Joints
Mehdi Teimouri; Mohammad Dehghani; Fatemeh Mazarei
Abstract
Background: Distal radius fractures are among the most common fractures. They can happen at any age group, and there are several treatment options and several classification systems for these fractures. One of these classifications is that of Fernandez. In this study, we evaluated the results of treatment ...
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Background: Distal radius fractures are among the most common fractures. They can happen at any age group, and there are several treatment options and several classification systems for these fractures. One of these classifications is that of Fernandez. In this study, we evaluated the results of treatment of distal radius fractures by bridging external fixator and percutaneous pinning.Methods: In a cross-sectional study, 72 patients with Fernandez type 3, 4 and 5 that underwent external fixation and percutaneous pinning for comminuted distal radius fractures were followed and assessed after 3 and 6 months.Results: The 72 patients had mean age of 44.2 years. 55% were male. The most common cause of fractures was vehicle accidents. 4 cases of malunion, 4 radial nerve injuries, 2 fixator loosening and 6 cases of infection were encountered.Conclusion: External fixator supplemented by percutaneous pinning is an efficient technique for treatment of unstable distal radius fractures. It has low rate of complication and high rate of patient's satisfaction.
A Mavian; F Biglari; S Shabani; H Mahdavi Mohtasham; S M Kazemi
Abstract
Background: The outcome of ankle fractures treatment is great importance. The purpose of the present study was to investigate the outcome of ankle fractures treatment by open reduction method and internal fixation.
Material and Methods: The method of study was cross-sectional. A total of 169 patients ...
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Background: The outcome of ankle fractures treatment is great importance. The purpose of the present study was to investigate the outcome of ankle fractures treatment by open reduction method and internal fixation.
Material and Methods: The method of study was cross-sectional. A total of 169 patients with ankle fracture who underwent open surgical and internal fixation surgery were the statistical sample. Patients were evaluated by a Clinical rating system for the ankle and hindfoot and eventually gave them a point from 100.
Results: Of the 169 samples, 53 were female and 116 were male. The average a Clinical rating system for the ankle and hindfoot was 51 (95% CI 49-53). The most common fractures type was bimalleoalr fracture. The majority of patients suffering from daily dysfunction and pain, their gait pattern was also changed.
Conclusions: According to the results and available studies, the results of surgical treatment of ankle fractures were not optimal and further investigation and finding more appropriate intervention methods were needed in order to obtain the desired results. To achieve optimal surgical outcome, it is recommended that the time interval between injury and surgery should not exceed 4 days.
Alireza Saied, MD; Afshin Ahmadzadeh Heshmati, MD; Amir Reza Sadeghifar, MD; Ali Okati, MD
Abstract
Background: Tibia and femur fractures are among the most common fractures and intramedullary nailing is the standarad treatment. This study was performed to determine the best preoperative method for estimating the intramedullary nail length.
Methods: In a cross sectional study, 82 patients with tibia ...
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Background: Tibia and femur fractures are among the most common fractures and intramedullary nailing is the standarad treatment. This study was performed to determine the best preoperative method for estimating the intramedullary nail length.
Methods: In a cross sectional study, 82 patients with tibia and 25 patients with femur shaft fracture were studied in a training center of Kerman-Iran. The estimated preoperative intramedullary nail length and the length of used nail at operation were compared. The measurment methods for femur fractures were greatrer trochanter-patella, greater trochanter-lateral epicondyle and olecranon-fithe finegr tip; and for tibia fractures were medial malleolus-tuberosity, intact leg radiogram and olecranon fifth metacarp were assessed. Data was assesed by statistical methods.
Results: Almost all of the examined methods showed "good" interobserver and intraobserver reliability. In femur fracture, the greater to patella method showed the best ICC (0.876) and the lowest SEM (0.777). In tibia fracture, best ICC (0.860) and the lowest SEM (0.602) were for medial malleolus tubercle method. For femur fractures, 64% of the measurements in greater to patella, 93% in olecranon fifth finger, 100% of greater to epicondyle methods; and for tibia fractures 40.9% in medial malleolus tubercle, 37.3% of olecranon metacarp and 65.06% of radiogram method were larger than the nail used at operation.
