[Comparison of close and open interlocking intramedullary nailing treatment of femoral shaft fractures]

Femoral shaft traumatic fracture is one of the major causes of mortality and morbidity. Nowadays, the standard treatment method in adult is reduction with femoral interlocking intramedullary nailing. This study was performed to compare the open and closed methods femoral interlocking intramedullary nailing in femoral shaft fractures treatment. This clinical trial study was done on 40 18-50 year old patients [33 men and 7 women with mean age of 26.3 years] with femoral shaft closed fracture who were referred to the Shahid Kamyab hospital of Mashhad, Iran during 2007-08. Patients were divided into two 20 membered groups of open and close femoral interlocking intramedullary nailing treatment. Subjects were followed for one year and the union time, infection and non-union level were measured. Clinical and radiological findings were analyzed using SPSS-13, Student's t-test and Fisher's exact test. 97.5% of union was obtained within six months in both groups. Full weight bearing was determined 6-12 weeks [mean of 9.3 weeks] in close and 12-16 weeks [mean of 13.25 weeks] in open reduction. Complications included non-union in open [one patient, 5%], infection in open [one patient, 5%], shortening in both [one patient in, 5%], limited range of movement in both [one patient, 5%] and malrotation in close [one patient, 5%] groups. Close reduction group showed higher rate of radiologic callus formation and earlier full weight bearing than open reduction group [P<0.005], but union rate was not significant. This study showed that there is no difference between final union rate of open and close reduction by interlocking intramedullary nailing in femoral shaft fractures

[Relationship between official performance measurement scores and relative efficiency in general hospitals]

The aim of this research was to measure and compare relative efficiency of general hospitals under supervision of Mashhad University of Medical Sciences [MUMS]. The study also seek to investigate the likely relationship between the official evaluating scores reported by MUMS with findings of this study. Data Envelopment Analysis [DEA] is utilized to determine relative efficiency of individual decision making units [DMUs]. From state-run general hospitals in this study, 17 were selected based on the criteria suggested by the model. To distinguish efficient hospitals from inefficient ones, revised input-based BCC model was used incorporating 'number of physicians' and 'number of nurses' as inputs. Outputs were set as 'the rate of inpatient days to staffed beds', 'outpatient visits' and 'number of surgeries' reported both at emergency and wards. The findings based on both CRS and VRS simulations indicate that the mean of technical efficiency was 0.823, mean managerial efficiency was 0.931 and subsequently mean scale efficiency was 0.881. It was further noticed that, there was no significant relationship between the performance appraisal outcomes from DEA model, and scores allocated to each hospital through official evaluation system. Current official appraisal system based on pre-defined checklists may not be a reliable mean for evaluating and ranking efficiency of general hospitals

Spino-pelvic fixation for vertically unstable type C fractures of the pelvis

Evaluating the radiological and functional results of surgical treatment of unstable pelvic injuries by spinopelvic fixation. The purpose of this study was to find out whether the surgical technique can reduce fractures of the sacrum and dislocations of the sacroiliac joint and provide pelvis with stable fixation. Ten vertical shearing pelvic fractures were treated by pedicular screw placement in L5 vertebra and in the wing of the ilium. According to Tile's classification system, there were 10 type C fractures [8 type C1, one type C2 and one type C3]. The patients were evaluated by plain radiographs at a mean follow-up period of 2 years [range 1-3 years] after surgery. The patients had a mean age of 37.3 years at the time of surgery. The fracture was reduced by skeletal traction under general anesthesia and in prone position. A pedicular screw was placed in L5 vertebra on the same side of the fracture. Another screw was placed into the pelvic wing from PSIS [posterior superior iliac spine] toward AIIS [anterior inferior iliac spine]. A molded titanium rod connected these two pedicular screws. This study supports the use of screw and rod system for posterior fixation of the VS injuries of the pelvis

[Intramuscular haemangioma of the forearm with radial and ulnar periosteal reaction [Report of one case]]

