مجله جراحی استخوان و مفاصل ایران
سال نوزدهم شماره 4 (پیاپی 75، پاییز 1400)

The novel COVID-19 disease was presented at first in Wuhan, China, in December 2019. During COVID-19 pandemic, approaching trauma patients, whom could have COVID-19, is a challenging issue required special consideration and healthcare setting.

This retrospective cohort study was conducted at Emtiaz hospital, the main trauma center of the south of Iran, between March 2020 and August 2020 from the beginning of the COVID-19 pandemic. Trauma-related data such as the mechanism of trauma, injury pattern, and surgical intervention procedure of all the suspicious COVID-19 patients were documented. ICU admission and mortality rate were investigated as outcome variables.

During six months of the pandemic period, 9248 patients were referred to our referral trauma center, with 222 patients suspicious of having COVID-19 infection. Among sixty-four cases, whom were confirmed to be positive, 33 orthopedic injured patients were observed. The mortality rate of COVID-19 positive cases was 15.6 % (10 patients out of 64) and COVID-19 negative ones was 10.1 % (16 patients out of 158) which was not statistically significant (p.value:0.25). Multivariate analysis of the effect of the baseline and trauma related factors on mortality rate, showed that older age (p. value: 0.001), COVID-19 infection (p. value: 0.033), and surgical procedure (p.value:0.038) are the poor prognostic factors associated with mortality rate.

. The mortality rate of trauma patients with COVID-19 positive infection was 15.6 % (10 patients). Older age, COVID-19 infection, and surgical procedure were observed as the statistically significant prognostic factors leading to more mortality rate.

Ewing's sarcoma is a primitive and malignant bone tumor that is a serious medical challenge in preserving the patient's life and choosing the appropriate treatment. The aim of this study was to consider the metastasis and survival rate after preoperative chemotherapy, surgery and postoperative chemotherapy as a treatment protocol.

In this study, 42 patients with Ewing's Sarcoma admitted to Chamran and Namazi Hospitals during 2005 to 2016 were enrolled. After considering inclusion and exclusion criteria, 27 patients were finally entered the study. Neo adjuvant chemotherapy and again restaging with MRI and chest CT scan was done. After restaging, treatment was selected. Treatments included amputation; only wide resection; wide resection and allograft; wide resection and prosthesis and only chemotherapy. After surgical treatments, patient had adjuvant chemotherapy.

In this study, 42 patients were investigated of whom 29 (%69) were male and 13 (%31) female. The age mean and standard deviation were 21.45± 7.69 and 16.23± 4.9 in the male and female in respect. Femur (%30) and tibia (%23.8) were of more involvement respectively. Treatment of 27 patients that was entered to study included amputation (5 subjects), only wide resection (6 subjects), wide resection and allograft (8 subjects) and wide resection and prosthesis (3 subjects). Patients with pelvis involvement received only chemotherapy (5 subjects). 46.2% of subjects had a 5-year survival period.

Early diagnosis of Ewing's sarcoma and appropriate treatment using preoperative chemotherapy followed by, surgery through proper margin removal and then postoperative chemotherapy is highly recommended for this condition. Our study confirmed above result.

There is increasing trend of orthopaedic surgeons for closed pinning of type II supracondylar fractures, in this study, the result of treatment of closed reduction and casting in comparison with pinning is evaluated.

In a retrospective cross-sectional study, 39 children aged 3-11 years with Gartland type II supracondylar fracture who were treated with closed reduction and pinning and closed reduction and casting were evaluated by using the demographic information and measurement of Baumann’s angle and in hospital stay, by easy non-random sampling method.

By using the independent sample t test, there was a significant difference between the time of hospital stay and type of treatment and it was significantly lower in the group who had undergone treatment with close reduction and casting [p value < 0.005, Mean, SD: 37.43 +- 6.42]. There was no significant difference between the Baumann’s Angle in the two groups.

With no significant difference in the outcome of the two types of treatment a significantly lower hospital stays. With similar radiographic results was observed after four weeks of follow-up.

One of the methods to control and reduce bleeding in spine surgery is the use of tranexamic acid. The aim is to compare bleeding in intravenous and local administration and determine the protocol of its use in spine surgery to reduce bleeding .

Study was retrospective cross-sectional in the patients undergoing spine surgery in Baqiyatallah Hospital. Inclusion criteria were elective surgery > 3 levels and exclusion criteria were bleeding disorder, dural tear and surgery > 3 hours. The local and intravenous groups were 27 and 22, respectively. Analysis was performed by SPSS. The significance level of the statistical test was 0.05. Intravenously with a loading dose of 10 mg / kg and a maintenance dose of 1 mg / kg / h. Local was initially 1gr in 300 ml and 500 mg in 50 ml at the end. The amount of bleeding was the volume of the drain. 49 patients, 22 (44.9%) took the drug intra-venously and 27 (55.1%) locally.

