مجله جراحی استخوان و مفاصل ایران
سال بیستم شماره 1 (پیاپی 76، زمستان 1400)

The anterior cruciate ligament (ACL) reconstruction is one of the most frequent surgeries on the adult knee. Auto grafts are essential for providing knee stability while minimizing donor site morbidity. The peroneus longus tendon may be an alternative auto graft for ACL reconstruction. This study aimed to evaluate the short-term clinical outcomes and donor site morbidity of ACL reconstruction using the peroneus longus tendon.

This cross-sectional study was conducted on patients with an ACL tear, who underwent arthroscopic reconstruction using the peroneal longus tendon. The knee functional outcomes were investigated based on the Lysholm and IKDC scores at preoperative and end of at least one year after the procedure. The follow-up period was at least one year, and the graft diameter was measured intra-operatively. In addition, the American Orthopaedic Foot and Ankle Score (AOFAS), the Foot & Ankle Disability Index (FADI), and ankle range of motion were applied to evaluate ankle donor site morbidities.

A total of 50 patients (47 men and three women) were followed up for at least one year with a mean age of 24.2 years (17 to 50 years old). The mean follow-up time was 19 months (12-24 months). The mean diameter of the peroneal longus auto graft was 8.22 ± 0.5 mm (7-9 mm). The AOFAS, FADI and ankle range of motion indicated no obvious ankle joint dysfunction.

According to the results, arthroscopic anterior cruciate ligament reconstruction with the peroneal longus tendon is be a safe and effective auto graft source.

Compression fractures of the spine are common complications of osteoporosis that lead to persistent pain, inability to perform daily activities, and a significant reduction in quality of life. Kyphoplasty and vertebroplasty are two semi-invasive treatments for this complication. Therefore, the purpose of this research was to evaluate and compare the treatment results obtained from the use of the two mentioned methods with non-surgical medical treatment in patients with compression fracture of the spine.

The cases of thoracic spine compression fracture referring to 2 teaching hospitals during a 2-years period (2015 to 2017) were retrospectively studied the results of 3 treatment methods of non-surgical, vertebroplasty and Kyphoplasty were compared by chart review and also direct questioning and examination at a minimum follow-up of one year. The evaluation of pain by VAS, and functional status Oswestry Disability Index (ODI) and SF-36 short form were completed.  

From total of 138 cases of compression thoracic spine fracture only 96 had the inclusion criteria and were entered into the study. 42 male and 54 female patients were evaluated. The patients had a minimum of 3 months and maximum of 1 year (Mean=7.5 months) follow-up. VAS score in non-surgical group was 6.75±1.32, in vertebroplasty was 3.58±1.94 and in Kyphoplasty was 2.67±1.64. The ODI scores were: 56.82±14.4, 28±15.40, and 25.64±13.52 for non-surgical, vertebroplasty and Kyphoplasty respectively. The SF-36 scores were almost similar in all 3 treatment methods.

The two methods of vertebroplasty and Kyphoplasty, in comparison with non-surgical treatment, had significantly reduced pain and better quality of life and ability of work. Therefore the two surgical treatments are preferred techniques for compression spine fractures.

Facilitating the fracture healing process is important to increase the fracture healing speed and to decrease the time period till union. This study aimed to evaluate the effects of blood clot and doxycycline on bone healing process.

Twenty mature male New Zealand white rabbits were used, in this study. A defect was created in the middle part of the radius. The rabbits were randomly distributed into 4 groups and the gaps were filled with the graft materials: blood clot, doxycycline, combination of blood clot and doxycycline and control group in which the defect was left empty. Radiographs of operated limbs were taken on 14th, 28th, 42nd and 56th postoperative days. Histologic samples were taken on the 56th day post surgery.

On radiographic evaluation significant difference between the groups was not observed (p>0.05). On histopathological evaluation, blood clot and doxycycline groups were superior to control group (P<0.05), also combination of blood clot and doxycycline group was superior to other ones (P<0.05). There was no evidence of graft rejection in any group.

This study demonstrated that the combination of blood clot and doxycycline has a better function in bone healing process than other groups.

Spinal cord surgery, particularly thoracolumbar surgery, is associated with deep vein thrombosis (DVT). Therefore, this study aimed to evaluate the incidence rate of deep vein thrombosis after thoracolumbar surgery using Doppler sonography.

This prospective cohort study was conducted on 51 patients with spinal cord and thoracolumbar surgeries from January 2021 to October 2021. All the patients were evaluated for DVT by Doppler sonography one day before and one month after surgery. The elastic stockings were worn by all the cases, and low molecular weight Heparin (LMWH) was started after surgery and continued for two weeks.

According to preoperative results, no evidence of DVT was present. Based on Doppler sonography results, the incidence rate of DVT was 3.92% one month after surgery. Clinical thrombosis was not detected in any of the patients.

According to the results, the DVT incidence rate was 3.9% in patients with Thoracolumbar Surgery. Prophylaxis needs to be seriously considered because DVT is a life-threatening issue.

There are advantages and disadvantages for bilateral simultaneous carpal tunnel release (CTR) surgery and also lack of clinical guidelines about this type of surgery. This study aimed to compare the activity level and level of satisfaction post surgery among people who have undergone unilateral and bilateral simultaneous release surgery.

