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Abstract Use of dual pre-contoured plates has been accepted as the treatment of choice in distal humerus fractures despite challenges especially in very distal or highly fragmented fractures. Aiming to improve results in such instances, our newly proposed method uses several K-wires fixated by a small reconstruction plate. Drawing on the results of previous finite element studies, the current study aims to compare the stiffness of three clinically common variations of this method using biomechanical testing in cadaveric humeri. 24 samples were divided into three groups and fractures were simulated. Groups I and II used 1.5 mm K-wires in differing configurations while 2 mm wires were used in group III. All samples underwent compression, anterior and posterior bending, and torsional testing as well as failure testing. Our results indicated that Group III had significantly higher stiffness in flexion, extension, and torsion (p

Abstract Distal humerus fractures commonly occur in adults with low bone mineral density causing major technical challenges for orthopedic surgeons. Persian fixation method was introduced as a novel technique to stabilize small fragments in comminuted distal humerus fractures using a set of K-wires and a reconstruction plate. The present study aims to measure this technique's stiffness and stability of this technique and analyze the effect of influential parameters with numerical simulation and biomechanical testing on a cadaveric specimen. Validation of the finite element (FE) model was conducted based on results of experiments. The results indicated that Delta configuration mainly led to a higher stiffness in the case of axial loading and anterior bending compared to L configuration. Analyzing the influential factors of this technique suggests that changes in diameter and number of K-wires have a similarly significant effect on the construct stiffness while the height of plate had a slight influence. Also, the diameter of wires was the most effective parameter for implant failure, particularly in the 3-pin construct, which caused a reduction in failure risk by about 60%. The results revealed that the Persian fixation method would achieve suitable stability compared to the dual-plating technique.

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.

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.

Background: Scaphoid nonunion remains a challenging problem for hand surgeons. In this study, we assessed the functional outcome of scaphoid nonunion treatment and the influence of a number of variables on it. Methods: In this study we recruited 24 patients with scaphiod nonunion by consecutive sampling at Dr. Ali Shariati Teaching Hospital, in Tehran, Iran in 2008-2011. We examined the patients by antero-posterior (AP) and lateral view radiographies and wrist MRIs. Functional outcome of surgery was scaled according to Mayo wrist and Quick DASH scoring systems. Results: Among 10 cases with osteonecrosis, there were 7 (70%) cases of radiological union. In 13 (92%) out of 14 cases who had no signs of osteonecrosis, we radiologically confirmed scaphoid union after the treatment. The total union rate was estimated to be 83% at the end of 24 months follow up (P<0.05). Conclusion: The results showed that patients with scaphoid nonunion have improved function after surgical treatment [ABSTRACT FROM AUTHOR]

Purpose: Kienböck 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 Kienböck 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 Kienböck disease. Type of study/level of evidence: Therapeutic IV. [ABSTRACT FROM AUTHOR]

Summary: 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 1.9h in our patients with a mean rescue to first medical aid time of 13.5h. 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. [Copyright &y& Elsevier]