Iranian Journal of Orthopedic Surgery

Abstract Aims:
Distal radius fracture (DRF) has the highest rate among pediatric fractures. The management of distal radius fractures in children has to be as non-invasive as possible, which requires definitive care for proper reduction and stabilization. This study was designed to evaluate the short-term complications of pinning radius fractures in children, help the surgeon make an appropriate decision according to the situation of patients, and also look for solutions to reduce complications.
Methods:
In this cohort study, patients diagnosed with distal radius fracture aged 3-15 years who visited Shahid Madani Hospital in Karaj were evaluated. Demographic characteristics and type of fracture of patients who underwent pinning of distal radius fractures, were collected after obtaining their consent. Then the complications of patients were evaluated based on Clavien-Dindo-Sink, and dahl scores four and five weeks, and three and six months after the surgery.
Findings:
According to the Clavien-Dindo-Sink score, 96 cases had no complications, 35 cases had complications of grade 1, 27 cases had complications of grade 2, 9 cases had complications of grade 3, and 1 patient had complications of grade 4. In the examination of the DahlPin operative site complication score, 108 cases had no operative site complications, 30 cases had complications of grade 1, 22 cases had complications of grade 2, 6 cases had complications of grade 3, and 2 cases had complications of grade 4. Four cases had transient neurapraxia and 20 cases had limited range of motion.
Conclusion:
The results obtained from this study create a more comprehensive understanding of the complications and weaknesses of the percutaneous pinning treatment method for distal radius fracture patients.

Abstract Introduction:
Genu varum is a type of knee deformity. In this deformity lower limb mechanical axis, moves inward to the knee centre. In genu varum mechanical axis usually lies through the medial of the knee joint. In this deformity, the patient's lower limbs become bow shape. One of the best techniques for genu varum correction is high tibial osteotomy that this procedure can change some index include posterior tibial slope (PTS), and insall-salvati index (ISI).
Method:
Our study was a cross-sectional study performed on patients with genu varum before and after a step cut of the high tibia osteotomy. The method of examining the posterior tibia slope was that before and after the high tibia osteotomy by Step Cut-MCL sparing method, a simple radiographic image in true lateral view (True lateral) was taken from the knee of patients. The significance level of P Value <0.05 was considered.
Result:
In this study 21 patients ( 11 male and 10 female ) were enrolled. Mean age was 36.19 ± 10.17 year-old. Mean PTS pre operation was 11.48 ± 1.94 degrees and post operation was 11.48 ± 2.15 degrees.
Conclusion:
In our study, PTS increased after HTO that this increase was not statistically significant difference between men and women. In addition, we showed that this increase did not have significant relationship with age and BMI. In the present study, Insall-Salvati index showed no significant difference before and after the treatment.

Abstract Introduction: Knee arthroplasty is one of the most successful orthopedic surgeries, and many studies have been done on Eproch and the timing of surgery, but few studies have been performed on the outcomes and complications of knee arthroplasty and its comparison 48 hours later. Therefore, we decided to conduct a study to determine the clinical outcomes and complications of two knee joint replacements and to compare them within 48 hours.

Methods: This study was a cohort study, the first group consisted of patients undergoing concurrent arthroplasty and the second group were patients undergoing 48 knee arthroplasty within 48 hours then postoperative complications, duration Time of hospitalization, clinical outcome two weeks after surgery, one month after surgery and three months after surgery were evaluated.
Result: None of the criteria evaluated by lysholm questionnaire were significantly different in the studied patients. Postoperative complications were also evaluated in both case and control groups, with no significant difference in either group. (P> 0.05).
Discussion: Overall, there was no significant difference in pain rate, knee function, and surgical complications during the study after both treatments.

Abstract Introduction: The most common cause of knee pain is knee osteoarthritis, many surgical and non-surgical treatments have been proposed but the preferred treatment remains unknown. One of the non-surgical treatments was PRP (plasma reach platate) injection in these patients. Various studies have shown the improvement of the effect of PRP injection with substances such as calcium gluconate, so the aim of this study was to evaluate the effectof PRP with and without calcium gluconate on the clinical results of intra-articular injection of this substance in patients with knee osteoarthritis.
Methods: This was a cohort study in which patients were divided into two groups: PRP injection and PRP injection with calcium gluconate. The results of the study were evaluated by KOOS questionnaire and pain by VAS. A significance level of 0.05 was considered.
Result: Generally, during the study, the pain level in patients after receiving both treatments significantly decreased during the six-month period, while the pain in the case group significantly decreased. (P Value <0.05).
Discussion: From the results of this study, it can be concluded that simultaneous injection of PRP and calcium gluconate can further improve the results of injection.

