مجله جراحی استخوان و مفاصل ایران
سال دهم شماره 1 (پیاپی 38، زمستان 1390)

Diagnosis of carpal tunnel syndrome is based on clinical findings and these findings are used to confirm the diagnosis. Sonography is also a noninvasive method for diagnosis of carpal tunnel syndrome. The purpose of this study was to investigate the role of sonography and electrodiagnostic studies in diagnosis of this syndrome. In a prospective study، 76 hands with diagnosis of carpal tunnel syndrome (study group) were compared with 80 hands (control group) in a training hospital in Kerman-Iran. In both groups the diameter of median nerve was measured by sonography and electrodiagnostic studies were performed only on the study group. The study group، post surgery، was followed up for 6 months and the DASH preoperative functional scoring was compared with post operative scores. The difference between the diameters of the median nerve measured by sonography (p=. 0001); and also the difference between before and after-operation Dash Score in the patient group (p=. 001) were statistically significant. Sonography was 95% sensitive and 93% specific for the diagnosis of carpal tunnel syndrome. A weak correlation was found between the severity of the disease in electrodiagnostic studies and sonography (p<. 01، r=. 38). No correlation was proved between the sonographic or electrodiagnostic findings and Dash score before and after the operation (p≥. 05). sonography might be a suitable module for the diagnosis of carpal tunnel syndrome، but there were no correlation between its findings or electrodiagnostic findings and functional scores. Whether or not sonography could be substitute for electerodiagnostic tests، will need further investigation.

General information about the ulnar impaction syndrome is scarty and often neglected. The ulnar styloid process and ulnar variance have important roles in this syndrome. The statistical data related to these factors is not enough in Iranian literature. This study measured ulnar styloid length and ulnar variance in a group of healthy adults. In a prospective study، the ulnar styloid length and ulnar variance were measured on the posteroanterior view on 140 of wrist radiographs in a training hospital in Shiraz-Iran. The relative length of the ulnar styloid process and the ulnar impaction potential were assessed with the styloid-capitate ratio (SCR) and ulnar styloid process index (USPI)، respectively. Clinical examination of the wrists for ulnar impaction was also done. The mean ulnar styloid length was 5. 38±1. 45 mm. The average styloid-capitate ratio (SCR) was. 24±. 06 and the average of ulnar styloid process index (USPI) was. 34±. 11. 40. 71% of the radiographic views in SCR، and 56. 42% in USPI were more than average. The ulnar variance showed 19. 3% neutral (23% male، 10% female)، 12. 1% positive (11% male، 15% female) and 68. 6% negative (66% male، 75% female) measurements. It seems a long ulnar styloid process with SCR>. 24±. 06 or an overall styloid length greater than 6 mm is one of the most important cause of pain in ulnar sided wrist pain in our population.

Enchondroma is the most common benign bone tumor in hand، which can be seen in various manifestations such as swelling، pain، deformity and pathologic fracture. Different surgical treatments were reported for enchondroma to prevent the progressive deformity and pathological fractures. The purpose of this study was to investigate the result of treatment of enchondroma of hand with curettage alone.

In a cross sectional study، 17 patients with average age of 32 years with enchondroma of hand who were operated in a 6-year period in a training hospital in Tehran-Iran were evaluated. The patients received the treatment of tumor removal without filling the resultant defect. The cases were evaluated for range of motion، grip power and radiographic Tordai classification.

In a 15. 2 month (12-88 months) follow-up no recurrence was observed and all of the patients re-gained their previous finger range of motion.

Treatment of enchondroma of hand with curettage alone، without filling the defect would result in satisfactory outcome with low recurrence rate and good restoration of power and function.

The objective of this study was to evaluate the results of our experience in open reduction and internal fixation of fractures of calcaneus. In a quasi experimental study، 20 patients with mean age of 35. 5 years (15-69 years) with calcaneus fracture - grade II and III- underwent surgery with open reduction and fixation in a 5-year period in a training hospital in Tehran-Iran. The patients'' profile، Bohler and Gysan angles before and after surgery were measured and statistically analyzed. Post surgery Bohler and Gysan angles showed significant improvement (p=. 000). Open surgery with internal fixation contributed to improving the angles. The questionnaire with a 4-6 months follow-up showed that the average American Orthopaedic Foot and Ankle Society (AOFAS) score and Food Function Index (FFI) score was good or excellent in 80% and fair in 20%. Overall، 7 patients had complications after surgery، which were controlled successfully painted patients have had good results after surgery. The results of calcaneus fractures treated with open reduction internal fixation surgery have a positive effect and are in line with previous studies.

There are various methods to correct leg length discrepancy (LLD)، each with their own specific problems and complications. We would like to report the results of lengthening over an intramedullary nail. In a prospective study، twelve patients who had LLD from previous femoral fractures underwent lengthening with Wagner external fixator over intramedullary nail in a training hospital in Tehran-Iran. The intramedullary nails were locked with screws after the projected length was achieved and external fixator was removed. The outcome of treatment and the complications were evaluated in a 2-year follow-up. The average achieved lengthening was 4. 2 cm (3-6 cm). Eight patients developed pin track infection، one case had osteomyelitis. All the cases united، with no malunion of fracture. The increased duration of external fixation remaining on the limb was closely related to the occurrence of pin track infection (r=. 821، p=. 001). Femoral lengthening over a nail decreases the duration of external fixator usage، improves patient’s comfort and compliance and avoids axial deviation and fracture of regenerate bone.

Cementless total hip replacement is an accepted alternative to total hip replacement with cement in younger patients، but it remains controversial for elderly patients. This study evaluated the functional results and complications of cemented and cementless methods in old patients. In this cross-sectional study، all the patients aged 65 years or older who had been hospitalized for total replacement of hip joint because of femoral neck fracture or osteoarthritis of hip were studied during a 3-year period in three educational hospitals in Iran. «Harris hip score» was used to assess the functional consequences. The early complications -thrombophlebitis of lower limbs، dislocation، hematoma and infection - and late complications - aseptic loosening، dislocation، and reoperation، were documented. 209 eligible patients، including 96 (45. 9%) cemented and 113 (54%) cementless were studied. Patients were followed for a mean period of 5 years and 2 months (51-82 months). The overall rate of early complication was 8 cases (3. 8%): five in the cemented and three in cementless group، respectively. Late complications were seen in two cases -one loosening in cemented group and one dislocation in cementless group. The final Harris hip score at the final follow-up was 84. 01±4. 71 in cemented and 85±5. 02 in the cementless groups (p≥. 05). Cementless hip replacement can have a satisfactory functional result like cemented hip replacement procedure in the elderly patients over 65 years of age.

Brown tumor is an osteolytic lesion caused by excessive production of parathyroid hormone. We present a 20 year old man with symptoms of severe muscle weakness and multiple fractures of shoulder and hip that the Brown tumor was observed in most of his bones

Tourniquet is a device that prevents blood entrance and exit from a limb. Its use goes back to 200 years BC- the Roman emperors’ era - and has been utilized especially in amputations. During the history، several types of tourniquets have been used by surgeons and its design has changed regularly. Nowadays tourniquet is used very often in orthopaedic، vascular and plastic surgery. Although its usage is not routine، but it is a great help to the surgeon. Tourniquet، like other techniques has risks and side effects and the surgeons have to be aware of them as well as its proper use. This article mainly deals with pneumatic tourniquet، its usage and complications.