IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2006 | Volume:5 | Issue:1 (17)|Papers Count:9

Background: Congenital vertebral development produces the congenital scoliosis which is often progressive requiring surgical intervention. Convex hemiepiphysiodesis of the involved segments is a useful technique in young children. We are reporting our experience with such a treatment.Methods: Among the congenital scoliotic curves treated in Shafa hospital in Tehran in 19 year period, the ones that had undergone convex hemiepiphysiodesis were identified. Twenty three patients (13 females, 10 males) with a mean follow- up 5.6 years (2-19 years) were clinically and radiographically evaluated, and the per and post operative findings were analyzed.Results: Improvement in curve magnitude was best observed in hemivertebra cases. Nine cases of hemivertebra obtained 18 degrees correction while in 14 cases of type III (mixed type) anomaly 15 degrees correction was observed (p=0.04). Failure (continued progression of scoliotic curve) had a large kyphotic angle at the beginning.Conclusions: Convex vertebral hemiepiphysiodesis in congenital scoliosis, especially hemivertebral cases is a useful procedure when performed in early childhood.

Background: The likelihood of transmission of hepatitis C virus through a single skin perforation is 2.7 to 10 percent. The serologic test of “Elisa” is about 99 percent sensitive in detecting hepatitis C virus (HCV) infection. The aim of this study is to evaluate the possibility of disease transmission to orthopaedic surgeons or orthopaedic assistants by serologic testing of orthopaedic trauma cases for HCV.Methods: In a one year period (2005-2006), 670 patients who had been admitted to the orthopaedic trauma center of a hospital in Meshhad were tested for HCV by serologic tests with “Elisa” technique.Results: From the 670 tested patients, 22 male and 3 female who had a mean age of 38.7 had positive serology for HCV. This would mean 3.9 percent male and 2.8 percent female prevalence.Conclusions: A worrisome number of patients with orthopaedic trauma are serologically positive for hepatitis C. Protective measures are, therefore, essential for all the people who handle orthopaedic trauma.

Background: There have been many operations for treatment of recurrent anterior shoulder dislocation. The Bristow procedure with its dynamic and static effect can prevent shoulder dislocation. The aim of this study was to evaluate the long term results of this procedure in our center.Methods: 19 patients with mean age of 25 years had undergone Bristow procedure for anterior shoulder instability. A retrospective clinical evaluation was not performed with an average follow- up of 7.5 years (3-14 years). Pain, recurrence of instability, range of motion and ability to return to sporting activities were the parameters evaluated by constant shoulder score (CSS).Results: No dislocations but 3 cases of instability feeling were observed. The two athletes (one volleyball player and one wrestler) were unable to return to their sports. Fifteen patients (78.9%) gad excellent or good CSS scores.Conclusions: Bristow is a good procedure for controlling recurrent shoulder dislocation, but because it produces limitation in external rotation of shoulder, is not recommended as the first choice for athletic population. The radiographs of the shoulders at follow- up revealed early osteoarthritis in 3 cases. These were the same cases that had limited external rotation.

Background: Double osteotomy of first metatarsal has been advocated as a procedure of choice for severe hallux valgus in adolescent age group. We would like to report our experience with such an osteotomy in Meshhad.Methods: Over a five year period (1999-2004), 26 feet in 17 adolescents- mean age of 15.5 years- with moderate to severe hallux valgus underwent double first metatarsal osteotomies. With a mean follow- up of 26 months, the cases were evaluated by American Ortopaedics Foot & Ankle Society Hallux Metatarso- phalangeal- interphalangeal scale (AOFAS/ HMI). In this study per and post hallux valgus (HVA), intermetatarsal (IMA), and distal metatarsal articular (DMAA) angles, and the relation between the angles and patient satisfaction were evaluated.Results: The mean angular corrections for hallux valgus (HVA), intermetatarsal (IMA) and distal metatarsal articualr (DMAA) angles were 26.56, 6.20 and 5.55 degrees respectively. Four cases could not be reached and from the remaining 13 patients, 2 cases had required second surgery for non- union and 3 cases had stiffness in MTP (metatarsophalangeal) joints. Sixteen cases reported good to excellent results.Conclusions: Double first metatarsal osteotomy for severe hallux valgus is reasonable procedure in adolescents which maintains the correction. Non- union and first MTP joint contractures are the two main side effects.

