Although the intramedullary nailing is thought to be the method of choice for treatment of closed tibial shaft, there is ongoing debate on the optimal surgical approach in patients with open types of these fractures. In addition, choosing between the reamed and unreamed intramedullary nailing is still an issue for the orthopedic surgeons. In present study, we aimed to compare the outcome and consequences of OA tubular external fixation vs. unreamed intramedullary nailing in open grade IIIA-IIIB tibial shaft fractures. In a randomized clinical trial, 50 patients with open tibial shaft fractures (grades IIIA-IIIB) were recruited in Tabriz Shohada teaching centre in a 2-year period of time. They randomized in two equal groups underwent either AO tubular external fixation or unreamed intramedullary nailing. These 2 groups were matched for sex, age and fracture-grade. The follow-up time was one year. Union time, surgical outcome, postoperative complications and the ambulation time were compared between the two groups. Twenty five patients, 20 males and 5 females with a mean age of 30.80 +/- 5.24 years were allocated in unreamed intramedullary group and 25 other patients, 22 males and 3 females with a mean age of 28.92 +/- 8.88 years were studied in the external fixation group (p = 0.70 and 0.37, respectively). The two groups were matched for sex (p = 0.70) and age (p = 0.37). The time of union was 3, 4, 5 and 6 < or = weeks after operation in 28, 12, 32 and 28% of the cases in unreamed intramedullary group vs. 4, 12, 48 and 36% of the cases in external fixation group, respectively (p = 0.14). Post-operative infection, soft tissue injury, malunion and nonunion were documented in 16, 8, 0 and 4% of the cases in unreamed intramedullary group vs. 32, 12, 24 and 8% of the cases in external fixation group, respectively (p = 0.19, 0.50, 0.02 and 0.50, respectively). The mean ambulation time after operation was 2.92 +/- 2.43 weeks in the unreamed intramedullary nailing group vs. 2.68 +/- 2.14 weeks in the external fixation group (p = 0.71). Our results are in favor of unreamed intramedullary nailing against external fixation in treatment of open tibial shaft fractures.

BackgroundEvaluating demographic characteristics, distribution and types of orthopedic injuries following major earthquakes may be helpful in future planning for disasters.ObjectivesThis study aimed to analyze data from trauma patients with extremity injury resulting from the earthquakes of East Azerbaijan, Iran.Patients and MethodsMedical records of 686 patients admitted to Shohada hospital, Trauma Center of Tabriz University of Medical Sciences were reviewed. There were 200 patients with extremity injury assessed. Demographic characteristics and patterns of injuries in these patients were evaluated.ResultsIn this study, there were 105 females (52.5%) and 95 males (47.5%), out of which, 6 (3%) patients with associated severe head injuries died. The most common sites of injury were lower extremities (81 patients, 41.5% of total victims) while 32 patients (16%) suffered from both upper and lower extremity injuries. Open Fractures were seen in lower extremities of 26 (13%) patients. Compartment syndrome was observed in 3 (1.5%) patients with lower limb fractures. Also, 42 (21%) patients living in Tabriz were injured while they were running away (falling down the stairs and jumping out of windows).ConclusionsExtremity injuries especially open fractures of lower limbs account for the majority of hospitalized victims. Compartment syndrome is one of the main problems that should be addressed. Our study demonstrates that people still need more education regarding earthquakes and the government should direct more attention to this issue.

