Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 1 4 Amir Mehrvar Assistant professor, Department of orthopedics, Taleghani Hospital Research Development Committee, Shahid Beheshti University of medical sciences, Tehran, Iran. ORCID: https://orcid.org/0000-0002-6661-2275 Reza Zandi Associate Professor, Department of orthopedics, Taleghani Hospital Research Development committee, Shahid Beheshti University of medical sciences, Tehran, Iran. Mohammad Ali Okhovatpour Associate Professor, Department of orthopedics, Taleghani Hospital Research Development committee, Shahid Beheshti University of medical sciences, Tehran, Iran. Shahab Sarlak : Resident of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammadreza Minator Sajjadi Taleghani Hospital Research Development committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran. Akbar Ehsani Resident of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ahmadreza Ahmadi Abdashti Resident of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2023 01 07 2024 03 13 Background: The purpose of the 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. Methods: A total of 60 patients with Neer 2b distal clavicle fracture were 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. Results: In all patients, the bony union was achieved without wound-related complications. The mean time to union in distal radius volar T plate group was 3.30.6 and 3.60.7 in the pre-contoured locking plate (p =0.14). The mean Constant-Murley score was 93.12.2 and 92.1 2.5 in T plate group and pre-contoured plate group, respectively (p =0.09). Five cases with T plate and eight cases with pre-contoured plated were candidates for device removal (p =0.53). Conclusion: Distal 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, besides its economical price https://jost.tums.ac.ir/index.php/jost/article/view/462 https://jost.tums.ac.ir/index.php/jost/article/download/462/360

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 5 8 A Ganesh Indian orthopedics association, Odisha orthopedics association, SICOT, AO Trauma society Subrat Mohapatra 0000-0002-1825-3351 Nego Zion 0000-0001-5881-3221 2023 05 30 2024 03 13 Background: Neck pain is the most common complaint that we deal with in orthopedics, most of which are information technology (IT) professionals. These individuals have vocational mismanagement which leads to high incidence of forward head posture (FHP). Methods: A cross-sectional study was carried out from January 2019 to June 2019 during which a total of 300 patients were taken into study. Clinical assessment of neck pain, head posture, range of motion (ROM), and radiological assessment of craniovertebral angle (CVA) and anterior head translation (AHT) was done. Results: Out of 300 patients, the majority of the patients were men. On average, men used computers for 9.6 hours compared to 9.2 hours for women. The average CVA was higher in women (58.8). The average AHT was more in men (22.9). Conclusion: As compared with the previous literature, our study showed that 84.3% of male and 92.91% of female participants had FHP. CVA was lower, while AHT was higher in both groups than the usual range. The mean AHT in our sample was 18.8 mm, which was found to be aberrant in the prior research studies. In our study, we have found a negative correlation between the CVA and AHT, resulting in FHP, 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. https://jost.tums.ac.ir/index.php/jost/article/view/498 https://jost.tums.ac.ir/index.php/jost/article/download/498/359

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 9 14 Reza Zandi https://orcid.org/0000 0002 0095 6745 Alireza Manafi-Rasi http://orcid.org/0000-0001-6355-704X Mohammadreza Minator Sajjadi https://orcid.org/0000 0003 2081 7619 Esmaeel Yousefi-Hajivand https://orcid.org/0000-0002-9337-0662 2023 06 06 2024 03 13 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. The aim of the current study is to evaluate the safety and efficacy of TXA use for blood loss reduction and the need for blood transfusion in patients with fractures of the pelvis or acetabulum. Methods: 108 patients were recruited from two tertiary care hospitals and assigned evenly either to the intervention (TXA) or the control 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 recorded. 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, and 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 the reconstructive surgery and fracture occurrence was significantly higher in the TXA group (P = 0.032). The mean postoperative hospitalization time was significantly lower among TXA group patients (P = 0.037). The mean hemoglobin in the TXA group was significantly higher, postoperatively (P = 0.028). The mean EBL, the blood volume collected by suction or drain, the weight of the consumed gauze during the surgery, and the number of transfused blood units were significantly lower in the TXA group. The transfusion rate was significantly lower in patients with a shorter time gap between fracture occurrence and reduction surgery (P = 0.021).  Conclusions: TXA can decrease blood loss, the transfused blood units during and after the operation, and hospital admission days. Moreover, it did not increase the chance of pulmonary thromboembolism or deep vein thrombosis in the patients receiving tranexamic acid; thus, it can be assumed as a safe and efficient drug in patients with acetabulum or pelvis fractures. https://jost.tums.ac.ir/index.php/jost/article/view/505 https://jost.tums.ac.ir/index.php/jost/article/download/505/358

