IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2006 | Volume:4 | Issue:3 (15)|Papers Count:7

Background: To find the patterns and common mechanisms of motor-vehicle related pediatric trauma in a metropolitan city (Tehran-Iran), to guide the health planners of the city in proper planning and resource application and distribution.Methods: A pilot study was started in three major pediatric-trauma referral centers in Tehran by the Iranian Orthopaedic Association. All the cases below age 14 who visited the emergency department of those three hospitals, with body trauma resulting from a vehicle-related accident were studied. Cases were collected on a 24-hours basis in one month of each four seasons of the last year. The data collection was done by contracted physicians with the use of a detailed questionnaire.Results: From a total of 318 children that visited the emergency department because of motor-vehicle related accident, 287 patients had trauma to various parts of the body (215 male 72 females), 151 cases had only musculoskeletal trauma and 31 others had sustained no significant injury of any kind. Multiple trauma was seen in 33.6% of the cases.52.8% of accidents happened in spring & summer, 21.7% in autumn, and 25.5% in winter season. The place of accidents were usually on the streets (70%), followed by small allies (17.5%), then major roads (12.5%). 65% of the accidents had happened at night and 35% during the day. The injuries were from motorcycles hitting pedestrians in 33.7% and, car-pedestrian accidents in 31.9%.The musculoskeletal injuries included fracture of tibia and fibula (62 cases), femoral fracture (25 cases), forearm (18 cases) and humerus (11 cases) in order of frequency. 24% of patients were transferred by ambulance and the rest by their family members or by-standing people.Conclusions: Children become disabled far too frequently in the city, from lack of proper training, proper enforcement of traffic rules by the children and the drivers. An appropriate measure of safety in the crowded metropolitan city of Tehran is essential, and this report can be a guide for the other major cities of the third world.

Background: Ipsilateral fractures of tibia and femur or’ “floating knee”, commonly occur as a result of high energy trauma. It is, therefore, associated with high of knee injuries. This articles looks at the prevalence of intra-articular knee injury in “floating knee” when the fractures are extra-articular, both in tibia and femur. Methods: During a 3.5 year period of time (March 2002-Oct 2005), 61, out of total of 76 cases of “floating knees” that had extra-articular femur and tibia fractures, had no history of prior knee problems, and the fractures of both segments had been internally fixed were studied. Each knee was examined for any possible ligamentous injury, following rigid fixation of the fractures, under the same anesthesia. The findings were documented and the patients were later followed for any new findings or complaints up to nine months after the incident. Results: The mean age in these 61 cases (57 males, 4 females) was 29.3 (18.46). Lachman and Pivot tests were positive in 5 and Posterior Drawer test in 3 cases. Valgus instability in 9 and varus instability in 6 other cases were detected. After the 9-months follow-up, knee pain was the chief complaint in 19 patients, while the MRI study which was done in 16 cases was positive for meniscal damage in 13 patients. Conclusions: Concomitant knee insults are fairly common in “floating knee” injuries. A thorough knee examination, following fixation of “floating knee” while the patient is still under anesthesia is essential. Further evaluation during the course of fracture treatment for any knee complaint is also recommended.

Background: Ipsilateral fractures of femur and tibia, the so called “floating knee” are usually the result of high-energy trauma. They are associated with increased risk of local soft tissue injures around the knee including ligamentous injuries, delayed union, and more importantly, vascular injuries. We are reporting our experience with such fractures in a teaching hospital. Methods: A cross sectional study of “floating knee” injuries treated in Shahid Bahonar hospital of Kerman over a 1 year period (2003 to 2004) was performed. Seventy eight patients (69 males, 9 females), with a maximum follow-up of 2 weeks entered the study and are reported here. The injury type and, in particular, the vascular status of the limb in terms of prevalence and the fate of limb in first two weeks were the points of concern. Seventy eight “floating knee” patients comprised the study group that was divided into six groups in accordance with the limb vascular status. Group 1: Forty nine cases with normal pulses and normal capillary refill; group 2: Seven cases with low blood pressure and poor pulse, but intact capillary refill; group 3: Thirteen cases with no pulse and no capillary refill, and ischemic time of below 6 hours that had angiographic studies; whit severe crushing and vascular compromise referring 24 hours later who underwent amputation; group 6: Two patients who developed vascular compromise after fracture fixation. Each “floating knee” case was further classified according to the level and type of each bone fracture. Results: Out of 78 cases 18 had no pulse and did not regain any hemodynamic stabilization, and 13 had angiography and 5 went directly for arterial exploration. In general 15 cases (19.2%) of “floating knee” had vascular compromise, 8 of whom ended up with amputation. The vascular damage had no direct correlation with age, or anatomic location of fractures. Discussion: Simultaneous ipsilateral fractures of femur and tibia are associated with around 20 percent chance of vascular injury. Careful and immediate assessment of limb circulation is mandatory for any “floating knee” injuries.

