Iranian Journal of Orthopedic Surgery

Abstract Abstract Introduction: Arthroplasty as a treatment option for femoral neck fracture in elderly people has been widely supported although the type of arthroplasty is debatable. This study was conducted to evaluate the functional outcome of bipolar hemiarthroplasty (BHA). Materials & Methods: 49 patients with femoral neck fracture who were operated with BHA within 5 years were included in the study. The clinical, radiographic, and functional results, using modified Harris-Hip score (HHS), were evaluated with a follow-up of 47 months. Results & Discussion: 49 patients, - 66.7% men and 33.3% women, with 9 patients (18.4%) below 60 and 40 (81.6%) over 60 years old were studied. The average follow-up period was 48.66 months in people below 60 years and 46.60 months in over 60 years patients. The difference in the average HHS between the two groups was marginally significant (p=0.06). In the performance section of HHS, 55.6% showed poor performance, 33.3% relatively good performance and 11.1% good performance in people below 60- years group. These scores for over 60- years group were 85%, 7.5% and 7.5% in respectively. Conclusion: The present study could not observe a satisfactory functional outcome after BHA in below or over 60-years population in this medium-term study. Therefore, evaluating the hip function after BHA in the long term and the cause for poor function is needed to be investigated. Slow erosion of the acetabulum following BHA can be a possible reason, lowering performance which requires in-depth investigation in long term studies. Keywords: Femoral neck fractures, Hemiarthroplasty, Outcome assessment.

Abstract Abstract
Introduction: Intertrochanteric femoral fractures are common and can be associated with significant complications and mortality. This study aimed to assess the mortality rate and related factors in patients undergoing surgical treatment for intertrochanteric fractures.
Materials & Methods: This retrospective descriptive-analytical study included patients with intertrochanteric hip fracture who underwent surgery between 2017 and 2018 in a teaching hospital .The demographic data were collected from patients’ records, with specific attention to age, osteoporosis, previous fracture history, cognitive disorders, hypertension, delay in surgery, and the type of fixation implant. Mortality status was assessed through follow-up phone calls. Data were analyzed using STATA software and logistic regression analysis.
Results & Discussion: 227 case within one year were studied. The overall mortality rate was 16.3%. In the deceased (p<0.05). Logistic regression revealed that advanced age, osteoporosis, previous fracture history, cognitive disorders, history of falling, surgical delay, and type of surgery were independent predictors of mortality (p<0.05).
Conclusion: Postoperative mortality following intertrochanteric fracture surgery is influenced by a range of clinical and modifiable factors. Timely selection of an appropriate surgical method and identification of high-risk patients can play a significant role in improving treatment outcomes.
 

Abstract Abstract
Introduction: Spastic cerebral palsy (CP) is the most prevalent motor disability in children, defined by chronic spasticity, muscle stiffness, and motor control impairment, resulting in gait disturbances, postural instability, and decreased walking speed. Orthopedic surgery, including tendon lengthening and muscle releases, is routinely employed to rectify musculoskeletal deformities and enhance motor function. The extent to which these surgeries affect gait kinematics, postural balance, and walking speed is uncertain. The purpose of the current study was to assess the influence of orthopedic surgery on gait kinematics, postural balance, and gait speed in children with spastic CP via a multi-dimensional approach.
Materials & Methods: A prospective observational cohort study was carried out in 30 children (5–12 years, GMFCS Levels I–III) who were scheduled for orthopedic surgery. Participants were evaluated preoperatively and 6 and 12 months after surgery. Outcomes were gait kinematics (stride length, cadence, joint angles), postural balance (Pediatric Balance Scale [PBS], Timed Up and Go [TUG] test), and gait speed (10-Meter Walk Test [10MWT]). Data were analyzed using repeated-measures ANOVA, and effect sizes (Cohen's d) were determined.
Results & Discussion: At 12 months after surgery, there were significant improvements in all outcome measures. Stride length improved by 12.5% (p < 0.01), and cadence by 8.3% (p < 0.05). Knee flexion angle and ankle dorsiflexion angle also improved significantly (p < 0.01). Postural balance was improved, with PBS scores rising from 42.3 to 48.7 (p < 0.01) and TUG test times falling from 12.5 to 9.8 seconds (p < 0.01). Walking speed was enhanced by 18.6% in comfortable speed and 15.2% in fast speed (p < 0.01). Subgroup analysis showed greater improvement in children with GMFCS Level I compared to Levels II and III (p < 0.05). No differences were noted between tendon lengthening and muscle releases (p > 0.05).
Conclusion: Orthopedic surgery significantly improves gait kinematics, postural balance, and gait velocity in children with spastic CP, with the effects being preserved 12 months post-surgery. The findings emphasize the contribution of surgical interventions and personalized rehabilitation protocols in improving functional mobility and quality of life in these patients.

