Journal of Research in Orthopedic Science
Volume:2 Issue: 2, May 2015

Old unreduced elbow dislocation and fracture-dislocation, although rare, are one of the challenges in orthopedic surgery. The application of the hinged elbow external fixator can confer early range of motion after open reduction and reconstruction in spite of severe soft tissue and bony injury. This study presents our results of open reduction and reconstruction in old simple elbow dislocation and old elbow fracture-dislocation. Patients and In 12 patients with old elbow dislocation, open reduction and bone and soft tissue reconstruction was done and early postoperative range of motion was begun with the aid of hinged elbow external fixators. The mean elbow range of motion at the final follow-up was 98 degrees (SD = 10). According to the Mayo Elbow Performance Index score, 6 patients achieved excellent results and 2 other had good results with a mean value of 92 (SD = 8). We recommend hinged elbow external fixation in old elbow dislocation for early range of motion and maintenance of concentric reduction with acceptable results.

An increased incidence of osteonecrosis of the femoral head (ONFH) has recently been observed in Iran, likely associated with the introduction of an illegal, steroid-containing opioid drug, Temgesic. The correlation of risk factors associated with the course of ONFH has yet to be determined. The purpose of the present study was to assess the effects of etiologic factors on the course of ONFH after emergence of symptoms. Patients and We retrospectively assessed patients with untreated ONFH due to one of the four etiologies of steroid medication, Temgesic abuse, trauma and idiopathic. Patients with multiple risk factors and those without collapse at the last follow-up visit were excluded. The effect of age, gender, etiology of osteonecrosis, opium addiction and smoking on the time interval between pain onset and radiologic collapse were investigated. In total, 110 patients (174 hips) were categorized into four etiologic groups. The average time between onset of pain to radiologic collapse in different etiologic groups was 12.8 months for all groups, 12.4 months for steroid, 8.7 months for Temgesic, 18.5 months for trauma and 16.6 months for idiopathic groups. Thirteen hips had collapse in less than six months. Patients who used steroid and Temgesic had shorter time interval to collapse, which was statistically significant (P Values < 0.001 and < 0.001, respectively). Smoking had a statistically significant association with the time to femoral head collapse (P Value = 0.003). Steroid medications and Temgesic abuse are associated with shorter time interval to femoral head collapse. Smoking is also a factor associated with shorter time interval to collapse. These factors should be considered in any joint preserving treatments for patients with FHON.

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy. Diabetes mellitus is the most common disease that predisposes the patients to CTS. Diabetic neuropathy is a progressive disease and diabetics nerve is more susceptible to compression at known sites of anatomic constrains such as in the carpal tunnel; clinical results of carpal tunnel release has been questioned not to be as good as non-diabetic patients. This study was carried out to compare the clinical and electrodiagnostic outcomes of diabetic and non-diabetic carpal tunnel release (CTR) surgery. Patients and Twenty diabetic hands (14 patients) and 18 non-diabetic hands (14 patients) that underwent CTR between Octobers 2009 - 2012 were evaluated. They were operated by one hand surgeon and were evaluated at least six months after the operation. Clinical symptoms as numbness, pain, paresthesia and nocturnal symptoms were evaluated. Electrodiagnostic results were evaluated pre- and post-operatively. After surgical release, both groups showed significant improvements in clinical results, as 81.6% of patients had excellent and good outcomes, 18.4% had fair outcomes, and no one had poor outcome. Except for median sensory nerve conduction velocity (NCV) changes that had significant differences between diabetic and non-diabetic groups, other parameters had no significant differences between both groups. Furthermore, significant reverse correlation was found between the duration of CTS and the outcome. Clinical and electrodiagnostic results after CTR are approximately the same in patients with diabetes and without it. Diabetics with CTS as well as non-diabetic patients have satisfactory results after CTR surgery. Furthermore, the duration of CTS has a significant influence on the result of CTR; the shorter duration of diabetes, the better the result of CTR surgery.

Traumati c anterior dislocation of the hip is not common and open perineal variant of the inferior type of anterior dislocation is an even rare event. We report a case of open perineal variant of the inferior type of anterior hip dislocation, with concomitant fracture of the femoral head and greater trochanter, in a 17-year-old male patient. Closed reduction of dislocation and later open reduction and fixation of the greater trochanter were performed. Eighteen months after the injury, the femoral head resorption, due to infection and avascular necrosis, led to a poor functional outcome. Open perineal variant of anterior hip dislocation can lead to very poor outcome when performed with closed reduction.

Treatment of adolescent idiopathic scoliosis (AIS) is one of the most challenging problems for spine surgeons. Although it has been previously demonstrated that curve pattern in AIS is different between males and females, there are, however, limited studies specially focused on the differences of AIS characteristics between the two genders. In current study, we compared the demographics and curve patterns in male and female patients with AIS. Patients and A total of 68 girls and 17 boys with AIS were included in this cross-sectional study. The magnitude of curvature, thoracic kyphosis, flexibility and pattern of the deformity were measured on x-rays and compared between the two genders. Although girls were significantly younger (15.3 ± 2.5 versus 16.7 ± 2.1 years; P = 0.036), however, the Risser sign was the same. Most of the males were hypokyphotic (70.6%), while most of the girls had normal thoracic kyphosis (69.1%) (P = 0.001). The main scoliotic curve (77.2 ± 18.2 versus 59.6 ± 18.6 degrees) and flexibility (25.5% ± 18.2% versus 41.9% ± 18.6%) were significantly greater and lower in males, respectively (P < 0.05). The typical AIS pattern was present in 64.7% of boys and 95.6% of girls (P < 0.001). The radiographic characteristics of AIS are substantially different between genders. In male patients, AIS is more severe and rigid compared to females. Also, hypokyphosis and atypical pattern of AIS are common findings in males compared to females.

Thoracolumbar fractures are the most common fractures of the spinal column. There is no consensus about treatment method of choice among authors. The purpose of this study was to compare radiographic and functional outcomes of conservative management with that of surgical treatment in thoracolumbar spine fractures. Patients and Forty-nine patients with single level acute thoracolumbar fractures and normal neurological examination were evaluated, of those 21 patients underwent surgery and 28 treated with orthosis. Radiographic outcomes were evaluated by measuring sagittal kyphotic angle, anterior vertebral body collapse and functional outcomes were assessed using SF36 health survey questionnaire and the Denis work and pain scales. Among the surgically treated patients, sagittal kyphotic angle was significantly corrected immediately after operation and in the last follow-up compared to preoperative measurements (P < 0.001), functional results of SF36 score and pain scale were satisfactory. Among those received conservative management, sagittal kyphotic angle and anterior vertebral collapse were not significantly different before and after bracing (P = 0.4 and P = 0.8, respectively); functional outcome of SF36 scores were satisfactory and functional and radiographic results had no correlation. Functional outcome in both groups with surgical and non-surgical treatment was satisfactory. Radiographic indices were improved with surgical treatment and no correlation was found between functional and radiographic outcome.