مجله جراحی استخوان و مفاصل ایران
سال هفدهم شماره 1 (پیاپی 64، زمستان 1397)

Developmental dysplasia of the hip (DDH) includes a wide range of abnormalities of the hip that can emerge at any time including embryonic period, infancy, or childhood. The purpose of this study was to examine the clinical and radiographic outcomes of patients with DDH, treated with adductor tenotomy and closed reduction.

The study was retrospectively performed on 30 children (33 joints) with DDH,who were treated with adductor tenotomy, closed reduction and SpicaCast in Ahvaz Razi Hospital during 2015-2017. Inclusion criteria were patients diagnosed with DDH and below 2 years of age. Exclusion criteria were connective tissue diseases, secondary dislocation due to previous infection and acetabulum dysplasia in the context of specific syndrome. After the operation, the patients were evaluated for the severity of injuries associated with dislocation or subluxation of hip joint and hip joint congruity. Theradiographic results were studiedbased on Severin, Tonnis grading, McKay and acetabularindices.

The preoperative mean acetabular index of36.54 ± 3.27 degrees significantly dropped to postoperativeof 27.06 ± 2.15 degrees. According to McKay criteria, 90.9% of the patients had excellent and good therapeutic results after the surgery. According to Tonnis criteria, 93.9% of patients were in Class I and II after the surgery. Moreover, in radiographic evaluations,96.9% of the patients were in Class Ia and Ib  based on Severin criteria.In 1 patient (3.03%), osteonecrosis of the head was found, in 2 patients (6.06%), walking and lameness impaired walking, and in 3 patients (9.09%), sitting was reported. All patients were female in this study.

According to the clinical results and evaluations of this study, closed reduction along with adductor tenotomy can be used as an appropriate technique for the treatment of patients with DDH at an early age.

Despite years of study, there is no consensus on the best method for treatment of intraarticular calcaneum fracture. This study aims to compare the outcome of operative versus nonoperative modality of management in intraarticular displaced calcaneum fractures over one year.

This is a prospective study carried out at a tertiary care hospital over a period of 2 years: 2017 to 2018 in Surat, Gujarat, India. In this period, out of 49 fractures 25, were treated non-operatively and 24 by operative method (11 Open Reduction Internal Fixation ORIF plating, 13 Minimally Invasive Surgery – (MIS). The outcome was recorded using American Orthopaedic Foot & Ankle Society (AOFAS) score and radiographs up to 1-year post injury. The assessment was made using Analysis of Variance (ANOVA) method.

Operative method of management of intraarticular calcaneal fractures had a significantly better (95% confidence) functional outcome at 3 month compared to non-operative management. However, at 6 and 12 months follow ups the difference between them become insignificant. Non-operative management, however, had more complications as compared to operative management.

Operative modality even in experienced hands has better outcome in terms of AOFAS score and radiographically compared to non-operative method in treatment of intraarticular displaced calcaneal fractures only in first few months. At 6 and 12 months follow up, the functional outcomes become similar.

A delay in diagnosis and inadequate treatment of Benign bone tumors may lead to malignant transformation or damage to other internal organs with time. We decided to Survey the frequency of benign bone tumors and its related factors in patients in a ten-year period referred to Orthopaedic ward of Poursina Hospital, Rasht.

A descriptive retrospective study was designed on bone tumors collected from medical records of 2007 – 2017 patients referred to Guilan university of medical sciences. All the demographic data were collected and analyzed.

The mean age of patients with benign tumors of bone in this investigation was the 43.5 ± 12.93 years. The highest percentage of patients with benign tumors of bone were males (63.9%). The highest percentage of benign tumor of bone was multiple exostosis 25% followed by osteochondroma 22.2% and then osteoid stoma by 16.7%. Using Fisher's exact test showed a statistically significant relationship between gender, age, educational level and location of the benign tumors of bone seen in this study (P=0.001).

Exotosis and osteochondroma are the most common benign bone tumors, and are more in the lower limb in the male gender -Blood pressure and higher education level were the common associated findings.

Developmental dysplasia of the hip (DDH) includes a wide range of abnormalities of the hip that can emerge at any time including embryonic period, infancy, or childhood. The purpose of this study was to examine the clinical and radiographic outcomes of patients with DDH, treated with adductor tenotomy and closed reduction.

The study was retrospectively performed on 30 children (33 joints) with DDH,who were treated with adductor tenotomy, closed reduction and SpicaCast in Ahvaz Razi Hospital during 2015-2017. Inclusion criteria were patients diagnosed with DDH and below 2 years of age. Exclusion criteria were connective tissue diseases, secondary dislocation due to previous infection and acetabulum dysplasia in the context of specific syndrome. After the operation, the patients were evaluated for the severity of injuries associated with dislocation or subluxation of hip joint and hip joint congruity. Theradiographic results were studiedbased on Severin, Tonnis grading, McKay and acetabularindices.

The preoperative mean acetabular index of36.54 ± 3.27 degrees significantly dropped to postoperativeof 27.06 ± 2.15 degrees. According to McKay criteria, 90.9% of the patients had excellent and good therapeutic results after the surgery. According to Tonnis criteria, 93.9% of patients were in Class I and II after the surgery. Moreover, in radiographic evaluations,96.9% of the patients were in Class Ia and Ib  based on Severin criteria.In 1 patient (3.03%), osteonecrosis of the head was found, in 2 patients (6.06%), walking and lameness impaired walking, and in 3 patients (9.09%), sitting was reported. All patients were female in this study.

According to the clinical results and evaluations of this study, closed reduction along with adductor tenotomy can be used as an appropriate technique for the treatment of patients with DDH at an early age.

Obturator type traumatic anterior hip dislocation in adult is rare of all type hip dislocation. Here we report the case of a 30 year old man brought to the emergency department after motor accident, complaining of left hip pain. The X RAY showed an obturator hip dislocation.  Femoral pulse was weaker than the other side and had paresthesia in anteromedial of thigh and could not extend left knee. Dislocation was reduced under general anesthesia. Traction was applied for two weeks. After 1 month he could extend left knee ans sensation was regained in anteromedial of thigh.

K-wiresare generally used in orthopedic fracture surgery. Pinning with metal wires is a reasonable option for proximal humeral fractures treatment. One 91-year-old man received multiple K-wire fixation for left proximal humeral fractures. Later in postoperative follow-up at the outpatient department, he illustrated symptoms of tenderness, swelling, coin-sized bullae formation and ecchymosis over left axillary region.K-wire migration was noted, which lead to brachial artery injury with traumatic pseudoaneurysmformation. The patient underwent emergent surgery wherepreviously placed K-pins were removed and then received revascularization surgery afterward. Functional shoulder brace was adopted for his postoperative immobilization of left shoulder and fracture site bony :union: was noted an year later. He lead independent activity of daily life as previously before the accident.
Previous documents had reported potentially dramatic complications related to wires migration and most of them were intra-thoracic migration cases. We present the uncommon case of brachial artery injury with traumatic pseudoaneurysm. While it may not be as detrimental injury as intra-thoracic migration of K-pins, brachial artery penetration could lead to more undetected clinical symptoms and result in irreversible damage. Orthopedic surgeons should consider related risks when using K-wire fixation over proximal humerus,especially in cases of elder patients with possible lowcompliance to immobilization and low bone quality. Most important of all, doctors must alert patients about the importance of returning for follow-up evaluation postoperatively,and for the removal of K-wires.