مجله جراحی استخوان و مفاصل ایران
سال دوازدهم شماره 4 (پیاپی 49، پاییز 1393)

Nano could promote strong biological bonding between implants. In this study the effect of cancellous bone scaffold coated with/without Nano-hydroxyapatite in vivo using an animal model of bone healing was studied. In an experimental study، 18 adult male New Zealand white rabbits were used dividing into three groups of six rabbits each. A segmental bone defect of 10 mm in length was created in the middle of the right radial shaft under general effective anesthesia in all rabbits. The defects in group I were left as such without filler، in group II the defect were filled up with harvested 10 mm rib bone and in group III the defect were packed with rib bone covered with nano-hydroxyapatite. The operated radiuses were removed on the 60th day and were pathologically and biomechanically evaluated. The radiographs showed a trace of internal callus filled the gap in 60 days in group I، whereas in group II and III internal callus almost was formed on 30 days. Repair defect in group I and II with group III; and load bearing of group II، III compared with group I showed no significant difference (p<. 05). In pathological evaluation، active endochondral ossification and secondary fracture repair took place in the middle of the defects in group II، III. In this study، significant difference was observed between cancellous bone scaffold coated with/without nano-hydroxyapatite and healing process of these two materials were significantly better than the control group at 12 weeks post injury.

Thromboembolic disease (TED) after knee arthroplasty occurs infrequently in Iran. The aim of this study was to examine the incidence of TED in patients with osteoarthritis undergoing knee replacement in Southern Iran while on prophylaxis. In a prospective case series study from January to December 2012، 100 consecutive total knee arthroplasty (TKA) candidates were evaluated for TED by clinical evaluation and doppler sonography preoperatively and 2 months postoperatively and by clinical evaluation one year after surgery. The patients in this study randomly received either warfarin or enoxaparin prophylactically. A total of 77 women and 23 men with mean age of 67 years (52-82 years) entered the study. The average hemoglobin drop of 2. 7 g with warfarin and 3. 3 with enoxaparin was observed. No case of TED، pulmonary embolus (PE)، major bleeding، post-thrombotic syndrome، or hemarthrosis was observed. No clinically significant DVT was found using either enoxaparin or warfarin prophylaxis after TKA in Southern Iran. Relatively excessive postoperative bleeding was observed، particularly with enoxaparin.

Forefoot fractures are the most common orthopaedic injuries. In this study the outcomes of nonoperative treatment of forefoot fractures using off-loading shoes was studied and compared with those of casting. In this case-control study، 60 patients with forefoot fractures in two hospitals in Tehran، Iran، who were not surgical candidates، were divided into two treatment groups: casting and off-loading shoe. The rate of bone healing was investigated. Also، patients'' satisfaction and the pain severity were measured before and after treatment. The AFAOS (American Orthopaedic Foot and Ankle Society) was completed. The treatment results were compared between the two groups. The patients were followed for 36. 5±4. 2 days in group C and 33. 3±4. 7 days in OS group (p≥. 05). Clinical and radiolographic success were achieved in all of the cases and all the patients returned to their previous activities. At final visit، the pain intensity was as follows: 5. 4±1. 4 in group C versus 5. 9±1. 1 in group OS (p≥. 05). The AOFAS was 92. 3±14. 7 points in group C and 94. 5±12. 3 in group OS Two patients developed skin problems and another one developed symptoms of deep venous thrombosis، all in group C. Off-loading shoes are suitable tools to treat forefoot fractures. Although no significant difference was found between the two groups، but due to satisfactory outcome and lack of complication، off-loading shoes are recommended in non-operative treatment of forfoot fractures.

Hip fracture is very common orthopaedic fracture in elderly. The present study investigates the outcome after surgical treatment. The hip fractures of over 65-year old patients that had undergone surgery in a 5-year period were retrospectively studied in a hospital in Semnan، Iran. The information of 259 patients (120 male، 139 women) were collected including demographic data، medical history، history of surgery (type of anesthesia، technique of surgery)، length of hospitalization before and after surgery، and death in hospital. From all the operated cases، 174 (67. 2%) received spinal، 68% (26. 3)، epidural and 17% (6. 6) general anesthesia. 185 pateints (71. 4%) had no complication and 74% (28. 6) had at least one complication. 12 patients (6. 4) died while in hospital. 56 cases (21. 6%) were walking with no problem; 32 (12. 4%) required walking and 9 patients (3. 5%) were not able to walk. Complications after surgery for hip fracture are relatively high. To recover faster and reduce more serious complications، it is recommended to change the strategies on how to care for the elderly during and after surgery.

Knee osteoarthritis is a common joint disorder in the older age patients. This study was performed to compare the efficacy of injection of methyl-prednisolone versus sodium-hyaluronate in symptomatic mild to moderate knee osteoarthritis. In a randomized clinical trial، 53 patients with knee osteoarthritis were assigned to receive either methyl-prednisolone (26 patients) or sodium-hyaluronate (27 patients) in a hospital in Tehran، Iran. Sodium-hyaluronate three injections within 2-weeks interval and a single injection of 40 mg of methyl-prednisolone were given. The improvement rate was compared after one and six months. The total score significantly improved in both groups (p=. 001). There was no significant difference between the two groups after the first month (p≥. 05); but the results were better after six months in sodium-hyaluronate injection group (p=. 001). Intra-articular injection of sodium-hyaluronate in comparison with methyl-prednisolone has longer efficacy in treatment of symptoms of mild to moderate knee osteoarthritis.

A 19 year old malesustained femoral shaft fracture in misedsection o previous Ender''s nailing following a low-energy trauma. Ten years prior to that، he had suffered a femoral shaft fracture treated with two Ender nails. The patient trauma. Ten years prior to that، he had suffered a femoral shaft fracture treated with two Ender nails. The patient