Posterior cruciate ligament avulsion fixation: A minimally invasive retrograde fixation by a single cannulated screw

The optimal surgical treatment of isolated tibial avulsion fractures of the Posterior Cruciate Ligament remains controversial. The purpose of this study was to evaluate the results of an arthroscopic technique using two ordinary portals and an incision to stabilize an avulsed fragment. Five patients were treated and followed up for 4 years. The mean score measured by KT-2000 was 9.2 mm preoperatively, 4.6 mm a year (P<0.042) and 3.8 mm 4 years postoperatively (p<0.041). This study showed that fixing the PCL avulsion fractures by a cannulated screw could improve knee function and stability. &nbsp

Incompatible Blood Transfusion as a Result of a Well-Known Human Error; a Case Report

Blood product transfusion is a double-edged sword; it can be lifesaving in many circumstances, yet life-threatening serious complications may occur. Although transfusion-related reactions have decreased over the years as a result of hemovigilance networks all over the world, human errors still remain an important concern.  In this case report, we describe a patient undergoing elective spinal surgery who received an incompatible blood product. Then we will describe measures to mitigate such errors

The Mortality Rate in COVID-19 Patients Undergoing Anesthesia for Surgical Procedures

Background: Planning anesthesia for coronavirus disease (COVID) positive patients remains a big dilemma for anesthesiologists. Aside associated harms of postponing surgeries, there is concern about the outcome of COVID after surgical stress, limitation of resources, and personal safety. Therefore, we aimed to investigate the effect of surgery and anesthesia on the course of coronavirus disease 2019 (COVID-19). Methods: A total of 179 patients (COVID-positive) who underwent surgery under anesthesia from March 2020 until March 2021 were retrospectively evaluated. The type of surgery, type of anesthesia, and outcome of patients were recorded. Renal and liver function tests as well as respiratory system function before and after surgery were compared. Results: Among them, 39 patients died (27%). Laboratory data including creatinine (Cr), Aspartate Transaminase (AST), Alanine Transaminase (ALT), Alkaline Phosphatase (ALK), and troponin were not significantly different preoperatively and post-operatively. 28 patients (15.6%) were intubated due to post-operative respiratory failure. In our study mortality rate for all types of surgery was 27% and the postoperative intubation rate was 15.6%. We did not have any organ failure after interventional procedures. Conclusion: The risk of infection progression must be weighed before scheduling invasive procedures. Moreover, regional anesthesia may be less harmful in case of urgent or emergent need for surgery in infected patients

Introducing a Novel Combined Acetabuloplasty and Chondroplasty Technique for the Treatment of Developmental Dysplasia of the Hip.

BACKGROUND: The aim of the treatment of developmental dysplasia of the hip (DDH) is to maintain a concentric reduction. We describe a novel approach to treat DDH that involves improvement of cartilaginous acetabular coverage, involves the preservation of the secondary ossification center of the acetabulum, and is adjunctive to early open reduction. METHODOLOGY: Thirty-nine children (40 hips) aged six to 18 months were included in the study. Open reduction with chondroplasty was performed during the same surgery. Patients were followed up for 15 years with both clinical and radiological assessments. At the final follow-up, all patients were graded as good or excellent according to Severin's classification. RESULTS: The mean age at reduction was 11.9 months (range: 8-16). The mean preoperative acetabular index (AI) was 43.43 (range: 40-48). After the operation, mean AI decreased to 16.97 (P < 0.0001, 95% confidence interval (CI) = 16.24-17.70). AI improved significantly during growth (mean AI changes 13.50, P < 0.0001, 95% CI = 12.65-14.34). The mean lateral center-edge (CE) angle at skeletal maturity was 32.94° (SD = 4.16°). Mild avascular necrosis (AVN) was observed in two hips with involvement of the epiphysis and was of Kalamchi grade 1. CONCLUSION: Chondroplasty in conjunction with open reduction can yield a concentric reduction with improved acetabular coverage that facilitates acetabular remodeling that is sustained until skeletal maturity. Prompt correction through this procedure may help to improve the development of the hip and lead to near normal function as demonstrated by improved mean AI and Severin scores at the last follow-up. With low complication and reoperation rates, this procedure could be considered as a surgical treatment option for DDH in patients between the age of six and 18 months

Comparison of Different Methods of Femoral Fixation Anterior Cruciate Ligament Reconstruction

The aim of this study is to compare three modes of femoral fixation, namely Aperfix, Rigidfix and Endobutton, in anterior cruciate ligament (ACL) reconstruction. 120 patients were randomly assigned to three groups, each consisting of 40 patients, and each group was treated by one of the above mentioned methods of femoral fixation. All patients were examined prior to and 24 months after surgery, and they were compared for anterior tibial displacement using the Lysholm score and KT-1000. The three modes of femoral fixation were not significantly different in terms of time of surgery. In the Endobutton group, the Lysholm score rose from 63.21±18.59 prior to ACL reconstruction to 90.64±9.47 after the surgery, while it rose from 65.72±18.74 to 96.22±5.35 in the Aperfix group and from 69.21±17.45 to 90.64±9.47 in the Rigidfix group. Anterior tibial displacement was 3.96±1.58 mm for Endobutton, 4.28±1.48 mm for Rigidfix and 4.03±1.79 mm for Aperfix. Aperfix was indicated to yield a better outcome in terms of instant stability and general results

