Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 9 3 2023 10 10 107 9 Mohammadreza Salehi Department of Infectious Diseases, Imam Khomeini Hospital complex, Tehran University of Medical Sciences Leila Seddigh Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences Sahar Shafagh Department of Infectious Diseases, Research Center for Antibiotic Stewardship and Anti-Microbial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Behshad Pazooki   Department of Internal Medicine, Imam Khomeini Hospital complex, Tehran University of Medical Sciences Minoo Sadat Hajmiri Department of Internal Medicine, Imam Khomeini Hospital complex, Tehran University of Medical Sciences Banafsheh Moradmand-Badie   Black Dog Institute (BDI), University of New South Wales (UNSW), Sydney, Australia Nasim Khajavi Rad Department of Internal Medicine, Imam Khomeini Hospital complex, Tehran University of Medical Sciences Seyed Ali Dehghan Manshadi Department of Infectious Diseases, Research Center for Antibiotic Stewardship and Anti-Microbial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Nima Bagheri     Department of Orthopedics, Imam Khomeini Hospital, Tehran University of Medical Sciences Mehrnaz Rasolinejad Department of Infectious Diseases, Research Center for Antibiotic Stewardship and Anti-Microbial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Seyed Mahmoud Sajadi Jazi Department of Internal Medicine, Endocrinology & Metabolism ward, Shariati Hospital, Tehran University of Medical Sciences 2021 11 09 2022 02 26 Background: The diabetic foot is a chronic complication of diabetes. There is a strong relationship between glucose levels, the severity of diabetic foot ulcers (DFUs), and the need for amputation. This study aimed to evaluate the blood sugar (BS) trends before and after surgery in patients with DFU who had been amputated. Methods: The adult patients who had undergone DFU-related amputation surgery between 2017 and 2020 in Imam Khomeini Hospital Complex, Tehran, Iran, were evaluated. The cases whose BS levels were charted at least three days before and after amputation were recruited. The main data, including hypoglycemia (defined as a blood glucose level < 70 mg/dl) and mean BS and fasting BS (FBS) levels, were recorded. The data were then analyzed and compared before and after amputation. Results: Of 267 patients reviewed for inclusion criteria, 55 patients were included in the study. Twenty-eight patients (50.9%) were men, and the mean age was 60 years. The mean FBS before and after amputation was 229.5 and 181.3 mg/dl, respectively, and the mean BS before and after amputation was 227.3 and 197.8 mg/dl, respectively. The differences were significant (P < 0.001). Twelve patients (21.8%) before and 21 patients (36.4%) after amputation suffered from hypoglycemia (P = 0.057). Conclusion: DFU-related amputation is associated with a significant decrease in blood glucose levels and inflammatory indexes. However, it can increase the risk of hypoglycemia during the first three days after the surgery. https://jost.tums.ac.ir/index.php/jost/article/view/334 https://jost.tums.ac.ir/index.php/jost/article/download/334/322

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 9 3 2023 11 05 156 7 Masoud Yavari Department of Hand and Microsurgery, Panzdahe Khordad Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran Iran Mehdi Koushkzari Military Hospital, Urmia, Iran. Ali Tabriz Department of Orthopedics , Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia 2022 06 23 2023 11 05 No abstract is available., https://jost.tums.ac.ir/index.php/jost/article/view/406 https://jost.tums.ac.ir/index.php/jost/article/download/406/333

