مجله جراحی استخوان و مفاصل ایران
سال دهم شماره 2 (پیاپی 39، بهار 1391)

The use of stem cell is believed to reduce pain and delay the deterioration in the early stages of femoral head osteonecrosis. The aim of this study was to evaluate the effect of autologus concentrated mononuclear bone marrow cell implantation after core decompression in femoral heads that were in the early stages of osteonecrosis.

Twenty eight femoral heads with osteonecrosis that were undergoing core decompression were randomly divided into two groups of 14. One group received additional implantation of autologus bone marrow mononuclear cells. The two groups were، then evaluated within 2 years with WOMAC (Western Ontario and McMaster University osteoarthritis index)، visual analogue pain index (VAS) and MRI of the femoral heads.

A significant improvement in WOMAC، and VAS scores was observed within the 2 years of follow-up in the implanted group، compared to the control group (p<. 001). The MRI findings were also significantly better in the implanted group (p=. 046)، with 3 cases showing change to a lower osteonecrosis stage. The control group، on the other hand، showed worsening in the osteonecrotic heads (p<. 001).

Implantation of concentrated bone marrow mononuclear cell in the femoral heads undergoing core decompression in the early stages of osteonecrosis can reduce symptoms، and improve staging of osteonecrosis، better than core decompression alone.

This study evaluated the long-term (>5 y) outcomes of radial shortening osteotomy and vascularized bone graft in Kienböck disease patients. In a retrospective study of 16 patients with early stage Kienböck disease، 9 patients with average follow-up of 6. 4 years had radial shortening osteotomy (group 1)، and 7 with average follow-up of 6. 5 years had pedicled vascularized bone graft (group 2). The 2 groups were similar in age، sex، operated side، initial Lichtman stage، and follow-up duration. There were significant differences in ulnar variance between the 2 groups. At the last follow-up، the patients were evaluated for pain، wrist motion، grip strength، functional status، and radiographic assessment. The overall results were evaluated by Cooney wrist function score and Nakamura scoring system for Kienböck disease. The 2 groups had no significant difference in pain، motion، grip strength، and radiologic assessment; however، grip strength percentage was better in group 2. There was no significant difference between the radiographic changes of the 2 groups. In group I، 7 patients had satisfactory Nakamura scores، and 5 patients had satisfactory Cooney scores. All of the patients in group 2 had satisfactory Cooney and Nakamura scores. The difference in the mean Cooney wrist function score in the 2 groups was significant. The difference of Nakamura scores in the 2 groups was not significant. Both groups had reasonable long-term outcomes. We were unable to recognize a substantial clinical or radiological difference between the 2 surgical treatments in long-term outcome.

Bioactive bioceramics have been regarded by researchers in recent years. Bioglass and Hydroxyapatite (HA) are the examples of these bioactive bioceramics. Production and characterization of nano bioglass and HA for bone repair applications were the purpose of this study. Nano bioglass and HA were produced and the particles shape and size were characterized by X-ray flurescence (XRF). The bioactivity of the particles of HA and nano bioglass and combination of the two were tested، by introducing them into the cavities formed in rabbit''s Tibia. The incorporation and bone induction of these 3 different paricles in bone were evaluated by radiography and also histopathology of the resected specimens. The characterized tests confirmed that nano bioglass and natural HA were produced with desired composition. The radiographic and histopathologic evaluation illustrated good bioactivity of nano-size bioglass، HA and HA-bioglass composite، leading to restoration of bone defects after 4 to 6 weeks. It was also observed that bioactivity of HA-bioglass composite was superior to bioglass and HA used singularly. The osteoconductivty of HA and osteoinductivity of bioglass combined as a composite lead to excellent bioactivity and good response in the hard bony tissue.

The syndesmotic sprains account for 1% to 11% of all ankle injuries. Good understanding of the mechanism of injury، physical examination، new imaging techniques and ankle arthroscopy help to improve assessment and management of high grade ankle sprains with a normal mortise relationship. Eleven patients (9 men، 2 women) with average age of 26 years (22-38 years)، who had syndesmotic sprain confirmed by ankle arthroscopy، were studied by the clinical symptoms and imaging assessments. The treatment results were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score. The mean duration of injury was 9 months، and the follow up was 12 months Postoperatively، 7 ankles obtained excellent and 4 good results according to AOFAS score. Impingement of syndemotic scar tissue in the ankle joint was the main cause of persistent pain. These cases had no diastasis on the plain radiography and no obvious sign of instability during the ankle arthroscopy. In some cases، chondral softening and lesion were seen at the medial ridge of the Talus، which could be due to subtle instability and change in the ankle biomechanics. Syndesmosis ankle injury could produce chronic pain. Arthroscopic debridement، in the absence of ankle instability could be an effective tool.

