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1.  Evolution in diagnosis and treatment of Legg-Calve-Perthes disease 
Legg-Calvé-Perthes disease (LCPD) is an idiopathic osteonecrosis of the femoral head with variable complications and resultant deformity of the femoral head and osteoarthritis. Suggested risk factors are acetabular retroversion, obesity, latitude, hyperactivity, and coagulopathy. The most commonly applied classification is based on radiolucency in the lateral pillar of the femoral head, which is strongly correlated with the outcome. In the fragmentation stage of the disease involvement can be classified into three groups. After skeletal maturity, the outcome can be classified using the Stulberg classification based on the sphericity and congruence of the femoral head in relation to the acetabulum. The early goal of treatment is to prevent head deformation by weight transmitted forces during remodeling and ossification stages containment is the widely accepted principle of treatment. Although the Petrie cast still has a role in the short-term treatment of LCPD before and during the reossification stage, available data does not support additional benefits from braces during the course of LCPD.
PMCID: PMC4151449  PMID: 25207324
Brace; Lateral Pillar; Legg-Calvé-Perthes; Osteotomy; Stulberg classification
2.  Vicious Cycle of Multiple Invasive Treatments in a Hemophilic Inhibitor Positive Child with Resistant Knee Flexion Contracture, A Case Report 
Uncontrolled recurrent hemarthrosis can end to contracture, deformity, pain, joint destruction and gait disorders which are disabling. We are going to report a challenge, a unilateral knee flexion contracture in a child with severe hemophilia A and inhibitor who underwent different treatment options with unsatisfactory improvement of knee range of motion. Mismanaging postoperatively, patient and parents irresponsibility in managing self-care, lack of access and affordability to treatment and unavailability of proper treatment can be the reasons of recurrence in addition to the tough nature of a patient with inhibitor.
PMCID: PMC4151423  PMID: 25207302
Arthroscopy; Hemophilia A; Inhibitor; Knee flexion contracture; Manipulation under anesthesia; Radiosynovectomy; Supracondylar fracture
3.  The influence of dominant limb involvement on DASH and QuickDASH 
Hand (New York, N.Y.)  2015;10(3):512-515.
Purpose
The purpose of this study is to determine whether involvement of the dominant limb affects Disabilities of the Arm Shoulder and Hand (DASH) scores.
Methods
A convenience sample of 948 patients from 12 prospective studies that recorded hand dominance, affected side, diagnosis, and a DASH or QuickDASH score was used to assess the influence of involvement of the dominant limb on DASH scores. Diagnosis was categorized as traumatic and nontraumatic. Region was categorized as hand and wrist, elbow, and arm and shoulder.
Results
In bivariate analysis, involvement of the dominant limb, diagnosis, region, and sex had significant influence on DASH/QuickDASH score. In multivariable analysis, dominant hand condition, traumatic diagnosis, arm and shoulder involvement, and female sex were associated with significantly higher DASH scores (more disability), but accounted for only 10 % of the variability in scores.
Conclusion
Upper extremity disability as measured by the DASH is slightly, but significantly greater when the dominant limb is involved.
Level of evidence: Prognostic level II
doi:10.1007/s11552-014-9734-7
PMCID: PMC4551649  PMID: 26330787
DASH; Disabilities of the Arm Shoulder and Hand; Dominant affected; Hand dominance; QuickDASH
4.  Cross-Cultural Adaptation, Validation, and Reliability Testing of the Modified Oswestry Disability Questionnaire in Persian Population with Low Back Pain 
Asian Spine Journal  2016;10(2):215-219.
Study Design
Prospective study.
Purpose
We aimed to validate the Persian version of the modified Oswestry disability questionnaire (MODQ) in patients with low back pain.
Overview of Literature
Modified Oswestry low back pain disability questionnaire is a well-known condition-specific outcome measure that helps quantify disability in patients with lumbar syndromes.
