Osteoporosis guideline awareness among Iranian nurses: results of a knowledge and attitudes survey.

INTRODUCTION: Osteoporosis is a chronic and progressive disease associated with gradual bone loss and elevated risk of fracture. Role of health care professional especially nurses in lowering burden of osteoporosis via patients and public education is critical. Current study conducted to evaluate knowledge and attitude regarding osteoporosis among the nurses in orthopedic wards and their experience with national clinical osteoporosis guideline. METHODS: A cross-sectional study was conducted from August to December 2016 among all nurses in orthopedic ward of hospitals affiliated to Shiraz University of Medical Sciences. The 23- item self-administered scale consisted of knowledge and attitude questions were used. Moreover, data regarding participation in osteoporosis training courses and awareness of the national osteoporosis clinical guideline were collected as a measure of nurses' experience with guideline. The gathered data were analyzed using SPSS (V. 16), student t-test was used to compare total knowledge and attitude scores between categorical demographic and professional data. Pearson test was used to calculate the correlation between total knowledge and attitude scores and years of practice. A p-value < 0.05 was considered statistically significant. RESULTS: From total of 160 nurses, 143 of them completed the questionnaire (response rate: 89.3%). The total mean ± SD knowledge and attitude scores were 11.60 ± 3.10 and 3.47 ± 0.92 respectively. Six nurses (4.2%) had participated in osteoporosis training courses after graduation, and 39 (27.3%) had been aware of the national osteoporosis clinical guideline. Knowledge and attitude scores among nurses who practice in private hospitals was higher than those practices in the teaching hospitals. These differences were statistically significant based on student t-test. According to Pearson correlation coefficient, there was positive and significant correlation between nurses' knowledge and attitude score (Correlation coefficient: 0.199, p-value = 0.037). CONCLUSION: Our findings reveal that nurses' knowledge and attitude regarding osteoporosis was not satisfactory. Most of them were not aware of national osteoporosis clinical guideline and had not participated in osteoporosis training courses after their graduation. We need more empowered nurses to lowering burden of osteoporosis and its consequences in the future.

Three-Stage Treatment of Transcalcaneal Talonavicular Fracture Dislocation; A Case Report and Literature Review.

Transcalcaneal talonavicular fracture dislocation is an extremely rare debilitating injury with high complication rates. The present case report demonstrates highly comminuted joint-depressed fracture of left calcaneus treated with primary subtalar arthrodesis following reduction and fixation of the calcaneus. The right ankle sustained a highly comminuted fracture of calcaneal body with completely-destroyed posterior facet, fracture dislocation of the calcaneocuboid joint, dorsally dislocated talonavicular joint, fracture of anterior of tibial plafond, and subluxation of the tibiotalar joint. At first, talonavicular joint was reduced and fixed using a plate followed by reduction of calcaneus and arthrodesis of subtalar and calcaneocuboid joints. The plate of talonavicular joint was removed after 70 days. Logical approach to this injury can lead to an acceptable function.

Simvastatin vs. L-Carnitine: An experimental study on optimizing nerve repair.

AIM: Complicity and slow rate of axons regeneration necessitates microsurgery that adjuvant therapy can help it. Improving nerve metabolic capacity and response to neural growth factors are positive effects of simvastatin and L-carnitine. To decrease neuronal loss after axotomy and improve neuronal regeneration, this study was designed to assay effects of these agents on nerve repair. MATERIAL AND METHODS: Left sciatic nerve of 70 female rats were cut and repaired under aseptic microsurgery. Based on medications and treatment period, seven groups were formed. CONTROL: no medication. SIM1W: one week daily oral simvastatin. LC1W: one week daily oral L-carnitine. Plb1W: one week daily oral placebo. SIM1M: one month daily oral simvastatin. LC1M: one month daily oral L-carnitine. Plb1M: one month daily oral placebo. Following 90 days, behavioral assessments and then histopathology were done. RESULTS: Mean reflex time of withdrawal reflex latency and toe out angle in all experimented groups increased than normal. Long-term drug-medication significantly improved toe out angle. In long-term drug-medication, inflammation and neural bundle differentiation were significantly lower and higher, respectively. Vascular index showed reduction but number of myelinated nerve fibers had rises in drug-medicated groups compared to control and placebo groups. No obvious differences were detected in myeline diameter. CONCLUSION: Both Simvastatin and L-carnitine can accelerate and improve the process of nerve regeneration in a long enough treatment period. The regulatory influence of these exogenous neurotrophic drugs may be essential to optimize regeneration of nerve fibers; so can broaden horizons for novel therapeutic modalities to decrease neuronal apoptosis.

