Iranian Journal of Orthopedic Surgery

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: 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.

Abstract Background: Tibial plateau fracture is an intraarticular injury that can affect the stability of the knee joint and lead to patient disability. The aim of this study was to determine the functional outcome of surgically treated tibial plateau fractures.Methods: In a prospective study, 70 patients (46 males, 24 females) with average age of 38 years (23-54 years), with closed tibial plateau fractures who treated by open reduction and plate fixation was studied in two hospitals in Iran, with a one year follow-up. The functional outcome was evaluated by "Hospital for Specific Surgery (HSS)" and SF-36 scores.Results: The average time to :::union::: was 13 weeks with a mean range of motion of 125 degrees one year after injury. Functional results showed a mean HSS score of 80 points (Range: 19-100). Schatzker type I, II, II, IV fractures showed statistically significant better results compared with Shatzker type V & VI fractures. With regard to SF-36 score 1 year after injury, of eight SF-36 subscales, the results were low in 6 subscales. The majority of patients were able to perform most of the pre-injury daily activities after 1 year. The most important independent factors influencing functional results in this study were age of the patients and fracture type.Conclusion: Functional results after open reduction and internal fixation of tibial plateau fractures seem to be excellent according to HSS score, however overall patients' subjective appraisal was not satisfactory.

Abstract Background: Tibial shaft fracture is one of the most common fractures in the lower limb which, in the case of displacement or instability, may need internal fixation. The aim of this study was to compare the results of plating and intramedullary nailing (IMN) for the treatment of closed tibial shaft fractures.Methods: In a prospective study, 106 cases of closed tibial shaft fractures admitted to two of the teaching hospitals of Ahwaz, during a 15 months period, were treated alternatively with plating or intramedullary rod fixation. The :::union::: and complication rates were compared with a 12-months follow-up.Results: From 50 cases treated by intramedullary rod and 56 who received plating, 48 (96%) and 52 (92.9%) patients respectively achieved :::union:::. Non-:::union::: was observed in 4% of intramedullary rod, and 7.8% of plate fixation cases. The infection rate in the plated tibias was significantly more than the intramedullary fixation cases (p < /em>=.034). The rodded cases had a shorter time to :::union::: than the plated ones (p < /em>=.006).Conclusion: :::union::: of closed tibial fracture is similar whether fixed by intramedullary rod or plate. A higher infection rate and a slower time to :::union::: are, however, to be expected with plating.

Abstract Background: Fracture dislocation of the hip is a result of high energy trauma and can lead to hip dysfunction and patient disability. Stable and perfect reduction of the femoral head and acetabular wall are the two most important prognostic factors. The aim of this study was to compare the results of surgical treatment with nonsurgical treatment in this injury.Methods: In a period of 2 years, the cases of posterior hip dislocation with acetabular rim fracture were studied. Two groups were recognized after closed reduction of dislocation. First group (18 patients) received open reduction and plating of acetabular fracture followed by 3-5 weeks of skeletal traction. The second group (14 patients) was treated by skeletal traction of 5-6 weeks. The patients were evaluated for hip motion, stability, complications or nerve injury and early osteoarthritis, and acetabular fracture index in average one year follow-up. The results were compared in the two groups.Results: Restriction of hip motion was more common in nonsurgical patients. Sciatic nerve injury was noted in 3 patients of surgical group with recovery in 2 of them. Perfect reduction was seen in 17 (94.4%) of surgical and 9 (64.3%) of nonsurgical patients. Primary osteoarthritis was seen in 7 patients (38.9%) of surgical and 8 patients (57%) of nonsurgical group. AFI in surgical and nonsurgical groups were 55.2% and 32.5% respectively. Surgical patients had better functional results.Conclusion: Articular damage by initial trauma, perfect reduction of the hip and stable anatomic fixation of the acetabular wall are the important prognostic factors. The patients with surgical treatment obtain better functional outcome.

Abstract 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.Methods: 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 mean 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 in 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.

Abstract Background: Lacerations of flexor tendons are among the common soft tissue injuries of upper limb, which are often caused by broken glass, or other penetrating wounds. The aim of this study is to report the treatment outcome of such injures in zone V.Methods: In a 14-month period, 30 consecutive cases of flexor tendon laceration in zone V that were repaired by a modified Kessler technique in Ahvaz teaching centers were prospectively followed with a minimum follow-up of six months. The cases were assessed by Buck-Gramcko scoring system. Results: 120 finger flexor tendons, consisting of 18 thumbs and 102 fingers were repaired. The patients had a mean age of 23 years, and each patient had a mean number of 4 tendons repaired. The functional results were excellent in 85 (70.62%), good in 6 (5.28%) and poor in 29 (24.1%) fingers. Seventeen patients could return to their original occupation.Conclusions:  Repair of zone V flexor tendon injury in our hand had satisfactory results in only 76 percent of cases, and resulted in inability to return to pre-injury occupation in about half of the cases.

Abstract Background:  There have been many operations for treatment of recurrent anterior shoulder dislocation. The Bristow procedure with its dynamic and static effect can prevent shoulder dislocation. The aim of this study was to evaluate the long term results of this procedure in our center.Methods: 19 patients with mean age of 25 years had undergone Bristow procedure for anterior shoulder instability. A retrospective clinical evaluation was not performed with an average follow-up of 7.5 years (3-14 years). Pain, recurrence of instability, range of motion and ability to return to sporting activities were the parameters evaluated by constant shoulder score (CSS).Results: No dislocations but 3 cases of instability feeling were observed. The two athletes (one volleyball player and one wrestler) were unable to return to their sports. Fifteen patients (78.9%) gad excellent or good CSS scores.Conclusions: Bristow is a good procedure for controlling recurrent shoulder dislocation, but because it produces limitation in external rotation of shoulder, is not recommended as the first choice for athletic population. The radiographs of the shoulders at follow-up revealed early osteoarthritis in 3 cases. These were the same cases that had limited external rotation.

Abstract Bilateral traumatic shoulder dislocation is rare, and is usually posterior dislocation, often happening with convulsion of electrical shock therapy. There are only couple cases of bilateral anterior dislocation reported in the English literature. Hereby we would like to report on one such rare lesion.