During an open fracture, the barrier of skin that protects the bones is breached, and the unprotected bones are exposed to the environment, resulting in contamination that leads to hematoma formation. It is often found that open fractures are associated with a high rate of morbidity and infection. In spite of the lack of evidence supporting negative pressure wound therapy (NPWT), open fractures may benefit from it. An increasing number of studies have demonstrated that it can be used to treat open fractures and open complex wounds after failure of arthroplasty or spinal surgery. Based on the recent studies and evidence, we reviewed the role of the NPWT in the open fracture in the present study.

Background: Quality of the bone before surgery determines the choice of the appropriate prosthesis and the surgical approach as well as the result of total hip arthroplasty (THA). The proximal femur morphology determines the decision of cemented or uncemented THA, and the Dorr classification is often employed for this purpose.

Methods: 100 patients over the age of 40 who had been referred to the emergency department of Shohada Hospital, Tabriz, Iran, for any reason and had an accurate pelvic anteroposterior (AP) X-ray with proximal femur were included in this study, and Dorr classification and mean cortical thickness index (CTI) just below the lesser trochanter and 10 cm below it were measured.

Results: In this study, the Dorr classification differed significantly in men and women, and type C was higher in women. Classification is strongly subjected to the surgeon's clinical experience, and training class significantly affects it. There was a significant relationship (P < 0.001) between the CTI 10 cm below the trochanter and just below it.

Conclusion: The proximal femur morphology covers a wide range. Therefore, it is difficult to determine the exact morphology, especially for groups B and C. There was also a significant correlation between the mean CTI below the lesser trochanter and 10 cm below it. Therefore, we think this is a practical and most straightforward method for classifying proximal femur morphology with cortical index (CI) just below the lesser trochanter and 10 cm below it, especially for inexperienced training residents.

Background: Vitamin B12 is a micronutrient essential for deoxyribonucleic acid (DNA) synthesis, which can affect osteogenesis. Based on in-vivo investigations, vitamin B12 is associated with osteogenesis, and low levels of this vital vitamin in the human body can be related to an increased risk of osteoporosis.

Methods: In this descriptive-analytical study, 60 women over 65 years who visited an orthopedic clinic were included. They were divided into three groups based on bone density in the hip and lumbar areas using dual-energy X-ray absorptiometry (DEXA) scans, including normal bone density, osteopenia, and osteoporosis. The average serum level of vitamin B12 in the experimental subjects was then determined and compared.

Results: 6 (10%) showed normal bone density, 25 (41.7%) osteopenia, and 29 (48.3%) were considered to have osteoporosis. Measured vitamin B12 levels showed no statistically significant difference between the two groups of normal bone density (601.3 ± 194.8) and osteopenia (560.4 ± 131.5). However, there was a significant statistical difference between vitamin B12 levels in people with osteoporosis (400.7 ± 162.4) and the two groups of normal and osteopenic individuals. There was also a negative statistical relationship between vitamin B12 levels and bone density (P = 0.004, r = -0.8).

Conclusion: A low serum level of vitamin B12 is associated with a severe decline in bone density in elderly Iranian women.

Background: Ankle ligament injuries in the sports like basketball, volleyball, and cricket are the most common reasons for missed participation in athletics, accounting for 14% of all sports injuries. These injuries may often require splinting and rest for a longer duration, leading to a permanently reduced level of sports performance. The autologous conditioned cytokine-rich serum (ACRS) is becoming a reliable treatment option in acute ankle injuries as it enhances biological healing. The objective of this study is to evaluate the role of ACRS in acute ankle injuries and report the efficacy of ACRS injections on time to return to physical activities.

Methods: 42 patients with clinical and radiological signs of ankle ligamentous injuries (grades 1 and 2) secondary to sporting or gaming activity were recruited for this study. Each patient received one injection of ACRS at the injury site and was put on a soft cast for one week. Clinical and functional evaluation was performed using the Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and the Foot and Ankle Disability Index (FADI) scores before the injection, at one week, i.e., after removing the soft cast, three weeks, six weeks, and three months.

Results: Our study showed gradual improvement of all the evaluation scales at all the follow-ups. Few patients showed minor side effects like aseptic effusion. The least common complaint was a pain in the subsequent days after the injection.