Osteoporosis guideline awareness among Iranian family physicians: results of a knowledge, attitudes, and practices survey.

AimThis study investigates the knowledge, attitudes, and practices (KAP) of family physicians in Iran, regarding osteoporosis and their experience with national osteoporosis guideline. BACKGROUND: Osteoporosis is a relatively preventable, chronic and progressive disease. Family physicians play a crucial role in relieving the burden of care. METHODS: This cross-sectional study was addressed at all qualified family physicians who registered at urban family physicians and referral system program. Data collection included demographics, professional experience, and knowledge of guidelines based on a standardized KAP questionnaire. Student's t-test was used to measure the associations between KAP scores and demographic, professional experience variables.FindingsThe response rate was 72% (540/750). Based on Bloom's cut off scale, family physicians knowledge and practice scores were in moderate level, and only 14 and 38.5% of them had good knowledge and practice, respectively. Attitude score was in good level, and 64.1% of participants had positive attitude. Mean score of knowledge and practice were higher significantly among family physicians that practice in public settings. Family physicians, who completed osteoporosis training courses, had higher attitude score (P=0.03). Only 23.5% of family physicians were aware of the existence of national osteoporosis guideline. CONCLUSION: Although most family physicians believed in the importance of preventive measures, however, limited number of them had good knowledge and practice regarding osteoporosis and less than a quarter were aware of national guideline. This is a clear need to disseminate the guideline more effectively, make greater use of efficient training methods.

MORTALITY AND FUNCTION AFTER SURGICALLY-TREATED HIP FRACTURE IN ADULTS YOUNGER THAN AGE 60.

OBJECTIVE: Hip fractures in young adults can cause poor functional capacity throughout life because of several complications. The purpose of this study was to prospectively evaluate 1-year mortality and functional outcomes for patients aged 60 years or younger with hip fracture . METHODS: We prospectively obtained data for all consecutive patients aged 60 or younger with any type of hip fracture who were treated operatively between 2008 and 2014. After one year, patient outcomes were evaluated according to changes in pain severity, functional status (modified Barthel index), and mortality rate . RESULTS: Of the total of 201 patients, 132 (65.7%) were men (mean age: 41.8 years) and 69 (34.3%) were women (mean age: 50.2 years) (p<0.001). Reduced pain severity was reported in 91.5% of the patients. The mean modified Barthel index was 22.3 in men and 18.6 in women (p<0.001). At the one-year follow-up, 39 cases (19.4%) were dependent on walking aids while only 17 patients (8.5%) used walking aids preoperatively (p<0.001). Seven patients (4 men and 3 women) died during the one-year follow-up period; 2 died in the hospital after surgery . CONCLUSION: Hip fractures in young adults have a low mortality rate, reduction in pain severity, and acceptable functional outcomes one year after surgery. Level of Evidence II, Prospective Comparative Study.

