Lateral epicondylitis (LE) is one of the major causes of elbow pain. Despite being a self-limiting condition, its high incidence can cause a significant socioeconomic burden. Many treatment modalities have been proposed for the treatment, but the optimal strategy is still unknown. In this article, we discuss surgical and non-surgical strategies for the treatment of LE and address the research gaps.

Background: Multi-level spine surgeries are associated with high bleeding during and after surgery. A majority of studies have previously evaluated the effect of tranexamic acid (TXA) in reducing bleeding with a focus on intravenous (IV) administration. The aim of the study was to evaluate the efficacy of topical TXA in decreasing bleeding after laminectomy and spinal fusion.

Methods: In this randomized, double-blinded, placebo-controlled clinical trial, 80 patients were enrolled from January 2017 to January 2019. The patients were eligible for laminectomy (2 or more levels) and posterolateral fusion with a pedicle screw. Patients were randomly divided into two equal groups; single-dose TXA (1 g/50 ml) and normal saline. Intergroup comparison was performed for the amount of bleeding during and after surgery, received packed cells, and the number of hospitalization days.

Results: The mean age of the patients was 55.51 ± 10.27 years, and 50 of them were women. 18 and 20 patients in control and TXA groups had intraoperative bleeding more than 400 ml, respectively (P ˃0.05). The only significant difference was observed in the first and second 12 hours, and total bleeding after surgery in patients who had bleeding above 400 ml (P = 0.011, P = 0.039, P = 0.015, respectively).

Conclusion: The application of topical TXA was effective in patients with high amount of hemorrhage during spine surgery for reducing the bleeding rate in the first and second 12 hours, as well as the mean total bleeding rate after surgery. It had no significant effect on total intraoperative hemorrhage, total packed cells, and total hospitalization length.

Background: About 20% of femoral neck fracture surgeries require re-operation. The use of medial buttress plate may reduce the re-operation rate. The purpose of this study is to examine the results of using the method of augmentation of the cannulated screws with medial buttress plate for treatment of unstable femoral neck fractures.

Methods: This study included patients with femoral neck fractures of Pauwels type 2 and 3 in which closed reduction was not successful. The patients underwent open anatomical reduction and implantation of three screws, and then the medial placement of the buttress plate was performed. Patients were followed up after 2 weeks, 6 weeks, 3 months, and 6 months. Union and fracture healing and operative complications were assessed using plain radiography.

Results: This study included 8 patients with Pauwels type 2 and 3 femoral neck fractures. All patients were men with the mean age of 38.0 ± 11.3 years. Re-hospitalization 30 days after surgery, surgical site infection, deep vein thrombosis (DVT), and deep infection were not observed in any of the patients. The angle between the neck and the femur shaft dramatically increased during the 6-month follow-up (P = 0.049). Union occurred in 6 (75%) patients after 6 months, while 2 patients were lost to follow up. Participants’ Harris Hip Score (HHS) had a significant improvement from 3 months to 6 months after surgery (P = 0.02).

Conclusion: Augmentation of cannulated screws with medial buttress plate for unstable femoral neck fractures in patients has advantages in short-term clinical follow-up.

Background: Flat foot is a deformity in which patients lack standard arches in the soles of the foot. Flat foot improves with age. This study was designed to determine the prevalence of flexible flat foot among male school children in Tehran, Iran.

Methods: A total of 1539 male school children were included in this study. Students were examined for the flatness of the sole of the foot as well as its degree and type. Flat foot was diagnosed on inspecting a poor formation of the arch. The severity of flatness was classified according to Denis criteria.

Results: Among 1512 children whose foot condition was recorded, 80.7% had normal/grade 1 sole, 16.7% had 2^nd degree flat feet, and 2.6% had 3^rd degree flat feet. Prevalence of genu varum was 16.1% and prevalence of genu valgum was 2.7% (P = 0.504). The prevalence of flat foot decreased significantly with age; in the group of 11-year-old boys and younger, 23.1% showed a grade 2 and grade 3 flat foot, whereas in the group of 12-year-old boys and older, only 13.6% had a grade 2 and grade 3 flat foot (P < 0.001).

Conclusion: In this study, a significant relationship was found between weight gain and body mass index (BMI) with flat feet. There is a significant association between passing the age of 12 years and a decrease in flat foot. Also, the association between flat foot with weight and height of children was examined separately, and it was found that weight could significantly be a poor predictor of flat feet.

No abstract is available.

Background: Although there are several surgical options for the treatment of acromioclavicular joint (ACJ) dislocation, there is no definite gold standard. Anatomical reconstruction techniques are becoming more popular due to the new understandings of the anatomy and biomechanics of the ACJ.

Case Report: A 40-year-old male with left ACJ dislocation (Type 3 Rockwood classification) underwent anatomical reconstruction with a semitendinosus tendon graft harvested from the left knee.

Conclusion: Anatomical reconstruction of ACJ by autograft is an effective treatment option.

Background: Interlocked intramedullary nailing is the most common treatment for closed tibial fractures. Reaming is a fundamental step in this surgical technique, and reamer breakage is a rare yet challenging complication during this operation.

Case Report: A 34-year old male with a tibial shaft fracture was admitted for early closed tibial nailing. During the reaming process, the reamer broke and stuck in the medulla at the isthmus level. We extracted the broken piece by back hammering a cannulated T-handle placed on the ball tip guide pin.

Conclusion: In this closed and quick method, we did not use any extra device other than standard equipment of intramedullary nailing.

Background: The application of a cannulated device is a widely used fixation method for hip fractures. Although the breakage of the guide wire during this procedure is an uncommon complication, migration of the broken fragment might be catastrophic.

Case Report: We presented a case of intertrochanteric fracture with breakage of the lag screw guide wire in the acetabulum during fixation with cephalomedullary nail. The broken fragment was located with computed tomography (CT) scan and removed through Stoppa approach.

Conclusion: We found the Stoppa approach a safe and useful method for extracting the intra-pelvic broken guide wire.

Background: Post traumatic lumbosacral plexopathy (LSP) is a well-known condition following pelvic fracture or abdominal trauma and surgery. A rare condition of LSP has been reported in the literature following femoral shaft fractures.

Case Report: Two cases of LSP after bilateral femoral shaft fracture presented to our center. In both cases, the mechanism of injury was a high energy trauma without any signs or symptoms of pelvic or spinal injury. Electrodiagnostic studies confirmed acute plexopathy and spontaneous recovery occurred in both.

Conclusion: LSP can be seen in association with fractures or traumas far from anatomical location of the plexus. Multidisciplinary approach and complete accurate examination are mandatory for diagnosis management of the condition.

No abstract is available.