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1.
Arch Bone Jt Surg ; 10(5): 453-458, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35755797

RESUMO

Background: The incidence of gunshot injuries is growing, and civilian orthopedics should be more aware of the treatment and consequences of these injuries. This study aimed to describe the characteristic features and complications of gunshot injuries to long-bones. Methods: A total of 50 patients who presented with an open gunshot fracture of the tibia, humerus, and femur in the emergency room of our hospital were included in this study. Primary irrigation and debridement, as well as prophylactic antibiotics, were administered in the emergency room. The treatment was performed either conservatively (n=4) or surgically (n=46). The external fixator, nailing, or plating was used for surgical fixation. Results: The mean age and follow-up duration of the patients were 32.3±9.9 years and 13.1±5.6 months, respectively. The most common injured long bone was the femur (32 of 50). Regarding the Gustilo grade, IIIa, IIIb, and IIIc were observed in 37, 7, and 5 patients, respectively. The Masquelet technique was used for 7 (14%) patients, and 12 (24%) cases had skin flaps. Furthermore, the vascular injury was present in 5 (10%) patients, and Malunion of the fracture site was observed in 5 (10%) cases. Nonunion of the fractured bone occurred in 13 (26%) patients that was significantly associated with the presence of vascular injuries (P=0.02). Postoperative infection occurred in 9 (18%) patients and was significantly associated with the presence of skin flap (P=0.014). Conclusion: Gunshot injuries of long bones are associated with a high incidence of post-treatment complications, such as infection and nonunion, and therefore, more intensive care should be taken to avoid these complications.

2.
BMC Musculoskelet Disord ; 23(1): 64, 2022 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-35042507

RESUMO

BACKGROUND: A higher mortality and morbidity rate has been reported in COVID-19 patients undergoing surgery. To reduce the morbidity and mortality rate in COVID-19 patients undergoing orthopedic procedures, we aimed to increase the threshold for surgical planning. METHODS: In a prospective cohort study, COVID-19 patients who underwent elective or emergent orthopedic surgery in three orthopedic surgery centers from February 2020 to September 2020 were included. In this period, 6751 patients were scheduled for orthopedic surgery. To increase surgical threshold planning, all patients with grade 5 of the American Society of Anesthesiologists (ASA) classification and patients with COVID-19 related moderate to severe pulmonary involvement were identified as high-risk patients and were excluded. RESULTS: 35 deaths occurred during the study. The frequency of deaths was significantly higher in patients with COVID-19, 6 (9.4%) than patients without COVID-19, 29 (0. 43%). The average hospitalization stay was 12.8 ± 12.1 days. The odds ratio (OR) for death was significantly higher in patients with COVID-19 than patients without COVID-19. [OR: 8.13, Confidence interval 95% (CI95%) (5.02-11.25), P: 0.001]. Four (6.3%) COVID-19-associated complications were recorded in this series that all were respiratory failure requiring unexpected postoperative ventilation. Twenty surgical complications (31.3%) were recorded. The odds ratio for ICU admission was significantly higher in patients with COVID-19 than patients without COVID-19. [OR: 5.46, CI 95% (2.68-8.68), P: 0.001]. CONCLUSIONS: An increased threshold for orthopedic surgery is suggested for COVID-19 patients with a mortality rate of 9.3%, which is less than the mortality rate in other studies. Level of evidence III.


Assuntos
COVID-19 , Procedimentos Ortopédicos , Humanos , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
3.
Arch Bone Jt Surg ; 9(1): 122-125, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33778125

RESUMO

Acrometastases are rare and account for approximately 0.1% of metastases. The most common primary cancer site is the lung, followed by colorectal and genitourinary system. We searched PubMed (www. pubmed.com), Google scholar (www.scholar.google.com), Science Direct (http://www.sciencedirect.com), and Springer (http://link.springer.com) databases, using a combination of controlled vocabulary and text word terms and reviewed the last 10 years literature in order to describe demographic trends, anatomical distribution, the most common primary sources of malignancy, and survival rates in the reports of foot metastases. In conclusion 38 cases were included in this review analysis. Lung and genitourinary system were the most frequent primary sites. Forefoot was involved in 71% of all metastases to foot either alone or in combination with other areas of the foot. Calcaneus was involved in about 23% of patients either alone or in combination with other foot bones.

