The predictive value of point-of-care ultrasonography versus magnetic resonance imaging in assessing medial meniscal tears in patients with acute knee injury.

OBJECTIVE: Musculoskeletal ultrasound is increasingly used as the modality of choice in diagnosing many medical situations. The present study aimed to compare the accuracy of point-of-care ultrasonography (POCUS) and magnetic resonance imaging (MRI) to detect acute medial meniscus tears in knee. METHODS: The prospective study was conducted on patients with suspected medial meniscus tears in knee. in the emergency department. In the absence of a knee fracture on x-ray, POCUS on the knee was performed. All patients underwent POCUS and MRI of the knee followed by arthroscopy. POCUS findings were then compared to MRI findings to diagnose medial meniscus tears. RESULTS: A final total of 157 patients with a mean age of 25.04±7.41 years was included. Out of 157 patients, 94 (59.9%) were male. Medial meniscus tears were detected in 89 patients (56.7%) using arthroscopy as the gold standard. The sensitivity, specificity, positive and negative predictive values, and accuracy of POCUS to detect medial meniscus tears were 88.8% (95% confidence interval [CI], 80.3%-94.5%), 89.7% (95% CI, 79.9%-95.8%), 91.9% (95% CI, 84.8%-95.8%), 85.9% (95% CI, 77.2%-91.7%), and 89.2% (95% CI, 83.3%-93.6%), respectively. The diagnostic accuracy of MRI to detect medial meniscus injury was 93.0% (95% CI, 87.8%- 96.4%). CONCLUSION: The present study demonstrated that POCUS is an accurate and reliable diagnostic tool alternative to MRI in detecting medial meniscal tears. POCUS had acceptable sensitivity, specificity, and accuracy in detecting meniscal injuries and could be performed as an effective immediate investigation to guide further modalities in patients with acute knee trauma.

The Comparison Between 3.5- and 4.5-mm T-plates for Management of the Patients with Schatzker Type II Tibial Plateau Fractures that Referred to our Emergency Department: A Clinical Trial.

Background: Tibial plateau fractures have become more frequent in recent years. The most prevalent Schatzker classification is type II, which is a lateral tibial plateau fracture with depression. Our null hypothesis was that the 3.5 T-plate and the 4.5 T-plate have no difference in the management of patients with Schatzker type II tibial plateau fractures. Materials and Methods: The current study is a clinical trial that was conducted on patients with tibial plateau fractures. The Knee Society Score (KSS) was this study's main outcome. Tourniquet time (TT) and patient quality of life using the 36-item Short Form Survey Instrument (SF-36) were secondary goals of the outcomes measurement study. VAS measured pain. Among 176 patients, 89 and 87 of cases underwent surgical treatment with 3.5-mm (group A) and 4.5-mm (group B) T-plate, respectively. The data were entered into SPSS software (version 25, IBM Corporation, Armonk, NY) and analyzed. Results: In our study, we evaluated 176 patients with a mean age of 34.8 ± 15.2 years. Functional and clinical KSS scores were similar between the two groups throughout follow-up (P > 0.05). Regarding the other variables of VAS, TT, SF-36 physical function, and SF-36 mental health, no significant difference was observed between the two groups, and the two groups had similar averages in terms of these indicators (P > 0.05). Conclusion: According to the results, both plates had the appropriate functional outcomes in patients with split depression tibial plateau fracture.

Comparison of the effects of preoperative celecoxib and gabapentin on pain, functional recovery, and quality of life after total knee arthroplasty: A randomized controlled clinical trial.

Background: Acute pain is one of the main complaints of patients after total knee arthroplasty (TKA), which causes delayed mobility, increased morphine consumption, and subsequently increased costs. Therefore, the present study was performed to evaluate the preventive effect of preoperative celecoxib and gabapentin on reducing patient pain as a primary outcome after TKA surgery. Materials and Methods: This randomized, double-blind controlled clinical trial was performed on 270 patients with osteoarthritis that were candidates for TKA surgery allocated into three groups. In the first group, 900 mg of gabapentin was administered orally on a daily basis for 3 days before surgery. In the second group, 200 mg of oral celecoxib was administered twice daily for 3 days before surgery. In the third group, oral placebo was administered twice daily for 3 days before the surgery. The patients' pain score and knee and its functional score were recoded. Results: The mean of reduction pain in gabapentin and celecoxib groups was significantly lower than that of the control group at 12, 24, and 48 h after surgery (P < 0.001); however, two groups were not significantly different from each other (P > 0.05). Furthermore, the two medication groups were not significantly different in this regard (P > 0.05). In addition, the knee score in the gabapentin group with the means of 85.40 ± 5.47 and the celecoxib group with the means of 87.03 ± 3.97 were significantly higher than those of the control group with the means of 78.90 ± 4.39 in the 1st month after the surgery (P < 0.001). Conclusion: According to the results of the present study, the preventive administration of gabapentin and celecoxib showed a significant and similar effectiveness on reducing patient pain after TKA surgery and on improving the KSS and quality of life scores.

