مجله جراحی استخوان و مفاصل ایران
سال هشتم شماره 2 (پیاپی 31، بهار 1389)

Calcaneal fracture is the most common tarsal bone fracture and is often associated with a high complication rate and disfunction. Open surgical treatment of calcaneal fracture is one of the most challenging orthopaedic procedures with somewhat vague functional outcome. In a retrospective study the clinical and radiographic results of 18 calcaneal fractures in 17 patients (13 males 4 females) with mean age of 31 years (21-53 years) that had undergone open reduction during a 4-year period (2002-2006) were evaluated with an average follow-up of 19 months (9-48 months). The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system was used to assess the treatment outcome Thirteen fractures were type II and 5 type III Sander's class.The preoperative average Bohler's angle of 7 degrees changed to 21.8 degrees in follow-up. The collective average AOFAS score was 89.05. This score was 93.3 for type II and 78 for type III Sander's fractures. Subtalar osteoarthritis was observed in 4 patients. Open reduction and internal fixation of intra-articular calcaneal fractures with achievement of good reduction of posterior articular facet can result in good or excellent outcome.

Posterior cruciate ligament (PCL) injury is reported in 3% to 23% of knee injuries. Ligament rupture usually requires reconstructive surgery. Avulsion injuries in acute cases however are often treated by fixation of avulsed bone and ligament. Fixation of avulsions in chronic cases is somewhat controversial. In a deh1ive study from 40 male patients with mean age of 27.87 years old who had undergone fixation of PCL avulsion with maleolar screw and washer through a posteromedial approach 20 cases with a mean of 40±16.02 weeks follow-up were studied. Twelve cases had received early fixation and 8 had fixation 8 weeks or longer after the injury. The cases were evaluated with clinical evaluation of stability as well as assessment of patients’ satisfaction and return to sports or regular activities. Improvement in “posterior drawer test” was observed in all the cases. The ones who had early surgery as well as the ones with isolated PCL injury had better results in comparison with late avulsion fixation or combined ligament injuries. Eight cases had no problem in knee function 7 cases had some limitation in sporting and 5 in some regular daily activities. Screw fixation of PCL avulsion through a posterio-medial approach even in delayed cases is safe easy and effective. Associated other knee injuries are detrimental for good results.

The alignment of lower limbs change with growth and accurate knowledge of such a change in any particular geography is necessary to differentiate the pathologic conditions from normal variations. We are reporting the normal variations in tibiofemoral alignment in young people in a region of Iran. A cross-sectional study on 853 children (455 girls 398 boys) of 3 to 16 years age was performed. Tibiofemoral angles and intermalleolar distances were measured in standing position. Normal limits of tibiofemoral angles and intermalleolar distances were separately determined based on age and sex. A valgus alignment was observed in all. The tibiofemoral angles in boys between ages 3 to 7 years were 7.1±0.35 and 4.97±0.36 between 8 to 16 years of age. The tibiofemoral angle in girls aged 3 to 7 years were 7.1± 0.38 and in girls of 8 to 16 years were 4.95±0.37 degrees. There was no significant difference between the tibiofemoral angle in girls and boys. The intermalleolar distance in boys of 3 to 7 years old was 2.7±0.9 and in boys of 8 to 16 years were 1.4±0.86 centimeters. The intermalleolar distance was 2.6±0.88 centimeters in 3 to 7 year old girls and 2.29±0.93 centimeters in 8 to 16 year old girls. Pierson correlation coefficient showed a reverse relationship between tibiofemoral angle and intermalleolar distance. The tibiofemoral alignment in Iranian children is similar to that of Europe North America and Turkey but different from Chinese children.

The posterior of acetabular cup in total hip replacement can be affected by the central osteophytes in the acetabular fovea. We are proposing a classification of such osteophytes based on direct observation and CT scan of osteoarthritis hips. This study was composed of two sections: first 276 cases with all clinical and radiographic evidence of osteoarthritis of hip–with no history of fracture or pelvic bony surgery – were studied by radiographs and CT Scans. The changes in the acetabular osteophytes were evaluated and categorized. Secondly 57 cases of hip osteoarthirites who were undergoing hip arthroplasty received direct observation of the acetabular osteophytes and categorization of the acetabular fovea in accordance with the above classification system. The relation of primary etiology of hip osteoarthritis with the osteophyte classification was also studied. According to radiographs CT Scans and direct visualization four types of acetabular osteophytes were identified. Type I: Normal acetabular with 5mm distance from rim to the floor; type IIa: Evidence of sclerosis around fovea; type IIb: Sclerosis forming a ceiling like an umbrella over the fovea; type IIc: The foveal osteophytes are almost touching in the center; type III: Osteophytes have fully covered the fovea making the acetubular look very shallow. Study and categorization of acetabular osteophytes with radiographs and CT scan would be a helpful pre-operative tool for more accurate reaming of the acetabular cavity and cup positioning in hip osteoarthrties.