4.
Clin Orthop Surg ; 12(4): 456-463, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33274022

RESUMO

BACKGROUND: Precise assessment of preoperative mental health and psychological determinants may be useful in identifying patients at risk for poor postoperative outcomes of total knee arthroplasty (TKA). The aim of this study was to investigate the influence of psychological status and physical and mental health on the outcome of patients undergoing TKA. METHODS: Fifty-two patients undergoing unilateral TKA were assessed preoperatively with Oxford Happiness Inventory, Eysenck Personality Inventory, 12-item short form health survey (SF-12), and Knee Injury and Osteoarthritis Outcome Score (KOOS) for evaluating depression, personality traits, physical and mental health, and function, respectively. At 1 year after surgery, health-related quality of life (HRQL) and function were assessed using the SF-12 and KOOS. RESULTS: HRQL and function of all personality traits increased significantly after TKA, without significant difference among them. Extroversion and neuroticism did not have significant correlation with subjective well-being, HRQL, and function before and after surgery. Subjective well-being and the baseline physical and mental health scores were correlated strongly and directly with postoperative physical component summary, mental component summary, and KOOS scores and their improvement. Among many factors that significantly affected the outcomes of TKA, the only independent predictor of physical, mental, and functional outcome was depression. CONCLUSIONS: Outcomes of surgery were not significantly different among diverse personality traits. Patients with less depressive symptoms and higher baseline mental and physical scores had significantly greater improvement in HRQL after surgery. The only independent factor affecting the physical, mental, and functional outcome was depression.


Assuntos
Artroplastia do Joelho/psicologia , Depressão/psicologia , Saúde Mental , Personalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Recuperação de Função Fisiológica , Inquéritos e Questionários
5.
Cancer Cell Int ; 20: 254, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32565738

RESUMO

MicroRNAs (miRNAs) involved in key signaling pathways and aggressive phenotypes of osteosarcoma (OS) was discussed, including PI3K/AKT/MTOR, MTOR AND RAF-1 signaling, tumor suppressor P53- linked miRNAs, NOTCH- related miRNAs, miRNA -15/16 cluster, apoptosis related miRNAs, invasion-metastasis-related miRNAs, and 14Q32-associated miRNAs cluster. Herrin, we discussed insights into the targeted therapies including miRNAs (i.e., tumor-suppressive miRNAs and oncomiRNAs). Using bioinformatics tools, the interaction network of all OS-associated miRNAs and their targets was also depicted.

6.
J Clin Pharmacol ; 60(10): 1362-1366, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32519800

RESUMO

Heparin-induced thrombocytopenia (HIT) is a high-risk adverse drug reaction because of its associated risk of life- and limb-threatening thrombosis. Rivaroxaban may be considered as an ideal nonheparin anticoagulant alternative for the management of HIT. In this preliminary retrospective study, the efficacy and safety of rivaroxaban to control the clinically suspected HIT (4Ts score 4 points or greater) were evaluated. Patients with chronic kidney disease, hepatic impairment, mechanical heart valves, and active bleeding were excluded. Forty-two eligible patients who received rivaroxaban for clinically suspected HIT were evaluated by medical records review, with 12-month follow-up after the first dose of rivaroxaban. End points included confirmed thrombosis (primary end point), mortality, and adverse treatment-related events. HIT-associated thrombosis was found in 17/42 (40.5%) patients before receiving rivaroxaban. After rivaroxaban therapy, platelet counts normalized in all patients, with only 1/42 (2.3%) patients developing new thrombosis. No hemorrhagic event was recorded in the patients. Twelve patients (28.6%) died, but the cause of death was not related to the thrombosis, hemorrhage, or adverse effects of rivaroxaban. Our findings are consistent with the available emerging data, suggesting that rivaroxaban is a safe and effective drug for the management of clinically suspected HIT. Rivaroxaban is a particularly valuable treatment option in developing countries, where there are issues of cost and availability of approved alternative agents.