OBJETIVO: As fraturas de quadril em adultos jovens podem ocasionar capacidade funcional insatisfatória durante toda a vida, devido a várias complicações. A finalidade deste estudo foi avaliar prospectivamente a mortalidade e os desfechos funcionais em um ano, em pacientes com 60 anos de idade ou menos com fratura de quadril. MÉTODOS: Coletamos prospectivamente dados de todos os pacientes consecutivos com idade de 60 anos ou menos, com qualquer tipo de fratura de quadril, que foram tratadas por cirurgia entre 2008 e 2014. Depois de um ano, os desfechos dos pacientes foram avaliados de acordo com as mudanças da intensidade da dor, estado funcional (índice de Barthel modificado) e taxa de mortalidade. RESULTADOS: Do total de 201 pacientes, 132 (65,7%) eram homens (média de idade: 41,8 anos) e 69 (34,3%) eram mulheres (média de idade: 50,2 anos) (p < 0,001). A menor intensidade de dor foi relatada em 91,5% dos pacientes. A média do índice de Barthel modificado foi 22,3 em homens e 18,6 em mulheres (p < 0,001). No acompanhamento de um ano, 39 pacientes (19,4%) dependiam de dispositivos auxiliares da marcha, enquanto apenas 17 pacientes (8,5%) usavam esses dispositivos no pré-operatório (p < 0,001). Sete pacientes (4 homens e 3 mulheres) morreram durante o período de acompanhamento de um ano; dois morreram no hospital, depois da cirurgia. CONCLUSÃO: As fraturas de quadril em adultos jovens têm baixa taxa de mortalidade, redução da intensidade da dor e desfechos funcionais aceitáveis um ano depois da cirurgia. Nível de Evidência II, Estudo Prospectivo Comparativo.

Mortality and function after surgically-treated hip fracture in adults younger than age 60 / Mortalidade e função depois de tratamento cirúrgico de fratura de quadril em adultos com menos de 60 anos

ABSTRACT Objective: Hip fractures in young adults can cause poor functional capacity throughout life because of several complications. The purpose of this study was to prospectively evaluate 1-year mortality and functional outcomes for patients aged 60 years or younger with hip fracture . Methods: We prospectively obtained data for all consecutive patients aged 60 or younger with any type of hip fracture who were treated operatively between 2008 and 2014. After one year, patient outcomes were evaluated according to changes in pain severity, functional status (modified Barthel index), and mortality rate . Results: Of the total of 201 patients, 132 (65.7%) were men (mean age: 41.8 years) and 69 (34.3%) were women (mean age: 50.2 years) (p<0.001). Reduced pain severity was reported in 91.5% of the patients. The mean modified Barthel index was 22.3 in men and 18.6 in women (p<0.001). At the one-year follow-up, 39 cases (19.4%) were dependent on walking aids while only 17 patients (8.5%) used walking aids preoperatively (p<0.001). Seven patients (4 men and 3 women) died during the one-year follow-up period; 2 died in the hospital after surgery . Conclusion: Hip fractures in young adults have a low mortality rate, reduction in pain severity, and acceptable functional outcomes one year after surgery. Level of Evidence II, Prospective Comparative Study.

RESUMO Objetivo: As fraturas de quadril em adultos jovens podem ocasionar capacidade funcional insatisfatória durante toda a vida, devido a várias complicações. A finalidade deste estudo foi avaliar prospectivamente a mortalidade e os desfechos funcionais em um ano, em pacientes com 60 anos de idade ou menos com fratura de quadril. Métodos: Coletamos prospectivamente dados de todos os pacientes consecutivos com idade de 60 anos ou menos, com qualquer tipo de fratura de quadril, que foram tratadas por cirurgia entre 2008 e 2014. Depois de um ano, os desfechos dos pacientes foram avaliados de acordo com as mudanças da intensidade da dor, estado funcional (índice de Barthel modificado) e taxa de mortalidade. Resultados: Do total de 201 pacientes, 132 (65,7%) eram homens (média de idade: 41,8 anos) e 69 (34,3%) eram mulheres (média de idade: 50,2 anos) (p < 0,001). A menor intensidade de dor foi relatada em 91,5% dos pacientes. A média do índice de Barthel modificado foi 22,3 em homens e 18,6 em mulheres (p < 0,001). No acompanhamento de um ano, 39 pacientes (19,4%) dependiam de dispositivos auxiliares da marcha, enquanto apenas 17 pacientes (8,5%) usavam esses dispositivos no pré-operatório (p < 0,001). Sete pacientes (4 homens e 3 mulheres) morreram durante o período de acompanhamento de um ano; dois morreram no hospital, depois da cirurgia. Conclusão: As fraturas de quadril em adultos jovens têm baixa taxa de mortalidade, redução da intensidade da dor e desfechos funcionais aceitáveis um ano depois da cirurgia. Nível de Evidência II, Estudo Prospectivo Comparativo.