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 9 3 2023 11 05 110 9 Moosa Javdani Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, Iran Pegah Khosravian Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran Abolfazl Barzegar Department of Clinical Sciences, School of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran Mohammad Hashemnia Department of Pathobiology, School of Veterinary Medicine, Razi University, Kermanshah, Iran 2022 12 30 2023 11 05 Background: In the present study, the effectiveness of a controlled-release drug delivery system of chitosan hydrogel loaded with ketorolac and buprenorphine on oxidative stress indices and albumin changes in the experimental bone defect model was considered. Methods: After creating an experimental defect in the right tibia of each rat, 5 groups, including (A) the control group that did not receive any pharmacological intervention, (B) the chitosan hydrogel receiving group, (C) the group receiving chitosan hydrogel loaded with buprenorphine, (D) the group receiving chitosan hydrogel loaded with ketorolac, and (E) the group receiving chitosan hydrogel loaded with ketorolac and buprenorphine, were considered. Serum concentrations of antioxidant factors and albumin levels were then measured on days 0, 3, 7, and 21 after surgery. Results: In the control group, the maximum amount of oxidative stress and the maximum activity of antioxidant enzymes on the third and seventh days were compared between the 4 treatment groups. Moreover, the maximum amount of albumin on the third day was recorded and compared between the 4 other treatment groups. In 4 treatment groups, a significant decrease was observed in the mean of parameters related to oxidative stress compared to the control group, which was more noticeable in the group receiving ketorolac. Conclusion: In the present study, the highest rate of control of oxidative stress conditions was observed in the group treated with the ketorolac-loaded chitosan hydrogel system, possibly due to its antioxidant properties and better control of inflammatory conditions caused by the use of chitosan and ketorolac in this treatment group. https://jost.tums.ac.ir/index.php/jost/article/view/457 https://jost.tums.ac.ir/index.php/jost/article/download/457/332

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 9 3 2023 10 10 120 4 Sunil Kar Vikas Multispecialty Hospital, Sambalpur, Odisha, India Anantharamakrishnan Ganesh Chettinad Hospital and Research Institute, Kelambakkam, Tamilnadu, India Anurag Singh rauma and Orthopedics, East Surrey Hospital, Redhill, United Kingdom 2022 10 23 2023 10 10 Background: Pediatric femoral shaft fractures are one of the common fractures that we encounter in the orthopedics outpatient department. These fractures have various treatment options ranging from traction and early hip spica casting to elastic titanium intramedullary nails [titanium elastic nailing system (TENS)] and reamed intramedullary nails. In this study, we are evaluating the functional outcome and results following the use of flexible intramedullary nails and conservative management for femoral shaft fractures in children. Methods: This was a prospective observational study which was carried out in a tertiary care hospital from October 2015 to May 2017 for two groups of children who sustained traumatic femoral shaft fractures. A total of 40 patients were taken into consideration with 20 patients each in two groups. Results: The male-to-female ratio was 2.6:1 in our study population. The overall post-operative complication rate was more in the TENS group. Besides, we found that the TENS group of patients had a less limb length discrepancy (LLD) (P = 0.004) and a lower degree of angular deformity (P = 0.36). Conclusion: TENS demonstrated advantages including sufficient axial stability, early mobilization, and more rapid return to function than spica cast treatment; however, it had the drawback of possible infection and pin site irritation. Overall, TENS offers a minimally invasive method for treatment of the femoral shaft fractures in children which stands superior to traditio nal spica casting. https://jost.tums.ac.ir/index.php/jost/article/view/431 https://jost.tums.ac.ir/index.php/jost/article/download/431/323

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 9 3 2023 10 10 125 8 Dixit Savajiyani Department of Orthopedics, Pandit Deen Dayal Upadhyay Medical College, Rajkot, India Nishant Chauhan Department of Orthopedics, Pandit Deen Dayal Upadhyay Medical College, Rajkot, India Shailesh Ramavat Department of Orthopedics, Pandit Deen Dayal Upadhyay Medical College, Rajkot, India 2022 04 09 2022 05 14 Background: Forearm shaft fractures are common in developing countries. Anatomical reduction of these fractures using plates and screws is considered an accepted treatment mode. Like other shaft fractures, this can be treated with intramedullary nails like square nails, Rush nails, and interlocking nails. This study evaluates radiological and functional treatment results using square nailing. Methods: A prospective study was conducted on 100 adult patients with diaphyseal forearm fractures over 3 years. Out of 100 patients, 68 were men, and 32 were women. Patients were followed up at 2 weeks, 6 weeks, 8 weeks, and then every 3 months till 1 to 1.5 years. We have used criteria described by Anderson et al. and the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score for functional evaluation of the patients. Results: Out of 100 patients, the union was achieved in 88 patients, while the rest 12 patients required re-surgery. 4 patients had delayed union, 4 patients developed an infection at the ulnar entry site, and 3 patients developed bursitis of olecranon bursa. Conclusion: Intramedullary nailing of both bone forearm shaft fractures using square nails can give satisfactory results in most cases, comparable with treatment by plates and screws, and provides an alternative, cost-effective treatment of both bone forearm shafts fractures with good cosmesis owing to small incisions. https://jost.tums.ac.ir/index.php/jost/article/view/384 https://jost.tums.ac.ir/index.php/jost/article/download/384/324