Assuntos
Anticoagulantes/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Heparina/efeitos adversos , Rivaroxabana/uso terapêutico , Trombocitopenia/induzido quimicamente , Trombocitopenia/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Plaquetas/efeitos dos fármacos , Terapias Complementares , Inibidores do Fator Xa/efeitos adversos , Feminino , Seguimentos , Hemorragia/induzido quimicamente , Heparina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Retrospectivos , Rivaroxabana/efeitos adversos , Trombose/induzido quimicamente , Resultado do Tratamento
7.
Arch Iran Med ; 23(6): 391-396, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32536176

RESUMO

BACKGROUND: Recent studies have revealed the increasing importance of sagittal spinopelvic alignment. Knowing the values of sagittal spinopelvic parameters, which are affected by ethnicity, is essential in the normal asymptomatic population. In the current study, these parameters were measured in a sample of asymptomatic Iranian population. METHODS: Seventy asymptomatic participants without complaint of musculoskeletal problems were enrolled. They had no complaint about musculoskeletal problems. Lateral full-length spinal and pelvic x-rays were taken. The following parameters were measured on x-rays and presented as mean ± standard deviation: pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), lumbar tilt (LT) and thoracic tilt (TT). RESULTS: The population consisted of 37 males and 33 females aged 26.6 ± 4.27 years. The mean values of PI, SS, PT, LL, TK, LT, and TT were 44.5 ± 10.1, 35.4 ± 6.7, 9.1 ± 7.9, 41.9 ± 14.7, 28.8 ± 8.3, 11.9 ± 7.4 and -7.5 ± 5.7 (median: -10; 5th percentile: -14; 95th percentile: 4.4) degrees, respectively. The variables were similar between males and females except for LL which was significantly higher in females (37.8 ± 16.5 versus 46.5 ± 11; P = 0.013). In addition, the linear regression model revealed age to be independently related with PI (beta = 0.344; P = 0.004) and PT (beta = 0.366; P = 0.002). PI (r = 0.344, P = 0.004) and PT (r = 0.359, P = 0.002) were positively correlated with age. Additionally, PI was positively correlated to SS, PT and LL and negatively to TT. CONCLUSION: These findings may be used as referential values for sagittal spinopelvic parameters in the Iranian population. The positive correlation of PI with age questions the constancy of PI throughout life. However, larger studies are required.


Assuntos
Cifose/diagnóstico por imagem , Lordose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Pelve/diagnóstico por imagem , Sacro/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Irã (Geográfico) , Modelos Lineares , Masculino , Radiografia , Adulto Jovem
8.
Mater Sci Eng C Mater Biol Appl ; 111: 110861, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32279793

RESUMO

BACKGROUND: Fracture healing complications are associated with significant healthcare and economic burden. In this study, we aimed to investigate how the combined administration of local simvastatin and ezetimibe into the femoral defect of the animal model affects the bone-healing process in comparison with their monotherapy. METHODS: A total of 32 four-month-old adult male Wistar rats were randomized into the four study groups: simvastatin + ezetimibe-loaded nanofibers (group 1), simvastatin-loaded nanofibers (group 2), ezetimibe-loaded nanofibers (group 3), and non-loaded nanofibers (group 4). After the generation of femoral defects, the predesigned nanofibers were locally administered into the defect site. The healing measures were serum and bone osteoprotegerin (OPG) expression, pathologic evaluation of union (Allen's fracture healing scores), and radiographic evaluation of bone density (Hounsfield scale) at weeks 2 and 4. RESULTS: The improvement of all evaluated healing measures was remarkably superior in rats that were treated with loaded nanofibers in comparison with the control group. Also, the improvement of all evaluated healing measures was considerably more in the simvastatin-ezetimibe combination therapy group compared to their monotherapy. All the evaluated measures were superior in the ezetimibe monotherapy group compared to the simvastatin monotherapy group. CONCLUSION: The cumulative effect of simvastatin and ezetimibe on the induction of bone healing is more significant than the individual effect of these drugs. Therefore, local administration of nanofibers loaded with simvastatin and ezetimibe could be regarded as a promising osteoinductive compound for the acceleration of bone repair.


