مجله جراحی استخوان و مفاصل ایران
سال دهم شماره 4 (پیاپی 41، پاییز 1391)

Developmental dysplasia of the hip (DDH) is a common problem and inappropriate treatment may result in serious complications. Several techniques have been used to monitor the status of the hip after reduction. Each has its own problem so that ultrasound found a special place where the assessment is needed. The aim of this study was to determine the diagnostic value of transinguinal and transgluteal ultrasound in comparison to CT scan in the evaluation of femoral head position in acetabulum in DDH treatment in spica cast. A cross-sectional study was performed on 37 affected hips in 24 infants at the age of 9 to 36 months during one year in a teaching hospital in Tehran، Iran. After close or open reduction and applying spica cast، an opening was made over the anterior edge of the inguinal region and transinguinal and transgluteal ultrasound was performed to confirm the quality of reduction in the acetabulum. The sensitivity، specificity، positive and negative predictive values of the postoperative ultrasonography was compared with CT scan. Data analysis was done by statistical tests. The rate of agreement between ultrasonography and CT scan results was 91% (p<. 001). The sensitivity of 87%، specificity of 100%، accuracy of 97%، PPV of 100% and NPV of 96% were reported for ultrasound in comparison to CT scan. Ultrasound could be applied after closed or open reduction for determination of the femoral head position in spica casts in the management of DDH.

The use of platelet-rich plasma (PRP) as an adjuvant to tissue repair is gaining favour in orthopaedic surgery. Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a recognised phenomenon that could compromise revision surgery. The purpose of this study was to determine whether PRP might prevent tunnel widening in ACL reconstruction. In a randomized clinical study، during one year patients undergoing ACL reconstruction using a hamstring graft were randomly allocated either to have PRP introduced into the tunnels (group 1) peri-operatively or not (group 2). Each group comprised 25 patients. CT scanning of the knees was carried out on the day after surgery and at three months post-operatively and the width of the tunnels was measured. Patients were also evaluated clinically at three months، when laxity was also measured. Three months post-operatively، all patients were pain-free with stable knees، a negative Lachman test and a good range of movement. Arthrometric results had improved significantly in both groups (p<. 001). Despite slightly less tunnel widening in the PRP group، there was no significant difference between the groups neither at the femoral opening or the mid-tunnel nor at the tibial opening or mid-tunnel (p≥. 05). We conclude that PRP has no significant effect in preventing tunnel widening after ACL reconstruction.

The standard method for repair of an injured peripheal nerve is epineural repair with separate sutures. In this article، we described a method of continuous running epineural suturing in an animal model، and compared it with the standard interrupted technique. In a clinical trial study، the sciatic nerve of 25 dogs was cut by a sharp blade under general anesthesia. The dogs were randomly divided in 3 groups. The 10 dogs received simple interrupted suturing of the cut sciatic nerve (control group)، another 10 had continuous suturing technique، and the remaining 5 were left unrepaired. After 6 weeks the dogs were sacrificed and the nerves were studied by light and electron microscopy. The amount of consumed suture material، time of repair، myelin thickness and axon diameter were examined. Ultrastructural studies were performed to assess the degeneration and regeneration process. The time of suturing and the amount of consumed suture material were significantly lower in the continous group (p<. 001). No difference was found in regards to light microscopic findings. The regeneration was، however، confirmed by electron microscopy، only in the continuous group. The continuous epineural suture technique described in the present study had a result similar to the standard interrupted method and may replace the standard continuous technique in many circumstances.

Total knee arthroplasty (TKA) is one of the common surgical procedures in an orthopaedic ward. It is often associated with severe postoperative pain. Femoral nerve block is utilized to provide pain relief after some types of lower limb surgery، including TKA. The main purpose of the current study was to determine the effect of continuous femoral nerve block (CFNB) on post-operative pain after TKA. Forty patients requiring TKA were entered into a randomized clinical trial. Patients were randomly divided into 2 groups: A control group receiving intravenous patient controlled analgesia (IV-PCA) and the second group receiving CFNB. After operation، the severity of pain was determined utilizing visual-analogue scale (VAS) at 6، 12، 24، 48 and 72 hours، and any potential complication was recorded. Finally، the data were compared between the two groups. There was no significant difference between the 2 groups 6 and 12 hours operatively. The severity of pain was significantly lower in CFNB group at 24 (p=. 042)، 48 (p=. 03)، and 72 (p=. 035) hours respectively. No complication was seen regarding any of the analgesic techniques. CFNB is a safe، pain relief and effective method and could be used for pain management after TKA.

Infection is a disastrous complication in orthopaedic surgery، because of poor blood supply of long bones and usage of metal devices. The aim of this study was to evaluate the effect of adding topical gentamicin to the surgical wound after open reduction and internal fixation of a long bone fracture.

In a clinical trial، 120 patients who were candidates for open reduction and internal fixation of a long bone fracture in a training hospital in Bandar Abbass، Iran were divided into two equal groups (60 patients each). Routine prophylactic standard systemic antibiotic regimen was used in both groups. In the «case group»، gentamicin was used topically in operation site in addition to the systemic regimen. All the patients were followed at least for 6 months and observed for superficial and or deep infection signs and symptoms.

In the control group، 12 infections were observed، 7 of which were superficial and cleared with antibiotic and wound care. In the study group only 3 superficial and no deep infections was found. Statistical analysis revealed that both superficial and deep infection rates were significantly lower in the study group (p=. 01).

Prophylactic topical use of gentamicin in addition to the systemic regimen can be effective in reducing the rate of infection after open reduction and internal fixation of long bone fractures.

It has been suggested that double-level osteotomy can prevent the occurrence of joint line obliquity، as one of the complications following high tibial osteotomy. In this study، we compared the preoperative distal femoral and proximal tibial obliquity in patients with primary genu varum with a group of normal subjects.

75 patients with primary genu varum and 75 normal persons، contributed to a case-control study. The medial distal femoral mechanical angle (MDFMA)، medial proximal tibial mechanical angle (MPTMA) and joint diversion angle (JDA) were measured and compared between the two groups. The percentage of patients with >3 degrees in both distal of femur and proximal of tibia were determined.

The mean of MDFMA and MPTMA was significantly lower and the mean of JDA was significantly higher in genu varum group compared to normal group (p<. 05). In 25. 3% of patients with genu varum، the varus in both the distal femur and the proximal tibia was >3 degrees.

The alignment of distal femur and proximal tibia is significantly different in patients with primary genu varum and normal controls. Abnormal alignment of joint line is a common finding in both primary genu varum and normal people; but more commonly in the cases of genu varum. As double level osteotomy may be required in many patients with genu varum، it is important to investigate distal of femur alignment before high tibial osteotomy

True duplication of the patella is extremely rare. We describe a case of duplication of the patella in an eight-year-old boy with the history of progressive deformity of his left knee.