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 19 24 Pezhman Shahbazi Hamadan university of medical science Gholamreza Ghorbani Amjad 0000-0000-0000-0000 2023 06 02 2024 03 13 Background: One of the proposed methods to reduce the risk of infection after joint replacement is the use of disinfectant solutions at the end of the surgery. Differing results have been reported regarding the effects of diluted povidone-iodine (betadine) washing solution and normal saline in reducing the risk of periprosthetic joint infection (PJI). The purpose of this retrospective cohort study is to compare the outcomes of diluted betadine solution with normal saline in bilateral knee replacement surgery. Methods: Patients who were referred to Ba’ath Hospital, Hamedan, Iran, from 2019 to 2021 for bilateral knee joint replacement were included. For each patient, 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 PJI three months after were collected and analyzed. Results: Out of 320 patients, 177 (55.3%) were women, and the most common underlying disease was type 2 diabetes with a frequency of 20.0%. Out of 640 operated knees, 17 cases (2.7%) of PJI occurred after surgery, of which 11 (4.3%) were washed with normal saline (P = 0.326). The multivariate regression analysis showed that being male (P = 0.028), diabetes (P = 0.030), high blood pressure (P = 0.019), and an increase in each body mass index (BMI) unit (P = 0.030) increased the chance of infection.  Conclusion: Intraoperative irrigation with diluted betadine solution in bilateral knee replacement surgery can reduce the risk of infection, especially in patients with underlying diseases and obesity. https://jost.tums.ac.ir/index.php/jost/article/view/499 https://jost.tums.ac.ir/index.php/jost/article/download/499/356

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 25 7 Prashant Modi Associate Professor, Department of Orthopedics, SMS Medical College, Jaipur, Rajasthan, India Aditya Rathore Senior Resident, Department of Orthopedics, SMS Medical College, Jaipur, Rajasthan, India Shubham Agarwal MS orthopaedics 2023 04 16 2024 03 13 Background: The anterior cruciate ligament (ACL) is a vital knee joint stabilizer with rising injury rates. 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) involves the use of autologous hamstring tendons with a braided ultra-highmolecular weight polyester or polyethylene suture or suture tape to act as a secondary stabilizer until complete integration. This study aimed to compare the outcomes of ACL reconstruction using hamstring grafts with and without suture augmentation. Methods: This trial 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). Participants provided informed consent. We collected baseline clinical characteristics range of motion (ROM), pain (numeric pain rating scale, NPRS), and functional outcomes (Lysholm and International Knee Documentation Committee, IKDC scores). Results: The mean age was 25.5 years, with 96% male and 4% female participants. We found a statistically significant improvement in both groups in ROM, NPRS scores, and functional outcomes at 1 and 6 months. There was no significant difference in both groups regarding the IKDC score. Lysholm’s score showed a remarkable improvement in both groups. Conclusion: The study concluded that suture augmentation could be an effective technique for ACL reconstruction, with comparable outcomes to standard ACL reconstruction. https://jost.tums.ac.ir/index.php/jost/article/view/488 https://jost.tums.ac.ir/index.php/jost/article/download/488/355

