Iranian Journal of Orthopedic Surgery

Abstract Background: twenty years has passed since the Iran-Iraq war and little has been written on war amputees and their stump problems. With the continued use of prosthesis, its problems increases and meticulous attention by expert team of rehabilitation and orthopaedic surgeons is needed to prevent complications. In this research, the problem caused by amputation were studied. Methods: In a retrospective study, 150 cases were studied in two outpatient clinics in Isfahan, Iran. The cases referring to these centers from June 2003 to December 2011 were evaluated by direct examination and completing a questionnaire. Results: The problems according to their prevalence were hyperpigmentation, itching, linkification, hyperhydrosis, fuliculitis, stump atrophy, decreased soft tissue coverage at the end of stump, stump ulcer, soft unsuitable tissue, bone pain, muscular pain, phantom pain, and stump edema. Other problems with lower prevalent were bone overgrowth, hyopsthesis, fracture bone, too much stump fat, inadequate circulation, pain and pallor of stump. Overall, the skin problems were the most and vascular problems the least prevalent. The rest of issues were seen more frequently in below knee amputations.Conclusions: With the high rate of skin problems in stumps, hygenic care of stump skin, and proper duration of prosthetic use can decrease stump problems.

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: The use of pedicle screws in thoracic or lumbar spinal fusion and deformity correction is becoming more privalent, even in children. Improper screw insertion can produce major complications. The accuracy of the screw placement is evaluated post operatively by CT scanning in a small group of children.Methods: In a cross section study, 7 children under 5 years of age who had undergone spinal surgery, using pedicular screws were evaluated in two training hospitals in Tehran, Iran. The position of pedicular screws was determined by an expert radiologist and documented along with probable neurovascular effect.Results: Seven children with total of 42 pedicle screws were assessed. 34 screws (80%) had been placed in the desired positions. The remaining 9 screws had produced minor breakage through the cortices, mainly in narrow thoracic pedicles. There was no case of neurovascular compromise, or stability problem in the 42 screws.Conclusions: Use of peducular screw in spinal fusion of young children is a proper technique.

Abstract Background: There are limited studies regarding the incidence of degenerative changes in asymptomatic adolescents. This study investigated the incidence of these changes in MRI and demographic factors affecting the presence of these changes.Methods: In a cross-sectional study, lumbar intervertebral disks of 84 asymptomatic adolescents aged between 12-18 years were evaluated using MRI in a educational training center in Tehran, Iran. The presence of degenerative changes in different levels was evaluated and demographic characteristics were compared between those with and without degenerative changes. The effects of these changes on mental and physical health were investigated using SF-36.Results: In total, 25.7% of disks were degenerated. The incidence of these changes was different in different levels. The incidence of degenerative changes was highest in L4-L5 level (45.2%) followed by L5-S1 (36.9%) and lowest in L1-L2 (5.9%). The mean of age of subjects with degenerative changes was significantly higher (p < /em>=.005). Gender and body mass index (BMI) had no effect on incidence of degenerative changes. The presence of these changes decreased the physical, mental and total score of SF-36 only at L3-L4 level, but not in other levels.Conclusions: The degenerative changes in lumbar disks occur at earlier ages and have no symptoms. These changes do not affect the quality of life. BMI has no role in development of degenerative changes in adolescents but increased age is associated with increased risk of disk degeneration.

Abstract Background: Destruction of pain receptors around patella by electrocauterization is commonly used during total knee arthroplasty. Its effect on cartilage was the goal of this survey.Methods: In a clinical trail study, 20 rabbits, divided into two equality sized groups (experimental-control) and experimental group underwent surgery via medial parapatellar arthrotomy of the knee joint. Electrocauterization denervation at a depth of 1 mm and a distance of 3 mm from border of patella performed in the cases animals. No patellar denervation was done in the control group. Range of motion of joint, macroscopic evaluation using modified outerbridge score, and histopathologic scoring were assessed after twelve weeks. Results: Finally, nine cases and eight control animals were included due to death of three animals. Full range of motion was seen in all rabbits. Statistically significant difference in outerbridge score (p < /em>=.002), cellularity (p < /em>=.016), loss of matrix (p < /em>=.004), and clustering of chondrocytes (p < /em>=.008) were obtained.Conclusions: Cartilage destruction may be the result of electrocauterization of patellar rim. So, routine electrocauterization should be discouraged.

Abstract Chylothorax is a rare complication of spinal surgery. Leakage of chyle into the pleural space occasionally occurs during anterior spinal approach as a result of damage to the thoracic duct. We present a case of chylothorax which took place 24 hours after posterior spinal fusion owing to an unusual etiology. Fourteen years-old boy patient with history of congenital cervicothoracic kyphoscoliosis underwent T7-T12 anterior spinal fusion through left fifth rib resection. He got through Postoperative phase with no untoward consequence. After ten days he underwent T2-L3 posterior spinal fusion with hook instrumentation. Over the next day following this surgical step, he developed tachypnea with milky-color effusion. The biochemical analysis verified chylothorax diagnosis.

Abstract Autologous platelet-rich plasma (PRP) therapies have seen a dramatic increase in breath and frequency of use for orthopaedic conditions in the past 5 years. Rich in many growth factors that have important implications in healing, PRP can potentially regenerate tissue via multiple mechanisms. Proposed clinical and surgical applications include spinal fusion, chondropathy, knee osteoarthritis, tendinopathy, acute and chronic soft-tissue injuries, enhancement of healing after ligament reconstruction, and muscle strains. However, for many conditions, there is limited reliable clinical evidence to guide the use of PRP. Furthermore, classification systems and identification of differences among products are needed to understand the implications of variability.