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Objectives: Based on WHO data, as of June 2022, there were 532.2 million confirmed COVID-19 cases globally. In the initial phase of the COVID -19 pandemic, patients experiencing critical illness marked by severe respiratory distress were commonly subjected to corticosteroid treatment. Regrettably, the administration of exogenous corticosteroids stands as the prevailing cause of ONFH. In the current narrative review, we aim to evaluate if active screening should be utilized to diagnose post-COVID-19 ONFH in its early stages., Methods: The databases for PubMed, CINAHL, and Science Direct were systematically queried in March 2022. The search terms were as follows: "COVID-19", "severe acute respiratory syndrome", "coronavirus", "systemic steroid", "corticosteroid", "femoral head osteonecrosis", "avascular necrosis", or "steroid therapy." The included studies for review were all required to be peer-reviewed studies in the English language with Reported complications linked to steroid therapy in COVID-19 patients or potential connections to the development of ONFH in individuals recovering from the novel coronavirus have been documented., Results: Systemic corticosteroids were frequently employed in managing critically ill COVID-19 patients. The CDC reports up to June 2022 showed more than 4.8 million COVID-19 hospitalizations in the US, with approximately over one million patients receiving steroids. In a study of ONFH after infection with COVID-19, all patients had bilateral involvement. The average duration from the initiation of corticosteroid treatment to the onset of symptoms was 132.8 days., Conclusion: In summary, a distinct correlation exists between the administration of steroids to individuals with COVID-19 and the subsequent risk of ONFH. Moreover, an elevated dosage and prolonged duration of steroid therapy in COVID-19 patients are associated with an increased likelihood of developing ONFH. Therefore, active screening for high-risk patients, that may have received systemic corticosteroid treatment during a COVID-19 illness, may be reasonable., Competing Interests: None

Despite widespread research on non-traumatic femoral head osteonecrosis (FHON), there is no consensus about preventative treatment options. Insufficient blood supply and increased intra-osseous pressure are the initiating events in the majority of cases. BMPs are growth factors that belong to the transforming growth factor β (TGFβ) superfamily. Two specific formulations of BMPs have already been approved by the FDA: 1. BMP-2 (Infused, Medtronic) for the treatment of tibial open fractures and spinal fusion; 2. BMP-7 (OP-1, Stryker) in the setting of long bone non-unions. To our knowledge there is no published work reviewing the utility of BMP-2 in the setting of FHON. Online databases (EMBASE, Cochrane, MEDLINE and PubMed) for literature relating to the use of BMP-2 in the treatment of FHON on 2nd June 2017. Animal studies: A total of 169 animal subjects with induced FHON were treated with BMP-2 in all the included in vivo studies. Improved histological parameters, areas of revascularization, areas of new bone formation and osteoid deposition were seen in all studies. The number of osteoclasts decreased post operatively, in the ibandronate and BMP-2 group. Human studies: In combination, 96 human hips were treated in two studies utilizing BMP-2 and mean follow-up was at least five years. Success rate of BMP-2 was above 80 % (based on Harris score and WOMAC score) in both studies. Both are level III studies. The present review of animal and clinical studies could not find well-designed prospective comparable studies with large sample size and preliminary evidence is not sufficient to supports the utilization of BMP-2, and its impact on the midterm outcomes of FHON.

Background: Limb salvaging surgeries are current surgical treatment of extremity bone sarcomas. Resected bone replacement consists of two main methods; tumor prosthesis versus structural allograft. Biological reconstruction with an allograft is an economic cheap method in young sarcoma patients, however, the surgeons are more convinced with tumor prosthesis replacement., Methods: We evaluated the short-term complications and functional results of 40 patients with aggressive extremity tumors in a retrospective cohort study. The mean age of cases was 25 and we followed them for 24 months. 17 patients underwent tumor prosthesis replacement after wide resection of limb sarcomas. 16 cases had structural allograft reconstruction and 7 patients treated with amputation. We matched confounders including age, sex, blood cell count and chemotherapy treatment in the study groups., Results: We found 15 major complications (45.5%) in limb salvage surgeries composing infection, allograft nonunion, allograft fracture, prosthesis fracture, prosthesis loosening and device failure that needed another surgery to be resolved. We had 10 major complications in allograft group (62%) and 5 in tumor prosthesis group (29.4%). Although the rate of complications was higher in allograft group, it didn't statistically indicate strong correlation (Fisher's exact: 0.084). Mean Musculo-Skeletal tumor rating Scale (MSTS) score was 25.8(73.7%) and 22.3(63.7%) in allograft group and prosthesis cases respectively. MSTS score had a normal distribution in the different groups with no significant difference between them., Conclusion: Although complications were higher in the allograft group, allograft could be offered to bone sarcoma patients, whom are predicted to have short life expectancy.