Methods
To test the validity in a pilot study, the Persian MODQ was administered to 25 individuals with low back pain. We then enrolled 200 consecutive patients with low back pain to fill the Persian MODQ as well as the short form 36 (SF-36) questionnaire. Convergent validity of the MODQ was tested using the Spearman's correlation coefficient between the MODQ and SF-36 subscales. Intraclass correlation coefficient (ICC) and Cronbach's α coefficient were measured to test the reliability between test and retest and internal consistency of all items, respectively.
Results
ICC for individual items ranged from 0.43 to 0.80 showing good reliability and reproducibility of each individual item. Cronbach's α coefficient was 0.69 showing good internal consistency across all 10 items of the Persian MODQ. Total MODQ score showed moderate to strong correlation with the eight subscales and the two domains of the SF-36. The highest correlation was between the MODQ and the physical functioning subscale of the SF-36 (r=–0.54, p<0.001) and the physical component domain of the SF-36 (r=–0.55, p<0.001) showing that MODQ is measuring what it is supposed to measure in terms of disability and physical function.
Conclusions
Persian version of the MODQ is a valid and reliable tool for the assessment of the disability following low back pain.
doi:10.4184/asj.2016.10.2.215
PMCID: PMC4843055  PMID: 27114759
Persian; Reliability; Modified Oswestry disability questionnaire; Validity; Low back pain
6.  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 Cronbach's alpha, and test-retest reliability was measured using intra-class correlation coefficient (ICC).
Results:
Cronbach's 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.
doi:10.4103/2008-7802.160336
PMCID: PMC4521304  PMID: 26288703
Persian; psychometric; Quick-disabilities of the arm; shoulder and hand; reliability; validity
7.  Radial Head Prosthesis Removal: a Retrospective Case Series of 14 Patients 
Background:
The purpose of this study was to report the preoperative complaints and postoperative outcome of patients after removal of the radial head prosthesis.
Methods:
This is a retrospective review of 14 adult patients (6 females and 8 males) from 2007 to 2011, who underwent radial head prosthesis removal by three surgeons. The average time between implantation and removal was 23 months (range from 2 weeks to 12 years, median 12 months).
Results:
The leading reported complaints before removal were restricted mobility of the elbow (active range of motion of less than 100 degrees) in 6, pain in 3, and pain together with restricted mobility in 4 patients. The objective findings before removal were restricted mobility of the elbow in 10 (71%), capitellar cartilage wear, loose implants, and heterotopic ossification each in 8 (57%), subluxation of the radio-capitellar joint or malpositioning of the stem in 5 (36%), and chronic infection in 2 (14%) patients. All patients with pain had wear of the capitellar cartilage on radiographs. The ulnar nerve was decompressed in four patients at the time of removal. Four patients underwent a subsequent operation for postoperative ulnar nerve symptoms 5 to 21 months after removal. Four patients were still complaining about persistent pain at the last follow-up visit. Except two patients, the total range of motion improved with a mean of 34 degrees (range 5 to 70) after a mean follow-up of 11 months.
Conclusions:
Removal of radial head prosthesis improved function and lessened pain in our case series. The reoperation rate was yet nearly 30% due to ulnar neuritis. Selective ulnar nerve decompression at the time of removal must be evaluated, especially in patients with expected large gain in range of motion after removal.
PMCID: PMC4468614  PMID: 26110173
Prosthesis; Radial head; Radial head fracture; Removal
8.  Short Form-McGill Pain Questionnaire-2 (SF-MPQ-2): A Cross-Cultural Adaptation and Validation Study of the Persian Version in Patients with Knee Osteoarthritis 
Background:
We aimed to develop and validate the Persian version of Short Form McGill Pain Questionnaire-2 (SF-MPQ-2) in patients with knee osteoarthritis.
Methods:
Translation and back translation was performed using Beaton's guideline. After a consensus has achieved on the Persian version of SF-MPQ-2, it was administered to 30 patients with knee osteoarthritis in a pilot study. Then, we enrolled 100 patients with knee osteoarthritis to fill the final SF-MPQ-2 as well as SF-36 and WOMAC questionnaires. Forty-three patients returned 3 days after the initial visit to fill the Persian SF-MPQ-2 for the second time. Construct validity was tested by Pearson's correlation coefficient between subscales of SF-MPQ-2 and subscales of SF-36 and WOMAC. Internal consistency for total and subscales was calculated by Cronbach's alpha and reliability between test retest was performed using Intraclass correlation coefficient (ICC).