Traumatic cutting of peripheral nerves of median and ulnar in forearm and wrist can cause disablating sensory and motor disorders in patients' hands. We conducted the present study to compare the results of three surgical methods for repair of injured median and ulnar nerves. We studied 85 patients aged 12-59 years (average, 34 +/- 18 years) with 105 cut median and ulnar nerves at forearm and wrist presenting to Tabriz Shohada hospital from 1994 to 2003. The patients followed for 2-10 years. Sixty patients (65 nerves) underwent primary repair, 16 (25 nerves) treated with delayed method and 9 (15 nerves) received nerve graft. Success was obtained in all patients underwent primary repair. The excellent results were common in younger patients. Of 65 nerves (60 patients) repaired by primary method, 25 had excellent result. Of 16 patients 25 nerves (16 patients) underwent delayed repair, 7 was unsuccessful. Of 15 nerves (9 patients) underwent delayed repair, 5 was unsuccessful. It is concluded that the recovery following primary repair was faster than other methods. For reaching excellent results in repairing peripheral nerves, it is important to considering all rules needed for repairing cut peripheral nerves, as well as accurate evaluation and correct repair of injured surrounding soft tissue such as tendons and their synovium and injured vessels.

The management of an Anterior Cruciate Ligament (ACL) avulsion is principally by surgery. There are two major techniques in this regard; fixation through open surgery (arthrotomy) or arthroscopically-assisted repair. These are not new in the literature; however, the debate regarding the better approach is still under debate. This study focused on comparing outcome and consequences of arthroscopically-assisted vs. open surgery in repairing ACL avulsion. In a randomized clinical trial, 44 patients with unilateral ACL avulsion were recruited in Tabriz Shohada teaching Centre during a 12 month period of time. These patients were randomized in two equal age and sex-matched groups underwent either arthroscopically-assisted or open ACL repair. The constructive technique was the same in both groups without using any graft. The minimum follow-up period was 6 months including 3 weeks, 3 months and 6 months postoperatively. Range of Motion (ROM), laxity, Anterior Drawer Test (ADT) result, duration of hospital stay, wound status, nonunion and return to previous work were compared between the two groups. Mean time of suture removal (p = 0.10), minimum and maximum ROM at months 3 (p = 0.43 and 0.22, respectively) and 6 (p = 0.73 and 0.77, respectively), ADT at months 3 and 6 (p = 0.16 for both), laxity at month 6 (p = 0.28) and wound status at week 3 (p = 0.35) were not significantly different between the two groups. There was no case of nonunion at month 6 in either group. The mean hospital stay was significantly shorter in the arthroscopy group (3.77 +/- 0.92 vs. 2.50 +/- 0.51 days; p < 0.001). The mean laxity score was significantly higher in the open surgery group at month 3 (4.82 +/- 0.59 vs. 4.45 +/- 0.60; p = 0.05). The rate of nonunion was significantly higher in the open surgery group at month 3 (40.9% vs. 9.1%; p = 0.02). Patients in the arthroscopically-assisted technique group returned sooner to previous work (17.41 +/- 1.53 vs. 14.82 +/- 0.96 weeks; p < 0.001). Based on our results, arthroscopically-assisted reconstruction of ACL avulsion is superior to open surgery.

Developmental Dysplasia of the Hip (DDH) is a common congenital malformation. Avascular necrosis of femoral head is the major complication of both close and open reduction of the dislocated joint. Aim of this study was to determine the incidence and influencing factors in different types of a vascular necrosis of femoral head, following surgical treatment of developmental dysplasia of hip in 1-7 years patients. In this study, 120 patients aged from 1 to 7 years old with DDH who had been undergone open surgery, entered to the study. All of these patients followed up for at least 1 year. Surgery procedures divided to 4 groups: open reduction, open reduction+salter osteotomy, open reduction+femur shortening and open reduction+salter osteotomy+femur shortening. The presence of Avascular Necrosis (AVN) had been appraised. 27.5% of surgeries performed on male and 72.5 on female patients. 35.0% of DDH cases were unilateral and remaining was bilateral. 36 patients (30%) shows radiologic findings of AVN, although all of them placed at group I of Bucholz-Ogden classification. 40% of group A patients, 25% of group B, 14.3% of group C and 36.4% of group D patients developed this findings. Open reduction of DDH in older children is effective in the management of DDH and if all of the contrivance considered in the surgery, the rate of AVN would be low and mild (at least in short term follow ups).