Iranian Journal of Orthopedic Surgery

Abstract Background: Tea consumption and exercise loading may have favorable effects on risk of osteoporosis. However, effects of tea plus exercise training on bone density are not clear. The aim of this study was to clarify the influence of combined treatment with tea extract and treadmill exercise on bone mineral density in middle-aged rats. Material and Method: Forty male Wistar rats (14 weeks old) were randomized into four groups: control, sham, exercise training and tea plus exercise training. Rats in the exercise groups were participated in a running exercise program (1 h/day, 5 times/ week for 8 weeks). Tea extract were intraperitoneally injected by 0.3 mg/kg. Body composition and bone mineral density of the whole body were assessed by dual-energy X-ray absorptiometry at baseline and after intervention. Data were analyzed using SPSS software using ANOVA and post hoc Tukey test. Results: Running on treadmill significantly increased femur bone mineral density in rats compared to control group (P=0.04). On the other hand, it was observed that exercise plus tea consumption increased bone mineral density in whole body (P=0.01) and femur (P=0.03) of middle aged rats. Conclusion: Tea enhanced the bone response to mechanical loading and a synergistic effect was observed in a rat model.

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: Physical activity reduces the risk of bone fractures by decelerating the bone loss and enhancing muscle strength. Such activities promote the bone strength and bone density through bone stimulation. The present study aimed to compare the effect of endurance training with varying intensities on the selected biomechanical properties of femurs in old male Wistar rats.
Methods: 24 male Wistar rats (23 months old) with an average weight of 441.75 grams were randomly divided into 2 experimental and one control grpups: Moderate intensity continuous training (MICT, n = 8), high intensity Interval training (HIIT, n = 8), and control group (CG, n = 8). Moderate and high intensity endurance training sessions were held five days a week with 60-70% and   80-110% of the maximum speed) and high (maximum speed) for eight weeks, respectively. In the MICT and HIET groups, the duration and distance (volume of training) were the same and only the intensity of training differed. Forty-eight hours after the last training session, the rats underwent surgery and their femur removed. Three–point bending flexural test was used to determine the effects of training on modulation, maximum endurance, fracture energy, and femur strength in the rats. The statistical analysis was performed using one-way ANOVA test at P <0.05.
Results: The study results indicated that eight weeks of endurance training with varying intensities had no significant effect on modulation (p < /em>=0.198), bone strength (p < /em>=0.24), fracture energy (p < /em>=0.204), deformation-to-maximum strength (p < /em>=0.89), and femur strength (p < /em>=0.31), and that no significant difference was observed among the three groups.
Conclusion: The biomechanical changes of the bone by such exercises require longer periods of training, which could be examined in future studies.
 

Abstract Background: Drilling of bone is used to fix the fractures with screws, wires or plates. The interaction between hole surface surface and fracture stabilization components is effective in the bonding strength of the stabilization process. During bone drilling, the temperature could increase above 47 °C and cause irreversible thermal necrosis. The surface roughness can be considered as a sign of damage of the bone cells. Methods: This study looks at the effect of rotational speed of drilling of bone on production of surface defects to determine the best processing condition for minimizing the osteonecrosis and surface defects. Seven different rotational speeds in drilling beef femur were used-in non-cooling and liquid cooling phases. In all tests the temperature was measured. After cutting samples, using hematoxylin-eosin staining were stained for detection of surface defects. Results: The lowest heat prodution was with use of liquid cooling. The drill speed of 1500 rpm with liquid cooling showed the maximum temperature of 48.5°C without production of surface debris and defects as witnessed in stained bone segment. Conclusions: Cooling application in bone drilling process avoids over and thus less thermal necrosis, which gives the lowest number of surface defects and highest quality wall surface hole.

Abstract Bone Drilling is one of the most essential procedures in orthopaedic surgery and it is executed for various purposes. Fixing the bone in fractures, non:::union:::, deformities, mal:::union:::, and cosmetic lengthening corrections, are the main purpose for internal and external fixations. In both internal and external fixations, use of pins or screws drilling becomes necessary.   One of the important issues we face while drilling, is heat escalation of the drill and its transference to the bone causing thermal osteonecrosis.

Abstract Background: Bone bruise is a signal change in MRI and could be the result of bleeding or edema with microfractures in trabecular bone system. Analysis of the location of bone bruise could be a clue for mechanism of trauma. Awareness of pattern, severity and location of bone bruise and pain gives a better understanding of its nature and the related concomitant injuries. In this research the relation between pain and its severity with bone bruise is investigated. Methods: In a prospective study, 22 patients (20 males, 2 female) with mean age of 34 years old and with isolated bone bruise after a knee trauma was studied in a trauma center in Urmia, Iran. Patients scored their pain using Visual Analogue Scale (VAS). For volumetric calculation of bone bruise we used A*B*C vectors multiplication and for severity of bone bruise we used software that measures the resotution of pictures. The locations of bone bruise were also determined and recorded. Finally, the relationship between these parameters and patients’ pain were statistically analyzed. Results: The mean pain score were 4.40±1.56 in males and 7±2.82 in females. Mean bone bruise intensity was 176.4±42.47. There was no relationship between patient's age and pain severity. There was also no significant correlation between volume or location of bone bruise and severity of pain score (p < /em>≥.05). The mean bone bruise volume was 8.77±8.12 and the mean pain sc ore was 4.63±1.78. Conclusions: Among the multiple characteristics of bone bruise, the intensity has the most direct correlation with severity of pain.

