مجله جراحی استخوان و مفاصل ایران
سال هفتم شماره 2 (پیاپی 27، بهار 1388)

Shoulder deformity and contracture is a common finding after brachial plexus birth palsy even in those who have had good recovery of nerve function or have had micro surgical nerve repair at infancy. We would like to report our results with the reconstructive shoulder surgery in a group of older children. Shoulder contracture from brachial plexus birth palsy was surgically released in 24 older children with simultaneous transfer of the latissimus dorsi and teres major tendons to the posterolateral humerus or rotator cuff. The mean age at surgery was 8 years 11 months. The children were evaluated at a mean follow-up time of 6 years 8 months by the Modified American Shoulder and Elbow Surgeons Form and Shoulder Pain and Disability Index standardized shoulder assessment forms a questionnaire assessing activities of daily living and parent and patient satisfaction scales. The fixed internal rotation deformity of 30º±12º improved to 72.5º±27º of external rotation. Improvements of 65º±26º and 47º±33º were seen in abduction and forward elevation respectively all without preoperative casting or manipulation. Increased external rotation had a more positive correlation with a higher functional score than abduction. Patients with lower preoperative functional scores had more rotational gain and higher functional scores after surgery. Those aged over 9 years had a functional gain similar to that of the younger children. Simultaneous release of contracted shoulder and transfer of latissimus dorsi and teres major tendons in brachial plexus birth paralysis is effective and rewarding even in older children who have had late referral and might have already developed glenoid dysplasia.

Ganglion cyst is one of the common causes of wrist mass presenting with weakness and pain in the wrist. Among the arrays of treatment options for this problem arthroscopic resection is probably the most recent treatment modality. We would like to review a short-term result of such a treatment in a small group of patients. In a case series study 13 patients (10 women 3 men) with dorsal wrist ganglion treated with arthroscopic resection in a two-year period were evaluated for post operative recurrence pain swelling or wrist motion limitation and grip strength. The mean age was 29.8 years old. The cases had an average of 12 months (7-19 months) follow-up. In the all cases no intra-or post operative complication was encountered. The wrist range of motion and grip strength showed improvement no scapholunate instability was seen. One recurrence after 6 months had occurred. Arthroscopic ganglionectomy is a swelling surgical alternative for dorsal wrist ganglion with less scar and comparative results to open surgery.

Article abstract: Postural round back is a common entity with unknown etiology. Reports on the results of brace treatment are scarce. The purpose of this study was to determine the effect of bracing in different stages of treatment and also the amount of preservation of kyphosis after stopping the brace. from 1991 through 2005 165 cases (39 male 126 female) who had a diagnosis of idiopathic postural kyphosis were treated with a Milwaukee brace. The mean age at the initiation of treatment was 13.06 years (8-16 years) at the completion of treatment was 15.06 years (11-17 years) and at the final follow-up was 17.9 years (12-25 years). The mean initial kyphosis was 59.26° (51°-74°). The patients were evaluated after an average follow-up of 34 months (6-102 months). The mean angle of kyphosis was 42° (28°-68°) at completion of treatment and 47.9° (28°-75°) at the final follow-up. Angle of kyphosis was 50° or less in 85.9% at the end of treatment and in 74.7% of patients at final follow-up. 5.9 degrees of original correction was lost in final follow-up. Two cases underwent surgery. Brace was effective in correction of kyphosis (p=0.001). Milwaukee brace is effective in treatment of postural kyphosis. Longer period of treatment even after maturity is needed in more stiff deformities.

Lower limb amputation is the most common type of amputation in veterans. The aim of the study was to assess the orthopaedic problems in war related bilateral lower limb amputees. In a cross-sectional study 335 out of 578 survivors with bilateral lower limb amputation were assessed by three orthopaedic surgeons. The mean age was 42.05±6.3 and 97.6% were male. The most common cause of amputation was land mine 89.7% (601 limbs). Both trans-tibia was the most common level of amputation 37.6% (126 people). The length of stump in about half of the survivors was short or tall. The most common orthopaedic problems were spasm of stump muscle 42.7% (281 limbs) which was followed by heterotypic ossification 11.55% (76 limbs) neuroma 10.2% (67 limbs) and inflammation 10.1% (67 limbs). About 10.9% of survivors needed stump revision. The study revealed that the prevalence of orthopaedic complications among the amputees was high. Regular and routine assessment rehabilitation programs and treatment is necessary for the bilateral lower limb amputees.

