IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2016 | Volume:14 | Issue:1 (54) |Papers Count:7

Background: Fracture of phalanx is common upper extremity fracture. There are two pining methods for fixation extraarticular proximal phalanx transverse fracture: First, transarticular parallel pins passing through (MCP) joint and, extraarticular cross pining of fracture without going through MCP joint. In this study we will try to compare these two fixation methods.Methods: This study was a clinical trial on proximal phalanx transvers fracture. In first method we used two parallel pins from metacarpal head passing through MCP joint intoproximal phalanx. In second method we used two cross pins from proximal phalangeal condyles across the fracture. We then evaluated MCP, proximal and distal interphalangeal joints active range of motion and how long it took the patients to resume their daily activities. Complications were also evaluated for each group.Results: The mean MCP, PIP and DIP joints active range of motion 3&6 month after surgery showed no significant difference between the two methods of surgery .There was no significant difference between the two methods in the time delay to return to work.Conclusion: In using cross pining or parallel transarticular pin fixation for proximal phalanx fracture give similar results. Since using intramedullary method is easier and need, less CARM usage, less soft tissue damage and less distraction in fracture. We suggest transarticular intramedullary parallel pins fixation for proximal phalanx fracture.

Background: Pedicle screw instrumentation has many advantages for correction of adolescent idiopathic scoliosis (AIS) deformity including better correction and fewer late complications. On the other hand, screw insertion in AIS is challenging. Intraoperative fluoroscopy or navigation techniques are expensive, time-consuming, and exposed to high radiation. Free-hand technique relies on the surgeon's experience and locating the pedicle entry point with anatomical landmarks. There are few studies that evaluated pedicle screw position accuracy with postoperative multi-slice computed tomography scan.Materials and Methods: We prospectively considered 38 consecutive AIS cases, who underwent corrective surgery with all pedicle screw technique. All the screws were inserted with free-hand technique using anatomic landmarks as a guide for an entry site. We divided pedicle penetration in medial, lateral, inferior, superior, and anterior vertebral body as Grades 0-4, that Grade 0 is fully contained within the pedicle, Grade 1 (<2 mm), Grade 2 (2.1-4 mm), Grade 3 (4.1-6 mm), and Grade 4 (>6 mm).Results: A total of 720 screws were inserted, of which 623 screws (86.5%) were perfect and 97 screws (13.5%) were misplaced. Of those which were misplaced, 39 screws (40.2%) were medial and 58 (59.8%) were lateral, which shows that the prevalence of lateral misplacement was more in comparison to medial misplacement. However, in all misplaced cases, the deviation of the screw was <2 mm (Grade 1). There was no misplacement in the inferior and superior.Conclusion: Pedicle screw insertion in AIS with the free-hand technique is a safe and reliable method.

Background: Drilling of bone is used to fix the fractures with screws, wires orplates. The interaction between hole surface and fracture stabilization components is effective in the bonding strength of the stabilization process. During bone drilling, the temperature could increase above 47oC and cause irreversible thermal necrosis. The surface roughness can be considered as a sign of damage of the bone cells.Methods: This study looks at the effect of rotational speed of drilling of bone on praluction of surface defects to determine the best processing condition for minimizing the osteonecrosis and surface defects. 7 different rotational speeds in drilling beef femur, were used-in non-cooling and liquid cooling phases. In all tests the temperature was measured. After cutting samples, using hematoxylin-eosin staining were stained for detection of surface defects.Results: The lowest heat production was with use of liquid cooling. The drill speed of 1500 rpm with liquid cooling showed the maximum temperature of 48.5oC without production of surface debris and degree as witnessed in stained bone see.Conclusion: Cooling application in bone drilling process, avoids over, and thus less thermal necrosis, which gives the lowest number of surface defects and highest quality wall surface hole.

Background: The open fractures of femur and leg are among the common fractures of orthopedic injuries. Utilization of external fixator has worldwide acceptance. Pin tract infection, neurovascular injuries, compartment syndrome are among some of the complication of external fixator application. In this research, the complications and treatment pitfalls of external fixator insertion are studied?Material and Method: 140 patients with comminuted periarticular fracture of knee and ankle were studied from 2002-2003. One day after surgery, the neurovascular status was documented and when patients referred for exchange of external fixator the pin tract infection was recorded. The final data were analyzed by means of independent t-test and spss20.Results: The rate of infection was %52. The rate of neurovascular injury was %6. The rate of compartment syndrome and vascular injury was zero and the rate of tendon injury was %5.7. In comparison between pin tract infection and neurovascular injuries and tendon injury in open and comminuted close fracture only the injury of nerve has significant differences( P=0.049).Conclusion: External fixator placement for open or comminuted fractures of knee area and leg is associated with high rate of pin tract infection, but neurovascular injury and muscle / tendon damage or compartment syndrome are very infrequent. Associated with a considerable degree of pin tract infection, but neurovascular effects and complications of tendon muscle, compartment syndrome is uncommon.

Background: Osteoarthritis is a progressive joint disease. Mastic fruit has antioxidant and anti-inflammatory properties. Bone marrow stem cells have the ability to differentiate into chondrocyte. The purpose of this study is to evaluate the effect of Pistacia atlantica hydro alcoholic extract with bone marrow- derived stem cells on induced knee osteoarthritis in rat.Methods: 50 male Wistar rats were divided into 5 groups of 10. Then, under anesthesia on days zero and 3, fifty ml collagenase type 2 was injected in the left knee. After 10 weeks, osteoarthritis was induced. The rats were divided into 5 groups: 1.control, 2.Pistacia atlantica hydro alcoholic extract therapy, 3.treatment by stem cell and Pistacia atlantica hydro alcoholic extract, 4.stem cell therapy alone and 5.treatment with hyalgan. After 12 weeks of treatment for osteoarthritis, radiographic and histopathologic surveys and also measurement of antioxidant properties as MDA-TAC were performed.Results: After 12 weeks, histopathologic and radioghraphic evaluation revealed that results of the cell with extract group was significantly different compared to other treatment groups as well as the control group (p<0.05).there was also signified reduction in oxidative stress-based on biochemical evaluation of MDA-TAC in group with cell extracting ejection, compared with the control and also other treatment groups, based on biochemical evaluation of MDA-TAC in cell with extract group significant reduction in oxidative stress is observed compared to other treatment groups and control (p<0.05).Conclusions: It seems that Pistacia atlantica hydro alcoholic extract with bone marrow- derived stem cells are effective in knee cartilage repair.

The use of orthosis in many musculoskeletal conditions and neurologic defects is mandatory.The making of orthosis is usually, with thermoplastic material. Such material can be divided into 3 categories depending on the amount of heat necessary for its making. It may require no heat, some heat or a lot of heat for making an orthosis. The use of each type of thermoplastic material is, therefore, dependent on its strength, malleability and also on what type of person or disease it will be used for.