مجله جراحی استخوان و مفاصل ایران
سال سیزدهم شماره 4 (پیاپی 53، پاییز 1394)

Anterior cruciate ligament (ACL) is one of the major stabilizing ligaments of the knee. ACL reconstruction usually has high success rate. The choice of graft in ACL reconstruction has been a source of controversy. This study compares the outcome of two commonly used grafts.
Seventy patients with ACL tear among the cases referring to training hospitals of Kerman, Iran from 2013 to 2015 were studied. The patients underwent reconstruction, using, randomly, either the "four-fiber semitendinosus autograft" or tibias abterior allograft". The Lysholm, IKDC, KOOS and SF36 scores were evaluated for comparing clinical stability examination, laxity, subjective satisfaction, and return to work before and after surgery.
The two groups were the same in term of age, range of motion, knee flexion, IKDC, KOOS, Lysholm scores as well as SF36. The ligament laxity did not show a significant difference either. The operative time was significantly different between two groups (p ACL reconstruction with tibias anterior allograft has similar clinical, functional and stability results as semitendinosous autograft in a short time follow-up; although the operation time was shorter in allograft group.

The congenital absence of the tibia is a rare disease, and an orthopaedic surgeon may not encounter such cases during the course of his/her career. This is the largest report to date of the management of such cases by a single surgeon. The foot and leg were persevered in the majority of the cases, and a functional evaluation system was used to report outcomes.
Thirty-six patients (19 girls, 17 boys) with 48 tibial deficient limbs were evaluated clinically and radiographically. The mean age of patients was 12 years old. The patients or their parents filled out the Pediatric Quality of Life and the parents’ satisfaction forms. The surgical interventions performed, and their effects on school attendance and the shoe type they wore were documented.
The mean time of follow-up was 9 years. The 48 limbs included 14 type I, 16 type II, 11 type IV, and 7 unclassified by using the Jones classification; and 6 type I, 11 type II, 16 type III, 1 type IV, and 14 type VII by using the Weber classification. Primary amputation was performed in 10 limbs (8 patients) and limb preservation surgery on 38 legs (28 patients). Tibiofibular synostosis, centralization of the ankle, and Ilizarov lengthening were the most common procedures. Non:union: of tibiofibular synostosis (2 cases) and knee stiffness (6 cases) were the main complications. Among the reconstructed limbs, 12 were in regular and 18 in modified shoes. The Pediatric Quality of Life of 68 points in the reconstructed group was a significant achievement, and it was also better than the score of patients who had undergone amputation.
Reconstruction of tibial hemimelia with foot preservation provides good functional outcome in the majority of cases.

One of the most important challenges after vertebroplasty (VP) and kyphoplasty (KP) is the stress concentration at the junction of bone and cement which would cause not only pain, but also new microfractures or osteonecrosis. We would like to present a new concept of using hexagonal porous structure. This model is tested biomechanically in comparison with vertebrae treated with VP and KP.
Ten Ovine vertebrae were divided into 5 groups - 2 in each group: the groups included normal vertebrae, VP, KP and vertebrae treated by hexagonal porous structure as metal pearls (steel or brass). These vertebrae were all put under mechanical static pressure. The displacement and yield points were compared in the 5 groups.
The hexagonal metal treated vertebrae showed a displacement of 5.5-6 mm before reaching the ultimate strength of 3.5-4.5 KN. This displacement for VP and KP was 2.5-3 mm. The improvement of mechanical behavior was observed in vertebrae treated by hexsgonal metal pearls compared to those treated by the VP and KP.
The toughness vertebrae by hexsgonal metal pearl treatment increases and this will reduce the stress in vertebral end plates and interdiscal pressure. This would reduce the chance of fracture in the adjacent vertebrae.

Supracondylar humerus fracture is the most common elbow fracture in children and accounts for about 16% of pediatric fractures. To maintain stability in the reduced segment in medial and lateral columns is an important treatment concept. The aim of this study was to compare two methods of proximal distal lateral pinning with medial and lateral cross pinning.
In a cross-sectional study, 140 children (63 boys, 77 girls) with supracondylar humerus fracture were evaluated in a training center in Tabriz, Iran. The mean age was 5.04 years. The cases were divided into two groups (each 70 patients), matched for age, sex and type of fracture and were treated with two above methods. Complications and outcomes were copmpared.
Ulnar nerve lesion in the medial and lateral cross technique was 4.3%, and none in the group done by all lateral pin technique. The need for further surgery and loss of stability was 2.9% and 1.4% respectively with no statistical difference. Pin site infection around the pins was 4.3% and 12.9% percent respectivly. Cubius varus deformity rate was 2.9% in lateral cross pinning and 4/1% in medial lateral cross pinning.
Proximal distal cross pinning technique for suprocondylar humerus fracture is comparable to medial and lateral cross pinning in terms of stability in maintaining a good reduction. The possibility of ulnar injury is negated in cross-lateral technique.

The proximal femur has a complex anatomy and its fracture is associated with high frequency of morbidity and mortality. These fractures are one of the common lower extremity fractures that may occur in young or old people. The aim of this study was to investigate the relationship between age and sex of the patients with proximal femoral fractures in different anatomical locations.
In a retrospective study, 5000 registered proximal femur fracture (39.5 men, 60.5 women) were studid in a 5-year period in a teaching hospital in Tabriz-Iran. The demographic information, mechanism of trauma and type of proximal femur fracture were extracted from the medical records. The information was classified and analyzed.
Average age of patients was 73.2 ±12.3 years old (32-100 yrs old). Intertrochanteric fracture was seen more in women than men (70% vs 60%). The sub-trochanteric and femoral neck fractures occurred more in men (31% vs. 27%). 91% of fractures were intertrochanteric in patients over 65 years of age, and most of subtrochantric fractures happened below 65 years of age.
Conclustions: The intertrochanteric fracture is occurred more in the elderly and in ages above 65 years. Women are at greater risk of proximal femur fractures. The trochanteric and femoral neck fractures often occur in young people.

Bone Drilling is one of the most essential procedures in orthopaedic surgery and it is executed for various purposes. Fixing the bone in fractures, non:union:, deformities, mal:union:, and cosmetic lengthening corrections, are the main purpose for internal and external fixations. In both internal and external fixations, use of pins or screws drilling becomes necessary. One of the important issues we face while drilling, is heat escalation of the drill and its transference to the bone causing thermal osteonecrosis.

Tenth Section: Operative Environment
Chairmen: Javad Parvizi MD, FRCS; Thorsten Gehrke, MD

The abstracts of 23rd Congress of Iranian Orthopaedic Association from 5 to 9 October, 2015.