Assuntos
Ezetimiba/farmacologia , Fêmur/patologia , Consolidação da Fratura/efeitos dos fármacos , Nanofibras/química , Sinvastatina/farmacologia , Animais , Densidade Óssea/efeitos dos fármacos , Fêmur/diagnóstico por imagem , Fêmur/efeitos dos fármacos , Fêmur/cirurgia , Masculino , Nanofibras/ultraestrutura , Osteoprotegerina/sangue , Ratos Wistar
9.
World J Orthop ; 11(3): 177-183, 2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32280607

RESUMO

BACKGROUND: Electrosurgical smoke could be different by the device of cutting or the type of tissue that is being cut. AIM: To analyze the electrocautery smoke released from the tissues that are frequently cut in orthopedic surgeries. METHODS: The released smoke from electrocautery of five different tissue types (meniscus, ligament, adipose, muscle, and synovium) of five patients who underwent total knee arthroplasty were collected and analyzed for volatile organic compounds (VOCs) and 27 candidate polycyclic aromatic hydrocarbons (n = 25). Surgical smoke was produced with an electrocautery device for 4 min. RESULTS: None of the 27 evaluated polycyclic aromatic hydrocarbons compounds were detectable in electrocautery smoke collected from the surgical cutting of the different tissues. The number and identity of detected VOCs were similar between the patients but not between tissue types. The number of detected VOCs was the highest in synovial tissue (n = 21) and the lowest in the meniscus and adipose tissue (n = 12). The number of toxic and/or carcinogenic VOCs were the most in the muscle and meniscus tissues (Toluene, Ethylbenzene, and Styrene). No toxic and/or carcinogenic VOCs were identified in the ligament and adipose tissue. CONCLUSION: Meniscus and muscle tissue are associated with the highest number of toxic and/or carcinogenic VOCs. Therefore, we recommend that surgeons avoiding the electrocautery of these tissues.

10.
J Foot Ankle Surg ; 59(2): 385-387, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32131007

RESUMO

Tarsal coalition is a condition characterized by abnormal connections between ≥2 tarsi. Although tarsal coalition is not rare, tarsal coalitions involving >2 tarsi are very unusual. In this report, we describe a case of multiple tarsal coalitions in a 24-year-old male who experienced progressively worsening pain for 3 to 4 months before presenting for care. This case was unique in that all the tarsal and tarsometatarsal bones in the foot were fused and formed 1 integrated tarsal. All of the metatarsals were fused as well, and the patient had no joints or ranges of motion in the hindfoot or midfoot. The patient's pain was responsive to anti-inflammatory medications, and no surgical intervention was necessary. To the best of our knowledge, this is the most extensive case of multiple tarsal coalitions described in the literature to date.


Assuntos
Procedimentos Ortopédicos/métodos , Ossos do Tarso/cirurgia , Coalizão Tarsal/cirurgia , Adulto , Humanos , Masculino , Radiografia , Ossos do Tarso/anormalidades , Ossos do Tarso/diagnóstico por imagem , Coalizão Tarsal/diagnóstico , Tomografia Computadorizada por Raios X
11.
Biomed Mater ; 15(3): 035014, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-31896091

RESUMO

Tendon tissue engineering based on stem cell differentiation has attracted a great deal of attention in recent years. Previous studies have examined the effect of cell-imprinted polydimethylsiloxane (PDMS) substrate on induction differentiation in stem cells. In this study, we used tenocyte morphology as a positive mold to create a tenocyte-imprinted substrate on PDMS. The morphology and topography of this tenocyte replica on PDMS was evaluated with scanning electron microscopy (SEM) and atomic force microscopy. The tenogenic differentiation induction capacity of the tenocyte replica in adipose tissue-derived mesenchymal stem cells (ADSCs) was then investigated and compared with other groups, including tissue replica (which was produced similarly to the tenocyte replica and was evaluated by SEM), decellularized tendon, and bone morphogenic protein (BMP)-12, as other potential inducers. This comparison gives us an estimate of the ability of tenocyte-imprinted PDMS (called cell replica in the present study) to induce differentiation compared to other inducers. For this reason, ADSCs were divided into five groups, including control, cell replica, tissue replica, decellularized tendon and BMP-12. ADSCs were seeded on each group separately and investigated by the real-time reverse transcription polymerase chain reaction (RT-PCR) technique after seven and 14 days. Our results showed that in spite of the higher effect of the growth factor on tenogenic differentiation, the cell replica can also induce tenocyte marker expression (scleraxis and tenomodulin) in ADSCs. Moreover, the tenogenic differentiation induction capacity of the cell replica was greater than tissue replica. Immunocytochemistry analysis revealed that ADSCs seeding on the cell replica for 14 days led to scleraxis and tenomodulin expression at the protein level. In addition, immunohistochemistry indicated that contrary to the promising results in vitro, there was little difference between ADSCs cultured on tenocyte-imprinted PDMS and untreated ADSCs. The results of such studies could lead to the production of inexpensive cell culture plates or biomaterials that can induce differentiation in stem cells without growth factors or other supplements.


