مجله جراحی استخوان و مفاصل ایران
سال شانزدهم شماره 3 (پیاپی 62، تابستان 1397)

The history of the new nailing method dates back to Gerhard Küntscher, who introduced this concept in Germany in 1940. He believed in two general principles: Stable fixation and fixation of fractures without opening the fracture site. In the beginning, primary nails with various weaknesses were only used in fractures of femur. Over time, effective changes were made in the design and insertion of bone nails. This article aimed to review the evolution of the design of nails and simple but significantly important principles of inserting nails in long bones. In any case, lack of adherence to these simple principles by surgeons leads to lack of desirable fixation.

Determining the association between knee joint proprioception and stability in Taekwondo players shows the importance of incorporating proprioception exercises in the Taekwondo training program. In addition, it can be considered by athletes and Taekwondo coaches as one of the components that promote the professional level of performance. Therefore, this study aimed to compare the knee proprioception and postural stability between Iranian amateur and professional Taekwondo players. This cross-sectional comparison study was performed on 40 Taekwondo players who were randomly divided into two amateur and professional groups. The level of players (professional and amateur) was considered as the independent variable, whereas the mean error of target angle reconstruction at 30, 60, and 90 degrees and postural stability were recognized as the dependent variables. Knee joint proprioception and postural stability were assessed using a gyroscope and Biodex stability system, respectively. Data analysis was performed using independent t-test, and its non-parametric equivalent, Mann-Whitney U (in case of lack of establishment of the assumptions of parametric test).  A significant difference was found between amateur and professional groups regarding proprioception at 30 (P=0.001), 60 (P=0.001) and 90 (P=0.008) degrees as well as postural stability (P=0.001), where the professional group obtained better results, compared to the other group. According to the results of the study, performing professional Taekwondo techniques can positively affect joint proprioception and postural stability by increasing physical performance. These issues are important factors for the difference between professional and amateur players.

Nowadays, there is consensus regarding arthroplasty as the preferred treatment method for displaced femoral neck fracture among the elderly population. Although posterior and lateral surgical approaches are the most commonly used approaches for hip arthroplasty, direct anterior approach (DAA) has become popular in many centres. Considering the many advantages of DAA, this study aimed to study the results of hemiarthroplasty via DAA for femoral hip fracture in the elderly people in our centre.

All the femoral neck fractures that had received hemiarthroplasty via DAA between January 2010 and January 2013 in a teaching hospital were extracted from the database. The pre, intra, and post-operative information and clinical follow-up data were all collected and analysed. The Harris Hip Score and physical exam was used for functional assessment.

45 patients (16 males and 29 females) with a mean age of 73.4 years and a mean follow-up of 76 months entered the study. There was no complication such as dislocation, wound problem or deep infection. The final mean Harris Hip Score was 87 (76-95).

given that the patients with femoral neck fractures are often old, hemiarthroplasty treatment via direct anterior approach (DAA), has multiple advantages and is recommended for this population.

Distal femur is the most frequently affected site by giant cell tumor (GCT). Surgery including tumor curettage and defect reconstruction with bone cement is a widely-used treatment. While post-operative fracture is a common complication, no criteria and/or biomechanical data are available to identify patients at high risk of fracture.  Since there is a strong correlation between bone strength and its fracture risk, in this study, bone strength following GCT surgery was predicted using quantitative computed tomography (QCT)-based finite element method (FEM). Mechanical properties of bone-cement interface, along with non-linear and non-homogeneous, as well as post-yield properties of bone were taken into account in the FE models. The accuracy and precision of FE models in predicting bone strength were evaluated using statistical tests by comparing the FE results with the results obtained using in-vitro mechanical tests on 14 cadaveric specimens and an independent data set. According to paired t-test analysis, no significant difference was observed between the bone strengths predicted by FEM   and those calculated by in-vitro tests  . In addition, based on the results of regression analysis, there was a linear relationship between  and with a slope not different from 1. The obtained results show the capability of QCT-based FEM in predicting bone strength in distal femur following GCT surgery, and thus they can be employed to investigate various features of the bone-cement construct with the hope of shedding light on the obscure aspects of the problem.

