Iranian Journal of Orthopedic Surgery

Abstract Abstract
Introduction: Intra-articular pilon fractures of the distal tibia are complicated fractures with far-reaching long-term functional consequences. Despite improved surgical methods, the ideal management protocols and resulting recuperation patterns continue to be topics of recent investigation. This study aims to compare functional outcome, and rates of complications after surgical management of pilon fractures by open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO) and also to compare the effect of age on recovery and modes of complications.
Materials & Methods: This is a prospective observational cohort study of 183 type B or C pilon fracture patients treated at a single trauma center. The level of functional recovery 2 weeks, 6 weeks, 3 months, 6 months, and 12 months post-injury was measured by the Foot Function Index (FFI). Postoperative complications were noted, and the time to return to normal activities. Repeated-measures ANOVA was employed in the assessment of temporal changes in FFI scores.
Results & Discussion: There was significant improvement on all subscales of FFI during 12 months of time (P<0.001), with most improvement in the first 6 months. The mean duration of time to return to activity was 25.5±7.5 weeks. Complications were malunion (23.0%), nonunion (30.6%), deep infection (15.8%), loosening of implant (14.8%), and reoperation (36.6%). Age was correlated with increased complications. Compared with ORIF, MIPO achieved comparable 12-month functional recovery (FFI improvement) while demonstrating a lower, though not statistically significant, rate of deep infection, suggesting similar efficacy with a potential advantage in soft-tissue preservation.
Conclusion: Operative management of pilon fracture yields significant functional improvement, although complications are common. Prognosis depends on age. Preoperative planning should be meticulous, close observation necessary, and individualized rehabilitation in order to maximize outcome.

Abstract Abstract
Introduction: Dual mobility (DM) implants have been increasingly adopted in total hip arthroplasty (THA) to reduce the risk of postoperative instability. However, evidence comparing DM and conventional THA in Middle Eastern populations remains limited.
Materials & Methods: In a retrospective case-control study the patients who had undergone primary unilateral THA in one year at two major medical centers were evaluated. The case-group received DM implants, and the control- group had conventional THA. Within a one-year follow-up, the pain (Numeric Rating Scale), hip function (Harris Hip Score), and quality of life (EQ-5D), and Postoperative complications were compared.
Results & Discussion: The 86 patients studied included 42 DM and 44 conventional THA cases. Both groups experienced significant improvement in pain, function, and quality of life at one-year follow-up. The DM group demonstrated greater improvements in EQ-5D scores and higher postoperative HHS compared to the conventional group. The only dislocation (4.6%) in the conventional-group had no statistically significance. Other postoperative complications, including infection and DVT, were comparable between the groups.
Conclusion: DM hip arthroplasty was associated with more favorable postoperative functional recovery and quality of life outcomes, without a significant increase in complications, in short-term follow-up. These findings support the broader application of DM implants in primary THA, although further prospective studies are needed to assess the long-term outcomes and also cost-effectiveness.

Abstract Abstract
Introduction: Intra-articular pilon fractures of the distal tibia are complicated fractures with far-reaching long-term functional consequences. Despite improved surgical methods, the ideal management protocols and resulting recuperation patterns continue to be topics of recent investigation. This study aims to compare functional outcome, and rates of complications after surgical management of pilon fractures by open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO) and also to compare the effect of age on recovery and modes of complications.
Materials & Methods: This is a prospective observational cohort study of 183 type B or C pilon fracture patients treated at a single trauma center. The level of functional recovery 2 weeks, 6 weeks, 3 months, 6 months, and 12 months post-injury was measured by the Foot Function Index (FFI). Postoperative complications were noted, and the time to return to normal activities. Repeated-measures ANOVA was employed in the assessment of temporal changes in FFI scores.
Results & Discussion: There was significant improvement on all subscales of FFI during 12 months of time (P<0.001), with most improvement in the first 6 months. The mean duration of time to return to activity was 25.5±7.5 weeks. Complications were malunion (23.0%), nonunion (30.6%), deep infection (15.8%), loosening of implant (14.8%), and reoperation (36.6%). Age was correlated with increased complications. Compared with ORIF, MIPO achieved comparable 12-month functional recovery (FFI improvement) while demonstrating a lower, though not statistically significant, rate of deep infection, suggesting similar efficacy with a potential advantage in soft-tissue preservation.
Conclusion: Operative management of pilon fracture yields significant functional improvement, although complications are common. Prognosis depends on age. Preoperative planning should be meticulous, close observation necessary, and individualized rehabilitation in order to maximize outcome.

Abstract Abstract
Introduction: Knee dislocation has potential for complex injury to blood vessels nerves and ligaments. It requires prompt diagnosis and treatment. Radiological assessments aid in guiding appropriate orthopedic and surgical interventions. This study aims to assess the treatment outcomes of knee dislocations.
Materials & Methods: A cross-sectional study of patients admitted to an orthopedic center within 4 years with knee dislocation was conducted. Demographic data, initial treatments, correlated injuries, pain severity, and post-surgery outcomes were collected. The initial management which was with external fixation or bracing were conquered. Statistical analysis was performed using SPSS v25.
Results & Discussion: Sixty-two patients (11 female, 51 male) were enrolled. Motor vehicle accident, car accident, and falls were common causes. Co-occurring injuries included ligamentous, vascular, and nerve injuries, with the first one being predominant. The initial treatments were by either bracing or external fixation. No re-dislocation was reported in the external fixator group, while 5 occurred in the bracing group. Pain severity scores were lower in the external fixator group at 1 and 3 months post-surgery. Time to return to work and duration of rehabilitation were, non-significantly, shorter in brace treatment group.
Conclusion: Both brace and external fixator show promise as initial knee dislocation treatments, offering distinct benefits. Definitive conclusions warrant comprehensive clinical trials.

Abstract Abstract
Introduction: Humeral shaft fractures are highly prevalent. These fractures can lead to complications and significantly impact quality of life. Choosing the appropriate surgery type presents challenges of high cost, and economic burden. We are investigating and comparing the outcome of Intramedullary Nailing (IMN) surgery with reaming and nailing without reaming as a treatment method for humeral shaft fractures and its outcomes.
Materials & Methods: This study was a prospective cohort study that examined patients with humerus shaft fractures in 2023. The study was conducted on nailing humeral fractures in a teaching hospital. The patients were randomly divided into two groups: One group was treated with intramedullary nailing with reaming, and the other group without reaming. The patients were monitored for pain, delayed union, non-union, infection, radial nerve palsy, and healing status at intervals of two weeks, one, three, and six months after surgery.
Results & Discussion: Sixty-nine patients including 29 in non-reamed and 40 in the reamed cases were studied. Union was observed at 11.1±3.5 weeks in non-reamed and 8.2±1.9 in reamed group, delayed union was observed in 3 of non-reamed and 2 of reamed cases. One case of non-union was in non-reamed group. In the second week of the follow-up, the reamed group reported significantly higher pain levels; however, no significant difference was observed in the 4th and 12th weeks of follow-up. There was no significant difference between the two groups regarding complications.
Conclusion: Reamed IMN of humeral fracture can reduce the union time, and helps to lower the occurrence of delayed union and non-union. However, the patients would experience more pain in few first post-surgery weeks and reaming.