Assuntos
Tecido Adiposo/metabolismo , Células-Tronco Mesenquimais/citologia , Tenócitos/citologia , Engenharia Tecidual/métodos , Adulto , Animais , Fatores de Transcrição Hélice-Alça-Hélice Básicos/metabolismo , Materiais Biocompatíveis , Proteínas Morfogenéticas Ósseas/química , Diferenciação Celular , Dimetilpolisiloxanos/química , Fatores de Diferenciação de Crescimento/química , Humanos , Imuno-Histoquímica , Masculino , Proteínas de Membrana/química , Microscopia de Força Atômica , Microscopia Eletrônica de Varredura , Impressão Molecular , Ratos , Tendões/citologia
12.
ACS Biomater Sci Eng ; 6(11): 6285-6298, 2020 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-33449643

RESUMO

The human amniotic membrane (HAM) has been viewed as a potential regenerative material for a wide variety of injured tissues because of its collagen-rich content. High degradability of HAM limits its wide practical application in bone tissue engineering. In this study, the natural matrix of the decellularized amniotic membrane was developed by the double diffusion method. The results confirmed a reduction of the amniotic membrane's degradability because of the deposition of calcium and phosphate ions during the double diffusion process. Real-time PCR results showed a high expression of osteogenesis-related genes from adipose-derived mesenchymal stem cells (ADMSCs) cultured on the surface of the developed mineralized amniotic membrane (MAM). Further in vivo experiments were conducted using an MAM preseeded with ADMSCs and a critical-size rat calvarial defect model. Histopathological results confirmed that the MAM + cell sample has excellent potential in bone regeneration.


Assuntos
Âmnio , Engenharia Tecidual , Animais , Biomimética , Regeneração Óssea , Diferenciação Celular , Humanos , Ratos
13.
Arch Med Sci ; 15(1): 141-145, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30697264

RESUMO

Introduction: It has been shown that long bone fractures are correlated with the inflammatory response. In the initial injury, surgical reduction and fixation of fractures induce the immunoinflammatory response. This study aimed to evaluate serum variation of inflammatory markers in patients undergoing surgical treatment for early and delayed femoral fractures. Material and methods: This study aimed to evaluate serum variation of inflammatory markers in patients undergoing surgical treatment for early and delayed femoral fractures. The patients were randomly divided into two groups using the method of block randomization including early surgery (within 24 h) and delayed surgery (after 48 h). Serum levels of inflammatory markers in both groups including interleukin (IL)-1, 5, 6, tumor necrosis factor α (TNF-α) and interferon γ (IFN-γ) were determined using specific kits. From each patient 10 ml blood was collected for cytokine assay in their serum. Results: Our findings suggest that serum levels of IL-8 were markedly decreased from 12 h until 48 h postoperatively (p < 0.05). Moreover, the results indicated that serum levels of TNF-α were significantly increased in the early hours, but after 48 h a decreasing trend was detected (p < 0.05). Furthermore, serum levels of IL-10, IFN-γ, and IL-6 were significantly increased from 12 h until 48 h postoperatively (p < 0.05). Conclusions: The inflammatory status of the patient may be a useful adjunct in clinical decisions. With an improved understanding of the molecular basis of the inflammatory response, and by identifying relevant clinical markers of inflammation, surgeons can better manage the timing of surgical stabilization.

