Iranian Journal of Orthopedic Surgery

Abstract Abstract
Objective: Frozen Shoulder is a painful and debilitating illness that affects 2 to 5% of the general population, characterized with significant shoulder pain and reduced mobility, resulting in loss of passive and active movements.This is  a cross-sectional study to evaluate serological factors in these patients and their relationship with Constant Shoulder Score (CSS) which may be of diagnostic benefit.
Material and Method: Frozen shoulder (Adhesive Capsulitis) cases  referring within  4 months of the disease were considered for the study (referred sample). Diagnostic criteria for adhesive capsules included: 1) limited and painful shoulder for at least 4 weeks, 2) severe shoulder pain that interfered with daily life or work performance, 3) nocturnal pain, 4) painful limitation of raising active and passive to less than 100 degrees, and 5) limitation of at least 50% in external rotation.  After primary clinical evaluations, a series of specific blood tests were requested and the shoulder range of motion and scores were recorded The mean levels of fasting blood glucose (FBS), Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) CRP levels and  associated with constant shoulder score (CSS) were documented.
 
Results: Fifty patients with frozen shoulder referred to the orthopedics clinic of a tertiary teaching  hospital within  one year period were included. A total of 29 patients with adhesive capsulitis were assigned to the study, of whom 22 were female (76%) and 7 male (24%). The mean levels of fasting blood glucose (FBS), Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) were 100.61 ± 17.29 mg/dL, 16.89 ± 13.14 mm/h and 2.85 ± 6.88 mg/L, respectively. CRP levels were inversely associated with constant shoulder score (CSS).
Conclusion: The serum level of CRP might be a reliable biomarker for predicting the qualitative state of pain and range of motion in patients with 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 Introduction: Elbow fractures are common in both pediatric and adult populations, and accurate diagnosis is crucial for proper treatment. While radiography is the standard method, alternative imaging techniques such as ultrasound are increasingly explored, especially when radiographic imaging is not ideal. This study evaluated the diagnostic accuracy of ultrasound in detecting elbow fractures, comparing it with radiography and computed tomography (CT) as reference standards. Materials & Methods: Forty patients with suspected elbow fractures underwent imaging using ultrasound, radiography, and CT. Results from all three methods were compared to assess sensitivity, specificity, and agreement between ultrasound and the reference standards. Results & Discussion: The mean patient age was 15.5 years (range: 4–49), with 72.5% male (n=29). Supracondylar fractures were most common in patients under 18, while radial head fractures predominated in those over 18. Ultrasound showed good diagnostic performance, with 88.9% sensitivity, 87% specificity, and a kappa value of 0.73 compared to radiography. Against CT, ultrasound demonstrated 94.8% sensitivity and 89.7% specificity. Conclusion: Ultrasound is an accurate, non-invasive, and cost-effective alternative to radiography and CT for diagnosing elbow fractures, especially in emergency or resource-limited settings. Its strong diagnostic performance, particularly in children, supports its use as a reliable tool. Further studies with larger samples and follow-up are recommended.

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.

Abstract Tennis elbow, or external epicondylitis of the arm, is usually associated with chronic tracheitis and is treated, and it is acceptable to have a full effect, it is not introduced to be necessary to treat this condition. Therefore, the purpose of this study is to investigate the effect of corticosteroids on the pain and performance of tennis elbow patients. This study was conducted on 43 patients (21 in the normal saline group and 22 in the corticosteroid group). Patients are randomly divided into two groups, and the prescribed drugs and pain and function are recorded in patients 1 month and 3 months later. Chi-square and Mann-Whitney tests are used to compare data. The results of our study showed that both treatment methods of corticosteroid injection and normal saline in the short term improved the pain and performance of patients based on the DASH questionnaire (P<0.05), but in the long term (3 months after the intervention) it was similar to normal saline. , we saw the return of symptoms in such a way that the pain score increased between 0.5 and one unit and the DASH score increased between 5 and 10 units. As a result, it can be seen that corticosteroid injection is not superior to normal saline, and both methods have little effect in the long term and are more effective in the short term, and due to the high side effects of corticosteroids, treatment with normal saline is better.

