Clinical and functional results of radial club hand with centralization and pollicization using the second metacarpus: A clinical case series.

INTRODUCTION: Radial club hand (RCH) is a rare congenital deformity leading in several functional and psychological problems. However, our knowledge about the long-term functional outcomes of treating RCH is limited. In current study, we investigated the outcomes of centralization and pollicization using second or third metacarpal bone in RCH patients. METHODS: There were 15 hands (13 patients) with RCH underwent centralization and pollicization using second or third metacarpal bone or tendon transfer. The patients aged 1.2 ±â€¯1 years at the time of the surgery. On early postoperative x-rays, the forearm-hand angle was measured. The patients were followed for 6.2 ±â€¯2.3 years. At the final visit, disabilities of arm, shoulder and hand (DASH) score was completed. Furthermore, forearm-hand angle and range of motion of both wrists in sagittal and coronal planes were measured. RESULTS: The mean of forearm-hand angle increased significantly. In 11 wrists, forearm-hand angle increased only 10 degrees of less. The range of operated wrist was improved in sagittal and coronal planes. The relative range of wrist motion in patients with unilateral deformity in sagittal and coronal planes was 83 ±â€¯11 percent and 61 ±â€¯12 percent. Three patients developed skin necrosis. CONCLUSION: Early centralization and pollicization using second or third metacarpal bone can significantly restore the range of motion and function in patients with RCH.

Iranian Joint Registry (Iranian National Hip and Knee Arthroplasty Registry).

Periodic evaluation and monitoring the health and economic outcome of joint replacement surgery is a common and popular process under the territory of joint registries in many countries. In this article we introduce the methodology used for the foundation of the National Iranian Joint Registry (IJR) with a joint collaboration of the Social Security Organization (SSO) and academic research departments considering the requirements of the Iran's Ministry of Health and Education.

First Carpometacarpal Joint Dislocation and Review of Literatures.

Dislocation of the first carpometacarpal (CMC) is a rare occurrence. Treatment of this dislocation varies from closed reduction and casting to ligament repair. Neglected dislocation or incomplete reduction of the 1(st) CMC cause chronic instability and painful arthritis, muscle imbalance and decreased grip force. In our study 6 patients is evaluated that were visited in less than 24 hours from their injury. All were primarily reduced and except one patient later injured ligament were repaired. All patient after 6 months had normal range of motion without pain and they had not any complaint. Stability at the 1(st) CMC joint is dependent on static and dynamic forces. However, dislocation of the 1(st) CMC occur rare, but important function of the thumb specially in gripping and grasping makes it a significant problem. Injured ligament should repair for increased stability of 1(st) CMC joint, because neglected dislocation or incomplete reduction cause chronic instability and painful arthritis.

Comparison of morphologic consequences of open and endoscopic carpal tunnel release.

OBJECTIVES: The objective of this study is to evaluate the carpal canal morphologic consequences following endoscopic carpal tunnel release compared with open approach. METHODS: 48 Patients with CTS were enrolled in our prospective trial. Participants were classified in 2 groups: 24 patients underwent open surgery technique and 24 underwent endoscopic carpal tunnel decompression. Carpal canal shape and volume, configuration and position of contents, were analyzed by using imaging techniques. RESULTS: Preoperative carpal canal volume in endoscopic patient group averaged 5.7±1.4 cc and 7.3±2.9 cc at 6 weeks postoperatively (28%±7%, p=0.018). In contrast preoperative carpal canal volume in open carpal tunnel release group averaged 4.9±1.1 cc (and increased to 6.2±1.7 cc at 6-week follow up investigation (36%±5%, p=0.002). Preoperative carpal arch width calculation in endoscopic carpal tunnel release group averaged 21.7±1.1mm and 21.5±1.9mm in open carpal tunnel release patients (p=0.6575). Postoperative carpal arch width measurements in endoscopic carpal tunnel decompression group averaged 22.6±4.1mm and 22.1±2.9mm in open carpal tunnel release patient population at 6-week follow-up investigation (p=0.628). CONCLUSION: Endoscopic approach causes an increment in carpal canal volume comparable to open technique and provides equivalent anatomic outcomes and will produce at least equivalent long-term clinical relief.

