مجله جراحی استخوان و مفاصل ایران
سال شانزدهم شماره 4 (پیاپی 63، پاییز 1397)

This study aimed to evaluate the relationship between changes observed in an ultrasonography before and after the surgical release of carpal tunnel syndrome (CTS).

This prospective study was performed on 15 candidates of CTS surgery during 2017-2018 who underwent an ultrasonography before and three months after the surgery. The structural changes in the median nerve and their correlation with the carpal tunnel were analized.

According to ultrasonography results, the findings related to height, diameter and cross-sectional area  of the median nerve decreased in the pisiform region of carpal tunnel while they increased in the area of hamate hook (P=0.002 in pisiform and P=0.001 in hamate hook), which might be due to the elimination of nerve dysfunction in the pisiform and effective decrease of pressure on nerve in hamate hook.

In terms of evaluation of changes in the area of the median nerve, ultrasonography of the median nerve could be an effective and accurate technique to recognize the compression and follow up the nerve status in patients with CTS after surgery.

In a total knee arthroplasty surgery the goal is to produce 90 degree angle between the knee articular lobe and the mechanical femoral line. Most orthopedic surgeons usually utilize a 5 to 7 degree for distal femoral cutting angle. In this study we will aim at clearing this question, that whether the” five-seven degree” distal femoral cutting angle supposed to be an equable spectrum? In this three year course of study, 123 candidate patients for knee arthroplasty with varus knee deformities underwent pre operatore radiologic assessment before joint replacement surgery. The femoral bowing angle, distal femoral cutting angle, neck shaft angle, angle between knee articular line and mechanical femoral angle were assessed and statistically analyzed. The mean varus angle was in 13.71±4.34 in male and 16.41±7.87 in female. The mean distal femoral cutting angle (DFCA) was 6.50±1.09 in male and 7.38±1.75 in female. In 48 patients (%39) the female DFCA was out of 507 degree range. In 32 (26%) of patients the DFCA was 7-9 degrees and in 8 (%6) it was over 9 degrees, and in 8 (%6) was less than 5. The angle differences had no sex-related variation. There was a good co-relation between DFCA and bowing angle (r=0.769). The co-relation between DFCA and NSA was moderator (r=0.523). The co-relation between DFCA and DFA (r=0.11) and varus angle with LDFA (r=0.28) was low. LDFA was also related to NSA (r=0.15). Therefore, the candidates for knee replacement who have varus deformity may need a distal femoral cutting angle over 7 degrees. Based on these results, the distal femoral cutting angle in patients in need of a knee arthroplasty and varus deformity might be more than seven degrees. The distul femoral cutting angle in knee arthroplasty in face of severe varus does not have a constant value and maybe over 7 degrees. A long standing radiograph is needed to measure the mechanical and correlate with axis the anatomic axis of distal third of femur. When the bowing angle is high the DFCA will need to be higher.

The destruction of articular cartilage is the major cause of articular problems. The articular cartilage has little repair postertial due to lack of perichondrium and direct blood circulation. It is, therefore important to consider this phenomena in surgical treatments. One of the articular cartilage reconstructive surgeries is using Osteo-Chondral graft. The main purpose of this research was to investigate the use of Xenogenic (calf foetal) Osteo-Chondral graft in repairing articular cartilage defect on Rabbit’s model. Osteo-Chondral pieces were prepared under aseptic condition from the joints by skin punch device and kept at a temperature of 70ºc below zero. Ten male New Zealand rabbits of one year old were randomly divided into two groups of five, as control and transplantation groups calf's fetal. The skin and joint capsule were opened by surgery and articular cartilage was exposed. After defect creation by drill, in the transplanted group an Osteo-Chondral piece was inserted in the defected area; however, in the control group the defect was created but left empty. Joint capsule and skin were sutured in both groups. During 60 days of study, radiographs were taken from rabbits of each group randomly to evaluation of osteoarthritis signs on days 14, 28 and 42. Finally all rabbits were euthanized for histopathological sampling and evaluated on day 60. The result of the clinical evaluations did not show any sing of inflammation nor limping. In radiological evaluation there was no evidence of arthritis complications but showed defect filling signs in experimental group. In the histopathologic evaluations, the defect of transplanted group was filled with fibro-cartilage tissues and without any signs of graft rejection. In two samples of five specimens of transplanted group Fibrous tissue was the dominant tissue and in other two as the dominant tissue. Only in one sample of this group the integrity of the cartilage tissue was completely formed. But in the control group, the lesions were observed without any restorative tissue and only filled by red blood cells. The study suggests that Xenogenic Foetal Osteo-Chondral tissue is an effective tissue for repairing articular cartilage defects.

This is a report on simultaneous dislocation of the left shoulder and elbow resulting in a 16 years old boy. Bipolar dislocation of Luxatio Erecta and posterior dislocation of the elbow is extremely rare. After clinical examinations (attention to pain, swelling, and deformity of the shoulder and elbow joints and neurovascular examinations), the necessary radiography was performed for the patient at the level of his tolerance: AP of the shoulder and side imaging of the elbow. Closed reduction was carried out with emergency maneuvers, followed by physiotherapy. Good result was obtained in the 6 weeks follow-up the examination of the adjacent joints of a dislocated limb is an important issue and must be emphasized.

Ehlers Danlos syndrome (EDS) is an inherited connective tissue disease due to impaired collagen metabolism. Joint hypermobility and skin hyper extensibility are the major findings. Six types of EDS are recognized. Type I or Gravis type is characterized by skin hyperextensibility, joint hypermobility, skin splitting autosoml dominancy inheritance, preterm premature rupture of membrane (PPROM) and varicose vein.  Mental retardation has not been reported in the literature. Two cases of unusual type 1 EDS with joint deformity and mental retardation will be reported in this article.

Considering the extent of the disability caused by spinal cord injury and the increasing incidence of it, many attempts have been made to understand how this lesion is repaired. Most of the spinal cord injuries are traumatic injuries. The annual incidence of this damage is estimated between 15-40 cases per million people worldwide. Considering the extent of this incident, the need for study of the effects of spinal cord injuries, in particular, in traumatic injuries, is necessary. Due to the ethical and practical difficulties and limitations, as well as the high cost of performing empirical studies on the living and corpse, the use of finite element modeling is a powerful and complementary tool for the study of spinal biomechanics. This method is able to predict how the spinal cord gets injured in different loads and whether one can determine the amount of spinal cord strain and the critical level for spinal cord injuries. Such prediction can play an important role in treating these lesions and improving patients. This study, reviews the previous studies about finite element analysis on the spinal cord. Different aspects of finite element model include methods of its modeling, determination of mechanical properties, loading injury determination of spinal cord have been presented. The results of these studies are compared in order to provide accurate model in future.

Subject Iranian Journal of Orthopaedic Surgery (Volume 16, No. 1-4)

Author Indexes Iranian Journal of Orthopaedic Surgery (Volume 16, No. 1-4)

Abstract's of 26th Congress of Iranian Orthopedic Association 22-26 Oct 2018