Factors associated with recurrence of clubfoot treated by the Ponseti method.

AIM: To assess several associated factors on the recurrence of clubfoot after successful correction by the Ponseti method. METHODS: A total of 115 children with 196 clubfeet deformities, treated by the Ponseti method, were evaluated. Demographic data, family history of clubfoot in first-degree relatives, maternal educational level and brace compliance were enquired. Based on their medical files, the characteristics of the patients at the time of presentation such as age, possible associated neuromuscular disease or especial syndrome, severity of the deformity according to the Dimeglio grade and Pirani score, residual deformity after previous Ponseti method and number of casts needed for the correction were recorded. RESULTS: There were 83 boys (72.2%) and 32 girls (27.8%) with a male to female ratio of 2.6. The mean age at the initiation of treatment was 5.4 d (range: 1 to 60 d). The average number of casts applied to achieve complete correction of all clubfoot deformities was 4.2. Follow-up range was 11 to 60 mo. In total, 39 feet had recurrence with a minimum Dimeglio grade of 1 or Pirani score of 0.5 at the follow-up visit. More recurrence was observed in non-idiopathic clubfoot deformities (P = 0.001), non-compliance to wear braces (P < 0.001), low educational level of mother (P = 0.033), increased number of casts (P < 0.001), and more follow-up periods (P < 0.001). No increase in the possibility of recurrence was observed when the previous unsuccessful casting was further treated using the Ponseti method (P = 0.091). Also, no significant correlation was found for variables of age (P = 0.763), Dimeglio grade (P = 0.875), and Pirani score (P = 0.624) obtaining at the beginning of the serial casting. CONCLUSION: Using the Ponseti method, non-idiopathic clubfoot, non-compliance to wear braces, low educational level of mother, increased number of casts and more follow-up periods had more association to possible increase in recurrence rate after correction of clubfoot deformity.

Does Mobility of the Elderly with Hip Fractures Improve at One Year Following Surgery? A 5-year Prospective Survey.

BACKGROUND: Hip fracture and its consequences are one of the major causes of morbidity and disability in the elderly. The purpose of this study was to collect epidemiologic data and assess the daily activities and walking ability of patients 3 months and 1 year following surgery because of a hip fracture. MATERIAL AND METHODS: We prospectively obtained data of all consecutive patients more than 50 years of age with any type of hip fracture from 2008 to 2013. After excluding pathologic fractures, hip fracture dislocations, non-surgically treated cases, and dead patients, functional status of the subjects at 3 months and 1 year after surgery was evaluated using a 10-degree scale of pain, modified Barthel index of daily activity, and independent walking ability. RESULTS: In total, 1015 cases were enrolled. Mean age was 75.6 year with a female to male ratio of 1.33. Left-sided hip fractures were seen in 51.7 % of cases. Intertrochanteric fractures were the most common type (72.1 %), followed by femoral neck (24.0 %) and subtrochanteric fractures (3.9 %). At both 3-month and 1-year follow-up visits, 562 subjects (317 women and 245 men) completed the questionnaires. Activities of daily living and independent walking ability were improved significantly at 1 year and the improvements were statistically superior to the results obtained at 3 months (p-value < 0.001 for both variables). CONCLUSION: By continuing rehabilitation of elderly patients with surgically-treated hip fractures for one year, improvement in activities of life and walking independence can be expected even if they have a poor result after the first 3 months of rehabilitation.

