Iranian Journal of Orthopedic Surgery

Abstract Abstract
Introduction: Plantar fasciitis is a common problem presenting  with heel pain and functional limitations. Given the contradictory results of previous studies on the effectiveness of medical and non-invasive treatments, this study was designed to compare  the results of shockwave therapy and medical treatment on pain intensity, function, and treatment complications.
Materials and Methods: In a prospective cohort study, 80 patients with plantar fasciitis from an orthopaedic clinic were selected during a 2-years period  and, after obtaining informed consent, were assigned to two groups of medical treatment and shockwave therapy. Shockwave therapy was performed with the Dornier Epos Ultra device and medical treatment included plantar fascia traction, ice massage, and NSAID medication. Pain and function indices were assessed at 12 weeks and one year after treatment using the VAS and Roles and Maudsley scales. Data analysis was performed with SPSS version 26.
Findings: The reduction in VAS score and improvement in function based on Roles and Maudsley in the shockwave therapy group was significantly greater than the medical treatment group (P<0.05). No significant difference was seen in the age and gender distribution of the two groups. The incidence of side effects in both groups was not statistically different, and all recorded side effects were transient.
Conclusion: Shockwave therapy has a stable and higher efficacy than medical treatment in controlling pain and functional improvement in plantar fasciitis and can be used as an effective  and safety treatment.

Abstract Abstract
 
Introduction: Bone fracture is one of the most common bone injuries in the world. It is, therefore, not surprising that bone healing is a critical orthopedic problem. Currently, bone grafts (autografts, allografts and xenografts) have been used as bone replacement strategies. The purpose of this study was to evaluate the efficacy of application of chitosan (CHS) as an osteo-inducer in the process of bone healing.
Materials and Methods: Fifteen male rats, in the same age and weight range, were divided into three groups of 5.  3 mm of metaphysis of the radius bone of each animal was removed. The defect was left empty in the first ,   filled with autograft in the second ,and filled with CHS in the third group. Radiographs of the defects were obtained  on  28^th  and 56^th  day post-operation. The animals were euthanized according to human ethics and the defects  were investigated histologically  on  the 56^th  post-operation day.
Results and Discussion: According to radiographic and histopathologic results, CHS indicated a improved  effect ,and improved bone healing process in comparison with the other two treatment modalities.
Conclusion: It can be concluded that use of chitosan improves the potential for  bone formation and bone healing criteria. These composite materials, however,  deserve more  studies.

Abstract Abstract
Objective: Frozen Shoulder is a painful and debilitating illness that affects 2 to 5% of the general population, characterized with significant shoulder pain and reduced mobility, resulting in loss of passive and active movements.This is  a cross-sectional study to evaluate serological factors in these patients and their relationship with Constant Shoulder Score (CSS) which may be of diagnostic benefit.
Material and Method: Frozen shoulder (Adhesive Capsulitis) cases  referring within  4 months of the disease were considered for the study (referred sample). Diagnostic criteria for adhesive capsules included: 1) limited and painful shoulder for at least 4 weeks, 2) severe shoulder pain that interfered with daily life or work performance, 3) nocturnal pain, 4) painful limitation of raising active and passive to less than 100 degrees, and 5) limitation of at least 50% in external rotation.  After primary clinical evaluations, a series of specific blood tests were requested and the shoulder range of motion and scores were recorded The mean levels of fasting blood glucose (FBS), Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) CRP levels and  associated with constant shoulder score (CSS) were documented.
 
Results: Fifty patients with frozen shoulder referred to the orthopedics clinic of a tertiary teaching  hospital within  one year period were included. A total of 29 patients with adhesive capsulitis were assigned to the study, of whom 22 were female (76%) and 7 male (24%). The mean levels of fasting blood glucose (FBS), Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) were 100.61 ± 17.29 mg/dL, 16.89 ± 13.14 mm/h and 2.85 ± 6.88 mg/L, respectively. CRP levels were inversely associated with constant shoulder score (CSS).
Conclusion: The serum level of CRP might be a reliable biomarker for predicting the qualitative state of pain and range of motion in patients with adhesive capsulitis.

Abstract Abstract
Introduction: The patella has an important role in knee extension and shock absorption. This retrospective study assessed factors influencing surgical outcomes of patellar fractures over ten years at a single center.
Methods: A descriptive-correlational design was applied to patellar fracture cases treated at a university center over a decade. Patients were stratified into follow-ups of <5 or ≥5 years. Data included demographics, medical history, functional outcomes (Koo’s and WOMAC indices), pain, range of motion, and osteoarthritis severity (Kallgren/Lawrence classification). Census sampling was used. Analyses were performed in SPSS, with visualizations in Excel and GraphPad Prism.
Results: Among 53 patients (mean age 60.45 ± 16.00; 90.6% male), 62.3% had <5-year and 37.7% had ≥5-years follow-up. Follow-up duration did not correlate with outcomes. Treatment complications significantly correlated with degenerative arthritis. Functional scores were higher (p < 0.05) and pain scores lower (p < 0.05) in patients without complications.
Conclusion: Patellar fracture surgery yielded favorable mid-term outcomes, with complications linked to poorer function and higher pain. Reoperation rates were low, supporting surgical efficacy.

