Iranian Journal of Orthopedic Surgery

Abstract Background: One of the common operations for lower limb mal-alignment below 50 years of age is proximal tibial osteotomy. In the open wedge technique, the superficial medial collateral ligament (MCL) usually needs to be released.  This study seeks to evaluate the results of open wedge high tibial osteotomy with or without releasing MCL.Methods: In a prospective clinical trial, 59 patients with symptomatic genu varum between 16-50 years of age who were candidates of tibial osteotomy were divided into open wedge surgery with (30 patients, 40 knees) or without MCL release (29 patients, 36 knees). The outcome was studied comparing the stability in valgus, pattelar height slope of tibial plateau, and also the knee score (KSS) in a 17.4 months (3-24 months) follow-up.Results: The patients from MCL preserving group, with mean age of 26.7±9 improved their scores of 53.5±15.2 to 81.9±13.4. The cases from MCL-releasing group with mean age of 25.5±8.4 improved the score of 52.4±14.6 to 65.4+17.8. The rates of surgical complication and valgus instability were lower in MCL preserving ones, but tibial slope remained unchanged in either group.Conclusions: Both techniques lead to an improvement in the KSS score however it was more significant in MCL preserving group with lower complication and without valgus instability.

Abstract Background: Cementless total hip replacement is an accepted alternative to total hip replacement with cement in younger patients, but it remains controversial for elderly patients. This study evaluated the functional results and complications of cemented and cementless methods in old patients. Methods: In this cross-sectional study, all the patients aged 65 years or older who had been hospitalized for total replacement of hip joint because of femoral neck fracture or osteoarthritis of hip were studied during a 3-year period in three educational hospitals in Iran. "Harris hip score" was used to assess the functional consequences. The early complications -thrombophlebitis of lower limbs, dislocation, hematoma and infection - and late complications - aseptic loosening, dislocation, and reoperation, were documented. Results: 209 eligible patients, including 96 (45.9%) cemented and 113 (54%) cementless were studied. Patients were followed for a mean period of 5 years and 2 months (51-82 months). The overall rate of early complication was 8 cases (3.8%): five in the cemented and three in cementless group, respectively. Late complications were seen in two cases -one loosening in cemented group and one dislocation in cementless group. The final Harris hip score at the final follow-up was 84.01±4.71 in cemented and 85±5.02 in the cementless groups (p≥.05). Conclusion: Cementless hip replacement can have a satisfactory functional result like cemented hip replacement procedure in the elderly patients over 65 years of age.

Abstract Brown tumor is an osteolytic lesion caused by excessive production of parathyroid hormone. We present a 20 year old man with symptoms of severe muscle weakness and multiple fractures of shoulder and hip that the Brown tumor was observed in most of his bones.

Abstract Background: Entrapment of flexor pollicis longus at the level of A1 pulley is the most common cause of snapping or painful thumb upon flexion and extension motion the so called which is called "Trigger Thumb". The aim of this study is to assess the efficacy of sonographically-guided intra tendon sheath corticosteroid injection in the management of trigger thumb. Methods: In a prospective study 104 patients (7 males, 97 females, 112 trigger thumbs) with the mean age of 52.11±7.63 who had trigger thumb underwent intra flexor sheath corticosteroid injection under the guide of ultrasound in a 2 year period in Rasht-Iran. Improvement was measured using the "Quinnell" grading system before and in intervals after 3 and 6 weeks 3, 6 and 12 months after injection. Results: From the 112 thumbs, 15 (13.4%) required reinjection and/or surgery. Twelve (80%) of these 15 thumbs were simply re-injected, 2 (13.3%) underwent surgery without re-injection but because of no improvement, underwent surgery. Reduction in Quinnell grade after the first injection was significant (p < .0001). One year after the first injection, 111 of 112 thumbs (99.1%) were symptom-free. Conclusion: Sonographically guided intra flexor sheath corticosteroid injectionis an effective method in the management of trigger thumb and would reduce the need for surgical release.