Conclusion: Our results, in conjunction with pre-existing studies in the literature regarding the biological effects of ACRS, demonstrate the viability of this therapy for the treatment of acute ankle injuries, showing the positive influence on pain and healing capacity and returning to gaming activities immediately in about two weeks without significant adverse effects.

Background: Trauma is a leading cause of death and morbidity in developing countries. Previous research has revealed that epidemiological features of fractures may change from one study to the next. National Trauma Registry of Iran (NTRI) was launched in 2015, but it did not include any centers in northern Tehran, Iran. This study aimed to evaluate the epidemiology of fractures in the only Level 1 Trauma Center in that area.

Methods: This retrospective cross-sectional study was performed on all patients with the primary diagnosis of orthopedic injury, from July to October 2019, who referred to the emergency department of Shohada Tajrish Hospital, Tehran. The patients’ files and operation notes were reviewed for demographics, medical history, physical examination, referral time, mechanism of injury, hospital stay, level of education, and intensive care unit (ICU) hospitalization.

Results: 398 patients with orthopedic trauma were referred to the hospital with a mean age of 40.85 ± 21.03 years. 317 patients (79.65%) were men. The peak referral time was between 12 AM and 12 PM. A road traffic accident was the main cause of orthopedic trauma (39.4%). The mean days of hospital stay were 6.29 ± 5.36 days. The waiting time for surgery and days of hospital stay were related to the fracture site (high in lower extremity fractures) and older age.

Conclusion: Trauma in northern Tehran is primarily caused by motor vehicle accidents and falls, respectively. Patients with older age and lower extremity fractures need more time of hospitalization.

No abstract is available.

Background: Transolecranon fracture is an unstable intra-articular injury in the elbow caused by high-energy trauma. Here, we introduce a medial humerus plate for severely comminuted transolecranon fracture.

Case Report: This article presents the case of a 29-year-old man who had a severely comminuted transolecranon fracture due to a motorcycle accident. A dorsal longitudinal approach was used in order to reach the fracture site. An olecranon anatomical plate and a medial humerus plate were applied for fixation, a new treatment method. The range of motion (ROM) was complete at a two-month follow-up, and the Mayo Elbow Performance Score (MEPS) was obtained 100 with no signs of complications.

Conclusion: Despite the several methods available for fixing transolecranon fractures, using the medial humerus plate, especially in severe comminution, can yield acceptable results. It should be considered in future studies to prove its efficacy in this type of fracture.

Background: Neurilemmomas also called schwannomas are benign tumors originating from the Schwann cells participating in the peripheral nerve sheath and the pathophysiology of the formation of these tumors is not completely understood. Schwannomas are mostly benign with equal incidence rate in men and women. These tumors have been mainly found in the head and neck, upper extremities, and the trunk. Lower extremity schwannomas are extremely rare, specifically in the dorsum of the foot.

Case Report: In this report, we present an 18-year-old man referred to surgery clinic with a painful mass on the anterolateral dorsal aspect of his left ankle with radicular pain and paresthesia to the distal dorsum of the forefoot. After completing all the assessments including ultrasonography and magnetic resonance imaging (MRI), he underwent the surgical resection procedure. The pathology laboratory reported an encapsulated 35 * 20 * 15 mm solitary benign schwannoma.

Conclusion: The dorsal aspect of the foot is an extremely rare site for schwannoma formation, but practitioners should always be aware of rare underlying diseases for neurologic deficits or just a simple pain in the lower extremities.

Background: Proximal humerus shortening and varus can occur secondary to neonatal shoulder septic arthritis and focal fibrocartilage dysplasia. Valgus osteotomy of the proximal humerus compensates for a little bite of shortening, and improves the shoulder joint's range of motion.

Case Report: In this study, we present two patients with severe proximal humerus deformity following glenohumeral septic arthritis. Both of them underwent valgus osteotomy, and had a satisfactory result in terms of range of motions and cosmesis at five years follow-up.

Conclusion: Treatment of varus deformity of proximal humerus is challenging issue. There are few reports of surgical treatment. Sever varus deformity of proximal humerus impacts the motion of shoulder. We reported a novel method of valgus osteotomy of proximal humerus in patients with severe varus deformity secondary to neonatal septic arthritis and long-term clinical follow-up.

No abstract is available.