مجله جراحی استخوان و مفاصل ایران
سال دوازدهم شماره 1 (پیاپی 46، زمستان 1392)

Doing surgery on wrong location، or wrong person، or doing a different surgery by mistake، are all horrible، though not infrequent happenings. This is a report on an attempt to determine the incidence of «wrong-site” surgery among the Iranian Orthopaedic Surgeons. A one-page questionnaire، regarding personal experience or having witnessed or heard about» wrong-site«surgery during the last 2 years، was mailed to the active members of Iranian Orthopaedic Association (IOA). All the members were also contacted by phone to confirm the receipt of the questionnaires and request an earlier return of the forms. The returned forms and the telephone responses were analyzed. From the 736 questionnaires sent out to the IOA members، 54 (5. 7%) written response was received back. 368 (50%) members denied having personally faced or heard of any»wrong site«surgery. 313 IOA members (%42. 5) did not participate، and gave no answer – nor on phone، neither by writing. Among the 54 returned questionnaires، 29 members had encountered or were aware of 40 cases of»wrong «، surgery which included 32 mistakes in the side of surgery and 8 cases of wrong limb surgery. The response rate to questions regarding» wrong«surgery is very low in IOA members. Adherence to a strict protocole in avoiding wrong-site or wrong limb surgery may decrease the number of mistakes in any busy operating room.

Sutures and glue are the commonly used techniques in peripheral nerve repair with controversies in the results of experimental researches studying either technique. This experimental study aimed at evaluation of the axonal regeneration after end-to-side nerve repair with glue and suture in rats. In an experimental study، 30 male Wistar rats were divided into three groups: group 1 (n=10) were submitted to fibular nerve transection with end-to-side nerve anastomosis using sutures alone; group 2 (n=10) were submitted to fibular transection with end-to side nerve anastomosis using sutures and cyanacrylate glue in the lateral surface of an intact tibial nerve; and group 3 (n=10)، were submitted to surgery without repair (control group). At the end of the study (after 16 weeks) period، the three groups were evaluated by «walking track»، and posterior morphometrical analysis. At the end of the study، the mean weight of the groups had increased. The functional tests showed difference in the walking track analysis in groups 1 and 2، with important recovery in group 2 in walking pattern، while group 3 showed no function. Histological comparison showed no statistically significant difference between group 1 and 2، regarding the count of regenerated axons in the site of nerve repair. The number of regenerated axons، however، was more in group 2. The surgical time in group 3 was shorter than groups 1 and 2. End-to-side nerve repair using glue presented better results than suture following transection of fibular nerve in the rat experimental model.

Perfect rotational positioning of femoral component in total knee arthroplasty is mandatory for good outcome، particularly in knees with severe varus. Posterior condylar line (PCL) and transepicondylar axis TEA are the two current methods used to determine the appropriate rotational positioning of femoral component. The aim of this study was to compare the accuracy of femoral component rotation after TKA، using either PCL or TEA reference points. In a retrospective study، 42 consecutive TKA candidates with severe varus knees were divided into two groups: In group I posterior condylar line، and in group II transepicondylar axis was considered as the primary landmark for rotational positioning. Erosion of medical femoral condylar was recorded in millimeters. One year after operation all the patients underwent CT scan and the angles between TEA and PCL of the prosthesis was meausured. The degree of knee flexion and also WOMAC scores were recorded. The female gender was prominent in both groups (81% in group 1، 85. 7% in group II). There was no significant femoral condylar erosion in either group. The mean Womac score in group 1 was 71. 4±17. 51 and 72. 07±15. 48 in group II (p=. 9). The degree of external rotation according to condylar twisting angle was 3. 35±1. 74 in group 1 and 1. 9±1. 7 in group 2 (p=. 009). In severe Knee-varus deformity، TEA landmark gives more external rotation position for femoral component، despite of lack of significant erosion in femoral condyle.

The objective of this study was to evaluate the results of repairing root and para-root radial tears of lateral meniscus during cruciate ligament reconstruction. In a retrospective study، from the 60 patients who had been treated for root or para-root injury of the lateral meniscus from 2007 to 2011 in 3 centers in Tehran-Iran. Only 40 patients were studied with an average followe-up of 32. 4 months (24-48 months). The patients were evaluated by International Knee Documentation Committee (IKDC)، Lysholm and Tegner scoring systems subjectively، and by objective Lachman and McMurray tests. 34 patients were operated for ACL reconstruction and 6 for ACL and PCL reconstruction; and lateral meniscus tears were repaired simultaneously. On the final follow-up، all the patients had firm end-points tested by Lachman. None reported popping or clicking. The mean IKDC score was 75. 25 (range: 54-92)، the mean Lysholm score was 94. 4 (excellent) in 22 patients; and the mean Tegner score was 7. 15. From the 16 patients who were professional soccer players، 14 were still playing competitively at the time of follow-up. The midterm results of lateral meniscus repair - at root or para-root level - in association with ACL or / and PCL reconstruction، are acceptable.

The aim of this study was to compare the results of percutaneous sub capital metatarsal osteotomy with open distal chevron osteotomy of first metatarsal in hallux valgus surgery. In a clinical trial study، 29 patients with bilateral hallux valgus (58 foot) were selected randomly. All patients were female and the average age was 31 years old (17-55 yrs). The average time of follow-up was 13 months (6-20 months). Hallux valgus angle (HVA) up to 40° and intermetatarsal angle (IMA) up to 17° were included. For each patient، a percutaneous sub capital osteotomy on one foot and an open distal chevron osteotomy on the other foot were performed at the same time and by the same surgeon. Left or right side deformities were randomly selected for MIS or open procedure. The average HVA correction was similar in both groups but the IMA correction was better in the open distal chevron osteotomy. In the chevron osteotomy، both patient''s and surgeon''s satisfaction level were in the similar range. In the MIS technique، the level of satisfaction varied between the surgeon and the patient. 86% of the patients were completely satisfied but the surgeon was fully satisfied in only 38% of the cases. Distal chevron osteotomy is recommended as a reliable corrective technique in mild to moderate hallux valgus but the percutaneous sub capital osteotomy can still be considered in selected patients with relatively low IMA.

Tibial shaft fracture is the most common fractures of long bones. The aim of this study was to report the short-term results of intramedullary (IM) nailing in tibial shaft fractures in emergency setting. In a prospective study، 226 cases (193 men، 33 women) treated with IM nailing during 2 years (2009-2011) in a training hospital in Rasht-Iran، and followed for two years. The mean age was 34±3 years old. We investigated for open or closed fractures، accompanied with fibular fractures، proneal nerve or anterior tibialis artery injury، degenerative changes in knee joint، knee pain، atrophy of quadericeps muscle، malunion، chronic osteomyelitis، delayed union، and nonunion. Short musculoskeletal function assessment questionnaire (SMFA) was also completed and the data were analysed by statistical software. There were 151 Open fractures and 75 closed fractures. Open procedure was used in 155 cases and closed one in 71 cases. Knee pain was the most frequenct and non union the least common complication. Musculoskeletal limitation appeared more in open fractures and in association with fibular fracture and was more in female than male patients (p<. 001). SMFA score also raised by passing time. Intramedullary nailing is a proper and effective method in emergency treatment of tibial shaft fractures.