14.
Arch Bone Jt Surg ; 6(5): 346-352, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30320172

RESUMO

Background: Adult degenerative disorders of hip and spine are common. The recent studies inconsistently have discussed about the influence of spinal disorders on total hip arthroplasty (THA). In this review, we discussed clearly about these relationships and their effects on the most appropriate position of the acetabular component. Methods: We searched on databases and evaluated the articles about spinopelvic parameters in patients with spinal disorders who needed THA. Results: The literature search showed a prevalence of 21.2 % to 60.4% of low back pain (LBP) in patients, who are candidates for primary THA. The coexistence of degenerative disease of hip and spine or other diseases can significantly alter spinopelvic alignment. Accordingly, pain management or any other treatment in these patients requires proper understanding about the biomechanics of the hip and the spinal and their corresponding interactions. In this review article, we discussed about these interactions and their effects on the most appropriate position of the acetabular component. Conclusion: We concluded that counseling sessions among patients, orthopedic surgeons and spine surgeons can result in obtaining the best outcome for these individuals.

15.
Cancer Cell Int ; 18: 158, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30349420

RESUMO

Osteosarcoma (OS) is one of the most prevalent malignant cancers with lower survival and poor overall prognosis mainly in children and adolescents. Identifying the molecular mechanisms and OS stem cells (OSCs) as new concepts involved in disease pathogenesis and progression may potentially lead to new therapeutic targets. Therefore, therapeutic targeting of OSCs can be one of the most important and effective strategies for the treatment of OS. This review describes the new molecular targets of OS as well as novel therapeutic approaches in the design of future investigations and treatment.

16.
Interv Med Appl Sci ; 9(1): 15-19, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28932491

RESUMO

BACKGROUND: In this study, the results of the partial lateral facetectomy of the patella to better patellofemoral motion and congruence are compared with the results of the osteophyte removal of the patella and neurectomy only in total knee arthroplasty (TKA). METHODS: Data from 55 patients undergoing TKA with osteophytes removal of the patella and neurectomy only, and those undergoing osteophytes removal of the patella and neurectomy and partial lateral facetectomy were reviewed retrospectively. Clinical outcomes were evaluated by knee society score (KSS) and functional score of knee. Clinical anterior knee pain (AKP) rating and knee range of motion and extension lag were assessed for each patient. RESULTS: There was significant difference between two groups in AKP (p < 0.05), and the mean range of motion of the knee in groups 1 and 2 was 117° ± 9° and 116.6° ± 8.2°, respectively. Three (13%) patients of the reshaped patella group and three (11%) patients of the non-reshaped patella group had extension lag <10°, respectively. The mean KSS and knee functional scores showed no statistical difference between groups (p > 0.05). CONCLUSION: Partial lateral facetectomy of the patella can decrease AKP and can be used routinely for every patient that surgeon does not decide to resurface the patella.

17.
Interv Med Appl Sci ; 9(2): 94-99, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28932503

RESUMO

BACKGROUND AND AIMS: The aim of this study is to evaluate the effect of proximal tibia osteotomy on hip biomechanics. METHODS: This cohort study was conducted on 50 knees of 37 patients divided into two groups of unilateral and bilateral surgeries during 2015-2016. Patients underwent medial open-wedge osteotomy of proximal tibia. Axial alignment of lower limb radiography was carried out for the patients before and after the osteotomy. RESULTS: Findings from unilateral and bilateral high tibial osteotomies demonstrated that the average of greater trochanter (GT) angle from femoral head center and also the average angle of knee varus were significantly decreased (P = 0.001). Although not statistically significant, the average angle of the mechanical axis of lower limb showed an increase in unilateral osteotomy (P = 0.889) and a decrease in bilateral osteotomy (P = 0.887). The average angle of pelvic obliquity after unilateral osteotomy increased significantly (P = 0.001) but showed no statistically significant difference in bilateral osteotomy (P = 0.631). CONCLUSION: High tibial osteotomy significantly affects the GT and causes the downward replacement of GT and consequent shortening of the abductors moment arm, increased hip joint reaction force, and reduction of the shear force on the femoral neck.

