Objective: The term volvulus is derived from a Latin word volvere means to turn, twist which is mainly referred to as twisting of sigmoid and can lead to ischemia and gangrene. Nowadays, it is the 3rd most common reas...Objective: The term volvulus is derived from a Latin word volvere means to turn, twist which is mainly referred to as twisting of sigmoid and can lead to ischemia and gangrene. Nowadays, it is the 3rd most common reason of bowel obstruction mostly in the Middle East countries, Africa, India, and Russia where average age is younger compared to the west (about 40 to 50). Methods: In this study, patients who referred to Imam Hossein and Firoozgar Hospitals within2014 and 2015were included by the first impression of obstruction and finally diagnosis of sigmoid volvulus that were not in septic shock. After primary survey, routine lab profile, electrolyte correction and resuscitation if needed, the process of choices of patients and terms and conditions were explained for patients. They were prepared for operation after obtaining a written consent. During operation, those who are not necrotic sigmoid and do not have peritonitis undergone primary resection and anastomosis of intestine as suggested by surgeon. Anastomosis has given by 3-0 silk thread separately. Results: Twenty-five patients, 7 females (28 %) and 18 males (72%), underwent primary resection and anastomosis whose age ranged from 18 to 84 (mean 61.5 years, variance 56, 25). Average leukocytes count for our patients once they entered the emergency ward was 8500(with max level of 14/9 and min of 4/1). Two patients had fever after operation. Five patients experienced tachycardia within 24hours after surgery and one patient experienced infectious wound and 2 cases passed away. Conclusions: With regard to the obtained results, examining all aspects of patients is recommended to conduct primary anastomosis. Primary anastomosis is not recommended for patients with multiple underlying diseases considering the longer operation time.展开更多
Background: Intertrochanteric fractures are of intense interest globally. They are the most frequently operated fracture type, have the highest postoperative fatality rate of surgically treated fractures, and have bec...Background: Intertrochanteric fractures are of intense interest globally. They are the most frequently operated fracture type, have the highest postoperative fatality rate of surgically treated fractures, and have become a serious health resource issue due to the high cost of care required after injury. A number of problems exist when determining the best option for treatment for intertrochanteric fractures. The classification systems do not work well enough for preoperative planning and the reduction criteria have not been well defined. Methods: All patients who presented to Firoozgar Hospital, Tehran with intertrochanteric fracture, between March 20th 2013 and December 21st 2015, underwent DHS implementation, after 6-month follow-up period. Demographic data, preoperative radiographic fracture, bone quality typing (AO/OTA and Dorr classification), American Society of Anesthesiologists (ASA) score and evaluation of their correlation with the complication of fixation including nonunion and device failure were recorded and analyzed. Result: 101 patients including 54 males (53.5%) and 47 females (46.5%) underwent DHS implementation. Mean population age was 73.06 ± 16.36 years with an age range of 30 to 94 years;the most frequent age period was 76 - 85 years, injured by low-energy trauma mechanism and 23.8% patients were injured in a high-energy trauma. 56 patients completed the 6-month follow-up evaluation which ranged from 1 to 80 weeks. According to AO/OTA classification, the most common type among the patient population was A2, 27 patients (51.5%);while the most common group from Dorr classification turned to be group B (39.6%). Classification by ASA score revealed Class II to be most frequent among the patient population (56.4%). Nonunion was seen in eight of patients (14.3%). Three patients (5.4%) had device failure, two cases showed side plate breakage, and another one had screw cut out. There was no significant relationship between AO/OTA classification with the both complications i.e. the development of device failure (P = 0.85) and nonunion (P = 0.99). Non-significant correlation was found between Dorr classification with device failure (P = 0.06) and nonunion (P = 0.11). Conclusion: Regarding recent studies, more effective factor on the outcome is patient’s medical condition before surgery compared to the radiographic findings including AO/OTA and Dorr classification.展开更多
Objective： Interphalangeal joint con- tracture is a challenging complication of hand trauma, which reduces the functional capacity of the entire hand. In this study we evaluated the results of soft tissue distraction...Objective： Interphalangeal joint con- tracture is a challenging complication of hand trauma, which reduces the functional capacity of the entire hand. In this study we evaluated the results of soft tissue distraction with no collateral ligament transection or volar plate removal in comparison with traditional operation of contracture re- lease and partial ligament transection and volar plate removal. Methods： In this prospective study, a total of 40 pa- tients in two equal groups （A and B） were studied. Patients suffering from chronic flexion contracture of abrasive trau- matic nature were included. Group A were treated by soft tissue distraction using pentagonal frame technique and in Group B the contracture release was followed by finger splinting. Results： Analyzed data revealed a significant differ- ence between the two groups for range of motion in the proximal interphalangeal joints （P〈0.05）, while it was not meaningful in the distal interphalangeal joints （P〉0.05）. There was not a significant difference in the degrees of flexion contracture between groups （P〉0.05）. Regression analysis showed that using pentagonal frame technique significantly increased the mean improvement in range of motion of proxi- mal interphalangeal joints （P〈0.001）, while the higher the preoperative flexion contracture was observed in proximal interphalangeal joints, the lower improvement was achieved in range of motion of proximal interphalangeal joints after intervention （P〈0.001）. Conclusion： Soft tissue distraction using pentagonal frame technique with gradual and continuous collateral liga- ment and surrounding joint tissues distraction combined with skin Z-plasty significantly improves the range of mo- tion in patients with chronic traumatic flexion deformity of proximal and/or distal interphalangeal joints.展开更多
