IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2005 | Volume:4 | Issue:1 (13)|Papers Count:9

Background: Femoral neck fractures in children are rare and are associated with high risk of avascular necrosis (AVN) and Coxa vara. The aim of this study was to evaluate the result of surgical treatment of paediatric femoral neck fractures in our center. Methods: In this retrospective study, 17 patients with femoral neck fractures with a mean age of 10 years (6-13) and mean follow-up of 26 months (12-60) were evaluated. Closed or open reduction and internal fixation were performed for all patients. Clinical and radiographic examination was performed and the treatment results were assessed. Results: One Case was type I, 12 type II, and 4 type III according to Delbet classification. AVN was noted in 6 patients, nonunion in 2 and Coxa vara in 2.Limb shortening of average 2.6 cm (2-5) was seen in 7 cases. Conclusions: Femoral neck fracture has been associated with high rate of complications. AVN was the most common complication related to initial trauma and late treatment.

Background: Anterior cruciate ligament (ACL) is one of the most important stabilizers of knee joint, which is often injured in major accidents or in sporting activities. Among the many different available techniques for its reconstruction, bone-patellar-tendon-bone graft is a commonly used method. We are reporting our experience with this particular technique. Methods: This was a prospective clinical trial on 39 male patients in a 4-year period who received bone- patellar- tendon- bone graft substitution for their ACL deficient knees. The patients were evaluated in follow-up by American Orthopaedic Society for Sport Medicine (AOSSM) questionnaire, as well as clinical testing 3-48 months after surgery. Results: Anterior knee pain of varying degrees was the most common problem and was observed in 31(82.1%) cases. Giving- way was the main complaint in 33 (84.6%) cases pre-operatively, which decreased to 8 (20.5%) post surgery. Five patients (12.8%) returned to full sporting activities, while 27 (71%) still participated in sports but not to their previous capacity. Twenty seven cases (75.7%) were satisfied with the surgery. Conclusions: Patellar- bone- patellar- tendon grafting is a suitable procedure for symptomatic anterior cruciate ligament deficiency and is successful in two third of the cases.

Background: Need for progressive methods of reconstructive surgery for hand is a rule. Many surgeries are multistage, including coverage and tendon separately. Present method includes single stage of tibialis anterior flap with extensor tendons for reconstruction of dorsal hand defects simultaneously. Therefore rehabilitation and start of range of motion becomes possible and adhesion becomes minimal. Methods: Six patients with extensive dorsal hand defects were operated micro surgically. After debridement of recipient site, free flap was removed from donor site. Then vascular anastomosis and tendon graft was done. After Operation 4 weeks was immobilized and then rehabilitation was started. Results: Overall results were 85% range of motion (compared to opposite side) and 83% strength and release. Extension lag was 20%. Conclusion: If microsurgery is possible (both equipment and surgeon experience), reconstruction of hand defects (zone 4 and 5) can be treated with T.A. Free flap with extensor tendons. Then ROM can be started as soon as possible thus adhesion is minimal and final ROM is maximal.

Background: Ulnar nerve compromise concomitant with carpal tunnel syndrome (CTS) has been cited by previous researches. It seems that the incidence previously mentioned is much higher than what we observe in our electrodiagnosis studies. Methods: A cross- sectional prospective study was designed to evaluate the incidence of ulnar nerve compromise in patients with electrodiagnostic evidence of CTS according to age and sex, and also to determine the site of ulnar nerve involvement. Results: 165 limbs with standard elestrodiagnostic criteria of CTS were evaluated. In 9.7% of the tested limbs, the ulnar nerve was involved. Regarding the site of involvement, in 43.75%, the site of the involvement was the wrist area. In 43.75 %, the elbow region was involved and in 12.5%, the forearm region was involved. The most prevalent age rane of concomitant involvement was 45-54 years old. In patients who had sensory symptoms in the 4th and 5th fingers, the incidence of concomitant ulnar nerve compromise was significantly higher (p<0.001) than the patients without these symptoms. Conclusions: In patients with CTS concomitant ulnar nerve compromise is much lower than the incidence mentioned in previous researches. Apparently the rate of involvement in wrist and elbow are equal. It is recommended that in evaluation of patients for CTS specially when the patient has sensory symptoms in the hand, special attention to be paid to ulnar nerve involvement and two nerve comparison tests be interpreted with caution.

