Purpose The purpose of current study was to compare the clinical and radiographic outcomes of distal radius volar T plate and pre-contoured locking plate in distal clavicle fracture.

Materials and methods A total of 60 patients with Neer 2b distal clavicle fracture included in this study and undergone open reduction and internal fixation between March 2019 and November 2020 via two different plates; distal radius volar T plate and distal clavicle pre-contoured locking plate. All patients were followed at least two years post-operative. Union rate, time to union, need to device removal, and Constant-Murley score were assessed among them.

ResultsIn all patients, bony union was achieved without wound related complication. The mean time to union in distal radius volar T plate group was 3.3 0.6 and 3.6 0.7 in pre-contoured locking plate (p value=0.14). The mean Constant-Murley score was 93.1 2.2 and 92.1 2.5 in T plate group and pre-contoured plate group, respectively (p value=0.09). Five cases with T plate and eight cases with pre-contoured plated were candidate for device removal (p value=0.53)

ConclusionDistal radius volar T plate could be a reasonable choice to manage Neer 2b distal clavicle fracture as it restores functional range of motion with excellent bone union and without the necessity of device removal; beside its economical price.

Introduction- Neck pain is a most common complaint that we deal in the orthopedics OPD; most of which are IT professionals. In these individuals the incidence of forward head posture is high probably because of their vocational mismanagement. Materials and methods- A cross-sectional study was carried out from January 2019 to June 2019 during which total of 300 patients were taken into study. Clinical assessment of neck pain, head posture, range of motion and radiological assessment of Craniovertebral angle and anterior head translation was done. Results- Out of 300 patients, the major chunk was of males. On an average males used computers for 9.6 hours as compared to 9.2 hours of females. The average CVA was more in females (58.8). The average AHT was more in males (22.9). Discussion- As compared with the previous literature, our study showed 84.3% of males and 92.91 % of female participants had FHP. CVA was lower, while AHT was higher in both groups than the usual range. The mean anterior head translation in our sample was 18.8 mm, that was been found to be aberrant in prior research study. Conclusion- In our study we have found a negative correlation between the craniovertebral angle and anterior head translation resulting in forward head posture which can furthermore lead to early changes of cervical spondylosis in IT employees probably due to long hours of desktop usage resulting in fixed postural habit.

Background: Despite their low incidence, pelvis and acetabular fractures have a high mortality rate due to extensive hemorrhage. Tranexamic acid (TXA) is an antifibrinolytic drug that inhibits the production of plasminogen. This study aimed to evaluate the safety and efficacy of TXA use to reduce blood loss and the need for blood transfusion in patients with pelvis or acetabulum fractures.

Methods: 108 patients were recruited from two tertiary care hospitals, and assigned evenly either to the intervention (TXA) or the control (CTL) group. TXA group received 15mg/kg TXA 30 minutes before the fracture reduction and fixation surgery. The number of transfused blood units before, during, and after the surgery was registered. Blood loss was assessed by calculation of estimated blood loss (EBL), collected blood with drain, collected blood with suction and weight of the used gauzes during the surgery. The time between fracture occurrence and the surgery, the duration of the surgery, and the days of admission were assessed.

Results: The mean age was 39.49 ±15.81, 69.4% were female. 6 patients had pelvic and 102 patients had acetabulum fractures. The duration of the surgery was not significantly different. The time gap between fracture occurrence and the surgery was significantly higher in the TXA group (P value=0.032). The mean postoperative hospitalization time was significantly lower among TXA group patients (P value=0.037). The mean hemoglobin was significantly higher in TXA group postoperatively (P value =0.028). The mean EBL, the amount of collected blood volume by suction or drain, the weight of the used gauzes during the surgery and the number of transfused units were significantly lower in the TXA group patients. The transfusion rate was significantly lower in patients with a shorter time gap between fracture occurrence and reduction surgery (P value=0.021)

Conclusion: Tranexamic acid can reduce blood loss, the number of transfused blood units during and after the surgery, and hospital admission duration. Moreover, it did not increase the chance of PTE or DVT in the patients receiving tranexamic acid; thus, it can be assumed as a safe and efficient drug in patients with acetabulum or pelvis fractures.

Background: Surgical site hematoma is one of the factors that influences the results of the carpal tunnel release and patients’ satisfaction ; therefore, this study was designed to evaluate the effects of using Penrose drain in order to reduce the operation site hematoma and improve the results of surgery.

