IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2008 | Volume:6 | Issue:4 (24)|Papers Count:7

Background: Changes in the position of the patella in relation to the tibiofemoral joint (PB/PPB) are among important but often little reported complications of total knee arthroplasty. These complications may result in pain and decreased range of motion in the knee after surgery. The aim of our study is to measure the incidence of patella baja and pseudo-patella baja after total knee arthroplasty.Methods: In a retrospective study, 60 patients (49 women and 11 men) who had a total knee arthroplasty between 1992 and 2002 at Akhtar Hospital were selected. At the time of the study, patients were at least one year and at most eleven years from their operation. All measurements were made by a single person (Item 4). All patients had PCL retaining prosthetic knees (Rotaglide®, Corin Group, UK) through a medial parapatellar arthrotomy with patellar aversion. The average age at the time of the study was 62.5 years and the average follow-up was 27.5 months. The Knee Society Scoring System was used to score the knees. Patients' radiographs were examined using the Insall Salvati and Blackburne Peel methods. Results: Pseudo- patella baja was found in 15 (25%) patients while both PB and PPB were diagnosed in 2 (3%) patients. Although pain and limited range of motion were strongly related to PB/PPB no statistically significant relationship was discovered between PB/PPB and the score.Conclusion: Patella baja or Pseudo-patella baja after knee arthroplasty may cause pain or limitation in knee range of motion. Attention to proper bone cuts and patellar tracking during surgery id suggested.

Background: Low back pain in any community has a high prevalence acute sciatica does not usually have a very quick and effective non-operative remedy. Lingering disability and very stone return to work is a major finding in most cases. We aimed at testing the effect of early epidural steroid injection in pain relief and in shortening the disability period.Methods: 40 patients referring to two hospitals in Mashhad with acute radiculor pain during one year period were had clinical and MRI proof of a disc herniation occurring within 6 weeks of their referral and had not responded to regular medical treatment for 2 to 3 weeks. After full evaluation and completing the “Prolo” scoring questionnaire, the patients were injected epidurally with 40mg of triam 4 inolone and 2% lidocaine for 3 times intervals. The cases were then assessed shortly after injection and in 3 and 6 months.Results: 25 male and 15 female cases were inclined in the study. Improvement SLR positivity was statistically evident after the third injection. Dramatic reduction in pain and therefore, anergesic medication use was observed in second and third follow-up (p<0.05). There was, however no statistically significant improvement in function or effectively (p>0.05). Over all 27.5% of patients were fully satisfied and 62.5% were partially satisfied with the results.Conclusions: Epidural steroid injection following acute radiculor back pain has short term effect in pain control, but does not isoprene function or effectiveness of an individual to a significant degree.

Background: Unstable pelvic fracture means those fractures which are both vertically and rotationally unstable. They classified as lateral compression (LC 2 or 3) and anteroposterior compression (APC 3) and vertical shearing (VS) or Tile type C. All of them have posterior (sacrum, ilium or sacroiliac joint) and anterior (pubic symphysis or rami) components which must be fixed in nearly anatomic position. Transiliac rod insertion is one option for fixation of sacrum or SIJ dislocation when there are no possibilities for iliosacracral screw fixation.Method: About 11 patients with unstable pelvic fracture are treated with insertion of 2 threaded rod and bolts in prone position after reduction of fracture with skeletal traction. Then, for anterior fixation based of situation, we use symphysial plate or external fixator.Results: After 6 months follow up, there were no device failure, no infection, no neurological deficiency and no nonunion, but there was some LLD which remains from imperfect reduction during operation.Conclusions: This method is not choice because it needs prone positioning of trauma patient but in situations where insertion of iliosacral screws is impossible, it is a salvage procedure.

