مجله جراحی استخوان و مفاصل ایران
سال پانزدهم شماره 4 (پیاپی 59، پاییز 1396)

The record keeping of the experience gained at surgery is going “on-line”. This is the message of the paper presented in this issue by Qoreishy and colleagues.
Many programs, nowadays, have a final examination to evaluate the level of education of the trainees. “Logbook” has been used for years by many programs and disciplines, both surgical and medical, all over the world. It has been also customary in some programs in Iran including orthopaedics. This is primarily for assessing the exposure level of the residents to different surgeries. What a logbook of an orthopedic resident shows, in its most complete and accurate form, is the experience that has been gained in the operating room. It does not indicate the ability or competency of the trainee for any particular procedure.
There have been additional attempts in enriching the evaluation process by videotaping the procedure done by a resident, and have independent assessors to upraise the manual dexterity of a resident.
Simulation- experience obtained either on table-tops or by performing a procedure on cadavers -is another objective evaluation system of the trainee’s competency. It is an adjutant to skill training and also evaluation of the gained skill. This does not, certainly, compare to the experience obtained in operating room on a true patient on the table. Simulation, however, increases surgeon’s competency and also his/her confidence.
The on-line logbook is easy, efficient and, at the same time, very useful for assessing the deficiencies in exposure of a specialty candidate to different operations, and also the shortcomings of a training program. It can be effectively used by the Orthopaedic Board Examination and the Health Ministry for residency program accreditation, or re-appraisal following a probation. The collective data from logbooks can also define the strengths or the deficiencies of a program, helping constructive planning for a residency training program
There are, however, limitations in the accuracy of a logbook: a well-trained educator is needed to provide the reliable, honest assessment and an able body to give constructive feedback. If a trainer is weak, not well experienced or cannot stay objective in his/her assessment, then the appraisal of surgical abilities of a resident will not be reliable. The online program needs to be controlled, and monitored meticulously, and also needs frequent updating for the procedures that are pre-marked and included in the list of logbook items.
We should, however, remember that logbook still leaves out the other important aspects of a trainee’s evaluation like bed-side manner, sense of responsibility, ethical issues, relation with colleagues and medical personnel, ability of proper use of tests and investigations, the ability of accurate documentation of surgical findings by a good operating note dictation. It also lacks the ability to evaluate a resident in the clinic with a patient and in asking proper questions, doing the proper physical examination and ordering proper tests.

Scapholunate interosseous ligament injuries are common important conditions which include a wide range of pathologies in wrist joint. A lot of factors have significant role on clinical course or stage of disease. Treatment protocol depends on the stage of disease. Partial vs complete lesion, reparability, radioscaphoid angle, radiolunate angle, reducibility and degenerative changes are modifiers of disease stage. Re-education and strengthening of supinator muscles, percutaneous pinning, arthroscopic debridement, open repair, capsulodesis, screw fixation and ligament reconstruction with local tendons are common treatment options used for scapholunate injuries. In this article we will review the stages of disease as well as the various treatment options. Some case series related to each treatment options will be discussed.

Anterior cruciate ligament (ACL) is one of the key ligaments that help stabilize the knee joint. Considering the high rate of ACL ruptures, especially in athletes, reconstruction of this ligament is of paramount importance. The present study aimed to compare the level of function improvement and satisfaction of patients with ACL reconstruction by two-stranded and four-stranded hamstring autografts (HAs) with the diameter above six millimeters. In total, 60 patients with ACL ruptures, who referred to healthcare centers in a four-year period (2013-2017) and underwent arthroscopic ACL reconstruction via two-stranded and four-stranded HAs, were called to the clinic to assess their satisfaction with the surgery, time to return to unrestricted sports and work activities, the number of postoperative physiotherapy sessions, postoperative complications, range of motion of the injured knee after the surgery, and Lysholm score. Moreover, data analysis was performed using independent sample t-test. In this study, both groups were homogenous in terms of the evaluated parameters. In addition, the four-stranded and two-stranded HA groups had excellent and good grades, respectively, and their mean Lysholm scores were 91.05 and 88.98, respectively. While significantly different lysholm scores were obtained by the groups, no significant difference was observed between the research groups with regard to a slight numerical difference between the two means (P=0.585). According to the results of the study, no significant difference was observed in the functional and clinical outcomes of the participants, thereby confirming the equal effectiveness of the two-stranded and four-stranded HAs in arthroscopic ACL reconstruction. It seems that both surgery methods, provided that the graft diameter is equal to or above six millimeters, will have a similar success rate with close acceptable results.