Introducing and Prospective Efficacy Comparison of an Innovative and Affordable Technique for the Treatment of Distal Radius Fractures

BackgroundThere are different treatments as well as controversies surrounding the adequate treatment for Distal Radius Fractures (DRF). In the absence of enough evidence[HYPHEN]base data regarding clinical effectiveness of available treatments, cost should be considered as an essential factor in selecting the surgical technique for DRF treatment. The goal of this study is introducing an improved and modified pin[HYPHEN]and[HYPHEN]plaster (MP&amp;P) technique as an affordable alternative for treatment of DRF. This study also assesses and compares the outcomes of DRF treatment by using the introduced method versus external fixation (EF) technique.MethodsIn this clinical cohort study, 98 patients presenting with closed DRF Types III or IV, randomly were classified into two modified P&amp;P (50 patients) and EF (48 patients) groups and assessed for functional, clinical, radiographic and overall outcome at the time, 2, 10 and 22 months after surgery. They were also followed[HYPHEN]up for up to 3 years to determine the rate of complications.ResultsEighty one percent of EF and 86% of MP&amp;P group were female. The average ages in the EF and MP&amp;P groups were 44.9 ± 12.4 and 46.1 ± 5.4, respectively. Around 70% of the patients in each group had a Type III fracture, and 30% had Type IV. The rate of complications was higher among EF group patients (seven major and seven minor complications) compared to the MP&amp;P (only 4 minor complications), however the difference between two groups regarding the complications and treatment outcome were insignificant, except in extension ROM and the quick[HYPHEN]dash score (only in two and four months follow up visits) and also returning to work (only in two month follow up visit).ConclusionThis study introduces a modified P&amp;P technique that protects the transverse palmar curvature, prevents the collapse of the distal radius, and simplifies casting, thereby obviating a full arm cast and mitigating elbow stiffness in patient outcomes. This modified technique could be considered as a more cost[HYPHEN]conscious alternative to external fixation for patients with distal radius fractures

Introducing and Prospective Efficacy Comparison of an Innovative and Affordable Technique for the Treatment of Distal Radius Fractures

Background: There are different treatments as well as controversies surrounding the adequate treatment for Distal Radius Fractures (DRF). In the absence of enough evidence[HYPHEN]base data regarding clinical effectiveness of available treatments, cost should be considered as an essential factor in selecting the surgical technique for DRF treatment. The goal of this study is introducing an improved and modified pin[HYPHEN]and [HYPHEN]plaster (MP&P) technique as an affordable alternative for treatment of DRF. This study also assesses and compares the outcomes of DRF treatment by using the introduced method versus external fixation (EF) technique. Methods: In this clinical cohort study, 98 patients presenting with closed DRF Types III or IV, randomly were classified into two modified P&P (50 patients) and EF (48 patients) groups and assessed for functional, clinical, radiographic and overall outcome at the time, 2, 10 and 22 months after surgery. They were also followed [HYPHEN]up for up to 3 years to determine the rate of complications. Results: Eighty one percent of EF and 86% of MP&P group were female. The average ages in the EF and MP&P groups were 44.9 +/- 12.4 and 46.1 +/- 5.4, respectively. Around 70% of the patients in each group had a Type III fracture, and 30% had Type IV. The rate of complications was higher among EF group patients (seven major and seven minor complications) compared to the MP&P (only 4 minor complications), however the difference between two groups regarding the complications and treatment outcome were insignificant, except in extension ROM and the quick[HYPHEN]dash score (only in two and four months follow up visits) and also returning to work (only in two month follow up visit). Conclusion: This study introduces a modified P&P technique that protects the transverse palmar curvature, prevents the collapse of the distal radius, and simplifies casting, thereby obviating a full arm cast and mitigating elbow stiffness in patient outcomes. This modified technique could be considered as a more cost[HYPHEN] conscious alternative to external fixation for patients with distal radius fractures

The role of connective tissue genomics in ascending aortic dissection: A case of Marfan syndrome

Background: Aortic dissection is a rare yet life threating condition with some already discovered risk factors namely hypertension, connective tissue disorders such as Marfan syndrome (MFS), cocaine abuse and cigarette smoking.Case report: In this article we would like to present a case of MFS who presented with severe chest pain and undergone Bentall surgery due to aortic dissection and aneurysm.Conclusion: Although many risk factors and preventive measures are already investigated, there is no definite method to avoid its occurrence in genetically predisposed patients such as MFS. Patient-specific models utilizing embryonic stem cells (ESC) and induced pluripotent stem cells (iPSC) may offer some advantages