IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2005 | Volume:4 | Issue:3 (11)|Papers Count:9

Wrist involvement is common in patients with rheumatoid arthritis. Individual patient assessment is important in determining functional deficits and treatment goals. Patients with persistent disease despite aggressive medical management are candidates for surgery. Soft-tissue procedures offer good symptomatic relief and functional improvement in short term. Extensor and flexor tendons may rupture because of synovial infiltration and bony irritation. When rupture occurs, direct repair usually is not possible. However, when joints that are motored by the ruptured tendon are still functional, tendon transfer or grafting may be considered. Because of the progressive nature of the disease, dislocation and end-stage arthritis often require stabilization with bony procedures. The distal radioulnar joint is usually affected first and is commonly treated with either the Darrach or the Sauvé-Kapandji procedure. Partial wrist fusion offers a compromise between achieving stability of the affected radiocarpal joint and maintaining motion at the midcarpal joint. For pancarpal arthritis, total wrist fusion offers reliable pain relief at the cost of motion. Total wrist arthroplasty is an alternative that preserves motion; however, the outcomes of total wrist replacement are still being evaluated.

Background: Knowledge of the lumbar spinal canal diameters in different age groups and gender; in our community; is a useful and important parameter; which help to diagnose the abnormal cases. Ultrasound for this purpose is a noninvasive, simple, reliable and safe method. The purpose of this study was to evaluate the accuracy of ultrasound measurement of lumber spinal canal diameters in different age groups in comparison with MRI. Method: This was a case series study on 100 patients (45 females and 55 males); during a one year period. The cases were selected from the patients who were referred for lumber MRI to one of the teaching hospitals. Results: The mean sagital and coronal diameters of neural canal at L4-L5 disc space level with ultrasound were 11.7±2 and 15.9±2, and MRI values were 11.9±2 and 16.3±2 millimeters respectively. The mean sagital and coronal diamteres at L5-S1 level with ultrasound were 11.7±2 and 16.1±2 and with MRI were 12±2 and 16.7±2 respectively. The procedure was more reliable in thinner patients. Conclusions: Sonographic evaluation and measurement of the spinal canal is possible, and the diameters by ultrasound are about 1-2 millimeters less than the measurements done by MRI with 90-95 percent accuracy.

Background: The anatomical variations of the tendons of hand are well known but their prevalence is not the same among different races. In most textbooks, palmaris longus (PL) absence is reported to be 15%, with a lower rate for Asians compare to Europeans. The 5th finger flexor digitorum sublimes (FDS) tendon is also absent in nearly 20% of humans. There is no report of the anatomical variations of the tendons of hand in Iran, and we would like to report our findings in this matter.Method: Between October 2002 and October 2004, 417 medical students were examined. The presence of PL and 5th finger FDS tendons and the relationship between these two were recorded.Results: The PL tendon in 21% and the 5th FDS in 8.4% were absent. There was no statistically significant difference between the genders and hand dominancy.Conclusions: The rate of absence of PL is the same as Europeans. Due to presence of 5th FDS tendon in a high number of people, it may be a useful tendon to be used for transfer.

Background: Despite good results of Salter's innominate osteotomy in treatment of congenital dislocation of the hip, there are some failures including limb lengthening and are pressure effect on the hip joint. A few modifications of this procedure have developed in time. The present paper is a report on one such modification the objective is to compare the effect of Salter's innominate osteotomy with a modified posterior wedge osteotomy on the sacroiliac joint in patients with congenital dislocation/dysplasia of the hip. Methods: The radiographs of 62 cases of developmental dislocation of hip (DDH), who had undergone innominate ostetomies-31 classic Salter's and 31 modified posterior wedge osteotomy- were evaluated. The post operative epsilateral SI joint widening was compared with non-operated site to determine the possible stress effect of osteotomy on sacroiliac joint. Results: On the operated side, there was more than 1 mm widening (2-4 mm) in 20 of 31 cases in Classic osteotomy group compared with 9 of 31 cases in modified group post-operatively. There was no significant correlation between original height of dislocation, age and rate of acetanbular index correction with postoperative widening of the sacroiliac joint. Conclusions: These findings suggest that Salter's innominate osteotomy may create pressure on the inferior part of the sacroiliac joint, resulting in some displacement which may be avoided by the modified method.

