A randomized controlled trial to evaluate the progressive muscle relaxation technique in hip fracture patients.

The purpose of this research was to ascertain how progressive muscle relaxation (PMR) technique affected hip fracture patients' anxiety, sleep quality, and post-operative pain. This parallel randomized controlled trial was conducted on 100 patients with hip fracture hospitalized in one of the reference orthopedic hospitals in Tehran, Iran who were selected using convenience sampling and randomly were placed in two PMR group (n = 50) and control group (n = 50). Data were collected by Demographic information questionnaire, Visual analogue scale for pain rating, Pittsburgh Sleep Quality Index and State-Trait Anxiety Inventory. The PMR technique was the progressive muscle relaxation technique, which was started the night after the surgery for three nights before going to bed. Data were collected on two occasions, including before the PMR technique and the day after the last stage of the PMR technique. The data were analyzed by SPSS software using descriptive and inferential statistics. The results revealed significant within-group changes in both groups' post-operative pain, sleep quality, and anxiety scores (P < 0.001). The progressive muscle relaxation group experienced decreased post-operative pain and anxiety scores and increased sleep quality scores (P < 0.001). The linear mixed model showed that the absolute changes in the follow-up post-operative pain, sleep quality, and anxiety scores were 1.19 and 7.94 units, significantly lower than the baseline, respectively. The results revealed significant within-group changes in both groups' post-operative pain, sleep quality, and anxiety scores (P < 0.001). The progressive muscle relaxation group experienced decreased post-operative pain and anxiety scores and increased sleep quality scores (P < 0.001). The study's findings demonstrated the beneficial effects of progressive muscle relaxation on hip fracture patients' outcomes, such as their level of anxiety, sleep quality, and post-operative pain. The study's findings can be applied by medical professionals to improve patient satisfaction and care quality.This clinical trial has been registered with the Iranian Registry of Clinical Trials under the code IRCT20231120060119N1, which was approved on 7/12/2023.

The Impact of Delayed Osteosynthesis of Bone Healing in Patients with Extra-articular Distal Femoral Fracture.

Background: In extra-articular distal femoral fractures (EDFFs), nonunion is a serious complication that occurs rarely. In this study, we examined how longer preservation of initial fracture hematoma by delaying the osteosynthesis (OS) affects the fracture union. Methods: In a retrospective cohort study, 98 EDFF patients were included. The OS was done within 2 days of injury in 50 patients (early OS group) and after 2 days of injury in 48 patients (late OS group). Time to callus formation and fracture union, bleeding amount, surgical duration, pain, knee range of motion, knee function, and postoperative complications, including the nonunion, knee deformity, infection, and revision, were compared between the 2 groups. Statistical analyses were done with SPSS. A comparison of the mean between the 2 groups was made with an independent t test or its nonparametric counterpart. A comparison of categorical variables between the 2 groups was made using a chi-square or the Fisher's exact test. P ˂ 0.05 was considered statistically significant. Results: The mean time to callus formation was 47.1 ± 17.3 days in the early OS group and 46.9 ± 19.7 in the late OS group (P = 0.950). The mean time to fracture union was 114.9 ± 21 in the early OS group and 117.4 ± 28.8 days in the late OS group (P = 0.630). The mean operation time and bleeding amount between the 2 groups did not differ significantly (P = 0.230 and P = 0.340, respectively). The knee range of motion, pain, and function were not notably different (P = 0.620, P = 0.790, and P = 0.770, respectively). Nonunion occurred in 3 patients of early OS and 2 patients of the late OS group. Other complications were also comparable in the 2 study groups. Conclusion: Delayed OA in EDFF patients has no significant effect on bone healing and fracture union. Future standard studies are required to confirm these results.

Bicondylar Hoffa fracture with concurrent medial and lateral collateral ligament avulsion: A case report.

Hoffa fractures are rare fractures of the femoral condyle that occur in the coronal plane of the bone. In most cases, high-energy trauma leads to isolated coronal fractures of one of the femoral condyles, medial or lateral. Even with a typical unicondylar Hoffa fracture, our patient sustained a bicondylar Hoffa fracture in his right knee after falling from high and suffering direct trauma as well. The fracture was approached from both the medial and lateral sides of the distal femur. Three-month follow-up showed excellent functional scores, no laxity, and no pain.

Comparison of Eight-plate with Reconstruction-plate in Temporary Hemiepiphysiodesis to Correct the Idiopathic Genu Valgum in Pediatrics.

Background: High cost of eight-plate makes it unavailable in many countries; therefore, developing an alternative device for temporary hemiepiphysiodesis of knee deformities in pediatrics is valuable. In this study, we compared the outcome of the eight-plate with the reconstruction-plate in this setting. Methods: In this retrospective study, 109 skeletally immature patients (212 physes) who underwent temporary hemiepiphysiodesis to correct idiopathic genu valgum were included. The eight-plate and reconstruction-plate were used in 47 patients (90 physes) and 62 patients (122 physes), respectively. Outcome measures were the valgus angle, medial proximal tibial angle (MPTA), the lateral distal femoral angle (LDFA), the joint-line convergence angle (JLCA), and lower limb mechanical axis (LLMA). Results: The baseline characteristics of the patients were comparable between the two plate groups. The mean follow-up of the patients was 32.9 ± 15.1 months. The mean MPTA change was 2.7 ± 3.7º in the eight-plate group and 2.1 ± 3.4º in the reconstruction-plate group (P=0.2). The mean LDFA improvement was 8 ± 3.7º in the eight-plate group and 7.9 ± 3.5º in the reconstruction-plate group (P=0.61). The mean valgus correction was 10.7 ± 4.4º in the eight-plate group and 10.4 ± 4.6º in the reconstruction-plate group (P=0.74). Moreover, the mean change of JLCA was 0.7 ± 1.3º in the eight-plate group and 0.8 ± 1.3º in the reconstruction-plate group (P=0.58). The postoperative LLMA was comparable between the two study groups as well. In total, five postoperative complications were recorded in this series, which included one case of screw loosening in each group, two cases of overcorrection, and one screw breakage in the reconstruction-plate group. Conclusion: The radiologic results and complications of the reconstruction-plate are comparable with the eight-plate. Therefore, it can be safely and efficiently used in hemiepiphysiodesis to correct idiopathic genu valgum.