IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2009 | Volume:7 | Issue:4 (29)|Papers Count:8

Background: Persistent instability following an acute lateral ankle sprain has been reported to vary in incidence from 15% to 48%. Surgery is indicated when conservative management fails to produce a satisfactory functional outcome. Associated intraarticular lesions of talus or extraarticualr lesions like peroneus Brevis tendon injuries can impact the functional outcome of lateral ankle reconstruction. The aim of this study was to report our short-term experience and treatment of concomitant lesions in chronic lateral ankle instability.Methods: 18 patients, aged 21 to 45 years with recurrent ankle sprain and lateral ankle instability who had not responded to at least 3 months conservative treatment and had underwent direct lateral ligament repair were studied. All the patients received ankle arthroscopy and exploration of peroneus Brevis tendon before repair of anterior talofibular and calcaneofibular ligaments with 14 months (6-22 months) follow-ups. The cases were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score.Results: The mean duration of injury was 19 months. In the diagnostic ankle arthroscopy, 6 patients had some degree of talar chondral lesions, two requiring shaving and drilling. Preoperatively, all patients had poor scores (<50).Postoperatively, 14 (79%) ankles obtained excellent and 4 (21%) good scores.Conclusion: Chronic lateral ankle instability is often associated with concomitant injuries to peroneus Brevis and talar cartilage. Direct repair of anterior talofibular and calcanofibular ligaments is an effective procedure.

Background: Use of Tourniquet in orthopaedics, to produce a bloodless field, is mainly for the comfort of the surgeon.It is, however, associated with potential dangers. This study was performed to assess the effects of tourniquet use on patients’ and surgeons’ comfort when plating tibial fractures.Methods: 138 patients with acute extra articular tibia fractures were randomized into “tourniquet” and “no tourniquet” groups. Postoperatively patients’ pain, the amount of blood drainage, time to complete bony union, development of infection and nonunion was compared between the two groups in a minimum one year follow-up.Results: 73 cases who were in “no tourniquet” group had significantly less bloold drainage, and less postoperative pain in the first 24 hours. The surgical time was however shorter in 65 patients that had tourniquet. The union or infection rates showed no difference.Conclusion: Avoidance of tourniquet use does not decrease the time to union or the infection rate after plating of tibia fractures, but is associated with a decrease in pain perception by the patient in the early postoperative period.

Background: Tibial shaft fracture is one of the most common fractures in the lower limb which, in the case of displacement or instability, may need internal fixation. The aim of this study was to compare the results of plating and intramedullary nailing (IMN) for the treatment of closed tibial shaft fractures.Methods: In a prospective study, 106 cases of closed tibial shaft fractures admitted to two of the teaching hospitals of Ahwaz, during a 15 months period, were treated alternatively with plating or intramedullary rod fixation. The union and complication rates were compared with a 12-months follow-up.Results: From 50 cases treated by intramedullary rod and 56 who received plating, 48 (96%) and 52 (92.9%) patients respectively achieved union. Non-union was observed in 4% of intramedullary rod, and 7.8% of plate fixation cases. The infection rate in the plated tibias was significantly more than the intramedullary fixation cases (p=.034). The rodded cases had a shorter time to union than the plated ones (p=.006).Conclusion: Union of closed tibial fracture is similar whether fixed by intramedullary rod or plate. A higher infection rate and a slower time to union are, however, to be expected with plating.

Background: Carpal tunnel syndrome is one of the most common compression neuropathies in the upper limb and requires surgery if conservative treatment fails. This article compares the result of regular open incision, midpalmar mini incision and endoscopic technique in carpal tunnel release.Methods: This is a clinical trial study on 53 patients (5 males, 48 females) within one year, who were surgical candidates. The surgery was done by arthroscopy, with regular open incision or with mid palmar small incision. The clinical outcomes were evaluated one week, 4 weeks and 4 months post surgery.Results: Relief and satisfaction were better in the first month in the arthroscopic and mini-incision group. All 3 techniques had similar outcomes after 4 months. In 4-months follow-up, night pain relief, followed by parasthesia relief were the ones with the best improvement. Weakness was the symptom with the least improvement. Longer incision cases were associated with more delay to return to work.Conclusion: Carpal tunnel release with endoscopic and mini incision techniques have a better early satisfaction rates compared to regular open incision, but no difference is seen between the two groups after four months.

Background: The role of a mobile-bearing knee arthroplasty is still not clear. This study was designed to compare the mobile and fixed-bearing prosthesis.Methods: In 30 knees a fixed-bearing and in 38 knees a mobile-bearing prosthesis was used. The results were compared using the "Knee Society Scoring System".Results: The mobile-bearing group of patients had an average age of 65 and 34 months average follow-up. The fixed bearing group had an average age of 69 years and a mean follow-up of 30 months. The average knee score, functional score and overall score in the mobile-bearing group rose from 29, 45, 73 to 64, 67, 128; and in the fixed-bearing group from 31.7, 34, 65.9 to 68, 57, 125 prospectively. The difference between two groups was not significant statistically.Conclusion: Although in both groups the average knee scores increased after the operation, there were, however, no significant difference between knee scores in the two types in short-term, and no preference between two types of prosthesis.

Background: Patellofemoral pain syndrome is a common cause of anterior knee pain. This condition may arise from abnormal biomechanical factors that alter tracking of the patella within the femoral trochlear notch. This in turn may contribute to increased patellofemoral contact pressure causing pain and dysfunction. Some impairment such as limited flexibility of key lower extremity muscles may be important impairments to consider in the conservative management of patellofemoral pain syndrome. The purpose of this study was to compare lower extremity muscle length between persons with and without patellofemoral pain syndrome.Methods: Fifteen patients with patellofemoral pain syndrome and 15 age and sex matched controls participated in the study. Lower extremity muscle lengths (quadriceps, gastrocenmius and soleus muscles) were measured by a standard goniometer in both groups.Results: Patients with patellofemoral pain syndrome demonstrated significantly less flexibility of the gastrocnemius and soleus muscles compared to healthy persons (respectively, p=.01, p=.02), but flexibility of the quadriceps muscle was similar in the two groups (p³.05).Conclusion: This study suggests less flexibility of the gastrocnemius and soleus muscles in patellofemoral pain syndrome patients. This may be an important consideration in management of this syndrome.

Brodie's abscess of talus in adult is very rare. In this study, an adult patient with tenosynovitis of flexor and tibialis posterior tendon due to Brodie's abscess of talus is presented.