Iranian Journal of Orthopedic Surgery

Abstract Abstract:

Meniscal tears are one of the most common knee injuries, and effective repair techniques are crucial for maintaining long-term knee function and preventing degenerative changes. Among various repair methods, the vertical mattress sutures are frequently utilized. Here we present a technique that we believe provides the strongest fixation for longitudinal meniscal tears.
Abstract:

Meniscal tears are one of the most common knee injuries, and effective repair techniques are crucial for maintaining long-term knee function and preventing degenerative changes. Among various repair methods, the vertical mattress sutures are frequently utilized. Here we present a technique that we believe provides the strongest fixation for longitudinal meniscal tears.
Abstract:

Meniscal tears are one of the most common knee injuries, and effective repair techniques are crucial for maintaining long-term knee function and preventing degenerative changes. Among various repair methods, the vertical mattress sutures are frequently utilized. Here we present a technique that we believe provides the strongest fixation for longitudinal meniscal tears.

Abstract Abstract Introduction: Success in knee joint replacement surgery depends on various factors, one of which is the correct technique and avoidance of technical errors. This, in turn, requires the use of precise orthopedic instruments and tools. Over time, orthopedic tools may experience wear and corrosion, negatively impacting the clinical outcomes of joint replacement. In this study, we compare the clinical results of two groups of patients operated on with new and used sets, and we examine the effect of wear in this group of patients. Materials & Methods: Two groups of patients who underwent knee arthroplasty using new and used sets from the same company were compared in terms of range of motion and Oxford scoring. The new and used instrument sets were also compared visually to identify differences in the shape of the instruments. Results & Discussion: The average extension in the worn group was 7 degrees, while in the new set group, it was 2 degrees. The flexion in the worn set group was 115 degrees, and in the new set group, it was 120 degrees. Statistical calculations showed a significant difference between the two groups in both parameters, with a p-value > 0.05. Regarding the VAS pain scoring, patients in the new set group reported a pain score of 2.5, while the worn set group reported a score of 3. In the examination of the instrument, the diameter of the jig cutting guides for the distal femur was 4 millimeters and for the tibia was 3 millimeters. This measurement in the new set was 2 millimeters. Conclusion: Bone cutting jigs can undergo mechanical wear and lose their initial accuracy. This loss of accuracy negatively impacts clinical outcomes.

Abstract Background: Bone bruise is a signal change in MRI and could be the result of bleeding or edema with microfractures in trabecular bone system. Analysis of the location of bone bruise could be a clue for mechanism of trauma. Awareness of pattern, severity and location of bone bruise and pain gives a better understanding of its nature and the related concomitant injuries. In this research the relation between pain and its severity with bone bruise is investigated. Methods: In a prospective study, 22 patients (20 males, 2 female) with mean age of 34 years old and with isolated bone bruise after a knee trauma was studied in a trauma center in Urmia, Iran. Patients scored their pain using Visual Analogue Scale (VAS). For volumetric calculation of bone bruise we used A*B*C vectors multiplication and for severity of bone bruise we used software that measures the resotution of pictures. The locations of bone bruise were also determined and recorded. Finally, the relationship between these parameters and patients’ pain were statistically analyzed. Results: The mean pain score were 4.40±1.56 in males and 7±2.82 in females. Mean bone bruise intensity was 176.4±42.47. There was no relationship between patient's age and pain severity. There was also no significant correlation between volume or location of bone bruise and severity of pain score (p < /em>≥.05). The mean bone bruise volume was 8.77±8.12 and the mean pain sc ore was 4.63±1.78. Conclusions: Among the multiple characteristics of bone bruise, the intensity has the most direct correlation with severity of pain.

Abstract Background: Wrong placement of the ACL transplant especially in femoral site can result in early graft failure. Anatomical placement of the femoral tunnel results in restoration of knee kinematics closer to those of the intact knee. This placement could be performed by either using “aimer device” or with “free hand” methods. We compare the geometric position of femoral canal created by these two techniques. Methods: In a prospective study, 22 patients were devided into two groups (11 patients) and operated by using femoral aimer instrument and “Free hand” techniques. Intra-operative fluoroscopy for femoral guide pin position was performed to determine the guide pin position. Vertical and horizontal coordinates of guide pins in both groups were outlined and compared with standard anatomical point of guide pins.  Results: in “aimer” group the coordinates of the guide pin location was 41.33% vertically and 33.49% horizontally and the difference with anatomic location in both vertical (p < /em>=.03) and horizontal (p < /em>=.02) vectors was significant. The coordinates for the location of the guide pin in the “free hand” group were 35.33% and 33.07% respectively and the difference between anatomical location and guide pin width was significant (p < /em>=.04), and in this group, difference in the height was observed. The sum errors in width and height plane in “aimer” and “free hand” groups were 13.82 and 7.4 respectively. Conclusions: Anatomic positioning of guide pin is possible through both free hand and instrument techniques. The percentage of error in instrument technique is more than free hand method.

