Comparing the results of prevention of fat emboli in femoral shaft fractures

Fat embolism syndrome symptoms is due to the presence of free fat globules originates from bone marrow and deposit in parenchyma of the lung, brain, and other organs and in most cases is particularly due to long bones, or pelvic fractures and can be accompanied by considerable complications and mortality. The aim of this research is to evaluate effect of early fixation of femoral fractures on preventing of fat emboli. In a double blind nonrandomized clinical trial study 174 patients with femoral fractures enrolled in four groups and in the first 12 hours after fracture occurrence were treated as below Group I: included 53 patients were treated by means of open reduction and internal fixation with screws and plate. Group II: included 46 patients were treated by means of skeletal traction. Group III: included 33 patients that were not treated by means of any methods of fracture fixation. Group IV: included 42 patients were treated by means of interlocking intramedullary nailing. With use of Chi-square, ANOVA and Tukey post hoc test there were significant differences among groups [p=0.003]. 11 patients in all groups and in Group A, any patients, in Group B, four patients [7.8%] in group three, six patients [18.1%] in group four, one patient had fat embolism syndrome [4.2%]. The main point in the prevention of fat embolism syndrome is stabilization of fracture site of long bones as soon as possible

Assessment results of patellar fracture treatment after tension band wiring

To assess the results of patellar fracture treatment by tension band wiring. This retrospective study was performed to evaluate clinical and radiological results of patellar fracture during past 6 years. Twenty four patients were participated in follow-up. Union was occurred in the mean time of 2.67 +/- 0.61 months. Falling down and direct trauma were the most common cause of fracture. Most common complications were thigh muscle atrophy and pin irritation. Excellent and good results in 87.5% and fair results in 12.5% of the patients were seen. Fixation of patellar fractures with tension band wiring was associated with a high rate of union

efficacy of short-term vs. long-term antibiotic therapy in preventing deep infection after orthopedic procedures [a prospective observational study]

Antibiotic therapy prevents postoperative infections after orthopedic procedures, but the method and prescribed dose of this therapy are debated. Short-term prophylaxis and long-term prophylaxis are 2 accepted methods after orthopedic procedures. In this prospective observational study, we compared the results of short term and long-term prophylaxis after elective orthopedic procedures at 2 hospitals of Jundishapur University of Medical Sciences. We divided patients who underwent uneventful orthopedic operations into 2 groups, administered short- and long-term prophylactic antibiotic therapy, respectively, and observed the patients for signs and symptoms of superficial and deep infections. We compared and analyzed the results with SPSS, considering P values of less than 0.001 to indicate a significant difference. There was no significant difference regarding superficial and deep infections between short- and long-term prophylaxis groups; thus, both methods can be used for prophylaxis after elective orthopedic surgeries, effecting equal rates of success. Short-term prophylaxis can be used for clean orthopedic procedures with equivalent results as long-term therapy.

Comparison of displaced patellar fracture treatment by two methods: cerclage circumferential wiring versus tension band wiring

There are a variety of methods for operative treatment of patellar fractures. The aim of this study was to compare the outcome of cerclage wiring [CW] versus Tension Band Wiring [TBW] for treatment of displaced fractures of the patella. In this retrospective study we reviewed the medical files of the patients who had displaced transverse or comminuted patella fractures treated at two trauma hospitals between 2004 to 2010. Forty four patients were found that had been operated with either of these two methods: TBW=24, CW=20. Outcome was evaluated by Bostman rating score, at a mean follow up time of 2.3 years. Mean age of all patients was 32.7 years. There was no significant difference regarding the mean age, gender, and mechanism of the fractures in patients treated by two methods of TBW and CW. Atrophy of quadriceps muscle was [1.146 cm +/- 0.9cm] in 19 patients with TBW, and [2.3 +/- 0.6cm] in all patients with CW, which shows significant difference. No case of infection or nonunion had occurred. Good to excellent results in TBW and CW were found in 83.4% and 80% of patients respectively that reveals no major difference. Hardware removal due to pin irritation was performed in 66.6% of TBW and 10% of CW group. There was no significant difference between two groups with respect of PF osteoarthritis. Despite less secure fixation with CW, both TBW and CW methods had comparable outcome with a high rate of good to excellent results in the treatment of displaced patella fractures. Individualized treatment plan based on the type and pattern of the fracture is suggested.

