IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2016 | Volume:14 | Issue:2-3 (55) |Papers Count:7

Background: Orthopedic surgeons are trying to find best substitutes for bone defects in human. Bone is still the golden standard substitute where graft is needed. Effects of rabbit and bovine rib cartilages will evaluated in bone healing of rabbit bone defect model. The aim of the present study is testing the healing potential of rib cartilage as xenograft or allograft when used in bony defect.Method: 20 adult rabbits of 1.5-2 years old were used. 10mm of bone was removed from midradial bone in each rabbit. The produced defects were treated in 4 different ways by dividing the rabbits into 4 different groups of 5 animals each in one group, similar size bovine rib cartilage and in another group allograft rabbit rib cartilage was inserted in the defect. In the two remaining control groups, one received the same resected radial bone (autograft) and in the other group the defect was left empty. The healing was evaluated by radiographs at 14th, 18th and 56th days post surgery, and by histologic specimens at 8 weeks post surgery. Result and conclusion: Histologic and radiographic study indicated that allogenic and xenogenic cartilage acted almost like autograft groups and were better than empty group.

Backgrounds: Characterization of mechanical behavior of meniscus is an important issue considering the significant role of meniscus in load bearing within the knee joint. Identification of mechanical change in meniscal tissue is of particular interest with respect to osteoarthritis (OA) research. Anterior Cruciate ligament (ACL) tear can. also have deep effect on the meniscus health. Meniscus injury is common in patients who have ACL tear. The objective of this study was to investigate the effect of longitudinal meniscal tear on tenside orces inside knee ing presence or absence of ACL, using finiie element models.Methods: 3-dimensional finite element model of knee joint were developed using CT scan images. Healthy anatomical structures were designed using mimics software. The obtained model was imported to Abaqus software to simulate forces across the knee meniscus in association with ACL.Results: The maximum shear stresses were 1.73 MPa and 1.48 MPa on medial and lateral menisc, respectively, e.e. mor tension on medial than lateral tension meniscus In presence of stable ACL tear the sustained maximum shear stresson medial meniscus was 8.33MPa, and with instable cruciate ligament tears. The maximum shear stress on medial meniscus was 9.65Mpa.Conclusions: The result confirmed that biomechanical response of ACL tear plays an important role in the tension and stability of the meniscus. A meniscus tear associated with ACL tear increases the level of stress and stress distribution diagram.

Background: Carpal tunnel syndrome (CTS) is the most common form of localized peripheral neuropathy. CTS and cervical radiculopathy (CR) often co-occur and is known as double crush syndrome (DCS).Aim: This study aimed at determining frequency of CR in patients with CTS referred to electrodiagnosis department of Rasht Imam Reza clinic.Materials and Methods: This was a descriptive cross-sectional study on 117 patients with CTS referred to Imam Reza clinic. The patients’ data were recorded through a questionnaire including electrodiagnosis test results, patients’ demographic data, medical history, primary diagnosis and related results and electromyogram (EMG)/nerve conduction velocity (NCV) tests results. NCV test shows CTS type (unilateral and bilateral) as well as its severity, while EMG test determines co-occurrence of CR and CTS, type and severity of DCS. Finally, the data were entered into SPSS 19, and analyzed using statistical tests.Results: Out of 117 patients with primary diagnosis of CTS, 21 (17.9%) were male and 96 (82.1%) female, with a mean age of 46.5 years. The highest frequency (41.5%) in patients with CTS belonged to housewives. 48 patients (41%) had bilateral CTS and 69 patients (59%) suffered from unilateral one. 41 patients had DCS (35%): 25 patients (61%) unilateral DCS with moderate severity and mostly C7 radiculopathy (70.7%). Using binary logistic regression analysis (method=ENTER), age and body mass index (BMI) were the two effective variables on development of simultaneous CTS and cervical spines involvement (P<0.0001).Conclusion: Knowing the presence of simultaneous CR and CTS is important in treatment and surgical outcore the patients with CTS should be always examined for DCS.

