The effect of skin traction on pain relief in patients with isolated intertrochanteric fractures, a randomized clinical trial.

BACKGROUND: Hip fractures are common in elderly patients. The surgery is usually delayed due to underlying conditions, and pain control is crucial while the patient is cleared for surgery. In this randomized controlled trial (RCT) study, we hypothesized that the application of skin traction in patients with intertrochanteric fracture does not significantly change the Visual Analogue Score (VAS) of pain. METHODS: This is a prospective, single institution, parallel randomized controlled trial. Two hundred and twenty-nine patients with isolated intertrochanteric fractures were enrolled in the study. Patients with neurologic issues, drug addiction, scars or swelling, or vascular issues at the site of skin traction application were excluded from the study. Patients were divided into two groups: group A included 97 patients, and group B included 95 patients. Skin traction was applied for group A, while only a soft pillow was put beneath the patients' knees in the other group. The VAS score was measured after the diagnosis, two hours before the operation, and 24 h after the surgery. The morphine dosage administered per day was documented for both groups. RESULTS: After excluding patients with postoperative delirium, 154 patients (55 males and 99 females) with isolated intertrochanteric fractures (69 right-sided and 85 left-sided), and a mean age of 70 ± 10 remained in the study. There were no significant differences between the two groups regarding age, gender, and mean time from injury to admission (P > .05). The mean VAS score measures and morphine dosage administered per day were not significantly different between the two groups (P > .05). Both groups experienced significant pain relief 24 h postoperatively (P < .001). CONCLUSION: Pre-operative skin traction application affected neither the patients' VAS scores nor the mean morphine dosage per day in patients with isolated intertrochanteric fractures. Our data does not support the routine application of pre-operative skin traction in patients with intertrochanteric fractures. TRIAL REGISTRATION: The project was registered in the Iranian Registry of Clinical Trials (registration reference: IRCT20180729040636N3, registration date: 01/07/2020).

Avascular necrosis predictive factors after closed reduction in patients with developmental dysplasia of the hip.

Background: Developmental dysplasia of the hip (DDH) is a common pediatric orthopedic condition. Closed reduction (CR) is the conservative treatment approach with high success rates for DDH. However, avascular necrosis (AVN) is a severe potential complication after this procedure. This study retrospectively assessed the potential risk factors for AVN occurrence after CR and Spica cast immobilization. Materials and Methods: In a retrospective observational study, 71 patients (89 hips) with DDH aged 6-24 months old undergoing CR were enrolled. All patients were followed up for 3 years, and their demographic data, initial Tönnis grade, pre-reduction procedures, abduction angle in the Spica cast, and the AVN presence (based on Bucholz and Ogden classification [3rd-4th class]) were documented. Results: Of 71 patients (89 hips) with a mean age of 12.5 ± 3.9 months, 13 patients (18 hips) developed AVN. The mean age of patients in the AVN and non-AVN groups was 14.3 ± 4.9 and 12.2 ± 3 months (P = 0.07); also, the mean abduction angle in patients with and without AVN was 51.86 ± 3.66 and 58.46 ± 3.91 (P < 0.001) in univariate analysis. The distribution of initial Tönnis grade, and previous conservative procedures, adductor tenotomies during the CR were comparable between the two groups (P > 0.05). We found age 12 months and 54° in abduction angle as the best cutoff values for differentiating AVN patients from non-AVN and the risk of experiencing AVN for patients older than 12 months was odds ratio (OR) =4.22 (P = 0.06) and patients with abduction angle greater than 54 was OR = 34.88 (P < 0.001). Conclusion: In this study, older age at the time of intervention and larger abduction angle in the hip Spica cast were two predictors of experiencing AVN in DDH patients after undergoing CR treatment approach. Performing CR at a younger age and keeping the abduction angle lower than 54° in the hip Spica cast could help to have the best possible prognosis. Level of Evidence: IV, retrospective, observational, cross-sectional study.

Vitamin D Deficiency Associated with Disease Activity in Patients with Inflammatory Bowel Diseases.

