comparison between unreamed locked intramedullary nailing and plate-screw fixation in the treatment of tibial diaphyseal fractures

Tibial diaphyseal fracture is the most common fracture of long bones. In Iran plating and un-dreamed tibial nailing [UTN] are the most commonly used methods and because of paucity of equipments such as c-arm and reaming sets, the reamed method is rarely used. This study compares these two methods. In a randomized clinical trial study including 100 patients [78 males, 22 females; mean age=24 years; range=16-50 years] undergoing UTN and plate-screw in the treatment of uncomminuted closed tibial shaft fractures [50 patients in each group] were compared regarding the union time and complications after a mean follow up of 16 months [12-20 months]. the mean time to union was 16 weeks with UTN and 14.3 weeks with plate-screw fixation. There was 4 [8%] and 3 [6%] non unions after UTN and plating respectively. Plain radiographs in both groups showed angu-lation in 3 patients; all in distal third and in varus [6%]. There was not any infection after UTN but one case of superficial and one case of deep infection were noticed after osteosynthesis with plate and screw [4%]. Four patients after UTN and 4 patients after fixation with plate-screw required reoperation [8%]. plate-screw osteosynthesis yielded satisfactory results in uncomminuted closed fractures of the tibial shaft comparable with UTN results

[Comparison the effect of corticosteroid injection with physiotherapy in treatment of painful arch of shoulder]

Painful arch of shoulder is treated using both surgical and non-surgical methods. In the latter one, steroidal and non-steroidal analgesic drugs and/or physiotherapy are used. The aim of this study was to compare the effects of corticosteroid injection and physiotherapy in the treatment of disease. In this double-blinded clinical trial, 124 patients who referred to Shahrekord Kashani hospital and suffered from shoulder pain or with having limitation in its movement were considered as the patients with painful arch of shoulder. They were divided in two equal groups of 62. In the first group, 40 mg of prednisolone was locally injected in the painful site. The second one was subjected to ten sessions of physiotherapy for two weeks. The outcomes of these treatments were assessed using a questionnaire including shoulder disability and the amount of pain in the patients, 2, 6, and 11 weeks after the treatment. Data were analyzed using statistical analysis [X[2], t and repeated measures ANOVA]. The mean age of the patients was 42.3 +/- 9.5 years. The two groups were age and sex matched. The pain was relapsed in one patient of the first and 3 patients of the second group. Pain and shoulder disability were significantly decreased in the two groups [P<0.05]. The amount of shoulder disability and pain in the group received corticosteroid was less than that in the group subjected to physiotherapy [P<0.05]. Base on the results, injection of corticosteroid is more effective than using of physiotherapy in treatment of painful arch of shoulder. This cures pain and shoulder disability of the patients faster