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 9 3 2023 10 10 129 32 Kumar Sanjeev Department of Orthopedics, SGT University, Gurugram, Haryana, India Naresh Saini Department of Orthopedics, RNT Medical College, Udaipur, Rajasthan, India Manish chadha Department of Orthopedics, UCMS and GTB Hospital, Delhi, India 2022 12 15 2023 10 10 Background: Since long, thoracolumbar burst fractures have been treated either by prolonged bed rest or by surgical fixation. In this study, outcomes of early mobilization with non-operative treatment are evaluated to avoid unnecessary surgery and complications of prolonged bed rest. Methods: This prospective observational study included 40 patients with thoracolumbar burst fractures with no neurological deficit. Patients were mobilized with Taylor’s brace as soon as acute pain subsided and reviewed for at least two years with standing radiographs. They were evaluated for anterior vertebral height loss (VHL), kyphotic angle (KA), pain by Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and neurological deterioration at presentation, one month, six months, and two years. Results: The mean progression of kyphosis over two years was 7.8 degrees. The mean VHL also progressed from a mean of 51.9% at presentation to 60.4% at the two-year follow-up, a mean progression of 8.5%. At two years of follow-up, the mean ODI and the mean VAS score were 10.1% and 0.7, respectively. No patient developed a neurological deficit. Conclusion: Even though there is some deterioration in radiological parameters, there is constant improvement in functional parameters. For these fractures, non-operative management using a brace and early mobilization promises comparable results without the cost and risk of surgery. https://jost.tums.ac.ir/index.php/jost/article/view/446 https://jost.tums.ac.ir/index.php/jost/article/download/446/331

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 9 3 2023 10 10 133 7 Hadi Shojaei St. Joseph’s Care Group, Thunder Bay, Ontario, Canada; Assistant Professor, Northern Ontario School of Medicine University, Thunder Bay, Ontario,  Canada Imran Bagha MD Candidate, Northern Ontario School of Medicine University, Thunder Bay, Ontario, Canada Arman Shojaei 3 DO Candidate, Michigan State University, College of Osteopathic Medicine, East Lansing, Michigan, United States 2022 09 11 2022 09 29 Background: The presence of sudden-onset fibromyalgia (FM) is poorly understood, characterized, and appreciated in both previous literature and the clinical setting. In this case series, we present 10 cases of sudden-onset FM seen in a community-based pain clinic, to characterize the presentation of this condition, stemming from both external trauma and idiopathic etiology. Methods: This retrospective case series identified 10 patients diagnosed with FM attending the pain clinic. These patients were referred to chronic pain management clinic in Thunder Bay, Ontario, Canada, from January 2019 until December 2021 and met the diagnostic criteria for FM. Information was collected on sex, gender, age, details of signs and symptoms, and FM severity score as well as clinical findings and outcomes. Results: The case series identified 10 community residents (9 women and 1 man, F/M: 9/1, age range: 34-64 years, mean age: 51.7 years), with symptoms attributed to FM. Majority of patients suffered from total body pain and mental disorders such as depression. 60% of patieYear> 10 27 Background: Triphalangeal thumb (TPT) is a rare congenital anomaly, especially in the Asian population. Traditional treatments depend on the type of deformity and the presence of concomitant anomalies and include either excision in addition to the ligament reconstruction or fusion and shortening osteotomy. Instability and stiffness are the major concerns following the traditional techniques. Case Report: In this study, we report a case of right TPT with a small delta phalanx in a nine-year-old boy who was treated by proximal phalanx radial closed wedge osteotomy without delta phalanx resection or intracapsular dissection. The angular deformity and the appearance of the thumb were corrected by this simple procedure without resulting in instability and stiffness in the interphalangeal joint. Conclusion: Proximal phalanx closed wedge osteotomy is a rapid, simple, and effective technique with a low risk of unexpected complications for correcting the appearance in the cases of TPT with a small delta phalanx. https://jost.tums.ac.ir/index.php/jost/article/view/508 https://jost.tums.ac.ir/index.php/jost/article/download/508/379

