IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2001 | Volume:1 | Issue:2|Papers Count:8

The decision to salvage or amputate a severely injured limb is one of the most difficult an orthopaedic surgeon many face. Such a decision is rarely clear-cut. In this study we present 36 cases of severely injured limb with arterial damage. In our cases we evaluated the efficacy of limb injury scoring system like MESS, MESI, NISSSA, and PSI scoring system in predicting results of limb saving surgery. Eight (24.2%) of the limbs were amputated; seven (88%) amputations were lower extremity, and one (12%) was upper extremity. The MESS, NISSSA demonstrated a high specificity (88%, 80% respectively) and high sensitivity (87% each) but other scoring systems had lower values. The relative importance of each of the associated trauma parameters is still of questionable predictive value. We proposed a new Combined Salvage Scoring System.

Study design: this is a retrospective review of a consecutive series of patients with spinal disease who underwent posterior fusion and sacral fixation with different methods. Objective: To evaluate different methods of sacral fixation. Summary of background data: Spinal diseases that fixation, pose one of the challenging instrumentation problems. Mainly because of the poor bone quality frequently found within the sacrum, and long construct fixation with making cantilever forces. Complications include: Failure of instrumentation, loss of sacral fixation and a high rate of nonunion. Methods: Twenty five patients with spinal diseases like spondylolisthesis, fracture, paralytic scoliosis, were operated with posterior fusion, CD instrumentation with sacral fixation (Chopin block, pedicular screw and iliosacral connector). Corrective angles like cobb's angle, pelvic angle, sacral inclination were measured before and after surgery (mean follow-up=17 months). Influence of etiology, different sacral fixation methods, follow-up period, nonunion, corrective angles,… were assessed in spite of loss of sacral fixation. Results: There is a significant correlation between sacral fixation failure and increasing age of patients at surgery (P=0.006), long follow-up period (P=0.023) and tulip screw type in pedicular screw system (P=0.03). Pseudoarthrosis at failure area is a significant cause of sacral fixation failure (P<0.0001). Conclusion: There is not any significant difference between sacral fixation with CD instrumentation using Chopin block, iliosacral connector and pedicular screw in producing fixation failure. Other fixation methods like Luque Galvestone technique must be considered.

Local recurrence of osteosarcomas usually seen together with displant metastasis which provides a very poor prognosis for the disease. We evaluated the important factors in local recurrence of osteosarcomas in 34 patients. We excluded those tumors in central skeleton and pelvic bones for the reason that wide resection of those tumors is almost impossible and the rate of recurrence is high. We evaluated the impact of age, sex, location of tumor, neoadjuvant and adjuvant chemotherapy, tumor degree, king of surgery and margin of surgery on the recurrence of limb osteosarcoma. We concluded that except for the response to neoadjuvant chemotherapy and attaining a good margin of surgery, other factors mentioned above do not have any impact on recurrence of osteosarcoma after surgery in extremities.

Operative results of arthroscopic open ACL reconstruction in 32 patients by bone-patellar tendon-bone graft was evaluated in shariaty hospital from 1997 to 2000. For assessment we used criteria developed by international Knee documentation committee. Signs and symptoms of the patients, their satisfaction and activity level in preoperative and postoperative period were assessed. The IKDC score, signs and symptoms were significantly improved following surgery. One patient showed failure of fixation. Ninety one percent of patients were satisfied with subjective evaluation of normal or near normal. The type of operation (open or arthroscpic), associated meniscal tear, age of the patients and time interval between rupture and reconstruction had no effect on the result but in patients with a quadriceps atrophy in postoperative period, caused result decline.

Syndactyly is a common congenital anomaly with an incidence of one per 2000 incidence. One of the main problems in syndactyly surgery is inadequate skin for digital coverage. From 1990-1999 eight patients underwent syndactyly release, and foreskin obtained from simultaneous circumcision was used for finger coverage. Complete graft take and coverage was obtained in all eight patients. One case of superficial infection was controlled by regular betadine baths after one week.

Background: Autogenous osteochondral grafting articular defect in weight-bearing surface of large joints proved to be a proper biomechanical and physiological solution for localized full thickness defects. Objectives: To study the gross and histopathological results of mosaicplasty in an animal model (sheep's medial femoral condyle), evaluating the factors of defect and graft size, Assessing the effect of fixation with only cancellous bone impaction between graft columns, and early free post operative motion. Methods: Fourteen medium sized sheep were the subject of the study. Cylindrical osteochondral grafts of 4mm and 6mm diameter and 1cm length from the periphery of the medial femoral condyles at patellofemoral joint were used to fill corresponding 5 millimeter and 15 millimeter diameter cylindrical defects of 1cm depth at weight bearing surface of medial femoral condyles. The spaces between the grafts were packed with cancellous bone with double gloved thumb. The sheep were free for activities and weight bearing after the operation. Two of the 14 sheep died. All the sheep were sacrified after 4 months and their knees collected as specimens for further gross and histopathogical studies. Result: All grafted defects except one healed with smooth cartiulage. The quality of cartilage were evaluated by histopathological criteria, rating the cellular morphology, surface regularity, structural intesrity and thickness of cartilage, bounding to adjacent normal cartilage and clustering. Twenty-three out of 24 specimen showed excellent or good result, that is a success rate of 95.8%. Conclusion: Mosaicplasty, autogenous osteochondral grafting in this animal study was effective and successful even in larger between of 15-millimeter diameter. Cancellous bone cementing between the cylindrical grafts, respecting the normal convexity of the periphery of the defects and freedom of motion and activity were all helpful in obtaining the good result 4 months after graft implantation.

Although more than two decades has passed since the first peripheral never repair, unfortunately good result of peripheral nerve repair is still less that 50%. Seddan classification of never injury is still the best classification. In this article, we will review never degeneration, regeneration, technic of neurorraphy, material for repair of the nerve and how to evaluate the result of repair. At the end the result of neurorraphy will be discussed.