Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 6 2 2021 01 18 26 7 EN Hossein Shafiei Department of Orthopaedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Mohamadhossien Abotalebi Department of Orthopaedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Yusof Fallah Department of Orthopaedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Babak Siavashi Department of Orthopaedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Mohamadreza Golbakhsh Department of Orthopaedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2020 09 12 2021 01 18 Background: The recent outbreak of the coronavirus disease-2019 (COVID-19) in China has rapidly spread throughout the world and significantly affected orthopedic and trauma cases all over the world. This study aims to evaluate the impact of the COVID-19 pandemic on orthopedic and trauma cases at Sina Hospital, Tehran, Iran.   Methods: The study was conducted using the database of Orthopedics Department at Sina Hospital. It consisted of data before four and after four months of the COVID-19 outbreak. The demographic data of the patients with orthopedic problems and trauma, including sex, age, and type and mechanism of trauma was studied.   Results: In total, data of 1033 patients was studied, including 597 and 436 patients before and after the COVID-19 outbreak, respectively. In this period of time, the potion of patients with laceration and upper limb injuries increased significantly (P = 0.007 and P = 0.002, respectively). Additionally, the proportion of low energy trauma and high energy trauma respectively increased and decreased (P = 0.055).   Conclusion: Because of the outbreak and consequent lockdown in many countries, cases of orthopedics and trauma very significantly reduced. This resulted in less workload on orthopedic surgeons and residents during the COVID-19 pandemic. Decreases in trauma cases and road traffic accidents were also reported by most centers around world. https://jost.tums.ac.ir/index.php/jost/article/view/212 https://jost.tums.ac.ir/index.php/jost/article/download/212/230

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 6 2 2021 01 18 28 9 SM Javad Mortazavi Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Seyed Hadi Kalantar Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Alireza Moharrami Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohammad Zarei Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Nima Hosseini zare Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran 2020 09 14 2020 11 15 Background: Since the outbreak of the novel coronavirus disease-2019 (COVID-19) pandemics many orthopedic elective surgeries have been postponed all over the world. There are several guidelines for resuming elective surgeries during this crisis. In our center (Imam Khomeini hospital, Tehran, Iran), we resumed total joint arthroplasty (TJAs) surgeries using preoperative history taking and physical examination. Here, we report our experience.   Methods: From February 2020 to August 2020, we included 165 patients who underwent TJA [70 total hip arthroplasty (THA) and 95 total knee arthroplasty (TKA)] in Imam Khomeini hospital, a referral center for COVID-19. We followed each patient from the day of hospitalization to two weeks after discharge by telephone for clinical symptoms of COVID-19.   Results: Only one patient became infected with COVID-19 a week after discharge from the hospital, and other patients did not show any sign or symptoms within two weeks after the discharge.   Conclusion: We recommend resuming the elective surgeries using a careful physical examination and medical history for all patients, and in suspicious cases, referring to a specialized COVID-19 clinic for further investigation. https://jost.tums.ac.ir/index.php/jost/article/view/214 https://jost.tums.ac.ir/index.php/jost/article/download/214/181

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 6 2 2021 01 19 30 32 Seyed Hadi Kalantar Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences SM Javad Mortazavi Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences Nima Bagheri Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences Seyed Ali Dehghan Manshadi Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Alireza Moharrami Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences Parastoo Ariamloo Imam Khomeini Complex Hospital, Tehran University of Medical Sciences Esmaeil MohammadNejad Imam Khomeini Complex Hospital, Tehran University of Medical Sciences Sheila Rasta Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences 2020 09 17 2021 01 19 Background: The novel coronavirus disease-2019 (COVID-19) has become a significant worldwide problem since January 2019. Hospitals have spent most of their time and logistics on patients with COVID-19. During this crisis, many healthcare providers have been infected with the disease, and occasionally, some wards and operating rooms were shut down as a result. Here, we explain our experience with the healthcare staff involvement with COVID-19 in our hospital.   Methods: As a referral tertiary center, Imam Khomeini Hospital (Tehran, Iran) has 4,200 health-care workers (HCWs). From February 20, 2020 to August 21, 2020, we investigated the hospital database for COVID-19 involvement among the staff.   Results: During the study period, 973 (23%) hospital HCWs were detected with COVID-19, 378 (9%) of whom were involved between June 21 and July 21, 2020. In the orthopedic department, 20 of 43 (46%) HCWs were infected with COVID-19.   Conclusion: We believe that the increase in the incidence of the disease and higher risk of exposure is a highly noticeable factor which should be addressed by the administrative health officials. https://jost.tums.ac.ir/index.php/jost/article/view/215 https://jost.tums.ac.ir/index.php/jost/article/download/215/196

