IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2011 | Volume:9 | Issue:2 (35)|Papers Count:11

Background: Femoral neck fracture is uncommon but serious injuries in young adult with high complication rate. This study was designed to evaluate the outcome of surgical treatment of such a fracture fixed by screw in.Methods: In a descriptive prospective study form 2006 to 2009, 42 patients with the mean age of 37 years (15–60 yrs) were treated by closed or open reduction and screw fixation for femoral neak fractures in two university hospitals in Ahvaz- Iran. They all received surgery within the first 24 hours after injury. They were followed for 15 months on average.Results: In accordance with Garden classification, 2 patients were type I, 3 type II, 18 type III and 19 type IV Gorden fractures. Thirty two cases were fixed by open reduction and fixation and 10 by closed reduction. Union was achieved in 30 pateints. The 12 (28.6%) cases of nonunion were seen in the ones who received open reduction and fixation. Avascular necrosis was observed in 7 patients (16.7%), 4 of whom had obtained union.Conclusion: Femoral neck fracture is associated with high complication rate, in particular, if open reduction becomes necessary.

Background: Anterior glenohumeral instability is associated with anteroinferior rim defect of glenoid. Evaluation of such bony lesions may play a role in determining proper treatment and predicting recurrence of instability. The main purpose of the current study was to investigate the relation between number of dislocations and extent of bony lesion of the glenoid and also determine the sensitivity and specificity of 3-D CT for detection of patients requiring bone-grafting surgery.Methods: Thirty patients with recurrent anterior shoulder dislocation contributed to this study. The patients underwent bilateral 3-D CT imaging to determine the glenoid index (GI). Then, the correlation between the number of dislocations and GI, and also sensitivity and specificity of CT were determined.Results: The bony lesion was present in 28 (94%) of patients. There was no meaningful relationship between the number of dislocations and GI (p=0.05). Based on the CT, 2 patients required open surgery and bone grafting and 28 patients only Bankart procedure. This was proved to have been wrong in 2 cases at surgery. So, the sensitivity and specificity of 3-D CT was 50% and 96% respectively.Conclusion: The number of dislocations cannot determine the extent of the bony glenoid defect in recurrent shoulder dislocation lesion. 3-D CT can help in knowing the expansion and location of the lesion, but is not a reliable tool for surgical technique.

Background: Posterior tibial slope is the normal anteroposterior inclination of the tibia slope and plays an important role in the biomechanics of the knee and function of the cruciate ligaments. Posterior tibial slope angle varies in different populations and there is no report about its measurement in the Iranian population. The aim of this study was to investigate the normal posterior tibial slope in a teaching hospital in Tehran-Iran.Methods: In a desreptive study, 108 knees in 70 men and 38 female patients, with no history of prior knee problem were evaluated by lateral knee rodiographs in a teaching hospital in Tehran-Iran. The average age in these cases was 38 years (23-60 years). These patients had refered because of recent knee trauma, but no fracture or intra-articular derangement had been found. The angle of tibial slope was measured in all the cases and analyzed.Results: The mean slope angle was 9.4±1.8 degrees. There was no statistical relationship between age and gender and posterior tibial slope (p³0.05).Conclusion: The normal posterior tibial slope angle in this Iranian population was different from other countries. It may be necessary to consider these differences in designing tibial and femoral components for knee arthroplasty.

Background: Supracondylar humerus Fracture is among the common upper extremity fractures in children. In certain types of fractures of circumstances that open reduction becomes necessary; the best surgical approach is debatable. We would like to report our prospective study between posterior and lateral surgical approaches in type III supracondylar fractures.Methods: In a case series study, 87 children from birth till 18 years old, with type III humerus fracture were randomly selected for open reduction and pinning; 43 through lateral and 44 posterior approaches. With a 6-months follow-up, elbow range of motion, complications and radiographic parameters related to union type were evaluated.Results: Posterior approach was a faster surgery. Ranges of motion after 1 and after 6 months were more restricted in posterior approach. Baumann and carrying angles were closer to normal in a higher percentage in posterior approach. Varus and valgus malunion or joint stiffness rates or infection were similar in the two groups.Conclusion: The two approaches were similar for postoperative complications. Better range of motion was achieved in the lateral approach, and a more anatomical union in the posterior approach.

Background: Kienbock disease resulting from avascular necrosis of lunate bone leads to pain and disability in young active patients. Radial shortening is one of the treatment methods in this disease. In this study, we evaluated the mid-term results of treatment of Kienbock using radial shortening.Methods: In a retrospective study, 9 males and 6 females with Kienbock disease with average age of 28.6±9.37 years who had undergone radial shortening, were examined in a teaching hospital in Tehran-Iran. There were 2 patients in stage II, 5 in IIIa and 8 in step IIIb of Lichman’s class. In a mean follow-up of 5±2.44 years, these 15 cases were evaluated for wrist motion and gap strength and also with quick-DASH score. The radiograph Stahl index and carpal height ratio were also assessed.Results: Pain and range of motion improved and grip strength was favorable in 13 patients. Quick-DASH score was 8.5±0.84 in patients with stage II, 12.72±5.09 in stage IIIa, and 27.57±18.87 in stage IIIb. Stahl index and carpal height ratio were the same in patients with stage II, but significantly decreased in other patients. Kienbock disease progressed in 2 cases.Conclusion: Radial shortening can relief clinical symptoms, even in stage III and IIIb of Kienback diseases, although the disease X-ray show radiographic worsening.

Background: Large defects in chronic Achilles tendon ruptures are difficult to rapair. The purpose of this study was to evaluate the clinical and functional outcomes following reconstruction of the chronic large gaps in Achilles tendon ruture using free semitendinosus interposition tendon grafting.Methods: In a case series study, eleven male patients with mean age of 30±4 years and average defect size of 8.31±1.96 cm in their old Achilles tendon underwent reconstruction during 6 years in a teaching hospital in Tehran-Iran. Ipsilateral semitendinosus free tendon graft was used for reconstruction. The cases were evaluated by Ankle-Hindfoot Scale of American Orthopaedic Foot and Ankle Society (AOFAS), and the Achilles Tendon Rupture Score (ATRS) to with a mean follow-up of 25.36±3.3 months.Results: The pre-operative AOFAS and ATRS of 70.4±5.3 and 31.7±5.7 preoperatively improved to 91.8±4.8 and 88.7±4.2 values. The ankle dorsiflexion showed a significant decline-postoperative value of 13.5±4.2 degrees compared to preoperative of 17.2±3.9 degrees (p=0.04). All the cases except a professional athlete, returned to their previous activities.Conclusion: This technique offers good clinical and functional results in patients with large defects and is associated with no donnersite morbidity. We recommend this technique for the reconstruction of the chronic at ruptures in patients with over 6 cm defects.

We report a case of lateral tibia plateau fracture whose PCL avulsion was missed in primary radiographic studies. He had also reversed type of Segond fracture in medial tibia plateau. After open reduction-internal fixation of plateau fracture, the posterior tibia instability disclosed the PCL avulsion. Patient didn’t accept reoperation for PCL avulsion. We confirm the primary reports about association of reverse Segond fracture with PCL injuries. This association has not been previously reported in presence of tibia plateau fracture.

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