IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2004 | Volume:2 | Issue:2 (6)|Papers Count:12

Background: This is a descriptive analysis, performed on victims of Iran's December 2003 Bam earthquake that were referred to tertiary referral trauma management centers in Tehran.Materials and Methods: 210 patients were included in this study. Associated musculoskeletal injuries and renal function of the patients were studied.Results: The mean time under rubble was 1.9 hours with a mean rescue-first medicaid time (transfer time from field to hospital) 13.5 hours. We had 19 cases of compartment syndrome out of whom 6.7% had impaired renal function. The incidence of compartment syndrome had a direct relation to the under rubble and the incidence of renal failure was directly related to rescue-first medicaid time. Axial skeleton fractures, among them the lateral compression type pelvic fractures, were specifically common. Fracture associated neural injuries were noticeably more common.Conclusion: Installment of renal protective protocols from the implication of more conservative approaches in treatment of fractures and also more training by rescue team, are strongly recommended.

Background: Anterior cruciate ligament (ACL) tear is the most common ligamentous injury of knee in athletes. This is often accompanied with meniscal tear. In recent years, there had been more tendencies towards ACL reconstruction, even in cases of irreparable menisci. The study of patients who have had combined ACL and meniscus injury and have not had ligament reconstruction is warranted.Materials and Methods: 46 patients who had sustained both meniscus and ACL tears, and had been only treated by meniscectomy were studied with an average follow up of 10 years. The Lysholm Tenger and IKDC systems were used for assessment. Results: At the end of this intermediate-term follow up the Lysholm score was 84. The average Tenger activity level of 7.24 pre-injury had fallen to 4.71 in the last visit, the subjective IKDC scores was 73.5 on average. The objective IKDC score was D (severely abnormal) in 67%, C (abnormal) in 28%, B (near normal) in 4%. No one had A (normal) score, In spite of increased activity level post meniscectomy no patient experienced increased instability subjectively in presence, the patients did not have any major complaint and were happy with their knee.Conclusion: The knee with meniscectomy in presence of ACL tear did not have good functional outcome scores. The excision of torn part of meniscus, however, did not seem to increase the instability symptoms. The patients who can modify their sport activities and do not experience" giving way" symptoms would do well for at least 10 years without need for ligament reconstruction.We still recommend ACL reconstruction in those with irreparable meniscus tear, with uncontrollable giving way, or those who do not want to modify their activity level.

Background: Paralysis of quadriceps femoris is a disabling ailment observed in some of the neuromuscular diseases- poliomyelitis in particular. The resultant gait abnormality, and functional incapacity can be remedied by tendon transfer. Transfer of powerful hamstrings to quadriceps femoris could improve the limp, speed and quality of walking.Materials and Methods: 15 consecutive cases of poliomyelitis who underwent hamstring tendon transfer to paralized quadriceps femoris were studied. The change in gait pattern, and relief from use of walking aids or brace as well as patients' satisfaction were analyzed through a detailed scoring system.Results: In an average follow up of 48 months, 13.5% excellent, 73% good and 13.5% fair results were obtained. Significant improvement in gait pattern, relief from brace use or hand-on-thigh ambulation was observed in all cases. A mean extension lag of 300 degrees was observed in patients examined in sitting position. Lack of active terminal knee flexion, prohibiting comfortable floor sitting was the main complaint which was observed in four patients.Conclusion: Quadriceps paralysis can be managed effectively by transferring the hamstrings in presence of good triceps surae and gluteus maximus.

Background: Anterior knee pain is a common complaint in orthopaedic patients, and patellar malaignment is a fragment cause of this ailment. Severe malaignment would result into subluxation and dislocation of patella: The result of surgical treatment with proximal and distal realignment (P/D-R) for such a pathology, performed in sadoghee and AI-Zahra hospitals (in Esfahan) from 1994 to 1999 is reported in this article.Materials and Methods: A cross-sectional study of 26 cases, who had patellar instability and had undergone P/D-R during a five year period (1944-1999) in two of the hospital in Esfahan, was performed. These cases had all failed the initial conservative treatment. The cases were evaluated after 2-7ycars. Results of surgery were analyzed in term of subjective relief of symptoms, and objective evaluation of quadriceps power, knee motion, as well as radiographic signs of knee degeneration, Patellar subluxation, Patella alta or intra.Results: There were 4 male and 22 female patients, with average age of 28 years. 30 knees had received the index operation - 16 (53%) right and 14 (47%) left side. The result of surgery was good in 28 (94%) and poor in 2 knees. 20 patients (71%) had normal radiographs, 5 cases (I 8%) had evidence of mild and 2 cases severe degeneration. Patellar intra was also observed in one knee.Conclusion: Proximal and distal realignment surgery for cases of patellar instability non-responsive to conservative treatment, is associated with high rate of success.

Background: Osteoarthritis of knee joint produces significant functional disability. Pain is a prominent feature. It has been suggested that increased intraosseous pressure is a cause of pain and may be responsible for production of subchondral bone. Making multiple holes into the subchondral dense bone could, therefore, decrease pain and improve function. A study was designed to test this assumptions.Materials and Methods: 50 patients with knee osteoarthritis of knee who had consecutively referred to Baghiattalah hospital were randomly divided into two groups for management. 21 patients were treated by percutaneous subchondral drilling of osteoarthritic areas and 29 were treated by conservative management. The change in pain pattern functional status of the knee and knee rang of motion was then studied one week, two weeks, six weeks and 12 weeks after treatment.Results: From surgical group only 8 cases had improvement in their pain, and 13 obtained no benefit. 5 patients developed minor complications from surgery. The pain and limitation of motion continued in a high percentage of surgically treated cases up to 12 weeks.The nonsurgical patients had better pain relief and improvement in their range of motion in successive visits compared to the first group.Conclusion: Subchondral percutaneous drilling for knee osteoarthritis either cannot decrease intraosseous pressure or in creased pressure is not the cause for osteoarthritic knee pain.