There was no significant relationship between the groups in the amount of bleeding with the type of surgery (p: 0.48) with the surgical level and in the amount of total bleeding (p: 0.48) (p: 0.14). Bleeding rate of local group: intraoperative: 363.89 56 563.89 ml, postoper-ative: 116.30 ± 71.37 ml and total: 680.19 ± 394.83 ml , intravenous group: intraoperative: 496.64 ± 296.84 ml, postoperative: 75.84 120 120 ml Total: ml 616.64 ± was 311.45.

The results do not confirm the average amount of bleeding was similar in both groups.

The forward head tilt and round holding of shoulder are the two postural problems, being observed not infrequently in young and middle age people. The present study is aimed at investigating such postural abnormalities in two-age groups of women.

In a relatively randomized sampling, 500 women in two age groups were tested to investigate the incidence of "Forward head" and "Round shoulder" abnormalities. 400 women between the ages of 19-25  (mean 19 ) years and 100 between 35-50 (mean 40) years were examined for mild, moderate and severe   abnormalities. Evaluation of posture was carried out by plumb line. The kyphosis was also documented by a kyphosis goniometer . The  subjects were also asked about their back pain ,and then correlated with the postures and jobs and sporting activities.

 There was significant difference between variables of "age" and "round shoulder" (p<0.05), but the relationship between "age"  and "forward head" was not significant. (p <  0.05 ).Also, a significant correlation  was noticed between jobs that are position -dependent   and abnormalities and severity of pain with job( p<0.05).The  kyphosis angle was higher in  older age group.  There was also a correlation  between the kyphosis angle and pain  in interscapular region". (r=0.4, p=0.0001)

The postural abnormalities of “head tilt” and “round shoulder” are seen in both young and middle -age women .  The individuals  who do regular  exercises  have  less complaint of pain relative to their  postural anomalies. Age and Job are effective elements on incidence of most mentioned postural  abnormalities in older subjects.

Hip hemiarthroplasty is a common method in treating femoral neck fractures in patients older than 70 years old. Depending on the severity of bone destruction, and bone stock, two methods either cemented or non-cement bipolar prosthesis may be used.

In a prospective study, 60 patients with femoral neck fractures who were referred to the university hospitals of Isfahan, Iran, were divided into two treatment groups.: 30 patients were treated with cemented bipolar method and 30 with non-cement bipolar hip arthroplasty surgery. In a 6-month follow-up, the surgical outcomes were assessed using the VAS pain scale, SF36 general health instrument score, and Harris hip score (HHS).

The pain scale (VAS), SF36 and Harris scores showed non- significant differences in the two groups: pain=3.63 out of 10 in 3 months and 2.6 out of 10 in 6 months; SF36= 69 and 86 in 3 and 6 months ,respectively; HHS=78 in both in 3 and 6 month in the cemented group .In non-cemented group the pain scores were 3.91and 3.12 in 3 and 6 months; SF36=67 and 83, and HHS=82 in 3 and 6 months respectively..

It seems that the two methods of cemented and non-cemented bipolar hemiarthroplasty ,in elderly hip fractures, would have similar pain, quality of life, and hip function in short term follow-ups.

One of the issues related to stimulating and accelerating bone regeneration and bone repaired is the role of the immune system in fracture healing, known as osteo-immunology.

In these review 57 articles of science direct and pumped database is investigated for potential role and mechanism of the immune system's response to bone fracture. 

 biological materials such as tumor necrosis factor alpha (TNF-α), lipopolysaccharide (LPS), interleukin-17 (IL-17) protein, lipotic Acid (LTA) could regulates the immune system, which have the ability to improve the ossification process and faster healing.

The direction of future research was predicted regarding the emergence of new therapeutic compounds derived from bone-building materials such as bone growth factors and substances that regulate the behaviour of the immune system in order to regenerate bone.

The increasing elderly population has led to an increasing demand for orthopedic implants. With the advent of nickel-titanium memory alloys known as the nitinol brand due to its mechanical and biological properties including shape memory, superelasticity, long fatigue life and bio. Excellent compatibility has attracted wide spread attention by researchers for useing in medical industries such as orthodontic wires, drug delivery systems,cardiovascular stents and orthopedic implants, but in some cases may have superficial properties such as resistance to Corrosion and biological properties are not sufficient for clinical applications. Infection caused by the presence of implants in the body is one of the most common complaints of patients. Since bacteria play an important role in inefficiency, so the creation of antibacterial properties has been considered. Nanotubes created on the surface of nitinol through anodizing can be one of the useful solutions to create antibacterial properties as well as the ability of these structures Carrying drugs such as antibiotics can minimize the problems of implanting orthopedic implants in the body. In order to increase the long-term antibacterial ability of orthopedic implants, researchers have improved the physical and chemical properties of nitinol levels by using appropriate surface modification methods. In this report, a review of research on the modification of nitinol levels by anodizing method and the formation of nanotubes on its surface and drug loading and the effect of different parameters on morphology, nickel ion release, corrosion behaviors, biological and drug release in order to Application in orthopedic implants is given.