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 28 30 EN Hossein Azaditalab Department of Orthopedic and Trauma Surgery, Imam khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran Abdolnaser Farzan Department of Orthopedic and Trauma Surgery, Imam khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran Hossein Hamdollahzadeh Department of Orthopedic and Trauma Surgery, Imam khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran Ramin Shayan Moghadam Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Mosayeb Soleymani Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran 2023 04 29 2024 03 13 Background: Schwannoma, the most common primary neural tumor of the upper extremity, arises from Schwann cells of the nerve sheet. The tumor is usually painless and slow-growing. Symptomatic masses could be treated through intra- or extra-capsular excision. Herein, we aim to evaluate the long-term results of surgical treatment of 12 cases of upper extremity Schwannoma. Methods: Twelve cases of confirmed Schwannoma who were treated in Imam Khomeini University Hospital, Tehran, Iran, from 2011 to 2022, were included in our case series. All operations were done using loupe magnification or under a microscope. Age, sex, location of the mass, size of the tumor, affected nerve, histological diagnosis, and clinical follow-up, including the neurological status of the patients, were documented. Results: Twelve patients with a mean age of 44 years were included. Seven (58.3%) were men and five (41.66%) were women. The mean follow-up period was 45 months (range: 6-135). The hand was the most common location of involvement and the 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 the patient with motor deficit. 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. https://jost.tums.ac.ir/index.php/jost/article/view/491 https://jost.tums.ac.ir/index.php/jost/article/download/491/354

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 15 18 Seyd Houssein Saeed-Bandaky 0000-0002-6481-0227 Maziar Malekzadeh 0000000188666584 Abbas Tafti Trauma Research enter, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2023 01 10 2024 04 01 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. https://jost.tums.ac.ir/index.php/jost/article/view/464 https://jost.tums.ac.ir/index.php/jost/article/download/464/361

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 31 4 EN Arash Sherafat Vaziri Department of orthopedics and trauma surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Sina Javidmehr Department of orthopedics and trauma surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Fardis Vosoughi Department of orthopedics and trauma surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Erfan Babaei Nejad Department of orthopedics and trauma surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Kaveh Same Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran 2022 09 16 2023 10 10 During the past two decades, the use of robotic arms in knee arthroplasty has changed from a concept to a reality. These systems promise precision and accuracy while shortening the required learning curve. Although still largely in the early stages, there are currently several commercially available platforms with varying degrees of flexibility. The available models can be classified into several categories based on their mode of operation (whether the system requires imaging input) and degree of autonomy. The present study aimed to review the existing body of literature and provide an outlook of the current landscape. The strengths and weaknesses of the implementation of such systems in knee arthroplasty are also discussed. https://jost.tums.ac.ir/index.php/jost/article/view/404 https://jost.tums.ac.ir/index.php/jost/article/download/404/353

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 03 31 35 8 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 Orthopedic Surgeon, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shirin Sheibani Student Research Committee, School of Medicine, Mazandaran University of Medical Science, Sari, Iran. Abolfazl Ghadiri Assistant professor of orthopedic surgery, Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran 2023 05 18 2024 03 31 Background: After the spine, the hip is the most common site that can be infected with extrapulmonary tuberculosis (TB). In the early stages, patients present with complaints of pain around the hip, and after a while, they might experience deformities, shortening, and limited movements. Because hip TB mimics the symptoms of other hip diseases like rheumatoid arthritis (RA) and osteoarthritis, diagnosis is difficult. Here, we aimed to report a rare case of hip TB secondary to pulmonary TB and the result of the total hip arthroplasty (THA). Case Report: A 41-year-old man presented to the orthopedic clinic with a complaint of progressive pain in the right hip. After laboratory tests, imaging, and sputum culture, active TB infection and advanced arthritis of the hip joint were detected. A subluxation/ dislocation stage of arthritis and an acetabular protrusion were present, leading to the restriction of movements. After receiving medical therapy, we performed THA for the patient. Conclusion: The patient’s right hip reached a normal range of motion (ROM) without pain in the 18-month follow-up. Since TB can mimic the symptoms of many common diseases, considering hip TB along with other diagnoses can aid in reducing possible complications and improving patients' lives. https://jost.tums.ac.ir/index.php/jost/article/view/497 https://jost.tums.ac.ir/index.php/jost/article/download/497/348

