IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2009 | Volume:7 | Issue:1 (26)|Papers Count:8

Background: Fracture of talus is a relatively rare disease, and treatment outcome is not always predictable. The aim of this study is to report our experience with the surgical treatment of fractures of talar body and neck.Methods: In a retrospective study, 16 patients (12 men, 4 women) with body and neck fractures of talus were evaluated in a teaching hospital in Mashhad. The mean age was 24.8 years (15-50 years). The fracture pattern, mechanism of trauma, associated injuries, union rate, avascular necrosis, pain and disability were evaluated in mean follow-up period of 18 months (12-24 months).Results: All the patients showed union during the follow-up. Five patients (31%) had avascular necrosis. The mean for Hawkins score system was 8.25. All the cases showed evidence of pain and some disability at the end of study.Conclusion: Talus fracture is a disabling injury and high incidence of pain and activity restriction should always be expected, even with surgical treatment.

Background: The superior labral lesion causes shoulder pain, disability and severe dysfunction. These lesions can see separated or with rotator cuff tear. The pain and recurrent instability require surgical repairing. The purpose of this study was to evaluate the results of arthroscopy surgery of superior labral lesion of the shoulder.Methods: In a case series study, we evaluated 29 patients (23 men, 6 women, mean age=26 years, range: 19-36 years) at a mean 31 months (47 12 months) following arthroscopic surgery of superior labral lesion of the shoulder. The outcome of treatment was evaluated with the University of California-Los Angeles Shoulder Scale (UCLA). 13 patients were involved in athletic activities, 7 of which in “overhead” sports and one contact sport. 8 patients had type I, 17 type II, 3 type III, and 1 patient type IV of slap lesions. The treatment included debridment for type I, debridment and decortication of glenoid and anchor suture in type II, debridment and excision of labral tear in type 3 and, excision and anchor suture of labral tear in type IV.Results: Surgery of the superior labral lesion resulted in satisfactory UCLA score. 19 regained their preinjury level of shoulder function. The shoulder score and the return to activity were correlated with the type of sports activity. The patients participating in overhead sports had significantly lower shoulder scores and a lower percentage of return to their preinjury level of shoulder function compared with patients who were not engaged in overhead activity.Conclusion: arthroscopic surgery of superior labral is successful in the majority of patients but less satisfactory in those doing “overhead” sports. However, the result in patient who participates not involved in overhead sports.

Background: Treatment of femoral fractures in children sometimes requires open reduction and plate fixation. There is potential for complication in any type of fixation, leg length discrepancy being one of them. We are reporting the results of plate fixation, with special emphasis on limb length inequality problem.Materials: In a cross-sectional study, 42 patients at 6-12 years of age with femoral shaft fractures treated dynamic compression plate fixation were assessed for malunion, nonunion, infection, device failure, and limb length discrepancy in a mean follow-up of 26 months (18-60 months). Physical examination, serial X-rays and scanogram were used for assessment. Results: Out of the 42 cases, 32 (76.2%) were boys and the remaining 10(23.8%) were girls. Seven patients had comminuted fractures, 5 fractures were open Gustillo type 1. Twenty four were associated with polytrauma. The mean limb length discrepancy at the end of treatment was 1.17 centimeters (0.4-2.4 centimeters). There were no device failure, malunion, or infection.Conclusion: Treatment of paediatric femoral shaft fracture with dynamic compression plating has minimal side effects and causes minimal, if any, inequality in the length of the femur.

Background: This study presents a modification of tibial inlay technique in posterior cruciate ligament (PCL) reconstruction and evaluates the structural properties of tibial side fixation of the graft, comparing tibial inlay technique and a new modification, that is interference screw fixation of tibial side of the graft in suggested supine position which is more applicable, with less potential intraoperative neurovascular complications.Methods: Forty fresh calf knees that were prepared from 20 healthy 3 years old calves which were between 200 and 220 kg were the subject of this study. The tibias were separately used simulating tibial side PCL reconstruction with tibial tuberositypatellar tendon–patellar bone graft. Tibial side of the graft was fixed using two cancellous screws in 20 tibiae and with interference screw in obliquely oriented canal in another 20 tibiae. Load-to-failure test was carried out on ten samples from each group. The remaining samples were used for cycling loading. Structural properties of each group were compared. Results: No significant differences were observed between two methods at load-to-failure test; but mean elongation at 1,000 cycles of new modification was significantly lower than tibial inlay technique.Conclusion: In this biomechanical experimental study there found no significant differences between two methods at load-tofailure tests. Maximum load (N) was different between the tibial inlay method and the modified method but the difference was not statistically significant. Yield load and linear stiffness and deformation at the yield point were also not different between the two methods. The only important difference between the two methods was at cyclic loading test where the mean elongation at 1,000 cycles of the modified technique group was significantly lower than tibial inlay technique (p= 0.01).

Reconstruction of segmental tibial defect, in particular after sequestrectiomy for chronic osteomeylitis, is a challenging problem. This is a report of such a defect treated with two-stage direct transposition with an eighteen year follow-up.

Background: Clavicle fracture, especially midshaft fractures is a common bone injury that happens after a fall onto the shoulder. It is uncommon to need surgical treatment. We would like to report on a selected group of cases that required open reduction and plate fixation.Methods: 53 consecutive adult patients with severely displaced fresh fractures of the middle third of the clavicle, who were treated by open reduction and plate internal fixation, were studied in a one year period in Zahedan, Iran. Union shoulder motion and complications were analyzed in 49 patients (29 women, 20 men) who referred for follow-up, with an average follow-up of 12 months.Results: The mean age of patients was 33.4 years (19-62 years). 48 cases (97.9%) obtained union and one case (2%) developed malunion and required corrective osteotomy. Dermatologic complications were observed in 2 cases. All the patients had full motion and function.Conclusion: Open reduction and plate fixation of severely displacement fresh clavicle fracture in well-selected cases can result into good union with minimal complications rate.