Results:
ICC for subscales of SF-MPQ-2 ranged from 0.73 to 0.90. The ICC for total SF-MPQ-2 was 0.90. Cronbach's alpha for subscales was 0.65-0.74 at the first visit and 0.58-0.81 at the second visit. Cronbach's alpha for the total questionnaire was 0.88 and 0.91 at the first and second visit, respectively. Pearson's correlation coefficient was highly significant when comparing subscales specifically with WOMAC (r=-0.47 to -0.61; P<0.001). Interscale correlation between subscales of SF-MPQ-2 was significant as well (r: 0.43-0.88, P<0.001).
Conclusions:
Persian SF-MPQ-2 showed excellent reliability and good to excellent internal consistency throughout the questionnaire. It is a valid and reliable instrument for measuring the pain intensity and applicable in osteoarthritic pain assessment.
PMCID: PMC4322125  PMID: 25692169
Persian; Psychometric; Reliability; Short from McGill pain questionnaire; Validity
9.  Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ) Implant Arthroplasty 
Background:
Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ) such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna. The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker) prosthesis.
Methods:
We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months). Also, patients were contacted prospectively by phone in order to administer the disabilities of the arm shoulder and hand (DASH), patient rated wrist evaluation (PRWE), and visual analogue scale (VAS), and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median follow-up time of 60 months (range: 2 to 102 months).
Results:
No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively.
Conclusions:
Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation.
PMCID: PMC4225023  PMID: 25386579
Aptis; Arthroplasty; Distal radioulnar joint; Scheker
10.  Clinical Outcomes after Arthroscopic Release for Recalcitrant Frozen Shoulder 
Background:
To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders.
Methods:
Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant, University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient.
Results:
The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion.
Conclusions:
According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid-term outcomes.
PMCID: PMC4225030  PMID: 25386586
Arthroscopic release; Frozen shoulders; Outcome; Recalcitrant
11.  Validity and Cross-Cultural Adaptation of the Persian Version of the Oxford Elbow Score 
Oxford Elbow Score (OES) is a patient-reported questionnaire used to assess outcomes after elbow surgery. The aim of this study was to validate and adapt the OES into Persian language. After forward-backward translation of the OES into Persian, a total number of 92 patients after elbow surgeries completed the Persian OES along with the Persian DASH and SF-36. To assess test-retest reliability, 31 randomly selected patients (34%) completed the Persian OES again after three days while abstaining from all forms of therapeutic regimens. Reliability of the Persian OES was assessed by measuring intraclass correlation coefficient (ICC) for test-retest reliability and Cronbach's alpha for internal consistency. Spearman's correlation coefficient was used to test the construct validity. Cronbach's alpha coefficient was 0.92 showing excellent reliability. Cronbach's alpha for function, pain, and social-psychological subscales was 0.95, 0.86, and 0.85, respectively. Intraclass correlation coefficient (ICC) was 0.85 for the overall questionnaire and 0.90, 0.76, and 0.75 for function, pain, and social-psychological subscales, respectively. Construct validity was confirmed as the Spearman correlation between OES and DASH was 0.80. Persian OES is a valid and reliable patient-reported outcome measure to assess postsurgical elbow status in Persian speaking population.
doi:10.1155/2014/381237
PMCID: PMC4158467  PMID: 25214845
12.  Disabilities and Activities of Daily Living Among Veterans With Old Hip Disarticulation and Transpelvic Amputation 
Archives of Trauma Research  2014;3(1):e16003.
Background:
The Iran-Iraq imposed war lasted eight years and was one of the longest wars of the last century. Twenty-three years have passed since the war ended, but little has been discussed about the long-term results of war amputations in the literature.
Objectives:
In this long-term study, we have evaluated the activities of daily living among veterans with hip or hemipelvis amputations.
