IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2003 | Volume:1 | Issue:3|Papers Count:15

Background: The alignment of lower limbs change with growth. Accurate knowledge of such a change in any particular geography is necessary to differentiate the pathologic conditions from normal variations. This was the reason for undertaking a study on limb alignment in schoolchildren of Qom. Method: Across- sectional study on 2263 children-1378 girls and 885 boys was stated in 1999. The inter malleolar (IM) and inter condylar (IC) distances and Tibiofibular angle (TF) were measured. with children standing straight with knees in fun extension. Results: A valgus alignment was observed in all. The TF was 5.5±1.2 ranging from 3.1 to 8.3. This value was 5.7±1.3 in girls and 5.2±1.05 in boys. The IM-IC distance varied from -3.9 - 2.6 centimeters. There was a direct relation between T.F. angle with IM or IC distances. The body mass index (BMI) also had a meaningful relation with T.F. angle. A correlation between BMI and height was observed only in boys. Conclusions: The Tibiofemmoral alignment of school children of Qom is similar to that Europe and North America, but different from Chinese children. In order to verify in that the school children of Qom represent a good sample of Iranian children further studies in other part of the country is recommended.

Insertion of distal interlocking screws in interlocking intramedullary I.M. Rods is a demanding procedure. Although closed IM nailing, as an ideal internal fixation method, needs X-Ray to send the guide wire past the fracture site, some surgeons prefer making a small incision at fracture site and pass it manually. To find the distal holes of the rod, however, X-Ray has been considered unavoidable up to now. By this innovative method of applying a magnetic field, the whole sites can be precisely marked on the outer bone cortex. 63 distal holes were locked in 35 intramedullary nailings of femur and tibia by four orthopaedic surgeons. Distal screw fixation took only 5.2 ± 2 minutes in each case. During the total procedures there were 5 "error holes" ( three of them from the use of template for the second hole instead of repeat use of magnet ), 3 misplaced screws ( 4.8% ) and 8 single X-Rays Exposures used for placing 6screws while 57 distal bolts were correctly placed without any X-Ray. Omitting the X-Rays, the easy and cheap magnetic method can replace expensive, hazardous and time - consuming free - hand procedure in placing distal screws. A true expriemental study is recommended.

Background: Surgical treatment of developmental dysplasia of hip (DDH) is a real orthopaedic challenge. The ones who receive no treatment will develop knee, hip and spine osteoarthritis in addition to unsightly limp and awkward gait There are several methods of surgical treatment In our country, open reduction combined with Salter innominate osteotomy is the treatment of choice in many centers. Methods: In a retrospective case series study out of 1000 cases of DDH in Shafa Hospital (1971-1999), 390 patients (580 hips) had the above-mentioned surgery and were included in this study. Sufficient follow-up and information was available for 92 patients (143w hips), which comprise the bulk of this study. Clinical results and Harris Hip Score (HHS) were evaluated in these cases. Results: Among these 143 hips, 66 (46.2%) had full hip motion and 77 (53.8%) had different grades of motion limitation. Limitations in flexion and rotation were most common. Positive Trendelenberg sign was observed in 43 hips and 27 of these hips had evidence of avascular necrosis. Excellent results (according to HHS) were observed in 123 hips (76.4% were under 4 years of age and only 23.6% over age 4). Conclusion: Open reduction and Salter innominate osteotomy is a valuable procedure for DDH, and excellent result is to be expected if performed under age 4.

Background: Total hip arthroplasty in patients with dysplastic hips following developmental hip dislocation (DDH) is a demanding procedure with high rate of complication. DDH is, relatively, a common illness in our country. The information on hip arthroplasty and its results in this country is limited. We are reporting a short-term outcome on a group of patients from two hospitals in Tehran who underwent such a procedure during a 10 year period (1992- 2001). Method: This is a case series study of 53 total hip replacements in cases of hip dysplasia, which had at least, 2 years of follow-up. The preoperative Harris Hip Scores (HHS) and radiographic assessments were compared with post operative evaluations. The different additional procedures like femoral shortening, acetabular grafting, as well as the type of implants used for hip arthroplasty were assessed. The demographic parameters and their affects on final outcome were recorded. Results: 53 patients with age range of 27-70 with a mean follow-up of 3.9 years (2-10), obtained an improvement of HHS from 31 to that of 95. Improvement in limping was observed in 79% of cases. All cases were satisfied with the surgery, despite 18.5% complication rate (5 cases of transient nerve palsy and 4 cases of deep vein thrombosis). Conclusion: THR for DDH with the complexity of such hips is a difficult procedure which requires good preoperative planning and technical expertise. Femoral shortening can be useful to decrease the incidence of nerve injury and allow placement of the prosthesis into original acetabulum. The improvement in gait is the main reason for patients satisfaction observed in most cases.