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 3 2024 10 27 127 9 Sudhir Mane Department of Orthopedics, SVS Medical College, Mahabubnagar, Telangana, India - 509002 Jayaram P. Department of Orthopedics, SVS Medical College, Mahabubnagar, Telangana, India - 509002 Kyatham L. Rao Department of Orthopedics, SVS Medical College, Mahabubnagar, Telangana, India - 509002 2023 10 02 2024 10 27 Background:Missed or neglected Monteggia lesions are defined as classical fracture-dislocation presenting at least four weeks after injury. This injury in children is often challenging to treat and requires complex methods to achieve optimal results. Case Report: We report a 6-year-old girl with a 2-month-old neglected Bado type-I Monteggia fracture-dislocation. Our patient underwent ulnar osteotomy, bone grafting, and fixation with a semi-tubular plate along with open radial head reduction. Although the patient experienced wound complications at the bone graft harvest site, she achieved an excellent outcome with restored functionality and range of motion (ROM). Conclusion: Neglected Monteggia injuries in pediatric patients demand multifaceted treatment approaches due to their complexity and potential for long-term functional impairment. The absence of a consensus on definitive treatment underscores the importance of early diagnosis and open reduction to enhance long-term outcomes. This case report highlights the effectiveness of ulnar osteotomy, plate fixation, and open radial head reduction in achieving favorable results. https://jost.tums.ac.ir/index.php/jost/article/view/535 https://jost.tums.ac.ir/index.php/jost/article/download/535/380

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 3 2024 10 27 135 8 Arash Sharafat Vaziri Tehran university of medical sciences Hamid Rabie Tehran university of medical sciences Iman Menbari Oskouie Tehran university of medical sciences Mohammad Tahami Assistant Professor, Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Nazanin Rahimdoost Tehran university of medical sciences 2024 06 04 2024 10 27 Background:Tibial plateau posteromedial rim avulsions by semimembranosus tendon are a rare entity that have been reported in a few studies so far with controversial mechanisms. They are reported to accompany anterior cruciate ligament (ACL) or meniscal injuries. Their main fracture planes are usually placed in the coronal plane. Case Report: The patient was a 52-year-old man with a hyperextension-valgus tibial plateau fracture. The imaging studies revealed a compression fracture of the lateral and an avulsion fracture of the posteromedial plateau. However, no soft-tissue injuries were detected. The fragment was avulsed in the axial plane and covered by the medial meniscal posterior horn, creating the pattern of a longitudinal tear in the meniscal ramp lesion, but actually without any soft-tissue injuries. It was fixated using the tension band wiring technique with two Kirschner wires (K-wires) and one cancellous screw. Radiological and functional outcomes were excellent at 12-month follow-up. Conclusion: This fracture pattern merits special attention due to its unusual presentation, causing the meniscal posterior horn to separate from the articular surface. “Bony ramp lesion” best describes the simultaneous separation of the posterior horn of the medial meniscus (PHMM) and its underlying bony fragment without the meniscal tear that takes place in an actual medial meniscal ramp lesion. https://jost.tums.ac.ir/index.php/jost/article/view/596 https://jost.tums.ac.ir/index.php/jost/article/download/596/382

