Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 4 2022 12 04 109 112 Reza Shahryar Kamrani Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mahmoud Farzan Department of Orthopedics, School of Medicine, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mohamad Sadeghian Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran. Arash Farhoud School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Mahsa Akhtarzadeh Department of Anesthesiology, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran Iran. Mitra Ashrafi Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran. Amir Reza Farhoud Tehran University of Medical Sciences, Joint Reconstruction Research Center 2022 03 20 2022 05 10 Forearm nonunion is rare but a possible complication after standard treatment of the fracture of radius and ulna. The importance of precise restoration of length and anatomical relationship of both bones are among usual concerns. The situation is more complex when the infection is present in the union site. The several techniques have been applied to manage forearm nonunion consisting of osteosynthesis and using cancellous autograft, allograft, nonvascularized fibular graft, fibular flap, bone transport, induced membrane (Masquelet technique), and pedicled flap such as posterior interosseous and radial forearm bone flap (RFBF). Reviewing the recent studies focusing on treating forearm nonunion is the purpose of this review. https://jost.tums.ac.ir/index.php/jost/article/view/380 https://jost.tums.ac.ir/index.php/jost/article/download/380/284

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 4 2022 12 04 113 7 Rajendra Rayal Kishangarh, Rajasthan, India Vishal Shekhawat Department of Orthopedics, SMS Medical College, Jaipur, Rajasthan, India Rakesh Dukia Department of Orthopedics, SMS Medical College, Jaipur, Rajasthan, India Narendra Joshi Department of Orthopedics, SMS Medical College, Jaipur, Rajasthan, India Shubham Agarwal Department of Orthopedics, SMS Medical College, Jaipur, Rajasthan, India 2022 03 09 2022 05 14 Background: Tibial diaphyseal fracture is the most commonly encountered fracture in orthopedic practice. There are various methods to treat the same, ranging from conservative to operative treatment. The operative methods include internal fixation using nailing and plating and external fixation using fixator/ring fixator. This study aims to evaluate the results of primary treatment of segmental tibial fracture in patients with a compromised skin condition using the Ilizarov fixator and look for complications. Methods: This prospective study was conducted at a tertiary level health care center. It included a series of 40 patients with segmental tibial fractures. Classification of the segmental tibial fractures was done according to Melis et al. The fixator was designed with three fixation blocks and two working length sections. The patients were evaluated for the progression clinically and radiographically at 2-week intervals for the first 2 months and were then followed by 4-week intervals. Results were evaluated according to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) classification. Results: We treated 40 patients with a segmental tibial fracture with compromised skin using the Ilizarov ring fixator. Patients were followed up after surgery with an average follow-up of 13.8 months. The average union time came out to be 27.6 weeks for the proximal segment and 33.31 weeks for the distal segment. Out of the total patients, 15 (37.5%) patients had pin tract infection, and one (2.7%) patient had nonunion, which later required bone grafting. Bone results of patients at final follow-up as evaluated by ASAMI score were 91.7% excellent, 5.6% good, and 2.7% poor. Functional results of patients at final follow-up as evaluated by ASAMI score were 80.5% excellent, 1.7% good, and 2.8% poor. Conclusion: In the existing literature, segmental tibial fractures have always been difficult to treat. They are associated with high complication rates due to the lack of surrounding soft tissues. The proximal and distal fragments may be more difficult to treat because of the serious direct injury to the soft tissues overlying the segment and the difficulty stabilizing this bone segment with implants. With the use of Ilizarov technique, there is a good mean time to union, a low rate of reoperations, and good functional and general health-status outcome. https://jost.tums.ac.ir/index.php/jost/article/view/376 https://jost.tums.ac.ir/index.php/jost/article/download/376/285