Patients and Methods:
A cross-sectional study was performed on Iran-Iraq war veterans with hip or hemipelvis amputations in Iran. Eighty-four (96.5%) veterans out of 87 registered veterans with hip or hemipelvis amputations participated in the study. The degree of independence for activities of daily living (ADL) was assessed by the Barthel index. The degree of independence for instrumental activities of daily living (IADL) was assessed by the Lawton-Brody scale.
Results:
The average follow-up time was 26.6 ± 3.7 years. The average age of veterans was 44.1±7 years old. Of 84 amputees, 57 (67.85%) had limitations in at least one domain of the ADL. The most common single item that affected the patients was ascending and descending stairs seen in 45 (78.9%) veterans, followed by eating seen in 4 (7.01%) veterans. In addition, 70 (83.33%) had limitations in at least one domain of the IADL. The most common single item that affected the veterans was shopping seen in 56 (80%), followed by responsibility for own medications seen in 13 (18.57%) veterans. Spearman correlation coefficient of the sum scores of ADL and IADL showed an intermediate to strong correlation (r = 0.58).
Conclusions:
Increasing dependency in ADL is accompanied by increasing dependency in IADL. In the past, the duty of health care providers was saving the life of veterans due to injuries while at present, because these injuries occurred in young and healthy individuals, the need for increased function is being highlighted.
doi:10.5812/atr.16003
PMCID: PMC4080485  PMID: 25032170
Activities of Daily Living; Veterans; Brody Myopathy
14.  Developing an Appropriateness Criteria for Knee MRI Using the Rand Appropriateness Method (RAM)-2013 
Background:
Knee pain is one of the most common reasons patients visit their physician. In this regard Magnetic Resonance Imaging (MRI) is the tool of preference for diagnosis. The aim of this study was to determine appropriate guidelines for knee MRI administration using the RAND Appropriateness Method (RAM)-2013
Methods:
This qualitative study was done in the Mashhad University of Medical Sciences in 2013. The most appropriate approved knee MRI administration clinical guidelines were evaluated using Guidelines Evaluation and Research Appraisal (AGREE). Panel members consisting of six orthopedic and three rheumatologic doctors gave scores ranging from 1 to 9 for each scenario. The indications were grouped as appropriate, equivocal and inappropriate. Data were analyzed by descriptive statistics and SPSS ver. 18 software.
Results:
Sixty-three scenarios were extracted from the guidelines and then the scenarios were evaluated in 26 indications. Thirty-two (50.79%) cases were considered appropriate, 12 (19.04%) cases uncertain and 19 (30.1%) cases inappropriate.
Conclusions:
The RAND appropriateness method is helpful in identifying the opinion of stakeholders in health care systems. Moreover, making practical use of clinical guidelines can improve patients’ quality of care and prevent unnecessary costs.
PMCID: PMC4151442  PMID: 25207313
Guideline; Knee joint; MRI; RAND Appropriateness Method
15.  Bilateral One-half Spica Cast After Open Reduction and Pelvic Osteotomy in the Developmental Dislocation of the Hip 
Background:
The prevalence of DDH ranges from 1 per1000 to 3.4 per 100 live- births. One- and-one-half hip spica cast is the conventional technique of immobilization after the open reduction with or without osteotomy.
Objectives:
In this study, we evaluated the preference of bilateral one-half spica cast over the one-and-one-half spica cast.
Materials and Methods:
Eight hips in five patients with developmental dislocation of the hip have undergone open reduction. Salter osteotomy, Pemberton osteotomy and femoral shortening were done on two, two and six hips, respectively. Bilateral one-half spica cast with trochanteric molding was applied for all of the hips.
Results:
The patients’ age ranged from 1.5 to 7 years old. The only complications consisted of two osteonecrosis of the head and one superficial infection. No dislocation, graft displacement, nonunion and device failure was occurred.
