[ effect of presence of palmaris longus and fifth superficial flexor tendons on median nerve surface area; a cross-sectional study with sonography]

Background and Aims: Sonography has enjoyed much attention as a noninvasive diagnostic tool for carpal tunnel syndrome in recent years. The aim of the present study was to assess the effect of anatomic variations of existence or absence of palmaris longus and fifth superficial flexor tendons on the sonographic measurement of median nerve surface area in healthy individuals' wrists

Methods: 93 volunteers without any symptoms related to carpal tunnel syndrome underwent clinical evaluation for determining presence of tendons in both wrists and also, sonographic measurement of median nerve surface area

Results: In 22 of 186 hands [11.82%], there was absence of the palmaris longus tendon and absence of the fifth flexor was noted in 8 [4.30%]. The median nerve surface area in the hands without palmaris longus was meaningfully less than the hands with it [P = 0.025], while the difference in the median nerve surface area was not statistically significant regarding the presence of the fifth flexor [P = 0.324]

Conclusion: Based on the findings of the present study, it seems that the median nerve surface, area as a sonographic finding, is probably related to presence or absence of the palmaris Longus tendon. So, those hands with the tendon present have larger surface areas. Also, it seems that this sonographic finding is not dependent on the presence of fifth superficial flexor tendon

[Causes of amputations performed during a 9-year period in hospitals affiliated to Kerman University of Medical Sciences]

Amputation has different causes and is increasing in many countries. This study tried to determine the etiology of the amputations in one of the relatively large cities of Iran. Method: This retrospective study was undertaken on all of the amputees in hospitals affiliated to Kerman University of Medical Sciences during 9 years. Patients' demographic features including age and sex, as well as the amputated limb and its etiology, side and level were recorded. The level of amputation was recorded as minor [below wrist or ankle] or major [above wrist or ankle] too. In whole, 624 patients were enrolled into the study. The number of amputees per year was 54-118 ones. From all participants, 508 ones [31.4%] were male and 118 ones [18.6%] were female. Mean age of male participants was less than females'. Upper extremities had been amputated more than of lower ones and while 61.9% [n=386] of the amputations were major, 38.1% [n=238] were minor. Overall, the most common cause of amputation was trauma and the most common level was transmetatarsal. The most common level for major amputations was below knee. In the present study, in contrast to similar studies in the developed countries, trauma was found to be the major cause of all types of amputations and in all age groups, which emphasizes the need for preventive measures in the country

[ role presence/absence of palmaris longus and fifth flexor digitorum superfiscialis tendons in carpal Tunnel syndrome]

Etiologically the causing factor of carpal tunnel syndrome is not clear and multiple contributing factors such as the presence or absence of Palmaris longus tendon have been cited. The aim of the present study was to compare patients with carpal tunnel syndrome and healthy individuals in regard to the absence and presence of Palmaris longus and fifth flexor digitarum superficialis tendons. This prospective study was performed on 60 diseased and 180 normal hands. Presence or absence of each tendon was determined carefully by the same examiner in both groups. Data were compared by Chi-square test. The relationship between carpal tunnel syndrome and the absence of Palmaris longus tendon and fifth flexor digitorum superficialis was significant [P=0.041 and P=0.05 respectively]. Carpal tunnel syndrome group compared to the control group had higher rate of the absence of both tendons in one hand [P=0.017] and lower rate of the presence of both tendons in one hand [P=0.005]. By considering only the hands with Palmaris longus tendon, there were more cases of absence of fifth flexor digitorum superficialis in carpal tunnel syndrome group [P=0.048], but by considering only the hands with fifth flexor superficialis, there was no significant difference between the two groups in regard to the presence of Palmaris longus tendone. It seems that the absence of Palmaris longus tendon and fifth superficial flexor each alone and in combination is a risk factor for development of carpal tunnel syndrome. Probably the absence of superficial flexor is a greater risk factor than the absence of Palmaris longus

Effectiveness of hemovacum drain in orthopedic operations related to trauma

The application of droun in clean orthopedic operations takes place usually without a scientific basis. The purpose of the present study is to evaluate the hemovacum drain efficacy in some of orthopedic operations related to trauma. In this experimental trial, 141 patients who were admitted to Dr. Bahonar Hospital, between September 2004 to April 2005, for surgical operations related to trauma, were randomly divided into two groups. In the first group [102 wounds], a single hemovacum drain was inserted after completion of the operation, while in the second group [113 wounds], no drain was inserted. Statistical analysis was performed using SPSS 15 and independent T-test and chi-square test. At the end of the follow up period, 5 patients in the no-drain group [4.4%] and 2 of the drain group [2%] had deep infection. There was not any significant difference between both the groups. Severe hematoma formation [requiring drainage] occurred in only one patient of no-drain group. Again although the need for analgesics in the first 48 hours of the operation [70 of the no-drain group [61.9] and 58 of the drain group [56.0%] and the need for dressing change due to wetting in the first 24 hours [27 of the no-drain group [24.5%] and 19 of the drain group [18.6%] had increased, the difference was not statistically significant in either the groups. According to our findings, it seems that hemovacum drain is not effective in these aspects, however does not increase the risk of complications. Nevertheless, drain application seems to be a logical approach until larger studies to be performed

survey on current methods of carpal height ratio measurement and suggestion of a new method

Two famous methods are commonly used for the measurement of carpal height ratio. Both methods are performed on anteroposterior radiogram and have some shortcomings. We are going to introduce a new method for measuring this index in lateral view of the wrist radiogram. This cross-sectional and case-control study was conducted on 100 anteroposterior and lateral radiograms of asymptomatic individuals and then 20 radiograms of patients with Kienbock disease in various stages of the disease. After determining new reference points on the radiograms of the [normal] group, it was tried to define the ratio by new method. In the next stage the interobserver and intraobserver agreement of the new index was assessed along with previous defined indices. All three methods had some limitations, but overall it seems that the new method has more precise reference points. With regard to inter and intraobserver variability the new index was better than the Natrass group index, but not than the Youm group index. The new index can be used as a substitute or an alternative in carpal height measurement

[ case report of floating metatarsal: concomitant dislocation of the tarsometatarsal and metatarsophlangeal joints of the second toe]

An extremely rare case of floating second metatarsal is reported. The reported case is a young man with simultaneous dislocation of tarsometatarsal and metatarsophalangeal joints of the second metatarsus following a car accident. Because of patient's discontent for open surgery, blind percutaneus pinning was performed that was not completely successful and in follow up radiography, 18 months later, degenerative joint disease [DJD] signs were observed. In examining patients with injuries of the tarsometatarsal joint, the physician must pay attention to the whole foot as the forces acting on it which are axial and compressive can injure the metatarsophalangeal joint [in the same or the adjacent ray] as well. After reporting the case, we will discuss the probable mechanism and different aspects of this rare traumatic injury