Journal of Research in Orthopedic Science
Volume:1 Issue: 1, Feb 2014

Terrible triad injury of the elbow has been a real challenge for surgeons. New standard methods of treatment have significantly improved outcomes, but yet complications occur frequently and rate of reoperation is still noticeable. The outcomes of lateral surgical approach in 19 patients with terrible triad injury were evaluated through Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. A concentric congruency was achieved for 18 cases. The average of MEPS was 87.1112.05. There-fore, 17 patients had excellent and good and two fair and poor results. Average of DASH score was 1713.83. Due to early postoperative dislocation joint stiffness occurred in one patient. In our experience, lateral approach provides an adequate view to access and reconstruct all stabi-lizing elements and could be considered as an acceptable option in terrible triad injury treatment.

Genu valgum deformity is defined as lateral displacement of lower extremity mechanical axis in knee joint. This can be corrected by medial or lateral distal femoral approach. In this study the effectiveness of distal femoral osteotomy in medial and lateral approach is evaluated by the Knee Society Score and alterations in mechanical axis before and after osteotomy. This is a descriptive cross-sectional study on 27 patients referred to Shafa Orthopedic Hospital for corrective osteotomy by “medial close wedge” and “lateral open wedge” during 2005-2011. Data were collected from patient file, questionnaire, radiographs and physical examination. We evaluated 30 knee joints in 27 patients. Genu valgum was right-sided in 10 cases (37%), left-sided in 14 patients (52%) and bilateral in 3 cases (11%). The mean follow up was 30.7 ± 3.3 (range: 5-76) months. Patients were between 10-34 years. Osteotomy was medial in 11 and lateral in 19 cases. Postoperative tibiofem-oral angle was significantly different from preoperative value. Difference in tibiofemoral angle change was not significant between medial and lateral approaches. Knee Society Score in two groups was also insignificant. There was no significant difference in lower extremity mechanical axis change after genu valgum correction surgery between medial or lateral approaches.

As an established method of treatment for medial unicompartmental knee osteoarthritis, we aimed to evaluate results of short-term follow up of closed and open wedge high tibial osteotomy. In teaching hospital of Rasoul-e-Akram and during 2001-2009, we retrospectively surveyed docu-ments of 41 cases with osteoarthritis of the knee and genu varum deformity that underwent high tibial osteoto-my. Radiographic evaluation of knee alignment was performed using lower extremity scanogram in three measurements of preoperation, postoperation and last follow up visit (average of 2 years). Improvement of pain was assessed via visual scales. From a total of 13 closed and 28 open wedge high tibial osteotomies, the femorotibial angles were calculated varus of 7.7±2.5° preoperatively, valgus of 7±2.3° postoperatively and reached valgus of 6.1±3° at the final follow-up. In open-wedge osteotomies, loss of correction was meaningful during follow-up, mainly in patients without fixation. Higher amount of preoperative knee varus (>10°) was accompanied with more loss of correction postoperatively. About 80% of patients were satisfied of pain relief with average knee flexion of 125 degrees. Our major complications were two cases of intra-articular fracture. Open wedge cases without plate fixation experienced more failure of correction. With proper patient selection and applying appropriate technique plus sufficient correction, high tibial osteotomy can be an effective treatment for medial knee osteoarthritis with genu varum. It may diminish the need for knee arthroplasty or at least delay the surgery.

The upper extremity bones are infrequent sites for osteoid osteoma. Diagnosis of this tumor could be difficult and challenging. Thirty five patients with histologically confirmed osteoid osteoma of the upper extremity seen from 1992 to 2011 were studied retrospectively. The patients'' age at presentation averaged 23.4 years. Male to female ratio was 4 and right to left side ratio was 4, too. Twenty-five of the lesions were located in the wrist and hand, six around elbow, three around shoulder joint and one in radius diaphysis. Pain was present in all cases. Of 27 patients who took nonsteroidal anti-inflammatory drugs (NSAID) for pain, 20 obtained at least partial relief. Mass or swelling was more com-monly noted in lesions of the hand and wrist as compared to the arm and forearm. Osteoid osteoma, relatively rare lesions in the upper extremity, could be a persistent source of hand, wrist, elbow or shoulder pain. Patients under age 40 who have otherwise unexplained pain should be eval-uated in this regard.

Neurologic claudication (NC) is one of the most common clinical symptoms in patients with spinal canal stenosis. The patient feels pain and paresthesia in his lower extremity during walking that is relieved by stooping ahead. Sagittal balance of spine is one of the most important factors in treating patients with spinal stenosis. The study was conducted to determine if neurogenic claudication has any effect on spinal sagittal balance in patients with lumbar canal stenosis. In this study we analyzed 47 patients with lumbar canal stenosis and divided them into two groups based on the presence or absence of neurogenic intermittent claudication. We put those patients without intermittent claudication in group1 (n=26; mean age: 48.3) and those who have intermittent claudication in group2 (n=21; mean age: 53.3). All patients had standing radiography of spine from C1 to S5 and sagittal C7 plumb line and distance between it and posterior superior corner of S1, kyphosis of thoracic spine and lordosis of lumbar spine were measured. Sagittal plumb line in group 2 was more anterior than group1 patients (+1mm vs. +24mm), although it was not significant (p=0.063). However, thoracic kyphosis (42.4 vs. 51.2; p= 0.003) and lumbar lordosis (27.9 vs. 43.8; p=0.00) were significantly lower in group 2. Patients with intermittent neurogenic claudication had forward posture to relief their symptoms but they tried to maintain total sagittal balance as normal as possible by straightening thoracic spine.

Total knee arthroplasty in patients with rheumatoid arthritis is associated with some problems, and yet is an effective method for management of knee ailments in these patients. The aim of this cross-sectional study was to evaluate the results of this procedure in a series of patients with rheumatoid arthritis. Fourteen patients (23 knees) with rheumatoid arthritis who underwent knee arthroplasty were recruited. Clinical and radiographic results including knee score and functional score, radiographic score, the amount of deformity correction, the length of recovery time and complications were evaluated. All patients were female, with mean age of 64.8 years and were followed for an average of 50.3 months. Average knee range of motion had increased from 87 degrees to 108 degrees postoperatively (p=0.002). The mean knee and functional score were 93 (4.49 SD) and 73 (27.99 SD), respectively. None of the patients had radiographic signs of loosening. Total knee arthroplasty in patients with rheumatoid arthritis improved performance, reduced pain, increased range of motion and corrected knee deformities, but nonetheless was associated with few complications.

Benign fibrous histiocytoma is a very rare tumor with special radiographic and microscopic criteria. It mostly involves the ilium and sacrum but it also can occur in tubular bones. We report a benign fibrous histiocytoma in ulnar diaphysis.

Ewing’s sarcoma is a malignant small cell neoplasm of long bones and pelvis during the first or second decades of life. The involvement of phalangeal bones is extremely rare. We report a Ewing’s sarcoma of proximal phalanx of the second finger of a young man.

Total knee arthroplasty (TKA) after a previous high tibial osteotomy (HTO) is a technically demanding proce-dure. Previous approach, fixation devices, defect of tibial plateau, position of patella and anatomic position of proximal of tibia should be carefully evaluated before the operation. According to the literature the previous HTO has no adverse effect on the TKA outcome.