Background: Simultaneous knee ligament injury with femoral shaft fracture happens not infrequently such injuries could be missed on original evaluation of the broken limb. We are reporting the prevalence of such occurrence in a group of isolated femur fractures.Materials and Methods: 63 cases of isolated femur fractures were entered month period. All these cases had a through examination of knee ligaments following internal fixation of their femur fractures.Results: Among the 110 cases 80.6 percent were male. Their average age was 28.2 years and 69.3 percent were involved in motorcycle accident. 16 cases (25.8%) of ligamentous injury was observed which included 8 patients (12.9%) with medial collateral ligament (MCL) 5 (8.6%) posterior cruciate ligament (PCL) 2 (3.2%) lateral collateral ligament (LCL) and one (1.6%) anterior cruciate ligament (ACL) tear.Conclusion: Femoral shaft fructures, even in isolation are associated with high risk of ipisilateral knee ligament injuries. This is an important fact to remember when dealing with such fractures.

Background: Lumbar disc herniation is one of the common causes of low back pain in the third or fourth decade of life. Thorough clinical evaluation is the best method for diagnosis and localization of level of pathology. Paraclinical tests, including MRI are commonly used for confirmation of diagnosis and even in decision-making about treatment. MRI is, however, a very sensitive imaging study and its value as a primary diagnostic test is questionable. We have, therefore, decided to study the importance of obtaining MRI in suspected cases of lumbar disc herniations.Material and Methods: In a 21/2 years period, all the cases who had been referred to our center as candidates for disc-hemiation surgery, were evahiated. A total of 110 patients who had MRI study were enrolled into this study. The correlation of MRI findings with patients clinical evaluation, and response to treatment was studied.Results: In 35 of 110 cases, the MRI findings matched their clinical evaluation. 40 cases (36.4%) had inadequate signs and symptoms of disc herniation but positive MRI for such a pathology. 5 cases (4.5%) had lumbar disc herniation clinically while MRI was negative. 3 patients not only had evidence for disc herniation clinically which matched the MRI findings, but also had abnormalities in other levels.Conclusions: Diagnosis of lumbar disc herniation is best done on clinical grounds MRI is only useful to confirm the clinical diagnosis. A positive MRI without sufficient clinical evidence should never be used to plan surgery.

Background: Supracondylar fractures of humerus are the most common fractures around elbow in children. Type III supracondylar fractures often need surgical treatment. Cubitus varus deformity is one of the complications of such of fracture which does not, spontaneously correct. Some investigators believe that type III fractures, whether treated closed of with internal fixation, should be immobilized in pronation to avoid varus deformity. The present investigation is aimed at testing this belief.Materials and Methods: Out of 84 type III supracondylar, humerus fractures who had been treated by open reduction and internal fixation over a 2 year period in our center (Ahvaz hospitals), 27 participated in this study. These patients were all immobilized in supination or neutral position after surgery. On an average follow up of 40 weeks the cases were evaluated clinically and radiographically and comparison made with the opposite elbow. Results: In all cases except one who had cubitus valgus the carrying angles were equal to the healthy elbow. No difference between Bowmann, ulnohumeral or metaphysiodiaphyseal angles was observed between the affected elbows with the normal opposite sides.Conclusion: The most important factor, determining development of cubitus varus or valgus is accurate reduction and stable fixation. Position of forearm after such reduction does not affect the results as for as deformity is concerned.

Presenting case was a 55 years old man with left foot pain. In history there was trauma in left foot and the patient underwent short leg casting because of suspicious to medial cuneiform fracture. In rontgenograghy there were lytic lesions in medial and middle cunciforms, first metatarsus and navicular bones. The reports of MRI and bone scan were a benign aggressive tumor. Biopsy was taken and the result was clear cell carcinoma with renal origin. After radical nephrectomy and debulking of tumor, patient is free of sign and symptoms for almost one year.

Wear debris of polyethylene (PE) is the main factor causing osteolysis and loosening. Wear depends both on intrinsic characteristics of the PE and on the extrinsic conditions. The extrinsic conditions are the forces acting on the material, the prosthetic design and the other constituents of the prosthesis. Early diagnosis of osteolysis is important to ensure easier revision surgery and more reliable results.The intrinsic characteristics are a result of the nature of the polymer resin (especially its molecular weight); the mode of manufacture sterilization method.The role that particulate polyethylene debris plays in loosening of total joint prostheses has come under increasing scrutiny.Despite these problems, polyethylene remains a super material for orthpaedic implants and is unlikely to be replaced by any new or better polymer in the near future. However, improvements in the polyethylene itself and in the design of components are necessary to decrease wear debris. Cross-linked UHMWPE (Ultra High Molecular Weight Polyethylenc) has been recently approved by FDA for use in orthopaedic implants. The majority of commercially available UHMWPE orthopaedic components are cross-linked using gamma radiation.