Iranian Journal of Orthopedic Surgery

Abstract Abstract
Introduction: Intertrochanteric femoral fractures are common and can be associated with significant complications and mortality. This study aimed to assess the mortality rate and related factors in patients undergoing surgical treatment for intertrochanteric fractures.
Materials & Methods: This retrospective descriptive-analytical study included patients with intertrochanteric hip fracture who underwent surgery between 2017 and 2018 in a teaching hospital .The demographic data were collected from patients’ records, with specific attention to age, osteoporosis, previous fracture history, cognitive disorders, hypertension, delay in surgery, and the type of fixation implant. Mortality status was assessed through follow-up phone calls. Data were analyzed using STATA software and logistic regression analysis.
Results & Discussion: 227 case within one year were studied. The overall mortality rate was 16.3%. In the deceased (p<0.05). Logistic regression revealed that advanced age, osteoporosis, previous fracture history, cognitive disorders, history of falling, surgical delay, and type of surgery were independent predictors of mortality (p<0.05).
Conclusion: Postoperative mortality following intertrochanteric fracture surgery is influenced by a range of clinical and modifiable factors. Timely selection of an appropriate surgical method and identification of high-risk patients can play a significant role in improving treatment outcomes.

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 treated with two Ender nails. The patient

Abstract Background: Posterior tibial slope is the normal anteroposterior inclination of the tibia slope and plays an important role in the biomechanics of the knee and function of the cruciate ligaments. Posterior tibial slope angle varies in different populations and there is no report about its measurement in the Iranian population. The aim of this study was to investigate the normal posterior tibial slope in a teaching hospital in Tehran-Iran. Methods: In a desreptive study, 108 knees in 70 men and 38 female patients, with no history of prior knee problem were evaluated by lateral knee rodiographs in a teaching hospital in Tehran-Iran. The average age in these cases was 38 years (23-60 years). These patients had refered because of recent knee trauma, but no fracture or intra-articular derangement had been found. The angle of tibial slope was measured in all the cases and analyzed. Results: The mean slope angle was 9.4±1.8 degrees. There was no statistical relationship between age and gender and posterior tibial slope (p≥.05). Conclusion: The normal posterior tibial slope angle in this Iranian population was different from other countries. It may be necessary to consider these differences in designing tibial and femoral components for knee arthroplasty.

Abstract Background: Kienbock disease resulting from avascular necrosis of lunate bone leads to pain and disability in young active patients. Radial shortening is one of the treatment methods in this disease. In this study, we evaluated the mid-term results of treatment of Kienbock using radial shortening. Methods: In a retrospective study, 9 males and 6 females with Kienbock disease with average age of 28.6±9.37 years who had undergone radial shortening, were examined in a teaching hospital in Tehran-Iran. There were 2 patients in stage II, 5 in IIIa and 8 in step IIIb of Lichman’s class. In a mean follow-up of 5±2.44 years, these 15 cases were evaluated for wrist motion and gap strength and also with quick-DASH score. The radiograph Stahl index and carpal height ratio were also assessed. Results: Pain and range of motion improved and grip strength was favorable in 13 patients. Quick-DASH score was 8.5±.84 in patients with stage II, 12.72±5.09 in stage IIIa, and 27.57±18.87 in stage IIIb. Stahl index and carpal height ratio were the same in patients with stage II, but significantly decreased in other patients. Kienbock disease progressed in 2 cases. Conclusion: Radial shortening can relief clinical symptoms, even in stage III and IIIb of Kienback diseases, although the disease X-ray show radiographic worsening.

Abstract Background: The role of increased posterior tibial slope in rupture of the anterior cruciate ligament (ACL) is controversial. The purpose of current study was to determine the effect of posterior slope on the ACL injury. Methods: In a case control study, 61 consecutive cases with ACL injury, who were candidates for reconstruction, were compared with 61 persons with normal knees who were matched for age and sex, over a 2-year period at a teaching hospital in Tehran, Iran. The posterior tibial slope angles were measured on true lateral radiographs on all the cases. The measurement variations were analyzed between the two groups. Results: The mean posterior tibial slope was 9.4±1.8 degrees in controls and 12.3±4.4 in patients with ruptured ACL (p < .001). The incidence of tibial slope greater than 10 degrees in patients with ruptured ACL was 3.1 times greater than that of the controls. Conclusion: This study suggests that increased tibial slope angle may contribute to increased risk for ACL rupture.