Prevalence of palmaris longus agenesis in a hospital in Iran.

UNLABELLED:   BACKGROUND: The prevalence of the palmaris longus agenesis (PLA) has been variously reported to be from 1.5% to 64% in different ethnic groups. Lack of reliable information about the state of the PLA in Iran made us to design a study on the agenesis of the palmaris longus (PL) among a sample of Iranian population during 2009. MATERIALS AND METHODS: One thousand participants were included in this descriptive study. Subjects were patients and personnel of a major orthopedic surgery center in Iran. The Schaeffer test was used to detect the presence or absence of the PL. An orthopedic resident conducted the test (observer reliability 98%). The prevalence of agenesis was determined in the sample and its actual prevalence was estimated for the whole population. The role of gender and handedness was also considered in the presence or absence of the PLA.  RESULTS: The prevalence of the PLA was estimated to be 22.8%; 10.2% agenesis on the right side, 5.9% on the left side, and 6.7% bilateral PLA. The relationship between PLA and gender didn't appear to be significant. Among people with PLA 43% and among people without PLA 17% were left handed (P < 0.05, odds ratio [OR]: 3.7). CONCLUSION: The prevalence of the PLA in Iranians seems to be comparable with the average Caucasian values which is estimated to be 22.4%. Furthermore, significant relationship exists between the PLA and left hand dominance.

Achilles tendon repair, a modified technique.

BACKGROUND: Wound complications following open repair for acute Achilles tendon ruptures (AATR) remain the subject of significant debate. The aim of this study is to investigate the effects of covering repaired AATR using well-nourished connective tissues (paratenon and deep fascia) to avoid complications after open repair. METHODS: In this case series study, open repair was performed for 32 active young patients with AATR. After the tendon was repaired, the deep fascia and paratenon was used to cover the Achilles tendon. Patients were followed for two years and any wound complication was recorded. During the last visit, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score was completed for all patients. Calf circumference and ankle range of motion were measured and compared with the contralateral side. Patients were asked about returning to previous sports activities and limitations with footwear. RESULTS: Only, one patient developed deep wound infection (3%). None of the patients had any discomfort around the operation area, limitation with footwear, sural nerve injury, re-rupture, and skin adhesion. The AOFAS score averaged 92.5±6. Two patients (7%) were unable to return to previous sports activities because of moderate pain in heavy physical exercises. The calf circumference and ankle ROM were similar between healthy and operated sides. CONCLUSION: The present study showed that fascial envelope for full covering of the repaired Achilles tendon may help to prevent the occurrence of wound complications.

Efficacy of sonographically guided intra-flexoral sheath corticosteroid injection in the treatment of trigger thumb.

OBJECTIVE: The aim of this study was to determine the efficacy of sonographically guided intra-flexoral sheath corticosteroid injection in the treatment of trigger thumb. METHODS: This study included 112 trigger thumbs of 104 patients (7 males, 97 females; mean age: 52.11 years) studied prospectively from 2009 to 2011. All patients experienced pain, tenderness, discomfort and/or triggering with flexion/extension of the thumb and palpable nodules at the level of the A1 pulley. Ultrasonographically guided corticosteroid injection was performed on all affected thumbs. Thumb improvement was evaluated using the Quinnell grading system and patients were followed up for one year. RESULTS: All 112 thumbs received one ultrasonographically guided corticosteroid injection. Fifteen thumbs (13.4%) needed re-injection and/or surgery during their one year follow-up. Eight (53.3%) of these 15 cases, had a pre-treatment Quinnell Grade of 4, six (40%) thumbs were Grade 3 and one (6.7%) was Grade 2. Twelve were re-injected, two underwent surgery without re-injection and one underwent surgery after showing no improvement following re-injection. There was a significant reduction in the post-injection Quinnell grade (p<0.0001). One year after the initial injection, 108 thumbs (96.4%) were completely symptom-free. CONCLUSION: Sonographically guided intra-flexoral sheath corticosteroid injection is an effective method in the treatment of trigger thumb and reduces the need for surgery.

