IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2004 | Volume:2 | Issue:4 (8)|Papers Count:13

Absence of longitudinal arch of foot is a common reason for referral to pediatric orthopedic clinics. The majority of these referrals do not need any specific treatment. This article is an attempt to explore the various types of this clinical finding, and review the treatment options.

Background: Osteoatricular allograft is used to reconstruct a joint which has been resected for tumor involvement. Variable results of success have been reported. For proximal tibial tumors, resection with a wide margin is possible. An osteoarticular allograft reconstruction can be used instead of: Fusion, amputation, rotation-plasty, allograft-prosthesis composite or tumor prosthesis replacement. This is a report of our experience with such a treatment. Materials and Methods: 25 patients were studied in case-series method. Osteoarticular allograft was used in 25 patients to reconstruct skeletal defect after resection of a tumor in the proximal end of the tibia. The status of each allograft and the condition of each involved limb was evaluated for an average of 18.5 month (Range 5-41) postoperatively. Status of allograft was evaluated according to the survival of the allograft and the occurrence of complications.Results: There complications occurred in association with 25 original allografts that needed further surgery including infection (3 patients), non-union (1 patient), allograft fracture (3 patients), local recurrence which led to above knee amputation (5 patients), instability of joint (1 patient). There patients died, 2 due to distant metastasis and one due to septicemia. In the latest follow-up examination, 15 patients had retained the original allograft, 1 patient had a second allograft procedure, 5 had an above-knee amputation and one allograft was removed due to infection and replaced with spacer. Based on Mankin et al system the final results revealed an excellent or good in 16 and fair or failure in 9 patients. The mean MSTS score was 27 (90%) excluding 3 expired patients.Conclusion: Osteoarticular allograft reconstruction, despite it's high complication-in particular infect, and fracture-is a reasonable substitute for proximal Tibial tumor-resection defects.

Background: The more standard treatment for unicompartmental knee osteoarthritis is removal of a laterally based tibial for valgus osteotomy. A medial wedge proximal tibial osteotomy is another technique for the same ourpose. This is a short-term result of a medial wedge high tibial osteotomy using tri-cortical iliac crest bone graft and a buttress plate.Material and Methods: 19 cases of medial compartment osteoarthritis who were treated with medial open-wedge high tibial osteotomy and have an average follow-up of year are reported. The cases were assessed clinically and radiographically, using tagner, activity level score and British Orthopaedic Association patient satisfactione score.Results: With a mean change of tibia-femoral angle from (-7.6) to (+3.9) degrees, significant improvement in function and pain level along with subjective satisfaction was observed.There was no non-union or peroneal never injury. The observed complications were: medial collateral ligament avulsion in 1 case, intra-articular extension of osteotomy in 1, excessive valgus in one, and deep vein thrombosis in one other case.Conclusion: Medial open wedge high tibial osteotomy for knee osteoarthritis is a safe and reliable technique, and is a better was to preserve knee alignment.

Background: The concept of end-to-side never repair was recently introduced: however, most authors have reported conflicting results with this technique. This study was conducted to assess the effectiveness of end-to-side never repair in both fresh and predegenerated specimens by histological evaluation in an animal study in rabbits.Materials & Methods: Thirty male rabbits were divided into three groups. In group 1 (14 animals) fresh end to side anastomoses was done between the divided peroneal nerves and tibial nerves via an epineural windows. In group 2 (13 animals), the nerve was divided and sutured end-to-side to the tibial nerve after a 1- week "predegeneration period". In group 3 (N=3), which was considered the control group, the peroneal nerve was divided and sutured to the adjacent soft tissues. After 3 months, specimens were harvested for histological evaluation.Results: Nerve fiber count, in normal peroneal nerves, averaged 532/cross section. In groups 1 and 2 average nerve fiber count in implanted peroneal nerves was 6.24 and 7.00/cross section, respectively. No significant difference was observed between fresh and "predegenerated" groups (p=0.9).Conclusion: These data suggest that collateral sprouting of donor nerves is possible after end-to-side Neurorrhaphy through an epineuria window, but the number of nerve fibers in too low to result in any functional recovery in the target organ.

Background: different methods have been used to diagnose ACL injuries; a knee arthrometer was designed and constructed, taking into account the design of the arthrometer produced by Medmetric Co (KT).Material and Methods: To evaluate the sensitivity and the specificity of the device and its clinical applicability, clinical examinations on 60 healthy subjects and 20 patients with ACL tear was performed and the results were statically analyzed.Results: from 30 performed test-retests to evaluate device reproducibility, 90% had side to side differences lower that 1.6 mm. To investigate the effects of location of applied force, force was applied in 2 locations, and proximal handle of the instrument was selected. The sensitivity and the specificity of the device for compliance index criterion was 85% and 95%, respectively.Conclusion: The designed knee arthromere is clinically applicable, sensitive and the results are reliably reproducible. We recommend utilizing this device in diagnosis and grading of ACL tears.

Background: Coverage of soft tissue defects around heel and distal is difficult. Several different types of flaps have been designed and used for this purpose. A distally-based sural fascio-cutaneous island flap is one of such remedies for this difficult problem. We are reporting with the use of this coverage technique which has a reliable vascular supply.Material and Methods: The use of sural flap for heel or distal leg coverage in 7 cases of soft tissue defects from traumatic degloving injuries, burn and malignancy are reported. Survival of the flap grafts, and patients' satisfaction in terms of sensation and function are reported with a 6-24 months follow-up.Results: Flap survival was observed in 6 cases with satisfactory outcomes. The one case of failure was seen in the member of the group with history of surgery in that vicinity and vascular calcification.Conclusion: Distally-based sural fascio-cutaneous island flap is another armamentarium for successful coverage of difficult heel and distal leg defects which does not require microsurgical techniques.

Background: In the last two decades the third generation spinal instrumentations have revolutionized treatment of spinal deformities. The use of newer instrumentation systems have resulted in better correction and faster return activities. Pedicle screws have been in use in Europe for about 30 years. Since fixation of all three columns of vertebral units is achieved with such screws, more secure fixation and inclusion of fewer levels in a fusion surgery have possible.Material and Methods: The accuracy of pedicular screw positioning in spinal fusion was assessed in 100 patients with 500 screws between T11-S1 vertebrae. The screws had been put under fluoroscopic control. The position was determined using CT scan and "New systematic Method".Results: Five percent screw-position with 20% cortical was detected. No neurological or visceral problem was encountered.Conclusion: Using correct principals of insertion for spinal instrumentation, pedicular screws are safe, give better fixation, produce better correction, and give the chance of fusing shorter segments.

Anecurysmal bone cyst is a non-neoplastic vascular bone tumor that can involve any bone and sometimes it can affect a bone which already has another tumor.Different kinds of treatment have been reported for this expansible lesion starting excision to curettage and bone graft, cryosurgery, cortico-cancellous grafting and excision. The success rates have been variable. This is a report of distal radius aneurismal bone cyst of a child which was treated successfully with total excision and non-vascular fibular autograft.

sprengel's deformity is the most common congenital anomaly of the shoulder complex. It is postulated that anomalous location of scapula is due to failure of normal descent of scapula its normal anatomic site.This anomaly results in two major problems namely shoulder dysfunction and cosmetic deformity. Presence of associated anomaly (ie) is the rule and its prevalence among various studies ranges from 60% to 100%. We report a 13 years old boy with Sprengel's deformity who underwent surgery to improve his function and appearance. In his past history, there was history of choledochal cyst and cavernous hemorrhagic hemangioma of the brain which has not been previously reported.