BackgroundStabilization of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults; however, to ream or not to ream is still being debated.ObjectivesThe primary objective of this study was to determine clinical results following unreamed versus ream intramedullary nailing of femoral fractures.Patients and MethodsBetween January 2008 and August 2009, 50 patients with femoral shaft fractures were treated with unreamed or reamed femoral nails in our clinic. From this prospective single centre study, 16 patients were excluded due to insufficient follow-up data. According to the AO classification, fractures in this study were either type A or B. Dynamic proximal locking was performed in all cases. The remaining 34 patients were divided into two groups of 17 with ream or unream nailing. During and after the operation, we evaluated some variables in whole series.ResultsAfter statistical analyzes, we found that there were no differences in radiologic union time (P = 1) or full weight bearing time (P = 0.73) between ream and unream nailing. Nail breakage or iatrogenic fractures during nail insertion did not occur and we did not have any fat emboli in both groups but one secondary loss of reduction occurred in the unream group. Superficial infection after the operation was seen in one case which was treated successfully with antibiotics. In the ream group surgical time was about thirty minutes longer and differences were significant (P = 0.000). Patients had to pay more for ream nailing but the difference was not significant. We found no statistical difference between union time with or without reaming; on the other hand, there was significant increased operation length, blood loss and systemic changes in BP or So2 in the ream group versus the unream group.ConclusionsWe advocate that unream nailing in traumatic femoral shaft fractures is a simple, safe and effective procedure with significant advantages, especially in multitrauma patients.
Septic arthritis of the shoulder is uncommon in adults, and complete dislocation of the glenohumeral joint following septic arthritis is extremely rare. We report a case of pathologic shoulder dislocation secondary to septic arthritis in an intravenous drug abuser.
Context: Congenital scoliosis is a difficult condition for orthopedic surgeons. There are some influencing factors to choose the best treatment option for scoliosis. Objectives: Patients with congenital scoliosis may encounter different anomalies. There exist various surgical techniques with different indications. Methods: Electronic databases, such as Google Scholar, PubMed, and Scopus were searched for congenital scoliosis. Articles published from 1928 to 2020 were searched. A narrative review was conducted by focusing on treatment options. Results: Different methods are presented in the literature that consists of operative and nonoperative approaches. Nonoperative treatment methods are seldom a final choice. They are used to postpone the final surgery. There are different methods of surgeries in the literature; the best treatment strategy concerns the patients’ condition and the surgeon’s preference. Conclusions: The critical issue in the management of congenital scoliosis is to diagnose these patients’ curves before severe progression, i.e. mandatory to achieve desirable results. Usually, a course of nonoperative treatment can be started, but only to postpone the final surgery. The preferred surgical treatment depends on the type of congenital scoliosis and the age of the patient. The treatment of congenital scoliosis should be a multidisciplinary approach due to concomitant morbidity in these patients.
Introduction:Radiocolloids labelled with less costly and more accessible radionuclides such as rhenium-188 are of interest to developing countries compared with those labelled with rhenium-186 and yttrium-90.Aim: This study was aimed to evaluate the efficacy and safety of radiosynovectomy using rhenium-188 in patients with chronic haemophilic synovitis and recurrent hemarthrosis. Methods:In this quasi-experimental prospective study, 20 haemophilic patients were evaluated at preinjection, and at 1, 3, 6 and 12 months after injection. Magnetic resonance imaging (MRI) was done to measure synovial thickness and to calculate Denver score. Joint radiographs were taken to measure the Pettersson score. The Gilbert questionnaire, Functional Independence Score in Hemophilia (FISH) and visual analogue scale (VAS) for pain were completed, and the number of bleeding episodes and factor consumption were recorded at each follow-up visit. Results:The number of bleeding episodes, the amount of factor consumption per month, VAS pain scores and synovial thickness decreased significantly over time (P < .05). Gilbert and FISH scores showed significant improvement (P < .001).However, Pettersson score and Denver score showed no significant changes after injection. Minor complications including temporary pain and swelling occurred in 20% of patients, and no major complication was observed after rhenium-188 injection. Conclusion:Our results indicated high clinical impact, efficacy, safety and low invasion of rhenium-188 in radiosynovectomy of haemophilic patients. Considering the availability and relatively low cost of rhenium-188 in developing countries, this can be a good treatment option for haemophilic patients with recurrent hemarthrosis, particularly when the synovial hypertrophy is not massive yet. K E Y W O R D SHaemophilia, Hemarthrosis, Magnetic Resonance Imaging, Rhenium-188, Synovectomy, Synovitis | 143 KACHOOEI Et Al. How to cite this article: Kachooei AR, Heidari A, Divband G, et al. Rhenium-188 radiosynovectomy for chronic haemophilic synovitis: Evaluation of its safety and efficacy in haemophilic patients. Haemophilia. 2020;26:142-150. https ://doi.
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