A Rare Case of Humerus Synovial Sarcoma Originated from Bone Tissue: Case Report.

Synovial sarcoma (SS) is a malignant mesenchymal neoplasm that is relatively common in the distal extremities. Primary SS of bone is an extremely rare finding. Here in this report, we present a 44-year-old male patient referred with bone and later bone fracture that was finally diagnosed with primary SS of thumerus. So far, 13 documented cases of primary SS of the bone have been reported. The current case is the second known case of primary SS of humerus. Our case was treated with both neoadjuvant and adjuvant chemotherapies associated with surgical tumor removal and prosthesis implantation. Follow-up of the case demonstrated significant remission but with late metastasis and subsequent advanced chemotherapy regimens.

Acetabular and sacral insufficiency fractures in a patient with a long-term history of Alendronate consumption; a case report.

BACKGROUND: Long-term Bisphosphonate consumption has been reported to be associated with the incidence of atypical or insufficiency fracture, particularly in the proximal femur. We observed a case of acetabular and sacral insufficiency fractures in a patient with a long-term history of Alendronate consumption. CASE PRESENTATION: A 62-year-old woman was admitted with a complaint of pain in right lower limb following low-energy trauma. The patient had a history of Alendronate consumption for more than 10 years. The bone scan revealed increased radiotracer uptake in the right side of the pelvic, proximal right femur, and sacroiliac joint. The radiographs showed type 1 sacrum fracture, acetabulum fracture with femur head protrusion into the pelvis, quadrilateral surface fracture, fracture of the right anterior column, and right superior and inferior pubic fracture. The patient was treated with total hip arthroplasty. CONCLUSION: This case highlights the concerns regarding long-term bisphosphonate therapy and its potential complications.

Total hip arthroplasty revision etiologies: a cross-sectional study in Isfahan, Iran.

Background: Complications after primary total hip arthroplasty (THA) are the most common reason for revision. Due to the high prevalence of revision surgery, we investigated the frequency of postprimary THA complications and related risk factor revision surgery. Materials and Methods: This is a cohort study that was performed in 2011-2019 on all patients who underwent primary THA surgery re-admitted to the Kashani and Saadi Hospital affiliated to Isfahan University of Medical Science, Iran, due to some complications after THA. Demographic and basic data were collected from patient's medical documents. Harris hip score (HHS) was calculated for all patients 6 months after the last surgery. The obtained data were analyzed using SPSS software version 21. Appropriate statistical tests were conducted to compare the results between the study groups. Results: Among 1260 patients who underwent primary THA, 1006 of them entered the study after applying the exclusion criteria. Thirty nine patients were under revision, 53.8% had prosthesis infection, 56.4% had instability, 6% had aseptic loosening, and 30.8% had periprosthetic fracture. Odds ratio for the above complications were 45.5, 45, 6.4, and 15.5, respectively. HHS postoperatively was also significantly (P < 0.001) higher in patients without revision. No correlation between gender or surgeon experience and revision was detected; however wound discharge (P < 0.001), body mass index (BMI) (P = 0.003), and Infection during hospitalization (P < 0.001) affect revision rate significantly. All four postsurgery complications, i.e., instability, postoperative prothesis infections, periprosthetic fractures, and aseptic loosening, significantly increased the risk of revision (P < 0.001, for all). Conclusion: Instability, prosthetic infections, periprosthetic fractures, and aseptic loosening were the most common causes for increasing revision rates after THA, respectively. Higher BMI, persistent wound discharge, and nosocomial infections during the first hospitalization also increased the rate of revision after primary THA.

Comparing the effect of cup placement between true and false acetabula in total hip arthroplasty in patients with Crowe type 3 dysplastic hip: A randomized clinical trial.