Abstract Background: The prevalence of palmaris longus agenesis (PLA) has been variously reported to be from 1.5% to 64% in different ethnic groups. Finding the state of PLA among Iranian people was the aim of this study. Methods: 1008 participants were included in this descriptive study during a 6-month period in a teaching hospital in Tehran-Iran. The Schaeffer test was used to detect the presence or absence of palmaris longus. The role of gender and handedness was also assessed in PLA. Results: The prevalence of PLA was estimated at 22.8% - 10.2% agenesis on the right side, 5.9% on left side and 6.7% on both sides. The relationship between PLA and gender didn’t appear to be significant. Right handedness was seen in 90.9% of cases with PLA and 72.5% of those without PLA (p=.000, OR=3.8). Conclusion: The prevalence of PLA in Iranian people studied, were comparable to the average Caucasian values in the literature.

Abstract Background: Arthroscopic reconstruction of the anterior cruciate ligament is one the most common orthopaedic surgeries. There are scattered reports about the beneficial effects of post operative cox2-inhibitors administration on knee motion. The purpose of the current study was to determine the effects of cox-2 inhibitor on pain, range of motion and weight bearing after arthroscopic reconstruction of the anterior cruciate ligament. Methods: In this clinical trial, 70 patients who underwent arthroscopic reconstruction of the anterior cruciate ligament were assessed in a teaching hospital in Tehran-Iran. They were divided into case (cox2-inhibitor) and control groups. Postoperatively, pain, inflammation, range of motion and ability for full weight bearing were measured. Results: The mean of pain at the postoperative day 3 was 5.3±1.04 (visual analogs scale of 0 to 10) in the control and 3.3±0.71 in the case group. 29.6% of the patients in the control group and 82.8% in the case group were able to flex the knee more than 90° one week postoperatively. In the first week, all of the patients in the case group and only 28.6% in the control group were able to walk without any assistive device. The post operative knee circumstances were 2.73±0.59 and l.61±0.92 centimeters smaller respectively in case and control groups. Statistical analysis showed significant differences between the two groups, in the above measurements. Conclusion: Cox-2 inhibitor is effective in relieving pain reducing the inflammation, and accelerating the rehabilitation program after arthroscopic reconstruction of the anterior cruciate ligament.

Abstract Background: Incorrect tunneling is one of the concerns in arthroscopic anterior cruciate ligament reconstruction. The purpose of the current study was to determine the incidence of the correct femoral and tibial tunnel positions.Materials: In a cross-sectional study, the CT image positions of the tibial and femoral tunnels in 40 patients that had undergone arthroscopic ACL reconstruction using single-bundle hamstring tendon were studied. The parameters that were evaluated were: tibial tunnel position in axial and sagittal cuts, femoral tunnel position in axial cut, appropriate thickness of the posterior cortex at the intercondylar notch, and femoral exit point.Results: The correct position of the tibial and femoral tunnels, appropriate thickness of the posterior cortex at the intercondylar notch, and the correct position of the "femoral exit point" were respectively recognized in 60%, 52.5%, 70%, and 67.5%. In total, the correct position of the femoral and tibial tunnels was seen on 37.5% of patients. These parameters were compared with known standard anatomic positions.Conclusion: Although the incidence of correct tibial and femoral tunnel positioning in ACL reconstruction, when viewed separately, was acceptable when looked at as one tunnel was not satisfactory. More precise attention and expertise seem necessary for the operating orthopaedic surgeons.

Abstract Background: The anterior cruciate ligament is the primary structure that controls anterior displacement in the unloaded knee. Anterior cruciate ligament reconstruction may return normal functions of the knee. The aim of the present study was to compare three different femoral fixation techniques in anterior cruciate ligament reconstruction.Methods: In a clinical trial study, 120 patients that were candidates for ACL reconstraution were randomly divided into 3 groups of 40 individuals. The femoral fixations were by the three methods of "Aperfix", "Rigidfix" or "Endobutton". The cases were re-examined 12 months after surgery and evaluated by Lysholm score as well as with KT-1000 machine. The results were compered together for the three above methods.Results: The Lysholm score showed improvement from pre-operative values in all three techniques: From 63.21±18.59 to 90.64±9.47 in "Endobutton" group, from 65.72±18.74 to 96.22±5.35 in "Aperfix" and from 69.21±17.45 to 90.64±9.47 in the "Rigifix" group. There were 6 failures in "Endobutton", 4 in "Rigidfix" and one in "Aperfix" group. The anterior displacement tibia was 3.96±1.58 millimeters in "Endobutton", 4.28±1.48 in "Rigidfix", and 4.03±1.79 millimeters in "Aperfix" group. There was no significant difference in the operating time in the 3 groups.Conclusion: Regarding the instant stability of the graft, the "Aperfix" method seemed stranger. Further investigations with larger number of cases and longer duration of follow up are recommended.