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 3 2024 10 27 139 141 Prem Kumar Kothimbakkam Chettinad Academy of Research & Education Vijayashankar Murugesan Chettinad Academy of Research and Education Bharath Vadivel Chettinad Academy of Research and Education Esa Gokulakrishnan Chettinad Academy of Research and Education 2024 01 23 2024 10 27 Background: Chaput tubercle fracture is a counterpart to adolescent Tillaux fracture, which occurs at the anterolateral part or the attachment site of the antero-inferior tibiofibular ligament on the distal tibia. It is rare, and its presentation may not be well appreciated in X-rays, which depicts the importance of a computed tomography (CT) scan of the ankle to reveal the same. Case Report: A 25-year-old gentleman presented to Chettinad Hospital, India, casualty with acute onset of pain, swelling, and restricted movements at the ankle joint following a road traffic accident. Ankle CT revealed a Chaput fracture along with a bimalleolar fracture (posterior and lateral malleoli). The complex displaced fracture was managed with open reduction internal fixation (ORIF) with plate osteosynthesis for the posterior malleoli and lateral malleoli, and tension band wiring was done for the Chaput tubercle fracture. At the end of two-year follow-up, the patient was able to mobilise without any support. Conclusion: Through this case report, we would like to enumerate the rarity of Chaput tubercle fracture associated with bimalleolar fracture of the ankle, which will be evaluated better with a CT evaluation in the first place. At the same time, it gives valuable information for the preoperative surgical plan. https://jost.tums.ac.ir/index.php/jost/article/view/565 https://jost.tums.ac.ir/index.php/jost/article/download/565/383

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 3 2024 10 27 146 8 Arash Sharafat Vaziri Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran Nazanin Rahimdoost Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran Soodabeh Esfandiary Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran. Fardis Vosoughi Department of Orthopedics and Trauma Surgery, Shariati Hospital, TUMS, Tehran, Iran Mehdi Moezi Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran Iman Menbari Oskouie School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2023 11 09 2024 10 27 Background: Osgood-Schlatter disease (OSD), a form of traction apophysitis, predominantly affects adolescents engaged in high- impact activities. While conservative management is often effective, surgical intervention becomes necessary in refractory cases. Case Report: A 29-year-old male athlete with persistent OSD symptoms underwent arthroscopic surgery after unsuccessful non- surgical treatments. Arthroscopic removal of the bony particle was undertaken using six portals with a novel setting (consisting of medial and lateral superior, standard, and inferior portals) to minimize the damage to the patellar tendon and intermeniscal ligaments. This setting of portals also obviates the need for fluoroscopy since it provides adequate visualization for confirmation of complete removal of the bony particle. The lower portals also provide more convenient access to the bony particle, minimizing the possibility of incomplete removal and persistence of symptoms. The patient experienced complete resolution of anterior knee pain and prominence within six months post-surgery. Arthroscopic removal of the ossicle involved the use of superior portals for optimal access and visualization. Low portals were strategically employed to eliminate the need for fluoroscopy, offering a unique advantage. Postoperative rehabilitation included immobilization followed by a gradual return to weight-bearing and full range of motion (ROM). Conclusion: Arthroscopic removal remains the preferred method for treating OSD, emphasizing fewer complications. However, challenges related to limited access and anatomical restoration persist. https://jost.tums.ac.ir/index.php/jost/article/view/549 https://jost.tums.ac.ir/index.php/jost/article/download/549/385

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 3 2024 10 27 130 4 Hieu Huynh University of Medicine and Pharmacy at Ho Chi Minh City Maxime Lacroix Université Paris-Cité, Paris, France Pierre Guigui Université Paris-Cité, Paris, France Emmanuelle Ferrero Université Paris-Cité, Paris, France Tchao Meatchi Université Paris-Cité, Paris, France Marc Khalifé Université Paris-Cité, Paris, France 2023 06 04 2024 10 27 Background: Pseudomyxoma peritonei (PMP) is a rare condition, with no previously described location in the spine. Here is presented a case of PMP extension to the thorax and then the spine, treated with two-level vertebrectomy, laminectomy, and posterior fusion. Case Report: We report here the case of a 64-year-old man presenting pathological fractures of T6 and T7 due to PMP extension to the pleural cavity and thoracic spine. He presented interscapular pain with mild spinal cord compression symptoms. He was treated by achieving T5-T8 laminectomy, T2-T10 pedicle fixation, and T6-T7 vertebrectomy. The postoperative course was uneventful apart from a pulmonary embolism (PE) with favorable evolution under anticoagulants. Conclusion: To achieve spinal cord decompression, kyphosis correction, and spine stabilization, a two-level vertebrectomy, laminectomy, and posterior fusion would be beneficial for a PMP lesion of the thoracic spine. https://jost.tums.ac.ir/index.php/jost/article/view/501 https://jost.tums.ac.ir/index.php/jost/article/download/501/381