Complete isolated calcaneal dislocation, defined as dislocation of talocalcaneal and calcaneocuboid joints with intact talonavicular joint without significant fracture, is an exceedingly rare injury.
...A 49-year-old man, after a motor vehicle collision, presented with a closed isolated anterolateral dislocation of the calcaneus associated with fracture of the sustentaculum tali, cuboid, lateral process of the talus, and avulsion fracture of superior peroneal retinaculum. Urgent successful closed reduction was immediately performed in the emergency room under sedation. Two days later, through sinus tarsi approach extended proximally to posterior of the lateral malleolus and distally to the calcaneocuboid joint, peroneal tendons were reduced in the retromalleolar groove and avulsion fracture of the superior peroneal retinaculum was reduced and fixed by a suture anchor. A chondral lesion (6 × 8 mm) was seen in the posterior facet of the calcaneus for that chondroplasty and microfracture were performed. Also, small bony fragments from the cuboid were excised. The reduced calcaneocuboid joint was fixed by two Kirschner wires. In the second stage, 10 days later, through medial approach to the talocalcaneal joint, multiple free bony fragments were excised. Then sustentaculum tali was reduced and fixed using a lag screw. Postoperatively, a non-weight bearing short leg cast was applied for six weeks. The patient had permission to start partial weight bearing 6 weeks after removal of K-wires. Finally, at the 10th postoperative week, he had full weight-bearing without any aid instrument. He was able to return to his regular activities about 6 months after the injury. At 34 months, the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 92 from 100. The foot function index percentile was 7% and the visual analogue score for pain was 1.9. The last radiographs revealed normal configuration of talocalcaneal, calcaneocuboid, and talonavicular joints with a little joint space narrowing in posterior part of the subtalar joint.
Patients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes, if it is urgently diagnosed and properly managed.
Abstract
Background
Corona virus infectious pandemic makes outdoors rehabilitation a potential hazard. Patient education to perform simple home-based exercises seems to be an interesting and ...sometimes a mandatory option. This study provides a comparison between the conventional and home-based virtual rehabilitation after surgical repair of medial meniscus root tears.
Methods
In this prospective study, all patients who underwent medial meniscus posterior root repair with a modified trans-tibial pull-out technique from March 2019 to March 2021 were evaluated. Those who underwent surgery after December 2019 were trained to perform self-rehabilitation. The rest had undergone outdoors specialized rehabilitation according to a unified protocol and these were used as a historical control group. All patients were followed up for a minimum of 2 year after surgery. Final Lysholm scores were utilized to compare functional outcomes after considering the effect of age, body mass index and time from surgery by multivariate linear regression analysis.
Results
Forty-three consecutive patients with medial meniscal root tears were studied. Thirty-nine (90.7%) were women and 4 (9.3%) were men. The mean age of participants was 53.2 ± 8.1 years. The total Lysholm knee score, and all its items were significantly improved in both groups at a two-year follow-up (
p
< 0.05), except the “Using cane or crutches” item (
p
= 0.065). Nevertheless, the final Lysholm knee score improvement was higher in patients who performed outdoors specialized rehabilitation and in patients with shorter time-to-surgery.
Conclusion
Regardless of age and gender, home-based rehabilitation after meniscal root repair with the modified trans-tibial pull-out technique improved the patients’ function at a two-year follow-up. Nonetheless, this effect was still significantly lower than that of the outdoors specialized rehabilitation. Future work is required to clarify basic protocols for home-based tele-rehabilitation programs and determine clinical, radiological and functional results.
Level of evidence
Level IV, therapeutic, historically controlled study.
Objective: The adherence of the physicians to guidelines in resuscitation of the patients is of great importance since it can predict the outcome. To evaluate the adherence of the physicians of our ...center in hydration of traumatic patients with crystalloids regarding the Advanced Trauma Life Support (ATLS) guidelines. Methods: We designed an algorithm obtained from ATLS guidelines using vital signs and status of bleeding of the traumatic patients to classify them. After categorizing the patients according to the algorithm, we evaluated the adherence of the physicians to the guideline in hydration of traumatic patients with crystalloids. Results: This is a cross-sectional study in which 998 traumatic patients who were admitted to the emergency ward of Rajaee trauma hospital were enrolled. Most of the patients were men (89.6%) and the most common causes of traumatic injuries were traffic accidents. Proper hydration was seen in only 14.7% of the patients. Most of the patients were overhydrated (85%) regarding both our algorithm and the patients’ base excess. Conclusion: The present study showed that the adherence of physicians in our center in resuscitation with crystalloid was low. Also, most of the traumatic patients were overhydrated with crystalloids. It is suggested that physicians retrain concerning the side effects of over hydration. In addition, we need a user friendly and more applicable guideline for hydration with crystalloids.
Old simultaneous complex fracture–dislocation of the first metatarsophalangeal (MTP), Lisfranc, and naviculocuneiform joints as an overwhelming injury has not been reported in the literature yet. In ...a 29-year-old man, 6 months following the trauma, the medial column of foot was reconstructed using iliac tricortical bone graft from navicular to the first metatarsal. Arthrodesis of the second and third tarsometatarsal joints and resection arthroplasty of the first MTP joint were done. His clinical and radiographic evaluation after 18 months revealed an acceptable function with returning to pre-injury job but with some limitations in recreational activities.
Level of evidence: level 4
This study aimed to evaluate the radiologic and clinical outcomes of TKA with non-stemmed tibial components in relation to their body mass index (BMI).