The results of Colonna capsular arthroplasty in one hundred hips in eighty-six patients were reviewed. All the patients were at least ten years old at the time of the operation, which was performed for complete dislocation of the hip. The mean age at the time of Colonna arthroplasty was fourteen years (range, ten to twenty-five years), and the mean duration of follow up was twelve years (range, three to twenty-six years). At the most recent follow up examination, the mean Harris hip score was 82 points ( range 46 to 98.8 points) for all the hips, the patient had improved gait, and there was marked improvement in the radiographic appearance of the hip. All but six hips, had concomitant femoral shortening at the time of the Colonna arthroplasty. The procedure was done in two stages. 40 patients had avascular necrosis of femoral head postoperation. Hip pain increased in thirty four patients in the most recent follow up particulary in patients with more than fifteen years of follow-up. The natural history of colonnas capsular interposition arthroplasty is to lead to degenerative joint disease and then to total hip arthroplasty. Thus, this procedure can be considered a preparatory stage for a more successful total hip arthroplasty.

Thirty-three cases of acute hematogenous bone or joint infection in children were randomly treated with short term (7 days for joint infection, 10 days for bone infection) or long-term (14 days and 21 days, respectively).intravenous antibiotics after surgical drainage. The treatment outcome was measured through a detailed scoring system that included the ability to eradicate infection, the functional status of the limb, and the radiographic appearance of the bone and Joint. The results were similar in both groups, showing the added benefit of a shorter hospital stay for children with blood-borne musculoskeletal infection. The use of this scoring system in choosing the route of antibiotic administration is recommended.

Background: In Genu-valgum tibiofemoral angle increases above its normal value of 6°. This disorder causes difficulty in walking and sport activities in short-.term. But in long-term, because of increased force on lateral compartment of the knee, osteoarthritic changes of the lateral side of the knee and ligamentous laxity of medial side of knee could happen. In the past, osteotomies have been done on lateral side of distal femur for correction of Genuvalgum. We are suggesting a medial approach, posterior to vastus medialis with close-wedge osteotomy from medial side as an alternative approach for correction of genovalgum. Method: A Clinical trial study of 20 lower limbs operated between 1988 to 2002. Results: 20 lower limbs were operated with this technique. The mean age was 23.2, 14 patients were female and 2 male. 10 limbs were left and the other 10 were right side. Mean valgus angle was 14.75° preoperatively and 3° postoperatively the mean follow-up period was 628 days (Minimum 50 and maximum 1111 days). At follow-up, the range of knee motion in all limbs was normal. There was no infection postoperatively, quadriceps force was 5/5 in 18 and 4/5 in two limbs. Functional improvement was observed in 15 cases and all 16 patients had full satisfaction from the appearance of the limbs.

Background: Fractures of distal radius are common, and complications related to the fracture pattern and treatment method are seen frequently. The efficiency of use of external fixators for unstable distal radius fractures treated at one of the University hospitals during a one year period is reported here. Material and method: 22 patients with unstable distal radius fracture were managed with closed reduction and external fixation with A.O. fixator. Clinical and radiographic evaluation after a mean period of 7.5 months ( 4.5-12 months) was performed. Functional evaluation by two scoring systems was done. The wrists "Grip strengths" were measured and compared with the opposite side. Results: On the basis of pain and range of motion, 12 cases had excellent, 6 good and 4 fair results. The radiographs were rated as excellent in 16, good in 5, and poor in 1 case. The length of radius was well maintained in 17 and had more than 1 millimeter shortening in 5 cases. The following complications were encountered: Pin tract infection in 2, loss of reduction in 1, dorsal first web space hypoesthesia in 1, finger stiffness in 2, Sudek's dystrophy in 3 cases. Conclusion: Although a small series, but a relatively low complication rate and good functional results make us advocate this treatment modality for the unstable distal radius fractures.

Skeletal lipoma is a rare lesion. Multifocal lesions with a progressive and multiple-time presentation with no systemic manifestation are unusual. We are reporting on one such case with gradual appearance of new lesions.