Iranian Journal of Orthopedic Surgery

Abstract Abstract Introduction: In some cases of major lower limb trauma, either amputation or limb preservation is performed. The aim of this study was to compare the quality of life in patients undergoing amputation versus limb preservation. Materials & Methods: In a cross-sectional comparative study, patients with major lower limb trauma who underwent either lower limb amputation or limb preservation were evaluated at least six months post injury. Quality of life was assessed and compared between the two groups using SF-36 questionnaire. Results & Discussion: A total of 94 patients, including 80.9% male and 0.9% female, with mean age of 41.5 years (range 18 to 64), with the mean study period of 6 months, were included in the study. There was no statistically significant difference between the two study groups regarding age, gender, marital status, number of children, education level, smoking, or substance and alcohol abuse. The sub-scales of general health (P = 0.001) and vitality (energy) (P = 0.002) were significantly higher in the amputation group in comparison with the limb-preservation group within the six- months post injury. Conclusion: In patients with major trauma, attempts to preserve the limb, instead of immediate amputation results into longer hospital stays, increased incidence of infections, and higher rates of re-operation. Amputation, within a minimum of six months, leads to improved quality of life, particularly in the domains of general health and vitality.

Abstract Abstract Introduction: Osteoporosis is currently a public health problem and is known as the silent disease of the century. The complications of osteoporosis affect people's lives and lead to anxiety and depression. The main purpose of our study is to determine the frequency of depressive symptoms and related factors in patients with osteoporosis. Materials & Methods: The present study is an analytical cross-sectional study that was conducted on 35 patients with osteoporosis who referred to the osteoporosis clinic of a teaching hospital between March 2024 and March 2025. Patient information was gathered using a researcher-made checklist and the Hospital Anxiety and Depression (HADS) questionnaire. All statistical analyses were performed using SPSS 20 software at a significance level of 0.05. Results & Discussion: Out of the 35 patients studied, 24(68.57%) exhibited depressive symptoms. Of these, 32(91.40%) were female, and 3(8.60%) were male. Depressive symptoms were observed in 65.60% of women and in all men. The overall mean age of the patients was 63.86±6.80 years. Among the patients, 7(46.70%) with diabetes and 17(85.00%) without diabetes had depressive symptoms, showing a statistically significant link between diabetes and depressive symptoms in osteoporosis patients (P<0.05). However, no statistically significant association was found between other variables and depressive symptoms in patients with osteoporosis (P>0.05). Conclusion: The findings of the present study suggests that the frequency of depressive symptoms is high in patients with osteoporosis; therefore, it should be considered as an important factor in the treatment of osteoporosis.

Abstract Abstract Introduction: Osteoarthritis (OA) is a common joint problem that primarily affects the knee joint, leading to significant disability and imposing a substantial burden on healthcare systems. Therefore, treatment aimed at minimizing physical dysfunction in these patients is of great importance. This study aimed to assess how well a type of nutritional supplement works to reduce pain and improve joint function in people with knee osteoarthritis. Materials & Methods: This study was a randomized, double-blind clinical trial conducted on patients who presented to the orthopedic clinics in one year. Patients in the intervention group received a kind of nutritious supplement along with standard therapy, but control group received standard therapy with a placebo. Statistical analyses were performed using SPSS version 20, with the significance level described 0.05. Results & Discussion: The mean age was 58.93 ± 5.65 years in the control and 59.77 ± 6.44 years in intervention groups, and no statistically significant difference between them (P > 0.05). Results from multiple covariance regression analysis demonstrated a statistically significant difference between the two groups in terms of pain severity, symptom scores, functional capacity, and total WOMAC score (P < 0.05). Conclusion: Daily administration of this nutritious supplement for up to two months, in addition to standard therapy, is recommended for patients with knee osteoarthritis. This regimen can result in clinically meaningful improvement in pain, symptom severity, functional capacity, and total WOMAC score.

Abstract Abstract Introduction: Osteoarthritis (OA) is a prevalent and debilitating musculoskeletal disease characterized by chronic pain. Given the suboptimal efficacy of current analgesic drugs, identifying novel therapeutic strategies remains a clinical priority. This double-blind randomized controlled trial aimed to compare the efficacy of duloxetine and memantine in managing postoperative pain following total knee arthroplasty (TKA). A randomized, double-blind placebo controlled. Materials & Methods: A clinical trial was conducted on 187 patients undergoing TKA. Participants were assigned into three groups: placebo (n=63), Memantine (10 mg/day, n=62), and Duloxetine (20 mg/day, n=62). All groups followed a standardized perioperative protocol. Pain intensity was assessed preoperatively and at two weeks and three months postoperatively using the Visual Analog Scale (VAS; 0–10). Demographic variables and opioid consumption (morphine sulfate equivalents) were recorded during hospitalization. Results & Discussion: The mean opioid consumption during hospitalization was 70.5 ± 2.01, 71.29 ± 2.6, and 76.07 ± 2.5 mg in placebo, memantine and duloxetine respectively. One-way ANOVA revealed no statistically significant intergroup differences in opioid consumption (p > 0.05). Similarly, no significant differences in mean pain intensity were observed across groups at any timepoint (p > 0.05). However, longitudinal analysis (Friedman test) demonstrated a statistically significant reduction in pain intensity over time within all groups (p < 0.05), consistent with typical postoperative recovery trajectories. Conclusion: While both Duloxetine and Memantine were associated with temporal reductions in pain intensity, neither intervention demonstrated statistically significant superiority over placebo in mitigating postoperative pain or opioid demand. Further research into optimal dosing regimens, longer follow-up periods, and synergistic effects with these drugs may provide different findings in TKA pain management.  