文摘Objective: The term volvulus is derived from a Latin word volvere means to turn, twist which is mainly referred to as twisting of sigmoid and can lead to ischemia and gangrene. Nowadays, it is the 3rd most common reason of bowel obstruction mostly in the Middle East countries, Africa, India, and Russia where average age is younger compared to the west (about 40 to 50). Methods: In this study, patients who referred to Imam Hossein and Firoozgar Hospitals within2014 and 2015were included by the first impression of obstruction and finally diagnosis of sigmoid volvulus that were not in septic shock. After primary survey, routine lab profile, electrolyte correction and resuscitation if needed, the process of choices of patients and terms and conditions were explained for patients. They were prepared for operation after obtaining a written consent. During operation, those who are not necrotic sigmoid and do not have peritonitis undergone primary resection and anastomosis of intestine as suggested by surgeon. Anastomosis has given by 3-0 silk thread separately. Results: Twenty-five patients, 7 females (28 %) and 18 males (72%), underwent primary resection and anastomosis whose age ranged from 18 to 84 (mean 61.5 years, variance 56, 25). Average leukocytes count for our patients once they entered the emergency ward was 8500(with max level of 14/9 and min of 4/1). Two patients had fever after operation. Five patients experienced tachycardia within 24hours after surgery and one patient experienced infectious wound and 2 cases passed away. Conclusions: With regard to the obtained results, examining all aspects of patients is recommended to conduct primary anastomosis. Primary anastomosis is not recommended for patients with multiple underlying diseases considering the longer operation time.
文摘Background: Intertrochanteric fractures are of intense interest globally. They are the most frequently operated fracture type, have the highest postoperative fatality rate of surgically treated fractures, and have become a serious health resource issue due to the high cost of care required after injury. A number of problems exist when determining the best option for treatment for intertrochanteric fractures. The classification systems do not work well enough for preoperative planning and the reduction criteria have not been well defined. Methods: All patients who presented to Firoozgar Hospital, Tehran with intertrochanteric fracture, between March 20th 2013 and December 21st 2015, underwent DHS implementation, after 6-month follow-up period. Demographic data, preoperative radiographic fracture, bone quality typing (AO/OTA and Dorr classification), American Society of Anesthesiologists (ASA) score and evaluation of their correlation with the complication of fixation including nonunion and device failure were recorded and analyzed. Result: 101 patients including 54 males (53.5%) and 47 females (46.5%) underwent DHS implementation. Mean population age was 73.06 ± 16.36 years with an age range of 30 to 94 years;the most frequent age period was 76 - 85 years, injured by low-energy trauma mechanism and 23.8% patients were injured in a high-energy trauma. 56 patients completed the 6-month follow-up evaluation which ranged from 1 to 80 weeks. According to AO/OTA classification, the most common type among the patient population was A2, 27 patients (51.5%);while the most common group from Dorr classification turned to be group B (39.6%). Classification by ASA score revealed Class II to be most frequent among the patient population (56.4%). Nonunion was seen in eight of patients (14.3%). Three patients (5.4%) had device failure, two cases showed side plate breakage, and another one had screw cut out. There was no significant relationship between AO/OTA classification with the both complications i.e. the development of device failure (P = 0.85) and nonunion (P = 0.99). Non-significant correlation was found between Dorr classification with device failure (P = 0.06) and nonunion (P = 0.11). Conclusion: Regarding recent studies, more effective factor on the outcome is patient’s medical condition before surgery compared to the radiographic findings including AO/OTA and Dorr classification.
文摘Objective： Interphalangeal joint con- tracture is a challenging complication of hand trauma, which reduces the functional capacity of the entire hand. In this study we evaluated the results of soft tissue distraction with no collateral ligament transection or volar plate removal in comparison with traditional operation of contracture re- lease and partial ligament transection and volar plate removal. Methods： In this prospective study, a total of 40 pa- tients in two equal groups （A and B） were studied. Patients suffering from chronic flexion contracture of abrasive trau- matic nature were included. Group A were treated by soft tissue distraction using pentagonal frame technique and in Group B the contracture release was followed by finger splinting. Results： Analyzed data revealed a significant differ- ence between the two groups for range of motion in the proximal interphalangeal joints （P〈0.05）, while it was not meaningful in the distal interphalangeal joints （P〉0.05）. There was not a significant difference in the degrees of flexion contracture between groups （P〉0.05）. Regression analysis showed that using pentagonal frame technique significantly increased the mean improvement in range of motion of proxi- mal interphalangeal joints （P〈0.001）, while the higher the preoperative flexion contracture was observed in proximal interphalangeal joints, the lower improvement was achieved in range of motion of proximal interphalangeal joints after intervention （P〈0.001）. Conclusion： Soft tissue distraction using pentagonal frame technique with gradual and continuous collateral liga- ment and surrounding joint tissues distraction combined with skin Z-plasty significantly improves the range of mo- tion in patients with chronic traumatic flexion deformity of proximal and/or distal interphalangeal joints.
