مجله جراحی استخوان و مفاصل ایران
سال هشتم شماره 3 (پیاپی 32، تابستان 1389)

ackground: Tibial plateau fracture is an intraarticular injury that can affect the stability of the knee joint and lead to patient disability. The aim of this study was to determine the functional outcome of surgically treated tibial plateau fractures. In a prospective study 70 patients (46 males 24 females) with average age of 38 years (23-54 years) with closed tibial plateau fractures who treated by open reduction and plate fixation was studied in two hospitals in Iran with a one year follow-up. The functional outcome was evaluated by "Hospital for Specific Surgery (HSS)" and SF-36 scores. The average time to union was 13 weeks with a mean range of motion of 125 degrees one year after injury. Functional results showed a mean HSS score of 80 points (Range: 19-100). Schatzker type I II II IV fractures showed statistically significant better results compared with Shatzker type V & VI fractures. With regard to SF-36 score 1 year after injury of eight SF-36 subscales the results were low in 6 subscales. The majority of patients were able to perform most of the pre-injury daily activities after 1 year. The most important independent factors influencing functional results in this study were age of the patients and fracture type. Functional results after open reduction and internal fixation of tibial plateau fractures seem to be excellent according to HSS score however overall patient's subjective appraisal was not satisfactory.

Femoral neck nonunion could be a disaster in young and middle age patients. Conventional valgus osteotomy of femur is done without freshening of nonunion site. We would like to report our experience with valgus osteotomy of hip after freshening of the nonunion site. In a case-series study from all young and middle-aged patients with nonunion femoral neck fracture who were treated with freshninig of nonunion site and valgus ostetomy 22 patients (18 males 4 females) with mean age of 34 (20-47) entered the study. There were 10 broken implants in the heads with a one year follow-up. The cases were evaluated for union necrosis and also changes in Harris hip scores. Preoperative Harris hip score was 63 and postoperative score increased to 89. The neck shaft angle was reached about 150 degrees. In 2 cases necrosis developed and in 3 cases collapse of neck occurred with intrusion of implant into the joint and the implants were removed immediately. Mean time to union was 4.5 months. Freshening of nonunion site before valgus osteotomy in nonunion femoral fracture produces high union rate with low complications.

Treatment of femoral shaft fracture in children depends on age and condition of patient and may consist of spica casting traction followed by casting external fixator plate fixation and intramedullary nailing. Leg length discrepancy is a common complication after this fracture. Growth stimulation following this fracture has been known for years but precise cause remains unknown. This is a report on leg length discrepancy obsereved in a group of younger children who had been treated with casing and an older group who received plate fixation for their femoral shaft fractures. In a cross sectional study 233 children under 12 years with femoral shaft fracture who had been treated between years 1993 and 1997 in two hospitals in Ahvaz-Iran were studied. Patients were studied in two groups of surgery or plate fixation (125 patients) and non-surgery or casting (108 patients). With a mean follow of 49 months (22-82 months) clinical and radiographic evaluation of leg lengths was performed and possible factors responsible for discrepancy were assessed. The mean leg length discrepancy in plate fixation was 6.6 mm and with casting was 1.93 mm. Gender or side of fracture had no significant relationship with post treatment leg length discrepancy Leg length discrepancy is more likely to be observed in children's femoral fractures treated with plate fixation. The discrepancy however is not a significant amount.

Traumatic hand injuries can lead to major disabilities. Due to high number of young active people who can be affected with such disabilities finding the results of emergency tendon and nerve repairs would give us a guideline in managing such injuries. In a prospective study 91 patients (87 males 4 females) were randomly selected among the referrals to an orthopaedic emergency of a hospital in Mashhad Iran. The patients had a mean age of 26.6 years. Demographic information and details of the injuries were recorded before surgery and also in the post operative period with 18 months follow-up. The average size of the skin wounds was 4.4 centimeters and the majority had sharp edges. The most commonly injured tendons were flexor digitorom superficialis flexor carpi radialis extensor digitorom communis and extensor policis longus. The most common complication was joint stiffness which had a direct relation with inadequate physiotherapy. Ulnar nerve repair had a worse outcome compared with median nerve repair. None of the repaired nerves obtained full sensory and motor recovery. Repair of tendon and nerve injuries in emergency settings does not uniformly give good results. It is best not to attempt repair of nerve injury or more than three extensor flexor tendon injuries in emergency room.

Tendon transfer for radial nerve palsy is often a rewarding procedure. The aim of this study is to compare the results of three different kinds of transfers used for radial nerve paralysis. In a retrospective study 41 patients with irreversible radial nerve paralysis who had undergone tendon transfer over a of 5-year period (2005-2009) were studied. 18 patients had received flexor carpia ulnaris transfer 10 cases had flexor carpi radialis transfer and 13 had transfer of flexor digitorum superficialis. With a mean follow-up of 20 months the patients were evaluated for achieved range of motion return to previous job and their overall satisfaction. The DASH score was also calculated for each patient. There was no statistical difference between the 3 groups in terms of DASH score ability and time of returning back to job and their satisfaction with the procedure. The range of motion also did not show any difference. An overall satisfaction rate of 95 percent was observed with no major complication in any of the groups. The 3 different methods of tendon transfer studied in this paper give satisfactory results irrespective of the method used.

There are several techniques for treatment of humeral shaft fractures. The purpose of this study was to evaluate the outcomes of fixation of humeral shaft fracture with minimally invasive plate osteosynthesis. Ten patients (7 males 3 females) with traumatic humeral shaft fracture were included in this prospective study. The meas age of patients was 31.79.8 (16-51) years. According to OTA classiciation there were one case of A1 two cases of A2 three cases of A3 three cases of B2 and one case of C2 type. The mean distance measured from the fracture site to elbow joint was 7.7±3.11 (4.5-13) cm. Two patients had radial nerve contusion. All fractures were treated in a minimally invasive way. The function of elbow and shoulder were assessed by MEPS and UCLA scores. The mean time of follow-up was 9 months. The mean maximal final angulation was 7.73.2°. The final rotational alignment was within normal limits with no shortening in all cases. One patient needed second surgery and bone grafting because of delayed union. The mean UCLA score was 34.2±1.2 and the mean MCPS score was 97±6.3. There was no postoperative radial nerve injury. The 2 cases of radial nerve contusion recovered 4 and 4.5 months postoperatively. MIPO is a safe method in the treatment of humeral shaft fracture with a minimum lesion to soft tissue with a high union rate. It is suggested that minimally invasive plate osteosynthesis be considered in the treatment of humeral shaft fractures.

Congenital dislocation of the knee ranges from hyperextension of the knee to complete translation of the femur on the tibia. Treatment is usually started in very early infancy. In this report a 16-year-old girl presented with a grade III untreated congenital dislocation of the knee. She received surgical treatment at this late age and managed to stand upright and walk.