مجله جراحی استخوان و مفاصل ایران
سال دوازدهم شماره 3 (پیاپی 48، تابستان 1393)

Conventional X-rays، due to 2D viewing، may not have accuracy in assessing lower limb deformities. The aim of this study was to analyze the deformities in 3D and simulated the corrective surgery in virtual space; and to built patient-specific guide to achieve the precise correction. In this descriptive study، 10 lower limbs with various deformities around the knee were studied. Weight bearing alignment x-rays and CT scans were processed digitally to produce 3D weight bearing models. The landmarks were determined and lower limb indices were calculated to determine the deformities in 3 dimensions Under surgeon''s supervision، virtual correction of the deformity was performed، based on which، a patient-specific guide was designed and printed in 3D. The guide was then used in the surgery. The deformity and deviation from standard angles was obsereved in frontal plane in 6 cases، frontal and sagittal planes in one، frontal and axial planes in two، and a three planar deformity in one cases. The results showed that this method is effective in achieving the precise correction of the deformity. In all the patients who underwent surgery، the correction was the same or very close to what had been planned in frontal and sagittal planes (±1). Clinical assessment was used for rotational correction in the absence of postoperative CT-scan. The computer-assisted pre-op planning and patient-specific guide usage can highly optimize the results of corrective osteotomies، especially in difficult deformities around the knee.

The aim of the present study was to compare two methods of plating and intramedullary nailing in treatmant of closed noncomminuted tibia fractures with intact fibulae. Utimately 69 patients were followed for at least one year. The patients were randomly devided into two groups of plating and intramedullary nailing and operated on. One case of nonunion and one case of superficial infection occurred in the intramedullary group. One of the patients in the intramedullary group developed late deep infection in the screws location (in both cases p>.05). In both of the groups the tibia fractures reached union in about 4 months, though the intramedulary group had underwent more operations for union achievement (dynamization in 4, 12.1%, p≥.05). The need for implant removal was not statistically significant in the two groups (p≥.05). Of the other variables, the diffence between the two groups was statistically significant only with regard to their complaints of the limb and the number of individuals with knee pain (p<.001). It seems that both methods are suitable for closed noncomminuted isolated tibia fractures, but the patients with intramedullary nails, probably will need more operations to achieve union and probably will have more complaint of limb pain.

Electroporation of cells for cancer ablation has gained popularity. The aim of this study was to evaluate the effect of electroporation in nerve injury and neuroma formation. In an experimental study, the sciatic nerves cut in 38 rats and the repair was studied by dividing them in 3 groups; each group receiving a different treatment. Sixteen rats received electroporation, 16 received end-to-end repair, and 6 “control” rats received no electroporation. The repair and possible formation of neuroma was evaluated by light-microscopy and the function of the nerve was assessed with sciatic functional index (SFI). Complete nerve injury was demonstrated by SFI in the 3 groups, in the first-week evaluation. After 2 weeks, significant recovery of function was seen in the electroporation group; and in 4 weeks it was similar to control group. This group reached normal SFI in 5 weeks. The cut and repaired group never reached a normal SFI. The electroporation in the sciatic nerve of rat produces complete functional improvement after nerve injury and possibly could be useful for treating symptomatic neuromas.

Rotator cuff tear is one of the major causes of shoulder pain and disability especially in over 60 year old age people. The problems with arthroscopic repair and also failure to repair with strong and valuable sutures in massive tears have increased the trend towards open surgery. This study was done to assess repair of rotator cuff tear by open surgery. In this cross-sectional study, 14 candidates (8 female, 6 male) for rotator cuff surgery, were assessed for shoulder function by the use of ASES and SST scoring systems, before and after surgery, by the same observing orthopaedic surgeon. Mean age of patients was 57.94±14.04 years old. The mean SST score before surgery and 6 and 9 months after surgery were 10.17, 10.67 and 10.81, respetively; with a significant post-operative improvement (p=.026). The mean ASES score before surgery, 6 and 9 months post surgery were 42.82, 47.95 and 57.43, respectively; showing significant improvement after surgery (p=.025). The open surgical repair of rotator cuff tear is effective and shoulder function improves and pain decreases significantly. This is with the technique of constructing a surface, rather than making a trough, and also using of interoseous suture rather than anchor suture.

Wear and failure in inter-vertebral discs and facet joints with certain radiographical properties are called “cervical spondilosis”. The aim of this study was to evaluate the surgical results of neck spondiloarthrophaty. A cross-sectional study was done on 75 patients (40 male, 35 female) with neck spondiloarthropathy referring to two hospitals in Ardebil-Iran from 2008 to 2012. The mean age of patients was 52.3±14.4 years old. A part of data was extracted from patient’s files and another part was gathered by telephone call. The data was analyzed by statistical methods. Improvement of neurological symptoms and patient satisfaction were measured with “Visual analogue scale” (VAS) and Odom scale. The majority received anterior surgery and “cage” implantation (89.3%) and 8 (10.7%) of patients received posterior release and fusion. 43% of patients were highly satisfied. Maximum involvement level in 33 cases (44%) was C5- C6 level. High level of satisfaction and improvement in early stage is possible in cervical spondyloarthropathy surgery.

Alkaptonuria is a rare metabolic disorder. Symptoms include discoloration of tissues and degenerative joint disease and urinary stones. A 60-year-old man was admitted due to knee and hip pain. Brown lesions on the eye, ear, hand and fingers were visible. Limitation of motion of the hip and knee and elbow was present on both sides. He had history of kidney stones ad Achilles tendon rupture. During hip arthroplasty, black lesions on the greater trochanter and femoral head were visible.