Unstable pelvic fractures are major orthopaedic injuries with high rates of morbidity and mortality. Open surgical stabilization is the standard treatment for a great number of them. Percutaneous surgical fixation has become an accepted treatment method in last several years. We would like to report our experience with this relatively newer technique in a small mixed group of unstable pelvic ring fractures. This is a report of 16 cases (13 males 3 females) with mean age of 31±8 years of pelvic and acetabular fractures who received percutaneous iliosacral or iliopubic screw fixation under C-arm imaging control and had a 6 months period of clinical and radiographic follow-up. All 16 cases had healed their fractures at follow-up and had full weight-bearing status. 12 cases returned to their pre-fracture activities. One screw break and one wound infection were the complications list. There was no neurological deficit and average blood loss was 10 milliliters. Percutaneous iliosacral or iliopubic screw fixation for respectively posterior pelvic ring or anterior column acetabular injuries are useful surgical treatment options with low complication rates.

Acetabular fracture is usually due to severe trauma and it is often accompanied with other comorbidities. Most often the treatment of choice is open reduction and internal fixation. There are early and late complications of surgical treatment. In this study we tried to investigate early complications including nerve injury infection heterotopic ossification and thromboembolism among our patients. In this prospective deh1ive epidemiologic study 46 patients (39 men 7 women) with the mean age of 34.3 years old (range of 17–71 years) who had undergone open reduction and internal fixation of acetabular fracture in a 3 year period in two teaching hospitals in Ahwaz were studied for their early complications. The follow ups had a range of 3 to 35 months (mean: 11 months). From 46 patients 34 had type A and 12 type B acetabular fractures (based on AO classification). There were 5 cases (10.9%) of iatrogenic peroneal nerve injury 6 (13%) infection and 12 (26.1%) heterotopic ossification. There was no case of thromboembolism. Acetabular fracture fixation is generally associated with high complication rate. Our cases had unexpectedly more complications in comparsion to similar reports.

Ipsilateral postetior dislocation of radial head with radial shaft fractur is an uncommon injury in adults. We present an unusual case of 20 year old man with such a lesion. Our management was operative treatment with open reduction and plate internal fixation. The patient had limited motion in forearm and elbow

Colorectal carcinoma metastases are mostly seen in liver. Almost half of the patients with colorectal cancer have liver metastasis or develop liver metastasis during the disease. Any metastasis outside the liver is rarely seen and if present it is usually seen in lungs brain skin and skeletal system with the same probability. Skeletal metastases mostly involve weight bearing bones. Meanwhile skeletal involvement rarely occurs in clavicle. In this paper we report a case of colorectal cancer metastasis to medial head of clavicle.

Acetabular dysplasia is common in our country. The experience with periacetabular “Ganz” osteotomy is relatively low. We would like to report our short-term experience in a small group of patients who received such a surgery. In a deh1ive study 9 patients with dysplastic acetabulae who had undergone “Ganz” pelvic osteotomy were evaluated for their clinical and radiographic results. The pre-operative “acetabular roof obliquity” and “center-edge angle” measurements were compared with the post-operative values. With an average follow-up of 18 months (4 to 48 months) the cases were also evaluated for any possible side-effects of the surgery. The pre-operative “acetabular roof obliquity” of 20.8 (13-30) degrees dropped to 9.2 (3-19) degrees -a 55% decrease. The pre-operative “center-edge angle” of 15.1 (9-20) degrees changed to 29.9 (25-42) degrees-a 98% increase. No untoward effects were observed in these 9 patients. “Ganz” periacetabular osteotomy is an effective procedure in improving the radiographic parameters of “acetabular roof obliquity” and “center-edge angle”. In order to report the clinical outcomes larger number of cases and longer follow-ups are necessary.