مجله جراحی استخوان و مفاصل ایران
سال چهاردهم شماره 1 (پیاپی 54، زمستان 1394)

Drilling of bone is used to fix the fractures with screws, wires or plates. The interaction between hole surface surface and fracture stabilization components is effective in the bonding strength of the stabilization process. During bone drilling, the temperature could increase above 47 °C and cause irreversible thermal necrosis. The surface roughness can be considered as a sign of damage of the bone cells.
This study looks at the effect of rotational speed of drilling of bone on production of surface defects to determine the best processing condition for minimizing the osteonecrosis and surface defects. Seven different rotational speeds in drilling beef femur were used-in non-cooling and liquid cooling phases. In all tests the temperature was measured. After cutting samples, using hematoxylin-eosin staining were stained for detection of surface defects.
The lowest heat prodution was with use of liquid cooling. The drill speed of 1500 rpm with liquid cooling showed the maximum temperature of 48.5°C without production of surface debris and defects as witnessed in stained bone segment.
Cooling application in bone drilling process avoids over and thus less thermal necrosis, which gives the lowest number of surface defects and highest quality wall surface hole.

Osteoarthritis is a progressive joint disease. Mastic fruit has antioxidant and anti-inflammatory properties. Bone marrow stem cells have the ability to differentiate into chondrocyte. The purpose of this study is to evaluate the effect of Pistacia atlantica hydro alcoholic extract with bone marrow- derived stem cells on induced knee osteoarthritis in rat.
Fifty male Wistar rats were divided into 5 groups of 10. Then, under anesthesia on days zero and 3, fifty μl collagenase type 2 was injected in the left knee. After 10 weeks, osteoarthritis was induced. The rats were divided into 5 groups: control, Pistacia atlantica hydro alcoholic extract therapy, treatment by stem cell and Pistacia atlantica hydro alcoholic extract, stem cell therapy alone, and treatment with hyalgan. After 12 weeks of treatment for osteoarthritis, radiographic and histopathologic surveys and also measurement of antioxidant properties as MDA-TAC were performed.
The results after 12 weeks revealed that the group with stem cell and pistacia atlantica extract had a significantly different and favourable results compared the other treatment groups (p It seems that Pistacia atlantica hydro alchoholic extract with bone marrow-derived stem cells are effective in knee cartilage repair.

Pedicle screw instrumentation has many advantages for correction of adolescent idiopathic scoliosis (AIS) deformity, but screw insertion in AIS could be challenging due to distorted anatomy of pedicles and also rotation and tilt of the vertebrae. In “Free hand” technique, the surgeon locates the pedicle with anatomical landmarks. The purpose of this study was to evaluate the accuracy of pedicle screw position in correction of adolescent idiopathic scoliosis in “free hand” technique.
In a prospective study, 38 consecutive AIS cases who underwent corrective surgery with free-hand technique from 2013 to 2015 in a training hospital in Isfahan-Iran, were studied. Deformity corrections were evaluated with multislice CT-scan. In terms of position, pedicle screws were devided into “excellent” and “misplacement”. Misplaced pedicles were considered as medial, lateral, inferior, superior and anterior vertebral body and the dis-placement as grades 0 to 4.
A total of 720 screws were inserted. 623 screws (86.5%) were perfect and 97 (13.5%) were misplaced. In all the misplaced cases, 39 screws (40.2%) were medial and 58 (59.8%) were lateral and the deviation of screw was less than 2 mm (grade 1). There was no misplacement in the inferior or superior directions. Only one screw with 4 mm anterior misplacement associated with abdominal pain.
Pedicle screw insertion in adolescent idiopathic scoliosis with the “free hand” technique is a safe and reliable method with acceptable accuracy; if obviates time and radiation exposure.

The open fractures of femur and leg are among the common fractures of orthopaedic injuries. Utilization of external fixator has worldwide acceptance. Pin tract infection, neurovascular injuries, compartment syndrome are among some of the complications of external fixator application. The purpose of this study was to evaluate the complications and treatment pitfalls of external fixator insertion.
In a clinical trial study, 140 patients with comminuted periarticular fracture of knee and ankle were studied in a one-year period. One day after surgery, the neurovascular status was documented and when patients referred for exchange of external fixator, the pin tract infection was recorded. The final data were analyzed by statistical methods.
The rate of infection was 52%. The rate of neurovascular injury was 6%. The rate of compartment syndrome and vascular injury was zero and the rate of tendon injury was 5.7%. In comparison between pin tract infection and neurovascular injuries and tendon injury in open and comminuted close fracture only the injury of nerve has significant differences (p=.049).
External fixator placement for open or comminuted fractures of knee area and leg is associated with high rate of pin tract infection, but neurovascular injury and muscle/tendon damage or compartment syndrome are very infrequent.