Background: Rheumatoid arthritis is the most prevalent chronic inflammatory joint disease. Popliteal cyst may appear during the disease course and with increasing intra - articular pressure is extended down to the posterior involved leg and produce a giant Baker's cyst. Local compression, dissection, or rupture of the cyst may sometime lead to clinical presentation similar to thrombophlebitis.Objective: To investigate the clinical features, predisposing factors, diagnostic techniques, course and management of giant Baker's cyst in patients with rheumatoid arthritis.Methods: In a retrospective cohort study, the charts of patients with rheumatoid arthritis complicated with giant Baker's cyst who were admitted in the rheumatology unit during the last 20 years were investigated. The diagnosis of giant Baker's cyst was based on clinical picture and confirmation of imaging techniques, in cases that the cyst was extended down lower than inferior level of the popliteal fossa. The severity of underlying disease, predisposing factors, course, management and fallow of the patients with reference to their clinic charts were evaluated.Results: 23 patients with rheumatoid arthritis were complicated with giant Baker's cyst. They were 12 female and 11 male patients with the age of 24 to 71 years (mean 48 years). The history of rheumatoid disease when complicated with giant Baker's cyst was one to 20 years (mean 6.8 years). The involved knee was right in 13 and cyst of left knee in 10 patients. Clinical featurs other than underlying disease were pain and tenderness of the involved leg in 8 patients (34.8%) and the symtoms similar to thrombophlebitis in 15 patients (65.2%). Besides usual imaging techniques 7 patients were studied by color dopler sonography, and there was deep vein thrombosis accompanied with giant Baker's cyst in a patient with rheumatoid arthritis. Rupture of the Baker 's cyst was detected in 5 patients (21.7%). Management was generally medical and conservative with satisfactory results.Two patients with recurrence of Baker's cyst and signs of rupture of the cyst underwent surgical cystectomy along with synovectomy of the involved knee joint.Conclusion: Popliteal cyst in patients with rheumatoid arthritis should be specially considered and preventive and conservative management should be perform befor its extention to a giant Baker 's cyst and complication with local compression, rupture, and pseudothrombophlebitis syndrome.

Background: Several different methods for fixation of grafts in anterior cruciate ligament (ACL) reconstruction have been used. The purpose of present study is to compare two techniques of tibial fixation in hamstring quadruple graft reconstruction.Methods: In a randomized clinical trial study, 46 cases of isolated tears were reconstructed using hamstring grafts. In 24 cases the tibial fixation sites were fixed with interference screw, and in 22 patients the remnant end of graft at tibia was passed through a bony tunnel and fixed with suture to the bone. The cases were all assessed with a mean follow-up of one year with “Cincinnati knee ligament rating scale” and “KT-2000” examination.Results: The score in 22 “target group” cases was 8, and in 24 “control group” was 9. In “KT-2000” examination, 11 patients of double fixation were excellent and 11 good. In control group 4 cases had excellent and 20 good results.Conclusion: Double tibial fixation for ACL reconstruction with Hamstring tendon graft has a better outcome on “Symptom” evaluation and “KT-2000” instrument compared to single tibial - site fixation.

Background: Reports on associated intraspinal and other organ anomalies in congenital scoliosis are variable. We are reporting such findings in one of the orthopaedic referral centers in Tehran.Methods: A series of 381 patients with congenital scoliosis were evaluated for intraspinal abnormalities with physical examination, radiographs, MRI and/or myelograms. They were also assessed for cardiac urogenital or anomalies in other areas by physical exam, sonography and echocardiography.Results: Cord anomaly was present in 83 (21%) cases, 26 of whom had neurologic abnormality. The third cord syndrome was the most common neurologic problem in 38 patients (45.8%), followed by diastematomyelia in 37 cases. Anomalies in other parts of body detectable by physical examination were observed in 155 patients, and detected by help of paraclinical tests in 34 patients. 84 cases had trunk anomalies, 4 genitourinary and 10 heart anomaly, 37 head and neck, 7 maxillofacial, 3 upper and 23 lower extremity, 8 cases of gastrointestinal anomalies were also detected.Conclusion: The anomalies of nervous system associated with congenital scoliosis are often without clinical manifestations. Cardiac and urogenital anomalies are not very common in congenital scoliosis.

Psychosomatic disorders may occasionally present in the upper extremity and their diagnosis and treatment may prove to be extremely difficult. Herein, we describe one such patient and review the literature on this subject.