IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2007 | Volume:5 | Issue:2 (18)|Papers Count:10

Background: This study was intended to assess the total hospital cost of the patients with hip fractures (intertrochantric and femoral neck) in a teaching hospital. The aim was to show the financial burden on the patients and the society, and argue on the benefits of osteoporosis prophylaxis in order to decrease incidence of such fractures.Methods: The study was a chart review of 164 patients over 65 years of age with hip fractures hospitalized in Shariati hospital in a 3- year interval. The in-hospital expenses were calculated.Results: In 92 females and 72 males, the age range varied from 65 to 98 years. The average hospitalization period was 8 days. 85 patients spent an average of 2 days in the intensive care unit. The hospital cost for such person was 7.873.900 Rials (830 $US). The highest cost was 31.800.000 Rials, and the lowest, in a person who did not receive any operation, was 670.000 Rials. The total hospital expense in one year for hip fracture was 2000 million Rials.Conclusions: Personal and society costs are high for any hip fracture. Screening and treatment of osteoporosis may help to decrease this cost.

Background: Bracing is the most common non-operative treatment for idiopathic adolescent scoliosis. Milwaukee brace is the best- known orthosis for his purpose. We wish to report our results with the use of this brace in idiopathic scoliosis.Methods: In a retrospective study, among 681 who had been treated for idiopathic scoliosis from 1994 to 2004 in two hospitals in Tehran, 335 cases had received non- operative treatment with Milwaukee brace. The radiographs of these patients were reviewed to evaluate the treatment outcome. These patients, who were 12.1 years old on average and had received no other prior treatment, had started with 23 hours per day bracing and continued in accordance with Scoliosis Research Society (SRS) protocol.Results: Milwaukee brace reduced the cobb ankle from an average of 32.8 to 30.6 degrees. The brace had no appreciable effect on curves of upper thoracic, double or triple curves. Initial thoracic kyphosis had no effect on final bracing outcome. Curve progression, while in brace, was more commonly seen in association with Risser signs “0” to “1”. The best prognostic evidence in terms of control of progression was initial reduction of over 30 percent in curve magnitude in the first post- bracing visit. A reduction in curve magnitude of less than 17 percent after the first visit was associated with poor final outcome.Conclusions: Milwaukee brace can effectively reduce and control idiopathic scoliotic curves. However good patient selection and close follow- up is mandatory.

Background: Secondary hypertension in newborns and children may occur in many conditions including trauma and extremity fractures. This study was undertaken in two hospitals of Shiraz to determine the prevalence of hypertension among children undergoing orthopedic procedures.Methods: Sixty children (34 boys, 26 girls) aging 3-14 years old were cases of 7 clubfeet, 35 femoral fractures, 5 development dislocation of hip, 2 poliomyelitis, 3 pelvic fracture, 3 congenital short leg, and 5 miscellaneous conditions were studied in six month interval. Blood pressures were measured.Results: Hypertension was observed in 30 children in age groups of 3-14 years old from the second to fourth day after orthopaedic surgery, without any previous history of hypertension. Severe hypertension was demonstrated in 4 boys and 2 girls and returned to normal after changing of the traction angles and alignments of fixators. 24 cases had moderated increase in blood pressure that was normal on sixth post operative day. Femoral shaft fractures treated with skeletal traction, postsurgical casting of clubfoot deformities and leg- lengthening with external fixator were the top three causes of such findings.Conclusions: Secondary hypertension may happen among children undergoing orthopaedic procedures and needs careful monitoring.