Abstract Introduction: Scoliosis is one of the most common spinal deformities, which in severe cases requires extensive surgical intervention. These surgeries are often associated with significant blood loss and a need for blood transfusion. This study aimed to evaluate changes in complete blood count (CBC) parameters in patients undergoing scoliosis correction surgery over a five-year period at medical centers affiliated with Tabriz University of Medical Sciences.

Materials and Methods: In this retrospective study, data from 70 patients who underwent scoliosis surgery between 2015 and 2020 were analyzed. Demographic information, body mass index (BMI), hemodynamic status, duration of surgery, volume of blood loss, and details of intraoperative and postoperative blood transfusions were recorded. CBC variables were assessed preoperatively and over a five-day postoperative period.

Results: The mean age of the study population was 24 ± 18.43 years. The results indicated that higher body weight (p = 0.007), lower BMI (p = 0.033), and longer operative duration (p = 0.007) were significantly associated with increased intraoperative blood transfusion. Statistical analysis of CBC trends showed a significant decrease in RBC, PLT, HB, and HCT levels up to the fifth postoperative day. Conversely, WBC levels significantly increased on the first postoperative day, followed by a gradual decline.

Conclusion: These findings underscore the importance of accurate prediction of blood loss and optimal management of blood transfusion in scoliosis surgery. As postoperative hemoglobin decline is often self-limiting, unnecessary transfusions should be avoided. Moreover, in patients with high-risk indicators, preoperative preventive measures can help reduce complications. This study provides a foundation for developing more precise perioperative care protocols in scoliosis surgery.

Abstract One of the common complications after total knee replacement surgery is pain and instability in the patellofemoral joint, which significantly impacts patients' quality of life. Statistics show that 8–12% of revision knee replacement surgeries are due to issues related to the patellofemoral joint. A critical concern during surgery is patellar maltracking, which is frequently observed. This condition occurs when the patella does not move along its proper path, leading to functional problems and pain. Various methods have been introduced to evaluate and correct patellar maltracking. This review article addresses different aspects of this issue, including: Definition of patellofemoral maltracking, factors affecting patellar tracking, intraoperative evaluation of patellar tracking, the concept of Perfect Patellar Tracking, Surgical methods to correct patellar maltracking. This article aims to provide a comprehensive perspective on the importance of proper correction of patellar tracking to improve surgical outcomes and patients’ satisfaction.

Abstract Background: Severe acetabular bone loss following total hip arthroplasty (THA) presents a complex reconstructive challenge. Traditional classification systems, such as Paprosky, may not fully capture the morphology of defects in the most extreme cases. Additionally, previous revision plans could not safely manage such cases.
Case Presentation: A 71-year-old man presented with pain and instability four years after a primary THA. Imaging revealed a massive acetabular defect with extensive osteolysis and metallosis, including complete loss of the posterior column, medial wall, posterior wall, inferior rim, and ischium, and only the anterior wall and column remained intact. The acetabular cup had also protruded into the pelvic cavity, approaching the bladder, and had migrated centrally. While the defect resembled a Paprosky type IIC pattern, it was markedly more severe and did not fit existing classifications. A complex two-stage reconstructive surgery was performed, involving elevation of the hip center by 2.5 to 3 cm and compensation for limb shortening through femoral stem lengthening using a long-stem prosthesis. After 2-step revision surgery, the patient experienced prosthetic dislocation, necessitating a third surgery. During this procedure, a bipolar cup was manually drilled to allow bone cement to pass through the holes for improved fixation. Additionally, bone cement was applied over the screw heads (positioned superior to the cup) to construct a scaffold that enhanced implant stability and reduced the risk of dislocation.
Discussion: This case may represent a novel subtype of acetabular bone defect not encompassed by current classification systems. Furthermore, the innovative approach of penetrating a bipolar cup and using cement augmentation over a screw framework presents a potential new strategy for achieving stable fixation in cases of severe bone loss.
Conclusion: This case underscores the need for updated classification systems to account for atypical acetabular defect patterns and demonstrates a novel fixation technique that may improve outcomes in revision THA involving extensive bone loss.
 

Abstract Intrathecal opioids, such as morphine and fentanyl, are increasingly being used as adjuncts to spinal anesthesia and improve the quality of pain relief during and after surgery. This review investigates the mechanisms, benefits, and side effects of using these opioids, particularly in the context of femoral surgeries. The pharmacokinetics of these agents, including their rapid distribution in cerebrospinal fluid and binding to spinal receptors, contribute to effective pain management but also carry risks such as respiratory depression and urinary retention. Additionally, the impact of hemodynamic changes in femoral surgery is reviewed, emphasizing the importance of carefully adjusting anesthetic regimens and close postoperative monitoring to minimize complications. Evidence suggests that intrathecal opioids may reduce the incidence of postoperative delirium and opioid consumption in elderly patients, although further research is needed to confirm their efficacy in various surgical settings. This review underscores the need for more research into multimodal pain control using intrathecal opioids.