Abstract Background: There are several techniques for treatment of humeral shaft fractures. The purpose of this study was to evaluate the outcomes of fixation of humeral shaft fracture with minimally invasive plate osteosynthesis.Methods: Ten patients (7 males, 3 females) with traumatic humeral shaft fracture were included in this prospective study. The meas age of patients was 31.7±9.8 (16-51) years. According to OTA classiciation, there were one case of A1, two cases of A2, three cases of A3, three cases of B2, and one case of C2 type. The mean distance measured from the fracture site to elbow joint was 7.7±3.11 (4.5-13) cm. Two patients had radial nerve contusion. All fractures were treated in a minimally invasive way. The function of elbow and shoulder were assessed by MEPS and UCLA scores. The mean time of follow-up was 9 months.Results: The mean maximal final angulation was 7.7±3.2°. The final rotational alignment was within normal limits, with no shortening in all cases. One patient needed second surgery and bone grafting because of delayed :::union:::. The mean UCLA score was 34.2±1.2 and the mean MCPS score was 97±6.3. There was no postoperative radial nerve injury. The 2 cases of radial nerve contusion recovered 4 and 4.5 months postoperatively. Conclusion: MIPO is a safe method in the treatment of humeral shaft fracture with a minimum lesion to soft tissue with a high :::union::: rate. It is suggested that minimally invasive plate osteosynthesis be considered in the treatment of humeral shaft fractures.

Abstract Background: Unstable pelvic fractures are major orthopaedic injuries with high rates of morbidity and mortality. Open surgical stabilization is the standard treatment for a great number of them. Percutaneous surgical fixation has become an accepted treatment method in last several years. We would like to report our experience with this relatively, newer technique in a small mixed group of unstable pelvic ring fractures.Methods: This is a report of 16 cases (13 males, 3 females) with mean age of 31±8 years of pelvic and acetabular fractures who received percutaneous iliosacral or iliopubic screw fixation, under C-arm imaging control, and had a 6 months period of clinical and radiographic follow-up.Results: All 16 cases had healed their fractures at follow-up and had full weight-bearing status. 12 cases returned to their pre-fracture activities. One screw break and one wound infection were the complications list. There was no neurological deficit, and average blood loss was 10 milliliters.Conclusion: Percutaneous iliosacral or iliopubic screw fixation for, respectively, posterior pelvic ring or anterior column acetabular injuries are useful surgical treatment options with low complication rates.

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 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.

Abstract Background: Dislocation of total hip arthroplasty may happen for different reasons. Abnormal acetabular orientation is a common reason for such occurance. We would like to report the effect of acetabular inclination on incidence of dislocation.Methods: In a cross-sectional study all cases of total hip arthroplasty performed in a 2-yaer interval in one educational hospital in Tehran, were followed and assessed for possible dislocation in a 18.1 months (3-25 months) of follow-up. The inclination angles of acetabular components were measured, and the relationship of dislocation with gender, age and this angle was evaluated.Results: 132 cases entered the study. 4 patients (3%) encountered dislocation and all 4 had inclination angles of over 50 degrees. Gerder did not seem to play an important role. Older age, however, was probably contributing to risk of dislocation.Conclusion: Inclination angle of over 50 degree in acetabular component position is one of the factors making it more likely for the hip arthroplasty to dislocate.

Abstract Isolated fracture of the lesser tuberosity of humerus is rare. In this study we report one case of isolated fracture of lesser tuberosity, that was diagnosed acutely and was treated with open reduction and internal fixation.

Abstract Congenital Knee fusion - whether as an isolated lesion or in association with other anomalies – is a relatively rare condition. This is a report of such a case without growth plate around the fused knee, who underwent leg equalization procedure.