IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2003 | Volume:2 | Issue:1 (5)|Papers Count:12

Background: Salter innominate osteotomy and open reduction for treatment of congenital dislocation of hip had been done frequently in Iran, but no report can be found regarding the outcome. This study was carried out to evaluate the radiographic results in patients with long-term follow up. Materials and Methods: The radiographs of 580 hips, all having undergone open reduction and Salter Osteotomy during a 28 years period were evaluated and classified according to Severin classification. The avascular necrosis was typed according to the Mac Ewen and Kalamchi classification. Results: Good and excellent result were seen in 88.4%, growth disturbance of proximal femur (avascular necrosis) was observed in 37.2%, (22.2% was type Ι, 25% type ΙΙ, 36.6% type ΙΙΙ and 16.2% type IV). Conclusion: According to the obtained data open reduction and Salter innominate osteotomy is an effective procedure in a proper age group.

Background: Spinal Canal Stenosis is a common lumbar spine problem above age 65. The pain due to degenerative change is a principle cause of workman compensation claims. To stop the insidious progression and disabling outcome early diagnosis and treatment is warranted. Materials and Methods: We carried out a retrospective review of 60 patients with lumbar spinal canal stenosis who had been treated surgically with undercutting fenestration laminotomy, and had been followed regularly. 50 cases were evaluated at a mean of 3.5 years (1-9 years) after surgery. The outcome was assessed using the scoring system of Louise and rating system of Prolo. Instability was determined according to the criteria described by White and Panjabi. Results: A significant decrease in low back pain and disability was seen. An excellent or good outcome was noted in 82% of patients, 6% showed secondary radiologic instability. Claudication disappeared in all patients and radicular pain was relieved in 94% of patients. Conclusion: Thus undercutting fenestration laminotomy is a safe and efficient procedure. When instability is suspected, instrurnented fusion is recommended.

Background: Spinal stenosis due to degenerative changes in ligamentum flavum and annulus fibrosus presenting with radicular symptoms and neurogenic claudication does not often respond well to conservative treatment. Good results are achieved by surgical intervention. The results of laminectomy performed in a univesity hospital are reported. Materials and Methods: 14 consecutive cases of degenerative lumbar stenosis without spondylolisthesis who underwent decompressive laminectomy were included in this study. Results: 7 males and 7 females, with age ranging from 24 to 81 years were evaluated. Low back pain was present in 13 and neurogenic claudication in 11 patients. All the cases achieved improvement in their symptoms shortly after surgery. Mild leg pain was, however, present in about 50 percent of the cases six months after surgery. Conclusion: Laminectomy is an effective intervention for degenerative spinal stenosis and early good results could be predicted in majority.

Background: Scheuermarnn kyphosis is relatively common among adolescents, and is often treated non surgically. There has been no documented report on brace treatment for this disease in our country. Materials and Methods: We have followed up the results of such treatment in an 8 years period in patients referring to our treatment centres in Isfahan, Iran. 273 patients with mean age of 14 (12-17) years having been treated with Milwaukee brace in an 8 year period were evaluated. 29 cases who had not worn their braces properly were excluded from the study. The group of 244 patients consisted of 139 males and 105 females. Results: 225 patients (92%) obtained normal dorsal kyphosis with brace treatment. 19 cases (8%) showed progression but not to the extent to require surgery. Among the 225 cases who improved with bracing, 35 patients showed progression within 4 months from discontinuation of brace. 35 cases required bracing again tin skeletal maturity. There were 21 male cases among these 35. Conclusion: Scheuerman kyphosis can be treated with brace in 92% of cases.

Background: Different methods have been used for reconstruction of post-traumatic osteochondral defects of knee. We report the long term results of fresh osteochondral allograft for such defects. Materials and Methods: Fresh osteochondral allografts were used for post traumatic knee defects larger than 3cm in diameter and 1 cm in depth. Harvesting of the graft was carried out within 24 hours of the donors' death. Implantation into the recipient was carried out within 72 hours. The grafts were unipolar, fixed by screws and combined with realignment osteotomy if a deformity was present. Meniscal transplantation was also performed when indicated. Results: The survivorship of all grafts in plateaus and condyles at 7.5 years was 85%. This surviorship for femoral condyle was 85% at 10 years. Viable hyaline cartilage was confirmed at 17 years Post surgery. Conclusion: Possibility of reconstrution of big defects (more than 3 cm) and absence of donor site morbidity as in autografts, favour the use of fresh allografts for knee osteoarticular defects.