Background: Tibial and femoral fractures are among the common fractures and are usually treated with intramedullary nails, being often treated by intramedullary nailing. This study was performed to determine the best preoperative method for estimating the intramedullary nail length.Methods: 82 patients with tibial and 25 patients with femoral shaft fractures were studied for estimating the preoperative intramedullary nail length. The obtained measurement was compared with the length of the suitable nail used at operation. Intraobserver and interobserver reliability of the methods, was assessed by testing on healthy volunteers. For femur fractures the assessed methods were greater trochanter to patella (T-P), greater trochanterlateral epicondyle (T-LE) and olecranon to fifth finger (O-5F) tip. For tibial fractures medial malleolus-tuberosity (MM-T), intact leg radiogram and olecranon fifth metacarpal were assessed. The agreement of the data was assessed by measuring ICC, SEM, CV% and B & A plots.Results: Almost all of the measurement techniqes showed "good" interobserver and intraobserver reliability. In patients with femur fracture, with the greater to patella method showing the best ICC (0.876) and the lowest SEM (0.777). In tibial fracture, the best ICC (0.860) and the lowest SEM (0.602) were for "medial malleolus-tubercle" (MM-T) method. B & A plots were created for the findings of second part of the study, and the conclusion was confirmed. The estimated lengths were larger than the nail lengths used at surgery in 64% of (T-P); 93% in (O-5MF), 100% of (T-LE) for femur; and 40% in (MM-T), 37.3% of (O-MB) and 65.06% of radiograms.Conclusion: The medial malleolus to tuberosity method for tibia and the greater trochanter to patella method for femur fracture showed the best estimated methods; however, we couldn't find a completely reliable method from the all examined methods.

Total Hip Replacement has become one of the very common orthopedic surgeries that provide better life conditions for patients suffering from complex and painful hip problems. Considering the increasing growth of such surgeries, it is necessary to get familiarized with new challenges and threats in the hip arthroplasty. The wear and corrosion in variable design of stems has always been a debated issue. This paper tries to describe the scientific knowledge of problems in wear and corrosion of stem's neck cone region because neglecting this issue may cause a disaster.The corrosion caused by friction and wear in the surface shared between prosthetic head and cone region of prosthetic stem neck is called taperosis. Small particles and metallic ions are released onto the polyethylene liners of a hip arthroplasty and result into metalosis, leading to osteolysis and eventually to instability of prosthesis. Although the clinical importance of taperosis is still unclear; its destructive interaction in hip arthroplasty medium is gaining more importance. This article reviews the key papers of previous and recent studies in this context to describe this challenge, and also tries to clarify the importance of this issue.

Background: Removal of implants used for fixation in orthopaedic cases is a fairly common procedure. There are varied views as to the need for removal of such implants on elective surgical schedules. There is no evidencebased guideline for implant removal.Material and method: The patients who had referred to two hospitals of Sari for orthopaedic implant removal in a one year period were studied for the reasons and the bony location of implant removal.Results: The 105 patients that were studied included 80 (76.2%) men and 23 (25.8%) women with the mean age of 34.5±14.5 years. The hardware removal was from leg in %45.7, femur %35.2, and forearm %14.3 and less common sites were hip, elbow and arm (1%). The reason for implant removal was patients: request in %75.2 and implant compulsory reasons like infection hardware breakage nonunion or malunion or pain in %24.8. An average hospitalization time of 3.18±1.5 days and surgical time of 102, 43±35, 5 minutes was necessary for implant removal. The hospital and operating time for the compulsory cases were respectively 4.31±2.3 days and 120.27±49 minutes. Conclusion: The decision on removal of orthopaedic implant has to be made with specific attention to details and indications. Non-Compulsory implant removal accounts for the majority of removals, putting a lot of financial burden on medical resources.