18.
Med Arch ; 70(4): 284-287, 2016 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-27703290

RESUMO

INTRODUCTION: Severe defects in long bones can be caused by several factors such as trauma that lead to open wound and secondary infections after surgery. Induced membrane technique is one of the therapeutic strategies that can be used for these patients. Due to importance of this method and lack of information about this technique in Iran. AIM: this study was performed to investigate technical strengths and weakness of induced membrane technique. MATERIAL AND METHODS: This case series study conducted on 21 patients with bone defects in the femur and tibia and metatarsal bones referred to orthopedic clinic of Rasoul Akram Hospital, Tehran, Iran, for induced membrane surgery in 2012-2015. Demographic and clinical data were obtained using history, clinical examinations and observations for each patient. Union achievement was the main outcome of this study, which was confirmed by radiographic findings and physical examination. Obtained data was analyzed by SPSS ver. 16. RESULTS: All patients were male except one and their mean age was 30.52 years old. Bone defects were in tibia, femur and metatarsus in 9, 9 and 3 patients, respectively. Three patients received soft tissue reconstruction with flap before induced membrane surgery. Age, defects size, cigarette addiction and drug use and delay to start the treatment had no significant effect on union status. In total, 90% of patients had successful surgery. CONCLUSION: using induced membrane technique in patients with defects in their long bone such as tibia, femur and metatarsus would lead to high success for reconstruction.


Assuntos
Transplante Ósseo/métodos , Fêmur , Ossos do Metatarso , Procedimentos Ortopédicos/métodos , Osteomielite/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Tíbia , Adulto , Idoso , Cimentos Ósseos/uso terapêutico , Desbridamento , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Dispositivos de Fixação Ortopédica , Polimetil Metacrilato/administração & dosagem , Polimetil Metacrilato/uso terapêutico , Retalhos Cirúrgicos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Med Arch ; 70(4): 293-295, 2016 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-27703292

RESUMO

INTRODUCTION: Genovarum is a common orthopedic problem. Its optimal prompt treatment is an issue of importance. AIM: This study was conducted to determine the radiographic changes in patella bone before and after open wedge high tibial osteotomy. MATERIAL AND METHODS: In this quasi-experimental study, 43 patients were enrolled and underwent open wedge high tibial osteotomy and the radiographic and CT-scan indices including Q-Angle, Congruence Angle, Insall-Salvati index, and TTTG were measured and compared before and after surgery. RESULTS: The result revealed that all indices including Q-Angle, Congruence Angle, Insull-Salvati index, and TTTG were not significantly differed across the study (P > 0.05). There was no difference between DLFA values before and after the operation (P> 0.05), while MPTA values were significantly different before and after operation (p <0.001). CONCLUSIONS: Totally it may be concluded that imaging indices are not differed after open wedge high tibial osteotomy and monitoring for them is not necessary and they would have no prognostic role.


Assuntos
Genu Varum/diagnóstico por imagem , Genu Varum/cirurgia , Osteotomia/métodos , Patela/diagnóstico por imagem , Tíbia/cirurgia , Adulto , Feminino , Humanos , Masculino , Radiografia , Tomografia Computadorizada por Raios X
20.
Iran Red Crescent Med J ; 18(2): e21818, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27186388

RESUMO

BACKGROUND: Maintaining proper size and rotation of components of total knee arthroplasty is mandatory for optimal longevity. Ethnical differences may affect the fitness of prostheses that were manufactured mainly based on Caucasian dimensions. OBJECTIVES: To evaluate the distal femur morphology of the Iranian population at the level of standard cuts simulated via computed tomography. PATIENTS AND METHODS: During 2013, 150 consecutive patients (96 males and 54 females) from the outpatient Department of Orthopedic Surgery of Rasoul Akram Hospital with knee CT scans were studied. We entered cases with apparent normal extremity alignment and bone maturity. Exclusion criteria were history of fracture or conditions affecting knee profile. Standard cuts were simulated on the CT scan using the Marco Pacs program. For each bone, anteroposterior (AP), mediolateral (ML), and aspect ratio (ML/AP) were measured. Values were compared with the sizing of four currently available prostheses. RESULTS: The mean age of the patients was 43 years (range: 17 to 80). All isolated parameters were higher in men significantly (P < 0.001). However, the aspect ratio did not show any significant difference (1.51 ± 0.11 vs 1.46 ± 0.1), suggestive of a similar configuration of distal femur profiles between genders. Ultimately, close correlations were observed among simulated cuts and size-matched femoral components of the prostheses. For females, however, components were mostly overhang mediolaterally except for one gender-specific subset. Decrement in the aspect ratio for larger knees was another mismatch with current prostheses that preserve an almost constant ratio throughout all sizes. CONCLUSIONS: Our findings may be applied by manufacturers to design prostheses more compatible with Asian populations. Alterations to the shape of components should be considered to provide optimal coverage.

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