Iranian Journal of Orthopedic Surgery

Abstract Background & Aim: Orthopedic trauma is a common injury in children and may cause deep and permanent psychological and physical damages for the patients and their families. Recognition of the incidence rate of these injuries can help design effective treatment plans. This study aimed to identify various dimensions of orthopedic trauma in children in Abu Ali Sina Hospital of Sari, Northern Iran.
Materials and Methods: In this prospective descriptive study, patients under the age of 16 years with orthopedic injuries, hospitalized in Bu Ali Sina Hospital during 2015-2016 were entered into the research. Information related to the age, gender, and mechanism trauma was collected. Data analysis was performed in SPSS using Chi-square, as well as paired and one-sample t-tests.
Results: In total, 525 patients below the age of 16 years were assessed, (65.3%) with a mean age of 9.7±4.4 were male years and the rest were female (34.7%) with the mean age of 7.7±6.4 years. While most injuries in male subjects were in the age range of 14-16 years, for female participants two poaks in the age ranges of 2-4 and 14-16 years was seen. Moreover, 81.7% of the fractures were related to the upper limbs while 18.3% of the traumas were observed in the lower limbs. Furthermore, the most common location of incidents was home, and most frequent mechanism in both genders was falling (42.3%). In addition, the most common time of injuries was the fall season (44.6%). According to the results, most orthopedic trauma (56.7%) were observed in children and adolescents with normal body mass indexes, and only 8.29% of fracture cases were related to obese or overweight patients aged 2-16 years.
Conclusion: Children are at risk of severe orthopedic trauma, which is due to lack of information, awareness, and education. Examining the safety of children and keeping them away from such injuries is essential and must be stadied in other large cities in other the developing countries.
 

Abstract Background: Unstable pelvic fracture means those fractures which are both vertically and rotationally unstable. The site of posterior instability could be in sacrum, posterior ilium, or sacro-iliac joint. The anterior injury may be in the symphysis pubis or pubic rami.  Posterior fixation of pelvis with double rods inserted into the sacral alae of the ilium compressed together by knots is a stabilizing surgical option when iliosacral screw fixation is not feasible or available.Materials: Eleven patients with unstable pelvic fracture who had received posterior stabilization with two threaded rods and bolts in prone position after reduction of fracture with skeletal traction were studied retrospectively. The anterior fixation was either symphyseal plating or external fixator.Results:  with a 6 months follow up, there was no evidence of device failure, infection, neurological deficit, or non-:::union:::. There was, however, some leg length discrepancy due to imperfect initial reduction.Conclusion: Posterior stabilization of pelvis by transiliac rods, in unstable pelvic fractures, is a simple procedure to be used effectively when more secure fixation is not available.

Abstract acromioclavicular joint separation such as screw fixation, pin fixation, coracoclavicular ligaments reconstruction, tension band wiring. One of the recent methods is hook plate fixation.Methods: In a retrospective study, 81 patients with unstable distal clavicular fractures or acromioclavicular joint separation that were treated with hook plate, were assessed. The assessment included the reliability of fixation method and its impression on subacromial space. Clinical results were charted due to constant score system.Results: All the distal clavicular fractures were solidly united. In the last follow-up, the mean of constant score were 93.6 of 100. We had mild pain during range of motion in 16 patients (19.7%) although they had full range of motion, in 2 cases we had recurrent separation of joint that was revised in 3 weeks after primary operation.Conclusions: Hook plate fixation is a good method for unstable distal clavicular fractures and acromioclavicular joint separation, but we must inform the patient for expectable complications and plate removal necessity.

Abstract Background: Classification and treatment of lateral humeral condyle fracture in children is a matter of controversy. We report the results of treatment in 26 cases along with a comprehensive literature review.Methods: Medical records and radiographs of 26 children (8 girls, 18 boys) who had been treated for lateral humeral condyle fracture over 20 year period were reviewed. The cases had a mean age of 4.5 years (1.9-8 years). The patients were evaluated for elbow range of motion, deformity, neurological deficit, and avascular necrosis with an average follow-up of 6 (3-20) years. Results: From the 26 cases, 17 patients had less than 2 millimeters displacement, and had been treated non-operatively 8 patients with displaced fracture had received internal fixation. One case that presented late and had ulnar nerve symptom with fracture non-:::union:::, underwent only anterior transposition of the nerve. The cases had all full range of motion, with no avascular necrosis. The one non-:::union::: case had a carrying angle of 26 degrees.Conclusions: Lateral humeral condyle fracture in children requires surgical treatment more than most other pediatric fractures. Initial displacement of over 2 millimeters or any later displacement in the early post fracture period would require surgical intervention.

