[Distraction osteogenesis with AO tubular external fixator in chronic osteomyelitis with huge bone defect]

Chronic osteomyelitis with huge bone defect is one of the most catastrophic problems in long bone fractures. This study was done to evaluate the distraction osteogenesis with AO tubular external fixator in chronic osteomyelitis with huge bone defect. In this descriptive study, 12 patients [11 males, 1 woman] with chronic osteomyelitis with huge bone defect underwent distraction osteogenesis with AO tubular external fixator in 5th Azar teaching hospital in Gorgan, Iran. Patients were followed up for 16 months and the onset of re-infection, bone graft, pin loosening, refracture and neurovascular injury were evaluated. All of fractures were open, due to vehicle accident. The fractures include four legs, seven femurs and one tibial plateu fracture. Primary fixation was done with plate [5 cases], Intramedullary Nail [5 cases] and skeletal traction [2 cases]. Mean time onset of fracture to treatment with AO tubular external fixator was 75.5 days. Mean sequestrum length was 8.8 cm which it was in femur 10.71 cm and in leg was 6 cm. Mean overall treatment was 16.08 months or 1.91 month/cm. Re-infection and neurovascular injury were not seen. Eight superficial infections treated with antibiotic and four cases of pin loosening were assembled with pin fixation. Seven cases required bone grafting. Premature consolidation in five cases and deviation of bone transport segment were found in four patients which treated with modification in external fixation. Distraction osteogenesis using AO tubular external fixator in chronic osteomyelitis with huge bone defect is suitable treatment method, saving the organ and prevents the amputation

[Limited dorsal approach in treatment of scaphoid fracture]

Treatment of scaphoid fractures is studied extensively due to the specific anatomic shape and position, blood flow and its performance. In recent years, several treatment methods have been devised which are associated with various findings. This study was done to evaluate the short term results of limited dorsal approach in treatment of scaphoid fracture. In this descriptive study, 14 male patients with scaphoid fracture were gone under limited dorsal approach in treatment of scaphoid fracture in 5[th] Azar teaching hospital in Gorgan, Iran. Patients were followed up for 12 weeks and the onset of infection, screw breakage and joint degenerative changes were evaluated. 64% of scaphoid fractures were in waist of the bone. The mean time to union was 10.5 weeks. 64% of patients returned to work after 12 weeks. In none of the patients, infection, wound breakdown and joint destruction were seen. There were two-delayed union [> 12 weeks] and two screw head prominency in the scaphotrapezial joint but patients did not complain and their hand movements had no problem. During procedures, two guide pin failures occurred with no adverse effect in fixations. Complications were minor and wrist movements were nearly normal. Limited posterior approach in the treatment of scaphoid fractures is an easier, faster and better union rate. Despite the short duration of follow-up study, this method is recommended in the treatment of scaphoid fractures