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Key clinical message Subungual Onycholemmal Cyst (SOC) is a rare nail abnormality with different clinical presentations which can mimic different nail malignancies, such as melanoma, SCC, or glomus tumor. It is necessary for dermatologists and dermatopathologist to be aware of this pathology to make the proper diagnosis and treatment. SOC is a rare nail abnormality which affects the dermis of the nail bed. SOC has different clinical presentations, including onychodystrophy, ridging, clubbing, thickening, pigmentation, or even normal appearance. It can mimic different nail malignancies, such as melanoma, SCC, or glomus tumor. In this report, we describe a 54‐year‐old man with unilateral second right finger nail onychodystrophy and onycholysis for 1 year. He did not have any history of recent trauma, pain, or bleeding. It was completely resected by surgery. Nail biopsy can contribute to the early diagnosis of SOC and improvement of treatment outcomes.

This article discusses the use of the skin-stretching technique (SST) to manage large soft tissue defects resulting from various causes. The other surgical techniques for closing such defects, such as pedicle flaps and free tissue flaps, are often associated with significant morbidity and cost. The SST involves progressively stretching soft tissue using an external device to reduce defect size or complete wound coverage. The article describes a simple, inexpensive, and readily available method for managing large wound defects using clasps and rubber bands. The article also highlights the potential complications associated with SST such as skin necrosis, pin site infection, wound dehiscence, infection, and pain. Overall, SST is a promising alternative for the management of large soft tissue defects that are not amenable to direct suturing.

Background: Epidemiological characteristics of bone sarcomas are variant in different populations, however, there is no previous study on primary bone sarcomas among Iranian population. This study aimed to evaluate the incidence, age, sex distribution, histologic type, and location of malignant bone sarcomas, based on the Iran National Cancer Registry (INCR). Methods: This was a national population-based study using INCR data from March 20, 2008, to March 20, 2015, on patients who were diagnosed with primary bone sarcomas of the appendicular (C-code:40) and axial skeleton (C-code 41), excluding skull and face bones. Primary bone sarcomas were classified according to the International Classification of Diseases for Oncology (ICD-O-3: C40–C41). Results: A total of 4112 patients (59.5% males and 40.5% females) with a mean age of 36 years were included in the study. 60.38% of patients were between 10 to 44 years old. The overall age-standardized incidence rates (ASIR) was 8.23 (males=9.67 and females=6.80) per million person-years. Osteosarcoma chondrosarcoma and Ewing sarcoma were the three main histology subtypes with the ASIR of 2.36, 1.26, and 1.08 per million person-years. Long bones of the lower limb were the most affected area, with the ASIR of 3.18 (95% CI: 3.02-3.33) per million. We found an increasing trend in the incidence of bone sarcomas in Iran from 8.59 in 2007 to 11.37 per million person-year in 2015. Conclusion: This study provided the epidemiological features of bone sarcomas, including the histological type of sarcoma, tumors’ location, and patients’ age and gender in the Iranian population for the first time.

Background: Modified Broström-Gould (MBG) surgery is frequently used for chronic lateral ankle instability (CLAI). However, conventional postoperative management (CPOM) due to prolonged immobilization may have adverse effects on tendons, ligaments, and joints, causing stiffness. This prospective, randomized controlled trial aimed to determine outcomes among patients randomized to receive CPOM plus ultrasonography-guided triple injections of leukocyte-rich platelet-rich plasma (LR-PRP) compared to patients who receive only CPOM after MBG surgery. Methods: The present study included 40 patients with symptomatic CLAI who were candidates for the MBG surgery. The patients were randomized into 2 groups of 20, the control and PRP groups. In the PRP group, patients were injected with 3 doses of LR-PRP solution using ultrasonographic guidance. In the first injection, 2 mL of LR-PRP was injected near the injury site, and in the second and third injections, 4 mL of LR-PRP was injected in the tibiotalar joint. All patients received a short leg splint for 2 weeks, followed by 4 weeks in a walking boot. The primary outcome measure was the visual analog scale (VAS), and the secondary outcome measures were the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and ankle total range of motion (total ROM). The assessment was performed at baseline and 3 and 6 months after surgery. Results: The mean VAS and AOFAS scores improved significantly in both groups 6 months after surgery ( P

Abstract Propionibacterium acnes is a typical component of the human body's flora and has been implicated as the causative infectious agent following a variety of operations, including device installation. We present a case of a 21‐year‐old male patient with severe global acneiform eruption with a non‐healing limb lesion near the orthopedic surgery incisions.