Conclusions:
Bilateral one-half spica cast is sufficient after the open reduction with or without osteotomy in DDH patients and we can substitute the bilateral one-half spica cast above the knee cast for the conventional one and one-half spica cast.
doi:10.5812/ircmj.13366
PMCID: PMC3955506  PMID: 24693391
Open Reduction; Osteotomy; Bilateral one-half Spica Cast; Dislocations; Development
16.  Comparative Study of Peroneal Tenosynovitis as the Complication of Intraarticular Calcaneal Fracture in Surgically and Non-Surgically Treated Patients 
Background
Calcaneus has the most fracture prevalence among tarsal bones. About 3/4 of calcaneal fractures are intra-articular fractures with displacement. The majority of calcaneal fractures occur in 21 - 35 year old young men, and that are mostly active people, these fractures cause complete disability for 15 months. Moreover, inappropriate treatment leads to lots of social and economical damages.
Objectives
In this study we compared the incidence and the severity of peroneal tenosynovitis as a complication of non-operative and operative treatment of intra-articular calcaneal fractures. In this study, some other complications of this fracture were also analyzed and the prevalence of the complication was higher in non-operated patients.
Patients and Methods
A total of 140 patients with intra-articular calcaneal fracture were analyzed prospectively. These patients were divided into 2 groups: operated group and non-operated group.
Results
In non-operated group (56 patients), 22 patients were complicated by peroneal tenosynovitis. In operated group (84 patients), 8 patients had the same complication. Statistical analysis revealed that the prevalence, and the severity of this complication in the mentioned groups had a meaningful difference. The results in operated group were much better than the non-operated one.
Conclusions
Although some of the orthopedic surgeons are not interested to manage these fractures surgically and most of them treat these cases conservatively (casting, etc.), in most displaced intra-articular calcaneal fractures, surgical treatment is the method of choice. Moreover, in non-surgical treatment the prevalence of these complications among the patients is more and as a result, inevitable social, occupational and familial damages occur.
doi:10.5812/ircmj.11378
PMCID: PMC3950774  PMID: 24693362
Calcaneus; Zygapophyseal Joint; Gissane Angle; Boehelr Angle; Tenosynovitis
17.  Percutaneous Vertebroplasty in Iranian Patients with Osteoporotic Vertebral Fractures 
Background:
Osteoporotic compression vertebral fractures are common clinical problems. In those with refractory fractures, percutaneous cement augmentation has been suggested. The aim of this study was to evaluate the functional outcome of percutaneous vertebroplasty in Iranian patients with refractory osteoporotic fractures.
Methods:
We retrospectively studied 37 osteoporotic fractures in 28 patients (6 men and 22 women), who had been treated with vertebroplasty from August 2009 to June 2012. The mean follow-up period was 12.1±3.6 (range: 6-42 months). The patients’ states were assessed by the visual analogue scale and short form-36 questionnaire. Student t test was used to analyze the pre- and postoperative data.
Results:
The mean age of the patients was 71.6±6.1 (range: 50 to 91 years) and the most common fractured vertebrae were L1 and T12. There were five patients with two levels of vertebral fractures and two with three levels. Vertebroplasty could improve the scores for pain and quality of life from preoperative 7.6 ± 1.4 and 44.8 ± 7.6 to 1.8 ± 0.4 and 74.1 ± 5.3 at four weeks after surgery. At the last follow-up visit, this improvement continued with no significant decline. The most common complication was cement leakage (32.4% per vertebra), wherein all of of the patients were clinically asymptomatic. Adjacent vertebral fracture occurred in six cases.
Conclusion:
By understanding the risks, we propose vertebroplasty in Iranian patients with refractory osteoporotic vertebral fracture. If correctly performed, this procedure can significantly improve the pain and quality of life in these elderly osteoporotic patients.
PMCID: PMC4151396  PMID: 25207276
Vertebroplasty; Osteoporosis; Compression fracture.
18.  Carpal Tunnel Release in Diabetic and Non-Diabetic Patients 
Background:
Carpal tunnel syndrome (CTS) is a compression neuropathy that causes paresthesia, pain or numbness in the territory of median nerve. The aim of this study is to compare the open surgery outcome and patients` satisfaction in carpal tunnel syndrome among diabetic and non-diabetic patients.
Methods:
In a retrospective cohort study from April 2011 to June 2012, patients suffered from carpal tunnel syndrome at least 6 months, without response to conservative treatment, who had the inclusion and exclusion criteria, were evaluated by the usage of MHQ and WHOQOL-BREEF tests, one month before surgery and three months after that. Carpal tunnel decompression surgery was performed by two surgeons, experienced in hand surgery, which used the same surgical method. Statistical analysis was performed by SPSS 19.0.
