Trans-scaphoid perilunate fracture dislocation; a technical note

Carpal fracture-dislocation is regarded as an unusual orthopedic injury and, thus, orthopedic surgeons are less experienced in dealing with and treating these fractures and dislocations. We report a 20-year-old worker man suffering from an unusual carpal fracture-dislocation. There was trans-scaphoid fracture and lunate dislocation with other carpal proximal bones toward volar of the wrist. Two volar and dorsal approaches were used to treat and stabilize the fracture. It was completely stabilized after open reduction and fixation using several pins. After two days, neural symptoms were completely recovered and the patient was discharged. Postoperative radiographies revealed complete restitution of lesser and greater arcs and normalization of Gilula's line. Scapholunate and lunatocapitate angles reached to less than 60degree and 10 degree, respectively. The combined approach had favorable results for treatment of this unusual type of carpus fracture dislocation. However longer follow up is need to evaluate the arthritis and degenerative changes in wrist

[Comparison the results of Salter Osteotomy versus Femoral Osteotomy after open reduction in treatment of developmental Dysplasia of Hip]

Background and Objectives: Congenital dislocation of the hip [DDH] is a common cause of morbidity in different communities. Therapeutic implications include reduction and surgical stabilization of the hip joint. The purpose of this study was to compare the results of femoral osteotomy with Salter osteotomy

Materials and Methods: In a descriptive analytical study on 40 children 23 were treated with salter osteotomy and 17 cases underwent femoral osteotomy therapeutic outcome and complications were compared between two groups. Results were analyzed using Mc.Kay classification

Results: Studied group were 40 children [age 4.3 +/- 1.5 years M/F 17/23]. All patients in both groups had stable hip joint after treatment, and all patients achieved full range of joint motion. Trendelenburg gait was improved in all patients in both groups. Excellent results was achieved in 65% after Salter osteotomy and in 47% of cases femoral osteotomy, the difference was not statistically significant. The most important complication in Salter osteotomy was avascular necrosis of femoral head in 13% of the treated patients. It was not detected in femoral osteotomy method. On the contrary in femoral osteotomy, limb length discrepancy was the most important complication observed in 5 patients [29.1%]

Conclusion: Femoral osteotomy and Salter both methods are successful in stabilizing the hip joint. Both femoral and salter osteotomy methods could successfully stabilize the hip joint

[Comparisons between three different skin closure methods on incisions repair]

Background and Objectives: Various studies have proven the effect of closure technique on the repair outcome. But there are few studies to investigate the functional and cosmetic outcomes related to different closure techniques. As regards to method of wound and ruptures closure has effects on healing process and choosing the best technique by physician has the priority, the aim of this study is to compare three different suture techniques

Materials and Methods: In this study, sixty patients with anterior cruciate ligament rupture were studied. After subcutaneous tissue closure, skin incision was sutured by three different methods includings: Simple technique, vertical mattress or semisubcuticular suture techniques. To evaluate the cosmetic outcomes visual analogue scale was used. During the study wounds were observed for inflammation, infection or discharges

Results: In semisubcuticular method there was kr167 with p<0.001 between second and third observer, k=0.35 [p-A.001] between first and second observer and kA.22 [p4].001] between first and third observer. In simple technique group the result of second and third observer there was k=0.61 [p=0.01] and kappa results of first and second observer and first and third observer of 0.19 and 0.17 [p-A.002] respectively. The maximum calculated kappa for vertical mattress technique was k=0.54 [p<0.001] between second and third observer. All sutures were free of infection and dehiscence

Conclusion: It seems that semisubcuticular technique has better cosmetic results to other two techniques. So, using this closure technique may increase the patients' satisfaction from operation

Simultaneous dorsal base fracture and FDP avulsion of distal phalanx of the little finger

Avulsion injury of the flexor digitorum profundus [FDP] with concomitant fracture of the distal phalanx dorsal base is uncommon. Simultaneous avulsion fractures of the insertion of this tendon associated with rupture of the tendon from the bony fragment and combination with dorsal base fracture is very rare and also complicated. A 36- year- old man fell and injured his right little finger. FDP avulsion with simultaneous dorsal base fracture [containing extensor Tendon insertion] was detected. Our surgical repair by a single midlateral incision the avulsed fragment was replaced on the palmar base of the distal phalanx and successfully immobilized with 1.5 mm screw. After three months, patient had 20 degree range of motion in DIP joint. The digit was pain free and also relatively functional. It seems that FDP avulsion classification need to be extended and include this uncommon type as described in this case report for better management of these uncommon type

Albumin and fibrinogen levels' relation with orthopedics traumatic patients' outcome after massive transfusion

Severe bleeding is common during limb trauma. It can lead to hemorrhagic shock required to massive blood transfusion. Coagulopathy is the major complication of massive transfusion-induced increased mortality rate. Aim of this study was evaluation of fibrinogen and albumin levels association with orthopedics traumatic patients' outcome who received massive transfusion. In a cross sectional study, 23 patients with severe limb injury admitted to orthopedic emergency department were studied. All the patients received massive transfusion, that is, >10 unit blood. Albumin and fibrinogen levels are measured at admission and 24 h later, and compared according to final outcome. Twenty-three traumatic patients with severe limb injuries were studied, out of which ten [43.2%] died and 13 [56.8%] were alive. There was significant difference between patients outcome in fibrinogen level after 24 h, but no difference was observed in albumin levels. Based on regression model, fibrinogen after 24 h had a significant role in determining the final outcome in traumatic patients who received massive transfusion [odds ratio 0.48, 95% confidence interval 0.15-0.92, P = 0.02]. According to our results, fibrinogen level is the most important factor in determination of orthopedics traumatic patients when received massive transfusion. However, serum albumin does not play any role in patients' outcome

