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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.

Background: Proximal humerus shortening and varus can occur secondary to neonatal shoulder septic arthritis and focal fibrocartilage dysplasia. Valgus osteotomy of the proximal humerus compensates for a little bite of shortening, and improves the shoulder joint's range of motion. Case Report: In this study, we present two patients with severe proximal humerus deformity following glenohumeral septic arthritis. Both of them underwent valgus osteotomy, and had a satisfactory result in terms of range of motions and cosmesis at five years follow-up. Conclusion: Treatment of varus deformity of proximal humerus is challenging issue. There are few reports of surgical treatment. Sever varus deformity of proximal humerus impacts the motion of shoulder. We reported a novel method of valgus osteotomy of proximal humerus in patients with severe varus deformity secondary to neonatal septic arthritis and long-term clinical follow-up.

Orthopedic trauma is an area of significant controversy regarding indications and type of thromboprophylaxis. In 2014, the Iranian Orthopedic Association (IOA) organized a committee to review the available data to extract a national guideline to assist the orthopedic surgeons in decision making regarding the need and type of thromboprophylaxis for patients with orthopedic trauma. We found almost 12500 articles in regards to DVT and thromboembolism from PubMed and orthopedic journals from January 2004 to January 2017. We included only the articles related to orthopedic trauma patients (684 articles); then, we selected case control cohort and prospective studies (73 articles). Herein, we present a summary of the review.

Fragility fractures are characterized by a low energy trauma and should be considered as potentially osteoporosis-related fractures. This study aimed to determine whether the orthopedic surgeons’ awareness could increase the osteoporosis management rate in patients with fragility fractures. This study was undertaken in three phases: evaluation of existing practice patterns, educational intervention and evaluation of the effect of the training. During the study period, orthopedic surgeons who worked at academic hospitals attended five educational sessions and were provided with posters and brochures. Patients were interviewed at sixth and twelfth months after discharge using an evaluation questionnaire regarding their perceptions of the barriers to osteoporosis treatment. Seventy-two orthopedic surgeons volunteered to participate in the study between June 2008 and December 2011. The patients were followed for a minimum of 1 year. Rate of calcium and vitamin D prescriptions increased from 10 to 91 %. The rate of bisphosphonate administration reached to 73 %. The number of follow-up evaluations did not differ significantly. The detection and medication rates for osteoporosis in patients with fragility fractures increased more than tenfold after the intervention program.

Background: Open bone grafting has been the standard procedure for treatment of scaphoid nonunion. Arthroscopic bone grafting and fixation is a minimally invasive method, which is effective as open procedure with minimal complications. Objectives: The purpose of this study was to assess the results of arthroscopic treatment by refreshing and bone grafting on clinical wrist function and radiographic outcome in patients with stable scaphoid nonunion. Patients and Methods: Between June 2012 and May 2014, 17 patients received arthroscopic refreshing and bone grafting for treatment of stable waist scaphoid nonunion. The mean follow-up was 13 months (ranged 6 - 18 months). Results: The mean flexion/extension of the wrist was 72 degrees (ranged 50 - 160 degrees) compared with the pre-operation 53 degrees (ranged 35 - 160 degrees) (P < 0.04). Grip strength at final follow-up averaged 28 kg (ranged 12 - 455 kg) indicating a significant improvement from 21kg (ranged 5 - 41 kg) before the operation (P < 0.026). The mean Quick DASH scores showed a significant improvement from 48 (ranged 27 - 90) preoperatively to 84 (ranged 76 - 100) postoperatively (P < 0.05). The mean VAS score showed a significant improvement from 4.3 (ranged 2 - 7) preoperatively to 1.03 (ranged 0 - 4) postoperatively (P < 0.04). Conclusions: Arthroscopic treatment of stable scaphoid nonunion is an effective alternative to the conventional treatment of stable Scaphoid nonunion.

Objec:tive: Suspected Scaphoid fractures are common problems in medical practice, which account for countless work-hours losses each year. This was a prospective study that was performed on 51 patients with suspected Scaphoid fracture in Doctor Shariati and Shahid Moaieri hospitals within eight months. Materials & Methods: The patients were treated with removable thumb splint and weekly physical examination. Results: We found that 90% of immobilizations were unnecessary and removable brace and weekly examination. Conclusion: Early rehabilitation can reduce the immobilization time in more than half of our patients.

Multiple ruptures of the extensor and flexor tendons of the fingers, thumb and wrist at the musculotendinous junctions are reported after a blast injury.

Purpose Kienbock disease is characterized by avascular necrosis of the lunate bone, which is usually progressive without treatment. This study examined lunate core decompression for its treatment potential. Methods We surgically treated 20 patients with stage 1 to 3b Kienbock disease with lunate core decompression. We evaluated pain, range of motion, functional disability, and radiographic indices in these patients at baseline and 5 years after surgery. Results The mean age of the patients was 29 years; 16 were men. Ten patients had Lichtman stage 1 disease, 6 had stage 2 disease, 3 had stage 3a, and 1 had stage 3b disease. Range of motion scores showed meaningful improvement. Two patients did not improve with this technique and were revised with radial shortening procedures. Conclusions Lunate core decompression is a simple surgical procedure that is effective in the treatment of Kienbock disease. Type of study/level of evidence Therapeutic IV.

This is a descriptive analysis, performed on victims of Iran's December 26, 2003 Bam earthquake that were referred to tertiary referral trauma management centre in Tehran. Two hundred and ten patients were included in this study. Associated musculoskeletal injuries and renal function of the patients were recorded. The mean time under rubble was 1.9 h in our patients with a mean rescue to first medical aid time of 13.5 h. We had 19 cases of compartment syndrome and 6.7% of patients had impaired renal function. The incidence of compartment syndrome had a direct relation to the time under rubble and the incidence of renal failure was directly related to rescue to first medical aid time. Axial skeleton fractures, amongst them the lateral compression type pelvic fractures, were particularly common. Fracture associated neural injuries were also common. Institution of renal protective protocols from the very first hours after injury more conservative approaches to treatment of fractures in these crush trauma patients are strongly recommended.