Abstract Abstract
Introduction: Bone grafting is the main treatment of scaphoid nonunion. In this study, we intend to evaluate the radiographic results in patients with non-vascularized bone graft in scaphoid nonunion with or without AVN.
Materials & Methods: In a cross-sectional study, patients with scaphoid nonunion were chosen in a census sampling method and were followed up and immobilized with plasterfor four weeks. Then a radiography was taken and the patients were followed till the union were seen in radiography. Data were analyzed by SPSS 24.
Results & Discussion: In this study, 43 patients were admitted. The mean total age of patients was 29.91 ± 8.58 years.13 patients had complications, 6 reported limited mobility and 7 reported pain. Fifteen patients (34.9) had avascular necrosis. All patients were able to perform daily activities with hands, and none complained of inactivity. The mean duration of first incision to the end was 49.16 ± 5.98 minutes. The mean time elapsed from scaphoid fracture to surgery was 36.59 ± 47.42 weeks. The mean time from surgery to complete recovery was 145.79 ± 73.85 weeks. The mean time from surgery to the first evidence of healing was 36.59 ±47.42 days which resulted in scaphoid union in all patients.
Conclusion: This study demonstrated that non-vascularized bone grafting resulted in radiographic union of the scaphoid in all patients, including those with avascular necrosis. All participants regained the ability to perform daily hand activities without functional complaints. Complications occurred in 30.2% of cases, mainly presenting as mild pain and minor limitations in hand motion. These findings suggest that this technique is a safe and effective option for treating scaphoid non-union.

Abstract Abstract Orthopedic screws play a crucial role in internal fixation for fracture stabilization, joint fusion, and osteotomy procedures. Recent advancements in material science and biomechanics have led to the development of various screw designs aimed at optimizing fixation strength and reducing postoperative complications. Understanding the biomechanical properties, classifications, and technological innovations of orthopedic screws is essential for improving surgical outcomes. This study presents a comprehensive review of the classification, design, biomechanical characteristics, and clinical applications of orthopedic screws. A systematic analysis of scientific literature was conducted to evaluate different screw types based on their material composition, mechanical properties, and fixation techniques. Additionally, emerging technologies, including bioabsorbable screws, locking screws, and smart implants, were examined for their potential impact on modern orthopedic surgery. The findings indicate that locking screws provide superior fixation in osteoporotic bone and complex fractures, reducing implant failure risks. Bioabsorbable screws have shown promise in eliminating the need for secondary implant removal surgeries; however, challenges such as degradation rate control remain unresolved. Drug-releasing screws have demonstrated effectiveness in lowering post-surgical infection rates, yet further studies are needed to determine optimal drug dosage and release kinetics. Advancements in orthopedic screw technology, including material innovation and improved mechanical design, have significantly enhanced clinical outcomes. However, challenges remain regarding the long-term stability of bioabsorbable screws, the optimization of mechanical properties, and the reduction of implant-related complications. Future research should focus on developing patient-specific implants and refining biomechanical designs to further improve surgical success rates.

Abstract Abstract Femoral neck fracture is one of the most disabling affections in older patients. The usual surgical position in fixation of femoral neck fracture is the supine position on radiolucent fracture table. A technique of placing the patient in lateral decubitus position has been reported. This report describes this position in a patient with prior knee disarticulation. A 40-year-old man with a right hip fracture (Pauwels I, Garden II) fracture with a previous knee disarticulation secondary to extensive tibial trauma underwent close reduction and internal fixation in left lateral decubitus position. The knee and hip joint were flexed to 45° securely on the Mayo stand. Then, the patient's affected limb was lifted, and a pillow - pad was placed under it. This position was supported by two side supports -one on the back and one on back of trunk. Improving C-arm accessibility and adjustment, leading to reduction of contaminating, a more accurate lateral view of the proximal femur, decreasing the risk of reduction loss, optimizing the workflow, and more suitability in complex patients are the benefits seen in this case. On the other hand, increasing total surgical time, and harder fluoroscopy adjustments were the challenges. In this patient with prior disarticulation, lateral decubitus position for femoral neck fracture showed promising intra and post-operative results.

Abstract Abstract Total Knee Arthroplasty (TKA) is a surgery performed to treat patients with advanced knee osteoarthritis. Currently, about 95.3% of knee arthroplasties are performed using the cemented technique. Since the introduction of Polymethylmethacrylate (PMMA) cement, it has played a primary role in arthroplasty. Cementless fixation may lead to better survival rates in selected patients, while cemented TKA is believed to have lower infection rates. With the increasing number of TKAs, improving cementing techniques is essential to reduce primary TKA failure and avoid revision surgeries. A narrative review was conducted by searching the MEDLINE database from 2000 to 2024 to investigate the most appropriate cementing techniques in knee replacement. Recent studies have identified several factors affecting the results of cement placement in TKA, such as cement penetration depth, cementing technique, and cement viscosity. Preparing the bone surfaces before cementing is essential to ensure adequate cement penetration. Bone surfaces must be thoroughly dried before cementing. For optimal cement penetration, sclerotic surfaces should undergo drilling. Poor cementing technique is associated with loosening of the prosthesis leading to early or late joint replacement failure. Therefore, it is essential to use an accurate cementing method at the time of TKA to avoid aseptic loosening and, early failure of TKA.