Iranian Journal of Orthopedic Surgery

Abstract Background and purpose: Despite its effectiveness as a therapeutic intervention, Total Knee Arthroplasty (TKA) is sometimes followed by joint infection as a serious postoperative complication. That is why this study aimed to investigate the effect of modified irrigation on the frequency of knee joint infection following TKA.

Methods: In this descriptive, cross-sectional study, 1201 patients undergoing TKA in private medical centers in Ardabil were investigated. For the selection of the patients to be included in the study, census sampling method was used. The information about each of the patients including their age, sex, education level, underlying diseases with or without infection, the type of infection, and laboratory test results (including WBC, hemoglobin, ESR, creatinine, blood sugar, platelet count, urea, and PMN) was obtained via checking their medical records, asking their treating doctor, and getting information from the patients themselves. The obtained data were analyzed using SPSS Software.

Findings: Out of the total number of patients, 586 (48.8%) were female and 615 (51.2%) were male. The mean age of the patients was 64.8±6.1 years. Acute or chronic deep infections were not observed in any of the patients following the surgery. In 2 of the patients, late hematogenous infection in the respiratory and urinary systems was detected. Non-purulent wound drainage was observed to be released from the surgical site in 11 patients. Also, lack of full closure of wound was observed in 4 of the patients under investigation. Fistula, however, was not observed in any of the patients. 
Conclusion: As the result of using modified irrigation method after TKA, no occurrences of joint infection (acute or chronic) or fistula were observed. This method was only found to be associated with late hematogenous infection and other non-infectious complications such as non-purulent wound drainage and lack of full closure of wounds.

Abstract Background: Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure to restore the stability of the knee. However, there is still no consensus on the optimal approach for determining the position of the tibial and femoral tunnels. In this study, we aimed to evaluate the effect of endobutton positioning on the clinical outcomes of the patients who underwent ACL reconstruction.
Methods: We evaluated 100 adult patients who underwent single-bundle ACL reconstruction surgery at our institution. The patients were categorized based on the position of the femoral endobutton observed in lateral and AP radiographs. We investigated the relationship between the position of the femoral endobutton in lateral and AP radiographs and the clinical outcomes of range of motion (ROM), Pivot Shift examination, and knee function scores at the 6-month follow-up.
Results: The Intermediate group had the largest number of patients, but there were no significant differences in the clinical examination results and knee function among these groups. Although the majority of individuals fell into the <39% group, there were no significant differences in clinical outcomes and knee function across these groups.
Conclusion: In conclusion, our study found no significant relationship between the position of the femoral endobutton as determined by radiography and the clinical examination results and knee function. These findings suggest that further research is needed to better understand the optimal approach for determining the position of the tibial and femoral tunnels and the appropriate grip for ACL reconstruction.

Abstract Aims:
Distal radius fracture (DRF) has the highest rate among pediatric fractures. The management of distal radius fractures in children has to be as non-invasive as possible, which requires definitive care for proper reduction and stabilization. This study was designed to evaluate the short-term complications of pinning radius fractures in children, help the surgeon make an appropriate decision according to the situation of patients, and also look for solutions to reduce complications.
Methods:
In this cohort study, patients diagnosed with distal radius fracture aged 3-15 years who visited Shahid Madani Hospital in Karaj were evaluated. Demographic characteristics and type of fracture of patients who underwent pinning of distal radius fractures, were collected after obtaining their consent. Then the complications of patients were evaluated based on Clavien-Dindo-Sink, and dahl scores four and five weeks, and three and six months after the surgery.
Findings:
According to the Clavien-Dindo-Sink score, 96 cases had no complications, 35 cases had complications of grade 1, 27 cases had complications of grade 2, 9 cases had complications of grade 3, and 1 patient had complications of grade 4. In the examination of the DahlPin operative site complication score, 108 cases had no operative site complications, 30 cases had complications of grade 1, 22 cases had complications of grade 2, 6 cases had complications of grade 3, and 2 cases had complications of grade 4. Four cases had transient neurapraxia and 20 cases had limited range of motion.
Conclusion:
The results obtained from this study create a more comprehensive understanding of the complications and weaknesses of the percutaneous pinning treatment method for distal radius fracture patients.

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: Despite the global reduction in the transmission and mortality of Coronavirus (COVID-19), this infection remains a significant challenge for orthopedic surgeons. This study aims to evaluate the impact of COVID-19 infection on complications, prevalence, rates, mortality, and predictors of surgical outcomes in proximal femur fractures.

