Iranian Journal of Orthopedic Surgery

Abstract Acrometastasis or metastasis distal to elbow and/or knee is a very rare event. A 31 y/o female, a known case of breast cancer for 3 years presented with a swollen 4th right finger. Radiographs and then biopsy showed separate metastases to middle and distal phalanges, an extremely rare event. She was managed with ray amputation. Four months later she developed a second metastasis, this time to her left tibia, again a rare site for metastasis, that was managed by closed intramedullary nailing. Sadly, she died of pulmonary metastasis, 9 months after her hand event. Acrometastasis is a rare finding and predicts a short survival.  

Abstract Background: Tendon transfer for radial nerve palsy is often a rewarding procedure. The aim of this study is to compare the results of three different kinds of transfers used for radial nerve paralysis.Methods: In a retrospective study, 41 patients with irreversible radial nerve paralysis who had undergone tendon transfer over a 5-year period (2005-2009) were studied. 18 patients had received flexor carpia ulnaris transfer, 10 cases had flexor carpi radialis transfer, and 13 had transfer of flexor digitorum superficialis. With a mean follow-up of 20 months, the patients were evaluated for achieved range of motion, return to previous job, and their overall satisfaction. The DASH score was also calculated for each patient.Results: There was no statistical difference between the 3 groups in terms of DASH score, ability and time of returning back to job, and their satisfaction with the procedure. The range of motion also did not show any difference. An overall satisfaction rate of 95 percent was observed, with no major complication in any of the groups.Conclusion: The 3 different methods of tendon transfer studied in this paper give satisfactory results irrespective of the method used.

Abstract Background: Use of Tourniquet in orthopaedics, to produce a bloodless field, is mainly for the comfort of the surgeon. It is, however, associated with potential dangers. This study was performed to assess the effects of tourniquet use on patients’ and surgeons’ comfort when plating tibial fractures.Methods: 138 patients with acute extraarticular tibia fractures were randomized into “tourniquet” and no "no tourniquet" groups. Postoperatively patients' pain, the amount of blood drainage, time to complete bony :::union:::, development of infection and non:::union::: was compared between the two groups in a minimum one year follow-up.Results: 73 cases who were in “no tourniquet” group had significantly less bloold drainage, and less postoperative pain in the first 24 hours. The surgical time was however shorter in 65 patients that had tourniquet. The :::union::: or infection rates showed no difference.Conclusion: Avoidance of tourniquet use does not decrease the time to :::union::: or the infection rate after plating of tibia fractures, but is associated with a decrease in pain perception by the patient in the early postoperative period.

Abstract Psychosomatic disorders may occasionally present in the upper extremity and their diagnosis and treatment may prove to be extremely difficult. Herein, we describe one such patient and review the literature on this subject.

Abstract Background: Distal radius fracture is a common fracture encountered in fracture clinics. One of the common complications of this fracture is restriction of rotational movements of the wrist and forearm. Identification of factors affecting this loss of motion is of importance. This study was designed to identify the factors that may be responsible for loss of rotational motion of wrist and forearm in those extra articular distal radius fractures that are associated with ulnar styloid fracture.Methods: 47 patients with extra-articular distal radius fracture were enrolled in a prospective case control study from March 2005 to December 2006. pre and post operation. These were all stable extra-articular distal radius fracture that were treated by closed reduction under general anesthesia and long-arm casting. 24 patients had associated ulnar styloid fracture without extension into the joint and 23 others had no ulnar fracture. The patients had their final clinical follow-up after 6 months. The rotational movements of wrist and forearm were assessed for both groups by an independent observer. The pre and post operation findings were compared.Results: Ultimately the 23 patients with intact ulnar styloid had an average of 8.9 degrees less supination (compared with their non-broken side), and the ones with ulnar styloid fracture had 25.44 degrees average loss of supination (p < /em>