[Comparing the therapeutic outcomes of arthroscopic and open synovectomy]

Deeming the very fact that synovectomy is still being performed due to various diseases of the knee joint and having no published document comparing the outcome of arthroscopic synovectomy with open synovectomy, this study was conducted at Akhtar hospital. The design was historical cohort study. All patients who underwent synovectomy of the knee joint during 1997 to 2004 and were followed up for at least two years were enrolled. Arthroscopic synovectomy were the case group and the open synovectomy were the control one. The groups were matched through their age, sex, duration of disease and follow up. Mismatched cases were excluded. The outcome of treatment was evaluated by subjective feelings, range of motion, recurrence, postoperative pain and the days of admission. Recurrence rate were more common in arthroscopic group [P<0.008]. Limitation in range of motion of the knee joint were 5 times more in open group [P<0.000]. Fisher's test showed that subjective feelings were equal in both groups [P<0.5]. Duration of in-hospital course were 9.8 days in open group and 6 days in arthroscopic group. Opioid analgesics were utilized less in the arthroscopic group [P<0.007]. This study showed that limitation of range of motion, duration of hospitalization and the use of opioid analgesics were more in open group, compared to arthroscopic group. In contrast, the arthroscopic group had more recurrence. Subjective feelings were same in both groups

[Osteoarthritis after open reducation and internal fixation of lisfranc fracture]

Open reduction and internal fixation is the standard surgical approach for lisfranc fracture, however, osteoarthritis is a long term complication. We surveyed the frequency of osteoarthritis after open reduction and internal fixation of lisfranc fracture and its associated factors including accompanied fracture, delayed diagnosis and open or closed fracture. Patients who suffered from lisfranc fracture between 1997 and 2005 and underwent open reduction and internal fixation at least 2 years ago were included. Tarsometatarsal osteoarthritis was investigated among these patients. Of 94 patients, 44 were included with a mean follow up duration of 36 months, among whom, 34 had anatomic reduction while 12 [35.3%] developed osteoarthritis. Meanwhile, of 10 patients with non-anatomic reduction, 8 [80%] developed osteoarthritis. The difference is statistically significant [p=0.004]. Unfortunately, 4 patients [9.1%] were misdiagnosed during the first visit, while 10 [22.7%] patients referred late. Accompanied fractures were reported in 34 [77%] patients. Higher prevalence of osteoarthritis among patients with non-anatomic reduction support the prior theory that open reduction and internal fixation could prevent further degenerative changes in lisfranc joint