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 39 41 Farzad Amouzadeh Omrani ssociate Professor, Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Kourosh Kharkan Ghamsari Orthopedic Surgeon, Joint, Bone, Connective tissue, and Rheumatology Research Center (JBCRC), Department of Orthopedics, 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran Mojtaba Baroutkoub Assistant Professor, Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Sina Afzali Orthopedic Surgeon, Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Saeed Kookly Assistant Professor, Joint, Bone and Connective Tissue, Rheumatology Research Center (JBCRC), Department of Orthopaedics, 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran 2022 11 14 2024 03 13 Background: Only 3% of all proximal tibial fractures result in an avulsion fracture of the tibial tuberosity. It is often seen in youngsters between the ages of 3 and 6 and is less frequent after puberty. Case Report: A 15-year-old boy was presented with severe left knee pain following a high jump. X-ray and computed tomography (CT) scan showed a tibial tuberosity fracture with joint surface involvement. The damaged part was fixed with a 4.5mm cannulated screw and washer, reinforced with 2 SwiveLock anchors. In the sixth week, full weight bearing and full range of motion (ROM) were obtained. Conclusion: The primary objective in managing tibial tubercle fractures is the restoration of both the extensor mechanism and the integrity of the joint surface in cases where they have been compromised. https://jost.tums.ac.ir/index.php/jost/article/view/437 https://jost.tums.ac.ir/index.php/jost/article/download/437/351

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 42 4 Prem Kothimbakkam Chettinad Academy of Research & Education Arun Kumar Indira Medical College and Hospital Anantharamakrishnan Ganesh Chettinad Academy of Research and Education Vijayashankar Murugesan Chettinad Academy of Research and Education 2023 04 11 2024 03 13 Background: The commonest benign bone tumors, osteochondromas, which can be solitary or multiple involving the metaphyseal region of long bones, rarely present 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 an unusual case of pubic tubercle osteochondroma, which is solitary and pedunculated in a 37-year-old woman. She has had the swelling for the past 15 years, which was asymptomatic except for mild hydroureteronephrosis, which was an incidental diagnosis; however, we managed the patient with surgical excision of the tumor with elaborate preoperative radiological imaging using both X-ray and computed tomography (CT) scan. Histopathological examination confirmed the diagnosis of osteochondroma. Conclusion: Asymptomatic pelvic osteochondroma should be considered in patients with incidental swelling in the groin region, especially women who may be reluctant to seek medical attention due to social stigma. https://jost.tums.ac.ir/index.php/jost/article/view/487 https://jost.tums.ac.ir/index.php/jost/article/download/487/350

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 45 7 Naresh Saini assistant professor Anamendra Sharma Senior Professor 2023 04 30 2024 03 13 Background: Calcific myonecrosis is a rare entity that is considered a sequela of chronic compartment syndrome. A fusiform mass with central liquefaction and peripheral calcification replaces the affected muscle unit. Case Report: We are presenting a case of calcific myonecrosis of the tibialis anterior in a 76-year-old man. Although the mass was present for several years, the patient recently developed leg pain and foot drop. After radiological and histopathological diagnosis, patient was treated with surgical excision of the mass. Conclusion: Although calcific myonecrosis is a benign condition, due to the pressure effect on surrounding structures, it may be a source of leg pain and foot drop. Cortical erosion and scalloping of underlying major bone may be reasons for extremity pain. To relieve pain, alleviate pressure effect, and prevent pathological fracture of the underlying bone, complete surgical excision of the lesion is essential. https://jost.tums.ac.ir/index.php/jost/article/view/492 https://jost.tums.ac.ir/index.php/jost/article/download/492/352