IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2008 | Volume:6 | Issue:3 (23)|Papers Count:7

Background: Proximal tibial factures are complex injuries and are, historically associated with complication rates. The purpose of this study is to evaluate the clinical usefulness of locking compression plates (LCP) in comparison with T-buttress plates in treating proximal tibial fractures.Methods: In a prospective study, 62 patients (51 men, 11 women) with proximal tibial fracture referring to Mashhad Medical University Trauma Center were treated with T-buttress plate fixation in 35 and LCP in 27 cases. The treatment outcome was evaluated clinically and radiographically with 24 months (18-36 months) average follow-up.Results: In LCP group, there were 3 cases of Knee motion limitation, 1 malunion, 1 infection and no non-union; and in T-plate group, 4 cases of knee motion limitation, 6 malunions, 2 non-unions and 4 infections. There was, therefore, no significant difference in terms of joint range of motion between the two groups. Malunion and infection were, however, more common in T-plate fixation group.Conclusions: Locking compression plating in proximal tibial fractures provides stronger fixation and is associated with less malunion and infection as compared to T-plate fixation.

Background: Osteoarthritis is common especially in over 50 years of age patients. There are several non-surgical treatment modalities such as non-steroid anti-inflammatory drugs, physiotherapy, and intra-articular injection of steroids and Hyaluronic Acid. Surgical procedures include arthroplasty, osteotomy of tibia and arthroscopic debridement. Careful selection of patients in particular, for arthroscopic debridement is a very important point.Methods: In a prospective study, 88 patients with mean age of 55.28 (55-63 years) with knee osteoarthritis who had failed non-surgical treatments were selected for arthroscopic debridement. Radiographic inclusion criteria were presence of 3-4 millimeters of joint space, less than 10 degrees flexion contracture and varus/valgus malalignment, and at least 100 degrees of flexion. The treatment results were assessed annually in 3 successive years, using Lysholm knee Scale. Seventy-four patients (43 females, 31 males) had complete follow-up and are reported here. Results: The pre operative Lysholm score of 37.2 (range: 26-55) increased to 81.9 (range: 70-90) in first year, to 82.9 (range: 70-95) by the second year and to 78.5 (60-90) in the third year (p<0.001). while relief of pain and swelling was observed in all the cases, knee range of motion and radiographic joint space showed no change during this period.Conclusions: Arthroscopic debridement of knee joint in selected osteoarthritic knee with no major contracture or malalignment that still have some remaining joint space on radiography, gives favorable results within the first three years.

Background: There are many methods of treatment that are introduced for distal clavicular fractures and acromioclacicualr joint separation such as screw fixation, pin fixation, coracoclavicular ligaments reconstruction, tension band wiring. One of the recent methods is hook plate fixation.Methods: In a retrospective study, 81 patients with unstable distal clavicular fractures or acromioclavicular joint separation that were treated with hook plate, were assessed. The assessment included the reliability of fixation method and its impression on subacromial space. Clinical results were charted due to constant score system.Results: All the distal clavicular fractures were solidly united. In the last follow-up, the mean of constant score were 93.6 of 100. We had mild pain during range of motion in 16 patients (19.7%) although they had full range of motion, in 2 cases we had recurrent separation of joint that was revised in 3 weeks after primary operation. Conclusion: Hook plate fixation is a good method for unstable distal clavicular fractures and acromioclavicular joint separation, but we must inform the patient for expectable complications and plate removal necessity.

Background: Clavicle is a common bone to fracture, and is most often treated with nonsurgical methods. Surgery may become indicated in occasional case of irreducible fracture with considerable displacement, open fracture, floating shoulder, and associated neurovascular injury, nonunion. There is still uncertainty about the best surgical method for this condition. In this study, we evaluated the results for intra-medullary screw fixation of clavicle fracture.Methods: In a prospective study between March 2005 and March 2007, 20 clavicular fracture (13 males, 7 females) with mean age of 32 years old (20-55), that had indication for surgery, were fixed with intra-medulary cannulated screw through a mini incision. We evaluated time to union, shoulder range of motion, side effects and patient satisfaction with a mean follow-up of 6 months (4-10 months).Results: The mean time to union was 10 weeks. The union was uncomplicated in 19 (95%) patients, while 1 case (5%), the bending of cannulated screw after a new trauma, required replacement by a thicker screw. There was no significant complication after surgery. All the patients were satisfied with the surgery.Conclusions: Cannulated screw is an effective fixation method for the claviclular fractures that are amenable to surgical treatment. Supplemental studies are necessary.

Background: Long term follow up of war-related bilateral upper limb amputees is rarely reported. The aim of this study is to evaluate functional problems of residual limbs of these patients.Methods: During a cross sectional study, we gathered 98 patients suffering bilateral upper limb amputation following Iran-Iraq was and an experienced orthopaedic specialist visited all the subjects in regards of stump conditions. The amputees were all men except one; and being visited 16.9±5.9 years after injury. The mean age was 37.2±9.7 years (15-82 years). Results: 54.5% of the amputated limbs were at finger or wrist level; 34.2% had been performed below elbow and transhumeral or higher amputation was seen in 11.3% of the subjects. 41.8% of the patients had not undergone any more operation after the injury; while 4.5% had history of single and 33.2%more than one surgeries after injury (mean: 3.5±4.6; range: 1-33). 40.9% of the stumps didn’t have standard length to wear prosthesis. Too little soft tissue bulk (22%), adhesion of soft tissue to bone and scar (24.2%), and neuroma (37%) were also reported. Evaluations revealed that 35.2% of the stumps needed more surgeries. No statistical correlation between presence of any orthopaedic problem of the stump and sue of the prosthesis, level of amputation and number of operation of stumps was found (p ³0.05).Conclusions: Stump problems along with low rate of limb usage, lack of rehabilitative programs and insufficient training and support for prosthesis usage would result in disuse of assistive devices.

Background: The more common technique in instrumentation of adolescent idiopathic scoliosis has been multisegmental fixation and use of hooks and rods. This study is aimed at locking at short-term results of hybrid fixation with pedicular screws in lumbar area and hooks in thoracic area of scolotic curves.Methods: Thirty four cases (28 girls, 6 boys) of adolescent idiopathic scoliosis that had received spinal fusion with pedicular screw in lumbar and hook in thoracic area for rod fixation and instrumentation were retrospectively evaluated, with mean age of 14.4 (11-27) years and 33.6 (24-72) months follow-ups. The correction of coronal, sagital, rotational deformities and maintenance of correction at follow-up were assessed. Clinical evaluation according to Scoliosis Research Society questionnaire (SRS-24) was also performed.Results: The initial average coronal angle of 63.2 degrees improved to 27.1 degrees after surgery. This corresponded with the observed correction in preoperative bending films. 60 percent de-rotation and 55 percent improvements in deviation from midline axis were also observed. The angulations of first vertebra and first disc below fusion showed, respectively, 51 and 70 percent improvement. According to Lenke’s classification, the “lumbar modifier” in sagital plane of (+) 1.1 degrees changed to (-) 8.9 degrees.Conclusions: Use of pedicular screws in lumbar region during instrumentation of adolescent idiopathic scoliosis produces better correction and lowers the change of “correction loss” in short time.

Volar radioulnar dislocation without fracture in ulna or radius is rare. This is a report of and old volar dislocation of distal ulna that required open reduction and ligament reconstruction with free tendon graft.