Abstract Background: The term “floating knee” is used to describe the flail knee separated from the ipsilateral hip and ankle. Its various forms are expressed in the classification framework. The objective of this research was to review the authenticity of previous floating knee classifications.Methods: In a retrospective study, 74 patients (64 males, 10 females) with floating knee, the epidemiology of this trauma and the prevalence of its various kinds of fractures were studied in relation to the five existing classifications. The study was done in two educational trauma centers in Mashhad, in a two year period at one and 3 year period at the other hospital. The mean age of the patients was 25.6 years.Results: In classification of patients, there was some non-conformity with the previous classifications. In previous classifications there are some weaknesses such as not to have location for open fractures, cases with both injured epiphyses and cases that have more than two fractures around the knee. In the new classification ''the floating knee'' has been divided into three types: Conventional floating knee (A,B,C), Complex knee fractures (D,E) and variant floating knee (the hip and ankle ipsilateral fractures). Each subgroup is marked with one of the numerical codes (0,I,II) which determines the open or closed status of the fracture(s). In this research 12% of injuries were complex knee fractures.Conclusions: In the new classification, fractures’ types are classified as relatively comprehensive and simple and are coded.

Abstract How would you deal with a large bony piece which has vital value for stability and function, has fallen out of wound in an open fracture and is brought to you in a severely contaminated shape? How about a large bony fragment falling out of your hand onto the operating room floor during surgery?Can one take an osteochondral piece as an autologus composite graft out of a badly contaminated amputated limb. If yes, how one may prepare such a graft?There is scanty information in the literature on this subject. The following is an overview of the sporadic reported cases on such issues.

Abstract Background: Fracture of metacarpal and phalangeal bones of hand are common sport and industrial injuries in the upper extremity. Mini-plate fixation is one of the techniques used in fixation of unstable kind of fractures in hand. We would like to report our experience with such fractures treated with titanium mini-platesMethods: In a clinical trial study, 29 patients with 48 unstable hand fractures (21 metacarpal, 27 phalanges) received titanium mini-plate fixation during 1999-2006. The mean age was 27 years (14-53). Twenty eight cases were periarticular and 20 shaft fractures. The cases were evaluated with an average follow-up of 17 months (6-52), and range of motion and function were assessed.Results: The results, based on total active motion, were considered excellent in 39 (³221 degrees), good in 8 (121-220 degrees) and poor in1case (

Abstract Background: Treating open fracture of the femur is problematic. In this study the results of unreamed intramedullary (IM) nailing in this kind of fracture is reviewed.Methods: In a prospective study, 41 patients (40 males, 1 female) with open femur fractures were treated, using the above method, in two hospitals in Meshhad from 2004 to 2006. Fifteen cases could not be followed. The remaining 26 patients, with 28 years mean age (16-45 years) were comprised of 6 type A, 9 B, and 11 type C fractures - according to AO classification. There were 2 type II, and 24 IIIA, Gustillo/Anderson open fractures, with a mean injury severity score (ISS) of 10.96. The cases were followed from 18 to 36 months, and the :::union::: rate, infection rate, and limb function were assessed.Results: Twenty three patients reached :::union::: in 156 days on average (84-250 days). Infection occurred in 2 patients. At the end of the follow-up period, the range of motion of the knee was 120 degrees. Shortening of 3 centimeters was observed in one case.Conclusions: Unreamed intramedullary titanium nailing is effective in treatment of type II and IIIA open femoral fractures.

Abstract Proximal humerus fractures - a common occurrence in elderly- comprise 4-5% of skeletal fractures. Twenty percent of such fractures require surgical treatment.Presence of painful movement at fracture site, 2-3 months after treatment, is called non-:::union:::. “Mal:::union:::” is the name given to a fracture with over 40 degrees rotation and or angulations or more than 10 millimeters displacement. The fracture pattern, age and personality of the patient and previously rendered treatment are the elements which determine the occurrence of mal:::union::: or non:::union:::.Good clinical evaluation, high quality standard radiographs and other imaging modalities like computerized tomography are mandatory for a successful treatment plan. Painful, limited range of motion and functional impairment are the two major indications for surgical intervention. Treatment with internal fixation and bone grafting of a non:::union::: or osteotomy for mal:::union::: should be individualized according to patient’s complaint and functional demands.The results of implant arthroplasty are better for acute fracture than old healed mal:::union:::s or non:::union:::s. Prevention of non-:::union::: or mal:::union::: is superior to secondary reconstructive surgeries and reconstruction outcome is dependent on meticulous planning and technique and patient selection.