مجله جراحی استخوان و مفاصل ایران
سال یازدهم شماره 1 (پیاپی 42، زمستان 1391)

One of the common complications following total knee arthroplasty (TKA) is excessive post operative blood loss. Tranexamic acid (TXA)، an antifibrinolytic drug، is commonly used to control post-operative blood loss. However، the ideal route of administration is not yet quite clear. In this study، the different administration routes of TXA for blood loss control after TKA will be evaluated. In a clinical trial study، 200 patients who were scheduled for knee arthroplasty were randomly divided into 4 groups. In group 1، TXA (500 mg mixed in 100 cc of saline) was administered intravenously at the time of wound closure. In group 2، the knee joint cavity was irrigated and soaked for 5 minutes with 3 g of TXA in 100 cc of saline just before wound suturing. In group 3، immediately after wound closure، 1. 5 g of TXA in 100 cc of saline was injected into the knee through the drain. Group 4 (control group) received no TXA، but the drain was clamped completely for an hour. The amount of blood loss and transfusion، and changes in hemoglobin levels were documented accordingly. The mean post-operative blood loss in the groups 1 to 4 were respectively 476. 8±114. 8، 743. 2±116. 5، 173. 9±60. 5، and 860. 5±152. 2 ml (p<. 001). The post-operative hemoglobin decreased by 2. 63±0. 9، 4. 2±1، 3. 9±1. 1 and 4. 5±1 mg/dl in the groups 1 to 4، respectively (p<. 001). Intravenous injection of TXA is more effective than intra-articular administration، in reducing the post-operative hemoglobin drop.

In patients with late diagnosis of DDH after open reduction of the hip joint، we can use pelvic osteotomy or varus-derotational osteotomy (VDO) of the femur to make the open reduction more stable. The goal of the present study is to report on redirection of the femoral head towards acetabulum by femoral osteotomy. In this prospective study we performed only VDO in 67 hips in 46 patients (36 females، 10 males) after open reduction of the hip in cases of 18 months to 10 years of age whom Salter innominate osteotomy was needed in a hospital in Ahvaz، Iran. The patients were followed up until complete weight bearing and plate removal. Concentric reduction was achieved in 67 hips. Acetabular index showed 6 degrees of reduction after 26 months. No redislocation was seen after plate removal in 61 hips (91%) but pelvic osteotomy was done in 6 hips (9%) due to redislocation or residual displasia. Ninety percent of patients were classified as group 1 or 2 in «severin» classification. VDO is a simple operation with low complication rate. Although more than 90% success rate was observed in these patients، in order to see possible residual dysplasia in these patients longer follow-ups are needed.

Knee dislocation، although a rare injury، is a severe injury which can endanger the limb viability or cause a significant impairment in the knee function. The purpose of this study was to evaluate the knee function and knee osteoarthritis in the patients who had sustained an acute traumatic knee dislocation. In a retrospective study، 19 consecutive patients with knee dislocation who were treated by different therapies were studied during 5 years in a teaching hospital in Urmia، Iran. Vascular injuries lead to amputation in 3 patients. The follow-up study was performed on the remaining 16 patients within 37±13 months. The patients were evaluated for knee stability، range of motion and the «Tegner-Lysholm» knee function scores. The development of knee osteoarthritis was classified according to Kellgren and Lawrence classification. The knee function was excellent in one، good in 3، fair in 9، and poor in 3 cases. The younger patients and knees with wider range of motion had better «Tegner-Lysholm» scores. The knee scores had significant correlation with the severity in the class of dislocation. The time of surgical reconstruction، whether early or delayed، had no significant effect on the outcome. The mean knee range of motion for the 12 patients who were treated surgically was 120±15 degrees and for the 4 patients who were treated non-surgically was 115±28 degrees. There was a significant correlation between the «Tegner-Lysholm» scores and knee range of motion. Knee dislocation is a very severe complex trauma and normal knee functional outcome is not often achieved. The knees with the more extensive ligament injuries have less favorable outcomes. Younger patients and knees with larger range of motion had better functional outcomes.

The knowledge about acetabular version and angle changes in different conditions is important. The normal acetabular version may be different in various populations. We would like to report measurement of this value in a small sample of Iranains with non-orthopaedic conditions. One coronal pelvic CT film of 81 patients (54 male، 27 female) who had undergone CT scanning for non-orthopaedic reasons was examined in a retrospective cross-sectional study. The acetabular versions were measured and compared for different genders and different age decades. The patients were aged 41. 5±14. 1 years. The acetabular version was 17. 7±3. 4 degrees (range: 8 to 32 degrees). There was no significant relationship between acetabular version and age or gender in this sample. The acetabular version in this Iranian group ranged from 17. 4 to 19. 4 degrees with 95% confidential intervals.

Carpal tunnel syndrome is the entrapment of median nerve in carpal tunnel، resulting in pain and numbness in hand and fingers. It is the most common cause of nerve entrapment in the upper limb. There are two main treatment protocoles: medical and surgical.

In a cohort study، in 220 patients with carpal tunnel syndromes، splinting was compared with sugery. During a 12 months period، symptoms relief and function improvement were evaluated، using the Levine questionnaire.

There was no difference between the two groups at the beginning. In the first and third months of follow-up the symptoms severity was lower in splint group but in the six and twelve month evaluation، the surgical group had less symptoms. Regarding functional improvement، the same results occurred with better results in one and three months for splint group and in six and twelve months for surgical group.

Although splinting for carpal tunnel syndrome had superior results in first two months، the improvement with surgery is better maintained into 6-12 months.

Internal immobilization of skeletal fractures is usually done by drilling of fracture site and screw fixation. During bone drilling، the temperature could increase above 47°C causing irreversible thermal necrosis. This study will try to determine the best drilling condition to minimize the chance of osteonecrosis. Drilling tests were performed with two different drilling techniques -conventional and high speed- on the femur of bovine measuring the temperature and thrust force in drilling site. The results demonstrated that in conventional drilling، in all of the processing conditions، the value of generated heat was higher than allowable limit and occurrence of thermal necrosis was unavoidable. On the other hand، the increase of cutting speed of drill bit in high speed range (6000-7000 rpm) lead to considerable decrease of thrust force and increase of heat dissipation with chips، leading to reduction of local temperature raise in drilling site. But with more rotational speed of drill bit، the amount of temperature elevation was increased due to very little change in drilling force but increased friction between body of drill bit with the chips. High speed bone drilling in 6000-7000 rpm، compared to conventional drilling، produces less heat and less thermal necrosis.

Penicillin is one of the commonly-used antibiotics. Parenteral injection is either intravenous or intramuscular.We are reporting a case of foot gangrene leading to toe amputation following intramuscular buttock injection of penicillin in a child.