Iranian Journal of Orthopedic Surgery

Abstract Abstract
Introduction: Adhesive capsulitis, commonly known as frozen shoulder, is a prevalent and painful condition that limits shoulder mobility. A strong association exists between diabetes and this condition. This study aims to investigate the inflammatory risk factors involved in the development of adhesive capsulitis in diabetic patients.
Materials & Methods: In a descriptive-analytical study, individuals diagnosed with adhesive capsulitis were evaluated over three years. Among these patients, those with a confirmed diagnosis of diabetes who were undergoing treatment were identified and included in the study. They were compared to non-diabetic individuals. A pre-defined questionnaire was used to collect demographic data, diabetes duration, treatment type, and laboratory findings, which were then analyzed for associations with this condition.
Results & Discussion: A total of 53 patients were examined, with the prevalence of concurrent diabetes and adhesive capsulitis being 47%. Hyperlipidemia and hypercholesterolemia showed a significant association with the co-occurrence of diabetes and adhesive capsulitis. The mean duration of diabetes was 4.43 ± 2.22 years in patients receiving oral medication and 4.55 ± 2.60 years in those on insulin therapy (P = 0.26). The mean HbA1C level was 7.72 ± 1.01 in the oral medication group and 6.71 ± 0.48 in the insulin therapy group, indicating a significant association between treatment type, diabetes duration, and the development of adhesive capsulitis.
Conclusion: Based on the findings of this study, the coexistence of hyperlipidemia and hypercholesterolemia with diabetes plays a significant role in the development of adhesive capsulitis.

Abstract Abstract
Introduction: Adhesive capsulitis, commonly known as frozen shoulder, is a prevalent and painful condition that limits shoulder mobility. A strong association exists between diabetes and this condition. This study aims to investigate the inflammatory risk factors involved in the development of adhesive capsulitis in diabetic patients.
Materials & Methods: In a descriptive-analytical study, individuals diagnosed with adhesive capsulitis were evaluated over three years. Among these patients, those with a confirmed diagnosis of diabetes who were undergoing treatment were identified and included in the study. They were compared to non-diabetic individuals. A pre-defined questionnaire was used to collect demographic data, diabetes duration, treatment type, and laboratory findings, which were then analyzed for associations with this condition.
Results & Discussion: A total of 53 patients were examined, with the prevalence of concurrent diabetes and adhesive capsulitis being 47%. Hyperlipidemia and hypercholesterolemia showed a significant association with the co-occurrence of diabetes and adhesive capsulitis. The mean duration of diabetes was 4.43 ± 2.22 years in patients receiving oral medication and 4.55 ± 2.60 years in those on insulin therapy (P = 0.26). The mean HbA1C level was 7.72 ± 1.01 in the oral medication group and 6.71 ± 0.48 in the insulin therapy group, indicating a significant association between treatment type, diabetes duration, and the development of adhesive capsulitis.
Conclusion: Based on the findings of this study, the coexistence of hyperlipidemia and hypercholesterolemia with diabetes plays a significant role in the development of adhesive capsulitis.

Abstract Abstract
Avascular necrosis (AVN) of the capitate is extremely rare and leads to chronic wrist pain. Currently, there is no standard treatment protocol for AVN of this wrist bone. Due to the rarity of these cases, limited experience exists regarding treatment methods. This report presents a 30-year-old male patient with AVN of the capitate. The patient was treated with a vascularized bone graft. After one year of follow-up, the symptoms have resolved, and there has been no progression of capitate necrosis.

Abstract Background: Supracondylar humerus fracture is the most common elbow fracture in children and accounts for about 16% of pediatric fractures. To maintain stability in the reduced segment in medial and lateral columns is an important treatment concept. The aim of this study was to compare two methods of proximal distal lateral pinning with medial and lateral cross pinning. Methods: In a cross-sectional study, 140 children (63 boys, 77 girls) with supracondylar humerus fracture were evaluated in a training center in Tabriz, Iran. The mean age was 5.04 years. The cases were divided into two groups (each 70 patients), matched for age, sex and type of fracture and were treated with two above methods. Complications and outcomes were copmpared. Results: Ulnar nerve lesion in the medial and lateral cross technique was 4.3%, and none in the group done by all lateral pin technique. The need for further surgery and loss of stability was 2.9% and 1.4% respectively with no statistical difference. Pin site infection around the pins was 4.3% and 12.9% percent respectivly. Cubius varus deformity rate was 2.9% in lateral cross pinning and 4/1% in medial lateral cross pinning. Conclusions: Proximal distal cross pinning technique for suprocondylar humerus fracture is comparable to medial and lateral cross pinning in terms of stability in maintaining a good reduction. The possibility of ulnar injury is negated in cross-lateral technique.

