Ali Andalib

The Role of Routine Preoperative Magnetic Resonance Imaging in Idiopathic Scoliosis: A Ten Years Review

Study Design Prospective study. Purpose To determine the role of routine preoperative magnetic resonance imaging (MRI) to detect the incidence and risk factors for intraspinal anomalies in patients with idiopathic scoliosis. Overview of Literature The incidence and risk factors for intraspinal anomalies in patients with idiopathic scoliosis are controversial, and the indications for preoperative MRI in these patients vary among centers. Methods Information on patients with idiopathic scoliosis who were surgical candidates over 10 years (age at presentation, sex, magnitude and apex of major curve, intraspinal anomalies detected by MRI, and neurological examination results) were recorded, the patients were grouped according to the intraspinal anomaly, and the data were analyzed. Results Of the 271 patients with idiopathic scoliosis, 27 had neuroaxial abnormalities (9.9%). Of these 27 patients, 14 (52%) underwent a neurosurgical procedure. Significant differences were observed in the frequency of early disease onset and male sex (p<0.05) between the group of patients with neuroaxial abnormalities on preoperative MRI and those who did not have a cord anomaly. No difference was detected in the magnitude or direction of the curve. Conclusions Neuroaxial abnormalities in patients with idiopathic scoliosis and a normal neurological examination were highly frequent (9.9%). Missing these abnormalities before surgery could inflict catastrophic postoperative complications. The incidence of neuroaxial abnormalities was higher in male patients and in those with early onset disease. Thus, MRI is essential for all patients with idiopathic scoliosis who require medical intervention.

Is there a place for open intramedullary nailing in femoral shaft fractures

Background: Femoral shaft fractures are among the most common fractures following high trauma injuries. Different kinds of treatment have been suggested for these injuries. Aim: The aim of this study was to compare the results femoral fractures treated by mini open and close intramedullary nailing (IMN) technique. Materials and Methods: A total of 48 adult patients were operated due to fracture of the femur with close or open IMN technique between September 2010 and September 2011. 23 patients operated with close. IMN technique was included in Group I while 24 patients operated with mini open IMN technique constituted Group II. In Group I, all patients. Were operated on the fracture table in the supine position while in Group II, all patients underwent surgery on standard tables in the lateral position. Results: The mean age of patients was 27.3 years, ranging between 16 and 62. The mean age of the close nailing and open nailing groups was 30.5 and 24.5 respectively (P = 0.052). Only one patient from the open nailing group failed to unite. The mean time for union in close and open nailing groups was 13 + 2.4 and 17.7 + 2.3 weeks respectively (P = 0.001). No infection or limb length discrepancies were observed in the two groups. Conclusion: Although close nailing is the preferred methods in most cases, but in poly-traumatized patients or in centers where there are no fracture tables or C-arm, open nailing is a good option.

Outcomes of Unilateral Total Hip Arthroplasty in Patients Aged Under 35 Years in Iranian Population: A Preliminary Study

Background: The purpose of this study is to report outcomes of total hip arthroplasty (THA) in patients under the age of 35 years regarding pain and joint function. Materials and Methods: This preliminary analytic-descriptive study was performed in prospective consecutive series of forty-three patients younger than 35 years old who had undergone unilateral THA during a 36-month period. As the primary outcome, the severity of pain using visual analog scale (VAS) of 1–10, and as the secondary outcomes, joint range of motion (ROM) and the Harris Hip Score (HHS) were assessed in the preoperative visit, 1, 6, and 18 months after operation for each patient. Complications were recorded at 6 months and 18 months after surgery. Results: The data of VAS showed the mean severity of pain was significant between preoperation measurements and postoperative assessments (P < 0.001). The means of HHS and hip ROM were also statistically significant before the operation in comparison with postoperative assessments (P < 0.001 for both means). A total of 19 patients had postoperative complications including periprosthetic fracture in two patients, infection in two patients, cup loosening in three patients, limb length discrepancy in 10 patients, and heterotopic ossification in two patients. Seven patients had been readmitted. Conclusion: We believe THA using uncemented prosthesis has a high survivorship with low rate osteolysis in young patients with good bone stock. It is necessary to have longer follow-up to have a better evaluation on outcomes.

What are the results of minimally invasive plate osteosynthesis for femoral and tibial comminuted fracture

Methods: This analysis included five case-control studies reporting data from 1,251 individuals. With respect to alcohol intake habits (never, former, or current), average drinking consumption (g/week) and cumulative drinking consumption (drink-years) were extracted. The risk of ONFH was evaluated and a two-stage dose-response meta-analysis was performed using restricted cubic splines with four knots at fixed percentiles of 5%, 35%, 65%, and 95% of the distribution.Statement of the Problem: Medial compartment arthritis is very common in Asian population, because of a preponderance of varus knees. The choice in such early OA varus knees has been between two radical surgeries, total knee replacements, and high tibial osteotomies. The Prakash Fibular Osteotomy (PFO) is a much simpler, minimally invasive, day care procedure that realigns the knee joint, and delays knee replacements by a decade or longer.