IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2010 | Volume:8 | Issue:1 (30)|Papers Count:10

Background: The use of fibrin adhesive has broad background in medicine and peripheral nerve repair. The physical properties of these adhesives has restricted their usage. This experiment studied the performance and physical characteristics of fibrin glue (which is prepared from single donor human plasma) in the repair of posterior tibial nerve of rat.Methods: In this study, posterior tibial nerves of 40 rats were transected. In group A no repair was performed; in group B repair was done by one micro suture; in group C repair was done by three microsutures; in group D by one suture plus fibrin adhesive; and in group E repair was done just with fibrin adhesive. After 8 weeks of follow-up, Tibial Function Index; and at the end of the study, adhesive strength inflammation and scar formation were measured.Results: Functional recovery in the eighth week for groups A and E were significantly lower than groups B and C (p=.03).No rat repaired with fibrin adhesive had dehiscence, while half of rats in group A had complete dehiscence - was significantly higher than the others groups (p=.002). Inflammation and scar tissue were similar between the groups.Conclusion: The produced fibrin adhesive provides required adhesive and could hold nerve stumps in long term.

Background: Intetrochanteric hip fracture commonly affects over 70 years old people. While the best acceptable treatment is early fixation, the complication rate is fairly high because of patients' older age and associated age-related comorbidities. We would like to report our experience with the outcome of fixation of such fractures in our locality.Methods: In a descriptive study all the intertrochanteric fractures treated with compression screw-plate system during a 2 year period in two hospitals of Ahwaz were studied.84 patients with mean age of 73.4 (range of 59 to 98 years) were assessed.34 (40.5%) male and 50 (59.5%) female constituted the study group. Patients with a minimum of one year follow-up were evaluated.Results: The complications consisted of 8 (9.5%) varus, 8 (9.5%) shortening, 4 (4.7%) fixation "cut-out", 1 (1.1%) AVN, 13 (15.4%) wound infection and 2 (2.3%) non-union, 9 (10.7%) mortality in 24 weeks.10 (11.9%) underwent reoperation and re-fixation. The average time to returning to pre-fracture activity was 5 months.Conclusion: Complication rate is relatively high in intetrochanteric hip fractures even after screw-plate fixation.Except for high infection rate, in our series, the overall results are similar to the other reports in the literature.

Background: Hip fracture in older population is frequent and often costly. The patients, however, do not commonly regain their pre-fracture activity levels. We are reporting the outcome of surgery in intertrochanteric hip fractures during a ten-year period.Methods: This is a retrospective study of the intertrochanteric hip fractures treated from 1994 to 2004 in one teaching hospital of Tehran-Iran. The cases were called in for a full hip examination, evaluation of their activity levels and also measurement of Harris Hip Scores (HHS), as well as radiographic assessment.Results: 293 patients, comprised of 194 males (66.2%) and 99 females (33.9%), with a mean age of 65±6.67 years were studied. The cases had a one-year of follow-up.252 (86%) cases had obtained union. Acceptable ligament was observed in 158 (54%) cases. Harris Hip Scores over 60 points was seen in 222 (75.8%). Only 90 patients had returned to their pre-operative activity level.Conclusion: Patients with intertrochanteric hip fracture do not often return to pre-fracture activity of daily living.

Background: Thoracic outlet syndrome is treated using non-surgical or surgical approaches. Surgical treatment is necessary if non-surgical treatments fail. In this study we compared the supraclavicular and trans axillary approaches for surgery of the brachial plexus.Methods: We, retrospectively, studied 69 patients undergoing surgery to treat thoracic outlet syndrome from 2001 to 2008. Twenty six patients had bilateral thoracic outlet syndrome. Sixty three cases were operated with supraclavicular approach for the first time, 32 cases were operated with transaxillary approach for the first time, and 7 cases were reoperated with supraclavicular approach. The complications were evaluated for 24 months.Results: Pneumothorax, hemothorax, vessels injury in transaxillary and supraclavicular approach were the same but permanent and transient brachial plexus injury in transaxillay approach were more than supraclavicular approach.Conclusion: Supraclavicular approach for surgical treatment of thoracic outlet syndrome provides better access to braxial plexus and there is less need for reoperation compared to transaxillary method.

Background: Dislocation of total hip arthroplasty may happen for different reasons. Abnormal acetabular orientation is a common reason for such occurance. We would like to report the effect of acetabular inclination on incidence of dislocation.Methods: In a cross-sectional study all cases of total hip arthroplasty performed in a 2-yaer interval in one educational hospital in Tehran, were followed and assessed for possible dislocation in a 18.1 months (3-25 months) of follow-up. The inclination angles of acetabular components were measured, and the relationship of dislocation with gender, age and this angle was evaluated.Results: 132 cases entered the study.4 patients (3%) encountered dislocation; and all 4 had inclination angles of over 50 degrees. Gerder did not seem to play an important role. Older age, however, was probably contributing to risk of dislocation.Conclusion: Inclination angle of over 50 degree in acetabular component position is one of the factors making it more likely for the hip arthroplasty to dislocate.

Background: Acetabular fracture is a common injury, with unclear treatment outcome. We are reporting the results of treatment of unstable acetabular fractures, comparing operative with non-operative treatment in a small group of patients.Methods: In a retrospective study, in a teaching hospital, 20 cases of unstable acetabular fracture treated with open reduction and internal fixation were compared with 20 cases who had been treated non-surgically. The mean age was 34.5 years old (20-50 yrs old). The early clinical resuts, including complications, and also treatment costs were compared in those two groups.Results: There was no significant difference in the level of function between the two groups.There was a higher rate of heterotopic ossification and nerve injury in the operated cases, but not statistically significant. The time to fracture union was less in the non-operated cases. The hospital cost was significantly higher in the non-operative group (p<.01).Conclusion: Surgery in unstable acetabular fracture was associated with higher incidence of early complications. Surgical treatment of these fractures requires well trained experienced surgeons, and specific instrumentations and equipments to obtain a good clinical result.

Isolated fracture of the lesser tuberosity of humerus is rare. In this study we report one case of isolated fracture of lesser tuberosity, that was diagnosed acutely and was treated with open reduction and internal fixation.

This is the report of a foot infection following debridement of an open fracture. The acinetobacter which was grown from the wound did not respond to many doses of regular antibiotics.