IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2008 | Volume:6 | Issue:4-A (25)|Papers Count:8

Background: Magnetic Resonance Imaging (MRI) of the knee joint has often been regarded as the noninvasive alternative to diagnostic arthroscopy. New technology, however, masks the importance of history and physical examination. This study aims at evaluating the accuracy of physical examination and MRI scanning in diagnosis of knee injury, including meniscal tears and cruciate ligaments ruptures.Methods: In a cross-sectional, analytic-descriptive study, 120 patients (108 males, 12 females) with knee injury who were candidates for arthroscopy were recruited in a Hospital in Tabriz during a one-year period. Prior history of arthroscopy or knee surgery was considered as exclusion criteria. A complete history and physical examination was performed and diagnosis was documented before looking at the MRI results. The final arthroscopic diagnosis was then compared with clinical and MRI studies.Results: 120 knee injury cases with a mean age of 29 (16-54) years were enrolled. Accuracy, sensitivity and specificity of clinical examination was respectively 85, 94.8 and 75.8 percent for medial meniscus, 85, 70.8 and 88.5 percent for lateral meniscus, 95.8, 98.6 and 91.7 percent for anterior cruciate ligament and 100 percent for posterior cruciate injuries. Accuracy, sensitivity and specificity of MRI were respectively 77.5, 84.2 and 71.4 percent for medial meniscal. 85.8, 56.5 and 92.8 percent for lateral meniscal, 92.5, 98.6 and 83.3 percent for anterior cruciate, and 100 percent for posterior cruciate injuries. Overall, in isolated injuries, the accuracy of clinical examination was relatively better than MRI in complex injuries, while MRI had higher accuracy in complex intra-articular injuries. Conclusion: According to our results, both physical examination and MRI scanning are very sensitive and accurate in diagnosis of knee injuries, with a slight preference of physical examination. MRI should be reserved for doubtful or complex injuries.

Background: Mechanical articulated devices can replace the intervertebral disc in patients with chronic back degenerated pain. We would like to report our short-term experience with a disc prosthesis in a small group of L5-S1 disc degeneration. Methods: In a cohort study, 21 consecutive patients (17 males, 4 females) with degenerative L5-S1 disc disease with over 6 months history of disabling back symptoms non-responsive to conservative treatment were treated by disc prosthesis. The mean age was 36±5.7 years (22-48 years) at surgery and the average follow-up was 11 months (13-24 months). The cases were evaluated by visual analogue scale (VAS) for pain, Oswestry disability index (ODI) for disability, and also for personal satisfaction at 3, 6, 12 and 24 months post surgery. Results: Early improvement with pain control and return to function were seen in all patients (p<0.05). The improvement in later follow-ups was not statistically significant. The rate of satisfaction was 86 percent, and 81% drop in analgesic use was reported by the patients. No complication was encountered in this group. Conclusion: Disc arthroplasty in degenerated L5-S1 is a reasonable alternative to fusion surgery. In short-term, has a good success rate, without any major side effect.

Background: Hand injury is the most frequent body injury, requiring long duration of treatment with great cost to any community. The aim of this study is to review the epidemiology of such an organ in a teaching unit in Tehran, Iran.Methods: Between a period of one year, 2042 patients were treated for hand injuries in a referral center for hand injuries in Tehran. Age, sex, cause and place of injury, mechanism and type of trauma, traumatized structures, duration of admission, type of treatment and type of insurance were evaluated.Results: 2042 patients (89.3% male, 10.7% female) referred to this hospital with hand injury. The average age was 26.8±11.9 years. The predominant group was industrial workers (65.6%). Men were mostly injured by mechanical instruments and women by glass cuts. Children were more commonly injured by door closing on their fingers or cut by glass. Bony fractures were seen in 34.7% of the cases. Tendon and nerve were the most common structures injured. The majority of injuries were sharp lacerations. The mean hospital stay was 1.33 days (1-49 days). 58.36% of the cases have insurance coverage admission.Conclusion: hand injuries are seen more commonly in men, in particular industrial workers. Tendon and nerve injuries are most common afflicted and one third of cases have bony injuries.

Background: Fractures of distal radius are common injuries. Unstable distal radius fractures present a challenge to the treating orthopaedic surgeon. One of the therapeutic methods is Ilizarov hybrid external fixator. In this study short-term result of this method in a small group is reported.Methods: 18 consecutive patients with unstable fracture of distal radius were treated with non-bridging hybrid Ilizarov external fixator for 7 weeks. Clinical and radiological evaluation was performed at one and 7 days, and at 6 weeks and 6 months after surgery.Results: All fractures united but anatomic reduction was achieved in only 16 cases (90%). The achieved range of motion was: 80% flexion, 85% extension and 90% supination and pronation. Compared to the normal side, no extensor tendon injury and tendonitis of pin loosening occurred. Only 5 mild pin track infection was observed that resolved by findings of oral antibiotic therapy.Conclusion: The technique of hybrid non bridging external fixator is safe and reliable option method for unstable intra and extra-articular distal radius fractures. It permits free wrist motion during treatment preventing joint stiffness.

Background: Medial opening-wedge valgus high tibial osteotomy has gained popularity. However, the reported complication rate is high. The technique has been modified to remedy the problems of patellar descent and alteration in angle of the inclination of the tibial plateau and delayed union. Our aim is to compare the modified retrotubercle openingwedge osteotomy with the conventional technique.Methods: In a clinical trial study, 72 consecutive patients with varus knees who were candidates for high tibial valgus osteotomy were, randomly treated with either conventional medial opening-wedge upper tibial osteotomies (34 patients) or retrotubercle opening-wedge osteotomies (38 patients) from Feb 2006 to Feb 2008. These matched cases were evaluated for patellar height and upper tibial slope as well as tibial inclination measurements. The intra and inter-observer reliability of the radiographic measures were also assessed before surgery and in a mean follow up of 13 months (10-21 months). Results: In retrotubercle open-wedge osteotomies no surgical change in patellar length or any patellar infra was seen. The tibial plateau inclination also showed no significant change from the pre-operative values. On the other hand, the conventional medial open-wedge technique showed significant reduction in patellar height as well as increase in tibial plateau inclination as compared to pre-operative values.Conclusion: In high tibial valgus osteotomies for genu varum retrotubercle medial open-wedge osteotomy negates the ill-effect of conventional open-wedge osteotomy in producing patella infra or increased tibial plateau slope or change in Qangle of quadriceps mechanism.