Background: Recurrent patellar subluxation is clinically manifested by slippage of patella and positive apprehension test. Fulkerson osteotomy of tibial tubercle is a well- known surgery for this type of patellar malalignment. Little data is available for changes of apprehension test after Fulkerson operation. The goal of this survey was assessment of Fulkerson surgery for patellar instability and its effect on apprehension test.Methods: In a clinical trial study, 12 patients (9 females, 3 males) with mean age of 38.3 years (28.60 years) underwent tibial tubercle osteotomy for symptomatic patellar subluxation. Mean follow- up time was 10 months (6-18 months). The pre and post operative assessment of change in “apprehension test”, knee function and radiographic changes were respectively evaluated by visual analog scale (VAS) and with Bristol pain score, Fulkerson scoring and lateral pattelo- femoral angle or Merchant view.Results: The results in 8 patients were excellent or good, 3 fair and one poor. Eight cases believed the surgery had been effective. The Fulkerson score of 48.75 improved to 71.6, while Bristol pain score of 7.3 decreased to 4.1 and VAS for apprehension test of 7.5 decreased to 5.16. The “Apprehension test” did not change in 3 patients, and one case developed significant limitation of motion.Conclusions: Fulkerson tibial tubercle osteotomy in selected patients improves knee function and decreases pain in short- term, but does not improve patellar alignment.

Background: Despite being the largest rotator cuff tendon of the shoulder, the function and clinical relevance of subscapularis pathology has been largely ignored in the literature. Although more recent studies have focused on subscapularis tears, all have reported on techniques of repair. The advent of arthroscopy and arthroscopic repair techniques has opened new frontiers in the diagnosis and repair of torn rotator cuff tendons, including the subscapularis. In this article, we review the short- term results of arthroscopic subscapularis repair.Methods: Ten patients with subscapularis tendon tear of the rotator cuff were analyzed in 8 men and 2 women with an average age of 49.7 years who had an average delay in treatment of 23.5 months. The clinical outcome, including the UCLA score was assessed prospectively for all patients with 3 month intervals.Results: The score for pain improved from 1.75 to 9 points (p<0.001), and the UCLA score, from 8.8 to 30.6 points (p<0.001). Four patients had 12 and six had 6 months of follow- up.Conclusions: Arthroscopic repair of subscapularis tendon tear resulted in significant subjective and objective improvement and high patient satisfaction.

Bilateral traumatic shoulder dislocation is rare, and is usually posterior dislocation, often happening with convulsion of electrical shock therapy. There are only couple cases of bilateral anterior dislocation reported in the English literature. Hereby we would like to report on one such rare lesion.

The usage of electricity has revolutionized the surgical procedures. Electrical current less than 5 KHz, causes electrolysis and its main usage is in cosmetic procedures. Electrical current more than 20 and less than 350 KHz causes severe stimulation of nerves and muscles and even death and it does not have very much usage in medicine. Electrical current more than 350 KHz doesn’t stimulate the nerves and muscles and its heat will cause cutting the tissues and high voltage current will cause more coagulation. It electrocautery the electrical current does not pass from the body and the heat in the metallic loop of electrocautery causes the cutting and coagulation.In electrosurgery the electrical current passes from the body. In monopolar surgery, a return electrode is put underneath the patient and the other pole is in the surgeons, hand whereas in bipolar surgery the current passes from a small area of body between two electric points. Monopolar surgery is used in big surgeries and the bipolar is used in delicate ones. Attention should be paid in placement of the return electrode to prevent electrical burn.