Conclusions: The best method for estimation of nial length was medial malleolus to tuberosity for tibia fractures, and greater to patella method for femur fractures; however none of the examined methods was found completely suitable.
Alireza Saied, MD; Seyed Mohammad Sabet Jahromi, MD
Abstract
Background: Fracture of phalanx is common upper extremity fracture. Two pining methods are used for fixation of extraarticular proximal phalanx transverse fractures: transarticular parallel pins passing through (MCP) joint and extraarticular cross pining of fracture with out going through MCP joint. ...
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Background: Fracture of phalanx is common upper extremity fracture. Two pining methods are used for fixation of extraarticular proximal phalanx transverse fractures: transarticular parallel pins passing through (MCP) joint and extraarticular cross pining of fracture with out going through MCP joint. The purpose of this study was to comparie these two fixation methods.
Methods: This clinical trial study was done on proximal phalanx transvers fracture using two methods in a training center in Kerman-Iran. In first method, two parallel pins were used from metacarpal head passing through MCP joint into proximall phalanx. In second method two cross pins were used from proximall phalangeal condyles across the fracture. The active range of motion for MCP, PIP and DIP joints, the duration of resuming patients their daily activities, and post operation complications were evaluated.
Results: The mean active range of motion for MCP, PIP and DIP joints, 3 and 6 months after surgery showed no significant difference between the two methods of surgery. There was no significant difference between the two methods in age, gender and the duration of returining to work.
Conclusions: There was no difference in the results for using cross pining or parallel transarticular pin fixation for proximal phalanx fractures. Since intramedullary method is easier with less use of C-ARM, less damage to soft tissue damage and less distraction of fracture, using transarticular intramedullary parallel pins fixation for proximal phalanx fracture is suggested.
Asghar Elmi MD; Alireza Rouhani MD; Ali Tabrizi MD; Rasoul Golizadeh MD; Fardin Mirzatolouei MD
Abstract
Background: Supracondylar humerus fracture is the most common elbow fracture in children and accounts for about 16% of pediatric fractures. To maintain stability in the reduced segment in medial and lateral columns is an important treatment concept. The aim of this study was to compare two methods of ...
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Background: Supracondylar humerus fracture is the most common elbow fracture in children and accounts for about 16% of pediatric fractures. To maintain stability in the reduced segment in medial and lateral columns is an important treatment concept. The aim of this study was to compare two methods of proximal distal lateral pinning with medial and lateral cross pinning.
Methods: In a cross-sectional study, 140 children (63 boys, 77 girls) with supracondylar humerus fracture were evaluated in a training center in Tabriz, Iran. The mean age was 5.04 years. The cases were divided into two groups (each 70 patients), matched for age, sex and type of fracture and were treated with two above methods. Complications and outcomes were copmpared.
Results: Ulnar nerve lesion in the medial and lateral cross technique was 4.3%, and none in the group done by all lateral pin technique. The need for further surgery and loss of stability was 2.9% and 1.4% respectively with no statistical difference. Pin site infection around the pins was 4.3% and 12.9% percent respectivly. Cubius varus deformity rate was 2.9% in lateral cross pinning and 4/1% in medial lateral cross pinning.
Conclusions: Proximal distal cross pinning technique for suprocondylar humerus fracture is comparable to medial and lateral cross pinning in terms of stability in maintaining a good reduction. The possibility of ulnar injury is negated in cross-lateral technique.
Mohammadreza Effatparvar MS; Nima Jamshidi Ph.D; Alireza Karimian Ph.D; Shirvan Rastgar MD
Abstract
Bone Drilling is one of the most essential procedures in orthopaedic surgery and it is executed for various purposes. Fixing the bone in fractures, non:::union:::, deformities, mal:::union:::, and cosmetic lengthening corrections, are the main purpose for internal and external fixations. In both internal ...