Methods: This prospective observational study was conducted on 611 PPF patients suspected of having COVID-19 who underwent surgery at Firouzgar Hospital affiliated with Iran University of Medical Sciences between 2011 and 2013. Fifty-nine patients were identified with a confirmed diagnosis of COVID-19. Using frequency matching, we compared the 30-day mortality rate, hip function, average length of hospitalization, and likelihood of ICU admission between patients with and without COVID-19.

Findings: The 30-day mortality rate was significantly higher in the COVID-19 positive group (28.8% vs. 10.2%, p=0.018). At the last follow-up, the mean Harris Hip Score (HHS) was lower in COVID-19 positive patients. Multivariate analysis showed that infection rates, average duration of hospitalization, and ICU admission rates were higher in COVID-19 positive patients. Older age, hypertension, and smoking significantly increased the risk of postoperative outcomes in PPF patients.

Conclusion: COVID-19 infection increases mortality rates, average duration of hospitalization, and ICU admission likelihood while decreasing the mean HHS in the target population. These findings are particularly significant in elderly patients, smokers, and those with hypertension.

Keywords: Proximal Femur Fracture, Mortality Rate, Coronavirus Disease, COVID-19, Predictors

Abstract Introduction: Knee pain is one of the most common musculoskeletal complaints in children and adolescents. There are relatively wide differential diagnoses for knee monoarthritis in children. One of the causes of knee pain and swelling is the discoid meniscus which as the most common congenital anomaly of the knee, can have a wide range of symptoms such as pain, swelling, limited range of motion, and mechanical symptoms including clicking, snapping, popping, and locking of the knee. Therefore, it is necessary to accurately understand this disease and distinguish it from other diseases that show these symptoms. The purpose of this study is to introduce a disease with chronic knee pain and swelling with the diagnosis of discoid meniscus to show that a strong clinical view is necessary to be able to diagnose this disease in children, especially in cases that occur at a younger age.
Case presentation : The patient is a 6-year-old girl who presented with pain, swelling, and limited range of motion in the left knee since 4 years ago, and during this period, she was treated with the diagnosis of Juvenile Rheumatoid arthritis(JRA). Due to the lack of response to treatment and after more examination and consultation with the knee surgeon, the discoid meniscus was diagnosed as her real disease discoid meniscus was diagnosed as his real disease. The patient underwent arthroscopic saucerization and lateral meniscus repair.
conclusion: According to this study, discoid meniscus should be considered as an important, rare differential diagnosis in children presenting with knee pain and swelling.

Abstract Upper extremity injuries consist of a wide range of presentations, from small skin wounds to severe injuries that require replantation and reconstructive surgeries. Herein we present a hemi-amputation and crush injury to the upper extremity in a 7-month-old-infant following a motor vehicle accident which led to a replantation and reconstructive procedure. A replantation and reconstruction procedure was performed under general anesthesia. A month later, a wrist disarticulation procedure was performed due to necrosis. The bones were fixed with two pins. The following muscles and tendons were repaired: flexor digitorum profundus (tendons of the digits 4 and 5), extensor carpi radialis brevis, extensor carpi ulnaris, and flexor carpi ulnaris. Right radial and ulnar arteries were anastomosed and a splint was used to protect the injured limb. After a 6-month-follow-up, on the examination of the upper limb proximal to the wrist, the sensory examination including tactile, pain, temperature, and vibration sensation was normal.

Abstract In recent years, there has been a growing awareness of pediatric osteoporosis, a condition that can lead to weakened bones and a higher risk of fractures in children. It is essential for pediatricians to be knowledgeable about this issue so that they can identify and treat patients with osteoporosis or those at risk for it. Genetic factors and various disorders play a role in bone formation and quality. Osteogenesis imperfecta is the most common genetic condition linked to primary osteoporosis. Secondary osteoporosis can occur in children with chronic illnesses. X-rays can help diagnose the condition. Prevention is key in managing pediatric osteoporosis, as understanding normal bone development allows for early detection and treatment. Medications can help prevent bone loss in pediatric patients. The definition of pediatric osteoporosis involves low bone mass and significant fractures. Factors such as genes, medications, lack of movement, and corticosteroid use can contribute to osteoporosis in children. Treatment options for pediatric osteoporosis are limited, but anabolic agents and bisphosphonates may be used. Close monitoring and follow-up are crucial to prevent further fractures. It is important for pediatricians to understand the diagnosis and treatment of pediatric osteoporosis, as well as lifestyle factors and the effectiveness of treatment approaches.