Awareness of status of scientific production and research-activity trends are important for scientific development in every country. This study aimed to determine Iran''s scientific ranking in the orthopaedic field and introduce the top contributing authors and institutions in this field. The recent 20 years (1993 to 2012) period of scientific production in the field in ISI was also mapped. In a scientometric study، Iranians'' scientific production in orthopaedics analyzed with indicators such as citation count، and h-index in ISI and SCImago. This systematic review studied the total scientific documents as research population retrieved via SCImago and WOS with «Iran» and «Orthopedics» in their address. In the field of orthopaedics، Iran ranked 34th in the world and 3rd in the Middle East. Among scientific institutes، Tehran University of Medical Science (57 documents)، Sharif University (28 documents)، Urmia University of Medical Sciences and Iran University of Medical Sciences (27 documents) were respectively in the first three top institutions in this field. The studied documents have been overall cited up to 1253 times. Iran''s scientific production in orthopaedic field has increased during this period، especially since 2005 and the h-index of this field was 17 and documents have been cited 1253 times. According to h-index، Iran''s scientific production in orthopaedic field has been good، however the rate of participation in scientific production were low (23%).

Traditional treatment of unstable fifth carpometacarpal joint injuries is closed reduction and pinning. The aim of this study was to determine the safest corridor for pinning of fifth carpometacarpal joint to prevent the iatrogenic injury to the ulnar nerve and tendons. In the first phase of study، three fresh cadaver samples were dissected and the safest directions of kirschner wire insertion in coronal and sagittal planes were determined to the base of the fifth metacarpal. The second phase evaluated the accuracy of data obtained in previous phase. Therefore k-wires were inserted in combination of maximum angles in different planes determined previously. After taking X-rays، the ulnar nerve branches and tendons were explored to detect any possible damage. In the third phase، four fresh carpometacarpal joints were fixed with directions outside the range of defined angl es. The safe direction determined in the first phase was 20° to 30° coronal plane angle in regard to body of the fifth metacarpal bone and between 10° volar to dorsal to 20° dorsal to volar angle in sagittal plane. Insertion of k-wires in the second phase could fix the fifth carpometacarpal joint firmly. All inserted k-wires outside the defined range resulted in injuries to nerve or tendons or infirm fixation The safest corridor for pinning the unstable fifth carpometacarpal injuries is two centimeters distal to the joint with 20° to 30° in coronal plane and from 10° volar to dorsal to 20° dorsal to volar direction in sagittal plane.

Two patients with iatrogenic femoral neck fracture following intramedullary fixation of the diaphyseal fractures are reported. This is a rare complication of intramedullary nailing (IMN)، has poor prognosis and is preventable. It seems that choosing the piriformis fossa as the entry point، increased neck-shaft angle (coxa valga) and excessive nail insertion increased the risk of the iatrogenic neck fracture.

Hihg tibia osteotomy has its own position even with successful total knee replacement. A high tibial osteotomy affects not only the joint function as a whole، but also the dyferent sections of the knee joint. The biomechanical changes affect the patella inedial collateral ligament، quadriceps alignment and Q-angle and tibial plateau slope. The goal of high tibia osteotomy is more normal load distribution in nonarthritic knee in young persons، and slowing degeneration in arthritic knee in adults. All the high tibia osteotomies cause patellofemoral biomechanical changes، through tubercle displacement، or patellar tendon fibrosis or calcification. Q angle also increase with lateral displacement of tibial tuberosity when osteotomy is done proximal to the tibial tuberosity. The medial collateral ligament needs to be released in open wedge high tibia osteotiomy. If intact medial ligament is necessary، osteotomy should be done distal to medial collateral attachment. The proximal tibia configuration is roughly similar to a rectangle. Lateral cortex is in right angle to the posterior one. The posteromedial corner opens three times the anterior one in open wedge osteotomy otherwise there would be tibial slope change.