BACKGROUND: Evidence exists on the association between vitamin D deficiency and inflammatory bowel diseases (IBD). AIMS: To investigate whether vitamin D level is associated with disease activity and quality of life in IBD patients. METHODS: This cross-sectional study was conducted on known adult IBD patients referred to an outpatient clinic of gastroenterology in Isfahan city, Iran. Disease activity was evaluated using the Simplified Crohn's Disease Activity Index and Simple Clinical Colitis Activity Index. Quality of life was assessed with the Short-Inflammatory Bowel Disease Questionnaire. Serum 25[OH]D was measured using the radioimmunoassay method. Vitamin D deficiency and insufficiency were defined as concentration of <50 and 50-75 nmol/L, respectively. RESULTS: Studied subjects were 85 ulcerative colitis and 48 Crohn's disease patients (54.1% females) with mean age of 42.0 ± 14.0 years. Vitamin D deficiency and insufficiency were present in 52 (39.0%) and 24 (18.0%) patients, respectively. Thirty patients (22.5%) had active disease who, compared with patients in remission, had more frequent low vitamin D levels (80 vs. 50.4%, P = 0.005). Quality of life was not different between patients with low and those with normal vitamin D levels (P = 0.693). In the logistic regression model, low vitamin D was independently associated with active disease status, OR (95% CI) = 5.959 (1.695-20.952). CONCLUSIONS: We found an association between vitamin D deficiency/insufficiency and disease activity in IBD patients. Prospective cohorts and clinical trials are required to clarify the role of vitamin D deficiency and its treatment in clinical course of IBD.

Complex Bilateral Posterior Hip Dislocation with a Long-term Follow-up-A Case Report.

Bilateral hip dislocations are among the rarest traumatic incidents. We report a case of a 45-year-old, opium-addicted man with bilateral posterior hip dislocation and bilateral femoral head fractures proximal to the fovea with more comminution on the left side. After an unsuccessful closed reduction attempt, surgical reduction and internal fixation of the left and right femoral heads were performed on admission and 72 hours later. He was readmitted because of acute deep vein thrombosis (DVT) on the left side after six weeks and left femoral head avascular necrosis (AVN) after 14 months. All complications occurred on the left side regardless of the sooner intervention in this side compared with the right side. This may imply that the severity of the initial trauma could be a more important risk factor for AVN rather than other factors in case the reduction is delayed for more than six hours.

A study on the effect of radiographic angles on clubfoot's recurrence.

Clubfoot is one of the common orthopaedic deformities. However, regardless of its' treatment high success rate, recurrence of the deformity is a serious issue. The aim of this study is to evaluate if radiographic angles can be used for clubfoot recurrence prediction. This is a prospective study on 91 patients (134 feet) with mean age of 9.5 ± 2.3 days and male/female ratio of 2/1 on patients with congenital clubfoot admitted to our hospital. Pre and one-year post-tenotomy tibiocalcaneal (TIC-L), talocalcaneal (TC-L) and calcaneal-first metatarsal angles (C1M-L) in the lateral view of the patients' radiographs, and their recurrence status until three years were measured. Ten feet experienced relapse. The mean pre and one-year follow-up measurements of TC-L, C1M-L, and TIC-L angles were significantly different between patients who experienced relapse and others (P < .05). The cut-off points of 1.75 and 6.5 for one-year follow-up Pirani and Dimeglio scores for recurrence prediction were suggested respectively. Also, cut-off points of 26.5 and 79.5 for one-year follow-up TC-L and TIC-L angles for recurrence prediction were calculated, respectively. We demonstrated that the pre-tenotomy and one-year follow-up TIC-L, TC-L, and C1M-L angles are helpful in clubfoot recurrence prediction after Ponseti treatment.

Can clubfoot scoring systems predict the number of casts and future recurrences in patients undergoing Ponseti method?

BACKGROUND: Congenital clubfoot is one of the common congenital orthopaedic deformities. Pirani and Dimeglio scoring systems are two classification systems for measuring the severity of the clubfoot. However, the relation between the initial amount of each of these scores and the treatment parameters is controversial. METHODS: Patients with severe and very severe idiopathic clubfoot undergoing Ponseti treatment were entered. Their initial Pirani and Dimeglio scores, the number of castings as a short-term treatment parameter, and the recurrences as a long-term parameter until the age of three were prospectively documented. RESULTS: One hundred patients (143 feet) with mean age of 9.51 ± 2.3 days including 68 males and 32 females and the mean initial Pirani score of 5.5 ± 0.5 and the mean initial Dimeglio score of 17.1 ± 1.6 were studied. The incidence of relapse was 8.4 %( n = 12). The mean initial Pirani score (P < 0.001) and the mean initial Dimeglio score (P < 0.003) of the feet with recurrence were significantly more than the non-recurrence feet. The mean number of casts in the recurrence group (7 ± 0.9) was significantly more than the feet without recurrences (6.01 ± 1.04) (P = 0.002). The ROC curve suggested the Pirani score of 5.75 and the Dimeglio score of 17.5 as the cut-off points of these scores for recurrence prediction. CONCLUSION: In our study, Pirani and Dimeglio scores are markedly related with more number of casts and recurrence in patients with severe and very severe clubfoot. Also, we have introduced new cut-off points for both classification systems for prediction of recurrence. To the best of our knowledge, this finding has not been introduced into the English literature.