Abstract Background: Several studies have compared surgical and conservative methods for the treatment of fingertip injuries. However, there are few studies on the effect of phenytoin dressing and its efficiency in treating the fingertips compared to other common treatments. The aim of this study was to compare phenytoin dressing, surgical treatment with VY flap technique and conservative treatment with Vaseline in patients afflicted with fingertip injuries. Methods: This prospective cohort research was conducted on all patients referred to the Emergency Department of Gorgan Hospital during 2016-17 who suffered from fingertip injuries. The eligible patients were selected for further intervention and follow up and were divided into three groups including phenytoin dressing, surgical treatment with VY flap technique and Vaseline conservative treatment. The collected Data was analyzed using Chi-squared test and independent sample t-test and the significance level was considered below 0.05. Results: After 12 months, subjective, objective, and cosmetic complaints were evaluated based on the Allen Impairment Scale. According to the statistical evaluations, no significant difference was found between the three groups in subjective, objective, and cosmetic complaints after one year (P<0.05). Conclusion: The results of this study for the first time showed that phenytoin dressing has a similar effect to Vaseline dressing for the treatment of fingertip injuries and is not superior to it. Furthermore, the findings of this study, in agreement with previous studies, showed that clinical results are similar to conservative and surgical treatments and are not superior to each other.  

Abstract Backgrounds: several tests are used to assess the presence of Palmaris longus tendon. In the present study we attempted to assess the interobserver and intraobserver reliability of five of the most famous ones and also the examination of fifth superficial flexor function. Methods: Two observers, who had been trained about the tests and had practiced on them, examined 105 volunteers on two separate occasions and in one-month interval and the results were recorded. The reliability of each method was assessed with Kappa measurement. Results: Kappa ranged from 0.541 (moderate reliability) to 0.813 (almost complete agreement) for Palmaris. The highest interobserver and intraobserver reliability and also the best agreement with other tests was of Schaeffer. The lowest Kappa was for Thompson and the others had good to excellent reliability. Kappa for interobserver and intraobserver reliability for fifth flexor was respectively 0.415 and 0.500 (moderate reliability). Conclusion: the tests that were assessed have good reliability except for Thompson that has a moderate one. It seems that the standard test (Schaeffer) is the best method for assessment of Palmaris Longus absence or presence. The method assessed for evaluation of fifth superficial flexor variations assessment has a moderate interobserver and intraobserver reliability.

Abstract Background: Fracture of phalanx is common upper extremity fracture. Two pining methods are used for fixation of extraarticular proximal phalanx transverse fractures: transarticular parallel pins passing through (MCP) joint and extraarticular cross pining of fracture with out going through MCP joint. The purpose of this study was to comparie these two fixation methods. Methods: This clinical trial study was done on proximal phalanx transvers fracture using two methods in a training center in Kerman-Iran. In first method, two parallel pins were used from metacarpal head passing through MCP joint into proximall phalanx. In second method two cross pins were used from proximall phalangeal condyles across the fracture. The active range of motion for MCP, PIP and DIP joints, the duration of resuming patients their daily activities, and post operation complications were evaluated. Results: The mean active range of motion for MCP, PIP and DIP joints, 3 and 6 months after surgery showed no significant difference between the two methods of surgery. There was no significant difference between the two methods in age, gender and the duration of returining to work. Conclusions: There was no difference in the results for using cross pining or parallel transarticular pin fixation for proximal phalanx fractures. Since intramedullary method is easier with less use of C-ARM, less damage to soft tissue damage and less distraction of fracture, using transarticular intramedullary parallel pins fixation for proximal phalanx fracture is suggested.

Abstract Background: Infection is a disastrous complication in orthopaedic surgery, because of poor blood supply of long bones and usage of metal devices. The aim of this study was to evaluate the effect of adding topical gentamicin to the surgical wound after open reduction and internal fixation of a long bone fracture. Methods: In a clinical trial, 120 patients who were candidates for open reduction and internal fixation of a long bone fracture in a training hospital in Bandar Abbass, Iran were divided into two equal groups (60 patients each). Routine prophylactic standard systemic antibiotic regimen was used in both groups. In the "case group", gentamicin was used topically in operation site in addition to the systemic regimen. All the patients were followed at least for 6 months and observed for superficial and or deep infection signs and symptoms. Results: In the control group, 12 infections were observed, 7 of which were superficial and cleared with antibiotic and wound care. In the study group only 3 superficial and no deep infections was found. Statistical analysis revealed that both superficial and deep infection rates were significantly lower in the study group (p < /em>=.01). Conclusions: Prophylactic topical use of gentamicin in addition to the systemic regimen can be effective in reducing the rate of infection after open reduction and internal fixation of long bone fractures. 

Abstract Background: Knee replacement is one of the final remedies for severe, symptomatic knee destruction. The results of this surgery are usually excellent. The number of reports from Iran on this subject is very few. We would like to report our experience with knee replacement in Kerman.Methods: In a clinical trial and prospective study, 54 patients (11 males, 43 females) with knee disease who underwent joint replacement from 2001 to 2006 in a Teaching hospital in Kerman, were studied. Mean age was 65 years (41-80) and mean follow-up 34.4 months (3 months to 5 years). 46 cases had osteoarthritis and 8 rheumatoid arthritis. The pre and post operative findings were assessed using the ‘Knee Society’ evaluation system. The opposite knees were used to compare the patients’ satisfaction from the procedure.Results: In a study on 54 cases, the pain score of ‘Knee Society’ improved from 33 to 77 and the functional score improved from 41 to 72. Ninety six percent of the cases were satisfied with their surgeries. The complications included 1 deep and 1 superficial infection, 2 wound healing problem and one patellar dislocation. Three revisions become necessary: 2 due to infection, one for loosening and deformity in tibial component.Conclusions: Knee replacement in Kerman is associated with high satisfaction rate in short-term. Early failure is mostly related to infection or technical errors in surgery.