مجله جراحی استخوان و مفاصل ایران
سال یازدهم شماره 2 (پیاپی 43، بهار 1392)

Hemivertebra is one of the common causes of congenital scoliosis. In cases with curve progression، resection of the hemivertebra through a combined anterior and posterior approach (CAPA) is one of the usual treatment modalities which is associated with high morbidity. Recently، hemivertebra resection through a posterior only approach (POA) is introduced. In the current study، we are reporting our experience with a single posterior approach. Ten patients with lumbar CS who had undergone hemivertebra resection through a POA with transpedicular instrumentation and short segment fusion، between 2009 and 2012 were retrospectively studied. The main and the compensatory scoliotic curves and kyphotic curves were measured and compared before surgery and by the 16. 1±10 months follow-up. Fusion was obtained in all of the patients. The mean drop in the main، compensatory and kyphotic curves were 39. 6±6. 6 to 11. 3±5 degrees، 12. 9±5. 1 to 7. 8±3. 4 degrees and 15. 6±8. 1 to 2. 7±8. 2 degrees، respectively (p<. 05). The mean correction was 72. 5±9% for main، 37. 7±34. 3% for the compensatory and 90±51% for the kyphotic curve. There was no patient with perioperative neurovascular or general complications. No patient needed mechanical ventilation; however، allogenic blood transfusion was performed for 2 patients. The short-term follow-up of hemivertebra resection through a POA with transpedicular instrumentation and short segment fusion shows to be a safe and effective treatment for CS resulting from one level hemivertebra.

Acute Hematogenous Osteomyelitis (AHO) is a potentially dangerous disease of childhood which is often seen in boys and involves the metaphysis of lower extremity، especially tibia. The aim of this study is to review the common bones and common organisms involved in hematogenous osteomyelitis in children. In this retrospective study، the data of 111 children with acute hematogenous osteomyelitis admitted between 1997 and 2006 in two training hospitals in Ahvaz، Iran was studied. The responsible organism and the involved bone are the cases of interest in this study. Acute hematogenous osteomyelitis was 3. 27 times more common in boys than girls. The most common site of involvement was distal tibia in boys and proximal femur in girls. In 68. 89% of the patients the culture of the involved bone was positive and the most common organism was staphylococcus aureus in both sexes. Acute hematogenous osteomyelitis is more common in boys than girls. The most common site of involvement was different in boys and girls but the most common responsible organism for infection was staphylococcus aureus in both genders.

Some authors suggested using ultrasound in diagnosis of carpal tunnel syndrome (CTS)، however the efficacy of ultrasound in determining the severity of disease is unclear. In current study، we aimed to investigate the diagnostic efficacy of ultrasound in determining the severity of CTS in comparison with NCV using measurement of cross-sectional area of median nerve. In a prospective study، 181 CTS suspected wrists (94 patients) were investigated. The cross-sectional area of the median nerve was measured using ultrasound and the severity of disease was determined based on criteria of El Miedany et al. Based on the NCV، the patients were divided into four groups of normal، mild، moderate or severe CTS. Finally، the mean cross-sectional area was compared between the groups and the kappa agreement coefficient for determining the severity of disease by the two methods was calculated. The mean cross-sectional area increased significantly with increase in disease severity (p<. 0001). In total، the severity of the disease، based on the ultrasound، was matched with that of NCV in 56. 9% of wrists including 88. 8% of normal and 70. 7% of severe cases. The kappa agreement coefficient was. 436 (p>. 001). Determination of cross-sectional area of median nerve with ultrasound can be a useful tool in decision-making about surgical intervention in carpal tunnel syndrome. However، the clinical correlation is mandatory.

Phytoestrogens enhance bone integrity through prevention of bone loss and stimulation of bone formation، and also facilitation of bone healing. The aim of the present study was to evaluate the effect of vitex agnus castus extract، as a source of phytoestrogen on alkaline phosphatase and VEGF (vascular endothelial growth factor) and also callus formation in women with long bone fractures. In a double-blind randomized placebo controlled trial، 32 women with long bone fracture، age 20-45 years old، were randomly divided into the VAC (vitex agnus castus)، receiving 1 Agnugol tablet (containing 4 mg dried fruit extract of vitex agnus castus) -daily for 8 weeks or a placebo group. Serum alkaline phosphatase and VEGF were measured at the beginning and the end point، and also callus formation was checked at the end of study. Serum alkaline phosphatase was increased in both groups compared to the baseline. Although the elevation of ALP (Alkaline phosphatase) in placebo group was not significant، in treatment group، ALP was considerably increased (p=. 05). Comparison of the change of VEGF showed that، only in VAC group، VEGF level was significantly increased (p=. 01). The callus formation which revealed the fracture healing، in VAC and control groups was 71. 4% and 53. 8%، respectively. Treatment with vitex agnus castus extract for 2 months could enhance the VEGF level، however، further studies are need to show the effects of vitex agnus castus extract on alkaline phosphatase level and callus formation.

Treatment of intra-articular calcaneal fracture is a major orthopaedic challenge. The aim of this study was to evaluate the results of non-operative treatment of intra-articular calcaneal fractures، its effects and performance. In a retrospective study، 58 patients (44 males، 14 females) with intra-articular calcaneal fracture were evaluated clinically and radiographically using a general performance and AOFAS، and FFI questionnaires between 2003 and 2011 in Tehran، Iran. The mean follow-up time was 3. 27 years (2-6 years). Radiographic signs of osteoarthrities were also evaluated. The mean age of patients was 38. 4 (18-85 years). Ten cases (17. 2%) were «tangue» and 48 (82. 8%) «joint depression» type. Spine injury was abserved in 13. 8%، other limb injuries in 27. 6%، and head injury in 3. 4% of the cases. The mean AOFAS score was 79. 14 and FFI score 24. 7. Osteoarthritis of moderate degree was seen in 48% and severe in 17% of the cases an radiographs. By the time of follow-up، 5 patients had required surgeries to treat the delayed complications. Treatment of intra-articular calcaneal fracture is a real challenge. Close treatment، although maybe painless and give comparable results with open surgery in AOFAS and FFI testing، will show radiographic signs of osteoarthirits in about 50% of the time-even in short or mid-term follow-up.

The distal radius is frequently affected by primary bone tumors، and is a common site for occurrence of giant cell tumor. Giant cell tumor at the distal end of the radius can be treated by various methods. Small lesion can be treated by curettage and filling bone defect by autogenous bone graft or allograft، or bone cement. Large lesion that involved articular surface can be treated by wide resection and reconstruction with osteoarticular graft from proximal fibular. This report presents a 42 year-old lady that was treated with osteoarticular fibular graft for her recurrent distal radius giant cell tumor.