Background: Hip dysplasia is one of the most widespread hip disorders. Total hip arthroplasty (THA) is the preferred treatment in patients with cup placement choices in true or false acetabulum. The objective of this research was to compare the effectiveness of the two mentioned procedures. Materials and Methods: This study was a randomized, open-label, parallel-group clinical trial, in which 46 patients/51 hips with Crowe type 3 dysplastic hip having THA were assigned to two groups: Group 1 - patients who had cup placement in the true acetabulum and Group 2 - patients who underwent cup placement in the false acetabulum. The variables that were evaluated and analyzed included severity of pain using the visual analog scale (VAS), range of motion (ROM), gait ability, the need for repeated joint replacement, and the Harris Hip Score (HHS). Results: Forty-six patients/51 hips were included in the present study. The patients who were evaluated included 30 (65.2%) males and 16 (34.8%) females. The mean age in the population under study was 71.0 ± 10.22, and the mean body mass index of participants was 26.34 ± 2.22 kg/m2. The basic parameters in the two research groups were similar (P > 0.05). There were no significant differences between the two groups in terms of the mean values of VAS and ROM (P > 0.05); however, the mean HHS was significantly higher in the true acetabulum group, 57.90 ± 18.47 versus 48.29 ± 13.80 (P = 0.04). Conclusion: The effectiveness of cup placements both in the true and false acetabula was similar in all of the evaluated variables in terms of clinical outcomes except for HHS which was higher in the true acetabulum group. To further support the results of this research, it is recommended that more research be done on a greater population.

Comparing the Outcomes of Surgical and Non-Surgical Approaches in Management of Older Patients with Distal Radius Fracture; a Retrospective Cohort Study.

Introduction: Distal radius fractures (DRFs) are the most common orthopedic injuries in emergency department. This study aimed to compare the outcomes of conservative and surgical managements of DRFs in the aged population. Methods: In this retrospective cohort study, ninety patients with unilateral DRFs were treated using either surgical or conservative (casting) approach and the management outcomes as well as complications were compared between the two groups at 3 and 6-month follow-ups. Results: A total of 90 patients over 70 years old were included (45 treated with cast immobilization, and 45 using the surgical method). The mean age (p = 0.56) and gender (p = 0.85) was similar in the two groups. Except for quality of life in both follow-up times, patients treated with surgical methods showed better outcomes in other aspects, including 3-month (p = 0.042) and 6-month (p = 0.022) mean Disability of the Arm Shoulder Hand (DASH) score, 3-month (p = 0.013) and 6-month (p = 0.006) mean range of motion (ROM), and 3-month (p = 0.003) and 6-month (p = 0.033) pain intensity based on Visual Analogue Scale (VAS). A total of 70 (77.77%) adverse events were registered (33 (36.6%) in the casting group and 37 (41.1%) in the surgical group; p = 0.05). The rate of mal-union (p = 0.021) and superficial radial nerve injury (p = 0.026) were significantly lower in the surgical group. Conclusion: The findings suggest that surgical approach for management of DRFs in elder cases has better clinical and functional outcomes than cast immobilization.

Relationship between spiritual health, resilience, and happiness among a group of dental students: a cross-sectional study with structural equation modeling method.

BACKGROUND: Given the importance of spiritual health, resilience and happiness to encounter challenges facing dental students, we aimed to examine these variables, their relationship and the mediating role of resilience between spiritual health and happiness among a group of Iranian dental students in Islamic Azad University of Isfahan. METHODS: In this cross-sectional study, utilizing a stratified sampling method, 150 volunteer dental students in different academic years filled in the Persian version of Spiritual Well-Being scale, the Persian version of Connor-Davidson Resilience Scale, and Isfahan-Fordyce Happiness Inventory. Independent t-test, Kruskal-Wallis test, and Pearson correlation coefficient served for statistical analysis. In addition, we conducted a Structural Equation Modeling analysis. RESULTS: The mean age of the students was 23.43 ± 3.11, and 56% were women. The mean score of spiritual health, resilience, and happiness was 89.27 ± 16.69, 90.19 ± 15.03, and 295.17 ± 65.82, respectively. Spiritual health of a great majority of dental students was upper medium or high (87.3%), most of them had high level of resilience (69.3%), and 55.3% reported medium level of happiness. Spiritual health was directly associated with both happiness and resilience (p <  0.001). Resilience acted as an intermediary variable between spiritual health and happiness (p <  0.001). CONCLUSIONS: Spiritual health was associated with increased happiness, and this relationship was mediated by resilience. Thus, it is recommended to address the issue of spiritual health to those students with lower scores in order to increase their resilience and their level of happiness.

Role of point-of-care ultrasonography (POCUS) in the diagnosing of acute medial meniscus injury of knee joint.