Results:
24 of patient (34.2%) were male and 46 (65.8%) were female and there was no significant difference between two groups (P>0.05). MHQ total score before and after surgery was respectively 50.22±7.13 and 63.49±11.28 and this difference was significant (P<0.05). In WHOQOF-BREEF parameters, physical parameters (36.81±19.8 vs. 55.30±24.36) and psychological parameters (41.64±14.77 vs. 61.24±19.9) improved significantly after surgery.
Conclusion:
The outcome of carpal tunnel syndrome open surgery is good in both men and women, but diabetes has a negative impact on surgery outcome in short term.
PMCID: PMC4151404  PMID: 25207279
Carpal tunnel syndrome; Michigan hand questionnaire;  WHO quality of life –BREEF questionnaire
19.  A Modified Triple Pelvic Osteotomy for the Treatment of Hip Hypoplasia 
Background:
The prevalence of hip dysplasia is 1 in 1000. Several pelvic osteotomy methods have been developed to prevent early osteoarthritis, such as triple osteotomy. In this study we are going to introduce our new technique that was done on 4 patients with favorable short-term results.
Methods:
Four patients underwent triple osteotomy and fixation using a reconstruction plate and early weight bearing was started.
Results:
The Harris Hip Score, limb length, center-edge angle, and acetabular inclination showed improvement.
Conclusion:
This modified technique is suggested for corrective surgery on adult dysplastic hips.
PMCID: PMC4151405  PMID: 25207281
Triple pelvic; Osteotomy; Hip hypoplasia.
20.  Application of Orthopedic Dual Sliding Compression Plate (ODSCP) in High Medial Tibial Open Wedge Osteotomies 
Background
Angular deformities about the knee are one of the common disorders. High Tibial osteotomy is a way of correcting the deformity. Although the general agreement is focused toward the open wedge technique, discussion about the type of device is a subject to debate.
Objectives
This current study has attempted to evaluate the results of Orthopedic Dual Sliding Compression Plate (ODSCP) in high medial open wedge osteotomies of the tibia.
Patients and Methods
In this cross-sectional study, 16 patients with genuvarum undergone high medial tibial open wedge osteotomy and fixed by Orthopedic Dual Sliding Compression Plate. At the time of the last follow up visit, Lysholm score was gathered.
Results
The mean follow-up time was 9.33 ± 1.87 month. The average age was 45.13 ± 7.25 years. Three patients were male and 13 patients were female. The lysholm score showed a significant difference before and after surgery.
Conclusions
The ODSCP has many advantages over the other type of plates. It can help the surgeon to operate with a relaxed mind and it is advisable for high tibial medial open wedge osteotomies.
doi:10.5812/ircmj.8371
PMCID: PMC3785910  PMID: 24083009
Osteotomy; Range of Motion, Articular; Genu Varum
21.  Update of the Quick DASH Questionnaire to Account for Modern Technology 
Hand (New York, N.Y.)  2016;11(4):403-409.
Background: Almost 2 decades have passed since the development of the items contained in the Quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and during this time, daily tasks have changed to adapt to changes in technology. Methods: A cohort of 108 patients completed demographic information, the Quick DASH (both standard and technologically updated versions), and 2 Patient-Reported Outcomes Measurement Information System (PROMIS)-based computerized adaptive testing questionnaires: PROMIS pain interference and upper-extremity function. To create a technologically updated Quick DASH, we substituted 3 items from the standard Quick DASH questionnaire with 3 other items related to the use of technology: (1) Text or dial with your cell phone, (2) Type on a keyboard, and (3) Use a computer mouse. Results: The technologically updated Quick DASH questionnaire had lower scores compared with the standard Quick DASH (37 vs. 33, respectively), but they had a large correlation and both had high internal consistency. The items “Text or dial with your cell phone” and “Use a computer mouse” in the updated Quick DASH questionnaire had the lowest scores. Except for affected side, the standard Quick DASH and updated Quick DASH were influenced by the same factors. PROMIS pain interference was the only independent variable affecting both questionnaire scores. Conclusions: A technologically updated Quick DASH had no advantage over the standard Quick DASH.
doi:10.1177/1558944715628006
PMCID: PMC5256652  PMID: 28149205
Quick DASH; update; technology
22.  Distal Radius Volar Rim Fracture Fixation Using DePuy-Synthes Volar Rim Plate 
Journal of Wrist Surgery  2016;5(1):2-8.
