Iranian Journal of Orthopedic Surgery

Abstract Introduction: Anterior Cruciate Ligament is an extra synovial element, and the fibroblasts are involved in its ongoing renewal and maintenance. It seems that opium addiction and smoking have destructive effects on the healing process of the rehabilitation of anterior cruciate ligament. Thus, the purpose of the present study is to investigate the clinical outcomes of ACL reconstruction surgery in the opium-addicted patients, smokers, nicotine- and opium-addicted patients, and non-addicted patients.
Materials and Methods: This study is a prospective cohort study. The patients were divided into four groups: Smokers, opium-addicted, nicotine- and opium-addicted, and healthy. Then, the results of the ligament reconstruction in these four groups were evaluated according to the KOOS and Lysholm questionnaires as well as the KT-2000 system. The Chi-square test and independent sample t-test were used for analyzing the data, and a significant level was considered under 0.05.
Results: The rate of displacement based on the KT-2000 system in the non-addicted group was significantly lower than that of the exposed groups. The severity of knee pain and the amount of difficulty in daily activities and exercise on the basis of KOOS-criteria in non-addicted subjects were significantly lower than those of the exposed groups. According to the Lysholm questionnaire, the patient's lameness score, support score, instability score, stair-climbing score, and squatting score in the non-addicted group were significantly higher than each of the exposed groups. The level of locking and swelling did not differ significantly.
Conclusion: The results of the current study generally showed that the clinical results of anterior cruciate ligament reconstruction in the opium-addicted patients and smokers were significantly worse than the non-addicted patients. The results of following up the patients after 12 months showed that the displacement rate based on the KT-2000 system in the non-addicted group was significantly lower than in the exposed groups.

Abstract Introduction: Intertrochanteric fractures are among the most common hip fractures, especially in the elderly population. DHS and PFNA, remain the main fixation methods for these fractures. This study compares the long-term results of these methods in fractures classified as OTA/AO A1 & A2.1.
Materials & Methods: A retrospective cohort study was conducted. 154 patients treated with DHS, PFNA, within 10 years in a teaching hospital were studied. Outcomes, such as infection, reoperation rate, and mortality were assessed based on age and sex in different subgroups.
Results & Discussion: Analysis of the 154 patients revealed no significant differences in infection rates, need for reoperation, or 5-year mortality between DHS and PFNA methods. However, women and patients older than 70 years treated with DHS showed a higher need for reoperation.
Conclusion: Except for women and individuals over 70 years old who had higher reoperation rates with DHS, no significant difference was observed between the two groups.
 
 

Abstract Abstract
Fat embolism syndrome (FES) is traditionally associated with orthopedic trauma, particularly long bone fractures, but its occurrence in non-orthopedic contexts, such as cosmetic procedures, acupuncture, and other minimally invasive interventions, is emerging as a significant clinical concern.
This literature review explores the clinical cases, pathophysiology, and knowledge gaps related to fat embolism in these non-orthopedic settings. The review, mostly includes the articles from the last 14 years.
The review synthesizes existing case reports, highlighting the mechanisms by which fat globules enter the bloodstream, often through tissue disruption in fat-rich areas. While fat embolism is well-documented in orthopedic trauma, the risk in non-traumatic contexts remains underrecognized, with diagnostic challenges and limited understanding of the precise mechanisms involved. Procedures like liposuction, gluteal fat grafting, and acupuncture have been implicated in fat embolism, often resulting in severe complications such as respiratory distress and neurological impairment. Despite the rising frequency of these procedures, significant gaps remain in understanding risk factors, improving diagnostic techniques, and optimizing treatment strategies.
This review underscores the need for increased awareness and further research to understand non-orthopedic fat embolism better, refine diagnostic approaches, and develop preventive measures to reduce the risk of complications in clinical practice.

Abstract Abstract Introduction: Distal radius fractures are the most common fractures in the upper limb, and many studies have been conducted on its treatment. There is, as yet, no consensus on which treatment method is preferable. This paper compares the use of plate alone with plate + external fixator in this fracture. Materials & Methods: In a randomized clinical trial (RCT), patients with type C2 and C3.1(AO/OTA classification) distal radius fracture, were randomly divided into two groups of fixation with locking plate alone (control) and fixation with plate and additional external fixator (intervention). Then patients were evaluated in terms of radiographs and clinical outcomes  in first, third and, sixth weeks, and also 6 and 9 months after surgery by Quick Disabilities of the Arm, Shoulder and Hand questionnaire (qDASH) and visual analogue score (VAS). SPSS software was used for data analysis. Informed consent was obtained from the patients. Results & Discussion: 52 patient (26 in each group) were enrolled in the study. The mean age was 42 years in the control and 41 years in the intervention group. The qDASH score in the control group was 35 and 38 in the intervention group and this difference was not significant between the two groups. No significant difference was observed between the two groups in terms of pain level according to the (VAS) score either. Also, the radiographic criteria including radius height and palmar tilt, did not differ significantly between the two groups (p<0.05). Conclusion: In general, with similar results of plating, and plating with addition of external fixator in fixation of distal radius fracture, the method of “plate alone” is preferred.

