Corticosteroid Injection by Palpation Guide versus Palpation Guide and Needling Method for Coccydynia

Background: Coccydynia is a painful condition with tenderness and ache in sacrococcygeal area which may radiate to the buttocks and lower back. Coccydynia is a multifactorial disorder and the most common cause of it is trauma. The initial treatment of the disease is conservative methods. One of the most common conservative treatments of chronic coccydynia is the local corticosteroid injection, which performed usually by palpation-guided method. This study was conducted to compare the effectiveness of local corticosteroid injection using palpation and needling method with palpation method alone. Patients and Methods: In this prospective study, 50 patients with the diagnosis of coccydynia were enrolled between 2010 and 2017. All patients had chronic coccydynia which did not respond to conservative therapy for at least three months. Participants were divided into two groups and each group consisted of 25 individuals. Patients who underwent local corticosteroid injection using palpation guide technique alone were assigned as group A and others who underwent palpation guiding injection with needling technique were considered as group B. Results: There was a statistically significant difference between the mean VAS scores in preinjection and final follow up visit in each groups (P value < 0.001). Moreover, the difference between the mean VAS scores of the final visit in groups A and B was statistically significant (P value < 0.001). Conclusion: Local corticosteroid injection using palpation guiding technique with needling is an uncomplicated, inexpensive, and effective invasive conservative treatment for refractory chronic coccydynia.

Treatment of Complex Proximal Tibial Fractures (Types V &VI of Schautzker Classification) by Double Plate Fixation with Single Anterior Incision

Background: complex proximal tibial fractures (Types V & VI of Schautzker classification) are the major problems in orthopedic surgery and associated with high complication rates. There are many alternatives in treatment of these fractures. Aim: to evaluate the results of double plating with single anterior incision in complex proximal tibial fractures (Types V& VI of Schautzker classification).Methods and Materials: 22 patients (16 males and 6 females) with Types V and VI of Schautzker classification of proximal tibial fractures (14 cases were Type V and 8 cases were Type VI) were treated by double plating with single anterior incision method between May 2006 and May 2011. The bony and functional outcome was evaluated according to Knee Society Score. Results: According to Knee Society Score, the results were as follows: excellent in 19 patients (86.4%), good in 2 patients (9.1%), fair in 1 patient (4/5%), and poor in no patient (0%).Conclusion: the double plate fixation with single anterior incision is the best, effective and simple procedure in treatment of complex proximal tibial fractures (Types V and VI of Schautzker classification).

Hybrid External Fixation for Open Severe Comminuted Fractures of the Distal Femur

Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and then fix the condyles to the femoral shaft by minimum handling of the bone and soft tissues. Objectives: To evaluate the treatment of distal femoral open comminuted fractures (type C2 and C3) with hybrid external fixator. Methods: Thirty-four patients with distal femur open comminuted fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. All of the fractures were opened with extension to joint surface. 30 patients were male and 4 were female. Their average age was 30.5 years (17 to 72 years). Average follow up period was 36 months. 12 patients had isolated fracture and 22 patients had multiple fractures. The bony and functional results were evaluated by the association for the study and application of the method of Ilizarov (ASAMI) protocol and knee society score. Results: 29 out of 34 fractures (85%) had union without bone grafts. Average time of union was 6.1 months (4 - 19 ms). The average knee range of motion was 87.5 degrees (30 - 115 degrees). The bony results were excellent in 24 patients (70.5%), good in 6 (17.7%), fair in 2 (5.9%), and poor in 2 (5.9%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%) according to ASAMI protocol. According to the knee society score the functional results were excellent in 9 (26.44%) patients, good in 13 (38.26%), fair in 7 (20.6%), and poor in 5 (14.7%). Conclusion: Hybrid external fixator is an effective method for treatment of distal femoral open comminuted fractures (type C2 and C3) and may be considered as an alternative surgical methods in the management of these fractures.