Iranian Journal of Orthopedic Surgery

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 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.

Abstract Background: There have been investigations on the effect of absence or presence of Palmaris longus tendon on pinch and grip strength of the hand. In the same way the effect of presence of fifth superficial flexor digitorum on grip strength of the hand has been investigated. The aim of the present study was to assess the combined effect of these anatomical variations on pinch and grip strength. Methods: In a cross sectional study, 1046 hands in 523 volunteers were enrolled. Each hand was assessed for the presence or absence of palmaris longus tendon and also variations of fifth superficial flexor digitorum function. Then the grip and pinch power of the hands were measured with Jammar Dynamometer. Results: Presence or absence of Palmaris longus had no effect on grip strength of the individuals. In the same way, variations of fifth superficial flexor digitorum function had no effect on the grip and pinch strengths. But the positive and statistically significant effect of presence of palmaris longus on pinch strength (25.38 in hands with palmaris present v/s 24.43 in hands without it) was evident (p < /em>=.03). Grip and pinch powers were higher in men compared to women (p < /em><.0001) and in right compared to left hands (p < /em>=.013). Conclusions: Based upon the findings of the present study, it seems that absence of palmaris longus tendon is associated with a reduction in pinch strength, but has no effect on grip strength and the variations of fifth superficial flexor digitorum have no effect on pinch and grip strengths. 

Abstract Background: The aim of the present study was to compare two methods of plating and intramedullary nailing in treatmant of closed noncomminuted tibia fractures with intact fibulae.Methods: Utimately 69 patients were followed for at least one year. The patients were randomly devided into two groups of plating and intramedullary nailing and operated on.Results: One case of non:::union::: and one case of superficial infection occurred in the intramedullary group. One of the patients in the intramedullary group developed late deep infection in the screws location (in both cases p < /em>>.05). In both of the groups the tibia fractures reached :::union::: in about 4 months, though the intramedulary group had underwent more operations for :::union::: achievement (dynamization in 4, 12.1%, p < /em>≥.05). The need for implant removal was not statistically significant in the two groups (p < /em>≥.05). Of the other variables, the diffence between the two groups was statistically significant only with regard to their complaints of the limb and the number of individuals with knee pain (p < /em>

Abstract Background: The standard method for repair of an injured peripheal nerve is epineural repair with separate sutures. In this article, we described a method of continuous running epineural suturing in an animal model, and compared it with the standard interrupted technique.  Methods: In a clinical trial study, the sciatic nerve of 25 dogs was cut by a sharp blade under general anesthesia. The dogs were randomly divided in 3 groups. The 10 dogs received simple interrupted suturing of the cut sciatic nerve (control group), another 10 had continuous suturing technique, and the remaining 5 were left unrepaired. After 6 weeks the dogs were sacrificed and the nerves were studied by light and electron microscopy. The amount of consumed suture material, time of repair, myelin thickness and axon diameter were examined. Ultrastructural studies were performed to assess the degeneration and regeneration process. Results: The time of suturing and the amount of consumed suture material were significantly lower in the continous group (p < /i>

Abstract Background: Diagnosis of carpal tunnel syndrome is based on clinical findings and these findings are used to confirm the diagnosis. Sonography is also a noninvasive method for diagnosis of carpal tunnel syndrome. The purpose of this study was to investigate the role of sonography and electrodiagnostic studies in diagnosis of this syndrome. Methods: In a prospective study, 76 hands with diagnosis of carpal tunnel syndrome (study group) were compared with 80 hands (control group) in a training hospital in Kerman-Iran. In both groups the diameter of median nerve was measured by sonography and electrodiagnostic studies were performed only on the study group. The study group, post surgery, was followed up for 6 months and the DASH preoperative functional scoring was compared with post operative scores. Results: The difference between the diameters of the median nerve measured by sonography (p=.0001) and also the difference between before and after-operation Dash Score in the patient group (p=.001) were statistically significant. Sonography was 95% sensitive and 93% specific for the diagnosis of carpal tunnel syndrome. A weak correlation was found between the severity of the disease in electrodiagnostic studies and sonography (p < .01, r=.38). No correlation was proved between the sonographic or electrodiagnostic findings and Dash score before and after the operation (p≥.05). Conclusion: sonography might be a suitable module for the diagnosis of carpal tunnel syndrome, but there were no correlation between its findings or electrodiagnostic findings and functional scores. Whether or not sonography could be substitute for electerodiagnostic tests, will need further investigation.

Abstract Tourniquet is a device that prevents blood entrance and exit from a limb. Its use goes back to 200 years BC- the Roman emperors’ era - and has been utilized especially in amputations. During the history, several types of tourniquets have been used by surgeons and its design has changed regularly. Nowadays tourniquet is used very often in orthopaedic, vascular and plastic surgery. Although its usage is not routine, but it is a great help to the surgeon. Tourniquet, like other techniques has risks and side effects and the surgeons have to be aware of them as well as its proper use. This article mainly deals with pneumatic tourniquet, its usage and complications.