Iranian Journal of Orthopedic Surgery

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 Purpose: Correct axial positioning of the prosthetic knee components remains challenging. In the current study, the effects of the axial alignment of the components on patient satisfaction and functional outcomes after total knee arthroplasty (TKA) were investigated. It was investigated whether parallel axial axes of the components can affect the outcomes.
Methods: There were 89 TKA patients with correct coronal alignment investigated at least 1 year after the operation. Using CT scanning, the axial alignment of the components and prosthetic joint were evaluated. To measure the mismatch angle between two axes, the related CT images were superimposed. The criteria for the correct axial alignment of the prosthetic joint included: 1) correct axial alignment of the femoral component; 2) correct axial alignment of the tibial component; and 3) parallel rotational axes of the components. Patient satisfaction was measured using the visual analogue scale (VAS). Further, the Knee injury and Osteoarthritis Outcome Score (KOOS) was completed.
Results: The correct axial alignment of the femoral and tibial components was found in 80.9% and 67.4% of the patients, respectively. The correct axial alignment of the prosthetic joint was found in 35 patients (39.3%) and was not related to better KOOS and VAS scores. However, a mismatch >10° significantly decreased the KOOS and patient satisfaction (p<0.05).
Conclusions: The current study showed that a rotational mismatch > 10° between the axial axes of the prosthetic knee components is associated with poor functional outcomes and decreased satisfaction.

Abstract Introduction and purpose: loss of lordosis is an important factor in causing degeneration of the spine. There are several treatment methods for the correction of segmental lumbar lordosis. In this study, correction of lumbar lordosis in patients undergoing posterior interbody lumbar fusion was compared using peek cage and allograft impaction.
Methods: In this clinical trial, the correction of segmental lumbar lordosis after Posterior Interbody Lumbar Fusion was investigated in patients referred to Firuzgar Hospital in 2001. A total of 21 patients were randomly evaluated in two groups: treatment with impaction allograft (10 patients) and treatment using Peek cage (11 patients). correction of lumbar lordosis before and day after surgery, as well as pain intensity and side effects after 2 weeks of surgery were investigated in patients. The results were analyzed using SPSS version 25 software.
Results: The median age of the patients was 56 years and 38.1% were male. The results showed that in both impaction allograft (P<0.001) and PEEK cage (P<0.0001), lumbar lordosis increased significantly after surgery compared to before. The percentage of changes in the lordosis angle in impaction allograft method was significantly higher than PEEK cage (P=0.01). There was no significant difference in pain intensity after surgery in the two methods. No serious side effects were reported in any of the patients in the two groups.
Conclusion: Impaction allograft provides more correction of lumbar lordosis compared to PEEK cage in patients undergoing posterior Interbody lumbar fusion.

Abstract Introduction: Radioactive synoviorthesis, used as a local treatment for hemophilic arthropathy, causes the ablation of sub-synovial vessels. Previous studies have indicated that this procedure is effective in reducing the frequency of hemarthrosis in patients with recurrent episodes. However, it remains unclear how long this effect lasts and whether it has any impact on radiologic changes.
Aim: To assess the impact of follow-up duration after synoviorthesis on the incidence of hemarthrosis, as well as the extent of clinical and radiological involvement of the joint.
Methods: Synoviorthesis using 32P was performed once on 56 target joints in 56 patients. Thirty cases (29 males and one female) with an average age of 15.7 years (SD: 6.1) and a follow-up duration of 21.8 months ( 3–36 months) were compared to 26 males with an average age of 17.8 years (SD: 8.4) and an average follow-up duration of 43.6 months (38–102 months).
Results: The average reduction in the rate of hemarthrosis was 56.4% in the ≤36-month follow-up group (p<0.05) and 35.9% in the >36-month follow-up group (p<0.05).
Although there was greater improvement in the ≤36-month group, the difference was not statistically significant. Additionally mean improvement in clinical grade (Fernandez-Palazzi) was 0.56 (SE: 0.21) in ≤36-month group (p<0.05) and 0.65 (SE: 0.28) in the >36-month group (p<0.05), with the slightly better results in the ≤36-month group also not being statistically significant. The mean increase in radiographic grade (Arnold-Hilgartner) was 0.25 (SE: 0.15) in the ≤36-month group and 0.78 (SE: 0.14) in the >36-month follow-up group, and this difference was statistically significant.
Conclusion: The beneficial effects of 32P synoviorthesis on clinical involvement in hemophilic arthropathy persist over time. Despite an initial reduction in its effectiveness, longer follow-up demonstrated that synoviorthesis remains durable procedure. However, this treatment modality was unable to halt the radiologic progression of joint degeneration

