Open reduction and internal fixation of the bilateral proximal humeral fracture dislocation with head splitting in an active young adult: a rare case

Proximal humeral fracture is a common injury particularly in elderly. A proper management of these fractures is very challenging, based on the various characteristics of patient, fracture anatomy, equipment and the surgeon experience. Bilateral PHF is a rare condition, which almost always caused by seizure, electric shock and trauma, respectively. An appropriate treatment of these patients needs especial attention to obtain a good clinical outcome. We report a 29-year-old patient who suffered from bilateral proximal humeral fracture with posterior dislocation and splitted humeral head due to the combined mechanism of injury including severe trauma after high voltage electric shock. We did not find similar case(s) reported before in the literature. The patient treated with bilateral open reduction and internal fixation (ORIF). He was able to do his daily activities after 6 month

Operative Treatment of Acute Distal Femur Fractures: Review of literature

Fractures of the distal femur may be extra articular or have an intra articular component. Mismanagement of any of these fractures can result in abnormalities of alignment of the load-bearing axis of lower limb and/or rotational deformities. Essentially all supracondylar femur fractures require operative intervention because of the severe potential risks of prolonged bed rest. Yet, despite their proven track record and benefits over older implants, technical errors are common and must be overcome with proper preoperative planning and intra-operative attention to details. The goal of this study was   to present an update on the management of these fracture

Studying the effect of medial open wedge high tibial osteotomy on the posterior slope of tibia among patients with Genu varum

BackgroundA slight change in the posterior slope of tibia results in complications such as limited movement of knee joint and higher risks of Osteoarthritis.AimsThe present research seeks to study levels of tibia’s posterior slope change and limited movement of knee joint and knee stability following medial open wedge osteotomy used to treat patients with genu varum.Methods The present research is a clinical trial conducted in the form of a before and after study on patients with genu varum resorting to Imam Reza (PBUH), Khanevade, and Fajr hospitals from 2009 to 2012. As many as 40 knees (32 patients) were studied and the posterior slope of tibia before and after medial open wedge high tibial osteotomy was measured by someone totally unaware of the research using true lateral radiography. Movement limitation and stability of the knee was measured before and after the operation using scope of motion and Lachman and Drawer test. Paired sample test was used in this research and SPSS was used to analyse the data.Results The average posterior slope of tibia before the operation was 9.912, while this value changed to 11.625 after the operation signifying a significant increase. In terms of limited knee joint movement, 7 patients were diagnosed with grade 5 Extension LAG after operation, while the remaining 33 patients had a normal motion range (Extension LAG=0).ConclusionMedial open wedge osteotomy above tibia can help increase the posterior slope of tibia

Epidural catheter compared with local infiltration analgesia for postoperative pain relief in total knee replacement

AbstractBackground: This study compares the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty. Materials and methods: 47 females and 13 males with an average age of 65.7 years were randomly allocated into epidural (EA; n=30) and local infiltration anesthesia (LIA; n=30) groups. All patients received spinal anesthesia and were inserted epidural catheter. In LIA group, 50mL of a mixture, containing bupivacaine, ketorolac, morphine sulfate, and epinephrine was injected in to periarticular tissue and in EA group normal saline was injected. In the EA group, after surgery, an epidural catheter was attached to the patient-controlled analgesia (PCA) infusion pump with 25cc bupivacaine diluted in 75mL of normal saline but in LIA group, the PCA pump of the epidural catheter contained 100cc of normal saline, and the pump was blocked.Results: The difference in demographic data was not significant between the groups. The mean VAS score (Pain) of EA group was significantly higher than LIA group until 12 hours after surgery, At 24 hours, there was no significant difference between two groups, and Pain of EA group was significantly lower than LIA group at 48 hours after the surgery. Dranage volume and hemoglobin drops were lower in LIA group. Knee range of motion in the LIA group was not superior to that of the EA group two weeks after surgery. The patients’ ability to perform active straight leg raise had no significant difference between two groups one day after the surgery.Conclusion: local infiltration analgesia is better than epidural for postoperative pain control at first 12 hours. However, epidural analgesia can control postoperative pain more effectively at 48 hours after surgery. There was no significantly difference between two groups regard to patients ability to perform straight leg rising and Knee range of motion was similar in two groups

Comparison of the effectiveness of femoral fixation techniques (Aperfix and Endobutton) in anterior cruciate ligament surgery

