IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2006 | Volume:4 | Issue:4 (16)|Papers Count:11

Background: The treatment of large peripheral nerve defect in scarred tissue is still a major challenge. Two- stage grafting with preparation of a smooth bed before grafting is a technique used for tendon or bone defects in the past. We are now reporting such a technique for large scarred gaps in the sciatic nerves of rat.Methods: In each of the 20 female Wister rats, 15 centimeters of the sciatic nerve was excised. The nerve bed was then covered by tetracycline powder to induce scar tissue formation. In half of the rats a silicone tube was sutured into the nerve ends to produce a smooth tunnel for a two- stage grafting. In the second group the cut nerve ends were covered by silicone caps. After 4 weeks each rat received nerve grafting of its sciatic nerve defect from its bilateral median nerves. 15 weeks following the grafting the rats were tested for their sciatic nerve functions, then the nerves were excised for histological evaluation of the nerve regeneration and the scar tissue.Results: The motor and sensory motor function recovery of the nerves, as measured by “External Postural Thrust”, and “Withdrawal Reflex Latency”, were greater in the group that had the grafts replacing the silicone tubes. The histological evaluation also confirmed the presence of more nerve fibers and less scarring in the silicone tube treated group.Conclusions: Two- stage nerve grafting in severely scarred bed can improve the functional results of a nerve graft.

Background: Spinal stenosis is a common reason for referral to a spine center by adults. Pain and numbness in buttochs and lower limbs after a period of standing or walking are the common complaints. History, supplemented with good physical exam radiography and MRI of spine are the mainstays of diagnosis. Spinal decompression is the final step in treatment, which not always associated with long term patients, satisfaction.Methods: 38 patients with mean age of 56 years who had undergone posterior spinal decompression were retrospectively studied. The pre and post operative activity level and their degree of satisfaction were assessed.Results: In a 2-4 year follow- up period, 30 patients were satisfied with their operations, and no surgical complication had been experienced. In 30 patients (79%) back pain had aggravated. 3 folds improvement in standing or walking was reported by 29 cases, and 21 patients (57%) returned to their previous activity level.Conclusions: In short time, spinal decompression can effectively relieve the symptoms, but can not reduce back pain symptoms. Despite higher age range for this surgery, early complication rate is very low.

Background: Rotator cuff tear is one of the most common causes of shoulder complaint in the older age group. Treatments differ depending on the severity of tear and patient’s condition. Surgery is one of the important treatment options which may be done arthroscopically or by open technique. In this study we would like to report a short - term result of arthroscopic repair of complete tears of rotator cuff.Methods: A cross - sectional study was done in 3 hospitals in Tehran, Iran. 183 patients were treated for their rotator cuff disease by arthroscopic technique from January 2003 to August 2006. 107 cases that had complete tears, and had at least one year follow - up were considered for the study. 89 patients (56 male, 33 female) attended the assessment sessions and were evaluated by UCLA (University of California, Los Angeles) Shoulder and Elbow scoring system. The scores were compared with the preoperative UCLA scores. Acromioplasty was performed in 83 patients.Results: With a mean age of 53.2 (32-71) years, the average UCLA score was 11.3 before surgery and 31.4 in follow - ups. There were 11 patients with excellent, 62 good, 11 fair and 5 poor scores. Nine of the 11 cases with excellent scores and 34 of the good scores were younger than 55 years of age. Out of the 16 fair or poor results, 13 were older than 60 years of age.Conclusions: A significant improvement in UCLA scores is possible after arthroscopic repair of complete rotator - cuff tear, in short term. The treatment results are better in younger patients.

Background: Open reduction and internal fixation of intra - articular calcaneal fractures is technically difficult. Anatomical reduction is needed in order to obtain good subtalar motion and satisfactory clinical outcome. Reliable and accurate open reduction technique is needed for good results. We would like to report on a modification of open reduction technique for such a fracture.Methods: A cross - sectional study on 6 male and 1 female patients, with mean age of 39±7.72 with intra - aritcular calcaneal fracture was performed from 2001 to 2002. The cases had articular surfacer with Bohler angles of zero degree or less. The Sander’s classification of CT images included 4 cases into type IV and 3 into type III fracture types. Open reduction using the modified technique was performed through a lateral approach. The cases were evaluated by AOFAS functional scoring system with a mean follow - up of 3 years (18-60) months.Results: All the cases were satisfied to full pre - fracture jobs and activities. The AOFAS score was 82 (good) in type IV and 89 (excellent) for type III Sander’s fractures.Conclusions: Accurate open reduction of complex intra - articular calcaneal fracture with the modified reduction technique gives good functional results.

Background: Defects in elbow extensors usually occur with severe trauma and more in young or middle age people. The acute injuries can be repaired by direct suturing and bone anchorage. Such a repair is not feasible in chronic cases (a few weeks old) and in massive defects often seen in patients with head injuries. Use of Achilles tendo allograft is a good repair alternative, allowing earlier motion and producing more powerful extension. We would like to report our experience with four such cases.Methods: Four cases of chronic post traumatic in triceps brachi rupture, age range of 25-49 years, were treated with Achilles tendon allograft attached to a piece of calcaneous. Progressively increasing elbow motion was started after the second week. The patients were clinically evaluated with 14 months average follow - up, using Mayo Elbow Performance Score (MEPS). Each elbow was compared with the opposite side.Results: Excellent performance scores were seen in 3, and good in one patient. Elbow range of motion was 85 percent (82-96%) of the healthy side, and elbow extension power was 80% of the normal elbow. Transient uluar neuroparaxia in one case was the only complication which recoverd fully in 3 months.Conclusions: Massive chronic post traumatic tricep brachi defects can be effectively managed by bone / tendon allograft from Achilles tendon.

Background: In spite of common occurrence of ankle sprains, syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed.Methods: In 100 patients the sensitivity and specificity of standard radiography and physical examination were tested against MRI of the ankle for the diagnosis of syndesmosis sprain. The clinical tests included: syndesmosis tenderness, squeeze test, external rotation test, and crossed - leg test.Results: Four patients had syndesmosis sprain. In comparison with MRI, the sensitivity and specificity for standard radiography were 25% and 100%. The values for crossed - leg test they were 100%, 74%, for external rotation test 100%, 62.5%, for squeeze test 75%, 61.5%, and for tenderness of syndesmosis were 100%, 58% respectively.Conclusions: Physical examination has high sensitivity and low specificity for diagnosis of syndesmosis sprain. Crossed - leg test is more accurate than the other tests. AP and mortise views have low sensitivity and high specificity. Clinical evaluation and regular radiographs do not yield an accurate account of tiviofibular syndesmotic injury. MRI is recommended in athletes or those with equivocal findings.

Bioactive glass materials are being, commonly, used in spinal fusion as substitute for bone graft.Continuous serous discharge as a reaction to this foreign material has not been previously reported. The following case is a report of a patient who developed non - infected continuous serous discharge following the use of bioactive glass material “Nova Bone” for anterior and posterior spinal fusion.

Myositis ossificans is one of elbow traumatic injury complications. In this study, a patient with myositis ossificans of elbow that has been operated and achieved good result is presented.

Background: Intertrochanteric fractures continue to be one of the common orthopaedic injuries with heavy economic or / and social burden on the families and society. Internal fixation and early mobilization in the standard of care for these fractures. DHS is widely used, and is highly successful for the fixation of the stable types but performs less well with unstable fracture patterns and has relatively higher failure rates. Proper positioning of the lag screw in central and deep part of the femoral head is crucial. It remains unclear if the presumed theoretical benefits of the intramedullary implant and lateral stabilizing plate warrant the additional expenses.