Ali Moradi

Cross-cultural adaptation, validation, and reliability testing of the Shoulder Pain and Disability Index in the Persian population with shoulder problems.

We aimed to validate the translated and cross-culturally adapted Persian version of the Shoulder Pain and Disability Index (SPADI). The final Persian SPADI was administered to 190 patients, out of whom 83 patients returned for the retest. We administered the Persian version of the SF-36 quality-of-life inventory and the disabilities of the arm shoulder and hand (DASH) questionnaires at the first visit to assess the convergent validity. Cronbach’s &agr; was 0.94 for the total SPADI, which showed excellent internal consistency. The intraclass correlation coefficient was 0.84 for the total SPADI, which showed good reliability between the test and retest. Convergent validity was confirmed, as the Spearman correlation between total SPADI and DASH was 0.61. Moreover, there was significant correlation between the subscales of the SPADI and SF-36 scales. The Persian version of the SPADI proved to be a reliable and valid instrument to be implemented in the Persian population with shoulder disorders. Level of evidence: level II.

Mesenchymal stem cell based therapy for osteo‐diseases

Stem cell therapy in recent years has gained much attention as the modern therapeutic approach to treat diseases. Mesenchymal stem cells (MSCs) are seen as the most reliable cells applied in therapy over other stem cells because of their versatility. Bone and cartilage diseases (osteo‐diseases) are the major target of therapy using MSCs. In this perspective, we have statistically analyzed the data available on clinical trials registry databases regarding the mesenchymal stem cell based therapy for a number of mentioned diseases and paid attention towards the osteodiseases. We report that MSC therapy for osteo‐diseases needs optimization in its standards to achieve acceptable results so that we can apply it in daily routine clinical practice.

Neglected simultaneous bilateral femoral neck fractures secondary to narcotic drug abuse treated by bilateral one-staged hemiarthroplasty: a case report.

Simultaneous bilateral femoral neck fractures are extremely rare and associated with various conditions. Up to now Most cases had correlations with major trauma, repetitive minor trauma, seizure, parathyroid or renal dysfunction, anti-epileptic medications, seizure, etc. A 28-year-old addict man referred to us with a 10-year history of narcotic drug abuse and history of 8 months bilateral groin pain. He admitted with displaced bilateral femoral neck fracture. Because of long duration of this condition and osteonecrosis revealed on bone scan, one-staged bilateral hip hemiarthroplasty was done. A good function was noted after surgery to 4-month follow up. Up to now, have not be founded in the literature that a case of bilateral femoral neck fracture associated with narcotic drug abuse.Because of negative effects of opium or smoking on bone tissues, a simple bone pain should aware us about the risk of stress or fatigue fracture.

The Relationship Between Catastrophic Thinking and Hand Diagram Areas

PURPOSE To evaluate the relationship between the total area marked on pain and numbness diagrams and psychosocial factors (depression, pain catastrophic thinking, and health anxiety). METHODS A total of 155 patients marked painful and numb areas on separate hand diagrams. Patients also completed demographic, condition-related, and psychosocial (Pain Catastrophizing Scale, Patient-Reported Outcomes Measurement Information System Depression Computer Adaptive Test, and Short Health Anxiety Inventory) questionnaires. Bivariate and multivariable analyses were used to determine factors associated with total area marked on the pain and numbness diagrams. RESULTS The total area marked on the pain diagram correlated with catastrophic thinking, symptoms of depression, and health anxiety. In multivariable analysis, catastrophic thinking was the sole predictor of marked pain area, accounting for 10% of variance in the hand pain diagram. The total area marked on the numbness diagram correlated with the interval between onset and visit, diagnosis, catastrophic thinking, and symptoms of depression. In multivariable analysis, the interval between onset and visit, a diagnosis of carpal tunnel syndrome, and catastrophic thinking were independently associated with total area marked on the hand numbness diagram. CONCLUSIONS Catastrophic thinking was independently associated with larger pain and numbness areas on a hand diagram. This suggests that larger symptom markings on hand diagrams may indicate less effective coping strategies. Hand diagrams might be used as a basis for discussion of coping strategies and illness behavior in patients with upper extremity conditions. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.