This longitudinal descriptive study was conducted on 60 patients with bilateral CTS, who were candidates for surgery based on the inclusion and exclusion criteria of the relevant statistical population. A total of 30 patients who wanted to perform bilateral simultaneous CTR surgeries and 30 patients who wanted to perform unilateral CTR surgery were operated by an orthopaedic specialist. The ADL-IADL questionnaire was completed before the surgery, three and 14 days after the surgery.

The ADL-IADL questionnaire showed no significant difference between the two groups in the dependency score of the samples before surgery, three and 14 days after surgery. In the checklist used to evaluate the satisfaction of the results of the surgery in daily life tasks, 95% of patients expressed high or moderate satisfaction with their surgery, while only 5% expressed neither satisfaction nor dissatisfaction.

According to the results, the ability to perform daily life tasks, especially in observing personal hygiene in patients, who underwent bilateral simultaneous surgery three days after the surgery, did not significantly differ from those who underwent unilateral surgery. Most of the patients who underwent bilateral surgery were satisfied with this type of surgery. Finally, in this study, bilateral simultaneous CTR was suggested for people with bilateral CTS.

Porous titanium structures have recently gained considerable popularity among researchers in studies examining bone ingrowth and osseointegration. Porous implants fabricated using triply periodic minimal surface design (TPMS) and designed through 3D printing techniques exhibited remarkable mechanical strength and cell viability compared to conventional implants. This study aimed to evaluate the effect of pore size of titanium implants with gyroid structure.

This study was conducted on Adult male Wistar rats weighing 350 and 450 g for the animal study by the calvarial defect model to investigate bone regeneration. Three disk-shaped implants were designed using a gyroid structure with pore sizes of 400, 500, and 600 micrometers. All implants were made by additive manufacturing (Selective Laser Melting) using Ti6Al4V medical-grade powder. Animals were sacrificed after 12 weeks, the skin was removed from the calvaria, and the implants were removed for histological examination.

Gyroid structures had a high surface-to-volume ratio and pore connectivity, facilitating cell adhesion and ossification. A significant amount of bone ingrowth was observed in the 400 mm group, so that bone penetrated into pores significantly more than in the other groups. However, the vascularization was more pronounced in the 600 μm group than in the other groups.

According to the results, there was a positive effect of porosity in titanium implants in encouraging bone ingrowth. The porosity size of 400 μm was more suitable for the differentiation and proliferation of bone cells and thus the osseointegration in porous titanium implants with gyroid structure.

To find causes and number of elbow joint dislocation in Kunduz regional hospital- Afghanistan in 2021. The aim is to understand what the causes are and try to reduce the incidence by informing the people and discuss with the government.

We conducted a prospective case series study to figure out causes and number of elbow joint dislocations in Kunduz Regional Hospital- Afghanistan from the beginning up to the end of 2021. This study included 23 patients; the age was above 5 years old. The data were entered in spreadsheet and analyzed in SPSS program.    

Among 23 patients, 18 (78%) were male, 5 (22%) were female. Fourteen cases were 10-30 years of age; 15 (66%) were residents of Kunduz province. In 10 (43%) fall from height, 6 (26%) road traffic accident, 5 (22%) sports injuries, and in 2 (9%) family assault were the causes of elbow joint dislocation.In 19 (84%) cases posterior dislocation, in 1 (4%) anterior dislocation, in 1 (4%) lateral dislocation, in 1 (4%) open posterior dislocation with fracture and in 1 (4%) complex closed posterior dislocation; were the types of dislocations. Elbow dislocation was more on right side (61%). 21 (92%) of elbow dislocations were treated non-operatively, and 2 (8%) operatively. In 21 (92%) there was no complication, in 1 (4%) myositis ossificans and in 1 (4%) non-reduced dislocation treated by traditional bone setter were observed.

The most common causes of elbow dislocation were fall from height and road traffic accident. Postero-lateral was the most commonly seen type of dislocation.

Total Hip prosthesis replacement is one of successful invasive procedures in medical history. Hip joint replacement started by Sir John charnley by using of low friction artificial joint on 1960s. Subsequently bearing material, fixation methods and new designs were defined and modified. The main concerns about THA are biological response due to particles produced by bearing surfaces that lead to Osteolysis and prosthesis loosening. Modern THA biomaterials were developed to remedy this problem.

A journal research strategy was performed using different terms. The highest quality technical articles and reports were selected that included the best and newest related contents. Key search words were hip, biomaterial, wear, titanium, zirconia, alumina, UHMWPE and CO-Cr. Finally 69 sources were chosen and used in this review.

Recent advances in hip prostheses have focused on mechanical strength, biocompatibility, bioactivity, increasing wear resistance and reliability using new technologies, as well as structure modification and nanotechnology hybridization. A hybrid design in nano-ceramics has increased resistance up to four times that of alumina, allowing for a smaller femoral head. The prosthesis stability, longer life, and reliability are needed due to the increase in young patients who need hip arthroplasty with higher activity levels, which can be achieved with scientific methods and newly improved materials.

This study introduces the biomaterials used in hip joint prostheses and discussed them from different aspects. In addition, more advanced biomaterials for THA have also been investigated to further reduce wear and increase the life of the prosthesis in the future.