Effects of "vitex agnus castus" extract and magnesium supplementation, alone and in combination, on osteogenic and angiogenic factors and fracture healing in women with long bone fracture.

BACKGROUND: The purpose of this study was to investigate the effects of the combination of vitex agnus castus extract, as a source of phytoestrogens, plus magnesium supplementation on osteogenic and angiogenic factors and callus formation in women with long bone fracture. MATERIAL AND METHODS: In a double-blind randomized placebo controlled trial, 64 women with long bone fracture, 20-45 years old, were randomly allocated to receive 1) one Agnugol tablet (4 mg dried fruit extract of vitex agnus castus) plus 250 mg magnesium oxide (VAC + Mg group (n = 10)), 2) one Agnugol tablet plus placebo (VAC group (n = 15)), 3) placebo plus 250 mg magnesium oxide (Mg group (n = 12)), or 4) placebo plus placebo (placebo group (n = 14)) per day for 8 weeks. At baseline and endpoint of the trial, serum alkaline phosphatase, osteocalcin, and vascular endothelial growth factor (VEGF) were measured together with radiological bone assessment. RESULTS: There were no significant differences in the characteristic aspects of concern between the four groups at baseline. Despite the increased level of alkaline phosphatase in the VAC group (188.33 ± 16.27 to 240.40 ± 21.49, P = 0.05), administration of VAC + Mg could not increase alkaline phosphatase activity. However, treatment with VAC + Mg significantly enhanced the osteocalcin level. The serum concentration of VEGF was increased in the VAC group (269.04 ± 116.63 to 640.03 ± 240.16, P < 0.05). Callus formation in the VAC + Mg group was higher than the other groups but the differences between the four groups were not significant (P = 0.39). No relevant side effect was observed in patients in each group. CONCLUSION: Our results suggest that administration of vitex agnus castus plus magnesium may promote fracture healing. However, more studies need to further explore the roles of vitex agnus castus in fracture repair processes.

sCD30 and sCD40L detection in patients with osteosarcoma, chondrosarcoma and Ewing sarcoma.

BACKGROUND: Primary malignant bone tumors are heterogeneous groups of neoplasms, which affect mainly children and adolescents. The most common types are Osteosarcoma, Ewing sarcoma and chondrosarcoma. Elevation of sCD30 and sCD40L has been observed in lymphoma, leukemia and autoimmune disorders. OBJECTIVE: To evaluate serum concentrations of sCD30 and sCD40L in patients with primary malignant bone tumors. METHOD: Fifty-four cases (31 Osteosarcomas, 14 Ewing sarcomas, and 9 Chondrosarcomas) and 54 healthy controls enrolled in this study. Cases with the history of prior treatment (surgery, chemotherapy and radiotherapy) were excluded from the study. Serum levels of sCD30 and sCD40L were detected by an enzyme linked immunosorbent assay (ELISA). RESULTS: Mean serum concentration of sCD30 in Ewing sarcoma was significantly higher than that of the control groups (p=0.007), but mean serum concentrations of sCD30 in osteosarcoma and chondrosarcoma groups were not significantly different, compared to the controls (p=0.41 and p=0.11, respectively). Mean serum concentrations of sCD40L in osteosarcoma, Ewing sarcoma and chondrosarcoma groups were significantly higher than that of the control group (p<0.0001). In addition, the mean serum level of sCD40L in chondrosarcoma patients was higher than that of both Ewing sarcoma and osteosarcoma groups (p<0.001). CONCLUSION: sCD30 and sCD40L increase in primary bone tumors; however the significant of these findings for diagnosis or prognosis of these tumors needs further investigation.

Bilateral subcapital femoral neck fractures secondary to transient osteoporosis during pregnancy: a case report.

Transient osteoporosis during pregnancy is a rare, self-limiting disease. We report on a 36-year-old woman who had bilateral subcapital femoral neck fractures during the 6th month of pregnancy. The diagnosis was made 4 days after delivery, because radiography was declined by the patient for fear of radiation. Fixation was not feasible owing to bone resorption, and 2-stage bipolar hemiarthroplasty was therefore performed. Magnetic resonance imaging is the best non-invasive investigative tool for pregnant women with hip pain. Early detection can prevent complications and resorting to major surgeries.