The burst fractures of the vertebrae include about 15% of spinal column injuries, and the most common location is in the lumbar back area. The diagnosis of fracture types and associated injuries is usually done by using simple radiography, CT scan, and MRI. In this research, we tried to present a new method for fracture detection with the thermographic images. The present study was a preliminary study, which was conducted on a set of thermal images obtained from a Clinical Center in California. The diagnosis (detection) of unstable burst fractures of the lumbar spinal column was performed based on the thermal pattern using the Fuzzy C-Means (FCM) clustering method and recursive connected components algorithm. In this study, the procedure was validated and confirmed by examinations and evaluation previously made by an orthopedic surgeon on the same patients After applying the preprocessing steps and FCM clustering on the image, the clusters belonging to the lumbar spine, which center was at the first and second places of the clusters centers matrix, were gathered together. Then, the unstable lumbar spinal burst fractures were diagnosed based on the components labeling technique. From the 130 thermographic images, 93 showed fracture and in 33 no fracture was seen. This confers with the CT scan images, and shows 95% accuracy. The method presented in this article is a non-invasive and cost-effective approach for the diagnosis of unstable burst fractures of lumbar spinal column. The techniques and tips derived empirically, based on the scientific principles of this research, can help the physicians to quickly diagnose the burst fractures of lumbar spinal column based on the analysis of thermal images.

Hip fracture in the elderly is associated with a high mortality rate, imposing considerable burden to healthcare system. This study aimed to evaluate the functional score of Harris Hip Score (HHS) in elderly patients with intertrochanteric fracture treated by bipolar hemiarthroplasty. This study was conducted on 40 patients (mean age of 78.21 years) with unstable intertrochanteric fracture after surgery using cemented bipolar hemiarthroplasty. The cases were assessed in terms of radiographic and clinical evaluation. Harris Hip Score (HHS) questionnaire was filled for all the patients. Four patients had incomplete follow-ups and 5 patients had deceased. The HHS score was excellent for 6, good for 14, fair for 7, and poor for 4 patients. The mean HHS was 85.12 (good). Performing surgery with cemented bipolar hemiarthroplasty in older patients with unstable intertrochanteric fracture would lead to acceptable clinical and functional results with earlier ambulation, and HHS score of 85.12 .

Documentation, examination, and observation of surgical information and experiences are among the important methods for evaluating surgical exercises. To this end, documenting the performed surgeries by residents and submitting the final log can be effective in assessing their acquired skills. Therefore, we apply a paper logbook, which is a time-consuming process with low accuracy. As a result, the traditional orthopedic surgical logbook was improved in the present study to provide a complete electronic report on surgical activities of residents and compare their results with other residents by professors online. The surgical activities of orthopedic surgery residents in the Akhtar hospital were assessed for two years using an electronic logbook, which was designed in Excel and uploaded on Google Docs Database. In addition, information about surgeries by residents was recorded in categories. The electronic logbook was implemented in the Akhtar hospital for two years without any error or problem. Using the mentioned system, it was possible to provide the reports on surgeries by residents and even the number of surgeries of professors on different diagrams, archive the information, assess the residents’ skills, and compare them to the expected scientific and practical levels. The results indicate that the satisfaction of the professors and residents from the Electronic logbook is greater than the traditional one. According to the results of the study, the electronic logbook of orthopedic surgery residents has many benefits and can provide easy access to the number and details of surgeries performed by the residents based on the course design. In addition, we can recognize the ability of these individuals in performing the necessary surgeries and compare them with residents of other universities. Moreover, this program can be implemented across the nation and in other medical fields.

Several studies have compared surgical and conservative methods for the treatment of fingertip injuries. However, there are few studies on the effect of phenytoin dressing and its efficiency in treating the fingertips compared to other common treatments. The aim of this study was to compare phenytoin dressing, surgical treatment with VY flap technique and conservative treatment with Vaseline in patients afflicted with fingertip injuries. This prospective cohort research was conducted on all patients referred to the Emergency Department of Gorgan Hospital during 2016-17 who suffered from fingertip injuries. The eligible patients were selected for further intervention and follow up and were divided into three groups including phenytoin dressing, surgical treatment with VY flap technique and Vaseline conservative treatment. The collected Data was analyzed using Chi-squared test and independent sample t-test and the significance level was considered below 0.05. After 12 months, subjective, objective, and cosmetic complaints were evaluated based on the Allen Impairment Scale. According to the statistical evaluations, no significant difference was found between the three groups in subjective, objective, and cosmetic complaints after one year (P<0.05). The results of this study for the first time showed that phenytoin dressing has a similar effect to Vaseline dressing for the treatment of fingertip injuries and is not superior to it. Furthermore, the findings of this study, in agreement with previous studies, showed that clinical results are similar to conservative and surgical treatments and are not superior to each other.