Abstract Abstract Introduction: Given the importance of the stability of the pelvic incidence (PI) angle in evaluating spinal alignment and its significance in spinal fixation during surgical procedures, this study aims to investigate the PI angle and compare it in two positions: Full Flexion and Full Extension. Materials & Methods: This cross-sectional study assessed 44 student volunteers using dynamic radiographic evaluation in two positions: Full Flexion and Full Extension. Dynamic radiographs were taken in two conditions: (1) seated with maximum forward bending (Full Flexion) and (2) lying supine with legs hanging off the edge of the bed to their maximum extent (Full Extension). The PI angle was measured using the PACS software. Results & Discussion: The mean PI angles in the Full Flexion and Full Extension positions were not equal, demonstrating positional changes. The mean PI angle in Full Flexion was higher than in Full Extension. The mean difference in PI angle between the two positions was 3.6±3.9 degrees. In females, the mean PI angle in Full Flexion was 55.83±11.23 degrees, which was higher than in males (53.22±7.62 degrees), though this difference was not statistically significant (P = 0.390). In Full Extension, the mean PI angle in females was 51.61±9.87 degrees, which was again higher than in males (49.65±7.05 degrees), but the difference was not statistically significant (P = 0.608). Conclusion: The study results indicate that pelvic positioning affects pelvic incidence, and PI measurements are not constant across different positions. Furthermore, PI in the Full Flexion position was greater than in the Full Extension position.

Abstract Abstract Introduction: Varus deformity is the most common deformity in patients undergoing knee replacement. Varus correction is based on the release of the medial soft tissue of the knee. But there is no exact measure of its extent. The present study aimed to investigate radiographic parameters that can predict the need for the release of medial elements. Materials & Methods: In this retrospective cohort study all patients who underwent primary knee replacement surgery performed in a university hospital by a single surgeon during a 2-years period were included in the study. Preoperative and post-operative knee radiographs were collected. Patients were divided into three groups based on the stage of medial release. The radiographic criteria including Mechanical Femoro-tibial angle (mFTA), Lateral distal femoral angle (LDFA), Proximal medial tibial angle (MPTA), valgus cut angle (VCA) and joint line convergence angle (JLCA) before and after surgery were compared between the groups. Results & Discussion: A total of 115 knee radiographs, related to 103 patients were examined. There was a significant association between LDFA , MPTA , mFTA , VCA and degree of varus correction with the medial release. The degree of varus correction significantly predicts the need for a high grade of medial release (OR=1.49, P=0.01) Conclusion: higher LDFA, mFTA, VCA, and the degree of correction of the femoral and tibial mechanical angle and lower MPTA were associated with a higher degree of medial release. And the amount of varus correction significantly predicts the need for more medial release.

Abstract Abstract   Tissue engineering is a modern and interdisciplinary science that examines the methods used in the structural and functional restoration of damaged tissues. One of the most important steps in tissue engineering is to prepare a suitable scaffold with characteristics compatible with the target tissue. In recent years, many scaffolds have been prepared, to repair different tissues. The present study examines recent research in the preparation of scaffolds in various tissue engineering. Many scaffolds including composites, nanofibers, hydrogels, synthetic or semi-synthetic polymers and ceramics have been prepared and used. Some scaffolds are also obtained during decellularization of natural tissues. Various methods, like electrospinning or 3D printing, have been used to prepare synthetic scaffolds. However, there is a need for more in-vivo studies to ensure the proper functioning of these scaffolds in in-body conditions.  

Abstract Abstract Corticosteroids are widely used medications with increasing prevalence in clinical practice. In autoimmune and rheumatological diseases, the use of corticosteroids in both pulsed and long-term manners is very common. Due to the COVID-19 pandemic, their consumption increased. However, long-term use is associated with several adverse effects on the musculoskeletal system, including osteoporosis, an elevated risk of fracture, avascular necrosis, hypocalcemia, hypovitaminosis D, and impaired bone growth in children. Corticosteroid-induced osteoporosis is the most common form of secondary osteoporosis. Several factors, such as age, time of use, family history of osteoporosis, previous fractures, and calcium intake, contribute to its prevalence. Corticosteroids exert their effects by disrupting the balance between the activity of osteoblasts and osteoclasts. These medications also disturb the calcium metabolism by altering intestinal calcium absorption and renal calcium excretion. To minimize these side effects, corticosteroid therapy should be limited whenever possible. Also, supplementing with calcium and vitamin D, incorporating breaks of at least three months between corticosteroid courses, and considering alternative therapies, especially in pediatric patients, can help mitigate the potential risks.

Abstract Abstract Stress fractures are rare injuries that occur due to redundant mechanical pressure or overuse of the bone. We aim to report a case of bilateral distal femoral stress fracture with intra-articular extension in an old woman with degenerative joint disease (DJD) and osteoporosis. Here we report a bilateral intra-articular distal femoral stress fractures in an elderly woman with a history of osteoporosis and osteoarthritis with complaints of intensification of pain, limitation of movements and weight bearing. Unfortunately, the patient neglected, and did not visit for more than a year after the initial visit. She underwent total knee arthroplasty for both knees three months apart. After two years of follow-up, her knees were free of pain, and no specific complaint was mentioned. Stress fractures even with intra-articular extension in the elderly with osteoarthritis may mimic arthritis symptoms and hide behind them. Orthopedics must consider stress fractures in the differential diagnosis of elderly patients with osteoarthritis and persistent pain.