IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2003 | Volume:1 | Issue:4|Papers Count:11

Background: Tarsal tunnel syndrome is a relatively rare disorder .the physicians need to be cognizant of this problem in complex, vague foot complaints.Material and. Methods: Five cases with tarsal tunnel syndrome underwent surgical decompression during a three year period (1998-2001). These cases had all failed the conservative treatment-including local steroid injection. The 4 females and one male consisted of one case of rheumatoid disease one post ankle-fracture adhesion and three cases with unknown etiology.Results: Four patients had complete relief of their symptoms and were satisfied with the, surgical outcome. One patient had some improvement, but not a full recovery from all the symptoms.Conclusion: Surgical release of compressing fibrous sheath for tarsal tunnel syndrome is a good alternative for cases who do not respond to non-surgical treatment. The results are, however, variable and not always predictable.

Background: Hip instability and abductor and extensor insufficiency can be seen in different conditions. One of these, no longer seen in many countries, but still a common illness in some others, is poliomyelitis. Tendon transfer is III option which can give stability and improved function.Material and Methods: The case histories of all the patients treated for hip abduction insufficiency from 1987-1997 in our hospital were reviewed. A total of 21 patients with 21 hips all affected by poliomyelitis and all operated by the senior author (G.H.S) was identified. Only 18 patients (5 male, 13 female) could be contacted and recalled for evaluation. The patients mean age at surgery was 15 years and 5 months and the average follow-up was 5 rears. The end results were obtained on the basis of clinical results and paraclinical tests.Results: An improvement in gait with decreased limp and swaying and increase ability to walk long distances was seen in 17 patients. 9 patients became free of their assistive ambulatory device. Subjective improvement was observed n 16 patients. The main reason for the satisfaction in a decreasing order were: improved appearance with decreased body swaying and limp in gait, sense of stability, decreased fatigability in walking and walking without the need to put hand on the thigh or pick up the limb with hand.Conclusion: External oblique transfer in hip abductor paralysis is effective and helpful in improving the cosmesis of gait and the ambulatory power.

Background: Anterior cruciate ligament avulsion has been classified and described since 1959 and has been modified to four subtypes by Zaricznyj in 1977. There are many articles on treatment of ACL injuries but little has been written on old mal or un-reduced ACL avulsion. Material and Methods: 15 consequitive cases of old un-reduced ACL avulsion who had referred to Shafa and Mehrad hospital in a 12 year period were retrospectively studied. There were 12 males and 3 females. Three patients had not yet closed their epiphyseal plates. The average follow-up was 6.7 years (1-13 years). The avulsed ligaments were re-attached to their original Positions in all 15.Results: Good results were observed in all but 3 patients who had few degrees of flexion contracture.Conclusion: Surgical fixation of old un-reduced anterior cruciate ligament givesa satisfactory result.

Background: Anterior Cruciate Ligament injury in adolescents is often an avulsion injury Mid substance tear is however, a serious injury. This is a report of 67 patients between 11 to 16 years of age with midsubstance tear of the ligament.Material and Methods: In a retrospective review 67 adolescents with mid substance anterior cruciate ligament (ACL) injury sustained between t980-1990 were evaluated. 27 had received non-surgical treatment and were assessed with a mean follow up of 70 months. 45 patients on the other hand, had undergone reconstruction with 4-strand Hamstring Tendon graft. This group had 49 months average follow-up.Results: In the conservatively treated ACL group 4 cases required menisectomy, the majority did not return to their sporting activities, only 33% were IKDC group A and 58% were group B, and degenerative changes were recognized in 10 cases on radiography.ln the reconstructed group 87% returned to their pre-injury sports, 45% had IKDC scoring of group A, and 32% group B. No new knee injury, and no physeal growth disturbance was observed in this group.Conclusion: Anterior Cruciate Ligament injury in people with open physeal plate is a senous injury and requires early surgical reconstruction, especial1yin active children. 4-strand Hamstring tendon transplant produces good stabilization and protects the knee against new meniscus injury and early degenerative changes.

Background: To determine the effectiveness of "Turco posteromedial release" in the treatment of congenital clubfoot, we evaluated the clinical and radiographic results of 45 patients (74 feet) who underwent posteromedial release in a period of four years.Material and Methods: 30 patients were male and 15 were female. The mean age at surgery was 30 months (6 months- 5 years). The Turco posteromedial release was performed in all patients with two subsequent corrective casts under general anesthesia.Results: The main early post-operative complication was delayed wound healing that happened in 21 patients. After a mean follow-up of 3 years (5 months- 8 years) 39 feet had excellent and good results (52%) according to the scoring system used by McKay and Ponseti, 29 patients had fair (39%) and 6 patients had poor results (9%). Four patients needed reoperation (posteromedial release) and 13 patients underwent another procedure to correct residual forefoot adduction or heel varus.Conclusion: Postero-medial release is not the answer to every patient and modifications. should be done according to the age, severity of deformity and the amount of correction obtained by serial casting before surgery.

