Journal of Orthopedic and Spine Trauma
Volume:2 Issue: 1, Mar 2016

One of implants which is used for fixation of hip fracture (HF) is dynamic hip screw (DHS). Because of the destruction of the head of femur, or even acetabulum, during the cut out process or because of severe osteoporosis, refixation of fracture may be impossible. In this time, total hip arthroplasty (THA) is a good option.
In this study, we try to retrospectively evaluate the results THA after DHS failure.
This retrospective study was undertaken in Sina hospital, Tehran, Iran, from 2004 to 2014, and included all patients with intertrochanteric HF which was initially fixed with DHS and failed, that was further treated with THA.
In the total of 52 patients, nail cut out was responsible for 49 cases (94%) of DHS failure, whereas in three cases (6%) it was the fracture of the side plate. Pre-operative Harris hip score ranged from 30 to 50 (average 36) and post-operative score ranged between 65 and 90 (average 85). There were 12 cemented cups and 40 cementless cups. Fourteen standard stem and 38 long stem were used. Twelve of the 14 standard stems were cemented. Posterior approach was used in 45 cases and direct lateral approach was used in the remaining seven cases. Prophylactic wiring was done in 46 cases. Intraoperative penetration of the floor of acetabulum occurred in two cases. Constrained liner was necessary in five cases, three of which because of sever osteoporosis of trochanter and insecure fixation of it after fracture and two because of recurrent dislocation.
For achieving good results, the THA, after failure of DHS, requires the use of posterior approach, extremely careful acetabular reaming, prophylactic wiring of femur and the passing of the holes of screws with long stems.

Osteomalacia represents a risk factor for hip fracture (HF), which is one of the most common and costly injuries in elderly.
This study was performed to determine the frequency of histopathologic and laboratory osteomalacia in elderly patients with HF.
Patients and Totally, 87 patients with HF, admitted to Imam Khomeini hospital, Tehran, Iran, from 2005 to 2006, were studied. Laboratory investigations included serum calcium, phosphorus, alkaline phosphatase (ALP), albumin and 25-hydroxy vitamin D3 [25 (OH) D3]. Open biopsy from ipsilateral iliac crest was performed during the same surgery.
The average age was 78.06 ± 8.4 years. Bone biopsy showed osteomalacia in eight patients (9.2%), hypocalcaemia in 42.5%, hypophosphatemia in 17.2%, hypoalbuminemia in 66.6% and 25 (OH) D3 deficiencies in 66.6%. Concomitant hypophosphatemia and hypovitaminosis [25 (OH) D3 Elderly patients with femoral neck or intertrochanteric fractures may have osteomalacia, as a treatable cause for osteopenia, and laboratory tests may not be precise criteria for diagnosis in HF patients.

Bone drilling is a common step in orthopedic surgery. Thrust force is one of the most important parameters that can influence the quality of bone drilling. The number of drill bit usage has some limitations and it can affect the quality of bone drilling.
The aim of this study was to investigate the limitations of drill bit usage number to increase the bone drilling quality.
Two mid-diaphysis sections of male human cadaveric femora were prepared. Five orthopedic drill bits were used to identify the effects of the usage number. An orthopedic hand piece was attached to the dynamic testing machine. The spindle speed and feed rate of the drill bits were 900 rpm and 0.5 mm/s, respectively. Drill bit usage of 0, 20, 40, 60 and 80 were prepared for scanning electron microscopy (SEM). SEM images were taken to illustrate physical changes on the cutting surfaces of the drill bit.
There was an increase in the thrust force by increasing the number of drill bits usage. Irreversible physical damages were observed in drill bit point angle, frank face, and flutes of drill bits.
The number of drill bits usage has limitation. Drill bits that are similar to the ones of the current study are better to be used no more than 55 times.

