Tehran University Medical Journal

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Flexor tendon injury is one of the unanswered problems in reconstructive surgery of the hand. Although pull out method is one of the best reconstructive approaches but still is controversial. Surgeons prefer immobilization to prevent laceration at the site of the suture but it may cause adhesion and lead to surgical failure. The aim of this study was to perform a new surgical method to achieve a tendon repair without these problems.
Methods: In this case-series study, 80 fingers with flexor tendon impairment selected and divided into four groups (tendon laceration & avulsion, tendon graft reconstructed in 1 & 2 stages) then patients were surgically treated by the new technique. The most important aspect of the technique is the placement of the suture in the direction of strength therefore, following any tension the suture would be tighter and this point help us to mobilize the injured tendon immediately after the surgery then we analyzed the results depends on the patient's group.
Results: The pull out and surgical (functional) results were evaluated. 97% of the pull out results were good and 3% were poor and surgical results were 23.9% excellent, 52.2% good, 17.9% fair and 6% poor.
Conclusion: Depend on the acceptable results, immobilization in these patients is unnecessary & active and passive range of motion would be gradually increased as soon as possible. However biomechanical studies would be beneficial to evaluate this suture influence and designing future studies to compare this technique with old methods would be essential.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Kienbock disease is characterized by avascular necrosis of the lunate bone. Without treatment, it is usually progressive. While many factors may predispose to Kienbock's disease, it is likely caused by a combination of repetitive loading, vascular risk and mechanical predisposition. Treatments therefore have been designed to decrease compressive loading of the lunate, to prevent lunate collapse, and to allow lunate revascularization. There has been suggested different treatments, no treatment has ever been proved successful and the rate of surgical complication is relatively high. In this study we performed a new surgical method in the treatment of Kienbock disease. In this method we performed lunate decompression which is a very simple procedure and has no potential complication.
Methods: in this study, 11 patients with Kienbock disease in the stage of I to IIIb were surgically treated by a new method of lunate core decompression. The pain, range of motion, functional disability and radiographic indices of the patients were evaluated after two years.
Results: the average age of patients were 29 years, 8(72%) were men. The mean pre-operative pain score (VAS) diminished from 87.5 to 13.5 postoperatively (p<0.001) and DASH score from 84 to 14 (p<0.001) and range of motion was also significantly improved. 7(63%) persons were very satisfied, 2(18%) were satisfied and 2(18%) were not much changed.
Conclusions: Our findings suggest that the new surgical treatment of lunate core decompression could probably be a simple and effective treatment of Kienbock disease without any potential complication.

Background: Comminuted subtrochanteric fractures have been a challenge for orthopedic surgeons in terms of appropriate reduction and stable fixation. Numerous methods have been used for the fixation of comminuted subtrochanteric fractures among which some are accompanied with technical difficulties and complications of their own. Regarding the results of previous studies, we decided to evaluate the biological fixation method in comminuted subtrochanteric fractures.

Methods: In this prospective study, we evaluated 20 men with comminuted subtrochanteric femoral fractures. The patients underwent indirect reduction with dynamic hip screw (DHS) or dynamic condylar screw (DCS) fixation within one week of injury. The patients were evaluated clinically for pain, hip and knee range of motion, leg-length discrepancy and angular and rotational deformities, in addition the radiographic assessment of the ::::union::::.

Results: According to Seinsheimer's classification of subtrochanteric fractures, four patients had type III, nine had type IV and seven had type V fractures. Fracture fixation was performed by DCS in eight and by DHS in 12 cases. The average time of the operations was 79.4 (ranging from 60-125) minutes. Mean blood loss was 634 (ranging from 340-1160) milliliters. Uneventfully, ::::union:::: occurred in all patients with no clinical pain or dysfunction.

Conclusion: Submuscular plating with either DCS or DHS is a viable option to treat comminuted subtrochanteric fractures. The results of this study highly suggest use of submuscular plating in the treatment of comminuted subtrochanteric fractures, especially in the third world countries.