Long-term clinical outcomes of war-related bilateral lower extremities amputations

In a cross-sectional study, 291 out of 500 veterans with war-related bilateral lower limb amputations from Iran-Iraq war (1980-1988) accepted to participate in our study. Information related to amputees and amputated limbs were gathered and a Persian version of the Medical Outcomes Study Short Form 36 (SF-36) was filled. To evaluate the effect of amputation level on health related quality of life, we classified patients to seven types according to the functional remainder of major joints (ankles, knees, hips). 97% of patients were male and the average age at the time of injury was 20 years. The major cause of war injury was shells in 50. 54% of amputees were involved in sport activities. The most common amputation level was transtibial (48%).The major stump complaint was muscle spasm. History of being hospitalized for a psychiatric disorder was reported in 5.6%. The average SF-36 score in type 2 to type 6 were 68, 60, 60, 56, and 62, respectively. Except Energy/Fatigue domain, all the other domains were different from normal population. There was not any significant statistical correlation between amputation type and any domain of the SF-36. Type 6 amputees showed an increase in physical health domains compared with former types.

Evaluation of disabilities and activities of daily living of war-related bilateral lower extremity amputees.

Background: Long-term consequences and the activities of daily living of bilateral lower limb amputation are not well documented. Objectives: The aims of our study were to identify the long-term effects of bilateral lower extremity amputations on daily activities and understand how these amputees cope with their mobility assistive devices. Study design: Cross-sectional study. Methods: A total of 291 veterans with war bilateral lower limb amputations accepted to participate in a cross-sectional study. Results: The average of follow-up was 25.4 years. A total of 152 amputees (54%) were involved in sports averagely 6.7 h per week. Bilateral amputees walk 10 m by the average of 15 ± 33 s, and they could walk continuously with their prosthesis 315 ± 295 m. They wore their prosthesis 6.8 ± 1.7 days per week and 7.9 ± 8.1 h per day. Of these, 6.7% of bilateral lower limb amputees needed help to wear their prosthesis; 88.3% of amputees used assistant device for walking. According to this survey, 73 (42%) prostheses in right limb were appropriate, 95 (54.6%) needed to be replaced, and 6 (3.4) needed to be fixed. On the left side, it was 76 (42%), 92 (52.0%), and 9 (5.1%), respectively. A total of 203 (74.9%) amputees reported limitations in at least one domain of the activities of daily living. The most common single item that affected the patients was ascending and descending stairs by the score of 66% of normal population. Conclusion: Veterans with bilateral lower limb amputations suffering from vast categories of daily problems. Clinical relevance This study and its results confirm that bilateral lower limb amputees have major progressive disabilities in daily activities and their social performance. This should attract the attention of amputees’ administrative organizations, social workers, health-care providers and caregiver providers.

Clinical outcome of posteromedial versus posteromedial-lateral release for clubfoot.

Although the Ponseti serial casting method is the gold standard for the management of clubfoot, surgical correction remains the best option for resistant cases. Therefore, we compared posteromedial and posteromedial-lateral surgical approaches for the correction of resistant clubfoot. Between 2007 and 2013, 68 patients with idiopathic nonsyndromic resistant clubfoot, who were admitted to our referral institute, were enrolled in our study. The patients were divided into two groups. The patients in group 1 (33 cases of clubfoot) underwent posteromedial release with a single incision and those in group 2 (35 cases of clubfoot) underwent posteromedial-lateral release by two separate incisions. The severity of deformity was classified according to the Dimeglio classification. After the operations, all patients were followed up and surgical results as well as acute and chronic complications were evaluated. The patients were followed up for a mean of 43 months, and at the last follow-up visit, the Dimeglio scores in groups 1 and 2 were 4.8±3.8 and 3.3±2.6, respectively (P=0.04). Outcomes improved in both groups significantly. Although group 2 had more severe deformity, compared with group 1 at the baseline, the final outcome was better in this group. Heel varus and equinus was corrected more appropriately in group 2. Complications such as navicular dorsal subluxation and valgus overcorrection were less common in group 2. In cases of resistant clubfoot, it appears that a posteromedial-lateral approach with two separate incisions not only provides a better correction but is also associated with a lower complication rate in comparison with the single-incision posteromedial approach. Level of evidence: Level III, therapeutic study.

