Iranian Journal of Orthopedic Surgery

Abstract  Background: Bleeding from proximal screw drill-site in femoral neck fractures may have the ability to predict the occurance of avascular necrosis of femoural head. In this study the relationship of bleeding from proximal screw drill-site during internal fixation of femoral neck fractures with rate of avascular necrosis was studied. Methods: This study is a cross-sectional study that was carried out on 19 to 60 year patients with femoral neck fracture that referred to health care centers in Rasht, Iran during the year 2008. The age, sex, type of fracture based on Garden Category were recorded. Then, presence or absence of bleeding from the proximal screw holes within the first 5 minutes was recorded.  Results: In this study, 40 patients were enrolled with mean age of 39.78±14.4. Twenty two patients (55%) had bleeding from the proximal end of the screw, and 18 (45%) did not have any bleeding. Bleeding from proximal screw hole in patients without avascular necrosis was seen in 11 cases (61.1%). This difference was statistically significant (p < /i>=.005). Conclusions: Presence of bleeding from proximal screw hole in femoral neck fracture reduces odds of AVN in femoral head fracture and can help deciding between internal fixation or arthroplasty for treatment of such a fracture.  

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: The choice of graft for anterior cruciate ligament ACL reconstruction remains controversial. This study aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis grafts for ACL reconstruction over a 3 year follow-up interval.Methods: In a randomized clinical trial study, 71 patients with an average age of 29 years were treated for ACL between 2008 and 2009. Forty six patients underwent reconstruction with BPTB autograft, and 41 were treated with ST autograft. In the last year of follow-up, 37 patients in patella group and 34 patients in hamstring group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC score and complications.Results: At 36 month follow-up, 34 patients in BPTB and and 28 in ST group, had good-to-excellent IKDC score (p < /em>≥.05).Lachman test was graded normal, for 23 while patients in BPTB and / in ST group, (p < /em>=.043) normal pivot-shift test was present in, 29 and 15 patients, respectively (p < /em>=.038). There was no significant difference in terms of thigh circumference knee effusion, range of motion or pain. The complications rate was also similar.Conclusions: These results indicate a trend toward increased graft laxity and pivot-shift grades in patients undergoing reconstruction with hamstring autograft compared with patella tendon. However, the two groups had comparable results in terms of activity level, and knee function.

Abstract Background: Prevention of arthrofibrosis by different drugs and surgical techniques is an essential issue in modern orthopaedics. This study investigated the effect of bevacizumab on intra-articular fibrosis in a rabbit animal model.Methods: Arthrofibrosis was induced in right stifle joint of thirty male white rabbits by removing the cortical bone of femoral condyle in medial gutter under general anesthesia. The rabbits were randomly divided into three equal groups. The control group received intra-articular injection of saline the "one-injection" group received a single dose of bevacizumab (2.5 mg/kg), and the" two-injection" group received two intra-articular injections on the day of operation and 14 days later. Forty five days after the surgery, the animals were sacrificed. The severity of fibrosis was assessed by range of motion of the stifles, macroscopic adhesion score, and histopathologic variables.Results: Although no statistical difference was seen between the control group and the "one-injection" group in terms of range of motion and macroscopic evaluation, the histopathologic variables in prevention of arthrofibrosis, except for the granulation tissue, were significantly better in the "one-injection" group. The "two-injection" group in comparison to the "one-injection" group was better not only in range of motion evaluation (p < /em>=.001) and visual adhesion score (p < /em>=.012), but also in most of the histopathologic variables, except for the cell count and granulation tissue.Conclusions: Two injections of bevacizumab for prevention of arthrofibrosis resulted in better outcome than single injection.

Abstract Background: The aim of this study was to determine the efficacy of different antiseptic solutions (Control group (I), Antibiotic solution (II), Chlorhexidine .4% (III), and povidone – iodine 10% (IV) in sterilizing contaminated osteochondral plugs.Methods: Under sterile conditions, the femoral head and condyles of 20 rabbits were removed and cut into equal osteochondral pieces. A total of 200 osteochondral specimens were obtained. All 200 specimens were dropped on the operating room floor for 15 seconds and assigned to one of four experimental groups. Group I samples were cultured after washing with normal saline solution (Control group). In other three groups, prior to culturing process, samples were placed in an antibiotic solution after washing with normal saline (Neomycin & Polymyxin) (group II), Chlorhexidine .4% (group III), and povidone - iodine 10% (group IV), respectively.Results: In group I, 41 of 50 specimens had positive cultures. Of 50 specimens of group IV, 2 specimens had positive cultures after 10 days while in group II and III no positive cultures were found.Conclusions: All three agents including antibiotic solution, povidone-iodine 10% and chlorhexidine 0.4% seem effective in sterilizing the contaminated osteochondral samples.

Abstract Chairmen: Javad Parvizi MD, FRCS Thorsten Gehrke, MDPart 2: Preoperative skin cleansing

Abstract Background: There is a great debate about the proper autograft for arthroscopic anterior cruciate ligament reconstruction (ACLR). In current study, we compared the clinical and functional outcomes of ACLR using either medial hamstring (MH) tendon or patellar tendon (PT).    Methods: Eighty eight patients with anterior cruciate ligament (ACL) injury contributed to a retrospective study. The study was done in a teaching hospital in Yazd, Iran. Patients were divided into two groups based on the type of autograft used for ACLR: MD (48 patients) and PT (40 patients). In a follow-up of 18.5±2.2 months in MH and 19.3±2.9 months in PT group, the pain was analized using visual analogue scale (VAS) and the range of knee flexion was measured. The result of the surgery was assessed utilizing Tegner-Lysholm score, KOOS (Knee injury and osteoarthritis outcomes) and return to the previous activity. Results: The two groups were the same in term of range of knee flexion, KOOS and Tegner-Lysholm score. The VAS averaged .9±.3 in MH and 1.15±.5 in PT groups, with no significant difference. Return to previous activity was seen in 80% of PT group and 85.4% of MH group. Conclusions: ACLR using either MH or PT autograft, is effective in short-term, and is associated with satisfactory clinical and functional outcomes.