Abstract Background: We aim to evaluate the epidemiology and pattern of pediatric traumatic deaths in our city in a developing middle eastern country, Iran, during the period 2011-2020, in light of the importance of pediatric trauma information and mortality.
Methods: Present study is a retrospective cross-sectional study including children and adolescents admitted to our tertiary trauma hospital between 2011 and 2020. Information from the clinical profiles of 16413 children was gathered and analyzed, including demographics, injury type and mechanism, referral method, and site of injuries.
Results: 151 (0.92%) deaths related to trauma were identified, 128 (84.7%) were boys and 23 (15.3%) were girls (P = 0.033). The mean age of children with and without mortality was 10.0 ± 6.1 and 11.0 ± 5.6 years, respectively (P = 0.07). 51 (33.8%) deaths were occurred in children 15-18 years old (P = 0.004).
The highest mortality was in summer with 48 people (31.8%) (P = 0.96). Car accidents with 130 (86%) cases were the most common mechanism (P < 0.001). The most common traumas leading to death were head and neck traumas, with 64 (42.4%) deaths. Regarding the transfer to the hospital, 123 (81.4%) deaths were referred by ambulance, while 28 (18.6%) deaths were referred by personal vehicle (P < 0.001).
Conclusion: Most trauma-related deaths in pediatric and adolescent children in our city, Iran, were boys between 15-18 years of age, had head and neck or chest trauma, referred by ambulance, and caused by traffic accidents on streets, mainly with the car. 0.92% of trauma led to mortality, and the most common cause was head and neck injuries. Traffic accidents, the leading cause of trauma, requires social, legal, and environmental interventions.

Abstract Sickle cell disease (SCD), often leads to skeletal complications such as avascular necrosis (AVN) of the femoral head, osteoporosis, fractures, and infections. Despite joint-preserving surgeries, many SCD patients require total hip arthroplasty (THA). However, THA carries significant risks for these patients, including hypoxia and vascular. This case report describes a 29-year-old female with SCD who presented with recurrent hip pain after a previous surgery was canceled due to a sickle cell crisis. Physical examination revealed restricted hip motion, and imaging confirmed AVN of the right femoral head. After a thorough hematology consultation, uncemented THA was performed. The surgery was uneventful, with minimal blood loss and no need for transfusion. The patient recovered well and was stable at her first follow-up. THA is common in SCD patients due to the high incidence of femoral head osteonecrosis, but they face higher risks of postoperative complications. Therefore, careful preoperative planning and coordination among surgical, anesthetic, and hematology teams are crucial for optimizing outcomes.

Abstract Acromion, lateral projection of scapular spine, fracture is an uncommon injury which is often diagnosed late. Though, usually managed conservatively, the indications for surgery in these fractures are very specific. We are reporting on a 56-year-old active woman with an isolated displaced base of acromion fracture by tension- band wire fixation which resulted into uneventful union, and obtained good shoulder Constant Score and UCLA shoulder score .