Abstract Abstract Introduction: The aim of this study is to investigate the radiographic and clinical findings in patients before and after Smith-Peterson osteotomy to correct adult spine deformity. Materials & Methods: This is a case series study. Data be prepared and extracted retrospectively from patients' records. Inclusion criteria were age >18 years, American Society of Anesthesiology (ASA) risk class III or less, and sagittal spine deformity within three years. All the patients had pre-operative full standing digital spine radiography. Radiographic and clinical parameters were extracted from the patients' files before the operation and 1 month after the operation. Demographic and surgical and clinical information: information was obtained for each patient. The information from the questionnaire was coded and entered SPSS software. The level of significance was considered less than 5%. Results & Discussion: A total of 10 patients met the conditions for entering the study and were examined. The amount of change in SAV before and after correction of deformity post-surgery decreased significantly (P<0.0001), the amount of Pelvic Incidence increased from 51.7 to 52.5 after surgery, which is not statistically significant(p=0.269). Pelvic tilt decreased from 28.7 to 23.5 after surgery (P=0.002). Sacral slope increased from 23.5 to 29.4 (p=0.002). Lumbar Lordosis also increased from 8.5 to 42.1 after surgery (p<0.0001). The rate of Thoracic Kyphosis also increased significantly from 24.4 to 25.2 after surgery (P=0.003). There was a significant decrease in VAS from 7.7 to 3.1 after surgery (P<0.00001). Conclusion: The spinal deformity correction by the Smith-Peterson osteotomy method can improve the radiographic as well as clinical parameters in short term.

Abstract Abstract Introduction: The aim of this study was to investigate the effect of pentoxifylline on the healing process of wounds resulting from traumatic amputation of the fingertips in patients, especially those who need accelerated treatment and better outcomes. Materials & Methods: This study was conducted as a randomized clinical trial on 52 patients who had referred to a teaching unit with finger-tip amputation after trauma. The patients were divided into two intervention groups (receiving pentoxifylline) and control group (receiving placebo). Pentoxifylline was prescribed in the intervention group at a dose of 1200 mg per day for 21 days. Evaluations were performed at three times (days 7, 14, and 21) in terms of wound status and treatment results. Results & Discussion: The results showed that on the seventh day, a lower percentage of patients in the intervention group had central and peripheral necrosis. Also, on the fourteenth and twenty-first days, a significant improvement in the condition of the wounds was observed in the intervention group and the prognosis of treatment in this group was significantly better. On the twenty-first day, 90% of patients in the intervention group achieved complete recovery, while in the control group this figure was 75%. Also, the side effects of pentoxifylline in the intervention group were few and temporary, and none of the patients needed to discontinue the drug. Conclusion: The use of pentoxifylline as a complementary treatment in patients with traumatic finger amputation has a significant positive effect on accelerating wound healing and improving treatment prognosis.

Abstract Abstract This case report outlines the situation of a young woman suffering from intense back pain, along with pelvic tilt and rotation. Due to the extent of her postural deformity and the profound effect on her quality of life, a spinopelvic fixation was performed to, halt any progression of the deformity, and relieve her pain. During the procedural process, a mass was detected in the sacral area. It was, later found that her vagina had two separate openings, putting the case in the syndromic sacral agenesis group. The importance of genetic testing, multi-disciplinary evaluation and significance of continued follow-u and care is high-lighted.

Abstract Abstract Introduction: Bone defects resulting from trauma, pathological conditions, or surgical interventions often require advanced regenerative strategies, particularly when critical-sized defects exceed the body’s intrinsic healing capacity. Among various biomaterials, Leukocyte- and Platelet-Rich Fibrin (L-PRF) has gained significant attention for its autologous origin, bioactive properties, and potential application in both autologous and xenogenic forms to enhance bone regeneration. Materials & Methods: Adult male Wistar rats were randomly divided to four experimental groups to evaluate the effects of equine-derived lyophilized L-PRF, with or without autologous bone grafts, on critical-sized radial bone defects. L-PRF was prepared from equine blood, lyophilized, and applied to the defect sites, with bone healing assessed via radiography and histopathology, and statistical differences among groups analyzed using non-parametric methods. Results & Discussion: Radiographic and histopathological analyses demonstrated that the autograft + L-PRF group exhibited the most pronounced bone healing, with significantly higher Lane and Sandhu scores and evidence of progressive cartilage-to-bone formation compared to the L-PRF alone and empty defect groups. The autograft group also showed superior outcomes relative to L-PRF alone, while untreated defects displayed primarily fibrous tissue with no bone formation, highlighting the synergistic effect of combining L-PRF with autologous bone grafts. Conclusion: In this study, xenogenic equine-derived L-PRF enhanced the repair of critical-sized radial bone defects in rats, with its combination with autografts yielding superior osteogenic outcomes compared to L-PRF alone.