Abstract Background:Recently, the relationship between clinical outcomes and postoperative complications in diabetic patients who underwent arthroscopic rotator cuff repair has been reported. However, based on knowledge, very limited studies have focused on the association between preoperative hemoglobin levels and postoperative complications. Therefore, considering the importance of the subject, the aim of this study was to evaluate the association between complications 6 months after surgery and the average level of hemoglobin 3 months before and 3 months after surgery in diabetic patients.
Methods: This retrospective study was conducted on 61 patients with diabetes who underwent arthroscopic surgery for rotator cuff repair between 2019 and 2021 in rasoul-e-akram and Mohib mehr hospitals in Tehran, affiliated to Iran University of Medical Sciences. The hemoglobin HbA1c (HbA1c) level was evaluated for all patients three months before and after surgery. All patients were followed up 6 months after surgery, in terms of tissue infection, need for revision, wound dehiscence and postoperative stiffness.
Results: Sixteen patients (26.2%) had stiffness after surgery. There were no cases of wound dehiscence, tissue infection, or the need for revision 6 months after surgery. The results of multivariate logistic regression analysis showed that the age (odds ratio(OR): 1.13, 95% confidence interval (95% CI): 1.03, 1.27, p: 0.041), male gender (OR: 1.88, 95% CI: 1.11, 2.75, p: 0.001) and HbA1c after (OR: 1.23, 95% CI: 1.03, 1.48, p: 0.011) and HbA1c before the operation of patients (OR: 1.11, 95% CI: 1.02, 1.26, p: 0.023) were associated with a higher risk of Stiffness after surgery.
Conclusion: Our study showed that the mean level of HbA1c before and after the surgery was significantly associated with an increase in the incidence of stiffness after arthroscopic rotator cuff repair surgery.

Abstract Background: To find causes and number of elbow joint dislocation in Kunduz regional hospital- Afghanistan in 2021. The aim is to understand what the causes are and try to reduce the incidence by informing the people and discuss with the government.
Methods: We conducted a prospective case series study to figure out causes and number of elbow joint dislocations in Kunduz Regional Hospital- Afghanistan from the beginning up to the end of 2021. This study included 23 patients; the age was above 5 years old. The data were entered in spreadsheet and analyzed in SPSS program.
Results: Among 23 patients, 18 (78%) were male, 5 (22%) were female. Fourteen cases were 10-30 years of age; 15 (66%) were residents of Kunduz province. In 10 (43%) fall from height, 6 (26%) road traffic accident, 5 (22%) sports injuries, and in 2 (9%) family assault were the causes of elbow joint dislocation.
In 19 (84%) cases posterior dislocation, in 1 (4%) anterior dislocation, in 1 (4%) lateral dislocation, in 1 (4%) open posterior dislocation with fracture and in 1 (4%) complex closed posterior dislocation; were the types of dislocations. Elbow dislocation was more on right side (61%). 21 (92%) of elbow dislocations were treated non-operatively, and 2 (8%) operatively. In 21 (92%) there was no complication, in 1 (4%) myositis ossificans and in 1 (4%) non-reduced dislocation treated by traditional bone setter were observed.
Conclusion: The most common causes of elbow dislocation were fall from height and road traffic accident. Postero-lateral was the most commonly seen type of dislocation.

Abstract Object: Correlation between Diabetes Mellitus (DM) and musculoskeletal problem has been established in many of the past studies. There are reports of high prevalence (up to 63%) of upper extremity impairment in diabetic patients. The main aim was to conduct a study to determine the prevalence of diabetes and prediabetes in patients with shoulder complaints. It may help the treating physician in managing patients with shoulder problems.
Methods: During a period of six months from February 2018 to August 2018, patients who consulted shoulder clinic with complain of shoulder pain were included in this cross sectional study. Eligible patients were enrolled after informed consent was obtained. A uniform checklist was completed for every patient. The key components of the checklist were: demographic data, fasting blood glucose(FBS), diagnosis, body mass index( BMI).Diagnosis of diabetes and prediabetes was done by FBS level( FBS between 100 to 126 considered prediabetes and more than 126 as diabetes.
Results: 564 eligible patients were enrolled in the study. Of the 564 patients, 18.8% had DM, 25.9% had pre-diabetes, and 55.3% had normal fasting blood glucose. A higher proportion of men had abnormal fasting glucose compared to women (54% and 33.9% respectively). There was no significant difference in blood glucose levels in respect to different shoulder pathologies (P = 0.191).
Conclusion: This study shows that population with shoulder complaint have a higher prevalence of DM than the normal population. This high proportion of patients with impaired blood glucose levels and shoulder pain necessitates further research in this course and advancement towards risk factors of DM. It is more important in community areas where routine screening of diabetes is not performed.