About 15 % of all musculoskeletal tuberculosis (TB) have hip involvement. Early anti-tubercular drug therapy and other conservative treatment including short-term traction and mobilization programs could prevent hip joint destruction. Reactivation of TB accounts for a significant of active TB incidence, especially in the developed countries with a low TB prevalence. The risk of TB activation for population with the latent form of disease is about 5-10%. According to the existing literature surgery in tubercular hip arthritis would be safe once sufficient debridement and precise anti tubercular chemotherapy has been done.

Background: Developmental dysplasia of hip (DDH) is a common childhood disorder, and ultrasonography examination is routinely used for screening purposes. In this study, we aimed to evaluate a modified combined static and dynamic ultrasound technique for the detection of DDH and to compare with the results of static and dynamic ultrasound techniques., Methods: In this cross-sectional study, during 2013- 2015, 300 high-risk infants were evaluated by ultrasound for DDH. Both hips were examined with three techniques: static, dynamic and single view static and dynamic technique. Statistical analysis was performed using SPSS version 11.5., Results: Patients aged 9 days to 83 weeks. 75% of the patients were 1 to 3 months old. Among 600 hip joints, about 5% were immature in static sonography and almost all of them were unstable in dynamic techniques. 0.3% of morphologically normal hips were unstable in dynamic sonography and 9% of unstable hips had normal morphology. The mean β angle differences in coronal view before and after stress maneuver was 14.43±5.47° in unstable hips. Single view static and dynamic technique revealed that all cases with acetabular dysplasia, instability and dislocation, except two dislocations, were detected by dynamic transverse view. For two cases, Ortolani maneuver showed femoral head reversibility in dislocated hips. Using single view static and dynamic technique was indicative and applicable for detection of more than 99% of cases., Conclusion: Single view static and dynamic technique not only is a fast and easy technique, but also it is of high diagnostic value in assessment of DDH.

Background: Hand injuries are among the most common childhood injuries. No study has been performed regarding the epidemiology of hand injuries in the pediatric population of Iran. This study aimed to examine the epidemiology of hand injuries among children in southeast of Iran., Methods: This cross-sectional study was performed via census sampling on patients, aged 16 years or less, with a final diagnosis of hand injury. Patients presenting to the orthopedic department of Khatam-al-Anbia General Hospitalof Zahedan, Iran, were selected from March 2012 to December 2013. Data were analyzed retrospectively, using a chart review., Results: Two-hundred patients (136 males and 64 females with the mean age of 13±2.8 years) with 205 hand injuries were included in this study. As the results indicated, door-related injuries were the most common type (25%), accounting for 24% and 28% of injuries in male and female patients, respectively (P=0.016). Most injuries occurred at home (64%) and the lowest number was reported at school(22%) (P=0.012). Compared to boys, girls were more likely to be injured at home (78% vs. 57%) (P=0.13). In addition, the dominant hand was mostly injured by doors (28%). The most common type of injury was laceration(81%) and the least common type was finger amputation (7%); also, children with finger amputation were significantly younger than those with other types of hand injuries (P<0.001). Thumb alone (20%) and index and middle fingers together with anequal percentage (3.5%) were the most commonly injured digits. Also, the mean hospitalization cost was 297± 38 dollars., Conclusions: Most hand injuries occurred at home and were door-related; they were also more frequentamong younger children. Prospective studies in order to identify specific protective door devices could potentially decrease the frequency of these injures.

The Ponseti method is a safe and effective treatment for congenital clubfoot, and radically decreases the need for extensive corrective surgery. But a group of patients will still present with under corrected residual equinovarus deformities despite the proper use of the Ponseti method. About 25% of operated clubfeet will develop recurrence or show a marked residual deformity (recurrent clubfoot); however, in the recent literature, the failure rate of the Ponseti method, defined by the need for corrective surgery, ranges from 3% to 5%. Deformities encountered in patients with residual clubfeet comprise of various degrees of equinus, varus, adduction, supination, cavus, and toe deformity. Joint flexibility or stiffness, tarsal dysmorphism, articular incongruence, and progressive degrees of degeneration may be also present. We try to emphasize the current solutions for these deformities.