Background: Hip instability and abductor and extensor insufficiency can be seen in different conditions. One of these, no longer seen in many countries, but still a common illness in some others, is poliomyelitis. Tendon transfer is III option which can give stability and improved function.Material and Methods: The case histories of all the patients treated for hip abduction insufficiency from 1987-1997 in our hospital were reviewed. A total of 21 patients with 21 hips all affected by poliomyelitis and all operated by the senior author (G.H.S) was identified. Only 18 patients (5 male, 13 female) could be contacted and recalled for evaluation. The patients mean age at surgery was 15 years and 5 months and the average follow-up was 5 rears. The end results were obtained on the basis of clinical results and paraclinical tests.Results: An improvement in gait with decreased limp and swaying and increase ability to walk long distances was seen in 17 patients. 9 patients became free of their assistive ambulatory device. Subjective improvement was observed n 16 patients. The main reason for the satisfaction in a decreasing order were: improved appearance with decreased body swaying and limp in gait, sense of stability, decreased fatigability in walking and walking without the need to put hand on the thigh or pick up the limb with hand.Conclusion: External oblique transfer in hip abductor paralysis is effective and helpful in improving the cosmesis of gait and the ambulatory power.

Background: The purpose of this study was to document the duration and amount of prophylactic antibiotic administration, hospital stay, follow-up return of patients with lower extremity fractures and compare with AO methods of fracture treatment.Materials and Methods: During the year of 1997, 63 lower extremity fractures which could be matched with control group, were treated with open reduction and internal fixation. Duration of hospital stay, X-Ray requests, antibiotic administration and frequency of clinic return were documented.Results: Obtained data were compared with AO method. All patients had unnecessary hospital stay, X-Ray requests clinic return, casting and antibiotic administration than standard method.Conclusion: Unnecessary hospital stay, antibiotic use, casting and X-Ray request should be avoided and objective follow-up protocoles administred in our university hospitals mindful follow-up be executed.

Background: Arthrodesis or hip is a suigical treatment .for stabilization and pain relief in destructed hips as a result of infection, traunta .or paralysis. Using a cobra plate for fixatione eliminates the need for cast immobilization and allows early, easier weight bearing and ambulation. Material and Methods: In a retrospectiye review twenfy two patients who had undergone hip arthrodesis with cobra-plate fixation in a 13-year period were studied 4 patients had undergone simultaneous pelvic osteatomy, and one case had central displacement of femoral head as part of fusion. Clinical and radiographic evaluation of cases with a forty-month average follow up was performed.Results: Solid fusion was obtained, in17 cases (77%).Three cases. of failure were the ones with bacterial (non-Tuberculous) infection at fusion time. Malposition offi1sionwas observed in 5 patients (excessive adduction in four and too much flexion in one). Two cases of back pain and two patients with ipsilateral knee pain were observed.Conclusion: Cobra plate fixation, especially in combination with medializing Pelvic osteotomy is a useful technique for hip arthrodesis. In active pyogenic hip infection the non-union rate is higher, and simultaneous plating with debridement and infection treatment is not recommended.

Background: Patients with head injury have frequently been observed to produce abundant callus and show faster healing response. The aim of this study was to find a possible of such relation response with serum calcitonin level.Material and Methods: This clinicaltrial study was conducted from autumn of 1998 to spring of 1999 in 44 cases broken down into 4 groups: Group A Consisted of 11 patients with head injury and long-bone fructures; group B included 11 cases with head injury and no fructure; group C were 11 cases with long-bone fructure and no head injury, and group D - our control group - consisted of I1 healthy persons matched- for age and sex with the other three groups.Serum calcitonin levels were measured in all the patients on second and seventh days of their admission. This measurement was done only once on the control group.Results: The calcitonin level measurement on second day showed a statistically higher level in the head injured patients with associated long bone fractures (658 Pg/ml, 350, 49 respectively in group A, B, C on average). The Control group had a level of 20 Pg/m!. The mean serum levels of calcitonin on the seventh day showed a trend towards being higher in group A, but not a statistically significant difference in the three tested groups (A = 238 Pg/ml, B = 350, C = 49).Conclusion: Observed increased serum calcitonin level in patients with head injury may be one of the contributing factors to the faster fructure healing potential in this group of patients.

This is a report of a 52 years old man who developed cervical spine infection with E.Coloi following a hemorrhoid surgery and required spinal decompression and fusion. Cervical vertebal infection although might happen following variety of infections in remote areas of body, is very rate after anal surgery.