BackgroundAdolescent idiopathic scoliosis (AIS) is the most common form of idiopathic scoliosis, and surgery is considered as one of the therapeutic options. However, it is associated with a variety of irreversible complications, in spite of the benefits it provides. Here, we evaluated the long-term outcome of posterior spinal fusion (PSF) of AIS to shed more light on the consequences of this surgery.MethodsIn a cross-sectional study, a total of 42 AIS patients who underwent PSF surgery were radiographically and clinically inspected for the potential post-operative complications. Radiographic assessments included the device failure, union status, and vertebral tilt below the site of fusion. Clinical outcomes were evaluated using the Oswestry disability index (ODI) and visual analogue scale (VAS).ResultsThe mean age of the surgery was 14.4 ± 5.1 years. The mean follow-up of the patients was 5.6 ± 3.2 years. Complete union was observed in all patients, and no device failure was noticed. Pre- and post-operative vertebral tilt below the site of fusion were 11.12° ± 7.92° and 6.21° ± 5.73°, respectively (p < 0.001). The mean post-operative ODI was 16.7 ± 9.8. The mean post-operative VAS was 2.1 ± 0.7. ODI value was positively correlated with follow-up periods (p = 0.04, r = 0.471). New degenerative disc disease (DDD) was observed in 6 out of 37 (16%) patients.ConclusionIn spite of the efficacy and safety of PSF surgery of AIS, it might result in irreversible complications such as DDD. Moreover, the amount of post-operative disability might increase over the time and should be discussed with the patients.
Background: A preferred surgical approach to distal femur intra-articular fractures is still controversial. Objectives: In the current study, we assessed the outcome and complications of three different surgical techniques, including screw fixation, Retrograde Intramedullary Nailing (RIN), and Locking Compression Plate (LCP). Methods: A total of 63 patients with distal femur intra-articular fractures were included in this retrospective study. AO/OTA fracture and dislocation classification was used to categorize patients. Type B fractures were treated with screw fixation and type C fractures were treated using LCP and RIN. Outcome measures, including the knee range of motion (ROM) and pain level, were Results: The mean±SD age of patients was 36.7±15.7 years. The fracture types B and C were detected in 22 (32.4%) and 46 (67.6%) patients. The mean follow-up period was 27.2±15.9 months. Mild knee pain was the only complication of screw fixation that was observed in 21% of patients. LCP was associated with some complications, including pain (19.4%), infection (9.7%), limited ROM (47.4%), malunion (47.4%), and nonunion (6.5%). RIN was also associated with several complications, including pain (44.4%), infection (11.1%), limited ROM (33.3%), and malunion (41.2%). A comparison of the outcome in matched fracture types of LCP and RIN groups revealed no superiority of each technique. Conclusion: Screw fixation alone results in a satisfactory outcome in the treatment of type B distal femur intra-articular fractures. LCP and RIN are associated with a variety of complications with no superiority over each other.
Alkaptonuria is a rare inborn metabolic disease, in which an enzymatic deficiency accumulates alkapton in different tissues, causing darkness and injury, especially in spine and large cartilages, called ochronosis. The urine darkness can be a key to early diagnosis in childhood, but some cases are missed until adulthood and gradual damage to cartilages causes disability and impairs the patients’ quality of life. Here, a 49-year old male patient is presented with a 2 week history of left knee pain and swelling, who underwent arthrotomy, and the macro- and microscopic evaluation revealed ochronosis, superimposed by septic arthritis. Diagnosis of this rare disease should be considered in differential diagnoses of common joint disorders, like septic arthritis and osteoarthritis, so that appropriate management of the disease can prevent further damages.
Bisphosphonates, more particularly alendronate, are a popular category of drugs in the treatment of postmenopausal and corticosteroid-induced osteoporosis. The present study contends that the long-term consumption of bisphosphonates causes not only subtrochanteric and femoral shaft fractures but also pathological fractures at other musculoskeletal sites. This report presents a rare case of alendronate-induced pathological metatarsal fracture in a 59-year-old female with a history of cuboid fracture following a twisting with abnormal Bone Mineral Density (BMD) (T score: −3.5; lumbar spine and −2.6; proximal femur).
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