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 4 2022 12 04 118 124 Khazi Syed Asif Hussain Department of Orthopedics, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India Aluka Sundeep Kund Reddy Department of Orthopedics, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India     Mayani Raju Department of Orthopedics, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India Chandrashekhar Patnala Department of Orthopedics, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India 2022 04 23 2022 07 15 Background: Older adults who sustain hip fractures usually have multiple comorbidities that may impact their treatment and outcome. This study was conducted with the aim to analyze the risk factors that contribute to falls in elderly individuals and analyze the effect of comorbidities on the outcome and the treatment in elderly patients with hip fractures. Methods: This cohort study was conducted on patients with hip fractures. We prospectively analyzed 140 individuals with geriatric hip fractures who had undergone surgery. The Charlson Comorbidity Index (CCI) and American Society of Anesthesiology (ASA) score of each geriatric hip fracture patient were calculated based on data obtained from medical records. Clinical assessment was assessed using a modified Harris Hip Score (HHS) during each visit. Results: The mean age of patients was 72.21 ± 12.2 years. Their mean CCI and ASA was 1.02 ± 0.3 and 2.0 ± 0.53, respectively, and both were significantly associated with time-to-surgery (P < 0.001) and surgical treatment (P < 0.001). The length of hospital stay, duration of postoperative intensive care, and hospital expenses were associated with both CCI (P = 0.037) and ASA (P = 0.002). The greater the CCI and ASA scores were, the higher the chances of developing postoperative complications were (X2 = 15.724; P = 0.001). Delirium was the most common postoperative complication (15.7%), and pulmonary infection (11.4%) was the most fatal complication. Conclusion: Patients with high CCI and ASA grading, and revision surgery were at high risk of postoperative complications, morbidity, and mortality. Orthogeriatric care offers the best chance for a successful outcome through efficient medical co- management of these patients. https://jost.tums.ac.ir/index.php/jost/article/view/388 https://jost.tums.ac.ir/index.php/jost/article/download/388/286

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 4 2022 12 04 125 9 Arash Maleki Clinical Research Development Unit, Akhtar Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyed Reza Aghapour Clinical Research Development Unit, Akhtar Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Abaalfadel Saleh Clinical Research Development Unit, Akhtar Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2022 03 06 2022 05 14 Background: Clubfoot is a multifactorial disease with the prevalence of one in 1000 live births. The presentations of clubfoot are forefoot adductus, hindfoot varus, cavus, and equinus. Ponseti method is an efficient nonoperative clubfoot treatment containing manipulation, serial casting, and Achilles tendon tenotomy if necessary. Our prospective observational study assessed the outcome and probability of recurrence in the treated clubfoot with the Ponseti method. Methods: This prospective observational study was performed in Akhtar Hospital in Tehran, Iran. 27 patients with 38 feet of idiopathic clubfoot in our study were treated with the Ponseti method. The patients were assessed before and after treatment and demographic characteristics, Dimeglio scores, number of recurrenes, and need for tenotomy were recorded. Results: All patients (38 feet) successfully achieved complete deformity correction, but 13 feet had a relapse. The mean age of cases with relapse was more than cases without relapse. Cases with a higher initial Dimeglio score had a higher recurrence rate after Ponseti method treatment. Eight feet (five patients) out of 38 feet did not use Denis Browne (DB) splint as our protocol; all of them had a relapse. On the other hand, only 5 of 30 feet (16.7%) that used splint had recurrence. Conclusion: The treatment should be started as soon as possible because it is more effective at a younger age. Severe cases at the initial visit had more recurrence rate. Besides, the recurrence rate in cases that used DB orthosis improperly, irregularly, and incorrectly was higher than others. https://jost.tums.ac.ir/index.php/jost/article/view/375 https://jost.tums.ac.ir/index.php/jost/article/download/375/287

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 4 2022 11 27 130 3 Mohammadreza Golbakhsh Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Mohammad Jamshidof Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Amir Heydari 0 Parham Talebiyan Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Salar Baghbani Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Mazaher Ebrahimian Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Mohammad Rastegar Department of Orthopedics, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2022 05 17 2022 11 21 Background: Wound complications are major morbidities after orthopedic surgery, and thrombo-prophylactic drugs may increase the likelihood of such complications. In this regard, our study has evaluated the possible effects of rivaroxaban on wound complication issues following spinal canal stenosis surgery. Methods: This prospective cohort study was conducted on 40 patients suffering from spinal canal stenosis secondary to degenerative lumbar spine changes. The eligible patients included those patients receiving rivaroxaban to prevent thrombo-emboli post-operatively. The patients were followed up for three months and assessed for postoperative wound-related complications. Results: None of the patients suffered vascular and thromboembolic complications. Regarding wound complications, these events are mostly limited to the first week post-operatively, including wound dehiscence in 5.0%, serosanguineous discharge in 25.0%, erythema in 35.0%, superficial infection in 10.0%, requiring surgical debridement in 5.0%, cellulitis in 10.0%, and wound induration in 30.0%. Deep infection or hematoma was not reported in our patients. Erythema and wound induration remained 10.0% and 15.0% within the second week, respectively. The hypertrophic scar was a delayed complication that appeared in 15.0% of patients within 1 to 3 months post-operatively. Conclusion: The main risk profiles related to wound complications, especially infections, were a history of hypertension (HTN), uncontrolled diabetes mellitus (DM), and renal insufficiency. The use of rivaroxaban may be accompanied by temporary and minor wound complications and not with potentially debilitating morbidity in patients undergoing spinal canal stenosis surgery. Therefore, its prescription as a safe thrombo-prophylactic drug in patients undergoing spinal canal stenosis surgery is confidently recommended.   https://jost.tums.ac.ir/index.php/jost/article/view/395 https://jost.tums.ac.ir/index.php/jost/article/download/395/289