Background To assess the results of distal radius fractures with the involvement of the volar rim fixed with the DePuy-Synthes Volar Rim Plate.
Case Description We searched for the patients with volar rim fracture and/or volar rim fractures as part of a complex fracture fixed with a volar rim plate. Ten patients met the inclusion criteria: three patients with type 23B3, six patients with type 23C, and one patient with very distal type 23A. The mean follow-up was 14 months (range: 2–26). Fractures healed in all patients. Of the three patients with isolated volar rim fractures (type 23B3), two patients had no detectable deficits in motion. These patients had an average Gartland and Werley score of 9 (range: 2–14). Of the other seven patients (six with type 23C and one with type 23A fracture), three patients healed with full range of motion and four had some deficits in range of motion. Two patients had excellent results, three had good results, and two had fair results using the Gartland and Werley categorical rating. One patient healed with a shortened radius and ulnar impingement requiring a second surgery for ulnar head resection arthroplasty.
Literature Review Results after nonoperative treatment of volar rim fractures are not satisfactory and often require subsequent corrective osteotomy. Satisfactory outcomes are achieved when the fragments are well reduced and secured regardless of the device type.
Clinical Relevance Volar rim plates give an adequate buttress of the volar radius distal to volar projection of the lunate facet and do not interfere with wrist mobility. Furthermore, the dorsal fragments can be fixed securely through the volar approach eliminating the need for a secondary posterior incision. However, patients should be informed of the potential problems and the need to remove the plate if symptoms develop.
doi:10.1055/s-0035-1570740
PMCID: PMC4742267  PMID: 26855829
volar rim fracture; volar rim plate; distal radius fracture
24.  Psychometric Properties of the Persian Version of the Simple Shoulder Test (SST) Questionnaire 
Background:
To validate the Persian version of the simple shoulder test in patients with shoulder joint problems.
Methods:
Following Beaton`s guideline, translation and back translation was conducted. We reached to a consensus on the Persian version of SST. To test the face validity in a pilot study, the Persian SST was administered to 20 individuals with shoulder joint conditions. We enrolled 148 consecutive patients with shoulder problem to fill the Persian SST, shoulder specific measure including Oxford shoulder score (OSS) and two general measures including DASH and SF-36. To measure the test-retest reliability, 42 patients were randomly asked to fill the Persian-SST for the second time after one week. Cronbach’s alpha coefficient was used to demonstrate internal consistency over the 12 items of Persian-SST.
Results:
ICC for the total questionnaire was 0.61 showing good and acceptable test-retest reliability. ICC for individual items ranged from 0.32 to 0.79. The total Cronbach’s alpha was 0.84 showing good internal consistency over the 12 items of the Persian-SST. Validity testing showed strong correlation between SST and OSS and DASH. The correlation with OSS was positive while with DASH scores was negative. The correlation was also good to strong with all physical and most mental subscales of the SF-36. Correlation coefficient was higher with DASH and OSS in compare to SF-36.
Conclusion:
Persian version of SST found to be valid and reliable instrument for shoulder joint pain and function assessment in Iranian population.
PMCID: PMC5100458  PMID: 27847855
Persian; Reliability; Simple shoulder test; Validity
25.  Non-Simultaneous Bilateral Closed Rupture of the Triceps Tendon in a Woman 
Journal of Hand and Microsurgery  2014;7(1):205-207.
doi:10.1007/s12593-014-0159-x
PMCID: PMC4461630  PMID: 26078544
Bilateral; Non-simultaneous; Olecranon bursitis; Surgical repair; Triceps rupture

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