Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 3 2022 11 27 74 8 Mir Mansour Moazen Jamshidi Department of Orthopedic Surgery, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran Behzad Nezhad Tabrizi Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Ehsan Fallah Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Mazaher Ebrahimian Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Ali Salehi Department of Radiology, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Alireza Moharrami Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran SM Javad Mortazavi Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2022 01 09 2022 05 14 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.   https://jost.tums.ac.ir/index.php/jost/article/view/357 https://jost.tums.ac.ir/index.php/jost/article/download/357/274

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 3 2022 11 28 79 82 Alireza Sadeghpour Department of Orthopedics, School of Medicine Shohada Educational Hospital, Tabriz University of Medical Sciences Seyed Hamed Ghaffari Department of Orthopedic Surgery, Shohada Educational Hospital, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Jafar Ganjpour Sales Department of Orthopedic Surgery, Shohada Educational Hospital, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Hossein Aslani Department of Orthopedic Surgery, Shohada Educational Hospital, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Ali Hossein Zeinalzadeh Department of Community and Family Medicine Specialist, Social Determinants of Health Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran 2021 11 20 2022 08 19 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. https://jost.tums.ac.ir/index.php/jost/article/view/348 https://jost.tums.ac.ir/index.php/jost/article/download/348/275

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 3 2022 11 28 83 6 Nasrin Navaeifar Department of Orthopedics, Imam Khomeini Hospital Complex, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran Ali Tabriz Department of Orthopedics, Imam Khomeini Hospital Complex, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran   Mehrdad Motalebizadeh School of Medicine, Urmia University of Medical Sciences, Urmia, Iran 2021 12 16 2022 08 19 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.   https://jost.tums.ac.ir/index.php/jost/article/view/353 https://jost.tums.ac.ir/index.php/jost/article/download/353/276

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 3 2022 11 28 87 9 Koduru Kumar Department of Orthopaedics, NRI Medical College, Chinakakani, India Balakrishna Bathina Department of Orthopaedics, NRI Medical College, Chinakakani, India Tankala Jayadev Department of Orthopaedics, NRI Medical College, Chinakakani, India Manidhar Sane Department of Orthopaedics, NRI Medical College, Chinakakani, India 2022 02 02 2022 08 19 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. https://jost.tums.ac.ir/index.php/jost/article/view/358 https://jost.tums.ac.ir/index.php/jost/article/download/358/277

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 3 2022 11 28 90 4 Farsad Biglari Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Shohada Tajrish Hospital, Tehran, Iran Mehrdad Sadighi Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyyed Saeed Khabiri Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Meisam Jafari Kafiabadi Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Amir Sabaghzadeh Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Azadeh Hakakzadeh Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Pedram Khalighinejad Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Amir Human Hoveidaei Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Adel Ebrahimpour epartment of Orthopedic Surgery, Clinical Research Development Unit, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2022 02 02 2022 05 14 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. https://jost.tums.ac.ir/index.php/jost/article/view/359 https://jost.tums.ac.ir/index.php/jost/article/download/359/278

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 3 2022 11 28 95 6 Mir Mansour Moazen Jamshidi Department of Orthopedic Surgery, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran Sciences Alireza Moharrami Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Behzad Nezhad Tabrizi Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran 2021 12 04 2022 11 21 No abstract is available. https://jost.tums.ac.ir/index.php/jost/article/view/352 https://jost.tums.ac.ir/index.php/jost/article/download/352/279

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 3 2022 11 28 97 100 Seyed Peyman Mirghaderi Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Sadula Sharifpour Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Amirhossein Ghaseminejad Raeini Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran Maryam Salimi Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Alireza Moharrami Joint Reconstruction Research Center, Tehran University of Medical Scier> Habibollah Firoozjah Golestan University of Medical Sciences Setare Ozone Golestan University of Medical Sciences 2023 06 27 2024 06 30 Background: Dynamic nailing by placing only one screw on one side of the nail shortens the surgical time and reduces the complications during surgery and secondary dynamization. This study aimed to investigate the healing of dynamic intramedullary nailing (IMN) of tibial fractures. Methods: This cross-sectional study was done on 67 patients with dynamic IMN in 5th Azar Hospital, Gorgan, Iran, in 2015-2018. Complications, union time, Radiographic Union Score of Tibia Fracture (RUST) score, and Johner-Wruhs criteria were analyzed based on their grouping in AO classification. Results: The average age of the patients was 33.2 ± 13.0 years. Most of the fractures were closed type (71.6%), type C (43.4%). The mean healing time was 14.62 ± 4.38 weeks and RUST score was 8.90 ± 1.26. There was no significant difference between location s of fracture and the healing time or RUST score (P > 0.05). The healing time in the comminuted fractures (e.g., type C) and open tibial fractures was statistically longer than the simpler type (e.g., type A or B) and the mean radiological score in type C fractures was significantly lower (P < 0.05). The mean Johner-Wruhs criteria score of fractures was 46.31 ± 4.49, so that 61 patients had excellent results, four patients had good results, and two patients had fair results. Conclusion: Dynamic IMN of closed and middle third tibial fractures and simpler types of fractures (e.g., type A or B) have faster healing. Nevertheless, it is better to be more cautious for fixation of open or comminuted fracture (e.g., type C). https://jost.tums.ac.ir/index.php/jost/article/view/516 https://jost.tums.ac.ir/index.php/jost/article/download/516/367