Background: Combined arterial and skeletal trauma in lower limb imparts a substantially higher risk of limb loss and limb morbidity. Prompt diagnosis and rapid treatment is necessary for optimal limb salvage. The aim of this study was to evaluate the results of management of lower limb fracture, dislocations with vascular injuries in a university hospital.Methods: 16 male patients with combined lower limb fracture, dislocations and vascular injuries were studied during a 2 year period in a prospective cross-sectional manner.Results: The mean age was 25±10.33 (15-50). More than half of the cases were 20 yr old or Younger. Eleven cases had motorcycle accident. Eleven cases had 6 hour or more intervals between accident and surgery. Skeletal trauma in 7 cases was femoral, 3 cases proximal and 1 case supracondylar femoral fracture. Vascular injuries in 7 cases was popliteal, 3 cases femoral, and 4 cases tibial. The fracture treatment in 8 cases was external fixator, 3 cases internal fixation, and the rest conservative treatment. Popliteal artery and veins were repaired with resection of damaged part and autogenous reversed saphenous vein patch. Tibial vessels were repaired with end-to-end sutures.Conclusions: Amputation was done in 5 cases mainly due to long interval between accident and surgery.

Introduction: Finger injuries are very common and the majority can be treated under digital block anesthesia. Traditional digital block is one of the most commonly blocks performed by care providers in several medical fields. There is another less known method, Transthecal (Pulley) block, in which local anesthesia is injected into the flexor tendon sheat. This manuscript compares the effectiveness of these two techniques.Methods: A prospective randomized clinical trial was performed comparing Transthecal pulley block with digital block anesthesia in terms of length of achieved anesthesia and possible need for supplemental anesthesia. 100 consecutive patients who required surgery for their finger injuries randomly received Traditional digital block or Transthecal pulley block. The achieved finger anesthesia was assessed in terms of time and need for additional medication.Results: The mean achieved anesthesia was 34.2 minutes in Transthecal and 33.8 minutes in digital blocks. A repeat infiltration of local anesthesia became necessary in 5 instances in the Traditional digital block and none in Transthecal technique.Conclusions: Because of fewer needs for repeat for repeat local anesthetic injection, and lesser risk of neurovascular bundle damage, Transthecal block is suggested as a more suitable local for finger surgery.

Background: Low back pain is common disease which usually causes considerable individual and community-related functional disability. Lumbar disc herniation is one of the common causes of back pain in the third or forth decade of life. Surgical treatment imposes a heavy functional burden on the patient and the society. For this reason we have decided to evaluate the effectiveness of non-surgical treatment in lumber disc herniation in middle age people. Methods: Forthy five patients, who had referred with documented lumber disc herniation with positive clinical and CT scan evidence, were evaluated before and after six months of conservative treatment. The treatment included NSAID steroid 3-cyclic antidepressant, rest, physiotherapy and, at times, bracing or traction. Clinical and repeat CT scan was used for re-evaluation. Results: Among the 45 cases, clinical improvement was seen in 39 (86.7%) and 6 (13.3%) required surgical exploration. The 35 cases who referred for repeat CT scanning, 24 (68.6%) showed regression of disc bulge. Conclusions: In view of high rate of regression of symptoms and improvement of CT scans in this study, it is recommended not to rush to surgery for lumber disc herniation in non-urgent cases, and expect high rate of improvement with conservative approach.

 ‘Ergogenic aid’ is defined as any means of enhancing energy utilization, including energy production, control, and efficiency. Athletes frequently use ergogenic aids to improve their performance and increase their chances of winning in competition. It is estimated that between 1 and 3 million male and female athletes in the United States alone have used anabolic steroids. In response to the problem of drug use, many athletic organizations have established policies prohibiting the use of certain pharmacologic, physiologic, and nutritional aids by athletes and have implemented drug testing programs to monitor compliance. Therefore, it is important for physicians to be knowledgeable about the available ergogenic aids so they can appropriately treat and counsel the athletic patient.