Background: Soft tissue or bony injury especially fracture-dislocations can cause stiffness resulting in decrease finger and hand function. In this study dynamic traction was used for restoration of alignment and fixation of fractures.Methods: A cross- sectional study was done in a hospital in Isfahan. Eighteen patients with 10 forth finger. 5 fifth and 3 third finger injuries were treated with dynamic traction for fracture dislocation of proximal interphalangeal joints between 2001- 2006. Two fine k-wires were used- each on one side of the broken joint. Rubber bands were used to connect the pin and maintain traction on the fracture. All the fractures had involvement of more than 40% of articular surfaces. While active motion was started the next day, the fixator was left in place 4-6 weeks. The mean age of patients was 24 (18-39 years). They were assessed clinically and rediographically nine months (8-23 months) after surgery.Results: All the patients achieved union with an average joint motion of 92 degrees (82 to 98). Four patients had 10 degrees extension lag and 3 cases had 10 degrees of flexion contracture. Joint congruity was obtained all but two cases who have decrease in joint space.Conclusions: Dynamic traction with pins and robber band permit early motion with early soft tissue and bone healing in complex proximal interphalangeal joint finger.

Background: We evaluated the short term results of reconstruction of anterior cruciate ligament ruptures using a four strand hamstring autograft and cross pin femoral fixation.Methods: In a cross-sectional study 24 patients (1 female, 23 males) with mean age of 25 years (20-34) with chronic ACL ruptures were studied in a hospital in Urmia. The patients were treated with a four-strand hamstring autograft, cross pin femoral fixation (transfix) and an interference screw on the tibial side. Eight patients received simultaneous treatment for meniscal pathology. Final evaluation was performed 9 months after surgery, using simultaneous treatment for meniscal patholoty. Final evaluation was performed 9 months after surgery, using the Lysholm and tegner scales, radiographs and a simple arthrometer.Results: The Lysholm score was good or excellent in 22 petients, far in one and poor in one patient. Mean Lysholm score was 85.9. Tegner activity scores demonstrated that 16 patients had moved at least one level up, and the remaining cases stayed at their pre-operative level. Arthromeres showed a significant decrease in anterior tibial translation. Two patients developed septic arthritis one of whom required graft, pin and screw removal. Because of graft harvest failure, hamstring graft harvest failure, hamstring graft was taken from the contra lateral side in 2 patients.Conclusions: Reconstruction of ACL using four-strand hamstring tendons and cross pin femoral fixation results in considerably high success rate in short term. Infection and graft harvest failure are the major complications.

Background: Lacerations of flexor tendons are among the common soft tissue injuries of upper limb, which are often caused by broken glass, or other penetrating wounds. The aim of this study is to report the treatment outcome of such injures in zone V.Methods: In a 14- month period, 30 consecutive cases of flexor tendon laceration in zone V that were repaired by a modified Kessler technique in Ahvaz teaching centers were prospectively followed with a minimum follow-up of six months. The cases were assessed by Buck-Gramcko scoring system.Results: 120 finger flexor tendons, consisting of 18 thumbs and 102 fingers were repaired. The patients had a mean age of 23 years, and each patient had a mean number of 4 tendons repaired. The functional results were excellent in 85 (70.62%), good in 6 (5.28%) and poor in 29 (24.1%) fingers. Seventeen patients could return to their original occupation.Conclusions: Repair of zone V flexor tendon injury in our hand had satisfactory results in only 76 percent of cases, and resulted in inability to return to pre-injury occupation in about half of the cases.

Traumatic hip dislocation is rare in children. Ligamentous laxity is often a reason for this occurrence usually with a minor trauma.

Proximal bumerus fractures- a common occurrence in elderly- comprise 4-5% of skeletal fractures. Twenty percent of such fractures require surgical treatment.Presence of painful movement at fracture site, 2-3 months after treatment, is called non- union. “Malunion” is the name given to a fracture with over 40 degrees rotation and or angulations or more than 10 millimeters displacement. The fracture pattern, age and personality of the patient and previously rendered treatment are the elements which determine the occurrence of malunion or nonunion.Good clinical evaluation, high quality standard radiographs and other imaging modalities like computerized tomography are mandatory for a successful treatment plan. Painful, limited range of motion fixation and bone grafting of a nonunion or osteotomy for malunion should be individualized according to patient’s complaint and functional demands.The results of implant arthroplasty are better for acute fracture than old healed malunions or nonunion. Prevention of non- nuion or malunion is superior to secondary reconstructive surgeries; and reconstruction outcome is dependent on meticulous planning and technique and patient selection.