Background: Treatment for the intra-articular distal radius fractures, despite the increase in the number of patients, and decrease in average age of involvement, is still a challenge for the orthopaedic surgeons. In this study, we try to show the results of a simple, practical and inexpensive method of treatment. This technique is particularly, useful in cases with financial restrains, as is often the case in our patients' population. Materials and Methods: In a prospective study 32 consecutive patients with intra-articular fractures of distal radius type ΙΙΙ and IV A, B universal classification were treated with multiple pinning from ulnar side (modified Rayhack technique). All the patients were followed for a minimum of 1 year. Results: 32 patients with distal radius fracture type ΙΙΙ and IV A, B were gathered. 2 patients were lost to follow up. The remaining 22 males (mean age 43.5 years) and 8 females (mean age 50 years) were followed and assessed clinically and radiographically. "ScheckGrading" System was used for evaluation. The outcome was 90% excellent and good, and 10% poor. We did not have any major complication. The main problem, however, was maintenance of supination and pronation. Conclusion: Considering the simplicity of the technique and availability of the device in all hospitals we recommend this technique in selected patients with intra-articular distal radius fracture.

Background: Rotator cuff disease is a significient cause of shoulder pain. Radiographic evaluation plays an important role in diagnosis of such an illness. In spite of advancement in imaging studies, the measurement of acromio humeral distance on good quality plain radiographs could give us a good clue about an intact or deficient cuff. Materials and Methods: The acromio humeral interval (AHI) was studied on standard radiographs in 3 groups of people in order to establish the change in measurements in diseased versus healthy shoulders. Group Ι: 200 shoulders, 50 males and 50 females with 200 normal shoulders, group ΙΙ: 25 males and 25 females with shoulder pain, group ΙΙΙ : 50 patients who had undergone rotator cuff surgery (33 full-thickness and 17 partial-thickness) between 1964 to 2003. Results: In group Ι: no relation was found between AHI and sex, hand dominancy or age. In group ΙΙ: The AHI measurement difference in symptomatic shoulders versus painless shoulders was significant. The shoulders with more than 2 months pain had lower AHI than the symptomless opposite sides (p<0.05). Group ΙΙΙ: a significant difference was observed, with full-thickness tears having lower values (p=0.0001). Conclusion: The measurement of acromio-humeral distance on specific standard radiograph would have 96 percent specificity and 90 persent sensitivity in diagnosis of rotator cuff tear.

Background: The current treatment of osteosarcoma, a primary malignant bone tumor, is wide or radical surgical excision. With neo-adjuvant chemotherapy such a treatrnent would bring about five-year survival of 70 pecent with chance of limb preservation in almost all cases. Materials and Methods: In a retrospective review of cases treated at oncology clilrics of Omid Hospital, 83 patients with primary or secondary osteosarcoma were identified. The demographic information, overall theraputic modalities and disease free survival were collected. The data were statistically analyzed. Results: The case who received neo-adjuvant chemothrapy before surgery had the best results: 23 patients were disease free in 2 years and II cases up to 5 years. In 54 percent of cases with 5 year disease free survival neoadjuvant chemothrapy had been used. Conclusion: The best managment for osteosarcoma after early diagnosis is neo-adjuvant chemotherapy combined with free margin surgical excision.

We present a case of Trans-scaphoid perilunate dislocation due to blast injury. Intra-operatively, we found multiple ruptures of flexor and extensor tendons at musculo-tendinous junctions. The patient was managed by two-stage reconstructive surgery. This unusual case represents the susceptibility of the musculo-tendinous area to sudden stress even in the absence of rematkable damage to adjacent soft tissues, which to our knowledge, has not been reported before.

Most rotational variations in young children, such as in-toening, and torticollis, are benign and resolve spontaneously. Understanding the normal variations in otherwise healthy children is vital to identifying true structural abnormalities that require intervention. A deliberate assessment of the rotational profile is necessary wben evaluating children who in-toe or out-toe. In-toeing is usually attributable to metatarsus adductus in the infant, internal tibial torsion in the toddler, and femoral anteversion in children younger than 10 years. Out-toeing patterns largely result from external rotation hip contracture, external tibial torsion, and external femoral torsion.