Abstract Background: Bone bruise is a signal change in MRI and could be the result of bleeding or edema with microfractures in trabecular bone system. Analysis of the location of bone bruise could be a clue for mechanism of trauma. Awareness of pattern, severity and location of bone bruise and pain gives a better understanding of its nature and the related concomitant injuries. In this research the relation between pain and its severity with bone bruise is investigated. Methods: In a prospective study, 22 patients (20 males, 2 female) with mean age of 34 years old and with isolated bone bruise after a knee trauma was studied in a trauma center in Urmia, Iran. Patients scored their pain using Visual Analogue Scale (VAS). For volumetric calculation of bone bruise we used A*B*C vectors multiplication and for severity of bone bruise we used software that measures the resotution of pictures. The locations of bone bruise were also determined and recorded. Finally, the relationship between these parameters and patients’ pain were statistically analyzed. Results: The mean pain score were 4.40±1.56 in males and 7±2.82 in females. Mean bone bruise intensity was 176.4±42.47. There was no relationship between patient's age and pain severity. There was also no significant correlation between volume or location of bone bruise and severity of pain score (p < /em>≥.05). The mean bone bruise volume was 8.77±8.12 and the mean pain sc ore was 4.63±1.78. Conclusions: Among the multiple characteristics of bone bruise, the intensity has the most direct correlation with severity of pain.

Abstract  Background: Bleeding from proximal screw drill-site in femoral neck fractures may have the ability to predict the occurance of avascular necrosis of femoural head. In this study the relationship of bleeding from proximal screw drill-site during internal fixation of femoral neck fractures with rate of avascular necrosis was studied. Methods: This study is a cross-sectional study that was carried out on 19 to 60 year patients with femoral neck fracture that referred to health care centers in Rasht, Iran during the year 2008. The age, sex, type of fracture based on Garden Category were recorded. Then, presence or absence of bleeding from the proximal screw holes within the first 5 minutes was recorded.  Results: In this study, 40 patients were enrolled with mean age of 39.78±14.4. Twenty two patients (55%) had bleeding from the proximal end of the screw, and 18 (45%) did not have any bleeding. Bleeding from proximal screw hole in patients without avascular necrosis was seen in 11 cases (61.1%). This difference was statistically significant (p < /i>=.005). Conclusions: Presence of bleeding from proximal screw hole in femoral neck fracture reduces odds of AVN in femoral head fracture and can help deciding between internal fixation or arthroplasty for treatment of such a fracture.  

Abstract Backgroud : Most pediatric open long bone fractures are the results of high energy trauma, and can lead to complications. The aim of this study is to compare the results of two commonly used operative techniques for tibial or femoral fractures namely external fixator and flexible intrameduly rods. Methods: In this clinical series, 42 children with 45 femoral or tibail open fractures from 2009 to 2011 who were treated by either external fixator (EF) (24 cases) or TEN (21 cases) were compared. In few cases combination of TEN and pin were used for more stability. The patients were evaluated and compared for infection, non:::union:::, mal:::union::: and refracture. Results: Bony :::union::: in the EF group was achieved in 3.8 months and in TEN group in 3.6 months (p < /i>≥.05). In each group, 2 fracture-site infections without any evidence of osteomyelitis was obsereved. Five pin site infection in EF group needed changing the pin site. In TEN group early nail removal was necessary because of painful bursitis in one case at nail insertion site. There were 4 femoral refractures in EF group after frame removal. In 10 patients with TEN and extra pin no symptom or problem was seen. Conclusions: In our study EF was effective as a definitive treatment. Flexible intramedullary nails were also effective and their results were similar to those of EF. Combination of TEN and pin caused more stability without any symptoms.