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Bone Drilling is one of the most essential procedures in orthopaedic surgery and it is executed for various purposes. Fixing the bone in fractures, non:::union:::, deformities, mal:::union:::, and cosmetic lengthening corrections, are the main purpose for internal and external fixations. In both internal and external fixations, use of pins or screws drilling becomes necessary. One of the important issues we face while drilling, is heat escalation of the drill and its transference to the bone causing thermal osteonecrosis.
Reza Zandi, MD; Adel Ebrahimpour, MD; Alireza Yakhchalian, MD; Farshad Safdari, MSc
Abstract
A 19 year old malesustained femoral shaft fracture in misedsection o previous Ender's nailing following a low-energy trauma. Ten years prior to that, he had suffered a femoral shaft fracture treated with two Ender nails. The patient trauma. Ten years prior to that, he had suffered a femoral shaft fracture ...
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A 19 year old malesustained femoral shaft fracture in misedsection o previous Ender's nailing following a low-energy trauma. Ten years prior to that, he had suffered a femoral shaft fracture treated with two Ender nails. The patient trauma. Ten years prior to that, he had suffered a femoral shaft fracture treated with two Ender nails. The patient
Mehran Soleymanha, MD; Ahmadreza Mirbolook, MD; Hossein Ettehad, MD; Zahra Haghparast-Ghadim-Limudahi
Abstract
Background: Tibial shaft fracture is the most common fractures of long bones. The aim of this study was to report the short-term results of intramedullary (IM) nailing in tibial shaft fractures in emergency setting. Methods: In a prospective study, 226 cases (193 men, 33 women) treated with IM nailing ...
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Background: Tibial shaft fracture is the most common fractures of long bones. The aim of this study was to report the short-term results of intramedullary (IM) nailing in tibial shaft fractures in emergency setting. Methods: In a prospective study, 226 cases (193 men, 33 women) treated with IM nailing during 2 years (2009-2011) in a training hospital in Rasht-Iran, and followed for two years. The mean age was 34±3 years old. We investigated for open or closed fractures, accompanied with fibular fractures, proneal nerve or anterior tibialis artery injury, degenerative changes in knee joint, knee pain, atrophy of quadericeps muscle, mal:::union:::, chronic osteomyelitis, delayed :::union:::, and non:::union:::. Short musculoskeletal function assessment questionnaire (SMFA) was also completed and the data were analysed by statistical software. Results: There were 151 Open fractures and 75 closed fractures. Open procedure was used in 155 cases and closed one in 71 cases. Knee pain was the most frequenct and non :::union::: the least common complication. Musculoskeletal limitation appeared more in open fractures and in association with fibular fracture and was more in female than male patients (p < /i>
Seyed Abdolhossein Mehdinassab; Nasser Sarrafan; Reza Eerabian
Abstract
Background: Femoral fracture is one of the most common long bone fractures in the body that can lead to long term complications and significant disability unless properly treated. The aim of this study was to compare the results of plating with open interlocking nail in closed femoral shaft fractures.
Methods: ...
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Background: Femoral fracture is one of the most common long bone fractures in the body that can lead to long term complications and significant disability unless properly treated. The aim of this study was to compare the results of plating with open interlocking nail in closed femoral shaft fractures.
Methods: In a clinical trial study, 63 cases of type A and B femoral shaft fractures treated with plating and 61 with open interlocking nail fixation were evaluated in two training hospital in Ahvaz-Iran in a one-year follow-up. The mean age of patients was 31.1 years (15-60 years).
