Iranian Journal of Orthopedic Surgery

Abstract Abstract
Introduction: Intertrochanteric femoral fractures are common and can be associated with significant complications and mortality. This study aimed to assess the mortality rate and related factors in patients undergoing surgical treatment for intertrochanteric fractures.
Materials & Methods: This retrospective descriptive-analytical study included patients with intertrochanteric hip fracture who underwent surgery between 2017 and 2018 in a teaching hospital .The demographic data were collected from patients’ records, with specific attention to age, osteoporosis, previous fracture history, cognitive disorders, hypertension, delay in surgery, and the type of fixation implant. Mortality status was assessed through follow-up phone calls. Data were analyzed using STATA software and logistic regression analysis.
Results & Discussion: 227 case within one year were studied. The overall mortality rate was 16.3%. In the deceased (p<0.05). Logistic regression revealed that advanced age, osteoporosis, previous fracture history, cognitive disorders, history of falling, surgical delay, and type of surgery were independent predictors of mortality (p<0.05).
Conclusion: Postoperative mortality following intertrochanteric fracture surgery is influenced by a range of clinical and modifiable factors. Timely selection of an appropriate surgical method and identification of high-risk patients can play a significant role in improving treatment outcomes.

Abstract Abstract
Introduction: Varus deformity is the most common deformity in patients undergoing knee replacement. Varus correction is based on the release of the medial soft tissue of the knee. But there is no exact measure of its extent. The present study aimed to investigate radiographic parameters that can predict the need for the release of medial elements.
Materials & Methods: In this retrospective cohort study all patients who underwent primary knee replacement surgery performed in a university hospital by a single surgeon during a 2-years period were included in the study. Preoperative and post-operative knee radiographs were collected. Patients were divided into three groups based on the stage of medial release. The radiographic criteria including Mechanical Femoro-tibial angle (mFTA), Lateral distal femoral angle (LDFA), Proximal medial tibial angle (MPTA), valgus cut angle (VCA) and joint line convergence angle (JLCA) before and after surgery were compared between the groups.
Results & Discussion: A total of 115 knee radiographs, related to 103 patients were examined. There was a significant association between LDFA , MPTA , mFTA , VCA and degree of varus correction with the medial release. The degree of varus correction significantly predicts the need for a high grade of medial release (OR=1.49, P=0.01)
Conclusion: higher LDFA, mFTA, VCA, and the degree of correction of the femoral and tibial mechanical angle and lower MPTA were associated with a higher degree of medial release. And the amount of varus correction significantly predicts the need for more medial release.

Abstract Abstract
Stress fractures are rare injuries that occur due to redundant mechanical pressure or overuse of the bone. We aim to report a case of bilateral distal femoral stress fracture with intra-articular extension in an old woman with degenerative joint disease (DJD) and osteoporosis. Here we report a bilateral intra-articular distal femoral stress fractures in an elderly woman with a history of osteoporosis and osteoarthritis with complaints of intensification of pain, limitation of movements and weight bearing. Unfortunately, the patient neglected, and did not visit for more than a year after the initial visit. She underwent total knee arthroplasty for both knees three months apart. After two years of follow-up, her knees were free of pain, and no specific complaint was mentioned. Stress fractures even with intra-articular extension in the elderly with osteoarthritis may mimic arthritis symptoms and hide behind them. Orthopedics must consider stress fractures in the differential diagnosis of elderly patients with osteoarthritis and persistent pain.

Abstract Introduction: One of the factors affecting the prognosis of distal radius fracture is anatomical correction. Several studies conducted in connection with the reconstruction of anatomical and functional consequences, which have had conflicted results. This study has been designed and implemented aimed to investigate the relationship between radiological index (anatomical) after displaced distal radius fractures with function and clinical outcomes.
Methods: This is a retrospective cohort study to assess the association of radiological indices with clinical and functional outcomes of distal radius fractures. In this study, radiological indices, including the radius, volar tilt, tear drop angle, articular cavity depth and AP Distance were investigated. Pinch and grip strength were measured and Quick DASH questionnaire evaluated the performance.
Results: Pain score significantly correlated with radial shortening (P=0,038), but it was not independent of treatment method. Patients’ satisfaction rate was significantly lower in patients with abnormal articular depth, independent of age and treatment method (P=0.004). Quick-DASH score significantly correlated with radial shortening and articular cavity depth, independent of treatment method and age (P=0.006). Percutaneous pinning associated significantly with less pain, less disability and more satisfaction (P<0.05).
Conclusion: Radial shortening, articular cavity depth had a correlation with the clinical and functional outcomes. While Some studies suggested radiological indices in the elderly is not necessarily have a correlation with functional outcomes, in this study correlation of radiologic indices with clinical and functional outcome was independent of age.

Abstract Backgrounds: Various studies have been conducted on the local and systemic effects of orthopedic hardware. This study aimed to evaluate the pathologic reactions to orthopedic hardware (nail and plate) in patients. Methods: In this descriptive study, the pathologic reactions of 15 patients (12 males and 3 females) with a mean age of 37.41 years, who underwent orthopaedic hardware removal surgery in two Hospitals in Sari, Iran, were assessed through observation, laboratory tissue evaluation, and a questionnaire. Results: In this research, no allergic reaction was observed in the patients after the insertion of hardware. In this regard, 6.66% of patients reported infection after insertion of hardware, and there was one case of non:::union:::. Furthermore, no systematic complication was observed in any of the patients. The majority of patients had moderate tissue inflammation at the hardware site, and there was no evidence of malignancy in any of the pathology samples. Conclusion: According to the results of the research, a moderate level of tissue inflammation might be observed at the site of orthopedic hardware placement.