IRANIAN JOURNAL OF ORTHOPAEDIC SURGERY
Year:2007 | Volume:5 | Issue:3 (19)|Papers Count:9

Background: Rotator cuff tear is one of the most prevalent shoulder disorders in middle aged and old people and MRI is gold standard paraclinic diagnostic test. This research is aimed at assessing the accuracy of MRI reports in rotator tears.Methods: A cross-sectional study was done from May 2005 to February 2006 in two hospitals in Tehran. Fifty consecutive patients who had been investigated with MRI and then undergone shoulder arthroscopy were assessed. The reports on MRI findings of the shoulder were compared with the arthroscopic findings. The sensitivity, specificity, positive and negative values of MRI in reference to the arthroscopic findings was studied.Results: MRI in these 27 men and 23 women showed 97.4% sensitivity, 45.4% specificity, 86.3% positive predictive value, 83.3% negative predictive value and 84% accuracy. The valued for the same parameters were respectively 83.9%, 79.9%, 86.7%, 75% and 82% for complete; and 50%, 76.2%, 28.6%, 88.9% and 70% for partial rotator cuff tears.Conclusions: The MRI reports for rotator cuff disease, in our center, are reliable for complete tears, but not for partial tears.

Background: Extensor tendon lacerations are more common than flexor tendon injuries. The outcome of repair in these lesions depends on multiple factors including severity of initial trauma, other coexisting injuries, anatomic site of the laceration, experience of the surgeon, and also the post operative rehabilitation. The aim of this study is to evaluate the results of primary extensor tendon repair in different anatomic zones of the hand.Method: During a period of 28 months, 32 patients with open extensor tendon lacerations- with no associated hand fracture- were repaired by modified Kessler technique using 4-0, non-absorbable suture in Ahwaz teaching hospitals from 2004 to 2006. The men age of patients was 24.6 years (17-46 y). The patients were followed for a mean of 7 months, and were assessed using Miller’s rating system.Results: Seventy two extensor tendons in 32 patients were repaired. There was no re-rupture or infection. The most rupture was seen in zones 5 (36%) and 3 (34.7%) and the least in zones 1 (6.9%) and 4 (9.7%). The best results were obtained in zone 5, followed by zone 3 (88% and 84%). The worst outcome was n repairs of zones 1, 2 and 4.Conclusions: The site of tendon rupture is a strong determinant of repair outcome. The ruptures in the complex extensor expansion or beneath the extensor retinaculum have the worst results of repair.

Background: Percutaneuos pinning (PCP) is a minimally invasive but cost-effective procedure for treatment of distal radius fracture. There is some uncertainty about duration of post-pinning cast immobilization. The aim of this study was to compare 3 weeks of immobilization with 6 weeks in terms of the effect on wrist function.Methods: In a prospective randomized control clinical trial, 50 patients with A2, A3 or C1 distal radius fractures were treated with reduction and 2 trans- radius- styloid pin fixation. Then, first group received 3 weeks and second group 6 weeks of cast immobilization. The functional outcome was assessed in 3, 6 and 12 months by Lidstorm scoring system.Results: In 33 men and 17 women, the findings were as follows: At 3 months excellent or good function was seen in 10 cases (40%) of group 1 (3 weeks casting), and 3 patients (12%) of group 2. At 6 months the figures were 19 (76%) and 13 (52%) respectively. At 12 months 23 cases (92%) of group one and 21 cases (84%) of group two had good or excellent outcomes. The mean time period between injury and return to work in group one and two were 3 and 3.5 months respectively. Male patients had an earlier return-to-work period in either group.Conclusions: Extra-articular, non-comminuted distal radius fractures with no fracture of distal ulna can be safely treated with percutaneous pinning followed by only 3 weeks cast immobilization. This will results into faster return of wrist function and earlier return to work in 3 to 6 months, with no effect at 12 months.

Background: Fracture of metacarpal and phalangeal bones of hand are common sport and industrial injuries in the upper extremity. Mini-plate fixation is one of the techniques used in fixation of unstable kind of fractures in hand. We would like to report our experience with such fractures treated with titanium mini-plates.Methods: In a clinical trial study, 29 patients with 48 unstable hand fractures (21 metacarpal, 27 phalanges) received titanium mini-plate fixation during 1999-2006. The mean age was 27 years (14-53). Twenty eight cases were periarticualr and 20 shaft fractures. The cases were evaluated with an average follow-up of 17 months (6-52), and range of motion and function were assessed.Results: The results, based on total active motion, were considered excellent in 39 (³221 degrees), good in 8 (121-220 degrees) and poor in 1 case (<120 degrees).Conclusions: Mini-Plate fixation in unstable metacarpal or phalangeal fractures creates secure fixation and good alignment for early joint motion in hand.

Background: Treating open fracture of the femur is problematic. In this study the results of undreamed intramedullary (IM) nailing in this kind of fracture is reviewed.Methods: In a prospective study, 41 patients (40 males, 1 female) with open femur fractures were treated, using the above method, in two hospitals in Meshhad from 2004 to 2006. Fifteen cases could not be followed. The remaining 26 patients, with 28 years mean age (16-45 years) were comprised of 6 type A, 9 B, and 11 type C fractures- according to AO classification. There were 2 type II, and 24 IIIA, Gustillo/Anderson open fractures, with a mean injury severity score (ISS) of 10.96. The cases were followed from 18 to 36 months, and the union rate, infection rate, and limb function were assessed.Results: Twenty three patients reached union in 156 days on average (84-250 days). Infection occurred in 2 patients. At the end of the follow-up period, the range of motion of the knee was 120 degrees. Shortening of 3 centimeters was observed in one case.Conclusions: Unreamed intramedullary titanium nailing is effective in treatment of type II and IIIA open femoral fractures.

Background: A vascular necrosis- a common reason for hip reconstruction- can follow use of some medications including glucocorticoids. Temgesic and norgesic are two analgesic antagonists with high concentration on steroids on steroids and can produce osteonecrosis.Methods: In a case series study, cased of osteonecrosis in Akhtar hospital in Tehran with history of temgesic and norgesic abuse were identified in a 2 year period. The hospital charts of 11 cases with such characteristics were evaluated.Results: Eleven cases with mean age of 37.42±5.55 years comprised the study group. Five cases had used norgesic, 5 temgesic and 1 patient had used both of those agents. The average drug dosage was 4.36±2.29 vials per day for an average of 4.9±2.9 months. Onset of symptoms was 11.36±2.79 months after drug usage on average. Three cases had skin stria and 7 patients had localized obesity, both suggesting steroid effect. Bilateral involvement of bone ends was observed in all, while 3 cases had more than two joints affected.Conclusions: Norgesic and temgesic cause osteonecrosis with severe joint destruction. Raising the awareness of general public and physicians towards such a devastating complication is warranted.

Posterior cruciate ligament (PCL) avulsion associated with traumatic posterior hip dislocation is extremely rare in children. It is therefore, easily missed. We are reporting such an occurrence in an 8 year old boy.