Treatment of open tibial fractures: comparison between unreamed and reamed nailing a prospective randomized trial

Treatment of open tibial fractures is an orthopedic challenge. Interlocking nailing is one of the accepted forms of treatment in these fractures. Two accepted methods of nailing are unreamed and reamed which have been largely used in closed fractures of the tibia but their use in open tibial fractures is still challenging. In this randomized clinical trial, we treated open tibial fractures using these methods and compared the results. Between May 2008 until September 2010 we treated 119 healthy young patients with open tibial fractures [types I, II, IIIA] by two methods of interlocking nailing. We chose the type of nailing using random table of numbers. The age of the patients was between 20 to 45 years. One hundred and six male and thirteen female patients were in two groups. Parameters including type of open fracture, length of operation, amount of blood loss during operation, superficial and deep infection, mean union time, need for dynamization and bone graft, nail and screw breakage in two respective groups were compared and the data analyzed using SPSS 13 and T-test and the P value of less than 0.05 considered as significant difference. Fifty-eight and sixty-one patients were treated in unreamed and reamed groups respectively. The time of operation was 54 minutes in unreamed and 71 minutes in reamed group with significant difference [P= 0.023]. Superficial infection was seen more in reamed group in comparison with unreamed group [P=0.01] but for deep infection there was no significant difference between two groups. [P=0.31]. Screw breakage was seen more in unreamed group in comparison with reamed group with significant difference [P=0.026]. There was not any case of nail breakage in two groups. The time to complete union was similar in both groups. Unreamed and reamed interlocking nailing can be used in open tibial fractures types I, II and IIIA with quite similar rates of success.

Treatment of displaced midshaft clavicular fractures: a comparison between smooth pin and LCDCP and reconstruction plate fixation

To compare the results of internal fixation of the clavicular fractures by pin and LCDCP and reconstruction plates in displaced fractures of middle third. Between April 2008 to December 2010 a total of 68 clavicular fractures were treated in Razi hospital of Jundishapur University of Medical Sciences in Ahvaz, Iran and the results of the operations were investigated and reviewed according to DASH score [Iranian version] and Oxford Shoulder score. Comparison of the results performed using K and Fisher exact tests and the data analyzed by SPSS software and the values less than 0.01 considered as a significant difference. Eighteen patients were excluded because 11 patients did not return for follow up and seven patients had other fractures in extremities that could interfere with the results and at the end of the study 50 patients completed the follow up program. There were 42 male and 8 female patients with mean age of 28 years [18-48 years], pin group had 25 and plate group also had 25 members. There were not any significant differences in the union time, malunion, infection and DASH and Oxford shoulder scores. Significant differences were seen between the operation time and bleeding that both were lesser in pin group. Eight patients in plate group complained of symptomatic hardware compared with pin group [no symptomatic hardware] with P value = 0.001. Although both the procedures have been used in clavicular fractures with high rates of success, but pin fixation has lesser morbidity and complications if it is used by experienced surgeons with close observation

Results of posteromedial release in resistant Talipes Equinovarus [Club Foot]

Talipes Equinovarus [Clubfoot] is one of the most common foot anomalies which can be treated by serial casting technique with high rate of success. Surgery is indicated for deformities that do not respond to conservative treatment or for the patients that seek medical intervention too late. In this study, we reviewed the results of posteromedial release in treating resistant cases without appropriate response to serial casting. Between April 2005 and March 2010 we treated 133 resistant clubfeet in 72 male and 22 female patients using posteromedial release in Razi Hospital of Jundishapur University of Medical Sciences in Ahvaz, Iran and reviewed the results of the operation and the functional results according to Laaveg-Ponseti scoring system. We divided the patients into two groups according to the age of the patients at the time of surgery. The most common complication was recurrence of forefoot adduction in the patients over six months. There were wound problems ranging from mild wound edge necrosis to extensive skin slough in both groups without significant difference. The best functional results according to the Laaveg-Ponseti scoring system were found in the patients under six months of age. Posteromedial release can be used in all of the cases of resistant clubfoot but in older patients it is complicated by more relapse, and less functional results

Results of Magnuson-stack operation in recurrent anterior shoulder instability

To evaluate the clinical results of Magnuson-stack operation in recurrent anterior shoulder instability Twenty-six patients with mean age of 27 years had undergone Magnuson-stack operation from July 2001 to September 2009 with mean follow up of 40 months. The clinical outcome was recorded according to Quick DASH score [Iranian version]. There were no redislocations. Clinical outcome was excellent in eighteen [70%], and good in 8 [30%]. The limitation in shoulder external rotation was observed in all of the patients without significant functional impairment. We conclude that although in Magnuson-Stack procedure we do not correct the anatomical defect of the recurrent anterior shoulder instability, but the ease of the operation and the relatively good clinical results are the reasons to use them in these patients, if arthroscopic repair facilities are not available