Tehran University Medical Journal

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: One of the difficulties in acetabulum surgery is appropriate exposure of the site of surgery. Trochanteric flip osteotomy is one of the surgical methods for superoposterior and posterior acetabulum exposure. However, due to possible complications some surgeons prefer to avoid this procedure. This study was undertaken to determine the outcome of surgical treatment of acetabular fracture using trochanteric flip osteotomy.
Methods : In this prospective cohort study, 14 patients with acetabular fracture who had been admitted in Imam Khomeini Hospital in Tehran, Iran, during 2003-2006 underwent trochanteric flip osteotomy. The patients were followed for at least one year post-surgically. Demographics, radiologic findings, intensity of pain using visual analogue scale (VAS), Harris hip score (HHS), force of hip abductors and complications were noted. Data analysis was performed using SPSS ver. 13.
Results : The mean HHS was 82.5 (55-95). Heterotopic ossification was observed in three patients. There were no cases of postoperative infection or non::::union::::. Only two patients showed displacement of osteotomized fragments. Reduction was anatomic in 10 patients. In one patient, the force of hip abductors was three-fifth. The mean hip pain was 3.4 based on VAS. There were no cases of femoral head osteonecrosis. With respect to HHS, the final hip status was excellent and good in four and six patients, respectively. Three patients had fair and only one patient had poor condition.
Conclusion: It seems that trochanteric flip osteotomy has much fewer complications in comparison to other methods justifying its use in such cases.

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Background: High tibial open wedg osteotomy is one of the most important modality for treatment of varus deformity in order to correct deformity and improving signs and symptoms of patients with primary degenerative osteoarthritis. The aim of this study was to investigate the results of high tibial open wedge osteotomy in patients with varus deformities.
Methods: This retrospective study conducted on twenty nine patients (36 knees) undergone proximal tibial osteotomy operation in Shafa Yahyaian University Hospital from 2004 to 2010. Inclusion criteria were: age less than 60 years, high physical activity, varus deformity and involvement of medical compartment of knee. Patients with obesity, smoking, patelofemoral pain, lateral compartment lesion, deformity degree more than 20 degree, extension limitation and range of motion less than 90 degree were excluded. The clinical and radiologic characteristics were measured before and after operation.
Results: Fourteen patients were females. All of them were younger than 50 years, with mean (±SD) 27.64 (±10.88). The mean (±SD) of follow up time was 4.33 (±1.7). All the patients were satisfied with the results of operation. Tenderness and pain decreased in all of them. In all patients autologus bone graft were used, in 15 cases (42.5%) casting and in the rest T.Buttress plate were used for fixation of fractures. In both groups of primary and double varus the International knee documentation committee (IKDC) and modified Larson indices were improved after operation, but there was no significant difference between two groups.
Conclusion: High tibial open wedge osteotomy can have satisfying results in clinical signs and symptoms of patients with primary medial joint degenerative osteoarthritis. This procedure also may correct the deformity and improves the radiologic parameters of the patients.

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Background: Genu valgum deformity is exaggerated valgus alignment of lower extremity mechanical axis in knee with a joint line that slopes superolaterally and is corrected by distal femoral osteotomy. In this study the results of treatment and satisfaction in patients with genu valgum were evaluated according to knee society score (KSS) and changes in pre-operation and post-operation lower extremity mechanical axis were compared to each other. Methods: The present study is a cross-sectional study that was performed on 27 patients (30 knees) who have had distal femoral varus osteotomies between 2005 to 2011. Patient’s data were collected from hospital documents, pre-operation and post-operation alignment views and physical exams of operated patients. Radiographs were from the lower extremities and including three joints of hip, knee and ankle (alignment view). Mechanical axis of femur and tibia were drown and they were compared to each other. For measuring patient satisfaction, KSS score was used. All data was collected and evaluated by SPSS 16 software. Results: In this study, 30 knees (in 27 patients) by mean of 30.7±3.36 months follow- up, (range, 5-76 months) were evaluated. The mean of ages in patients was 19.66±4.35, (range 10-34 years). Ten cases (37%) of valgus were on the right side and 14 cases (52%) on the left side and three (11%) cases were reported on both sides. Based on Student’s t-test, there was a significant difference in post- operation lower extremity mechanical axis. The mean of KSS score was 82.52 and the score was defined as 60.7% excellent, 25.1% good, 7.1% fair, and 7.1% poor in patients. According to the results of study, in five patients were non-::::union:::: and re-operated. Conclusion: Distal femoral varus osteotomy is a reliable procedure in knees with valgus correction. This procedure with precise selection of patients, have acceptable end results.

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Background: Acetabular dysplasia is a well-known cause of early osteoarthritis of hip which may appear at any time (perinatal, breast-feeding and childhood). The aim of this study was to evaluate the clinical and radiographic outcomes of children with de-velopmental dysplasia of hip (DDH) after undergoing open reduction, capsulorrhaphy and Pemberton osteotomy procedures.

Methods: This study prospectively conducted on 13 patients with DDH who attended to Razi Hospital at Ahvaz Jundishapur University of Medical Sciences at Ahvaz, Iran, from April 2012 to March 2015. Inclusion criteria were children with age range of 18 months to 8 years and acetabular index≥ 40 degree. Exclusion criteria were the age less than 18 months or above 8 years, connective tissue diseases, secondary dislocation due to previous infection, and acetabular dysplasia with specific syndrome. All patients were evaluated before surgery and at least one year after surgery in terms of clinical evaluations, dislocation or subluxation of hip, congruity of hip and radiological out-comes according to grading systems of McKay, Tonnis grading system, Severin classi-fication and acetabular index, respectively. All patients underwent open reduction, capsulorrhaphy, and Pemberton’s osteotomy in single-stage surgery and if necessary femoral shortening was performed.

Results: Ten patients (12 hips) were evaluated. Of those, 4 patients (40%) had right hip involvement. The mean age score was 38.92±12.37 months (range: 24-65 months). Acetabular index showed significant reduction after surgery in compare to before sur-gery (P= 0.002). According to Tonnis grading, 91.6% of cases were in I-II classes. Moreover, 66.6% of cases at clinical examinations of McKay criteria had excellent and good results after surgery. According to Severin radiographic findings criteria, 83.2% of cases were in I-III classes after surgery. There was statistically significant improvement in patients according to different grading systems.

Conclusion: In conclusion, Pemberton osteotomy could be an effective procedure and also in conjunction with other surgical procedures for the treatment of patients with DDH who presented in higher age and late.