Abstract Background: Internal immobilization of bone fracture often requires drilling and screw fixation of implanted bone. During bone drilling, the temperature could increase above 47°C causing irreversible thermal necrosis. This study is an experimental bone drilling with ultrasonic-assist in evaluating the temperature increase in comparison with conventional drilling.Methods: An experimental study on a bovine femur specimen was performed by drilling holes with ultrasonic assisted drill. The generated temperature in different speeds was documented at the drilling site, and was compared with the conventional drilling technique.Results: Ultrasonic-assisted drilling at 1000 rpm produced less temperature elevation compared with conventional drilling. Furthermore, at rotational speed of 2000 rpm, the temperature raise was independent of “feed rate” of the drilling.Conclusions: Using ultrasonic vibration in drilling of bovine femur produces less temperature raise in drill site, and works independent “feed rate” when compared with conventional drilling.

Abstract Background: Acute Hematogenous Osteomyelitis (AHO) is a potentially dangerous disease of childhood which is often seen in boys and involves the metaphysis of lower extremity, especially tibia. The aim of this study is to review the common bones and common organisms involved in hematogenous osteomyelitis in children.Methods: In this retrospective study, the data of 111 children with acute hematogenous osteomyelitis admitted between 1997 and 2006 in two training hospitals in Ahvaz, Iran was studied. The responsible organism and the involved bone are the cases of interest in this study. Results: Acute hematogenous osteomyelitis was 3.27 times more common in boys than girls. The most common site of involvement was distal tibia in boys and proximal femur in girls. In 68.89% of the patients the culture of the involved bone was positive and the most common organism was staphylococcus aureus in both sexes. Conclusions: Acute hematogenous osteomyelitis is more common in boys than girls. The most common site of involvement was different in boys and girls but the most common responsible organism for infection was staphylococcus aureus in both genders. 

Abstract Background: Internal immobilization of skeletal fractures is usually done by drilling of fracture site and screw fixation . During bone drilling, the temperature could increase above 47°C causing irreversible thermal necrosis. This study will try to determine the best drilling condition to minimize the chance of osteonecrosis. Methods: Drilling tests were performed with two different drilling techniques -conventional and high speed- on the femur of bovine measuring the temperature and thrust force in drilling site. Results: The results demonstrated that in conventional drilling, in all of the processing conditions, the value of generated heat was higher than allowable limit and occurrence of thermal necrosis was unavoidable. On the other hand, the increase of cutting speed of drill bit in high speed range (6000-7000 rpm) lead to considerable decrease of thrust force and increase of heat dissipation with chips, leading to reduction of local temperature raise in drilling site. But with more rotational speed of drill bit, the amount of temperature elevation was increased due to very little change in drilling force but increased friction between body of drill bit with the chips. Conclusions: High speed bone drilling in 6000-7000 rpm, compared to conventional drilling, produces less heat and less thermal necrosis.

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:  Clavicle is a common bone to fracture, and is most often treated with nonsurgical methods. Surgery may become indicated in occasional case of irreducible fracture with considerable displacement, open fracture, floating shoulder, and associated neurovascular injury, non:::union:::. There is still uncertainty about the best surgical method for this condition. In this study, we evaluated the results of intra-medullary screw fixation of clavicle fracture.Methods:  In a prospective study between March 2005 and March 2007, 20 clavicular fracture (13 males,7 females) with mean age of 32 years old (20-55), that had indication for surgery, were fixed with intra-medulary cannulated screw through a mini incision. We evaluated time to :::union:::, shoulder range of motion, side effects and patient satisfaction with a mean follow-up of 6 months (4-10 months).Results:  The mean time to :::union::: was 10 weeks. The :::union::: was uncomplicated in 19 (95%) patients, while 1 case (5%), the bending of cannulated screw after a new trauma, required replacement by a thicker screw. There was no significant complication after surgery. All the patients were satisfied with the surgery.Conclusions: Cannulated screw is an effective fixation method for the claviclular fractures that are amenable to surgical treatment. Supplemental studies are necessary.

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 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: Soft tissue or bony injury especially fracture-dislocations can cause stiffness resulting in decrease finger and hand function. In this study dynamic traction was used for restoration of alignment and fixation of fractures.Methods: A cross-sectional study was done in a hospital in Isfahan. Eighteen patients with 10 forth finger, 5 fifth and 3 third finger injuries were treated with dynamic traction for fracture dislocation of proximal interphalangeal joints between 2001-2006. Two fine k-wires were used – each on one side of the broken joint. Rubber bands were used to connect the pin and maintain traction on the fracture. All the fractures had involvement of more than 40% of articular surfaces. While active motion was started the next day, the fixator was left in place for 4-6 weeks. The mean age of patients was 24 (18-39 years). They were assessed clinically and rediographically nine months (8-23 months) after surgery.Results: All the patients achieved :::union::: with an average joint motion of 92 degrees (82 to 98). Four patients had 10 degrees extension lag and 3 cases had 10 degrees of flexion contracture. Joint congruity was obtained all but two cases who have decrease in joint space.Conclusions: Dynamic traction with pins and robber band permit early motion with early soft tissue and bone healing in complex proximal interphalangeal joint soft finger.