Background: Trauma is a leading cause of death and morbidity in developing countries. Previous research has revealed that epidemiological features of fractures may change from one study to the next. National Trauma Registry of Iran (NTRI) was launched in 2015, but it did not include any centers in northern Tehran, Iran. This study aimed to evaluate the epidemiology of fractures in the only Level 1 Trauma Center in that area. Methods: This retrospective cross-sectional study was performed on all patients with the primary diagnosis of orthopedic injury, from July to October 2019, who referred to the emergency department of Shohada Tajrish Hospital, Tehran. The patients’ files and operation notes were reviewed for demographics, medical history, physical examination, referral time, mechanism of injury, hospital stay, level of education, and intensive care unit (ICU) hospitalization. Results: 398 patients with orthopedic trauma were referred to the hospital with a mean age of 40.85 ± 21.03 years. 317 patients (79.65%) were men. The peak referral time was between 12 AM and 12 PM. A road traffic accident was the main cause of orthopedic trauma (39.4%). The mean days of hospital stay were 6.29 ± 5.36 days. The waiting time for surgery and days of hospital stay were related to the fracture site (high in lower extremity fractures) and older age. Conclusion: Trauma in northern Tehran is primarily caused by motor vehicle accidents and falls, respectively. Patients with older age and lower extremity fractures need more time of hospitalization.

Introduction: Blunt traumas, like road accidents and falls, are common causes of injuries to pregnant women, and the major risk factors are young age and low socioeconomic level. Due to physiological and anatomical changes specific to pregnancy, such as changes in blood pressure and hemoglobin drop, trauma management involves certain complexities. Physical trauma is estimated to cause at least 1 complication in every 12 pregnancies. This study aims to evaluate orthopedic trauma during pregnancy and appreciate the different approaches to circumvent the resultant challenges. Methods: We reviewed 55 articles, published on orthopedic trauma during pregnancy between 2011 and 2021. The articles were identified by searching PubMed, google-scholar, Scopus, and Science-Direct. We utilized the search terms: fall in pregnancy, traumas in pregnancy, motor vehicle accident/crash in pregnancy, blunt trauma in pregnancy, pregnant trauma patient, penetrating injury during pregnancy, assault, interpersonal violence in pregnancy, and mortality and pregnancy. Results: According to available reports, after stabilizing the pregnant patient, diagnostic procedures, including radiography, and even gadolinium-based techniques when needed, can be performed to examine extensive trauma. In contrast to elective orthopedic surgery, emergency orthopedic surgeries, including reduction of open fractures, should be performed promptly. Conclusion: Based on our investigation, pregnant women with orthopedic injuries that are severe, or even seemingly less severe, experience significantly increased adverse pregnancy outcomes, which include preterm birth, placental abruption, poor infant condition at birth, infant death, and even maternal death.

Background: COVID-19 is spreading rapidly and potentially affects every person, including fracture patients. This study was conducted with the aim to evaluate our primary months’ experience of surgical treatment of fractures in COVID-19 infected patients in order to assist in better decision-making in the next waves of the infection. Methods: In this cross-sectional study, 15 patients with orthopedic trauma and COVID-19 infection were included from 2 trauma centers during February and March 2020. Results: Most of the patients were younger than 40 year of age. The most common COVID-19 related symptom at presentation was malaise, and a hypoxia rate of 85.7% was detected among the patients. Two-thirds of the fractures were in the lower extremities. One patient expired, but all others were discharged with no follow-up complications. Conclusion: Surgical management of fractures in COVID-19 patients is inevitable. To achieve this, sensitive screening techniques and standard protection measures are essential.

