Iranian Journal of Orthopedic Surgery

Abstract Abstract
This article is the second part of a comprehensive review focusing on the anatomy, physiology, and treatment of distal radius fractures. This injury is among the most common skeletal traumas. The first part provided a historical overview of the condition and outlined the advancements in its recognition and management. It was noted that the treatment of this fracture requires a precise understanding of the anatomy of the radius and the wrist joint. The importance of standard imaging modalities such as radiography and CT scan for fracture evaluation and surgical planning was emphasized, and various classification systems used in managing this fracture were also discussed. Since the primary goal of treatment is to restore wrist function to its pre-injury level, the first part highlighted the critical role of key parameters such as articular step-off, dorsal tilt, and radial length in clinical decision-making. Now, in the second part, surgical methods including pin and plaster, percutaneous pinning, the Kapandji technique, fragment-specific fixation, external fixators (both bridging and non-bridging types), locking plates (fixed-angle and variable-angle), and spanning plates are examined. The complications associated with each method, such as infection, radial nerve injury, and tendon-related problems, are also discussed. Postoperative pain management, follow-up care, and the importance of precise imaging—particularly the facet view—are among other key topics addressed in this section. Ultimately, it is emphasized that the choice of surgical method should be based on the characteristics of the fracture, the patient’s condition, and the surgeon’s experience.

Abstract Knee osteoarthritis is one of the most important causes of disability in elderly. Increasing age is associated with increased knee osteoarthritis. The average population age is increasing. In the next 30 years, Iran will enter the club of countries with the 30% of the population aged over 65. The cost of osteoarthritis treatment accounts for a significant amount of each country’s GDP. Knee osteoarthritis is caused by an imbalance between the destruction and repair of articular cartilage under the influence of several risk factors such as trauma, excessive use, and genetic predisposition. Overweight and joint disorders apply an increased load to the specific points of the knee. This overload creates a tissue response, which provides the conditions for the occurrence of osteoarthritis. No cure has been found for knee osteoarthritis so far. Although joint replacement (knee arthroplasty) at this point is the best solution, its survival and durability is not permanent. Some patients are not suitable for surgery; some are reluctant to have surgery, and finally, the cost of surgery is high. Treating knee osteoarthritis without joint replacement is another method to deal with this problem. Through extensive studies and review of medical literature, The American Academy of Orthopaedic Surgeons has prepared the Guideline for Non-Arthroplasty Treatment of Knee Osteoarthritis. This Guideline brings the promise of quality of life equal to the surgical approach. The Academy recommends its use to all orthopaedic surgeons and also calls for an assessment of the outcome studies. Nonarthroplasty treatment of knee osteoarthritis is a simple and inexpensive treatment method. The majority of patients will benefit from this treatment. We all need to set up centers to treat patients according to the academy Guideline with special interest on recording outcomes.

 

Abstract Background: Doing surgery on wrong location, or wrong person, or doing a different surgery by mistake, are all horrible, though not infrequent happenings. This is a report on an attempt to determine the incidence of "wrong-site” surgery among the Iranian Orthopaedic Surgeons.Method: A one-page questionnaire, regarding personal experience or having witnessed or heard about "wrong-site" surgery during the last 2 years, was mailed to the active members of Iranian Orthopaedic Association (IOA). All the members were also contacted by phone to confirm the receipt of the questionnaires and request an earlier return of the forms. The returned forms and the telephone responses were analyzed.Results: From the 736 questionnaires sent out to the IOA members, 54 (5.7%) written response was received back. 368 (50%) members denied having personally faced or heard of any "wrong site" surgery. 313 IOA members (%42.5) did not participate, and gave no answer – nor on phone, neither by writing. Among the 54 returned questionnaires, 29 members had encountered or were aware of 40 cases of "wrong", surgery which included 32 mistakes in the side of surgery and 8 cases of wrong limb surgery.Conclusions: The response rate to questions regarding "wrong" surgery is very low in IOA members. Adherence to a strict protocole in avoiding wrong-site or wrong limb surgery may decrease the number of mistakes in any busy operating room.

Abstract Background: To find the patterns and common mechanisms of motor-vehicle related pediatric trauma in a metropolitan city (Tehran-Iran), to guide the health planners of the city in proper planning and resource application and distribution.Methods: A pilot study was started in three major pediatric-trauma referral centers in Tehran by the Iranian Orthopaedic Association. All the cases below age 14 who visited the emergency department of those three hospitals, with body trauma resulting from a vehicle-related accident were studied. Cases were collected on a 24-hours basis in one month of each four seasons of the last year. The data collection was done by contracted physicians with the use of a detailed questionnaire.Results: From a total of 318 children that visited the emergency departments because of motor–vehicle related accident, 287 patients had trauma to various parts of the body (215 male 72 females), 151 cases had only musculoskeletal trauma and 31 others had sustained no significant injury of any kind. Multiple trauma was seen in 33.6% of the cases.52.8% of accidents happened in spring & summer, 21/7% in autumn, and 25/5% in winter season. The place of accidents were usually on the streets (70%), followed by small allies (17/5%), then major roads (12/5%). 65% of the accidents had happened at night and 35% during the day. The injuries were from motorcycles hitting pedestrians in 33.7% and, car–pedestrian accidents in 31.9%. The musculoskeletal injuries included fracture of tibia and fibula (62 cases), femoral fracture (25 cases), forearm (18 cases) and humerus (11 cases) in order of frequency. 24% of patients were transferred by ambulance and the rest by their family members or by- standing people. Conclusions: Children become disabled far too frequently in the city, from lack of proper training, proper enforcement of traffic rules by the children and the drivers. An appropriate measure of safety in the crowded metropolitan city of Tehran is essential, and this report can be a guide for the other major cities of the third world.