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 6 2 2021 01 18 33 8 Seyed Hadi Kalantar Department of orthopedics, Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran, SM Javad Mortazavi Department of orthopedics, Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran, Mohammadreza Razzaghof Department of orthopedics, Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran, Alirza Moharrami Department of orthopedics, Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran, Nima Bagheri Department of orthopedics, Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran, Mohammad Zarei Department of orthopedics, Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran, 2020 09 19 2021 01 18 Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the largest global healthcare crisis of the last century since its emergence in December 2019. As more of the condition’s chronicity became evident and the government policies changed, the unlocking of the orthopedic wards seemed necessary. In this study, we decided to share our experience regarding the unlocking of our orthopedic ward in the largest tertiary referral hospital of Iran and to explain its negative and positive consequences.   Methods: This observational study was done in Imam Khomeini Hospital Complex, Tehran, Iran, from April to August 2020. We extracted the data regarding the number of elective/trauma operations, emergency patients, and morning report sessions attendance from our registry database. The data were analyzed and plotted using Microsoft Excel 365.   Results: The mean weekly number of orthopedic operations decreased from 50 for elective and 30 for trauma operations in January 2020 to almost zero for both in late March and early April 2020 [the first coronavirus disease 2019 (COVID-19) peak]. Following the department unlocking, the mean weekly elective and trauma operations returned to 50 and 20 by mid-June, respectively. The mean weekly orthopedic emergency visits followed the same order with decrease from 50 to almost zero in late March and increase to 70 in mid-June. However, by the beginning of the second wave, it decreased to almost 38 in early July and further to 28 in late July by the end of the second wave.   Conclusion: The unlocking of the orthopedic department in a tertiary referral hospital during the COVID-19 pandemic is possible, provided that there is a set of protocols for patient care in the ward, emergency room (ER), operating room (OR), and clinic during the pandemic. https://jost.tums.ac.ir/index.php/jost/article/view/218 https://jost.tums.ac.ir/index.php/jost/article/download/218/182

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 6 2 2021 01 18 43 7 Seyyed Hossein Shafiei Assistant Professor, Department of Orthopedic Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Salar baghbani Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Mohsen Nosrati Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Babak Siavashi Department of Orthopedic Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Mohammad Reza Golbakhsh Department of Orthopedic Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2020 08 11 2020 11 15   Background: During the outbreak of the novel coronavirus disease 2019 (COVID-19), Sina Hospital in Tehran, Iran, dedicated a majority of its facilities and workforce to fight this crisis. Meanwhile, our academic trauma center continued to admit emergency trauma patients.   Case Report: In this case series, we tried to discuss five previously healthy trauma patients who underwent orthopedic surgery and were diagnosed with COVID-19 later. Also, we described our detailed protocol for the management of orthopedic patients during the pandemic. Conclusion: During COVID-19 time, we continued to provide our best service to the trauma patients while keeping our personnel as far as possible from direct contact with the patients until it was necessary. https://jost.tums.ac.ir/index.php/jost/article/view/208 https://jost.tums.ac.ir/index.php/jost/article/download/208/179

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 6 2 2021 01 19 48 52 EN Arash Sharafatvaziri Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Mohammad Hasan Sharafi Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Hamid Rabie Orthopaedic surgery department, Shariati hospital, School of medicine, Tehran University of Medical Sciences ,Tehran , Iran Mohammad Hossein Nabian Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran 2020 10 07 2021 01 19 Background: Coronavirus disease 2019 (COVID-19) outbreak had some adverse effects on the management and treatment of patients with different medical conditions in several ways, and one of the most important and devastating ones is a delay in seeking medical care.   Case Report: During the first months of the outbreak, we had met seven patients with orthopedic problems and significant delays in receiving treatment which completely changed the treatment plan, course of the disease, and outcome.   Conclusion: As the COVID-19 pandemic has adverse effects on the management of orthopedic patients, like other medical conditions, it is necessary to make decisions and to implant some strategies to provide safe and effective care for patients with orthopedic conditions. https://jost.tums.ac.ir/index.php/jost/article/view/225 https://jost.tums.ac.ir/index.php/jost/article/download/225/194

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 6 2 2021 01 18 39 42 SM Javad Mortazavi Professor, Department of Orthopedics, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Seyed Hadi Kalantar Assisstant Professor, Orthopedic Department, Imam Khomeiny Hospital Complex, Tehran University of Medical Sciences Nima Arunkumar Vijaykumari Indian orthopedics association, AO Trauma society, Chettinad Hospital and research institute, Indian arthroplasty association, Indian arthroscopy society Ashwini Dondapati Chettinad hospital and research institute, Kelambakkam Nithesh Bensam Chettinad hospital and research institute, Kelambakkam Abhiram Krishnan Chettinad hospital and research institute, Kelambakkam 2024 11 17 2025 04 26 Backgound: Incidence of osteochondral fractures with osteochondral bone defects without significant anterior cruciate ligament (ACL) injuries is rather uncommon with minimal literature available about the incidence rates of such lesions. Osteochondral injuries of the knee have different mechanisms of injuries like those following ACL rupture and patellar dislocation, which comprise direct and indirect modes of injuries. Various treatment modalities have been described for osteochondral defect depending upon the size of defect, such as debridement, lavage, microfracture technique, and osteochondral autograft transfer system (OATS) therapy. In case of osteochondral fractures, the main mode of management is surgical wherein osteochondral fractures are managed with headless compression screws and bioabsorbable implants. Robust management of the osteochondral fractures and osteochondral defects helps in achieving good prognosis for the patient. Case Report: An 18-year-old young man presented with complaints of pain and inability to move his right knee following alleged history of twisting of right knee while playing football. On examination, the patient had moderate effusion in the knee with tenderness over the medial patellofemoral joint line. Radiological investigation revealed traumatic osteochondral fracture of the patella and incidental finding of osteochondral defect in the lateral femoral condyle which was managed surgically with Herbert headless screw fixation for fracture and debridement with microfracturing for osteochondral defect. Post-operatively, patient had good rehabilitation and regained his normal range of motion (ROM) at the end of 12 weeks. Conclusion: The coincidental existence of both osteochondral fracture and osteochondral defect is a rare entity and warrants the need for surgical management to have better prognosis. https://jost.tums.ac.ir/index.php/jost/article/view/637 https://jost.tums.ac.ir/index.php/jost/article/download/637/451

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