Methods: Patients with a diagnosis of carpal tunnel syndrome (CTS) were randomly divided into intervention and control group and then were evaluated by pain with Visual Analog Scale (VAS) and Pinch power. Penrose drain was placed for the intervention group and removed after two days. Three months after surgery, all patients were re-evaluated by VAS and pinch power, and then the collected data were analyzed statistically using the Wilcoxon Signed Ranks Test by SPSS.

Results: Out of 46 patients, Penrose drain was placed for 21 patients. According to the results, the VAS and Pinch power evaluations were better in patients with Penrose drain (P-value = 0.001) but in patients without Penrose drain, only the VAS evaluation results were improved, but a decrease in Pinch powers was detected.

Conclusion: The results showed that CTR surgery with or without the Penrose drain decreases pain in patients after three months of operation. CTR with Penrose drain improve Pinch power and also decreases the pain, but in patients without Penrose drain, Pinch power was reduced after this period.

Background: One of the proposed methods to reduce the risk of infection after joint replacement surgery is the use of disinfectant solutions at the end of the surgery. Different results have been reported regarding the effect of diluted betadine washing solutions and normal saline in reducing the risk of infection around the prosthesis.

Purpose: The purpose of this retrospective cohort study is to compare the use of diluted betadine wash solutions and normal saline in bilateral knee replacement surgery.

Materials and methods: In this retrospective cohort study, 320 patients who were referred to Baath Hospital from the beginning of 2019 to the end of 2021 for bilateral knee joint replacement were examined. One knee was washed with diluted betadine (35%) and the other with normal saline for 3 minutes before closing the wound. Demographic information, risk factors, and the rate of infection of the prosthesis area in these patients were examined three months after surgery.

Results: The average age of the patients was 64.5±6.1 years and their BMI was 27.7±2.0 kg/m2. Out of 320 patients, 177 (55.3%) were women, and the most underlying disease was type 2 diabetes with a frequency of 64 (20.0%). Out of 640 cases of operated knees, 17 cases (2.7%) of prosthetic area infection occurred after surgery, of which 11 cases (4.3%) were washed with normal saline (P=0.326). Multivariate regression analysis test showed male patients (P=0.028, OR=3.38). Patients with diabetes, (P=0.030, OR=3.03) blood pressure, (P=0.019, OR=3.81), and with the increase of each BMI unit (P=0.030, OR=1.36), the chance of infection in patients showed a significant increase.

Conclusion: The use of diluted betadine solution in bilateral knee replacement surgery for washing at the end of the surgery, especially in patients with underlying disease and obesity, can reduce the risk of infection.

The anterior cruciate ligament (ACL) is one of the ligaments that stabilizes the knee joint, but injuries to this ligament are becoming more common. Anatomic ACL reconstruction aims to restore the ACL to its original dimensions, collagen orientation, and insertion sites, but complete restoration may not be possible. Suture augmentation (SA) is a technique that has gained attention as an augment to surgical treatment. It involves the use of autologous hamstring tendons with a braided ultra high–molecular weight polyester or polyethylene suture or suture tape to act as a secondary stabilizer until complete integration and ligamentization of the graft take place. This study aimed to compare the outcomes of ACL reconstruction using hamstring grafts with and without suture augmentation.

The study was conducted at a tertiary-level health care center, with 50 patients divided randomly into two groups: 25 patients for standard ACL reconstruction (Group A) and 25 patients for ACL reconstruction with suture augmentation (Group B). The study collected baseline clinical characteristics including demographic and clinical data. All participants gave informed consent before enrollment. The study evaluated patients by range of motion (ROM), pain assessment using the numeric pain rating scale (NPRS), and functional outcomes by the Lysholm score and International Knee Documentation Committee (IKDC) score.

The study found a statistically significant improvement in both groups in ROM, NPRS scores, and functional outcomes at 1 and 6 months. The mean age was 25.5 years with 96% male and 4% female participants. There was no significant difference between both groups in terms of IKDC score. LYSHOLM score showed a remarkable improvement in both groups. The study concluded that suture augmentation could be an effective technique for ACL reconstruction, with similar outcomes to standard ACL reconstruction.

Schwannoma, the most common primary neural tumor of the upper extremity, arises from schwann cells of nerve sheet. The tumor is usually painless and slow growing. Symptomatic masses could be treated through intra- or extra-capsular excision. We aim to evaluate long-term results of surgical treatment of 12 cases of hand Schwannoma.