BACKGROUND: In recent years, musculoskeletal ultrasound has increasingly become the common method for diagnosis for many medical specialties. Therefore, the present study was performed to evaluate the diagnostic value of point-of-care ultrasonography (POCUS) as a primary triage tool in the diagnosis of the acute medial meniscus injury of the knee. MATERIALS AND METHODS: The present cross-sectional study was performed on patients with a suspected medial meniscus injury of the knee in the emergency department (ED). After history taking and primary physical examination, radiographic imaging of the knee was done. If there was no fracture in the knee X-ray, the POCUS examination on the knee was carried out. All the patients were asked to refer to an orthopedic clinic 2 weeks after discharge from ED for the Magnetic Resonance Imaging (MRI) evaluation. Finally, the POCUS findings were compared with the MRI findings in diagnosing medial meniscus injury. RESULTS: Fifty-five patients with a mean age of 35.48 ± 11.58 years were analyzed in the study (69.1% male). In comparison with MRI scan, the sensitivity and specificity of POCUS in the detection of medial meniscus injury were 85.0 [95% confidence interval (CI), 54.0 to 98.9] and 65.7% [95% CI 42.2 to 85.7], respectively. Its positive and negative predictive values were 58.6% [95% CI 33.8 to 81.5] and 88.5% [95% CI 62.1 to 99.3], respectively. (Area under the ROC curve = 0.726, P value = 0.003). CONCLUSION: The present study demonstrated that POCUS can reasonably be applied in comparison with MRI to evaluate medial meniscus injury. POCUS is an effective initial diagnostic modality in patients with suspected medial meniscus injuries.

Etiology of Femoral Head Avascular Necrosis in Patients: A Cross-Sectional Study.

Background: Avascular necrosis (AVN), known as osteonecrosis, aseptic necrosis, or ischemic bone necrosis, results in the destruction of bone cells. In the present study, we aimed to report the most common causes of AVN in in patients referred to Isfahan educational and medical centers. Materials and Methods: This study is a cross-sectional study that was performed on all patients with AVN in medical educational centers in Isfahan during 2019 and 2020. We included all patients diagnosed with AVN. Patients' information including age, sex, cause of femoral head necrosis, medical history, and drug usage were collected. Finally, reliable data from 99 patients were recorded. Results: We collected data of 99 patients in this study. The most prevalent cause of ANV was corticosteroids use (32.3%), and it was more prevalent among women (51.4%); the second prevalent cause of AVN in our study sample was trauma (28.28%), and it was more prevalent among men (32.8%). Conclusion: The most common cause of AVN was corticosteroids, which was consistent with previous studies. Other main causes of AVN were traumatic or idiopathic issues.

Prevalence of Bacterial surgical site infection in traumatic patients undergoing orthopedic surgeries: a cross-sectional study.

BACKGROUND AND OBJECTIVE: Infection at the surgical site is one of the most common postoperative complications. Due to the high prevalence of orthopedic surgery site infection, epidemiologic studies that evaluate the frequency distribution of bacterial infection and related risk factors seem crucial. In the present study, we aimed to investigate and evaluate the prevalence of bacterial infections in traumatic operated patients. METHODS: This is a cross-sectional study that was performed in 2011-2020 on all trauma cases with closed fractures re-admitted to the traumatic referral hospital due to surgical site infection after orthopedic surgeries. Data regarding surgical site culture and antibiogram and the most effective antibiotics were also collected from medical documents of patients. RESULTS: During this study, 5950 people underwent traumatic closed fracture surgeries, of which 238 (4%) were readmitted due to infection. Data of 157 patients were analyzed and showed that the most common site of infection was knee in 46 patients (29.3%). Data also showed that gram-positive bacteria were detected in 55 patients (56.7%) while gram-negative micro-organisms were found in 42 patients (43.3%). Based on the statistical analysis, vancomycin was the most effective antibiotic in staphylococcus infections. There was also a significantly higher risks of bacterial surgical site infection for tibial injury (OR = 1.18, P < 0.001), knee injury (OR = 1.50, P < 0.001), presence of Staphylococcus (OR = 1.50, P < 0.001) and also Enterobacter (OR = 1.50, P < 0.001) both in the crude and adjusted models. CONCLUSION: The prevalence rate of infection was 4% and the most common bacteria was Staphylococcus aureus. Vancomycin was also the most effective antibiotic in patients. We suggest that more studies should be conducted on the use of prophylactic antibiotics.

Intraneural cavernous hemangioma: a rare case of extrafascicular left ulnar nerve tumor.

Hemangiomas are benign soft tissue tumors that may be found everywhere in the human body. As one of the hemangioma types, cavernous hemangioma consists of a flat endothelium along with blood-filled spaces and may be found in the central nervous system, but rarely occurs in peripheral nerves. This article pertains to the introduction of an old female patient complaining of pain and paresthesia of the ulnar side of the left forearm and hypothenar with numbness and tingling of the fourth and fifth digits and clawing. The patient was medically treated for a month but became a surgical candidate due to the poor response to medical treatment. A 1-cm lesion was observed in the surgery with compression on the ulnar nerve in the ulnar groove. Neurologic symptoms of the patient were improved after excision of the lesion, but clawing persisted.

