Background: Acute patellar dislocation is a common injury, with up to 40% of the cases missed due to a high rate of spontaneous reduction. Complications mainly arise due to osteochondral fractures, resulting in patellofemoral osteoarthritis and rupture of medial patellar stabilizers, leading to recurrent patellar instability.
Methods: Institutional database was retrospectively reviewed to find patients with missed transient patellar dislocation. From January 2010 to January 2015, ten otherwise healthy patients with a history of indirect trauma to the knee were diagnosed with missed patellar dislocation. They all had persistent pain and effusion, despite conservative treatment.
Results: Eight patients eventually underwent arthroscopic debridement of osteochondral fractures and repair of ruptured ligaments, with no case of recurrent instability.
Conclusions: Detailed history taking and physical examination of all acute knee injuries, with a standard three dimensional (3D) X-ray imaging and a low threshold to obtain magnetic resonance imaging (MRI) studies, could minimize cases of missed patellar dislocation and possibly severe complications.

Background: Closed reduction and intramedullary nailing is an established procedure in the treatment of diaphyseal femoral fractures. Postoperative malrotation of the femur is a complication that can be assessed with computed tomography (CT). A rotational difference >15° to the contralateral side appears in 17 to 35% of literature reports, and correlates with a reduced clinical outcome. Hence, an anatomical reduction of the femur plays an important role.
Method: sOne-hundred and seven cases of unilateral femoral shaft fractures were investigated. All fractures were treated with closed reduction and intramedullary nailing. All patients underwent computed tomography postoperatively, analyzing rotational differences. In cases with a rotational difference of > 15°, an indication of revision surgery was posed. Twenty-three patients were female and 84 male. The average age was 32.5 ± 14.4 years. The age ranged from 14 to 94 years.
Results: In the postoperative CT scan, according to Waidelich, an average femoral malrotation of 11° ± 9.16° to the healthy side was determined. In 16 cases (14.9 %), 11 males (13.1%) and 5 females (23.81%), a femoral malrotation larger than 15° (average: 23.23° ± 6.02°) was detected.
Conclusions: Femoral malrotation after closed reduction and intramedullary nailing is a delicate topic and occurs commonly. Postoperative computed tomography could in addition to the clinical examination identify critical postoperative deviations and lead to a correction of femoral malrotation in a revision surgery. Despite extensive efforts, an intraoperative adjustment of the rotation could not be achieved anatomically in more than 10% of all cases. As a consequence, after closed reduction and femoral nailing, a postoperative CT scan to detect femoral malrotation is recommended.

Background: The majority of acute traumatic hemarthroses of knee are due to anterior cruciate ligament (ACL) injury. However, their frequency and associated knee injuries in Iranian patients are not studied by arthroscopic examination, yet.ObjectivesThe authors planned an arthroscopic study of acute traumatic hemarthrosis of knee in patients with insufficient symptoms, signs to exact diagnosis.
Methods: A consecutive series of patients with acute traumatic hemarthrosis of knee and no facture around knee joint refereed to Imam Khomeini hospital, Tehran, Iran from December 2006 to December 2009, were evaluated. Patients with early-onset knee hemarthrosis and insufficient physical examinations were included in the study. Patients under local or regional anesthesia underwent arthroscopic examination.
Results: Over a 36-month period, 43 consecutive patients (male 39, female 4) with mean age of 27.21 ± 7.22 years (age range of 16 to 49 years) were evaluated. Average time between the injury and Arthroscopy was three weeks (from one to four weeks). Falling and Sport injuries were the most common modes of injury, and right knee was injured most frequently. The most common arthroscopic findings were rupture of the ACL (77.3%). The most common complaints were Knee swelling (84.1 %), pain (77%) and giving way (27%). Under anesthesia, 17 (38.6%) patients had negative anterior and posterior drawer and other laxity tests.
Conclusions: In patients with posttraumatic hemarthrosis of knee, surgeons could diagnose the injury etiology by taking history, physical and MRI examinations, but in case of doubts, the surgeon can perform an arthroscopy which is a minimally invasive and effective technique for correct diagnosis and proper treatment to prevent later complications such as meniscal tear and injury to the cartilage.