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 2 2024 06 30 82 6 Ashok Sharma Ananta Institute of Medical Sciences & Research Centre Tarachand Suthar Senior Resident, Department of Orthopedics, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India Saksham Sharma Assistant Professor, Department of Orthopedics, Sjp Medical College, Bharatpur, Rajasthan, India Shiv Sharma Senior Professor, Department of Orthopedics, Principal and Controller Jhalawar Medical College, Jhalawar, Rajasthan, India 2023 07 30 2024 06 30 Background: As operative techniques and the quality of implants are improving, surgical management of diaphyseal fractures of forearm bones in elderly patients is gaining widespread acceptance. Titanium elastic nailing system (TENS) provides flexural, axial, translational, and adequate rotational stability. This study aims to analyze the outcomes of the treatment of diaphyseal forearm bone fracture with TENS nail. Methods: Elderly patients with both-bone forearm (BBFA) fractures in diaphysis were evaluated clinically and radiologically and followed for an average of six months. The outcome was assessed using the Grace-Eversmann scoring system. We followed up with all 25 patients and evaluated them every two weeks until the fracture united. Results: After approval of the ethics committee, twenty-five elderly patients with AO type 22A3 and 22B3 fractures of the forearm bone who fulfilled the inclusion and exclusion criteria were taken for the study. The mean age of the participants was 65 years. The average time to bone union was 12 weeks, and the average surgery time was 35 minutes. There was a superficial infection in one case. Most patients had a full range of elbow and wrist movements after the union. Conclusion: The TENS is an acceptable and good tachnique for displaced BBFA diaphyseal fractures in elderly patients. It is easy, cheap, and convenient and gives elastic mobility, promoting a rapid union of fractures and stability, which is ideal for early mobilization. It provides a lower complication rate, shorter surgery time, good cosmetic outcome, and easy implant removal. https://jost.tums.ac.ir/index.php/jost/article/view/523 https://jost.tums.ac.ir/index.php/jost/article/download/523/369

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 2 2024 06 30 87 90 Reza Zandi Associate Professor of Department of Orthopedic Surgery, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Shahin Talebi Associate Professor of Department of Orthopedic Surgery, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Amir Mehrvar Associate Professor of Department of Orthopedic Surgery, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Saeed Nodehi Resident, Department of Orthopedic Surgery, Faculty of Medicine, Shahid Beheshti University, Tehran, Iran Akbar Ehsani Department of Orthopedic Surgery, Faculty of Medicine, Shahid Beheshti University, Tehran, Iran 2023 07 02 2024 06 30 Background: A variety of options including titanium elastic nails (TENs) and locking plates (LPs) are available for the internal fixation of subtrochanteric fractures (STFs). However, the preferred treatment option among children and adolescents is still controversial. Methods: We report four cases of STFs in school-aged pediatric patients, treated with an adult proximal humerus LP. Results: Based on the Flynn scoring system at the last follow-up visit, all patients exhibited excellent clinical outcomes, along with satisfactory radiological outcomes based on the Beaty scoring system. There were no complications. Conclusion: Our findings suggest the efficacy of using adult proximal humerus LPs in treating pediatric STFs. The advantage of these plates lies in their ability to accommodate many screws at appropriate positions and angles without damaging the physis. This approach holds promise for the management of pediatric STFs. https://jost.tums.ac.ir/index.php/jost/article/view/517 https://jost.tums.ac.ir/index.php/jost/article/download/517/371

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 2 2024 07 01