IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2006 | Volume:4 | Issue:2 (14)|Papers Count:9

Background: Open tibial shaft fracture is the most common long bone open fracture, and its main complications are infection and non-union. Unreamed tibial nails have been introduced to reduce such complications. We are reporting our experience with this instrument. Methods: 54 consecutive open tibial fractures that had been treated with unreamed tibial nails (UTN) were studied. There were 22 grade I, 19 grade II, 13 grade IIIA Gustilo-Anderson open fractures. The cases had an average of 11.5 months follow-up. Results: In the short-term follow-up of one year 14 cases (26%) of delayed union, 2 (3.6%) aseptic non-union, and 2 infections (3.6%) were encountered. The two non-unions and six of delayed unions were grade IIIA open fractures. The delayed unions were distal third shaft fractures in half of the cases. The time to union was 17.5 weeks on average- being longer for grade IIIA and distal shaft fractures. Conclusions: With this short-term follow-up report, UTN seems to be an effective instrument for open tibial fractures.

Background: Hand injuries are common skeleton trauma and account for 28 percent of musculoskeletal injuries. They may cause life-long disabilities. They are more common in young, and are seen more in relation to industries. This, by itself, makes them more serious injuries. The type of injury and treatment approach both have a big impact on the final disability. A study on causes and patterns of injury could guide to plan proper preventive measures. Methods: As a pilot study, a cross-sectional study has done in the whole country. In a 3-months period 128 cases of industry-related hand injuries in two major hand-trauma referral centers of Tehran were studied. Questionnaires related to the instrument and factory-type causing the trauma, the type of safety guards used at work, type of injury, and type and speed of initial instituted treatment etc. were completed by six senior medical students. The injury details were confirmed and documented, and data analyzed.Results: 128 patients with industrial hand injury had an average age of 28.9 (15-77) years; all except one were male and had isolated hand injuries. A proper wound dressing had been applied only in 40.6% (52) prior to admission. The injuries were the results of compression or sharp-blade instrument traumas in 116 or 90.7% of the time. The accidents happened in morning work shifts in 82% (105) of cases, and 47.6% (61) in the middle of the work time. The injuries were fractures in 33% (43) of the cases, tendon injuries in 40% (52), amputation in 17.1% (22) and moderate crush in 20% (26). Significant crushing was seen in 70.3% (90) patients were admitted to hospitals within 6 hours from the injury. The patients had average 13.5 months experience with their jobs. Conclusions: Industrial hand injuries in our study were mainly involved males, in their morning shift jobs. They often did not have adequate safely standards at their work place. Transport took place late with improper hospital care.

Background: Distal metaphyseal fracture of forearm is one of the common fractures in children for which closed reduction and long arm cast is a common treatment. A good number, however, re- displace in their casts in follow-up visits. The aim of this study is to find the factors which could predict re-displacement after a successful primary reduction. Methods: This is a retrospective review of charts and radiographs of 95 children aged 6-14 years who had their distal metaphyseal forearm fractures treated in Shafa hospital in Tehran during an 10 year duration. Initial closed reduction was under general anesthesia, and long arm cast had been applied. Follow-up radiographs of immediate past-op, first-week and 6-weeks post surgery were evaluated and the displacements and angulations were measured. The acceptable reduction was confirmed by comparing the measurements with the textbook acceptable values for any particular age. Results: From 95 cases (18 girls, 77 boys), 29 cases (%30.5) had displaced their initial reductions by the sixth week follow-up. Twenty of those displaced fractures were in over 11 years of age children and 9 in the younger group. Seventy nine cases of the 95 patients had complete displacement at the beginning of treatment, and 28 re-displaced in follow-up. From the 16 of the 95 that had incomplete displacement originally, only one case displaced. Gender and successful initial reduction had no productive value for future displacement.Conclusions: Children over 11 years of age with completely displaced distal metaphyseal forearm fractures have a good chance of re-displacement with closed reduction and long-arm cast immobilization. These would benefit from additional fixation.