Anatomic attainment of anterior cruciate ligament (ACL) to the femoral notch is not quite easily visible due to the synovial covering. There is no information on femoral attachment of ACL in Iranian population. Our aim is to study the topography of this ligament in a group of fresh cadavers. Ten fresh cadavers that were all younger than 50 years of age and had no evidence of trauma to or surgery on their knees were chosen for the study. The knees were dissected and the presence or absence of double ACL strands was evaluated. The ligaments were then taken off the femur and insertion sites were carefully studied and documented by digital photography. The distances were measured using a ruler. In 90º flexion with distal traction onto the ACL the ligament was like a twisted interwoven cord. The twist would decrease by releasing the traction or decreasing the knee bent. Two separate bundles (antero-medial and postero-lateral) were identified in 7 cadavers. In the 3 remaining ones in gross inspection and without dissection one could not recognize two separate bundles in the ACL’s. The femoral attachment sites were curve triangle or oblong. In cross-sectional however they were oblong. Anterior cruciate ligament could have both variable femoral attachment sites and also different bundle patterns in different individuals.

Femur shaft fracture can occur with different mechanisms in all age groups. Patients often develop instability problems when fracture is close to knee which functions as intermediate joint. This has been attributed to dysfunction of proprioception receptors. In this research we tried to analyze the frequency and type of instability in patients following femur shaft fracture. This study was carried out on 15 patients with isolated femoral shaft fracture within the range of 20-45 years of age treated by plate fixation and 15 healthy individuals as the control group that were matched with the previous group by age height weight and sex. Both groups were asked to stand on a round plate called “Biodex” (which is able to tilt in different direction) randomly. The “stability index” and “stability range” were measured. Our results showed that postural “stability index” in control group was statistically better in nearly all erect body positions. In contrast the difference in stability range in the two groups was not statistically significant. The presence of statistically significant difference between the two groups in “stability index” and its absence in “stability range” among the two groups indicate that the major stability problem in patients with femoral shaft fracture is asymmetric weight bearing and consequently impairment in static stability. Also a healthy neuromuscular system is a convincing evidence for absence of statistically significant difference in “stability range index”.

In recent decades there has been a boom in medical publication all across the world. There are numerous medical journals whose articles tend to form the basis of the art and science of medicine. Along with this widespread upward trend ethics of conducting and publishing medical research have undergone natural evolution. This article intends to review some of the existing publication related to the standards of medical and scientific research and publishing articles in medical journals. Paying meticulous attention to these standards guarantees credibility and originality of medical articles and the publishing journals.

Epiphysealis dysplasia heminelica (Trevor’s syndrome) is a rare disease which is the result of abnormal development of cartilaginous external or internal segments of epiphysis. It is usually a single lesion. But with breakage of outgrowing cartilaginous masses it may present as several free pieces in the joint. The abnormal cartilaginous outgrowths would stop with termination of child’s growth. The articular surface incongruity however can lead to early osteoarthritis. We are reporting this case because of rarity of this pathology and also because of the presence of lesions on both sides of an ankle.

Four patients with the intra-articular bony avulsion of the deep finger flexor (FDP) were treated by open reduction and internal fixation with mini screw. They were examined for the tendon function and range of motion of the distal interphalangeal (DIP) joint. The follow-up period was from 6 months to 60 months. DIP joint surface was involved in all the cases. Although the FDP function was restored there was reduced range of motion in DIP joints in all the patients. Beside the restoration of FDP function the condition of the DIP joint surface is another important factor which influences the prognosis and the treatment of FDP avulsion injuries