Journal of Research in Orthopedic Science
Volume:1 Issue: 2, May 2014

Sciatic nerve palsy during hip arthroplasty can negatively affect the outcome of total hip arthroplasty (THA). Although no causes could be found in majority of cases some risk factors including leg lengthening, direct injury, damage of vascular supply have been reported. We aimed to investigate if diabetes mellitus (DM) increases the incidence of sciatic nerve palsy during THA. In a retrospective review on 1528 primary total hip arthroplasty (1219 patients) 16 cases of post-operative sciatic nerve palsy were identified. They were matched to a group of 96 patients of the same sex and gender but with no sciatic nerve injury. The prevalence of DM and the amount of leg lengthening were compared between the two groups. The ratio of male to female was the same in both groups (69% female, 31% male). The mean age at the time of surgery was 47.3 years (range 33-62) and 49.2 years (range 32-64) for the groups with and without nerve palsy, respectively. The amount of limb lengthening resulted from surgery was not significantly different between the groups (18.5mm in for the study group with nerve palsy versus 17.6mm for the control groups, p = 0.79) Seven patients in the study group (44%) and 20 patients in the control group (21%) were found to have diabetes. The difference had a trend to be significant (p = 0.06). Although the number of diabetic cases in both groups showed no significant difference, but larger ratio of patient with sciatic nerve palsy had diabetes (44% versus 21%). Further studies with larger population are needed to evaluate the role of diabetic mellitus on the sciatic nerve palsy after hip arthroplasty.

Knee septic arthritis after anterior cruciate ligament reconstruction is a rare but very serious complication. The purpose of this study is to evaluate the clinical course and outcome of a series of such patients. Ten patients with knee joint infection after anterior cruciate ligament reconstruction were enrolled. Demographic data and information related to the surgical technique were collected. Onset time from index procedure, clinical and laboratory findings, interval between onset of symptoms and first debridement, number and type of operations were recorded. The latest status of patients and the relationship between onset time of symptoms with final results and also time interval between onset and debridement with the final results were also studied. Ten patients, all male, mean age 25(19-31) years, were followed for an average of 33 (18-112) months. Four patients had acute infection, 5 subacute and the remained one chronic infection. In subacute and chronic infections, patients often had not systemic symptoms. For each patient 2.3 times of joint debridement and lavage were performed. The graft was removed in 50% of cases. Increased erythrocyte sedimentation rate (ESR) and C – reactive protein (CRP) levels and synovial fluid polymorphonuclear (PMN) cells count were highly helpful in the diagnosis. Joint fluid culture was positive in 40% of the patients. In the latest survey, 20% had pain with vigorous activity, 30% had symptoms of instability and 20% had limited knee range of motion. Because symptoms of infection may overlap with postoperative natural course, the diagnosis of this complication may require special attention. Early detection and timely intervention can lead to graft preservation and better final results.

Following fusion surgery in patients with adolescent idiopathic scoliosis (AIS), the coronal balance undergoes some degrees of fluctuation. The frequent causes of these changes are stress relaxation of the spine and the gradual maturation of fusion mass. Health related quality of life is dependent on the final balance. Eighty five patients with AIS who underwent posterior spinal fusion surgery with different methods and in variable levels, were studied on time scales preoperatively, immediately postoperatively, 6 weeks, 3, 6, 12, 18 and 24 months after surgery. In every visit, the standing posteroanterior and lateral views were obtained. Coronal imbalance was proposed as the differences of C7 middle axis and S1 endplate middle axis. The imbalance less than 2cm was assumed as normal. Furthermore, postoperative trunk shift and lower instrumented vertebra (LIV) shift were measured as the other balance evaluation methods. Eighty five AIS patients were included, 17patients (20 %) were male and 68 (80%) female. The mean age of patients was 16.03±4.3 years (range 9-37 years).The mean follow up period was 38 months (24-60 months). Left side coronal deviation was assigned negatively and right shift of balance was assigned with positive amounts. The clinical measurements of coronal imbalance based on plumb-line were investigated in the medical records. The range of pre and post-operative imbalance varied between -40mm and +35mm. The correlation between clinical balance with radiographic trunk shift, C7 plumb-line and LIV were -0.185 (p= 0.04), 0.22 (p= 0.05) and 0.0341(p=0.38), respectively. The significant improvement of coronal balance was on the 12th months of follow up (p= 0.02). Based on our study, in AIS patients undergoing spinal fusion, the coronal balance is reached gradually to a steady state in an average of 12 months. Because of this spontaneous improvement in coronal balance over 12 months from a posterior spinal fusion surgery in AIS patients, surgical intervention is not recommended. Beyond 12 months, revision of symptomatic imbalance is justified before further consolidation of fusion mass.

Intraosseous ganglia (IG) are solitary, osteolytic lesion juxta-articular in the epiphyses of long bones. The origin of articular cysts is controversial and is not recognized well. From 2006 to 2011 in Shafa Orthopedic Hospital we identified 7 cases with final diagnosis of intraosseous ganglion cyst in medial condyle of tibia. We surveyed their medical documents and images and after final visit described the pattern of presentation, radiologic feature, treatment and their outcome after treatment. Of 7 patients, 6 were female and 1 was male. All had chief complaint of posteromedial knee palpable identified to be sub pes anserine bursa. There were two evidence of moderate degenerative joint disease (DJD) in the knee joint. We found conduit between the cysts beneath or near the pes anserine and the ganglion cysts in the medial condyle of the tibia in all of the cases. After surgery, patients became symptoms free, and there was no evidence of recurrence in 25 months mean follow up. IGs of medial condyle of tibia are usually associated with soft- tissue component. Considering the strength of cortex and resistance of bone trabeculation of medial condyle of tibia, it is more likely that the primary lesion originates in the bone and then will spread to the adjacent soft-tissue.

Distal radius fracture is the most common forearm fracture. The goal of distal radius fracture treatment is to restore normal anatomic indices. This study is designed for assessment of interobserver and intraobserver reliability of radiographic indices of the distal radius. We evaluated posteroanterior and lateral standard radiographs of 10 normal wrists. The obtained radiographs were evaluated for radial length, radial inclination and radial tilt by 4 observers and the process was repeated after 6 weeks. The interobserver reliability results for assessment of the radial length, radial inclination and radial tilt by using the intraclass correlation coefficient (ICC) were good (ICC = 0.672, 0.649, 0.631 respectively). Intraobserver reliability results for radial length (ICC = 0.606) and radial tilt (ICC = 0.605) were good but for radial inclination moderate (ICC = 0.582). Standard radiographs of wrist can be used for evaluation of radiographic indices with good or moderate interobserver or intraobserver reliability.

Hemangiomas are benign vascular malformations that closely resemble normal blood vessels. Synovial hemangioma is a well-recognized but rare entity. It originates from synovial lining, with typical intraarticular variety that almost invariably occurs in knee joint. We report an intraarticular synovial cavernous hemangioma, along with its clinical course and management.

Volar base fracture of the second phalanx in the proximal interphalangeal joint fracture dislocation is a challenging injury with high rate of permanent disabilities. Different methods of treatment like extension block splining, open reduction and internal fixation, volar plate arthroplasty and recently hemi-hamate arthroplasty address this complex injury.