مجله جراحی استخوان و مفاصل ایران
سال نهم شماره 3 (پیاپی 36، تابستان 1390)

Optimal nutrition plays a role in formation and maintenance of bone. Besides major components of mineralization such as Ca P and Vitamin D other nutrients like Boron and Fluoride have also beneficial role. In this study we are reporting the effect of these elements on metabolic hormones and biomechanical parameters of bone in rat. 34 male wistar rats were divided into five groups: Control diet Fluoride Fluoride+Boron Fluoride+ Ca+D and Fluoride+B+Ca+D. Boron equal to 1.23 mg Ca and Vit D 210 mg-55 IU and F 0.7 mg/rat/day was added to their drinking water for 8 weeks. The serum level of the above elements was analyzed. The change in mechanical properties of femur and fifth vertebral body were also tested. The addition of F+B intake revealed significant effects on bone mechanical changes properties and bone metabolic hormones. These findings suggested that combined intake of the above two elements had beneficial effect on bone stinffness and breaking strenght compared with Ca+Vit D supplementation. Dealing with health problems related to the skeletal system in humans this paper justifies further investigation into the role of Boron and Fluoride in bone mass and strength.

High tibia osteotomy remains an acceptable method for prevention of medial comportment knee osteoarthritis. The conventional technique is a closing wedge osteotomy. We planned to study short-term results of a medial open wedge high tibia osteotomy using T-Buttress plate and a metal wedge. In this case series study 60 patients (76 knees 27 male and 33 female) underwent an open wedge high tibia osteotomy surgery using a T-Buttress plate and a metal wedge in a in a teaching hospital in Kerman-Iran. Patients were assessed clinically and radiographically including Modified Hospital for Special Surgery Knee Scoring System (HSSKS) anatomical and mechanical limb alignment Insall-Salvati patellar height index and proximal tibia posterior slope angle. The mean tibia-femoral angle changed from -6.8 to +4.33 degrees. 26(43.3%) patients needed iliac cancellous graft. The mean metal wedge size was 11.07 mm (8-15 mm). The mean Modified HSSKS promoted from 75.5 to 98.73. The observed complications were: fracture in five intraarticular screw penetration in four (one in proximal tibia-fibular joint) infection in two and under-correction in one patient. There was no non-union proneal nerve injury over-correction plate failure deep vein thrombosis and bone graft donor site complication. The mean posterior tibia slope changed from 8.05±1.95 to 8.68±1.54 degrees and patellar height index changed from 1.06 to. 97. This procedure is a safe and reliable technique and lessened the need for an autograft. Significant improvement in score of Modified HSSKS was seen post operatively.

The final diagnosis of the tumors depends on the biopsy and the pathology result. The musculoskeletal tumor biopsy can be performed either by core needle biopsy or by open biopsy technique. The procedural cost is lower and the technique is simpler in core needle biopsy but tissue sample may not be enough. In this study we will compare the results of core needle biopsy with open biopsy in musculoskeletal tumors. In a prospective study 75 patients with skeletal lesions were scheduled for open biopsy. A needle biopsy was also done before starting the operation in the same operating session. The pathology reports of core needle biopsy and open biopsy were then compared. The final pathology report following the definitive surgery was also compared with either of those two biopsy techniques. The diagnostic accuracy of core needle biopsy for skeletal tumors was 77.2%. The value for benign tumors was 69.2% for primary malignant tumors 82.7% for tumor-like benign lesions 50% and for metastatic tumors 100%. The accuracy of open biopsy was 100% for all tumors. Needle biopsy is an accurate and low cost method for diagnosis of skeletal tumors but possibility of failure is present in very few cases.

The use of prophylaxis for deep vein thrombosis (DVT) in patients with ankle trauma treated with below knee cast is a controversial issue. The purpose of current study was to investigate the incidence of DVT to look into the necessity of thromboprophylaxis in these patients. Ninty five patients with stable fractures of the foot or ankle or ankle sprains contributed in this cross-sectional study. The level of D-dimer was determined between 7-14 days post-casting. If the level of D-dimer was higher than 0.2 µg/mL the result of the test was considered positive and patient was referred for further examination for DVT using doppler ultrasonography. The role of risk factors in the development of DVT was evaluated. There were 46 patients with at least one DVT risk factor. The D-dimer test was positive in 21 patients (22.1%). Based on the doppler ultrasonography 3 patients developed DVT. There was a statistically significant relation between the presence of multiple risk factors (≥3) and increased risk of DVT development (p=.01). DVT is not a common complication in below knee casting and routine thromboprophylaxis is not necessary in patients with less than 3 risk factors.

Femoral fracture is one of the most common long bone fractures in the body that can lead to long term complications and significant disability unless properly treated. The aim of this study was to compare the results of plating with open interlocking nail in closed femoral shaft fractures. In a clinical trial study 63 cases of type A and B femoral shaft fractures treated with plating and 61 with open interlocking nail fixation were evaluated in two training hospital in Ahvaz-Iran in a one-year follow-up. The mean age of patients was 31.1 years (15-60 years). The mean union time in the "nailed group" was 19.8 weeks and in the "plated group" 21.6 weeks. The complications in the "nailed group" included 2 infection 5 nonunion and 2 device failures while the same complications were 10 15 and 9 respectively in the "plated group". 59 patients in the "nailed" and 45 in the "plated group" had obtained over 90 degrees of knee motion. The most common complication that was observed in the "nailed group" was limping in 35 patients (57.4%). Treatment of type A and B femoral shaft fractures in adults will result in less number of complications and better range of motion when treated with interlocking nailing.

Distal radius fracture is among the most common fractures of the long bones that are seen in all age groups. Presence of different treatment protocols explains the challenge and controversy in treatment. In a clinical trial study on 100 patients with stable extra articular distal radius fractures 50 cases were randomly treated with short and 50 with long arm casts in a one year period in three training hospitals in Mashhad-Iran. All the long casts were changed to short casts in the forth week and all the casts discontinued in the sixth week and the patients assessed for the elbow range of motion forearm supination-pronation union malunion the patient satisfaction and distal radioulnar joint stability in the 6th and 18th weeks after treatment. The severity of fractures in both groups was similar. We didn’t find any case of nonunion unacceptable malunion regional pain syndrome carpal tunnel syndrome or compartment syndrome. All the patients with short arm cast were satisfied in contrast to the other group. Range of motion had been better saved in short arm cast and in younger patients. This study shows that the effectiveness of short arm cast is the same as long arm cast; the complications are fewer than long arm cast and the patient's satisfaction is better in short arm cast. So we suggest closed reduction and short arm cast for the treatment of stable extraarticular A2 type of OTA distal radius fractures.

Chondrodysplasia punctata characterized by transient and stippled calcification in epiphyses during first year of life and delay of their ossification and disorders such as cataract and short limbs could present with congenital dislocation of hips or coxa vara. In this case report a case of this rare skeletal dysplasia is introduced that had been treated with pavlic harness as bilateral CDH for long time. Ultrasonography and MRI before open reduction of hips demonstrated reduced cartilaginous femoral heads in acetabulums and bilateral coxa vara.