Iranian Journal of Orthopedic Surgery

Abstract  Background: Flexor and extensor tendon laceration is very common. The evaluation of these injuries may help to highlight the problem and put an end to missed diagnosis and mismanagement of these injuries. Methods: In a retrospective study, 852 patients who have been operated during one year (March 2011 to March 2012) in a training hospital in Shiraz, Iran were evaluated. Results: The 16-30 years old men were mostly affected. Flexor tendon injury was more common in zone IV and extensor tendon laceration in zone V. Associated nerve and/or arterial lacerations were detected in 22.6% patients. Digital nerve was the most commonly injured nerve followed by ulnar nerve. Radial or ulnar artery lacerations were seen in 6.1% of the patients.  Conclusions: Digital nerve is the most commonly injured nerve and should be examined precisely. The high number of affected patients in short period and the possibility of missed diagnosis by non orthopaedic physicians may signify the importance of termination of mismanagement of these injuries by general practitioners and specialists other than orthopaedic surgeons.  

Abstract  Background: Traditional treatment of unstable fifth carpometacarpal joint injuries is closed reduction and pinning. The aim of this study was to determine the safest corridor for pinning of fifth carpometacarpal joint to prevent the iatrogenic injury to the ulnar nerve and tendons .  Methods: In the first phase of study, three fresh cadaver samples were dissected and the safest directions of kirschner wire insertion in coronal and sagittal planes were determined to the base of the fifth metacarpal. The second phase evaluated the accuracy of data obtained in previous phase. Therefore k-wires were inserted in combination of maximum angles in different planes determined previously. After taking X-rays, the ulnar nerve branches and tendons were explored to detect any possible damage. In the third phase, four fresh carpometacarpal joints were fixed with directions outside the range of defined angl es.  Results: The safe direction determined in the first phase was 20° to 30° coronal plane angle in regard to body of the fifth metacarpal bone and between 10° volar to dorsal to 20° dorsal to volar angle in sagittal plane. Insertion of k-wires in the second phase could fix the fifth carpometacarpal joint firmly. All inserted k-wires outside the defined range resulted in injuries to nerve or tendons or infirm fixation  Conclusions: The safest corridor for pinning the unstable fifth carpometacarpal injuries is two centimeters distal to the joint with 20° to 30° in coronal plane and from 10° volar to dorsal to 20° dorsal to volar direction in sagittal plane.

Abstract Background: General information about the ulnar impaction syndrome is scarty and often neglected. The ulnar styloid process and ulnar variance have important roles in this syndrome. The statistical data related to these factors is not enough in Iranian literature.This study measured ulnar styloid length and ulnar variance in a group of healthy adults.Methods: In a prospective study, the ulnar styloid length and ulnar variance were measured on the posteroanterior view on 140 of wrist radiographs in a training hospital in Shiraz-Iran. The relative length of the ulnar styloid process and the ulnar impaction potential were assessed with the styloid-capitate ratio (SCR) and ulnar styloid process index (USPI), respectively. Clinical examination of the wrists for ulnar impaction was also done. Results: The mean ulnar styloid length was 5.38±1.45 mm. The average styloid-capitate ratio (SCR) was .24±.06 and the average of ulnar styloid process index (USPI) was .34±.11. 40.71% of the radiographic views in SCR, and 56.42% in USPI were more than average. The ulnar variance showed 19.3% neutral (23% male, 10% female), 12.1% positive (11% male, 15% female) and 68.6% negative (66% male, 75% female) measurements. Conclusion: It seems a long ulnar styloid process with SCR>.24±.06 or an overall styloid length greater than 6 mm is one of the most important cause of pain in ulnar sided wrist pain in our population.