Twelve cases of confirmed schwannoma who were treated in Imam Khomeini university hospital, Tehran, Iran during 2011 to 2022 were included. All operations were done using loupe magnification or under microscope. After incising the tumor capsule, nerve fibres were isolated then the mass resected. Age, sex, location of the mass, size of the tumor, affected nerve, histological diagnosis, and clinical follow-up including neurological status of patients were documented.

Twelve patients with a mean age of 44 years were included. Seven (58.3%) were male and five (41.66%) were female. The mean follow-up period was 45 months (range: 6–135). Hand was the most common location of involvement and digital nerve was the most frequent origin of schwannoma. Postoperative evaluation showed no tumor recurrence and pain resolved in all twelve patients (100%). Sensory dysfunction resolved completely in 5 out of 8 patients who reported sensory impairment preoperatively (62.5%) and no motor function improvement was seen in patient with motor deficit.

In conclusion, adequate operative techniques can lead to complete tumor removal without neurological loss or recurrence. Neural function improvement in most cases is achieved. New neurologic impairment after excision of schwannoma is rare.

During the past two decades, the use of robotic arms in knee arthroplasty has moved from a concept into a reality. These systems promise precision and accuracy while shortening the required learning curve. Although still largely in the early stages, currently there are several commercially available platforms with varying degrees of autonomy and flexibility. The present study aimed to review the existing body of literature and provide an outlook of the current landscape.

After tuberculosis of the spine, hip tuberculosis is the most common site that can be infected with extrapulmonary TB. In the early stages, patients are referred with complaints of pain around the hip, and after a while, they might experience deformities, shortening, and limited movements. Because hip tuberculosis mimics the symptoms of other hip diseases like rheumatoid arthritis, and osteoarthritis, diagnosis is difficult. Based on the clinical features of hip tuberculosis, four stages are known for this condition: synovitis, early arthritis, advanced arthritis, and advanced arthritis with subluxation/dislocation. Here, we aimed to report a rare case of hip tuberculosis secondary to pulmonary tuberculosis and the result of the total hip arthroplasty. Our patient was in advanced arthritis with a subluxation/dislocation stage and an acetabular protrusion that caused restriction of movements.

Introduction : avulsion fracture of the tibial tuberosity is uncommon (3% of all proximal tibial fractures ) , usually occur in children aged 3 to 6 years and is uncommon in adolescence.

PRESENTATION OF THE CASE: a 15-year-old boy with severe left knee pain following a high jump, X-ray and CT scan showed a tibial tuberosity fracture with joint surface involvement. damaged part was fixed with a 4.5mm cannulated screw and washer, reinforced with 2 swive lock anchors . at sixth week, full weight bearing and Full ROM were obtained.

Discussion : The goal of treatment for fractures of the tibial tubercle is to restore the extensor mechanism and the joint surface, when disrupted. We review the pathophysiology, mechanism, classification, diagnosis, and management of this injury

Introduction: The commonest benign bone tumours, Osteochondromas, which can be solitary or multiple involving the metaphyseal region of long bones, rarely presents in the axial skeleton such as pelvic girdle which warrants surgical excision in case of symptoms arising out of pressure effects. Case report: In this study we are herewith reporting unusual case of pubic tubercle osteochondroma which is solitary and pedunculated in a 37-year-old female. She had the swelling for the past 15 years which is asymptomatic except for mild hydroureteronephrosis which was an incidental diagnosis, however we managed the patient with surgical excision of the tumour with elaborate preoperative radiological imaging using both X-ray and CT. Histopathological examination was confirming the diagnosis of osteochondroma. Conclusion: Asymptomatic pelvic osteochondroma should be borne in mind in patients with incidental swelling in the groin region especially females who may be reluctant to seek medical attention due to social stigma.

Keywords: Osteochondroma, Pubic tubercle, surgical excision, solitary

Calcific myonecrosis is a rare entity which is considered a sequela of chronic compartment syndrome. A fusiform mass with central liquefaction and peripheral calcification replaces the affected muscle unit. We are presenting a case of calcific myonecrosis of tibialis anterior in 76 years old male. Although the mass was present for several years but recently patient developed leg pain and foot drop. After radiological and histopathological diagnosis patient treated with surgical excision of the mass.