Background: Comparative studies on the effect of different tissue dissection techniques concerning adhesion, scar formation and functional impact on nerve and muscles are scarce, especially in orthopedic traumatic conditions.
Objectives: In the present experimental study, we aimed to investigate the impact of the choice of dissection technique on the peripheral nerve and surrounding tissues in a rat model of lower limb injury.
Materials and Methods: Forty adult female Wistar rats were divided into five groups (n = 8): In group 1, surgical blade was used to simulate sharp dissection; in group 2, a standard surgical forceps was used to simulate dissection with muscle contusion; In group 3, a small piece of compressed steel wool was used to simulate abrading during dissection; In group 4, extracorporeally minced muscles were used to simulate aggressive dissection; In group 5, a bipolar electrocoagulation instrument was used to simulate electrocautery dissection. During 3 weeks, the five groups were evaluated with functional assessment by toe out angle (TOA), morphological assessments by Petersen gross anatomical scale and histological assessment by scar formation index.
Results: The mean TOA was higher significantly in group 5 (P < 0.001). The largest mass of gross scar and the highest nerve adherence (grade 3) was detected in group 4 (P = 0.002). Scar index in all experimental groups was significantly higher than normal (P < 0.001). Group 4 showed the highest scar index (P = 0.000) and group 1 showed the lowest scar index.
Conclusions: Deep dissection with sharp cutting tools, results in low scar formation, tissue adhesion and subsequent indirect nerve injury. Electrocoagulation dissection may have side effects on adjacent nerves. Aggressive dissection, abrading during dissection and contusion should be avoided.

Background: Orthopedic surgery of tibial plateau fractures has been a challenging procedure for a long duration. However, less-invasive surgical techniques have recently been developed for this condition.
Objectives: In an interventional study with a historical control, we evaluated the medium-term functional and radiological outcomes of treatments for tibial plateau fractures using the arthroscopically assisted reduction and internal fixation (ARIF) and open reduction and internal fixation (ORIF) techniques.
Patients and Methods: Eleven patients with tibial plateau fractures of Schatzker types I-VI were treated with ARIF, whereas 11 patients were matched historically as the ORIF group. There were no significant differences in gender, age, and fracture types between the groups (P > 0.05). At the last follow-up, range of motion, visual analogue score for pain, Rasmussen functional and radiographic scores, international knee society scoring system (IKSS) score, and the Ahlback radiologic scale score for osteoarthritis were evaluated.
Results: All patients achieved union. The ARIF group had a shorter rehabilitation period, as well as a lower rate of midterm osteoarthritis and complications (P < 0.05). There were no significant differences between both groups according to other functional and radiologic assessments.
Conclusions: We recommend that the ARIF technique is an acceptable alternative treatment for tibial plateau fractures, with good functional and radiological midterm results and without serious complications.

Background: Surgical site infection (SSI) is defined as an infection that occurs at or near a surgical incision, within 30 days of the procedure, or within one year, if an implant is left in place. They are the leading cause of nosocomial infections after surgery, accounting for nearly 40% of nosocomial infections in surgical patients. Identifying the risk factors that increase the probability of SSI can help us take preventive measures and design control strategies, leading to a decrease in the rate of infection.
Objectives: We aimed to assess the effects of probable SSI risk factors, making it possible to control these variables and to avoid complications of SSI, thereby decreasing its direct and indirect costs.
Patients and Methods: In this nested case-control retrospective study, 208 patients, who underwent orthopedic surgery in Dr. Shariati Hospital, Tehran, Iran, during 2006 - 2012, were included, as the study population. Data were gathered from the patients’ records and were analyzed by SPSS v.20 software via independent samples t test, chi-square test and binary logistic regression analysis.
Results: The mean age of the study population was 40.88 years, with a 2-year-old, as the youngest subject, and an 85-year-old, as the oldest. Statistical significance was achieved at a P < 0.05 and the differences observed between the two groups of SSI+ and SSI- were found to be statistically significant regarding opium addiction (P = 0.035), smoking (P = 0.009), blood transfusion (P < 0.001), duration of surgery (P = 0.003), duration of hospitalization (P = 0.013). According to multivariate logistic regression analysis, independent risk factors of SSI included smoking (P = 0.002, OR = 0.35) and blood transfusion (P = 0.001, OR = 0.24).
Conclusions: We found smoking and blood transfusion to be independent risk factors for SSI, whereas, regarding the disagreements between the results of various studies, further investigations are required to identify absolute independent risk factors of SSI.

Background: Despite improvements in the understanding of fracture repair and treatment techniques, delayed unions and nonunions still occur more frequently than expected. Although the prevalence of these complications is not very high and is reported to be approximately 2 to 7 percent, they are considered costly complications and impose great burden on patients and the health care system.
Objectives: We aimed to evaluate the risk factors associated with nonunion in long bone fractures in order to propose viable methods to control these factors and decrease the prevalence of nonunion.
Patients and Methods: In this retrospective case control study, all the patients with long bone nonunion fractures referring to Shariati Hospital’s orthopedic clinic during 2007 - 2013 were included as the case group. With a ratio of 1 to 3, patients matched according to the type of fractured bone were selected as the control group. Required data were gathered from the patients’ records in the archives. SPSS software version 20 was used to analyze the data.
Results: Multivariate regression analysis was performed to assess independent risk factors of nonunion. According to this analysis, aging (P value = 0.007), female sex (P value = 0.041), comminuted and segmental fractures (P value = 0.001), higher grades of soft tissue injury (P value < 0.001), smoking (P value < 0.001), and infection (P value < 0.001) were found to be independent risk factors for nonunion in long bone fractures.
Conclusions: Of the assessed risk factors, smoking, and infection can be controlled to decrease the prevalence of nonunion. Therefore, smoking cessation and prophylactic measures against infection might be viable actions for this objective.