Although intra-operative X-ray is deemed necessary for closed reduction and percutaneous pinning of distal radius fracture, it is not uncommon, in several operative rooms in developing countries, to encounter situations when the access to image intensifier or even portable X-ray emitter is impossible.
The aim of the present study was to assess the quality of reduction and pin insertion of distal radius fractures treated by closed reduction and percutaneous pinning without application of intraoperative X-ray.
Patients and Attempts were made to restore volar tilt and radial height by palpating of dorsal cortex of distal radius and styloid of radius, after infraclavicular block, by closed reduction and percutaneous pinning for 31 patients with types A2, A3 and non-displaced B1 distal radius fractures (AO classification). After careful pinning, dressing and splinting, X-rays were obtained in the radiology department, immediately.
Totally, nine male and seven female patients, with mean age of 39.2 years (SD: 16.6; range: 13 - 58 years), were included in the study. Parameters of reduction were acceptable in all patients. Three complications (18.75%) occurred, concerning placement of pins in three patients (wrong placement of pins from styloid of the radius, excessive length of pin with skin irritation at its tip and a pin penetration to radio scaphoid joint.
Closed reduction and percutaneous pinning of distal radius fracture may be possible in the absence of intraoperative X-ray by the risk of several insignificant complications.

Rupture of the anterior cruciate ligament (ACL) is one of the most common injuries in patients referred to the emergency and orthopedic clinics. Reconstruction of the anterior cruciate ligament (ACLR) is one of the knee surgery methods used nowadays.
This study aimed to compare the results of the ACLR with the hamstring tendon using all-inside and outside-in techniques.
Patients and This descriptive analytical study was conducted on 40 patients with anterior cruciate ligament rupture referred to Imam Hossein hospital, Tehran, Iran, during 2009 - 2011, who were under the ACLR with the hamstring tendon graft using all-inside and outside-in techniques. The Tegner Lysholm knee score questionnaire was completed for the patients to study the current clinical and functional status of the knee. Data were analyzed by the SPSS software version 7. A P The mean ± SD of the Tegner Lysholm knee score scale in the outside-in and all-inside groups were 91.5 ± 3.6 and 88.4 ± 2.1, respectively which was not statistically significant. It was also observed in both groups that 3 patients lost their ability to participate in sport activities.
There are no significant differences in the ACLR with hamstring tendon using the outside-in and all-inside techniques in terms of clinical and functional and also returning to the previous sport activity.

Supracondylar elbow fracture (SCEF) is the most common fracture in the elbow region in children. Considering its high prevalence and the potential complications, proper management of this condition is paramount.
The aim of this paper is to report the results of an assessment of timing for SCEF surgery and the prevalence of related complications.
Patients and We retrospectively reviewed the outcomes of patients with SCEF who presented to our tertiary care pediatric emergency department between September 2013 and March 2014. We reviewed their charts to assess several clinical parameters, including age, sex, Gartland classification of SCEF, weight, comorbidities, treatment intervention, physiotherapy, and the extremity involved. The children were divided into two treatment groups: 1) early, if treated within 24 hours after injury; and 2) late, if treated 24 hours or later after injury. Perioperative complications and short-term outcomes were compared between the two groups.
Of the 24 patients reviewed, 16 were in the early group and 8 were in the late group. There were no significant differences between the two groups regarding perioperative complications such as pin tract infection, iatrogenic nerve injury, compartment syndrome, or range of motion after six months of follow-up (P value = 0.227).
A delay in surgery for more than 24 hours after injury does not influence the perioperative complications and clinical results for displaced supracondylar humeral fractures in children. We conclude that night operations can be avoided.

Total hip arthroplasty (THA) in patients with chronic untreated fracture of the posterior acetabular wall represents a rare and challenging scenario for joint surgeons. There are many reports on THA following acetabular fractures treated by internal fixation; however, there are few previous reports on THA following missed posterior wall fracture.
In this study, a case series of patients with untreated posterior wall fracture of the acetabulum managed by cementless THA and superior placement of acetabular cup was presented.
Seven patients (mean age of 42 years) with untreated posterior wall fracture of the acetabulum, presented to our institution with severe osteoarthritis 5 months after primary trauma (ranged 3.4 to 7.2). There were 5 pure posterior wall fractures and 2 posterior wall and column fractures. It was decided to put the cup in a little higher center rather than reconstruct the posterior wall. All cases were performed with the lateral approach in supine position. All patients were ambulated on the day after surgery with weight bearing as tolerated program. We did not apply hip precautions to these patients.
Acetabular implants were placed within 8 - 18 mm upward from the tear drop (upward distance average 14.4 mm). Postoperatively, the function of hip joints improved with HHS rising from 42.5 ± 6.42 to 88.3 ± 7.27 after one year, which was significantly different (T = 12.49, P Putting acetabular cup in a higher but more supportive bone offers a reliable and easier technique for reconstruction of acetabular posterior wall deficiencies. Further studies are needed to prove long-term outcomes of this method.