ABSTRACT: IntroductionCarpal height is a radiographic ratio with clinical significance in rheumatologic diseases and Kienbock disease, which is
measured with different methods. The purpose of this study is assessment of two popular methods of measurement of this angle
with respect to inter- and intraobserver variabilities.
Materials and methodsGood-quality photographs were made of 20 radiograms and two experienced orthopedists, in two separate occasions measured the
length of third metacarpal, the longest length of capitate, and the distance between the base of third metacarp to the articular
surface of the radius. The remainder of the calculations was made by computer.
ResultsIntraobserver reliability of the Youm and Nattrass ratios was calculated as high and fair, respectively. With regard to interobserver
reliability, the accuracy of both indices was poor. Intra- and interobserver agreement for detection of collapse of the wrist
was substantial for Youm ratio and fair to moderate for Nattrass ratio. The ratios had poor agreement with each other with
regard to detection of collapse of the wrist joint.
ConclusionAlthough neither of the ratios had perfect or high reliability with regard to the subject of the study, it seems that the
accuracy of Youm index is higher.
KeywordsCarpal height-Interobserver reliability-Intraobserver reliability
European Journal of Orthopaedic Surgery & Traumatology 04/2012; 20(4):299-301. · 0.10 Impact Factor
ABSTRACT: IntroductionUpper part brachial plexus injuries result in paralysis of Biceps and inability of active elbow flexion. If repair of damaged
nerves proves to be impossible, reconstruction surgery will be indicated. Oberlin procedure is a reconstructive method for
restoration of elbow flexion in which, posteromedial fascicle of ulnar nerve is transferred to the motor nerve of Biceps.
In this article, we evaluated the results of this procedure in 10 patients in whom treatment was performed relatively late.
MethodTen patients with inability of active elbow flexion due to upper part brachial plexus injury were operated by Oberlin procedure,
on average 7months after the injury.
ResultsIn 9 patients among 10 patients, active elbow flexion by contracture of biceps muscle was restored and in 8 of them the result
was considered to be satisfactory. No complication was observed.
ConclusionOberlin procedure is a safe and effective method for restoration of active elbow flexion, in upper part brachial plexus injuries.
We did not find a statistically significant correlation between the interval between trauma and surgery, time of first of
contraction in biceps and grade of muscle power in biceps at 12months.
KeywordsBrachial plexus palsy-Ulnar nerve-Elbow flexion
European Journal of Orthopaedic Surgery & Traumatology 04/2012; 20(4):293-297. · 0.10 Impact Factor
ABSTRACT: Tendon transfer for radial nerve paralysis has a 100 years history and any set of tendons that can be considered to be useful has been utilized for the purpose. The pronator tress is used for restoration of wrist dorsiflexion, while the flexor carpi radialis, flexor carpiulnaris, and flexor digitorum superficialis are variably used in each for fingers and thumb movements. The present study was a retrospective analysis, designed to compare three methods of tendon transfer for radial nerve palsy.
41 patients with irreversible radial nerve paralysis, who had underwent three different types of tendon transfers (using different tendons for transfer) between March 2005 and September 2009, included in the study. The pronator teres was transferred for wrist extention. Flexor carpi ulnaris (group 1, n=18), flexor carpi radialis (group 2, n=10) and flexor digitorum superficialis (group 3, n=13) was used to achieve finger extention. Palmaris longus was used to achieve thumb extention and abduction. At the final examination, related ranges of motions were recorded and the patients were asked about their overall satisfaction with the operation, their ability, and time of return to their previous jobs, and in addition, disabilities of the arm, shoulder and hand (DASH) Score was measured and recorded for each patient.
The difference between the groups with regard to DASH score, ability, and time of return to job, satisfaction with the operation, and range of motions was not statistically significant (P>0.05). All of the patients had experienced functional improvement and overall satisfaction rate was 95%. No complication directly attributable to the operation was noted, except for proximal interphalangeal joint flexion contracture in three patents.
The tendon transfer for irreversible radial nerve palsy is very successful and probably the success is not related to type of tendon used for transfer.
Indian Journal of Orthopaedics 11/2011; 45(6):558-62. · 0.50 Impact Factor
ABSTRACT: Tourniquet use in orthopedics is practiced for the sake of the surgeon's comfort with a bloodless field, though it is associated with potential risks. This study was performed to assess the effects of using or avoiding a tourniquet when plating acute extra-articular tibial fractures.
One hundred thirty-eight patients with acute extra-articular tibial fractures were randomized into two groups: "tourniquet" and "without tourniquet". Postoperative pain, amount of hemovacuum drainage, and duration (time to complete bone union and nonunion, and development of infection) were assessed.
At the end of the study, all 138 patients had been followed up for at least 1 year. The difference between the two groups was statistically significant with regard to duration of surgery, amount of hemovacuum drainage, and postoperative pain. The patients in without tourniquet group perceived less pain (p = 0.007), and their hemovacuum drainage was lesser than that of the tourniquet group (p = 0.03), though the average duration of the operation was longer (p = 0.001).
Avoidance of tourniquet use does not decrease the time to union or nonunion or the infection rate after plating of tibial fractures, but it is associated with a decrease in the patient's pain perception in the postoperative period.
The Journal of trauma 12/2010; 69(6):E94-7. · 2.48 Impact Factor
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 16(6):e17-9. · 1.93 Impact Factor
ABSTRACT: Tibiotalar dislocation without concomitant fracture in the surrounding bones is a rare injury. We report this type of injury presenting unreduced after a 10-month interval. A 23-year-old woman presented to our clinic 10 months after an earthquake in Bam, Iran, during which she had sustained an anterior tibiotalar dislocation without any associated fracture. Open reduction was attempted twice, but was not successful because of poor bone quality. Although ankle dislocation has been reported to be associated with good prognosis, this was not the case with our late-presenting patient. We could not find a similar case in the literature.
The Journal of Foot and Ankle Surgery 46(4):307-9. · 0.52 Impact Factor