Safety of carpal tunnel release with a short incision. A cadaver study.

The standard long incision technique for carpal tunnel release causes inevitable damage to skin sensation, the inter-thenar plexus and especially the distal branches of the palmar cutaneous branch of the median nerve (PCM), and may cause long-term disabling pain and scar tenderness. There are many variations in the distal branches of the median nerve at the wrist. Anatomic studies of this region also have important clinical implications to prevent injury to important anatomic structures. The purpose of this study was to evaluate the short-incision carpal tunnel release in cadavers. Several important anatomic structures, with possible anatomic variations, pass through the carpal tunnel, and blind percutaneous transection of the transverse ligament seems to be a high risk procedure. Sixty hands from 40 fresh cadavers were evaluated. Both the transverse ligament and the distal third of the deep forearm fascia were released using a Smillie knife. At the end of each procedure, the hand was explored for injury to tendinous and neurovascular structures of the wrist. In all cases the release of the carpal tunnel and the distal third of the forearm fascia was found to be complete. The superficial palmar arterial arch, flexor tendons, ulnar nerve and vessels, digital nerves, median nerve and its recurrent accessory branches, the flexor tendons, and even the subcutaneous tissue over the transverse ligament were damaged in no instance. Guyon's canal was entered in 6 (10%) hands without damage to its components. The distal branches from the ulnar side of the palmar cutaneous branch of the median nerve (PCM) were injured in 8 (13.6%) hands, an injury that is almost unavoidable with the classic open technique.

The value of sonography with micro convex probes in diagnosing meniscal tears compared with arthroscopy.

OBJECTIVE: Meniscal tears are common in knee injuries. Sonography has been used in the knee to evaluate meniscal tears. Linear probes with high resolution have been used, and the overall accuracy of sonography has been more than 70% in many studies. In this study, we used a 6.5-MHz micro convex probe to evaluate meniscal tears, and the results were compared with arthroscopic findings. METHODS: Four hundred six knee joints with knee pain and a clinical indication for arthroscopy were examined from the popliteal fossa with the 6.5-MHz micro convex probe. Those patients with positive sonographic findings who had an arthroscopic examination (100 patients) were included in our study, and the results were compared. The results were statistically analyzed by the Fisher exact test. RESULTS: One hundred knees with sonographic examinations underwent arthroscopic evaluation. Three age groups were included in the study (20-30, 30-40, and >40 years). Comparison of the results between the two methods showed sensitivity of 100% and specificity of 95% for sonography in detecting meniscal tears. The positive predictive value for the medial meniscus was 95%, and the negative predictive value was 100%; these values for the lateral meniscus were 93% and 100%, respectively. CONCLUSIONS: Meniscal tears are common in all age groups. The use of sonography allows rapid, low-cost, and noninvasive exploration of meniscal tears as a first-line diagnostic method. We recommend high-resolution micro convex probes, which better fit the anatomic concavity of the popliteal fossa, as efficient investigation tools.

Anatomic variations of the median nerve at the carpal tunnel: a cadaver study

Introduction: There are many variations of the distal branches from the median nerve at the wrist. Anatomic studies of this region have fundamental clinical implications to prevent injuries to important wrist structures, especialIy in newer operative scoping techniques and short incisions for carpal tunnel surgery. Methods: In this study, 60 hands from 40 cadavers were analyzed. The median nerve from hands was explored from the distal third of the forearm to the distal palmar crease, and all of distal and terminal branches were examined. The results were compared with other similar tudies through Z-test percentage statistical comparison. Results: A median nerve bifurcation was seen in 5 cases (8.3 percent). Recurrent branch variations included subligamentous type in 17 cases (28.3 percent); transligamentous type in 7 cases (11.9 percent); andtransfascial in 8 cases (13.3 percent). The accessory branch of the recurrent nerve was found in 67.8 percent of cases. variations from the palmar cutaneous branch of the median nerve were type I in 36 cases (61 percent); type II in 13 cases (22 percent); and type III in 3 cases (16.9 percent). Conclusion: A1l results overlapped with other similar studies