Background: Scaphoid is the most common carpal bone to fracture, and non-union is the most common complication of scaphoid fracture. The vascularized bone grafting, based on pronator quadratus muscle for scaphoid non-union is an option for a more successful union. We would like to report our experience. Methods: In a descriptive study between 2003 and 2004, 11 patients with scaphoid nonunion were operated on with pronator quadratus vascularized bone graft. The mean age of the patients was 22.9 years (18-29) and the duration of non-union was 12.2 months (6-24). The patients were evaluated clinically and radiographically after 6 months. Results: Union was achieved in 10 out of 11 patients. The mean time to union was 12 weeks. The mean pain score in the patients with union was 3.8 before and 1 after surgery. Seven patients had no activity related pain and 3 others experienced minimal exertional pain. There was no instance of fixation failure or substantial loss of reduction. The mean final range of motion of the wrist was 19° extension, 15° flexion, 5° radial deviation and 10° ulnar deviation. Final assessment of pain relief, improved motion and increased wrist function was excellent in 5 patients, good in 3 and fair in 2 patients.Conclusions: Pronator quadratus vascularized bone graft is an effective method for treatment of scaphoid nonunion, leading to rapid union and good wrist function, although it is a bigger surgery and takes longer to perform.

Background: Introduction of the newest short-acting analgesic drugs for mtraoperative pain control and widespread acceptance of them in anesthesia practice, has made the postoperative pain control a new dilemma to anesthesiologist, especially in more painful surgical procedures (like orthopedic surgery). Opioid narcotics had been traditionally used for this purpose but because of their side effects scientists are still seaking for new analgesic agents with less side effects. Propacetamol-a prodrug of acetaminophen- is a new compound which has been studied for postoperative pain control. The aim of our study is to compare the analgesic effect of propacetamol and morphine in relieving postoperative pain after orthopedic surgery on lower extremity. Methods: We studied sixty patients ASA class I-II, aged between 15-55 years that were scheduled for elective open fixation of tibial fracture. Subjects were divided accidentally to two groups (I and 2). Technique of anesthesia was similar in all of them, Midazolam (0.03mg/kg) as premedication, Propofol (2mg/kg) and Remifentanil (1mg/kg) as induction agents and Atracorium (0.6mg/kg) for tracheal intubation. In the maintenance phase N2O-O2 (50%-50%), Propofol (100mg/kg/min) and Remifentanil (0.25-1 mg/kg/min) were used. Thirty minutes before the end of operation we administered Propacetamol (30mg/kg) in group 1 and morphine (0.1mg/kg) in group 2. After the end of surgery and extubation of patients the visual analog scale for postoperative pain evaluation was performed (every 15 minutes for one hour after extubation and then every 60 minutes for 5 hours). This evaluation was performed by a member of research team not involved in the study. Any patient complaining of pain, 0.05mg/kg of morphine was injected intravenously and if needed, the same dose was repeated every 20 minutes till the patient was free of pain. The total dose and the number of doses injected were recorded. Results: The data analysis showed that the pain relief in propacetamol group and the morphine group was not meaningful (Pvalue>0.05) as well as the total dose of rescue drug and the number of doses injected did not show a meaningful difference in the above groups (p value=0.75). Conclusions: Our study shows that although propacetamol 30mg/kg is not enough for postoperative pain relief following open fixation of tibia, but it can reduce 40% of total amount of intraoperative and postoperative morphine need till five hours after surgery.

Supracondylar humeral fractures can be associated with nerve injury, either at the time of fracture or as a result of treatment. Such nerve injuries often recover spontaneously. Late radial nerve problem from repeated traumatization by a protruding pin has not been previously reported. Exact pin length and removal of pin after fracture union could avoid the rare occurrence of nerve irritation by the sharp pin end.

Tendon rupture from non-penetrating trauma in healthy individuals is relatively uncommon. Multiple tendon rupture in the same setting is even rarer. We are reporting rupture of common digital extensor tendons in proximal forearm in association with closed single bone fracture of forearm.