Iranian Journal of Orthopedic Surgery

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 Investigating the relationship between ultrasound findings and the results of repair of Madin nerve tears in Imam Khomeini Hospital, Urmia

Abstract:
Introduction:
Median Nerve-traumatic injury is seen in 2.8% of trauma patients. Electrodiagnostic tests cannot provide the needed information about extent of healing, neuroma or scar formation following repair to help prognosis or decision -making on time for intervention. Sonography ,as a cheap, easily accessible tool might be helpful.


Materials & Methods: The median nerve traumatic injuries during one year in a teaching hospital were entered into a retrospective study. The cases with diabetes mellitus and systemic illness, congenital neuromuscular conditions, cervical discopathy were excluded. The cases underwent clinical , electro-diagnostic and ultrasonographic assessments three months post surgical repair.

Results:
within a one-year period ,21 patients -12 male and 9 female , with 20-55 years age range ,were evaluated 3 months post median nerve laceration repair.
The volume of neuroma formed at the site of repair was clearly less in cases with complete recovery than in patients with partial recovery. Also, the volume of neuroma formed at the site of repair was clearly lower
in cases with electromyographic results of nerve regeneration than in patients with severe
axonal injury, but with no statistical significance . All patients with injury at the carpal tunnel level had complete recovery after surgery, but without statistically significant relationship .
Conclusion: Ultrasound can be used as a low-cost and non-invasive method in the study of post -repair evaluation of peripheral nerve damage.

کلیدواژه‌ها / English median nerve, neuroma, ultrasound

Abstract Introduction: Anterior cruciate ligament (ACL) rupture disrupts knee stability and increases the risk of subsequent meniscal injury and degenerative joint disease. (ACL) reconstruction is one of the most common orthopedic surgeries. This study was conducted with the aim of investigating the effect of pre-operative and post-operative physiotherapy of ACL reconstruction with hamstring autograft on the success rate of surgery based on the eight parameters of Lysholm knee scoring scale (LKS) one year after the operation.
Method: In this descriptive-analytical study 140 patients underwent ACL reconstruction surgery with hamstring autograft after cruciate ligament rupture in Imam Khomeini Hospital of Ahvaz between 2020 and 2024. The relationship between the number of pre-operative and post-operative physiotherapy sessions and the starting time of post-operative physiotherapy with (LKS) one year after the operation was analyzed using SPSS version 22 software.
Results: In this study 112 men and 28 women were examined. There was no significant relationship between the (LKS) score and the number of pre-operative and post-operative physiotherapy sessions, but the (LKS) score was higher in patients who had 1 to 10 pre-operative physiotherapy sessions and in patients who had less than 10 post-operative physiotherapy sessions. Also the patients who started their physiotherapy in the first week after the operation had much better results.
Conclusion: Although the number of physiotherapy sessions before and after the operation of ACL reconstruction with hamstring autograft does not have a clear effect on the results of the operation but the patients who did physiotherapy before the operation compared to the patients who had no experience of physiotherapy before the operation and also patients who started their physiotherapy sooner after the operation had better results.

Abstract Introduction: Anterior cruciate ligament is one of the most important knee ligaments. This ligament is one of the ligaments that is damaged during vigorous activity. The purpose of this study was comparative evaluation of reconstructive surgery and physiotherapy in patients.
Material and methods: Sixty-three subjects were enrolled in this cross-sectional study which referred to Imam Reza Hospital since 1391 to 1398. 32 patients underwent reconstructive surgery and 31 underwent physiotherapy treatment. The IKDC questionnaire was filled out and collected data was entered into SPSS 21 And were analyzed by two-way ANOVA and BONEFERRONI supplementary tests.
Results: The results showed that both treatment and occupation were effective and reconstructive surgery had a higher score than physiotherapy. Also in the jobs, the score of the soldiers was significantly lower than the rest of the jobs and there were no significant differences between the three freelancer’s jobs, military personnel and athletes.
Conclusion: According to the findings, both the type of treatment chosen and the type of occupation were effective in patient’s follow up. In fact, according to the study, people undergoing reconstructive surgery had more pain than the physiotherapy group. But in spite of the pain, they were more able to perform higher performance and function and achieve higher scores.

Abstract The aim of this study was finite element analysis and biomechanical comparison of open wedge technique of proximal tibial osteotomy. For this purpose, an attempt was made to simulate the effect of osteotomy surgery on correcting the alignment of the lower limb. In this research, the biomechanical behavior of four states, including the profile of the plaque as curved and flat, and the orientation of the proximal screws as convergent and divergent under static load on the model made in the finite element software, and also to get closer to reality, a model of four states As mentioned, orthopedic screws are simulated as threaded. The images recorded by the CT scan method of the bone model prepared by the design consultant were used in 379 sections.The CT scan images were transferred to Mimics software, the geometry of orthopedic implants and screws was drawn in Solidwork software after physical preparation, then the model was subjected to static biomechanical analysis in the Abaqus software environment, to achieve the real model. From the point of view of properties, cortical bone as orthotropic and spongy bone as planar isotropic and implants and orthopedic screws were also considered titanium alloy.In the comparison of the von Mises stress between the four states, the bent plate state with the direction of the proximal screws converging has the highest von Mises stress on the implant and orthopedic screws, while the von Mises stress on the bone is the lowest in this state. The probability of occurrence of the stress shield phenomenon is the highest in this case, in the modeling considering the thread of orthopedic screws, the stress increased significantly on the model, and this issue indicates the importance of considering the thread of orthopedic screws in finite element modeling.

Abstract 1-Abstract
Metacarpal fractures are common hand injuries that often require surgical intervention for significant displacement or instability. Various fixation methods such as Kirschner wires, plates, external fixators, and intramedullary screws are used, each with potential complications. Understanding the anatomy and biomechanics of the metacarpal is crucial for successful management. We present a case of a 36-year-old man with a second metacarpal fracture following a motorcycle accident. After initial pinning failed, open reduction with internal fixation was performed, later replaced by an intramedullary headless screw. Subsequent physiotherapy led to a successful outcome with normal function and union. Surgical techniques for metacarpal fractures include pinning, plating, and intramedullary devices, each with specific indications and considerations. While pinning is cost-effective and minimally invasive, plating is preferred for certain fracture patterns, and intramedullary devices allow early mobilization. In our case, the intramedullary screw proved effective for delayed Union treatment after previous failures. Larger studies are needed to validate its efficacy and explore potential complications. This case highlights the importance of individualized treatment strategies in complex metacarpal fractures.