Introduction The traditional treatment for congenital vertical talus, which involves serial casting and extensive soft-tissue releases, has been associated with severe stiffness and other complications in adolescents and adults. Our hypothesis is that favorable results will be obtained using the Dobbs method of serial manipulation, casting, and limited surgery for vertical talus correction, even in older children and syndromic cases. Therefore, the present study aimed at evaluating the Dobbs method in such cases. Materials and methods We treated 15 feet of 10 patients (aged from 1 month to 9 years) using manipulation and serial casting or the reverse Ponseti method followed by percutaneous Achilles tenotomy and limited open reduction of the talonavicular joint. All patients were evaluated both clinically and radiologically in a mean follow-up period of 2 years. Results After 2 years, all patients had plantigrade and flexible feet with good radiographic correction. The mean talocalcaneal angle before (70.5°± 10.5) and after (31°± 5.2) treatment and the talar axis metatarsal base angle before (60°± 11.4) and after (15°± 6.7) treatment were significantly improved (P \ 0.001). Discussion Recent research has shown that manipulation and serial casting followed by limited surgery (Dobbs method) was successful in treating idiopathic congenital vertical talus. Our results also showed that this method resulted in an excellent outcome in both idiopathic and syndromic congenital vertical talus, even in older children.

BackgroundTibial fractures are the third most common pediatric long-bone fracture after forearm and femoral fractures. Approximately 50% of pediatric tibial fractures occur in the distal third of the tibia. This is followed by midshaft tibial fractures (39%), and least commonly, the proximal third of the tibia is involved. Tibial fractures in the skeletally immature patient can usually be treated without surgery but tibial fractures resulting from high energy traumas are of special importance considering type of the selected treatment method affecting the children future. Manipulation and casting are regarded as definite treatments for children tibial fractures. They are used following compartment syndrome in poly-trauma, neurovascular damages, open fractures, and fasciotomy cases.ObjectivesIn children, most open fractures occur due to high energy traumas and inappropriate treatment of the fractures may result in several complications. Flexible intramedullary nailing is one of the popular options as an effective method of treating long-bone fractures in children. The external fixator is used in cases with severe injuries and open fractures. The present study aims at comparing results of these two treatment methods in the open pediatric tibial fractures.Materials and MethodsIn this descriptive analytical study, 32 patients with open tibial fractures were treated with either fixator (n = 18) or TEN nails (n=14) during 2006-2011. Some patients were treated with a combination method of TEN and pin. The results were evaluated considering infection, union, mal-union, and re-fracture and the patients were followed up for two years.ResultsMean time required for fracture union was 12.5 (11-14) and 11.8 (10-12) weeks for the external fixator and TEN groups, respectively. There was no statistical difference in time of union between the two methods. The main complications in external fixation were infection around the pin 4 (22.2%), leg-length discrepancy 2 (11.1%) and re-fracture 4 (22.2%). In the TEN group, 2 cases (14.2%) of painful bursitis were observed at the entry point of TEN and the pin was removed earlier. There was not any report of mal-union requiring correction in the groups. No complication was seen in 6 patients treated with a combined method of pin and flexible intramedullary nails.ConclusionsAlthough external fixation in open pediatric fractures and severe injuries is recommended, intramedullary nailing is also an effective method with low complications. Combining pins and flexible intramedullary nails is effective in developing more stability and is not associated with more complications.

Study DesignDescriptive, cases series study.PurposeTo evaluate clinical findings and results of treatment of patients with spinal osteoid osteoma who underwent surgery.Overview of LiteratureOsteoid osteoma is a benign tumor with spinal involvement rate of about 10%. It is manifested during adolescence with symptoms such as painful scoliosis. To treat the problem, operation on the patients and excising the nidus are suggested.MethodsThis descriptive study was conducted on 11 patients with spinal osteoid osteoma at our orthopedic educational center. All patients were treated through open surgery and nidus curettage. All samples were pathologically confirmed. Imaging methods (spiral computed tomography-scan) was used in preoperative planning. Scoliosis and other clinical findings were studied.ResultsThe study was conducted on 11 patients comprising 6 females (54.5%) and 5 males (45.5%) with the mean age of 14.6 years. Mean deviation of scoliosis resulting from spinal osteoid osteoma was 22.8 degrees. There was more scoliosis in the involvement of the lumbar vertebra. In comparison with adults, scoliosis was more severe in youths. There was one case of vertebra body involvement with manifestation of painful scoliosis. Due to lack of careful preoperative examination, the surgery was repeated for this case. No sign of recurrence was observed in patients who underwent open surgery and all scoliosis in the follow-up had improved.ConclusionsBased on our findings, surgical excision of spinal ostoeid osteoma was successful and complete recovery was achieved in spinal deformity in the course of follow-up. Scoliosis is often seen during adolescence and lumbar involvement is more severe.

Level 3.

No abstract

II.

BackgroundDistal radius fractures are among common fractures in the elderly. Regarding the age, background diseases, and possible risks, analgesia method is of great importance in this group.ObjectivesThe aim of this study was to compare two analgesia methods including hematoma block and general anesthesia in people over 60 years in the orthopedic emergency department.Methods68 elderly patients referring to the emergency department of a medical teaching center were selected based on the inclusion criteria for a non-randomized clinical trial. The patients were placed in two groups of 34, which were matched for age and sex. Hematoma block was used as the analgesic method in one group and general anesthesia was used in the other group. These two groups were compared for pain intensity, analgesia duration, and anesthesia side effects. The SPSS software (Statistical Package for the Social Sciences, version 17.0, SPSS Inc., Chicago, Ill, USA) was used for data analysis.Results68 elderly patients (mean age of 70.3 ± 6.6) with a dislocated distal radius fracture which required closed reduction were examined. The duration of manipulation and surgery and discharging time were significantly different between two groups and they were all lower in the hematoma blocked group. Pain intensity evaluation indicated a statistically significant difference during initial hours after fracture reduction and fixation so that pain intensity was less in elderly patients under hematoma block than patients who underwent general anesthesia in one and six hours after surgery. Need for narcotic was 35.2% in the general anesthesia group which also showed a significant between-group difference.ConclusionsHematoma block analgesia used in distal radius fractures of the elderly is a very safe and effective method that seems preferable to general anesthesia in emergency departments.

Schwannomas and neurofibromas are rare benign tumors originating from the peripheral nerve sheath. Tumors in neurofibromatosis are mostly neurofibromas and often appear in the soft tissue of peripheral nerves. In this report, a patient presented with two large adjacent soft tissue tumors in the right wrist and distal forearm which originated from a common nerve. A schwannoma had formed beside a neurofibroma from the ulnar nerve and induced numbness and paresthesia in the little and ring fingers. Although the patient had café au lait spots on the skin, neurofibromatosis was not suspected due to lack of symptoms. The patient was referred to the current research clinic suffering from two soft tissue masses in the wrist and ulnar nerve dysfunction. In neurofibromatosis patients, two tumors of a different nature originating from a common nerve close together have rarely been described in the literature. The patient was treated by en bloc excision of the mass while protecting the nerve fascicles. The follow-up results indicated no neurological symptoms and complete restoration of ulnar nerve function.