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 4 2022 12 04 134 7 Sadula Sharifpour Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Seyed Peyman Mirghaderi Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Ali Dehghani Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Nima Bagheri Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohammad Zarei Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Seyed Hadi Kalantar Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2022 02 21 2022 10 14 No abstract is available. https://jost.tums.ac.ir/index.php/jost/article/view/366 https://jost.tums.ac.ir/index.php/jost/article/download/366/290

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 4 2022 12 04 138 141 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 Elham Rahmanipour Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Maryam Salimi Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Milad Salehi Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohamad Reza Guity Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran 2022 03 30 2022 10 14 Not abstract is available. https://jost.tums.ac.ir/index.php/jost/article/view/382 https://jost.tums.ac.ir/index.php/jost/article/download/382/291

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 4 2022 12 04 142 7 Maysa Eslami Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran Farzad Pourghazi Center for Orthopedic Trans-disciplinary Applied Research (COTAR) Tehran University of Medical Science Brice Ilharreborde Department of Pediatric Orthopedic Surgery, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France Mohammad Nabian Department of Orthopedic Surgery, Center for Orthopedic Trans-Disciplinary Applied Research (COTAR) Institute, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2022 03 13 2022 05 14 No abstract is available. https://jost.tums.ac.ir/index.php/jost/article/view/379 https://jost.tums.ac.ir/index.php/jost/article/download/379/292

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 4 2022 12 04 148 150 Mahmoud Farzan Department of Orthopedics, Imam Hospital Complex, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran Iran. Abbas Abdoli Department of Orthopedics, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Mohammad Sadeghian Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran Iran Mitra Ashrafi Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran Iran Mahsa Akhtarzadeh Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran Iran Shahram Akrami Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Amir Reza Farhoud Department of Orthopedics, School of Medicine, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2022 04 02 2022 05 10 Background: Entrapment of the ulnar nerve in the cubital tunnel occurs as the second most common compression neuropathy of the upper limb. Although the usual etiology is idiopathic or following cubitus valgus, a compressing mass can be a rare ca use and should be considered in atypical presentation. Case Report: A 45-year-old male patient presented with subacute onset of cubital tunnel syndrome that progressed rapidly and was associated with significant pain. An intra-canal ganglion cyst was found during surgical decompression of the ulnar nerve. Conclusion: Diagnosis of intra-cubital canal mass should be considered when sudden onset and rapid progression of the cubital tunnel syndrome and dramatic pain coincide. Imaging modalities like ultrasound or magnetic resonance imaging (MRI) may be helpful to reach the correct diagnosis before the surgery.   https://jost.tums.ac.ir/index.php/jost/article/view/383 https://jost.tums.ac.ir/index.php/jost/article/download/383/293

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 8 4 2022 12 15 151 3 Keyvan Rahbari Department of Orthopedics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Kian Zohrabi Department of Orthopedics, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Reza Shahriar Kamrani Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran 2022 02 23 2022 12 15 Background: Gorham's disease (GD) is one of the scarce and idiopathic skeletal diseases which causes osteolysis following the proliferation of blood vessels. Progressive osteolysis GD of distal humerus with articular involvement and pathologic fracture has not been reported and our case is the first report of this disease involving distal humerus and its joints’ surfaces. Case Report: A 9-year-old boy, case of nonunion of medial condyle of humerus and pathologic fracture of distal humerus after minor trauma, was referred to our clinic and treatment started by casting but due to displacement and nonunion, we decide to operate him. Intraoperative finding was in favour of aneurysmal bone cyst (ABC) near fracture site; therefore, wide resection and fixation by medial tension band wiring (TBW), lateral plating, and fibular allograft application was done (post-operation pathologic result did not show microscopical features of this tumor) and 6 weeks later, he developed stress riser fracture above lateral plate; thus, plate removal was done and severe bone resorption was revealed. Therefore, another specimen was sent for pathology that showed hamartomatous and hemangiomatous lesion of bone. All findings were in favour of GD. He was operated another time and fixed by Persian fixation with small pins and plate, and early plate removal was done for prevention of stress riser fracture. Conclusion: In cases of GD of distal humerus and pathologic fracture, Persian fixation is a good option for fixation and we suggest early device removal for prevention of stress riser fracture. https://jost.tums.ac.ir/index.php/jost/article/view/364 https://jost.tums.ac.ir/index.php/jost/article/download/364/294