Iranian Journal of Orthopedic Surgery

Abstract Abstract:
Introduction: Anemia is one of the most important and vital cases in internal medicine and surgery, and due to its important effects and complications on complete physical health and surgeries, in order to reduce the severity and frequency of anemia by recognizing the factors affecting its occurrence, the relationship between preoperative hemoglobin level and moderate to severe postoperative anemia in patients with complete knee replacement was performed in Imam Khomeini Hospital in Urmia.
Materials and methods: In this cross-sectional analytical study, with the aim of investigating the relationship between preoperative hemoglobin level and moderate to severe postoperative anemia in patients with total knee replacement, after obtaining the code of ethics from the ethics and research committee of Urmia University of Medical Sciences, the researcher referred to the archives of Imam Khomeini Hospital in Urmia and studied the files of 242 patients who underwent total knee replacement surgery in Imam Khomeini Hospital in Urmia.. Finally, the collected data were entered into SPSS 27 software with appropriate coding and analyzed based on the objectives of the study.
Findings: Of the total patients, 204 (84.3%) were female and 38 (15.7%) were male. The mean age of the patients was 66.69 years (age range 37 to 84 years) and the mean body mass index of the patients was 29.03 kg/m2 (body mass index range was 20 to 44 kg/m2). Considering the diagnosis of anemia on the second day after surgery, the best positive point in identifying high-risk patients for hemoglobin before surgery was 13.15 mg/dl (sensitivity and specificity of 73.6% and 72.6%, respectively).
Conclusion: Both preoperative and postoperative hemoglobin levels act as vital diagnostic markers in TKA, influencing not only immediate surgical outcomes, but also cure rates and longer-term complications.

Abstract Abstract
This article is the second part of a comprehensive review focusing on the anatomy, physiology, and treatment of distal radius fractures. This injury is among the most common skeletal traumas. The first part provided a historical overview of the condition and outlined the advancements in its recognition and management. It was noted that the treatment of this fracture requires a precise understanding of the anatomy of the radius and the wrist joint. The importance of standard imaging modalities such as radiography and CT scan for fracture evaluation and surgical planning was emphasized, and various classification systems used in managing this fracture were also discussed. Since the primary goal of treatment is to restore wrist function to its pre-injury level, the first part highlighted the critical role of key parameters such as articular step-off, dorsal tilt, and radial length in clinical decision-making. Now, in the second part, surgical methods including pin and plaster, percutaneous pinning, the Kapandji technique, fragment-specific fixation, external fixators (both bridging and non-bridging types), locking plates (fixed-angle and variable-angle), and spanning plates are examined. The complications associated with each method, such as infection, radial nerve injury, and tendon-related problems, are also discussed. Postoperative pain management, follow-up care, and the importance of precise imaging—particularly the facet view—are among other key topics addressed in this section. Ultimately, it is emphasized that the choice of surgical method should be based on the characteristics of the fracture, the patient’s condition, and the surgeon’s experience.

Abstract Abstract:

Meniscal tears are one of the most common knee injuries, and effective repair techniques are crucial for maintaining long-term knee function and preventing degenerative changes. Among various repair methods, the vertical mattress sutures are frequently utilized. Here we present a technique that we believe provides the strongest fixation for longitudinal meniscal tears.
Abstract:

Meniscal tears are one of the most common knee injuries, and effective repair techniques are crucial for maintaining long-term knee function and preventing degenerative changes. Among various repair methods, the vertical mattress sutures are frequently utilized. Here we present a technique that we believe provides the strongest fixation for longitudinal meniscal tears.
Abstract:

Meniscal tears are one of the most common knee injuries, and effective repair techniques are crucial for maintaining long-term knee function and preventing degenerative changes. Among various repair methods, the vertical mattress sutures are frequently utilized. Here we present a technique that we believe provides the strongest fixation for longitudinal meniscal tears.

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 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 Abstract Introduction: Delays in diagnosing musculoskeletal injuries in patients who have suffered polytraumas can lead to long-term functional and aesthetic disorders. This study investigates the undiagnosed cases of fractures and soft tissue damage in multiple trauma patients in a teaching trauma centre within 6 months. Materials & Methods: This cross-sectional descriptive study was conducted on polytraumas patients referred to a teaching trauma centre within 6 months. Results & Discussion: In 339 polytrauma patients, 21(6.2%) had undiagnosed injuries: 15 (71.4%) men and 6 (28.6%) women with mean age of 39.3 ± 8.5 years (11 to 82 years) were studied. The average duration of hospitalization for undiagnosed fractures and soft tissue injuries in polytraumas patients was 4.4 ± 2.3 days. The most common sites of undiagnosed injuries were the clavicle (22.2%), followed by metacarpal and femoral neck (16.7%), acetabulum and intertrochanteric (11.1%), and distal fibular fractures (8.3%). Conclusion: Late diagnosis of fractures in trauma hospitals is not uncommon, Middle age of 40-60 years and clavicular and femoral neck fractures are important and common ones to remember.

Abstract Abstract
Avascular necrosis (AVN) of the capitate is extremely rare and leads to chronic wrist pain. Currently, there is no standard treatment protocol for AVN of this wrist bone. Due to the rarity of these cases, limited experience exists regarding treatment methods. This report presents a 30-year-old male patient with AVN of the capitate. The patient was treated with a vascularized bone graft. After one year of follow-up, the symptoms have resolved, and there has been no progression of capitate necrosis.

Abstract Abstract
The brachial plexus block is a regional anesthesia technique primarily used for upper limb surgeries. This method involves injecting local anesthetics near the brachial plexus, a network of nerves that innervate the arm, temporarily blocking sensation and motor function in the affected area. It serves as an alternative or adjunct to general anesthesia, particularly benefiting patients with significant comorbidities or those at risk of complications associated with general anesthesia. Regional anesthesia plays a crucial role in orthopedic and outpatient anesthesia advancements by providing both intraoperative anesthesia and postoperative analgesia. Furthermore, with the advent of ultrasound technology, newer upper limb block techniques have been introduced for targeted anesthesia. These various approaches allow anesthesiologists to tailor pain management strategies based on the individual needs of patients and surgical requirements. Continuous improvements in ultrasound technology have enhanced the safety and efficacy of these blocks, making regional anesthesia a standard technique for pain management in upper limb surgeries.

Abstract Abstract
Carpal Tunnel Syndrome (CTS) is the most common idiopathic neuropathic compression syndrome in the upper extremity, with a reported prevalence of 2.7% in the general population. Trigger Finger (TF) is a common upper limb disorder characterized by the painful locking of one or more fingers. A review of the literature, and personal experiences of the authors indicates that the occurrence of Trigger Finger after Carpal Tunnel Syndrome surgery is significantly higher in patients with CTS compared to those without CTS, though this increase in incidence has not definitively been linked to the surgery. In most studies, thumb has been the most commonly involved finger in association with CTS; however, in some cases, the third finger was more common. In contrast, when TF occurs alone, the fourth finger is typically the most frequently affected finger with triggering in the fourth one.