Background: Supracondylar humorous fracture is the most common fractures around elbow, and is divided into two major extension and flexion types. When surgery becomes necessary, different surgical approaches maybe used. We would like to report a comparison of surgical results between two-posterior and lateral- surgical approaches. Methods: Among the patients younger than 14 years of age who were candidates for surgical treatment of their supracondylar humorous fracture, surgical approach was randomly selected to be either posterior or latral. Thirty children in each approach entered the study. The results of surgery including motion range, non-union or malunion, ectopic ossification, infection and nerve injury were compared in the two groups. Results: At 12-weeks follow-up, no meaningful difference in range of motion was observed. Two cases of ulnar nerve injury and one ectopic ossification were detected in the group with posterior approach. They had full recovery by the fourth or fifth week. Three cases of pintract infection occurred in the lateral approach. The posterior approach had two varus malunions of 10 degrees. The lateral approach had 2 and 3 cases of 10 and 5 degrees varus respectively. Conclusions: Lateral approach, compared to posterior approach is a safer method with less chance of nerve damage or heterotopic ossification. 

Background: Epidemiologic Investigations have revealed a high prevalence (44% - 65%) of shoulder complaints consistent with impingement in certain occupations. Multiple theories exist as to the primary etiology of shoulder impingement, including anatomic abnormalities of the coracoacrominal arch or humeral head, weakness or degeneration of the rotator cuff tendons and shoulder kinematics and postural abnormalities and improper scapular muscles control. The purpose of this study is to compare the positional parameters of shoulder complex in healthy individuals and cases of shoulder impingement. Methods: 17 patients with shoulder impingement syndrome at average of 43.82 years of age and 17 healthy persons (age 44.05 years) participated in the study. Scapular rest position (protraction and rotation) was measured according to Diveta method, and scapular asymmetry was assessed by using lateral scapular slide test (kibler test). Midthoracic curvature was measured by flexi ruler and forward head position was measured on a photograph of the lateral view of each subject. Results: Compared to non-impaired subjects, those with impingement demonstrated a significantly higher lateral scapular slide while the arm was elevated to 90º and full range of motion in the scapular plane and more forward head position posture. Conclusions: The effect of muscle imbalances about the shoulder girdle may lead to altered neuromuscular control and abnormal movement patterns which may result into impingement syndrome.  

Background: Occupational low back pain is a major cause for morbidity around the world. Many investigations have been performed to elucidate its associating characteristics. The results have not been consistent. Strict criteria have been used in this study to more clarify the statistical differences. Methods: A cross sectional descriptive and analytical study was performed on the volunteer workers with low back pain (case) and without low back pain (control) in a steel plant. Demographic data were collected after a formal history and physical examination in both groups. Results: We examined 45 and 72 persons as case and control groups; respectively. Mean age were 41.3±5 and 39.9±5.3 years for the case and control groups; respectively. Heavy work, job stress and dissatisfaction with income were associated with a high probability of low back pain. Longer job experience and cigarette smoking were not associated with low back pain. Conclusions: This survey showed a statistically significant association between moderate to severe chronic low back pain (with at least three months duration), heavy work, job stress and income dissatisfaction. No association was found for smoking, job experience and job satisfaction.

An intercondylar fracture of the distal humerus occurred in 3-year-old boy. The fracture was type one, and was treated by percutaneous pin fixation and splinting for 3 weeks. Then the pins were removed. After three months there was full range of motion and good union.

The treatment of old glenohumeral dislocation, because of secondary anatomic changes, is a real challenge. Therefore, early diagnosis and treatment in acute cases is mandatory. In multiple trauma cases, we should always have the possibility of associated shoulder dislocation, especially posterior ones in mind. Standard, good quality radiographs are helpful for correct diagnosis, and CT-Scan in doubtful cases. Treatment must be meticulous, and reliable stability should be obtained immediately, whether close or open reduction is used. In case of instability, exact cause should be found and addressed accordingly.