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Arthroscopic shoulder surgery is an orthopaedic technique that involves the use of normal saline or hyperosmolar serums as irrigation. The mentioned operation is commonly regarded as a safe medical intervention. Occasionally, it may have serious repercussions for the patient. Fluid extravasation into muscle tissues and tissue injury and instability are possible consequences. This can be affected by the type and amount of serum used and the length of the surgery. The objective of this study was to document four cases of shoulder arthroscopy in which sterile distilled water, wrongly labelled as irrigation fluid, was utilized during the surgical procedure. Patients were readmitted a week after discharge due to acute kidney injury symptoms like fatigue and lethargy. All four patients were released after haemodynamic stability and normalization after haemodialyses. Due to the incident, serums should be closely monitored and labeled for the safety of patients. Additionally, distilled water as an irrigation solution in arthroscopic surgeries can harm patients. Although normal saline and hyperosmolar serums are unavailable, this remains true. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Introduction: A high percentage of dangerous events in anesthesia occur due to airway problems, and proper airway management is always one of the key points during anesthesia. Airway management in critically ill patients is one of the most stressful situations for primary care physicians and even for anesthesiologists. The aim of this study was to evaluate the anatomical features of patients' airways, including the angle of deviation of the nasal line from the nasal to the mentum (NMLD), and perform a Mallampati test. Method: This cross-sectional study was performed on all patients admitted to Shohada Hospital in Tabriz, Iran, who were candidates for elective surgery for 1 year and 6 months, and underwent endotracheal intubation. Based on laryngeal observation, patients were classified into four groups. Then, all data related to individuals including type of surgery, age, sex, weight, height, body mass index (BMI), and nasal mentum line deviation (NMLD) were recorded. Then, all the collected data were analyzed using SPSS software version 19. Results: A total of 85 patients from 17 to 67 years with a mean age of 37.64 ± 12.89 were studied. There was a statistically significant relationship between laryngoscopy difficulty and Mallampati score (P = 0.001). The findings showed a statistically significant relationship between laryngoscopy difficulty and the mean NMLD (P = 0.01). A Mallampati of 85% indicates laryngoscopy difficulty. Also, NMLD can predict laryngoscopy difficulty by up to 66%. Conclusion: The present study demonstrated that both the Mallampati score variable and NMLD are related to the difficult airway problem. Furthermore, the Mallampati score has a higher predictive value for difficult intubation than the NMLD. [ABSTRACT FROM AUTHOR]

Abstract Background Untreated chronic shoulder dislocation eventually leads to functional disability and pain. Open reduction with different fixation methods have been introduced for most chronic shoulder dislocation. We hypothesized that open reduction and simultaneous Bankart lesion repair in chronic anterior shoulder dislocation obviates the need for joint fixation and leads to better results than previously reported methods. Methods Eight patients with chronic anterior dislocation of shoulder underwent open reduction and capsulolabral complex repair after an average delay of 10 weeks from injury. Early motion was allowed the day after surgery in the safe position and the clinical and radiographic results were analyzed at an average follow-up of one year. Results The average Rowe and Zarin's score was 86 points. Four out of eight shoulders were graded as excellent, three as good and one as fair (Rowe and Zarins system). All patients were able to perform their daily activities and they had either mild or no pain. Anterior active forward flexion loss averaged 18 degrees, external active rotation loss averaged 17.5 degrees and internal active rotation loss averaged 3 vertebral body levels. Mild degenerative joint changes were noted in one patient. Conclusion The results show that the overall prognosis for this method of operation is more favorable than the previously reported methods and we recommend concomitant open reduction and capsulolabral complex repair for the treatment of old anterior shoulder dislocation. Level of Evidence Therapeutic study, Level IV (case series [no, or historical, control group])

Background: Malunion is the most common complication following distal radius fractures. Aim of this study was to evaluate the results of distal radius corrective osteotomy and plate fixation by dorsal approach in the malunion. Methods: In this retrospective study, 14 patients with neglected distal radius malunion from 2005 to 2011 were studied. All patients were treated with an opening wedge osteotomy with a dorsal plate and cancellous bone grafting. Radiological and clinical measurements were performed pre and postoperatively. All patients were followed at least for two years. Results: Fourteen patients with a mean age of 42.5±10.2 years including 2 females (14.2%) and 12 males (85.8%) were studied. Radiological healing was achieved in all osteotomies at a mean of 11.5 (range: 11 to 14) weeks. There were significant differences between wrist function and radiological findings before and after treatment. Following the operation, all patients were relieved of pain. There were not any complications. Conclusion: Based on our findings, dorsal approach for osteotomy and plate insertion is an effective approach with good final results and no major complication for the treatment of distal radius malunion. [ABSTRACT FROM AUTHOR]

Background and Objectives: The Forearm fractures are common among children and usually managed differently comparing with other similar injuries in adults. The aim of this study was to identify the risk factors of forearm fractures in children. Materials and Methods: In this clinical trial study, 86 patients randomly were divided into two groups: group A (treated with a long arm cast method) and group B (treated with Sugar-Tong splint method). The risk factors of distal radial fractures were evaluated. Results: Eighty six children less than 15 years with the mean age of 12.24±2.24 years old were studied. The compared with a true transverse fracture, the 10°,20°, and 30° of obliquity increased the likelihood of redisplacement 3.23, 5.82 ,12.14 times, respectively. Conclusion: The complete initial displacements of the fracture and increases obliquity of the fracture line are the most important risk factors for redisplacement. [ABSTRACT FROM AUTHOR]