Venous thromboembolism (VTE), as deep vein thrombosis or pulmonary thromboembolism is a major clinical complication of orthopedic surgeries in adult population. To answer the question of how often and in what circumstances the surgeon should be worried about it in pediatric patients; the current paper reviewed the recent publications on the matter. It seems that the incidence of VTE increased and certain clinical conditions have strong relationships with it. It is uncertain that the increased reported incidence of VTE in pediatric population is due to unknown conditions or it just reflects the advanced diagnostic tools. Whatever the cause is, it is known that age increase, trauma severity and a number of other medical interventions and medical conditions directly affect the VTE occurrence in children. There is no evidence for prophylactic VTE treatment in pediatric orthopedic patients yet. Further information is under investigation in multiple large studies which may change the current opinion.

Introduction: Traumatic spinal cord injury (SCI) is a catastrophic event for patients with neurologic deficit and for the society in terms of economic issues. The prevalence of SCI seems to be increasing. There is not enough evidence regarding late neurologic decompression in patients with spinal cord injury.
Case Presentation: Here, we report on two patients with spinal cord injury, who were referred to our department after several days of trauma and both underwent decompression and posterior instrumented fusion (posterolateral decompression ) with favorable results.
Conclusions: It seems that late neurologic decompression might have some benefits for patients with SCI.

Introduction: Chronic osteomyelitis and infected non-union are relatively rare conditions in pediatric patients and are more frequently observed in the developing countries. Although relatively rare, they are challenging medical and surgical issues. The current study aimed to present a novel surgical technique used to manage three patients with chronic osteomyelitis of long bones.
Case Presentation: Three skeletally immature patients with chronic osteomyelitis and infected non-union of the long bones were treated surgically from 2010 to 2013 through infected site debridement of bone and soft tissues, excision of sequestrum, irrigation and antibiotic-laden cement spacer, to fill the bone defect zone, were performed in all patients. All patients underwent magnetic resonance imaging (MRI), computed tomography (CT) scan and laboratory evaluation prior to surgery. Antibiotic regimen started empirically and was adjusted according to the culture and sensitivity results. Once inflammatory markers normalized, all patients were re-operated for cement removal, bone substitute graft and concomitant osteosynthesis of the affected bone. The three patients aged 14 (two patients) and 10 years (one patient) at the time of injury. All patients had at least two years follow-up (range 2-5). Clinical and laboratory evaluation had been normalized, bone healed and all patients had returned to daily life and sport activities.
Conclusions: Surgical debridement is the standard approach to chronic osteomyelitis. Since antibiotic therapy plays an adjunctive role, it is recommended to use antibiotic-laden cement to penetrate local infection. The cement also induces membrane formation that aids bone reconstruction.

Introduction: Late-onset neurological impairment in unstable A3-A4/AO type thoracolumbar spinal fractures are rare, particularly if they are misdiagnosed as stable (25%). We present two neglected unstable burst fractures, who presented delayed trauma with neurologic deficit.
Case Presentation: Case 1: A 62-year-old male, who sought our department three months after trauma claiming neurogenic claudication, following fracture of L2.Case 2: A 50-year old male, who had a jerky fall from his vehicle with subsequent back pain for a few days. One-month after the trauma he presented urinary retention.
Conclusions: Unstable thoracolumbar A4 /AO type fractures, if left untreated or misdiagnosed, lead to vertebral body fragments retropulsed to the spinal canal under axial and bending forces resulting in progressively increased encroachment of the canal and finally compression on to cauda equina. Early recognition of an unstable A3-A4 /AO-type thoracolumbar fracture with C/T scan is mandatory along with appropriate treatment. This should be done in all cases, even in these without any neurological deficit and these with "normal" plain X-rays, because misdiagnosis and late onset neurological deficit is always a possibility. Physicians should be aware of this complication when treating thoracolumbar spine injuries with minor or absent symptoms and physiological neurologic findings.