Metallic artifact in MRI after removal of orthopedic implants.

OBJECTIVE: The aim of the present study was to evaluate the metallic artifacts in MRI of the orthopedic patients after removal of metallic implants. SUBJECTS AND METHODS: From March to August 2009, 40 orthopedic patients operated for removal of orthopedic metallic implants were studied by post-operative MRI from the site of removal of implants. A grading scale of 0-3 was assigned for artifact in MR images whereby 0 was considered no artifact; and I-III were considered mild, moderate, and severe metallic artifacts, respectively. These grading records were correlated with other variables including the type, size, number, and composition of metallic devices; and the site and duration of orthopedic devices stay in the body. RESULTS: Metallic susceptibly artifacts were detected in MRI of 18 of 40 cases (45%). Screws and pins in removed hardware were the most important factors for causing artifacts in MRI. The artifacts were found more frequently in the patients who had more screws and pins in the removed implants. Gender, age, site of implantation of the device, length of the hardware, composition of the metallic implants (stainless steel versus titanium), and duration of implantation of the hardware exerted no effect in producing metallic artifacts after removal of implants. Short TE sequences of MRI (such as T1 weighted) showed fewer artifacts. CONCLUSION: Susceptibility of metallic artifacts is a frequent phenomenon in MRI of patients upon removal of metallic orthopedic implants.

The effect of open Bristow-Latarjet procedure for anterior shoulder instability: a 10-year study.

Operative procedures are the usual treatment for patients with anterior traumatic shoulder instabilities. Soft tissue procedures, Bankart repair, cannot be performed in some patients. They need Bristow-Latarjet one. We decided to determine midterm results of this procedure in almost all types of anterior shoulder instability, even shoulders with Bankart lesion in non-athletic cases. Thirty patients after Bristow-Latarjet procedure from 1997 to 2007 were followed 2-8 years. Clinical outcomes, consisted of muscle strength, range of motion (mean 8.66 degrees decreased in external rotation with arm in neutral position and 18.33 with arm in 90 degrees of abduction), recurrent instability (no relapse), and Rowe score (mean 77.66) showed good to excellent results. We had no screw-related or neurovascular complications. Thirty percent of cases had signs of mild arthropathy. Although Bankart procedure is the preferred method in patients with isolated Bankart lesion, but we can perform Bristow-Latarjet for all types of anterior traumatic shoulder instability in non-athletics cases with acceptable results.

Q-angle: an invaluable parameter for evaluation of anterior knee pain.

BACKGROUND: Patellofemoral pain syndrome is a descriptive term applied to patients with nonspecific anterior knee pain, and is the most common knee problem. The pain in most patellofemoral disorders is generalized to the anterior part of the knee. One important concept in patellofemoral joint function is the quadriceps angle (Q-angle). Theoretically, a higher Q-angle increases the lateral pull of the quadriceps femoris muscle on the patella and potentiates patellofemoral disorders. This study was undertaken to evaluate the relationship between the anterior knee pain and Q-angle. METHODS: This prospective study was performed on two groups; the case group consisted of 100 outpatients (44 men, and 56 women) aged between 15 and 35 years, with anterior knee pain. The control group consisted of 100 outpatients (50 men, and 50 women) with the same age distribution, who presented with different problems in the upper extremities and no knee problems. The Q-angle of each knee was measured in all participants, using a universal goniometer. RESULTS: The mean Q-angle for men, women, and all participants in the case group was 15.2, 20.1, and 18.0 degrees, respectively. In the normal control group the angles were 12.1, 16.7, and 14.9 degrees, respectively. All these differences were statistically significant (P < 0.001). CONCLUSION: These results substantiate the fact that patients with anterior knee pain have larger Q-angles than healthy individuals.