Reoperation After Combined Injury of the Index Finger: Repair Versus Immediate Amputation

PURPOSE To identify factors associated with unplanned reoperation of severely injured index fingers and to address the number of amputations after initial repair. METHODS In this retrospective study, we included all patients older than 18 years of age who had repair or immediate amputation for combined index finger injury at 2 level I trauma centers and 1 community hospital tied to a level I trauma center between January 2004 and February 2014. Twelve patients were excluded because of inadequate follow-up. Bivariate and multivariable analyses sought factors associated with unplanned reoperation after repair and immediate amputation. RESULTS Among 114 patients with combined injury, 75 were treated with repair and 39 with immediate amputation. A total of 41 patients had an unplanned reoperation, 33 after repair (44%) and 8 after immediate amputation (21%). In multivariable analysis, patients who had a reoperation for fingers other than the index finger were at risk for unplanned reoperation after repair. Women were more likely to have an unplanned reoperation than men, and patients who had a ray amputation were at risk for unplanned reoperation after immediate amputation. Six patients (18%) had amputation after initial repair. CONCLUSIONS Surgeons may counsel patients that they are twice as likely to have an unplanned reoperation after a repair for combined injury of the index finger compared with an immediate amputation. Unplanned reoperations were more common among patients with injuries involving multiple fingers. Effective shared decision making is particularly important in this setting given that 1 in 5 repaired index fingers were eventually amputated. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Validity and Reliability of the Persian Version of Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Quick‑DASH)

Background: The aim was to assess the validity and reliability of the Persian version of shortened disabilities of the arm, shoulder, and hand (Quick-DASH) questionnaire in patients with upper extremity conditions. Methods: We administered the Persian version of Quick-DASH to 202 patients with upper extremity conditions, of which 71 patients randomly returned after 3 days to respond to the questionnaire for the 2nd time. In order to test the construct validity of the questionnaire, patients responded to the Michigan Hand Outcome Questionnaire (MHOQ) and Short Form 36 Health Survey (SF-36) as well. Internal consistency was tested using the Cronbachs alpha, and test-retest reliability was measured using intra-class correlation coefficient (ICC). Results: Cronbachs alpha was 0.90. ICC was 0.89. Convergent validity was confirmed, as the Spearman correlation between the Quick-DASH and MHOQ was 0.67 and ranged from 0.24 to 0.56 between the subscales of the SF-36 and Quick-DASH. Conclusions: Observation of excellent internal consistency, good to excellent test-retest reliability, and moderate to strong construct validity confirms the validity and reliability of the Persian version of Quick-DASH for evaluating the magnitude and level of disability in upper extremity conditions.

Minimally invasive modified latarjet procedure in patients with traumatic anterior shoulder instability.

Background: Despite recent advances in arthroscopic soft tissue repair and reconstruction for shoulder instability, Latarjet procedure is continuously a method of choice for many cases of unstable shoulders. Objectives: To evaluate the clinical results of minimally invasive modified Latarjet technique in recurrent, traumatic anterior shoulder instability associated with obvious Hill-Sachs and Bankart lesions. Patients and Methods: Between 2007 and 2013, 36 consequent patients with traumatic anterior shoulder instability who underwent modified Latarjet operation were enrolled in this prospective study. The MRI studies revealed labrum detachment and Hill-Sachs lesion in all shoulders. For all patients, demographic and injury data were obtained and Constant Shoulder score, Rowe score, and UCLA scores were completed by related surgeon. Stability of the shoulder was assessed with the Jobe’s relocation test preoperatively. The patients were followed up at two weeks, one month, three months, and six months from the date of the surgery and evaluated for probable complications. Above mentioned assessments were completed again at the time of the final follow-up. Results: The average age of the enrolled patients was 24.6 (ranging from 18 to 33 years) and 35 patients out of the total of 36 patients were males. Motor-vehicle accidents were the major cause of the injuries (52%) with the average interval between the injury and operation of 3.1 ± 1.2 years (Ranging from 1 to 5 years). The average number of incidents of dislocations between the injury date and the surgery was 7.2 ± 2.1 (Ranging from 4 to 20). The average follow-up period was 37 months (Ranging from 12 to 65 months). All patients had Jobe’s relocation test (Apprehension sign) pre-operatively and negative Jobe’s relocation test post-operation. Significant improvements in functional scores were demonstrated postoperatively compared to preoperational assessment in all cases. Final follow up radiographs showed union of all the grafts and patients reported no incidents of re-dislocation during the follow-up period. One incidence of a superficial infection 2 weeks post operation was the only complication in this study. The infection was resolved with antibiotic treatment. Conclusions: The Latarjet procedure demonstrated good or excellent short-term outcomes in management of patients with traumatic, recurrent anterior shoulder dislocation with a low level of post-operative complication risks.