IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2011 | Volume:9 | Issue:1 (34)|Papers Count:9

Background: The tibial plate with tibial pro-fibular screws is adapted to treat distal tibial fractures, in elderly osteoporotic patients in the presence of insufficient bone stock for screw grip, and in young individuals when separate fixation of tibia and fibula with two incisions carries the risk of soft tissue damage.Methods: In a retrospective study, 15 distal tibia and fibula fractures in 14 patients were treated with tibial profibular screw/plate fixation in a period of 6 year in two hospitals in Urmia-Iran. The cases were evaluated using the AOFAS scoring system. The mean time of follow-up was 28 months.Results: All the fractured had uneventful union. Tibio-fibular synostosis occurred in 2 patients. The AOFAS scores were good (80-90 in points) in 7, and acceptable (70-80 points) in remaining 7 patients. No patient had gait or any walking problem.Conclusion: Fixation of comminuted distal tibia and fibular fractures with tibial pro fibular fixation in selective cases with osteoporosis or poor skin condition is a useful technique.

Background: The role of increased posterior tibial slope in rupture of the anterior cruciate ligament (ACL) is controversial. The purpose of current study was to determine the effect of posterior slope on the ACL injury.Methods: In a case control study, 61 consecutive cases with ACL injury, who were candidates for reconstruction, were compared with 61 persons with normal knees who were matched for age and sex, over a 2-year period at a teaching hospital in Tehran, Iran. The posterior tibial slope angles were measured on true lateral radiographs on all the cases. The measurement variations were analyzed between the two groups.Results: The mean posterior tibial slope was 9.4±1.8 degrees in controls and 12.3±4.4 in patients with ruptured ACL (p<.001). The incidence of tibial slope greater than 10 degrees in patients with ruptured ACL was 3.1 times greater than that of the controls.Conclusion: This study suggests that increased tibial slope angle may contribute to increased risk for ACL rupture.

Background: The purpose of clinical examination is to make a correct diagnosis. There are several clinical tests with different diagnostic values for meniscus injuries. The aim of the present study was to evaluate the diagnostic value of modified "axial loading McMurray test".Methods: In a cross sectional diagnostic study, 146 patients (120 male, 26 female) with a mean age of 35 years who had clinical symptoms of knee meniscus injury and were candidates for arthroscopic evaluation entered the study in a teaching hospital in Guilan-Iran. "Axial loading Mc Murray – ALMM" test was performed in all the cases just before doing arthroscopic evaluation of the knees. The accuracy, sensitivity, specificity, positive and negative predictive values of the ALMM in relation to the later arthroscopic findings were analyzed.Results: From the 146 patients, 92 had evidence of meniscus tear on ALMM testing. The arthroscopy was, however, positive in 82 patients. In the remaining 54 cases with negative ALMM test, 38 patients had meniscus tear at arthroscopy.56% of tears were seen in medial meniscus, 75% of which were in posterior horn. The ALMM test had 67.1% accuracy, 68.3% sensitivity, 61.5% specificity, 89.1% predictive positive value and 29.6% negative predictive value.Conclusion: Positive "Axial loading Mc Murray" for knee meniscus injury is expected to show meniscal tear in 89% of cases.

Background: The prevalence of Palmaris longus agenesis (PLA) has been variously reported to be from 1.5% to 64% in different ethnic groups. Finding the state of PLA among Iranian people was the aim of this study.Methods: 1008 participants were included in this descriptive study during a 6-month period in a teaching hospital in Tehran-Iran. The Schaeffer test was used to detect the presence or absence of Palmaris longus. The role of gender and handedness was also assessed in PLA.Results: The prevalence of PLA was estimated at 22.8% - 10.2% agenesis on the right side, 5.9% on left side and 6.7% on both sides. The relationship between PLA and gender didn’t appear to be significant. Right handedness was seen in 90.9% of cases with PLA and 72.5% of those without PLA (p=.000, OR=3.8).Conclusion: The prevalence of PLA in Iranian people studied, were comparable to the average Caucasian values in the literature.