Abstract Background: Perfect rotational positioning of femoral component in total knee arthroplasty is mandatory for good outcome, particularly in knees with severe varus. Posterior condylar line (PCL) and transepicondylar axis TEA are the two current methods used to determine the appropriate rotational positioning of femoral component. The aim of this study was to compare the accuracy of femoral component rotation after TKA, using either PCL or TEA reference points. Methods: In a retrospective study, 42 consecutive TKA candidates with severe varus knees were divided into two groups: In group I posterior condylar line, and in group II transepicondylar axis was considered as the primary landmark for rotational positioning. Erosion of medical femoral condylar was recorded in millimeters. One year after operation all the patients underwent CT scan and the angles between TEA and PCL of the prosthesis was meausured. The degree of knee flexion and also WOMAC scores were recorded. Results : The female gender was prominent in both groups (81% in group 1, 85.7% in group II). There was no significant femoral condylar erosion in either group. The mean Womac score in group 1 was 71.4±17.51 and 72.07±15.48 in group II (p < /i>=.9). The degree of external rotation according to condylar twisting angle was 3.35±1.74 in group 1 and 1.9±1.7 in group 2 (p < /i>=.009). Conclusions: In severe Knee-varus deformity, TEA landmark gives more external rotation position for femoral component, despite of lack of significant erosion in femoral condyle.

Abstract Penicillin is one of the commonly-used antibiotics. Parenteral injection is either intravenous or intramuscular.We are reporting a case of foot gangrene leading to toe amputation following intramuscular buttock injection of penicillin in a child.

Abstract Background: The use of platelet-rich plasma (PRP) as an adjuvant to tissue repair is gaining favour in orthopaedic surgery. Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a recognised phenomenon that could compromise revision surgery. The purpose of this study was to determine whether PRP might prevent tunnel widening in ACL reconstruction. Methods: In a randomized clinical study, during one year patients undergoing ACL reconstruction using a hamstring graft were randomly allocated either to have PRP introduced into the tunnels (group 1) peri-operatively or not (group 2). Each group comprised 25 patients. CT scanning of the knees was carried out on the day after surgery and at three months post-operatively and the width of the tunnels was measured. Patients were also evaluated clinically at three months, when laxity was also measured. Results: Three months post-operatively, all patients were pain-free with stable knees, a negative Lachman test and a good range of movement. Arthrometric results had improved significantly in both groups (p < /i>≥.05). Conclusions: We conclude that PRP has no significant effect in preventing tunnel widening after ACL reconstruction.

Abstract We report a case of lateral tibia plateau fracture whose PCL avulsion was missed in primary radiographic studies. He had also reversed type of Segond fracture in medial tibia plateau. After open reduction-internal fixation of plateau fracture, the posterior tibia instability disclosed the PCL avulsion. Patient didn’t accept reoperation for PCL avulsion. We confirm the primary reports about association of reverse Segond fracture with PCL injuries. This association has not been previously reported in presence of tibia plateau fracture.

Abstract Background: Delivery of high quality services to the patients requires continuous refreshment with up-to-date information. This study was aimed at investigating the search behavior of Iranian orthopaedic surgeons in obtaining new information in their fields.Methods: During the 16th Annual Iranian Orthopaedic Association Meeting, questionnaires related to study were distributed among the participants. The questions were mainly related to: What source is commonly used for solving clinical problems? How often new journals of the field are utilized? What scientific route is used to increase personal information on subjects of specific interest? 178 orthopaedic surgeons completed the form.Results: The orthopaedic textbooks were the most common source on information used by the clinical problem cases. Orthopaedic seminars and conferences were the next common source followed by the journals. Direct one to one information seeking form colleagues were a very usual practice for specific clinical problem solving. 45% would use internet for new orthopaeic knowledge updating.Conclusion: Internet and online services are not commonly used for knowledge updating by the orthopaedic group that we studied.

Abstract Background: Anatomic attainment of anterior cruciate ligament (ACL) to the femoral notch is not quite easily visible due to the synovial covering. There is no information on femoral attachment of ACL in Iranian population. Our aim is to study the topography of this ligament in a group of fresh cadavers.Methods: Ten fresh cadavers that were all younger than 50 years of age and had no evidence of trauma to or surgery on their knees were chosen for the study. The knees were dissected and the presence or absence of double ACL strands was evaluated. The ligaments were then taken off the femur and insertion sites were carefully studied and documented by digital photography. The distances were measured using a ruler.Results: In 90º flexion with distal traction onto the ACL, the ligament was like a twisted interwoven cord. The twist would decrease by releasing the traction or decreasing the knee bent. Two separate bundles (antero-medial and postero-lateral) were identified in 7 cadavers. In the 3 remaining ones in gross inspection and without dissection one could not recognize two separate bundles in the ACL’s. The femoral attachment sites were curve, triangle or oblong. In cross-sectional, however, they were oblong.Conclusion: Anterior cruciate ligament could have both variable femoral attachment sites and also different bundle patterns in different individuals.