Congenital convex pes valgus or congenital ve

The most common method of treatment for vertical talus is the extensive soft tissue release. A minimally-invasive method based on Dobb's serial casting (Reverse Ponseti) was introduced 15 years ago and has yielded significant results. The aim of this study was to investigate and compares the midterm results of Casting with the extensive soft tissue release method.

12 patients with vertical talus were included in a prospective study, 6 patients with 10 feet were treated with reverse ponseti, and 6 other patients with 10 feet with externsive soft tissue release. In an 18-24 months follow-up the results were compared together, using ankle range of motion, oxford questionnaire, and radiographic measurements.

The mean range of ankle motion was comparable in the two groups (p=0.35), the oxford questionnaire score was not statistically different between the two groups (p=0.876).

With the comparable results between the ''reverse-ponseti'' casting land extensive surgical releases in this mid-term study, the casting technique is recommended because of its lower cost and non-invasive nature. rtical talus (CVT) is an uncommon congenital foot deformity. Incidence rate of CVT is 1 out of 10,000 live birth. CVT is one of the main causes of rigid flatfoot in newborns (1). Rigid talonavicular joint dislocation is the hallmark (inflexible in the sole of the foot with no arch) of CVT, accompanied by non-flexible equinus. In this structural abnormality, in fact, the convex plantar surface of the foot creates a rocker-bottom appearance (2). It occurs as an isolated deformity in half of patients and is associated with neuromuscular and genetic disorders in others (1, 3, 4).There is bilateral involvement in half of CVT patients, and there is no gender predilection (5). Although CVT is not painful for newborns and infants, if not diagnosed and left untreated, leads to major disabilities in the adulthood. Ambulation is not usually delayed; however, the gait is unbalanced. Patient`s shoes often show abnormal wear, and pain often develops in early adolescence (6). As the heels, do not touch the ground, push-off from the floor is poor and talar head acts as a weight-bearing structure, resulting in painful calluses in this region (7, 8).

One of the common reasons for referral to healthcare centers are orthopedic injuries which may occur due to spontaneous pathologic injuries, traffic accidents, workplace injuries, and during exercise. This study aimed to determine the frequency, types and causes of orthopedic injuries refering to Akhatr teaching hospital in Tehran. In this study, records of all the patients presented to the emergency department of the Akhtar hospital in 2015 were reviewed. Data were collected by random completion of the "damage record questionnaire" by nurses. Data were analyzed using descriptive (frequency, mean and standard deviation) and inferential (Chi-square) statistics to evaluate the incidence rate of injuries and demographic characteristics of the participants and to compare the incidence rate of injuries in various body parts. Most injuries occurred in lower extremities, followed by upper extremities. In addition, there was a significant association between gender and cause of incidents (P<0.03). Moreover, a significant correlation was observed between gender and rate of injury in left (P<0.001) and right (P<0.049) lower extremities and also in the right (P<0.001) and left (P<0.001) upper extremities. Results demonstrated a higher rate of injury among men, compared to women. Furthermore, the ankle was the most commonly injured area in the lower extremities while the wrist was the most common area of injury in upper extremities. According to our results, the main cause of orthopedic injuries in the emergency department was traffic accidents (drivers, car occupants, and pedestrians), and the majority of patients were in the age range of 20- 40 years.

Periprosthetic fractures about the humerus are a rare but difficult complication of shoulder arthroplasty, occurring in up to 3% of cases. Depending on the fracture pattern, open reduction and internal fixation (ORIF) may be used to definitively treat these injuries. This article demonstrates a new technique that uses a distal femoral locking plate to maximize bony fixation of such periprosthetic humeral fractures. Between November 2008 and July 2016, three patients with periprosthetic humerus fractures were treated with open reduction internal fixation using a distal femoral locking plate. All patients were followed until radiographic :union:. Fractures occurred at a mean of 5.2 years after arthroplasty (range, 1 to 7.5 years). Two of the fractures were classified as Wright-Cofield Type C and one fracture was Wright-Cofield Type B. Surgical fixation was performed at a mean of 6 days after fracture.  All were treated with a fixed angle distal femoral locking plate.  Healing was confirmed radiographically for all three patients at a mean of 11.8 months (range 3 to 28.5 months). No patient required reoperation. Obtaining adequate bony fixation around periprosthetic humerus fractures remains challenging.  The use of a distal femoral locking plate may be helpful in patients with long stem prostheses which require increased distal fixation.
Level of Evidence: Level IV