The role of fibular fixation in the treatment of tibia diaphysis distal third fractures.

INTRODUCTION: Combined fractures of the distal third of tibia diaphysis and fibula diaphysis are a common orthopedic injury. There is an ongoing debate about the necessity of fibular fixation when associated to distal third tibial fracture. This study aims at evaluating the role of fibular fixation in the treatment of distal third tibial fractures. HYPOTHESIS: We hypothesized that fixation of the fibula increases the stability of fixation in distal third tibial and fibular fractures. MATERIALS AND METHODS: In a randomized clinical trial, 53 patients with concomitant fractures of tibia and ipsilateral fibula at distal third level were recruited in this study during a 23-month period. Patients were randomized in two groups: patients with fibular fixation (case group) and without fibular fixation (control group). The patients were followed up for at least 6 months postoperatively. RESULTS: There were seven cases exhibiting malalignment on immediate postoperative radiographs. Six of them were in group II (control group) and one was in group I (case group) (P=0.084). We didn't find nonunion in group I and we found three patients in group II (P=0.141). Infection was one in group I and two in group II on gustillo II injuries (P=0.516). CONCLUSION: Despite its low count of patients, our study didn't show any advantage to fix the fibula fracture associated to distal third of tibia diaphysis fracture. It didn't show either an increase of complication after fibula open reduction and internal fixation. LEVEL OF EVIDENCE: Level III. Randomized prospective study.

Evaluation of surgical treatment of developmental dysplasia of hip for avascular necrosis of femoral head in children.

Developmental Dysplasia of the Hip (DDH) is a common congenital malformation. Avascular necrosis of femoral head is the major complication of both close and open reduction of the dislocated joint. Aim of this study was to determine the incidence and influencing factors in different types of a vascular necrosis of femoral head, following surgical treatment of developmental dysplasia of hip in 1-7 years patients. In this study, 120 patients aged from 1 to 7 years old with DDH who had been undergone open surgery, entered to the study. All of these patients followed up for at least 1 year. Surgery procedures divided to 4 groups: open reduction, open reduction+salter osteotomy, open reduction+femur shortening and open reduction+salter osteotomy+femur shortening. The presence of Avascular Necrosis (AVN) had been appraised. 27.5% of surgeries performed on male and 72.5 on female patients. 35.0% of DDH cases were unilateral and remaining was bilateral. 36 patients (30%) shows radiologic findings of AVN, although all of them placed at group I of Bucholz-Ogden classification. 40% of group A patients, 25% of group B, 14.3% of group C and 36.4% of group D patients developed this findings. Open reduction of DDH in older children is effective in the management of DDH and if all of the contrivance considered in the surgery, the rate of AVN would be low and mild (at least in short term follow ups).

Zone 2 flexor tendon repair in young children: a comparative study of four-strand versus two-strand repair.

This study compares the active ranges of finger motion and rupture rates of two-strand and four-strand repairs in zone 2 flexor tendon lacerations in young children. A total of 29 patients (under the age of 4 years) with 32 flexor tendon lacerations in zone 2 were evaluated. The injured tendons were randomly repaired with either two-strand or four-strand modified Strickland techniques. At a mean follow-up period of 11 months, the mean total active motion of interphalangeal joints was 156 degrees in the two-strand and 158 degrees in the four-strand group. According to the Strickland original method, this means an average of 89% (range 57-100%) of normal function in the two-strand and 90% (range 60-100%) in the four-strand group. There were no ruptures of the four-strand repairs, but one two-strand repair failed within 3 weeks of the repair. Statistically, we were not able to show any significant difference in the active ranges of finger motion achieved with two-strand and four-strand repairs.