In this study, radiation exposure to the surgeon and supporting staff from a mini C-arm unit during fluoroscopically guided orthopaedic surgeries was studied. A Diadose dosemeter and Gamma-Scout meter were used for air-kerma measurements for primary and scattered radiations. The entrance dose of hands, eyes and thyroid of the surgeon was measured during direct observation. Scattered air-kerma rate was measured to quantify the received entrance dose of the supporting staff. During direct observation, the skin-entrance exposure rates of the surgeon's hand, eye and thyroid gland were 8036, 0.85 and 0.9 μGy min-1, respectively. The scattered exposure rate was precipitously dropped beyond the path of the primary radiation beam, and reached 0.51 μGy min-1 at a distance of 40cm from the beam's central axis. This study showed that the surgeon's hand was the most dose-limiting organ for fluoroscopically guided orthopaedic surgery procedures when it was exposed to primary radiation. The exposure of supporting staff at a working distance of >20 cm from the beam was minimal during tluoroscopy by mini C-arm unit. [ABSTRACT FROM AUTHOR]

We present an unusual case of a traumatic bilateral simultaneous dislocation of shoulder in a healthy young male. Bilateral shoulder dislocation are rare and the reported cases, have been mostly associated with trauma or seizure. Only a few cases (about 4) have been reported in the literature so far and all of these are associated with trauma. The one we present is a bilateral anterior shoulder dislocation without traumatic history but associated with newly occurred seizures. [ABSTRACT FROM AUTHOR]

Background: Although the majority of soft tissue masses are benign, it is important to consider malignancy in differential diagnoses. Because most soft tissue sarcomas present as a painless mass, clinicians must watch for signs suggestive of malignancy, including large size, rapid growth, and site deep into the deep fascia. The purpose of this study was to determine the relative prevalence according to sex and age, site of tumor, skeletal distribution, and treatment (surgery, chemotherapy and radiotherapy) before and after surgery, and ascertain the relative frequency of these tumors in specific anatomic sites and age groups based on pathological studies., Methods: A total of 308 patients, with a musculoskeletal tumor were evaluated retrospectively. All of the patients enrolled into this study were referred to the Beirouni Hospital of Damascus University with a proven diagnosis of malignant soft tissue tumors from the beginning of January 2008 until the end of 2010. The prevalence of the malignant soft tissue tumors in these patients was analyzed. For purposes of analysis, all lesions were placed in 1 of 9 categories: hand and wrist, forearm, humorous (arm), proximal limb girdle (axilla and shoulder), foot and ankle, thigh, hip and buttocks region, trunk, and other lesions. Age and sex also were recorded., Results: MALIGNANT TUMORS CONSISTED OF SEVEN DIAGNOSTIC CATEGORIES: malignant fibrous histiocytoma (23%), liposarcoma (22%), rhabdomyosarcoma (9%), leiomyosarcoma (8%), malignant schwannoma (5%), dermatofibrosarcoma protuberans (5%), synovial sarcoma (10%), fibrosarcoma (13%), extraskeletal chondrosarcoma (1%), and extraskeletal Ewing sarcoma (4%)., Conclusions: Despite the multitude of pathologic possibilities, most malignant soft-tissue tumors are classified into a small number of diagnoses. These may be further defined when the site of the lesion and the age of the patient are considered. Knowledge of tumor prevalence will assist radiologists in establishing a suitably ordered differential diagnosis when a soft-tissue tumor has a nonspecific radiologic appearance.

Background: Lower extremity amputation has different etiologies and the purpose of the study was to describe the demographics and etiologies of amputations. This study was designed to evaluate amputations performed in the province of Eastern Azerbaijan (north-west of Iran) and to determine specific causes of amputations associated with geographical and cultural characteristics of the region., Methods: We have done this retrospective and descriptive study from June 1st, 2005 to June 1st, 2010 in Tabriz Shohada Hospital (Tabriz, Iran). The patients were evaluated with respect to age, sex, etiology, side and level of amputations, prevalence of amputations among the sexes at different ages and surgical interventions performed., Results: One-hundred-sixty files were identified with a diagnosis of lower limb amputation. Trauma was the most frequent cause in 67 patients (46%), followed by vascular disease in 61 patients (42%), and then infection in 18 c patients (12%). Eighty percent of patients were male and 20% were female., Conclusion: This investigation shows that trauma (especially due to car accidents) is the most common cause of amputations in our region, followed by vascular problems.

Background: Peritendinous adhesions after repairing an injury to the digital flexor tendons are a major problem in hand surgery. Non-steroidal anti-inflammatory drug therapy may affect tendon healing and the development of peritendinous adhesions. The aim of this study was to evaluate ibuprofen effect in patients function after flexor tendon surgical repair., Method: Thirty-five patients, who had sharp-edge lacerations of hand-zone II requiring flexor tendons repair, participated in this randomized double-blind clinical trial study. The patients were randomly classified into two parallel and matched groups (21 patients in the intervention group and 14 patients in the control group). The groups were matched considering age, gender, and laceration size. The control group received a placebo with the same appearance and dosage. In the intervention group, ibuprofen was prescribed at a high dosage (2400 mg/day). The range of motion improvement rate of the involved fingers and the patients' performance after their follow-up period were compared., Results: There was a statistically significant difference between the two groups for range of motion of the involved finger joints (P=0.03). According to the DASH score, there was a statistically significant difference between the final performance of the patients, such that it was 11±2.4 and 18.4±6.3 in the intervention and control groups, respectively (P=0.01). There was not any case of re-tear or need to re-operate in the intervention and control groups., Conclusion: Our findings reveal that ibuprofen with an anti-inflammatory dose was effective in improving the range of motion of the involved fingers joints after flexor tendon injury.