BackgroundAnterior cruciate ligament (ACL) is a Strengthener ligament of the knee. About 50 persons per 100,000 annually counter ACL rupture. Based on studies, the majority of people who have high mobility jobs, and had reconstruction surgery after ACL rupture, have returned to pre-injury level of activity.AimsWe compared two methods of surgery (aperfix and endobutton) in this article. We want to answer these two main questions in this study:1 is the effectiveness of surgical methods (aperfix and endobutton) in patients with anterior cruciate ligament rupture, the same?.2 Are the aspects of the knee function, in two surgical methods (aperfix and endobutton) after ACL reconstruction surgery, the same?Methods This study is a prospective clinical trial on patients who had complete ACL rupture in an isolated trauma, who were nominated for ACL reconstruction surgery. We excluded the cases that had underlying disease or other damages from the study. 100 patients were randomly divided into two groups of 50 individuals. Then each group underwent surgery. The femoral fixations were by the two common methods of ";;;;;;;;;;;Aperfix";;;;;;;;;;; or ";;;;;;;;;;;Endobutton";;;;;;;;;;;. We followed up, the cases one year after surgery and evaluated them by lysholm score as well as with IKDC score.Results The mean lysholm score and IKDC score do not have statistically significant difference in the two groups. (Mean lysholm score in Aperfix group=95.66 vs. 94.56 in Endobutton group (p=0.057) and IKDC score=92.32 in Aperfix group vs 92.20 in Endobutton group (p=0.28)). However, in some aspects of knee function, such as locking, Swelling, and climbing stairs, patients who had undergone Aperfix approach, had better results.ConclusionSurgical methods have little difference however due to better results in some aspects of knee functions in this study and due to other studies, it can be said Aperfix method slightly has more benefits. Further investigations with larger number of cases and longer duration of follow-up are recommended

The Efficiency of Locking Compression Plates versus Dynamic Compression Plates in the Treatment of Low Distal Fibula Fracture: A Randomized Clinical Trial

Background: Uncertainties remain as to which type of plate [locking compression plate (LCP) or dynamic compression plate (DCP)] is more efficient and cost-effective in fixing and stabilizing the fractures. We aimed to compare the clinical utility of the two types of plates including LCPs and 3.5-mm DCPs in the treatment of low distal fibula fracture (distal lateral malleolus fractures).   Methods: This randomized single-blinded clinical trial was performed on 54 patients with distal fibula fractures who were candidates for surgical treatment using compression plate fixation. The patients were randomly assigned into two groups scheduled for treatment with fixation of LCPs or with 3.5-mm T-plates (DCPs). The patients were finally followed-up for two years to assess the clinical outcome of the procedures.   Results: No difference was revealed between the two groups in the prevalence of postoperative infection, nonunion, wound dehiscence, skin reactions, and local surgical pain. The mean functional score [Olerud-Molander Ankle Score (OMAS)] in the DCP and LCP groups was 85.33 ± 4.92 and 84.85 ± 5.12, respectively, indicating no difference between the groups (P = 0.726).   Conclusion: In the treatment of low distal fibula fractures, the use of LCPs and 3.5mm DCPs can similarly result in improving functional status with minimal postoperative complications. Due to the similarity of the consequences of using both plates and the fact that the DCP type is more cost-effective and available in remote and deprived areas, this type seems to be preferred.

Studying the effects of primary arthroplasty on post-treatment results among elderly patients with pertrochanteric fracture

Various therapeutic methods are available to treat patients with intertrochantric fracture, which is usually caused by falling down. This complication is usually observed among the elderly, particularly old women. The choice of the proper therapeutic method depends on many factors including patient’s condition, type of fracture, and the amount of movement. Hip arthroplasty is one of these therapeutic methods, which have certain advantages and disadvantages. Immediate resumption of walking with the ability of weight toleration and absence of complications such as aseptic necrosis are some advantages of this method. Sixtyeight elderly patients with pertrochanteric fracture who had resorted to Iranian Army’s hospitals and had undergone arthroplasty. These cases were examined with due comparison with historical and external controls. Variables such a type of operation, age, post-operation pain, the pace of resuming walking ability, embolism, surgical site infection, bedsore and DVT were studied and compared against standard operation. The results achieved through assessment of variables showed a significant difference with standard operation in terms of variables such as post-operative movement ability, pain scale in various times, surgical complications, embolism, surgical site infection, bedsore, and DVT. Post-operative pain within the first 3 months following it are some complications with not much attention is paid to them, but they are important complications which can cause many negative and influential effects on patients. Arthroplasty is more expensive than standard operation and the patient may initially feel more pain

Comparative investigation of percutaneous plating and intramedullary nailing effects on IL-6 production in patients with tibia shaft fracture

Objective: The aim of this study was to analyze the effect of intramedullary nailing (IMN), open plating and percutaneous plating on the induction of IL-6 in patients with tibia fractures. Methods: A total of 30 patients with tibia shaft fracture underwent either intramedullary nailing (IMN, n = 15; 14 males and 1 female; mean age: 32.1 ± 15.6), ORIF plating (n = 8; 5 males and 3 females; mean age: 60.0 ± 17.8), or percutaneous plating (n = 7; 6 males and 1 female; mean age: 43.1 ± 21.4). Serum IL-6 cytokine levels were measured prior to, and 6 and 24 h after the surgery, using a special ELISA kit. Results: The IL-6 concentration increased to peak levels at 6 h in both IMN and percutaneous plating groups, and at 24 h in ORIF plating group (p < 0.001). The mean IL-6 concentration of percutaneous plating group was significantly lower than that of the IMN group at 6 h following the surgery (p = 0.022). In addition, the mean IL-6 concentration of ORIF plating group was significantly higher than that of the percutaneous plating group at 24 h post operation (p = 0.009). Conclusion: Our results suggest that percutaneous plating compared to the IMN has lower effects on IL-6 production in patients with tibia fracture. Level of evidence: Level III, therapeutic study Keywords: Interleukin 6, Intramedullary nailing, Percutaneous plating, Tibia fractur