(( Acromion, lateral projection of scapular spine, fracture is an uncommon injury which is often diagnosed late. Though, usually managed conservatively, the indications for surgery in these fractures are very specific. We are reporting on a 56-year-old active woman with an isolated displaced base of acromion fracture by tension- band wire fixation which resulted into uneventful union, and obtained good shoulder Constant Score and UCLA shoulder score Acromion, lateral projection of scapular spine, fracture is an uncommon injury which is often diagnosed late. Though, usually managed conservatively, the indications for surgery in these fractures are very specific. We are reporting on a 56-year-old active woman with an isolated displaced base of acromion fracture by tension- band wire fixation which resulted into uneventful union, and obtained good shoulder Constant Score and UCLA shoulder score . . ))

Abstract A review of the advancements in the field of jaw and alveolar bone defects regeneration with focus on the role of biomaterial and biological scaffolds

Hard tissue regeneration of jaw and alveolar bone has long been a focus of maxillofacial and dentistry surgeons, which a. Many bone defects have been regenerated with the aid of advanced materials and innovative solutions that are gradually developing and being introduced to the commercial market. Commonly , autografts, allografts, and xenografts have been used for reconstruction of jaw and alveolar bone defects for a long period of time and are nowadays commercially available in cancellous and cortico-cancellous models, offered in various shapes, sizes, and applications. Recently , use of fibrin clots obtained from individual's blood plasma (PRF) has encountered remarkable success in maxillary bone ridge augmentation. Progress on tissue engineering and biomaterials science has led to development of various biological scaffolds and compositions that there is no longer previous limitations and problems so weak osteoinduction potential and immunological stimulation have been resolved and they exhibited significant results especially for maxillary sinus-lift surgeries and crest bone augmentation. In this respect materials like Calcium phosphate compounds, synthetic biodegradable polymers such as PLGA and PLA, biomaterials consisting of bioactive glasses, as well as advanced biological membranes are under development . In addition, more efficient and effective jawbone and alveolar bone regeneration methods are available to patients through their integration with stem cells, bone substitute materials , biological molecules and cell growth factors , emphasizing the importance of understanding and studying efficient biomaterials and their compositions for jawbone and alveolar regenerative medicine.

Abstract این شکستگی یکی از رایج ترین اسیب های دست است. بر طبق ارزیابی سال ۱۹۹۸ در امریکا؛ سالیانه ۶۴۳۰۰۰ مورد مشاهده شده است. ۳۷۲۰۰۰ مورد مربوط به افراد ۶۵ سال ببالا بوده است.تعداد شکستگی ها با بالا رفتن سن افزایش می یابد.نوشتجات در مورد این شکستگی زیاد هست؛ تا جولای ۲۰۲۲؛ بیش از ۱۸۰۰ مقاله را مشاهده می کنیم؛۶۲۸ مقاله مقدم به دوازده ماه اخیر بوده است.
این شکستگی قبل از عصر ۱ACL (رباط صلیبی قدامی) ردیف اول شکایت های پزشکی قانونی را از آن خود داشت. بنظر می آید اکنون شکایات بیهوشی و ACL در ردیف اول قرار دارند.
در زمان جالینوس و بقراط[(۱۳۱-۲۰۱ قبل از میلاد) آنرا در رفتگی مچ میدانستند. پوتو Pouteau از فرانسه در سال ۱۷۸۳ این سنت را شکست و آنرا بنام شکستگی پوتو در نوشتجات ثبت کرد.جو سیاسی قرن هیجده اروبا طوری بود که دنیای انگلیسی زبان ؛فرانسه زبانان را به رسمیت نمی شناخت.مبادلات علمی بین آنها وجود نداشت.
ابرهام کالیس جراح ایرلندی این شکستگی رار سال ۱۸۱۴ در مجله Edinburgh Medical Surgical Journal چاپ کرد.شرح و بیان این شکستگی فقط بر پایه معاینات کلینیکی و بسیار درست بود. ناگفته نماند کالیس آنرا ۸۱ سال قبل از ظهور رادیو گرافی شرح داده بود. رادیو گرافی در سال ۱۸۹۵ اختراع شد.