Results: The mean :::union::: time in the "nailed group" was 19.8 weeks and in the "plated group" 21.6 weeks. The complications in the "nailed group" included 2 infection, 5 non:::union::: and 2 device failures while the same complications were 10, 15 and 9 respectively in the "plated group". 59 patients in the "nailed" and 45 in the "plated group" had obtained over 90 degrees of knee motion. The most common complication that was observed in the "nailed group" was limping in 35 patients (57.4%).
Conclusion: Treatment of type A and B femoral shaft fractures in adults will result in less number of complications and better range of motion when treated with interlocking nailing.
Amir Reza Kachooei, MD; Shiva Razi, MD; Reza Mahdavian Naghashzargar, MD; Hadi Makhmalbaf, MD
Abstract
Background: Posterior cruciate ligament (PCL) injury is reported in 3% to 23% of knee injuries. Ligament rupture usually requires reconstructive surgery. Avulsion injuries in acute cases, however, are often treated by fixation of avulsed bone and ligament. Fixation of avulsions in chronic cases is somewhat ...
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Background: Posterior cruciate ligament (PCL) injury is reported in 3% to 23% of knee injuries. Ligament rupture usually requires reconstructive surgery. Avulsion injuries in acute cases, however, are often treated by fixation of avulsed bone and ligament. Fixation of avulsions in chronic cases is somewhat controversial.Methods: In a descriptive study, from 40 male patients with mean age of 27.87 years old who had undergone fixation of PCL avulsion with maleolar screw and washer through a posteromedial approach, 20 cases with a mean of 40±16.02 weeks follow-up were studied. Twelve cases had received early fixation and 8 had fixation 8 weeks or longer after the injury. The cases were evaluated with clinical evaluation of stability as well as assessment of patients’ satisfaction and return to sports or regular activities.Results: Improvement in “posterior drawer test” was observed in all the cases. The ones who had early surgery, as well as the ones with isolated PCL injury had better results in comparison with late avulsion fixation or combined ligament injuries. Eight cases had no problem in knee function, 7 cases had some limitation in sporting, and 5 in some regular daily activities. Conclusion: Screw fixation of PCL avulsion through a posterio-medial approach, even in delayed cases, is safe, easy and effective. Associated other knee injuries are detrimental for good results.
Mohammad Reza Farahanchi Baradaran, MD; Mehrnoush Hassas Yeganeh, MD; Mohammad Reza Bigdeli, MD; Syavash Hemmati Eslamloo, MD; Farshad Safdari, MS; Reza Zandi, MD; Hamid Reza Seyyed Hosseinzadeh, MD; Seyyed Morteza Kazemi, MD; Alireza Eajazi, MD; Laleh Daftari Besheli, MD
Abstract
Background: Hip fracture in older population is frequent and often costly. The patients, however, do not commonly regain their pre-fracture activity levels. We are reporting the outcome of surgery in intertrochanteric hip fractures during a ten-year period.Methods: This is a retrospective study of the ...
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Background: Hip fracture in older population is frequent and often costly. The patients, however, do not commonly regain their pre-fracture activity levels. We are reporting the outcome of surgery in intertrochanteric hip fractures during a ten-year period.Methods: This is a retrospective study of the intertrochanteric hip fractures treated from 1994 to 2004 in one teaching hospital of Tehran-Iran. The cases were called in for a full hip examination, evaluation of their activity levels and also measurement of Harris Hip Scores (HHS), as well as radiographic assessment.Results: 293 patients, comprised of 194 males (66.2%) and 99 females (33.9%), with a mean age of 65±6.67 years were studied. The cases had a one-year of follow-up. 252 (86%) cases had obtained :::union:::. Acceptable ligament was observed in 158 (54%) cases. Harris Hip Scores over 60 points was seen in 222 (75.8%). Only 90 patients had returned to their pre-operative activity level.Conclusion: Patients with intertrochanteric hip fracture do not often return to pre-fracture activity of daily living.
