فهرست مطالب

Shafa Orthopedic Journal - Volume:4 Issue:3, 2017
  • Volume:4 Issue:3, 2017
  • تاریخ انتشار: 1396/07/15
  • تعداد عناوین: 6
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  • Farshid Bagheri, Mohamad Gharehdaghi, Azra Izanloo, Hassan Rahimi, Masoud Mirkazemi * Page 1
    Background
    Genovarum is the most common knee deformity for which a variety of surgical techniques have been proposed.
    Objectives
    We decided to share our experiences through a detailed presentation of a new and simple method called proximal tibia osteotomy using M-W method.
    Methods
    In this study, 68 patients (128 knees) with proximal tibia osteotomy with an average age of 34 years, who had undergone W-M osteotomy surgery in a community hospital during 2001 and 2014, were studied using knee society score (KSS) and functional KSS questionnaires, and their clinical results were analyzed.
    Results
    No significant difference was obtained between patients undergoing surgery by this method in KSS before (78.8) and after (89.6) the surgery. Although the mean score was improved, functional KSS improved significantly after surgery. None of the patients had peroneal nerve complication, infection, osteomyelitis, or postoperative nonunion. Moreover, no recurrence was detected in a mean of 2.7 years follow-up.
    Conclusions
    Considering the advantages of this method, it is recommended that knee varus deformity be treated using this method, as its rate of complications is low. However, further studies should be conducted on the effectiveness of this method in the future.
    Keywords: Knee, Osteotomy, Tibia, Varus Deformity
  • Davod Jafari, Hooman Shariatzadeh, Bahman Hosseini * Page 2
    Background
    The Kienböck's disease (KD), even today, has many obscurities. Its etiologies as well as classifications are under constant change and debate, therefore we decided to define the effect of proximal lunate morphology on KD and its usefulness in evaluating the course of the disease.
    Objectives
    The purpose of this study is to compare the 3 different morphologies of the proximal lunate as defined by Antuna-Zapico (A-Z) in KD patients with a control group of normal individuals, and also compare the morphologies in different aspects like ulnar variance (UV), radial inclination and radial volar tilt, lunate sizes in radiological views, males and females, symptom duration before seeking medical treatment, lunate fragmentation, and also Lichtman’s stages of the disease.
    Methods
    Unaffected wrist X-rays of 107 KD patients (71 male 36 female), 17 - 53 years old, since 2011 to 2016, compared with 100 age and sex matched normal individuals divided in 3 lunate morphologies “as Antuna-Zapico has proposed”; noticing also the wrist indexes and the disease stages according to Lichtman’s classification.
    Results
    The prevalence of 3 different A-Z classification morphologies were; 18 (16.8%) Type1, 77 (72%) Type 2, and 12 (11.2%) Type 3 in the case group that wasn’t statistically different from the control group, with 15 (15%) Type 1, 73 (73%) Type 2, and 12 (12%) Type 3 (P = 0.9), even separately as male (P = 0.4) and females (P = 0.5). Case and controls were different in ulnar variance UV, (P = 0.001), however, different morphologies had a different UV inside the case group (P = 0.4). All 3 morphologies were seen in all different Lichtman’s stages with no correlation to the specific stage or morphology (P = 0.2). In the case group, no correlation was found between different morphologies and lunate width (P = 0.5), diameter (P = 0.4), radial tilt (P = 0.8), volar tilt (P = 0.8).
    Conclusions
    Proximal lunate morphology, as depicted by A-Z, has no effect on the course of the disease and doesn’t play any key role in the etiology. Its prevalence is the same as the general population.
    Keywords: Lunate Morphology, Lunate Shape, Kienb?ck's Disease, Antuna, Zapico Classification, Lichtman's Stages
  • Avadhoot P. Kantak * Page 3
    Background
    Extramedullary alignment is a well established surgical technique during total knee replacement. There are different methods to achieve accuracy but variability is quite extensive. To attain uniformity in the surgical technique we have been using the tibialis tendon to align our resection guide. This may prove to be a useful aid for surgeons during knee replacement surgery.
    Objectives
    The purpose of our study was to establish if tibialis anterior tendon represents the centre of ankle joint and if it could be used as an anatomical reference for alignment during knee replacement.
    Methods
    We designed a retrospective radiological cohort study. We studied sixty MRI scans of normal ankles. The centre of ankle joint was marked as a bisection point of the intermalleolar line at the level of superior surface of the talus. A line was drawn connecting the centre of Achilles tendon to the ankle centre and this was extended anteriorly. This line was found to have a constant relation to the ankle centre and it would simulate the positioning of the standard alignment device used.
    Results
    The tibialis anterior tendon lies less than 3mm medial to the ankle centre in the frontal plane.
    Conclusions
    We conclude that the tibialis anterior tendon can be used during knee replacement surgery as an accurate alignment guide.
    Keywords: Total Knee Replacement, Tibialis Anterior Tendon, Coronal Alignment
  • Mohamed Ali Sbai *, Haythem Rejeb, Mayssa El Mchirgui, Wafa Gharbi, Chtai Mohamed Sadok, Souissi Mohamed, Jerbi Slim, Adel Khorbi, Riadh Maalla Page 4
    Introduction
    Dorsal dislocation of a proximal or distal interphalangeal joint is a common clinical problem. However, simultaneous dislocation of both joints in the same digit is rare.
    Case Presentation
    A 32-year-old male injured his left hand third finger while biking. Examination revealed a stepladder deformity. Neurovascular examination was normal. Radiographs revealed dorsal dislocation of both the proximal and distal interphalangeal joints. The finger was reduced easily by longitudinal manual traction under the digital block. The finger was splinted in the intrinsic plus position for 3 weeks accompanied with active range of motion. After 6 months, the patient returned to normal sporting activity without limitation of motion.
    Conclusions
    In case of simultaneous dorsal dislocation of a proximal and distal interphalangeal joint, closed reduction is the treatment of choice and it could result in good and normal range of motion.
    Keywords: Proximal Interphalangeal Joint, Distal Interphalangeal Joint, Dislocation
  • Mahmoud Jabalameli, Abolfazl Bagherifard, Hosseinali Hadi, Salman Ghaffari * Page 5
    Introduction
    Osteoarticular allograft, for reconstruction of large bone loss, was introduced for bone loss after tumor resection and subsequently has been used for posttraumatic cases. A main advantage of unicondylar osteoarticular allograft reconstruction is the bone stock preservation, after tumor resection, or traumatic bone loss, providing an opportunity for easier salvage procedures with conventional total knee prosthesis in cases that are complicated by joint pain as well as arthritis.
    Case Presentation
    A 50-year-old female with post-traumatic medial femoral condyle non-union and bone loss after multiple operations was treated by unicondylar fresh osteochondral allograft reconstruction. Three years later, due to severe pain, progressive varus deformity with varus thrust, as well as osteoarthritis, a total knee arthroplasty with conventional PS prosthesis was performed. A long term follow up reveals a stable prosthesis and acceptable functional outcomes.
    Conclusions
    Unicondylar osteoarticular allograft reconstruction can be recommended for post-traumatic massive femoral condylar defect. It has relatively good clinical and radiographic results, low rate of complications, and preserves bone stock for future total knee arthroplasty.
    Keywords: Bone loss, Total Knee Arthroplasty, Unicondylar Osteoarticular Allograft