 2011 underwent the modified Matti-Russe method of surgery. Union rate was evaluated four and six months after the procedure. Mayo wrist score (MWS) was calculated for the subjects six months after surgery. RESULTS: Mean age of the subjects was 25.9 ± 7.8 years, ranging from 16 to 35 years. Twenty-seven (90%) were men, and three (10%) were women. Four and six months after surgery, 10 (33%) and 26 (86.7%) subjects had a united fracture. Mean MWS was 75.0 ± 8.8 in all the subjects, ranging from 54 to 90 six months after surgery. Three subjects (10%) were grouped as excellent, 9 (30%) good, 16 (53.3%) satisfactory, and 3 (6.7%) poor. CONCLUSION: A fracture or nonunion of the scaphoid bone can be a complex and troubling injury, but the modified Matti-Russe method showed satisfactory results six months after surgery.