Abstract Four patients with the intra-articular bony avulsion of the deep finger flexor (FDP) were treated by open reduction and internal fixation with mini screw. They were examined for the tendon function, and range of motion of the distal interphalangeal (DIP) joint. The follow-up period was from 6 months to 60 months. DIP joint surface was involved in all the cases. Although the FDP function was restored, there was reduced range of motion in DIP joints in all the patients. Beside the restoration of FDP function, the condition of the DIP joint surface is another important factor which influences the prognosis and the treatment of FDP avulsion injuries.

Abstract 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 mal:::union:::, non:::union:::, 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, mal-:::union:::, 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.

Abstract Background: Carpal tunnel syndrome develops by compression of the median nerve within the carpal tunnel. There is no "gold standard" test for a definite diagnosis of this syndrome. Carpal tunnel syndrome is a constellation of signs and symptoms. The aim of this study is to investigate the correlation of the subjective, objective and electrophysiological findings in patients who had carpal tunnel syndrome and underwent carpal tunnel surgery.Methods: A prospective study performed on 103 patients who had carpal tunnel surgery. Subjective evaluation accomplished by two standard questionnaires. Objective findings were comprised of Tinel’s sign, Phalen test, pinch and power grip, and electrophysiologic evaluation. Statistical tests were used to evaluate the data.Results: There was a statistically significant linear correlation between the Tinel's sign and Phalen test. There was a positive correlation between the "means" of the pinch and power grip. There was a positive correlation between average symptom severity scale and functional status scale. In patient with severe electrophysiological findings there was a statistically significant correlation between subjective, objective and electrophysiological findings.Conclusions: It seems that in advanced stages, significant correlation between subjective, objective and electrophysiological findings is present.

Abstract 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.

Abstract Background: We evaluated the short term results of reconstruction of anterior cruciate ligament ruptures using a four strand hamstring autograft and cross pin femoral fixation.Methods: In a cross-sectional study 24 patients (1 female, 23 males) with mean age of 25 years (20-34) with chronic ACL ruptures were studied in a hospital in Urmia. The patients were treated with a four-strand hamstring autograft, cross pin femoral fixation (transfix) and an interference srcrew on the tibial side. Eight patients received simultaneous treatment for meniscal pathology. Final evaluation was performed 9 months after surgery, using the Lysholm and tegner scales, radiographs and a simple arthrometer.Results: The Lysholm score was good or excellent in 22 petients, fair in one and poor in one patient. Mean Lysholm score was 85.9. Tegner activity scores demonstrated that 16 patients had moved at least one level up, and the remaining cases stayed at their pre-operative level. Arthrometer showed a significant decrease in anterior tibial translation. Two patients developed septic arthritis one of whom required graft, pin and screw removal. Because of graft harvest failure, hamstring graft was taken from the contra lateral side in 2 patients.Conclusions: Reconstruction of ACL using four-strand hamstring tendons and cross pin femoral fixation results in considerably high success rate in short term. Infection and graft harvest failure are the major complications.

Abstract Background: Recurrent patellar subluxation is clinically manifested by slippage of patella and positive apprehension test. Fulkerson osteotomy of tibial tubercle is a well-known surgery for this type of patellar malalignment. Little data is available for changes of apprehension test after Fulkerson operation. The goal of this survey was assessment of Fulkerson surgery for patellar instability and its effect on apprehension test.Methods: In a clinical trial study, 12 patients (9 females, 3 males) with mean age of 38.3 years (28-60 years) underwent tibial tubercle osteotomy for symptomatic patellar subluxation. Mean follow-up time was 10 months (6-18 months). The pre and post operative assessment of change in “apprehension test”, knee function and radiographic changes were respectively evaluated by visual analog scale (VAS) and with Bristol pain score, Fulkerson scoring and lateral pattelo-femoral angle or Merchant view.Results: The results in 8 patients were excellent or good, 3 fair and one poor. Eight cases believed the surgery had been effective. The Fulkerson score of 48.75 improved to 71.6, while Bristol pain score of 7.3 decreased to 4.1 and VAS for apprehension test of 7.5 decreased to 5.16. The “Apprehension test” did not change in 3 patients, and one case developed significant limitation of motion.Conclusions: Fulkerson tibial tubercle osteotomy in selected patients improves knee function and decreases pain in short-term, but does not improve patellar alignment.