Background: Floating knee injury is defined as ipsilateral fractures of the femur and tibia. It was mostly seen among young men and is generally caused by high-velocity trauma such as motor vehicle accidents and falling from height. Although isolated fractures of the femur or tibia are relatively common in children, floating knee injuries are rare in adolescents and even less frequent in younger children. Case Report: In this study, we reported a case of bilateral floating knee injuries of a 10-month old girl infant. Radiographic examinations revealed diaphyseal fracture of the left femur and proximal metaphyseal fracture of tibia compatible with floating knee injury type B according to the classification proposed by Letts et al. To the best of our knowledge, there was not any previous report of bilateral infantile floating knee injury in the literature. Conclusion: Pediatric floating knee injuries are relatively uncommon and extremely rare among infants. The preferred method of treatment is a surgical fixation for all fractures of all ages

Background: In the current study, we aimed to assess the clinical outcomes of the double-plating method using 2.7 mm compression plates compared with the single superior 3.5 mm compression plating method in displaced midshaft fractures of the clavicle. Materials and Methods: Thirty patients with midshaft fractures of the clavicle were randomly assigned into two groups. In group A, 15 patients were fixed by a double-plating technique using two 2.7 mm compression plates on the superior and anteroinferior sides of the bone. The fractures in group B were fixed by a superior plating technique using a single 3.5 mm compression plate. Intraoperative bleeding measurement, length of surgical incision, duration of procedure time, and functional scores were assessed post-surgically through one-year follow-ups. Results: There was no significant difference between groups in terms of surgery time. Device failure was not found among all recruited patients. Incision length and device prominence complaint were significantly different between groups (P value = 0.02, P value = 0.03). Mean ± standard deviation intraoperative bleeding rate was 88.67 ± 29.96 milliliter in the double-plating group and 108.67 ± 41.72 milliliter in the other group, which was not different between these two groups (P value = 0.14). There were no signs of non-union either in radiographies or clinically. Conclusion: Double mini-plating of diaphyseal clavicular fractures could result in a smaller surgical incision and a lower rate of prominence without affecting fixation stability and clinical outcomes in comparison with single superior 3.5 mm plates.

Background: The application of a cannulated device is a widely used fixation method for hip fractures. Although the breakage of the guide wire during this procedure is an uncommon complication, migration of the broken fragment might be catastrophic. Case Report: We presented a case of intertrochanteric fracture with breakage of the lag screw guide wire in the acetabulum during fixation with cephalomedullary nail. The broken fragment was located with computed tomography (CT) scan and removed through Stoppa approach. Conclusion: We found the Stoppa approach a safe and useful method for extracting the intra-pelvic broken guide wire.

Lateral epicondylitis (LE) is one of the major causes of elbow pain. Despite being a self-limiting condition, its high incidence can cause a significant socioeconomic burden. Many treatment modalities have been proposed for the treatment, but the optimal strategy is still unknown. In this article, we discuss surgical and non-surgical strategies for the treatment of LE and address the research gaps.

شیوع پنومونی ناشی از COVID- 19در دسامبر2019 در شهر ووهان چین گزارش شد و اولین مورد گزارش شده آن درایران 29 بهمن ماه 1398 در شهر قم شناسایی شد . تظاهرات اولیه این بیماری طیف گسترده ای ازموارد بدون علامت تاعفونت متوسط دستگاه تنفسی فوقانی تا پنومونی کشنده است. درکناراین همه گیری می دانیم که مصرف سیگارسبب ساپرس کردم سیستم ایمنی و تشدید فعالیت های التهابی در ریه می شود وازطرفی اثرات منفی سیگار درجراحی های ترومای ارتوپدی برکسی پوشیده نیست.دراین مطالعه اطلاعات مربوط به31 بیماربا ترومای ارتوپدی ودرگیری با COVID-19 توسط پرسشنامه جمع آوری شده که از این تعداد 17 بیمار با سابفه مصرف سیگار و 14 بیمار بدون سابقه مصرف سیگار بوده اند که در دو گروه دسته بندی و مورد بررسی قرارگرفته اند . در نهایت به این نتیجه رسیده شده که هر چند بررسی انجام شده در مورد این 31 بیمارارتباط معناداری بین دو گروه سیگاری وغیرسیگاری با ترومای ارتوپدی مشاهده نشد ولی به نظرمی آید که بیماران سیگاری با ترومای ارتوپدی در طول بستری وجراحی و پس ازجراحی نیاز به توجه بیشتری دارند تا دچارعوارض کوتاه مدت کمتری شوند و ممکن است در شرایط مساوی ازهر بیماراحتمال طولانی تر شدن بستری بیماران سیگاری بیشتراز غیرسیگاری باشد .