Background: Little controversy exists on the indication for reconstruction in anterior cruciate ligament (ACL) tears. The question is what graft is the best and whether specific cultural needs of a population may affect the type of graft selected. Methods: This was a controlled trial study on 79 constructive patients who were randomly treated either with 4-surand hamstring (HTG) or bone patellar tendon bone graft (BPTB). All the cases were evaluated by Lysholm score, Tegner activity score (TAS) and IKDC grade. Relative anterior tibial displacement was calculated; using knee arthrometer. Results: 43 patients from BPTB group and 36 patients from HTG group with mean age of 28.8 (17-43) fulfilled the criteria of the study. Mean follow-up time was 12.5 months (6-50) and was similar in both groups. The pre-operative findings (age, pre-operative activity level, prevalence of associated meniscal and chondral injuries, pre-operative Lysholm and TAS) were similar. The mean pre-operative Lysholm score was 64.4 (BPTB) and 56.2 (HTG). Pre-op TAS was 2 (BPTB) and 2.7 (HTG). Post-operative mean Lysholm score was 87.5 (BPTB) and 91.7 (HTG). Post-op, more than 50% in each group were either IKDC A or B. There was no significant difference between 2 groups in this regard. No difference between the two groups was observed regarding anterior knee laxity or anterior knee pain. Conclusions: With a 12 month follow-u no significant difference in outcome was found in patients who underwent ACL reconstruction in this patient population using either BPTB or HTG.

Background: Treatment of comminuted fractures of long bongs has been a problem in orthopaedic surgery. Recently fixation with out opening the fracture site, known as biological fixation has been used. We performed this study to assess the results, and rate of complications of this treatment for comminuted fractures of the tibia and femur in our institution. Methods: Twenty patients, referred to two teaching hospitals, who has comminuted fractures of Femur (15 patients) or tibia (5 patients), not suitable for fixation with closed intramedullary nailing, were treated with biological fixation method. Two patients with femoral fracture, had type IIIA open fractures and two patients with tibial fracture had type II open fractures. The rest of the cases (16 patients) had closed fractures. After biological fixation, patients started range of motion of the joints, but avoided weight bearing until radiographic evidence of union. Results: All the patients had union of fractures with mean time to union of 5.5 months for femoral and 7.5 months for tibial fractures. One of the femoral fractures had shortening of 1 cm and another one, had implant failure due to early weight bearing. There was no infection in closed fractures, but two patients with open fractures developed infection. None of them had limitation in joint motion. Conclusions: Biological plating method is a safe, simple and effective method of fixation for closed comminuted fractures of long bones. It has a high rate of union with minimal complication. It is not recommended for open fractures because of high infection rate.

Background: Questionnaires are well accepted for outcome measurements, but they must be reliable, valid, internally consistent, and sensitive to clinical changes. In this study Levine outcome questionnaire for carpal tunnel syndrome are translated to Farsi and its properties are evaluated. Methods: The “Levin” outcome questionnaire was utilized in 35 cases of bilateral idiopathic carpal tunnel syndrome. These cases, from a one year period, were tested by this questionnaire prospectively and 6 months post surgery. Reliability, validity, internal consistency and sensitivity to clinical change were evaluated for this translated questionnaire and were compared with clinical and electrodiagnostic assessments. Results: Thirty five women with 46.6±9.8 years of age who had a mean duration of symptoms of 4.1±4 years were assessed. Reliability, sensitivity to clinical change and internal consistency for “symptom severity” score were respectively 0.853, 2.35, 0.94. The same parameters for “functional severity” score were 0.86, 1.7, and 0.96 respectively. Scores of the questionnaires correlated with objective findings and electrodiagnosis. Phalen test also had positive correlation with electrodiagnosis. There fore in both questionnaires the reliability was good, sensitivity and internal consistency were excellent. Conclusions: The translated questionnaires are valid, reliable, sensitive to clinical change and internally consistent. Its use is recommended for researchers who like to use a validated tool with reasonable precision for carpal tunnel surgery.

Leg amputation of the lower extremity is unusual. In the present case no pressure sore is seen. Range of motion of the ankle joint is normal. The patient can walk and run without any support.

Shoulder replacement Surgery had been popular since 1950. This special procedure is recommended for significant pain and/or functional impairment. Patient's ultimate demand and his/her understanding of terms and precautions, and disciplinary rehabilitation are essential point in decision-making process of shoulder arthroplasty. Pre operative conventional radiographs, CT scan and MRI are useful tools in choosing the correct surgical technique. This surgery depending on patient's general condition and status of other joints is indicated for osteoarthritis, rheumatoid arthritis osteonecrosis, fractures, fracture dislocations and locked dislocations. Familiarity with the anatomy and required special instruments is necessary for a successful surgery. Attention to details of bone-loss, osteonecrosis muscle balancing, use of special guides and jigs and also proper cementing techniques are all important issues to be addressed in each individual cases in order to avoid complications and obtain long-term satisfactory results.