Management of orthopedic patients during COVID-19 outbreak.

Coronavirus Disease 2019 (COVID-19) pandemic was declared on March 11, 2020, which led to the massive economic and social crisis in the world. Hospitals and healthcare systems faced the most changes during this time. As for any other medical departments, orthopedic departments were affected by this situation. Trauma and musculoskeletal injuries require emergency action or even operation which would not stop due to COVID-19 crisis. Special protocols and guidelines were used to minimize infection risks in Kashani educational trauma center. Here we explain the changes and protocols in the following sections: Outpatient-Clinic, emergency department, Operation room and Orthopedic Ward. These strategies included: reducing the number of admitted patients in clinics, changing the decoration of waiting rooms, screening the patients at the entrance and personal protection equipment for staff. We also dedicated special emergency rooms for patients suspicious to COVID-19 infection and also special operation rooms and corridor for patients with COVID-19 infection. Changes in discharging protocols and continuous consultations with infectious diseases specialists brought us the ability to manage these patients. Here in the present paper, we described different strategies of the management of patients in Kashani hospital during COVID-19 outbreak. We hope that our experience of patient's management could help other physicians and hospitals.

Periosteal chondroma of pelvis - an unusual location.

Periosteal chondroma is a slow growing benign tumor with prevalence rate of less than 2% of all chondromas. This tumor is mostly observed in clavicle, ribs and humerus and only one previous case has been reported in pelvis. Here we present an unusual case of periosteal chondroma due to uncommon presentation, location and age range. Our case is a 39 year-old male diagnosed with periosteal chondroma in pelvis. He had unspecific signs and symptoms overlapping with low back pain and disk herniation. By the time of admission he had gluteal muscle atrophy and also claudication. Differentiation of periosteal chondroma from other malignant tumors are pivotal in order to prevent aggressive and inappropriate therapies. He underwent surgical procedures and periosteal chondroma was ascertained by both radiological and Histopathological evidence. 6 months after surgery, he declared no pain, he was able to walk freely. He claimed partial paresthesia but he also declared that his paresthesia has ameliorated.

Distribution frequency of hepatitis C virus genotypes in 2231 patients in Iran.

AIM: Given the importance of frequency distribution of HCV genotypes, we studied genotypic distribution of HCV in Iran. In this cross-sectional study, 2231 patients with hepatitis C who presented in hepatitis clinics in Tehran were investigated for HCV genotypes. METHODS: Genotyping was performed by genotype specific primers. RESULTS: The highest frequency was for genotype 1a, with 886 (39.7%) of subjects. Genotype 3a and 1b were the other frequent genotypes, with 613 (27.5%) and 271 (12.1%) subjects, respectively. Of the samples, 401 (18%) had an undetermined genotype. Mixed genotypes were also found in 33 samples (1.6%). Genotype 1b frequency in patients under 20 years old was 10.2%, while its frequency in patients over 60 years old was 18.5%. Genotype 1b frequency significantly increased by age (P = 0.02). CONCLUSION: This study indicates that the dominant HCV genotype among patients living in Tehran was 1a.

Biochemical response to lamivudine treatment in HBeAg negative chronic hepatitis B patients in Iran.

AIM: To study the effect of a one-year lamivudine regimen in patients with chronic hepatitis B. METHODS: Medical records of HBeAg negative hepatitis B patients who attended a hepatitis clinic in Tehran between March 2002-March 2004 were evaluated. The patients received 100 mg lamivudine tablets once daily for at least 12 mo. Liver enzymes and complete blood count were checked at baseline and the end of treatment (12th mo) and 6 mo after discontinuation of treatment. RESULTS: Of all patients, 24 were excluded. Of 71 patients left, 58 (81.7%) were men. Mean age of the patients was 38 +/- 14 years. Mean level of ALT in serum was 1437 +/- 205 nkat/L at baseline with a significant reduction at the end of treatment to a mean level of 723 +/- 92 nkat/L (P = 0.002). In 38 patients (53.5%), the ALT level was normal after one-year treatment. Five patients (7.3%) relapsed (biochemically) within 6 mo after discontinuing lamivudine therapy (the patients with good end of treatment response). Mean level of AST in serum was 1060 +/- 105 nkat/L at baseline which decreased significantly to 652 +/- 75 nkat/L at the end of treatment (P = 0.002). CONCLUSION: Over half (53.5%) of chronic hepatitis B patients with HBeAg negative have normal liver enzyme level at 12-mo lamivudine therapy.