IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2005 | Volume:3 | Issue:2 (10)|Papers Count:9

The purpose of this update is to discuss, in summary fashion, topics presented at selected orthopaedic meetings and published in related orthopaedic journals during 2004. The sources for this review are articles published in The Journal of bone and joint surgery (American edition) and the journal of arthroplasty. The podium presentations mentioned in this article those given at the American academy of orthopaedic surgeons (held in san Francisco, California, on march 10 through 14, 2004), on combined specialty day at the meeting of the knee society (held in san Francisco, California, on march 13, 2004), at the interim meeting of the knee society (held in Jackson, Wyoming, on September 9 through 11, 2004), and at the annual meeting of the American association of hip and knee surgeons (held in dallas, texas, on November 5 through 7, 2004).

Background: how an acetabulum breaks is dependent upon the amount and direction of impact and the limb position at the moment of trauma. Fractures of posterior acetabular lip are the most common variety. The lip results of such intra-articular fractures have direct relation with accuracy of reduction. This is a report and analysis of a personal experience with posterior acetabular lip fractures in a university set-up.Methods: thirty one consecutive patients (29 males, 2 females) with posterior acetabular fracture underwent open reduction between 2000-2004, the mean age was 32 years (22-68). They were evaluated clinically and radiographically after an mean period of 22 months.Results: in the 31 patients, 8 cases had "marginal impaction", 7 cases had comminuted posterior lip fractures, and 5 patients had free fragments inside the joint. Five femoral heads showed articular surface damage. The follow-up harris Hip scores were excellent in 9, good in 12, fair in 4 and poor in 3 patients. In those with single fragment posterior lip fracture, one patient (14%) had fair or poor results, while about half of the patients with "marginal impaction" were either fair or poor. Two patients required hip replacement. Conclusions: posterior lip acetabular fractures are notorious and getting complicated even with good open reduction. "marginal impaction" fragments is in particular, an important determinant of final results and requires special attention and exact anatomic reduction.

Background: acetabular fracture is the result of high energy trauma which if treated properly, would cause little morbidity but improper treatment of this fracture might cause severe morbidity due to degenerative change in hip joint. This study considers short-term follow of acetabular fracture fixation in a 2-year period in a training hospital.Methods: out of 59 cases of acetabular fracture (50 males and 9 females with mean age of 34±7.4 years), 36 patients who had undergone open reduction and internal fixation filled the functional outcome form of western Ontario mcmaster (WOMAC). The follow-up time was 10-24 months.Results: the most common mechanism of injury was motor-vehicle accident and the most common fracture type was posterior wall fracture. The most common associated injury was distal metaphyseal fracture of radius and in the upper extremity ipsilateral posterior hip dislocation in the lower extremities. Sciatic nerve injury due to primary trauma was seen in 6 cases, peroneal nerve injury after surgery in 2 patients. Wound infection cases (19.4%) with no limitation in motion. Functional assessment was done in 6 and 10 months post op by WOMAC score. The maximum value was seen in posterior wall fracture and the minimum value in T type, trans+PW and PW+PC fractures.Conclusions: short-term WOMAC scores suggest good outcome in surgical treatment of acetabular fractures. A long-term follow up and correlation with radiographic reduction results is recommended.

Background: tibia is the most common bone to result in non-union after a fracture. Among the various approaches to non-union treatment, Ilizarov technique offers the advantage of simultaneous management of non-union, deformity bone defect and infection. We are reporting our results with such treatment in tibial non-union.Methods: 26 cases of tibial non-union that were treated with Ilizarov technique were evaluated clinically and radiographically in a retrospective manner, with and average follow-up of one year (7-21) months 12 cases were infected, 14 non-infected non-unions.Results: union was achieved in all the cases with a mean duration of 4 months (3-10 months). Pintract infection was observed in 6 cases. 2 required change of pintract, and one case of severe cellulites needed earlier discontinuation of Ilizarov fixation and use of cast brace which resulted in union. One case of knee and one ankle stiffness were observed.Conclusions: Ilizarov technique is a reliable method for treatment of tibial non-union, and is specifically useful for complicated cases.

Background: detachment of antero-inferior labrum (Bankart lesion) is the most common reason for recurrent shoulder instability. Arthroscopic repair of the labral pathology with various suturing techniques has become a popular modality of treatment. We are reporting a short-term result of our experience with the use of suture anchors.Methods: in a case-series study 40 male cases of arthroscopic repair of bankart lesions with suture anchors were evaluated. The mean age was 26 years old (16-41). With a follow-up period of 7-23 months the patients were evaluated by three shoulder scores, namely; Rowe, UCLA and ASES.Results: all patients had post traumatic shoulder instability. The surgery was successful in controlling the dislocation in all cases. Two patients continued to have positive apprehension test. None of the cases had more than few degrees of motion limitation. Thirty seven patients had excellent and 3 good results in accordance with rating of Rowe and colleagues.Conclusions: Arthroscopic Bankart repair with suture anchore has good and reliable results in short-term.

Background: Acute ankle injury is one of the common causes of referral to emergency departments. While only about 15% of such cases have clinically significant fractures, they are subjected to radiographic evaluation. The objective of the study is to assess the validity of a clinical diagnostic scoring system-ottawa Ankle Rules-in a university hospital in Iran.Methods: 200 cases of ankle injuries who referred to a university hospital emergency room during a 3-month period were entered into the study of diagnosis-accuracy testing of Ottawa Ankle Rules (OARs). Emergency physicians would fill out the OARs from which determines if taking radiographs was necessary for ankle or foot injuries. Then all these cases were subjected to radiographic evaluation and X-ray were read by orthopaedic residents. The sensitivity, specificity, positive and negative predictive values and likelihood rations were calculated for oars.Results: the sensitivity of the oars for diagnosing 37 ankle fractures-23 in malleolar zone and 14 in midfoot zones-was 100% (and 100% in both malleolar and midfoot zones); and the specificity of OARs to diagnose malleolar, midfoot and combined type of fractures was 10.50%, 56.00 and 10.50% respectively. The implementation of the OARs showed a potential for reducing radiographic evaluation by 33%.Conclusions: OARs is accurate and highly sensitive tool to diagnose ankle and foot fractures avoiding unnecessary radiography when used in a teaching hospital in Iran.

Background: due to prevalence of tibia fractures and by considering the different reports of its epidemiology, this research was conducted to determine distributed frequency of tibia fractures in adults who referred to an educational hospital between 1996-2003.Methods: this survey was conducted on a cross-sectional basis. The people examined were all over 14 years old suffering from tibia fractures. Information such as gender, age, mechanisms of fractures, site of fractures, type and patterns of fractures, imaging reports, treatments and their complications were collected, classified and reported along with descriptive statistics.Results: out of 2259 patients studied, 854 (768 males and 86 females) could match our criteria in this study. The age of patients was 31±14. The highest number of tibia fractures was seen in 20-30 age group and these fractures were more prevalent in men than women (aged up to 50). The most important cause of tibia fractures was accidents (61%). Forty six percent of tibia fractures were open and the most observed pattern was comminuted fracture (31%). 12% of fractures were seen in proximal part of tibia, 40% in middle, 38% in distal and 10% were seen "in-between" part respectively. 47% of the patients had some complications after treatment-the most frequent ones were pain in afflicted limb and fracture site (18%), non-union (17%) and infection (13%).Conclusions: The prevalence of tibia fractures in the patients of this study is one decade more, and in women is two decades less than European and north American countries. In addition to high energy trauma, the most frequent cause of these fractures are multiple and multidirectional traumas to limb.