Background: Arthroscopic reconstruction of the anterior cruciate ligament is one the most common orthopedic surgeries. There are scattered reports about the beneficial effects of post-operative cox2-inhibitors administration on knee motion. The purpose of the current study was to determine the effects of cox-2 inhibitor on pain, range of motion and weight bearing after arthroscopic reconstruction of the anterior cruciate ligament.Methods: In this clinical trial, 70 patients who underwent arthroscopic reconstruction of the anterior cruciate ligament were assessed in a teaching hospital in Tehran-Iran. They were divided into case (cox2-inhibitor) and control groups.Postoperatively, pain, inflammation, range of motion and ability for full weight bearing were measured.Results: The mean of pain at the postoperative day 3 was 5.3±1.04 (visual analogs scale of 0 to 10) in the control and 3.3±0.71 in the case group.29.6% of the patients in the control group and 82.8% in the case group were able to flex the knee more than 90o one week postoperatively. In the first week, all of the patients in the case group and only 28.6% in the control group were able to walk without any assistive device. The post-operative knee circumstances were 2.73±0.59 and l.61±0.92 centimeters smaller respectively in case and control groups. Statistical analysis showed significant differences between the two groups, in the above measurements.Conclusion: Cox-2 inhibitor is effective in relieving pain; reducing the inflammation, and accelerating the rehabilitation program after arthroscopic reconstruction of the anterior cruciate ligament.

Background: In massive irreparable shoulder rotator cuff tears in older patients, an alternative surgery is debridement of sub acromial bursa, biceps tendon and tuberoplasty. This is a short-term report of such a treatment performed arthroscopically in a small group of patients.Methods: In a prospective study, in a 2 year interval, 8 patients with massive irreparable rotator cuff tear with mean age of 65 (60-75) underwent arthroscopic debridement of necrotic rotator cuff tendon remnants and tuberoplasty without coracoaromial ligament excision. The sign and symptoms of patients before and after surgery were evaluated with modified UCLA score.Results: With a mean follow-up of 12 months (6-18 months), the modified UCLA score improved from 9.2 to 27.5. In 7 patients, pain and range of motion improved to near normal and 6 cases obtained near normal function.Although the acromiohumeral distance decreased from 5 to 4 millimeters and slight increase in degenerative changes was observed, the functional outcome was good.Conclusion: This simple arthroscopic procedure is recommended in massive irreparable rotator cuff tear especially in elderly patients.

Traumatic hip dislocation represents an orthopedic emergency. Given the severity of associated complications, every effort should be made to ensure prompt diagnosis and treatment. Bilateral traumatic dislocation of the hip is rare and simultaneous asymmetric traumatic dislocation even more unusual. This is a report on 17-year-old male patient with asymmetric bilateral dislocation of the hip joint with no bony fracture, following a motor-cycle accident. The right hip was reduced by closed manipulation, but the left hip required open reduction through a posterior approach. After 3 months there was a local osteoporosis in left hip which had an anterior dislocation initially.

The path mechanisms of secondary osteoarthritis (OA) of the hip such as avascular necrosis (AVN), posttraumatic OA, infection, and hip dysplasia were widely known.However, until the introduction of the theory of femoroacetabular impingement (FAI) syndrome by Ganz et al the exact pathogenesis for early onset idiopathic OA in hips without dysplasia was covered. They described the clinical, radiographic and intraoperative findings of this syndrome. From the advent of this topic a surge in the number of the published articles regarding the various aspects of FAI has appeared. This cleanly reveals its clinical importance. Today most physicians believe that untreated impingement or nonsurgical treatment leads to early OA, whereas the optimal surgical treatment would basically hamper or postpone the need for hip replacement.FAI initiates from abutment of the femoral head-neck junction with acetabular-labral complex due to the morphologic deformities of femoral head or acetabulum.Any developmental, posttraumatic or surgically induced deformity can alter the normal anatomic shape of the femoroacetabular unit and then this deformity elicits the impingement in the terminal range of hip motion. New evidences show that in young active patients, subtle morphologic deviations affecting the proximal femur and/or the acetabulum are the most common causes of FAI.