Babak Siavashi, MD; Mohammad Reza Golbakhsh, MD; Ali Kooshan, MD
Abstract
Background: Unstable pelvic fracture means those fractures which are both vertically and rotationally unstable. The site of posterior instability could be in sacrum, posterior ilium, or sacro-iliac joint. The anterior injury may be in the symphysis pubis or pubic rami. Posterior fixation of pelvis ...
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Background: Unstable pelvic fracture means those fractures which are both vertically and rotationally unstable. The site of posterior instability could be in sacrum, posterior ilium, or sacro-iliac joint. The anterior injury may be in the symphysis pubis or pubic rami. Posterior fixation of pelvis with double rods inserted into the sacral alae of the ilium compressed together by knots is a stabilizing surgical option when iliosacral screw fixation is not feasible or available.Materials: Eleven patients with unstable pelvic fracture who had received posterior stabilization with two threaded rods and bolts in prone position after reduction of fracture with skeletal traction were studied retrospectively. The anterior fixation was either symphyseal plating or external fixator.Results: with a 6 months follow up, there was no evidence of device failure, infection, neurological deficit, or non-:::union:::. There was, however, some leg length discrepancy due to imperfect initial reduction.Conclusion: Posterior stabilization of pelvis by transiliac rods, in unstable pelvic fractures, is a simple procedure to be used effectively when more secure fixation is not available.
Ali Birjandinejad, MD; Mohammad Hossein Ebrahimzadeh, MD; Eghbal Sadri Mahvelati, MD
Abstract
Background: Proximal tibial fractures are complex injuries and are, historically associated with high complication rates. The purpose of this study is to evaluate the clinical usefulness of locking compression plates (LCP) in comparison with T-buttress plates in treating proximal tibial fractures.Methods: ...
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Background: Proximal tibial fractures are complex injuries and are, historically associated with high complication rates. The purpose of this study is to evaluate the clinical usefulness of locking compression plates (LCP) in comparison with T-buttress plates in treating proximal tibial fractures.Methods: In a prospective study, 62 patients (51 men, 11 women) with proximal tibial fracture referring to Mashhad Medical University Trauma Center were treated with T-buttress plate fixation in 35 and LCP in 27 cases. The treatment outcome was evaluated clinically and radiographically with 24 months (18-36 months) average follow-up.Results: In LCP group, there were 3 cases of Knee motion limitation, 1 mal:::union:::, 1 infection and no non-:::union::: and in T-plate group, 4 cases of knee motion limitation, 6 mal:::union:::s, 2 non-:::union:::s and 4 infections. There was, therefore, no significant difference in terms of joint range of motion between the two groups. Mal:::union::: and infection were, however, more common in T-plate fixation group.Conclusions: Locking compression plating in proximal tibial fractures provides stronger fixation and is associated with less mal:::union::: and infection as compared to T-plate fixation.
Massoud Lak, MD
Abstract
Ipsilateral fractures of patella and femur are occasionally seen in multiple trauma cases. In such cases duration of surgery, amount of bleeding and treatment modality have effect on rehabilitation of the patient and return of joint motion. In this article we present 2 patients, 18 and 52 years of age ...
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Ipsilateral fractures of patella and femur are occasionally seen in multiple trauma cases. In such cases duration of surgery, amount of bleeding and treatment modality have effect on rehabilitation of the patient and return of joint motion. In this article we present 2 patients, 18 and 52 years of age that were treated by internal fixation of femur and arthroscopically-assisted percutaneous fixation of patella.
Dehghani, MD Mohammad
Abstract
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 ...
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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-platesMethods: 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 periarticular 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 in1case (
Mohammad Taghi Peivandi, MD; Mohammad Bahremand, MD; Ebrahim Hasankhani, MD; Sara Amel farzad, MD
Abstract
Background: Treating open fracture of the femur is problematic. In this study the results of unreamed 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, ...
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Background: Treating open fracture of the femur is problematic. In this study the results of unreamed 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.
Ahmad Shahla, MD; Saeed Charehsaz, MD
Abstract
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 ...
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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-articular 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.
