IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2007 | Volume:5 | Issue:4 (20)|Papers Count:8

Background: distal radius is the most common site of fracture in older postmenopausal women, with a lifetime risk of 15%. Evidence exists for its association with osteoporosis. Osteoporosis can be detected by measuring the bone mineral density (BMD) of the lumber spine with dual energy X-ray absorptiometry. Low BMD of the lumbar spine or hip is a strong predictor for future vertebral deformity and hip fracture. Elderly women with distal radial fracture are not investigated for osteoporosis on a routine basis. The aim of the present study is to evaluate the relationship between distal radius fracture and the BMD of the lumbar spine, and to investigate the need for osteoporosis screening in elderly women with a distal radius fracture.Methods: a prospective study was performed in a hospital in Mashhad in 2004-2005. In 104 women (mean age, 66.9 years) with a distal radius fracture, BMD of the lumbar spine was assessed. A biosphosphonate was prescribed when osteoporosis was diagnosed, and the BMD was reassessed after 2 years of treatment.Results: A low BMD was found in 87 patients (83.65%). Osteoporosis was diagnosed in 46 (44.23%) and osteopenia in 41 (39.42%) patients. Only 17 cases (16.23%) had normal bone density. The mean T-score of the lumbar spine was -2.10 (±1.06). The BMD in patients treated with pisphosphonate medication increased from T-score of -2.88 to -2.55 in 2 years (p<0.01).Conclusions: Since near half of the elderly women with a distal radius fracture have osteoporotic BMD values for the lumbar spine, it is advised to screen such a group of patients for osteoporosis.

Background: Knee replacement is one of the final remedies for severe, symptomatic knee destruction. The results of this surgery are usually excellent. The number of reports from Iran on this subject is very few. We would like to report our experience with knee replacement in Kerman.Method: In a clinical trial and prospective study, 54 patients (11 males, 43 females) with knee disease who underwent joint replacement from 2001 to 2006 in a Teaching hospital in Kerman, were studied. Mean age was 65 years (41-80) and mean follow-up 34.4 months (3 month to 5 years). 46 cases had osteoarthritis and 8 rheumatoid arthritis. The pre and post operative findings were assessed using the ‘Knee Society’ evaluation system. The opposite knees were used to compare the patients’ satisfaction from the procedure.Results: In a study on 54 cases, the pain score of ‘Knee Society’ improved from 33 to 77 and the functional score improved from 41 to 72. Ninety six percent of the cases were satisfied with their surgeries. The complications included 1 deep and 1 superficial infection, 2 wound healing problem and one patellar dislocation. Three revisions become necessary: 2 due to infection, one for loosening and deformity in tibial component.Conclusions: Knee replacement in Kerman is associated with high satisfaction rate in short-term. Early failure is mostly related to infection or technical errors in surgery.

Background: There are many different methods of treatment for Kienbock’s disease or avascular necrosis of the carpal lunate. We are reporting our experience with lunate excision, capitate osteotomy and inter capitate bone grafting.Methods: Eleven male patients with stage III lunatomalacia treated by lunate excision capitate osteotomy and intra-capitate bone grafting were assessed with a mean follow-up of 6 years (2-10 years). The cases were evaluated in terms of pain, function, grip power and return to pre-treatment activities.Results: Pain decreased significantly in all but one case. Grip strength had returned to above 70% of the strength of the opposite hand in all but one patient.Conclusions: Capitate osteotomy and inter-capitate bone graft without intercarpal arthrodesis in Kienbock disease is a safe and reliable technique for stage III disease.

Background: Most investigations agree that unstable thoracolumbar fractures require surgical treatment. There is, however, debate on the best approach-anterior, posterior or combined. We are reporting our short and mid-term results on a «posterior only» approach with ligamentotaxis-dependent canal decompression with a segmental instrumentation system.Methods: 37 consecutive patients with thoracic and lumbar vertebrae fractures over 4 year period, with a mean follow-up of 30 months, (12-46 months) were studied. The cases underwent subjective and objective evaluation, using the Denis back pain scale, functional independent measure, employment status, neurologic Frankel grading and radiographic indices of vertebral angles and height change.Results: Twenty patients were pain-free, 35 were functionally independent. Frankel neurological grading showed 1.6 points average recovery. The mean preoperative kyphoitc angle of 19.1o improved 1.1o post surgery and to 5.1o at final follow-up. There were 3 minor infections and one hardware failure.Conclusions: Posterior spinal decompression and instrumentation for unstable thoracic and lumbar fractures is safe, effective and is associated with effective, achievement of radiographic correction, and is easier than anterior approach.

Background: Distal radius fracture is a common fracture encountered in fracture clinics. One of the common complications of this fracture is restriction of rotational movements of the wrist and forearm. Identification of factors affecting this loss of motion is of importance. This study was designed to identify the factors that may be responsible for loss of rotational motion of wrist and forearm in those extra articular distal radius fractures that are associated with ulnar styloid fracture.Methods: 47 patients with extra-articular distal radius fracture were enrolled in a prospective case control study from March 2005 to December 2006. pre and post operation. These were all stable extra-articular distal radius fracture that was treated by closed reduction under general anesthesia and long-arm casting. 24 patients had associated unlar styloid fracture without extension into the joint and 23 others had no ulnar fracture. The patients had their final clinical follow-up after 6 months. The rotational movements of wrist and forearm were assessed for both groups by an independent observer. The pre and post operation findings were compared.Results: Ultimately the 23 patients with intact ulnar styloid had an average of 8.9 degrees less supination (compared with their non-broken side), and the ones with ulnar styoid fracture had 25.44 degrees average loss of supination (p<0.05).Conclusions: It seems that the association of an extra-articular distal radius fracture with the fracture of ulnar styloid, at least in short-term, causes restriction of supination of the forearm, though the mechanism and clinical significance of this finding cannot easily explained.

Background: Carpal tunnel syndrome develops by compression of the median nerve within the carpal tunnel. There is no “gold standard” test for a definite diagnosis of this syndrome. Carpal tunnel syndrome is a constellation of signs and symptoms. The aim of this study is to investigate the correlation of the subjective, objective and electrophysiological findings in patients who had carpal tunnel syndrome and underwent carpal tunnel surgery.Methods: A prospective study performed on 103 patients who had carpal tunnel surgery. Subjective evaluation accomplished by two standard questionnaires. Objective findings were comprised of Tinel’s sign, Phalen test, pinch and power grip, and electrophysiologic evaluation. Statistical test were used to evaluate the data.Results: There was a statistically significant linear correlation between the Tinel’s sign and Phalen test. There was a positive correlation between the “means” of the pinch and power grip. There was a positive correlation between average symptom severity scale and functional status scale. In patient with severe electrophysiological findings there was a statistically significant correlation between subjective, objective and electrophysiological findings.Conclusions: It seems that in advanced stages, significant correlation between subjective, objective and electrophysiological findings is present.

Osteosarcoma is the most common primary malignant tumor of bone. The time between the first symptoms and diagnosis is often very long. Pain is the first symptom. The most common symptom is palpable mass. Lower extremity edema as the first symptom of pelvis osteosarcoma is very rare and had not been reported before. We report the case history of a 16 year old man with left lower extremity edema with initial diagnosis of pelvic thrombophlebitis.