Comparison of the Combined Anterior-Posterior Approach versus Posterior-Only Approach in Scoliosis Treatment

STUDY DESIGN: This is descriptive analytical study. PURPOSE: The present study aims at comparing treatment results found between the two groups comprising of patients who underwent posterior spinal fusion using thoracic pedicle screws and the ones who underwent combined anterior-posterior method, respectively. OVERVIEW OF LITERATURE: There was controversy about surgical techniques including anterior, posterior, or a combined anterior-posterior approaches are applied to treat non-congenital scoliosis with surgical indications. METHODS: Medical records of 50 patients suffering from thoracic non-congenital scoliosis with curves exceeding 70degrees were reviewed. In this study, 25 patients who underwent posterior spinal fusion using thoracic pedicle screws were compared with 25 patients who underwent combined anterior-posterior method. RESULTS: Patients treated through posterior-only and combined approaches were respectively hospitalized for 11.84+/-5.18 and 26.5+/-5.2 days (p=0.001). There was a significant difference between these two groups considering intensive care unit admission duration (p=0.001), correction in sagittal view of X-ray (p=0.01), and number of days the patients underwent traction (0.001). Finally, coronal view was corrected without any significant difference (p=0.2). CONCLUSIONS: According to our findings, it is hypothesized that posterior-only method is associated with some significant advantages and is an advisable method in patients with severe scoliosis over than 70degrees.

Clinical Findings and Results of Surgical Resection of Thoracolumbar Osteoid Osteoma

STUDY DESIGN: Descriptive, cases series study. PURPOSE: To evaluate clinical findings and results of treatment of patients with spinal osteoid osteoma who underwent surgery. OVERVIEW OF LITERATURE: Osteoid osteoma is a benign tumor with spinal involvement rate of about 10%. It is manifested during adolescence with symptoms such as painful scoliosis. To treat the problem, operation on the patients and excising the nidus are suggested. METHODS: This descriptive study was conducted on 11 patients with spinal osteoid osteoma at our orthopedic educational center. All patients were treated through open surgery and nidus curettage. All samples were pathologically confirmed. Imaging methods (spiral computed tomography-scan) was used in preoperative planning. Scoliosis and other clinical findings were studied. RESULTS: The study was conducted on 11 patients comprising 6 females (54.5%) and 5 males (45.5%) with the mean age of 14.6 years. Mean deviation of scoliosis resulting from spinal osteoid osteoma was 22.8 degrees. There was more scoliosis in the involvement of the lumbar vertebra. In comparison with adults, scoliosis was more severe in youths. There was one case of vertebra body involvement with manifestation of painful scoliosis. Due to lack of careful preoperative examination, the surgery was repeated for this case. No sign of recurrence was observed in patients who underwent open surgery and all scoliosis in the follow-up had improved. CONCLUSIONS: Based on our findings, surgical excision of spinal ostoeid osteoma was successful and complete recovery was achieved in spinal deformity in the course of follow-up. Scoliosis is often seen during adolescence and lumbar involvement is more severe.

A Short Term Follow Up Comparison of Genu Varum Corrective Surgery Using Open and Closed Wedge High Tibial Osteotomy

Introduction: Knee deformity associated with osteoarthritis (OA) is one of the most common complications seen in patients referred to orthopaedic surgeons. High tibial osteotomy (HTO) is an accepted method for treatment of medial knee osteoarthritis with varus deformity. The aim of this study was to compare results of osteotomy methods in patients with genu varum (GV) deformity. Methods: In this cohort study, the sample consisted of 32 patients with genu varum deformity (42 knees) who were divided into two groups and matched according to age and gender. The patients were treated with open or closed wedge osteotomy. After surgery, they were followed-up and compared for 6 months. Results: The sample consisted of 25 women (87.2%) and 7 men (21.8%). Ten patients (31.2%) presented with bilateral deformity. The incidence of complications was the same for both procedures (12.5%); this included one peroneal nerve injury following closed wedge surgery. Overall, patient satisfaction was 87.5% and 75% for the open and closed wedge methods respectively. Operative time, days to full weight bearing, and days to return to routine activities were significantly shorter for patients treated with the open wedge method (p<0.001). Conclusion: Open wedged HTO is associated with shorter operating time, shorter recovery time, higher patient satisfaction, and probable lower risk of neurological injury.

Adolescence spinal epidural abscess with neurological symptoms: case report, a lesson to be re-Iearnt

Epidural abscess of the spinal column is a rare condition that can be fatal if left untreated. It promptly progresses and can cause neurologic paralysis, urinary retention or cauda equina syndrome. Compromised immune system that occurs in patients with diabetes mellitus, AIDS, chronic renal failure, alcoholism, or cancer is a predisposing factor. It mostly occurs in adults. Here we would like to report a case of spontaneous pyogenic lumbar epidural abscess with neurological deficit diagnosed in a 15 year old boy. We treated this case successfully with surgical microscopic decompression and drainage

Osteoid osteoma of a scapula: a case report in a 34 years old woman

Osteoid osteoma is a benign bone tumor and accounts for 10% of benign tumors. Almost any bones can be involved but half of cases involving femur or tibia. Osteoid osteoma is a rare tumor of the scapula with only 18 reported cases in the literature. We presented a case of osteoid osteoma of the scapula in right shoulder in angle of coracoid and geloneid in a 34- year old woman. She had right radicular shoulder pain increased at night for 4 years. An important point about this case is that, patient was treated in long-term with miss diagnosis of cervicospinal discopathy. The key of diagnosis in this patient was paying attention to the nature of night increasing pain and performing bone scan. After the operative curettage of the tumor, the pain dramatically stopped and a few weeks of physical therapy led to full range of motion in her shoulder