We present a rare case of intramuscular Haemangioma of the forearm with periosteal reaction of radius and ulna. A 38-year-old female presented with a tumefaction in distal and dorsoulnar side of the right forearm. She had 1.5 years history of tumor which was painful during resent 2 months. Plain x-ray and MRI was done and the diagnosis of Haemangioma was proved by open biopsy. The tumor plus periosteal reaction and enlarged bone was respected. After 4 years follow-up no recurrence was seen

Report of two cases of bone allograft in a open fractures of femur with massive bone loss

Treatment of bone loss in the open fracture of femur is a problem. Bone allograft is a new way and it introduces the short outcome of the use of bone allograft for large bone defect of femur. The goal of this study was to assess bone allograft in open fractures of femur with bone loss. Both of our subjects were young active traumatized patients that had open supracondylar fracture with bone loss. They were treated using bone allograft that was prepared from bone bank. In spite of the other route for treating bone loss of femur, this technique is safe and has fewer side effects. It seems that bone allograft will be more popular in the future, especially in the treatment of open fracture of the femur

Traumatic Hip dislocation in an infant

A 19 month-old child with pain and deformity in hip following a downfall was admitted to the Emergency Department of Emdadi Hospital. After clinical examination and plain X-ray, hip dislocation was diagnosed and the patient was transferred to the emergency operation theater. Under general anesthesia, the hip was simply reduced using closed method. In the following day, a hip spica-cast was applied for three weeks. Regarding the lowenergy trauma required in this kind of dislocation and long-term and hazardous complications due to the delayed diagnosis, it is important to consider the probability of hip dislocation in children

[Outcome of femoral neck fractures in children]

Femoral neck fractures in children, despite adults, are the result of high-energy trauma and, usually, accompanied with injuries of other parts of the body. The aim of this study was to evaluate the outcome and complications of femoral neck fracture surgeries. This descriptive study was done on 68 children with displaced femoral neck fracture in Mashhad Kamiab Hospital between 1993 and 2003. Demographic characteristics, clinical, laboratory, radiography, and surgery results were collected by a questionnaire and analyzed by descriptive statistics and frequency distribution tables. Of 68 patients, 72% had good radiographic results. Complications included AVN in 10 [14/7%], limb shortening in 9 [13/2%], premature epiphysial fusion in 5 [7/4%], coxa valga in 4 [5/9%], Coxa vara in 2[2/96%] slip in 1 [1/47%]. Nonunion was not seen. Anatomical and surgery reduction of the fractured femoral neck lowers the risk of complications. Because of the rarity of this fracture that constitutes 1% of the all pediatric fractures, Orthopedic surgeons treat only a few of such patients. The outcome of this fracture is strongly related to initial management

Osteoblastoma of the spine

To identify the factors that are associated with the development of scoliosis and its manifestations. Summary of the background data: Painful scoliosis is a well-recognized presentation of osteoblastoma but as a result of small number of previous reports, the outcome and habits of tumor in spine is not well-known. Ten factors were assessed including; age, sex, duration of symptoms, site of the lesion, site of lesion in individual, Cobs angle at presentation, chief complaint at presentation, neurological involvement, type of treatment, recurrence of tumor. Result: Fifty% of patients had scoliosis. All of the lesions typically were present on the concave side of the curve. In the thoracic and lumber spine 80% had scoliosis, but no scoliosis was seen on cervical and sacral regions. All the patients were under 30 years. The mean time to diagnose at our center was 18.4 months. All of the patients with cervical involvement [2 patients] had deformity [Cock Robin] and restriction in range of motion. The lesion was in posterior elements in all of the cases and localized in only one side of the spine. Chief complaint was pain in 67%, deformity in 16% and both [pain and deformity] in 17%. Radiological exam was diagnostic in 58% of the cases. Conclusions: Findings support the concept that scoliosis is secondary to asymmetric muscle spasm. The most common complaint is pain and then deformity. In the cervical spins deformity and restriction of motion are chief complaints. In children, spastic pain was more obvious than deformity. Treatment is curettage as wide as possible. There was no recurrence