In this retrospective cohort study, the outcome ...of TKA with non-stemmed tibial components based on their BMI was evaluated (BMI<30 vs. BMI≥30). The patients' function was assessed using the International Knee Documentation Committee (IKDC) and Lysholm knee questionnaires. Radiologic evaluation for probable signs of loosening was performed using two quantitative scoring systems by Ewald and Bach
Moreover, we reviewed the current literature on the application of non-stemmed tibial components in obese patients.
Twenty-one patients (two men and 19 women) with BMI≥30 and a mean age of 65.1±9.5 years, and 22 patients (three men and 19 women) with BMI<30 and a mean age of 63.6±8.5 years were studied. The mean follow-up periods with BMI≥30 (47.0±19.8 months) and BMI<30 (49.2±18.7 months) were comparable (
=0.618). No patients in either group experienced clinical loosening. Besides, none of the patients had any kind of revision surgery. The patients in both BMI groups had comparable IKDC scores (both the total score and its sub-scores;
>0.05). Furthermore, the total Lysholm knee scores were similar in both groups (
=0.122). Using both scoring systems, the peri-prosthetic bone radiolucency near the tibial components was similar in both groups (
>0.999).
The present study found no significant difference in the radiologic or clinical outcome of non-stemmed TKA in patients with BMIs under and over 30.
Thoracic ossification of the posterior longitudinal ligament (OPLL) is a rare condition that is mainly accompanied by cervical OPLL or ossification of thoracic ligamentum flavum. In case of causing ...neurological manifestations, it is preferred to treat the condition surgically. Several surgical procedures were introduced, including anterior, posterior, or combined approaches. Laminectomy with instrumented fusion is the most popular procedure utilized via the posterior approach. A 32-year-old obese woman, who suffered from back pain and weakness in both lower extremities for one month, was referred to our spine outpatient clinic. Imaging revealed lower thoracic OPLL (T7/T8 & T8/T9 & T9/T10). The posterior longitudinal ligament had a mixed ossification pattern (beaked and continuing cylindrical). To maintain thoracic spine stability and prevent future kyphosis, we performed laminectomy and long segment fixation (T7 to T12). The post-operative neurological examination revealed a considerable increase in muscle strength and significant pain relief.
Purpose： Unsafe behaviors are an important cause of accidents in adolescent age groups. This study was designed to examine the behaviors of adolescent pedestrians in southern Iran. Methods： This is a ...descriptive analytical cross-sectional study. The study population consisted of high school students in Shiraz, capital city of Fars Province, Iran. Five hundred and sixteen students were selected by multi-stage sampling. Data were collected by the use of three questionnaires, which included Persian copies of adolescent road user behavior questionnaire （ARBQ）, Duke University Religious Index （DUREL）, as well as the context and independent variables questionnaire. Results： The results showed that a decrease in dangerous behaviors on the road resulted in an increase in respondents＇ intrinsic religiosity. Also, engagement in unsafe crossing behavior in the road decreased with increasing respondents＇ intrinsic religiosity. Another finding showed that female students were less involved in dangerous play and planned protective behaviors on the road. Conclusion： Findings clearly indicate that intrinsic religiosity has a significant role in reducing the risky road behaviors of students. Hence, religion may improve road safety in school students＇ road behavior in Iran.
The aim of this present study is to investigate the prevalence of alcohol and substance abuse (ASA) and its relationship with other risky driving behaviors among motorcycle drivers.
This is a cross ...sectional study which is performed at Shiraz city of Iran. Data from motorcycle drivers were collected using a standard questionnaire in eight major streets at different times of the day. The data includes consumption of alcohol and other substances two hours before driving and some of the risky behaviors during driving.
A total of 414 drivers with a mean ± SD age of (27.0 ± 9.3) years participated in the study. Alcohol or substance consumptions two hours before driving was significantly associated with risky driving behaviors such as using mobile phone during driving, poor maneuvering, and driving over the speed limit (both p < 0.001). It was also associated with carelessness about safety such as driving with technical defects (p < 0.001) and not wearing a crash helmet (p = 0.008).
Screening for alcohol and substance consumption among motorcycle drivers is an efficient way to identify drivers that are at a greater risk for road traffic accidents.
Urban family physician program has been launched as a pilot in Fars and Mazandaran provinces of Iran since 2012. Attitudes of policy makers and people toward urban family physician program have ...become challenging. This study shows what people know and practice toward this program.
This cross-sectional population-based study was conducted by a multistage randomized sampling in Shiraz, Southern Iran. Knowledge and practice of adults toward urban family physician program were queried through filing the questionnaires. Single and multiple variable analyzes of data were performed.
Participation rate was 1257 of 1382 (90.9%), and the mean age of the respondents was 38.1 ± 13.2 years. Of 1257, 634 (50.4%) were men and 882 (70.2%) were married. Peoples' total knowledge toward urban family physician program was 5 ± 2.7 of 19, showed that 1121 (89.2%) had a low level of knowledge. This was correlated positively and in order to being under coverage of this program (P < 0.001), being under coverage of one of the main insurance systems (P = 0.04) and being married (P = 0.002). The mean score of people's practice toward the program was 2.3 ± 0.9 of total score 7, showed that 942 (74%) had poor performance, and it was correlated positively and in order to being under coverage of this program (P < 0.001) and having higher than 1000$ monthly income (P = 0.004). Correlation of people's knowledge and practice toward the program was 24%.
Current evidences show a low level of knowledge, poor practice and weak correlation of knowledge-practice of people toward urban family physician program.
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