Background: Open bone grafting has been the standard procedure for treatment of scaphoid nonunion. Arthroscopic bone grafting and fixation is a minimally invasive method, which is effective as open procedure with minimal complications.
Objectives: The purpose of this study was to assess the results of arthroscopic treatment by refreshing and bone grafting on clinical wrist function and radiographic outcome in patients with stable scaphoid nonunion.
Patients and Methods: Between June 2012 and May 2014, 17 patients received arthroscopic refreshing and bone grafting for treatment of stable waist scaphoid nonunion. The mean follow-up was 13 months (ranged 6 - 18 months).
Results: The mean flexion/extension of the wrist was 72 degrees (ranged 50 - 160 degrees) compared with the pre-operation 53 degrees (ranged 35 - 160 degrees) (P < 0.04). Grip strength at final follow-up averaged 28 kg (ranged 12 - 455 kg) indicating a significant improvement from 21kg (ranged 5 - 41 kg) before the operation (P < 0.026). The mean Quick DASH scores showed a significant improvement from 48 (ranged 27 - 90) preoperatively to 84 (ranged 76 - 100) postoperatively (P < 0.05). The mean VAS score showed a significant improvement from 4.3 (ranged 2 - 7) preoperatively to 1.03 (ranged 0 - 4) postoperatively (P < 0.04).
Conclusions: Arthroscopic treatment of stable scaphoid nonunion is an effective alternative to the conventional treatment of stable Scaphoid nonunion.

Background: Forearm nonunion is a challenging condition for orthopaedic surgeons.
Objectives: In this study, we used a new technique for the treatment of forearm nonunion with bone loss and/or current signs of infection.
Patients and Methods: Four patients were managed with thorough debridement and a vascularized regional osteocutaneous flap from the distal ulna based on the posterior interosseous artery.
Results: Union was achieved after an average of 3.75 months. Skin flap was viable in all patients. The Quick DASH score, VAS score and forearm and elbow range of motion improved compared to preoperative evaluations.
Conclusions: A posterior interosseous osteocutaneous flap from the distal ulna is a reliable vascularized bone graft for managing forearm nonunion.

Background: The sacrum bone is an integral part of pelvis and spinal column. It protects lumbosacral neurologic plexus and maintains the spinal column and pelvic alignment. Therefore, injury to the sacrum may lead to neurologic deficit, pain and disability. Due to difficulties in radiologic diagnosis and associated injuries, sacral fractures are usually missed or diagnosed late.
Objectives: To evaluate the clinical and functional outcome of surgical treatment of high-energy traumatic sacral fractures.
Patients and Methods: All patients with sacral fractures, who had undergone surgical treatment, were evaluated retrospectively and data were collected. Fracture type, preoperative and postoperative neurologic examination, according to the American spinal injury association (ASIA) score and Gibbons’ classification and visual analogue scale (VAS) were evaluated. In addition, postoperative complications, such as infection, deep venous thrombosis (DVT), rod breakage, screw loosening and dislodgment were assessed.
Results: Of the 27 patients with sacral fracture that were treated surgically, 15 (55.4%) patients were female and 12 (44.6%) were male. Fourteen (51.8%) patients underwent percutaneous iliosacral screw fixation and 13 (48.1%) patients underwent spinopelvic fixation. Three (11.1%) patients had neurologic deficit. After neurologic decompression, two of them recovered completely (with preoperative Gibbon’s grade 2, 3) and one of them, with Gibbons’ grade 4, improved incompletely in motor power and also remained incontinent after a year postoperatively. None of them developed postoperative infection, DVT, rod breakage or screw loosening or breakage. Only one patient, in the unilateral spinopelvic fixation group, developed asymptomatic rod dislodgment from distal (iliac) fixation. In all patients, VAS score changed substantially from mean 8, preoperatively, to mean 1, postoperatively.
Conclusions: For no displaced or minimally displaced sacral fractures and fractures without comminution, especially in young and non-osteoporotic patients, (Denis type 1 and 2) percutaneous iliosacral screw fixation could be an ideal treatment. For Denis type 3, spinopelvic dissociation, comminuted Denis type 1 and 2 and for sacral fracture in osteoporotic or elder patients, spinopelvic fixation may be the treatment of choice, with acceptable outcome.

In developing countries, due to the absence of proper management, lower than standard roads and highways and emergency supporting infrastructure, accidents have a high effect on human lives. Iran has a high rate of accident casualties and fatalities. In this paper, a light is shed on the process of victims’ management and underlying factors for this high rate of human sufferings. Here, the roles of emergency rescue teams and dilemmas they are facing are briefly discussed. We also tried to highlight the process and ways to address these problems.