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Background and Objective: Open fractures mostly appear in leg (24%), and often accompany with soft tissue defects that predispose the limb for amputation. One of the best ways for limb salvage is to support both bone and soft tissue by the means of soft tissue reconstructing surgeries. The aim of this study was to evaluate the outcomes of soft tissue reconstruction surgeries in legs open fractures. Materials and Methods: This descriptive study was performed on 59 patients with leg open fractures and soft tissue reconstruction surgery at Shahid Kamyab hospital in Mashhad, North-East of Iran during 2004-05. Individual characteristic, clinical and physical examination, and outcome of the surgery were gathered in a questionnaire and analyzed by descriptive and Chi-Square test. Results: Eight patients excluded and finally the study was done of 51 patients. Out of 51 patients 84.3% were male with mean age of 30 years. Leg open fractures in 76.5% of patients was IIIB type. Surgery was successful in 76.5% of patients. Delayed ::::union:::: occurred in 56.9% and osteomyelitis in 33.13% of patients. There was a correlation between the time of soft tissue reconstruction and ::::union::::, deep infection and osteomyelitis (P<0.05). Conclusion: This study showed that high frequency of deep infection, osteomyelitis and delayed ::::union:::: due to leg open fractures with lack of soft tissue.

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Background and Objective: Legg-Calve-Perthes disease is one of the most common disabling diseases of childhood and if not managed appropriately is truly disabling. Severity of disease and duration of disease onset are main determinants of choosing treatment strategy of either conservative management or surgical treatment. This study was designed to determine Legg-Calve-Perthes treatments and relation between type of treatment and duration of the disease.

Materials and Methods: This descriptive study was carreid out on 50 patients with Legg-Calve-Perthes disease admitted in Ghaem Hospital in Mashhad, North East of Iran from 1995-2005.

Results: According to age of patients and severity of disease, the subjects allocated to conservatine (11 patients) and surgical treatment (39 patients). Clinical improvment signs include pain reduction, range of joints motion, which were avaluate by physical examination and taking medical history of patients. In conservative group, only 4 patients assumed to be successfully treated with mean age of 7.25 years and the mean interval between disease onset and beginning of treatment was 2.25 months. Surgical group had mean age of 10.85 years and mean interval between onset of disease and initiation of treatment was 18 months. Conservative group showed less sever form of disease (lateral pillar group A and group B with age less than 8 years), but patients treated surgically were more severely involved (lateral pillar group B with age more than 8 years and group C).

Conclusion: This study showed that age and severity of disease (lateral pillar classification) are main elements in treatment strategy (choosing conservative VS surgical treatment). The interval between onset of disease and onset of treatment strongly affects treatment success.

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Background and Objective: Musculoskeletal injuries are the common causes of disabilities among young patients. This study was done to establish the causes and clinical evidences of bone and joint injuries among young patients in Gorgan, Iran. Materials and Methods: This cross-sectional study was carried out on 600 subjects with musculoskeletal injuries reffered to 5 Azar teaching hospital in Gorgan, north of Iran during 2009. Age, sex, type of initial treatment, location of injury and medical treatment for subjects were completed. Data were analyzed using SPSS-16, Chi-Square and student t-tests. Results: The mean age of subjects was 25±7 years. 83% of subjects were male. In 37% of injured people, time of accident was between 12 to 18 o’clock. The most common causes were car accident (49.7%), workplace injury (15.3%), falling down (10.3%), respectively. Street (38.3%) and road (18.7%) were the location with high accident. Fractures (71.7%), soft tissue injuries (48.3%) and dislocation (8.7%) were the most common injuries. Upper and lower limb were the most common in injury and fractur, respectively. Conclusion: This study showed that young men are more prone to accident and occupation injuries.

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Background and Objective: Femoral shaft traumatic fracture is one of the major causes of mortality and morbidity. Nowadays,the standard treatment method in adult is reduction with femoral interlocking intramedullary nailing. This study was performed to compare the open and closed methods femoral interlocking intramedullary nailingin femoral shaft fractures treatment. Materials and Methods: This clinical trial study was done on 40 18-50 year old patients (33 men and 7 women with mean age of 26.3 years) with femoral shaft closed fracture who were referred to the Shahid Kamyab hospital of Mashhad, Iran during 2007-08. Patients were divided into two 20 membered groups of open and close femoral interlocking intramedullary nailing treatment. Subjects were followed for one year and the :::::union::::: time, infection and non-:::::union::::: level were measured. Clinical and radiological findings were analyzed using SPSS-13, Student’s t-test and Fisher's exact test. Results: 97.5% of :::::union::::: was obtained within six months in both groups. Full weight bearing was determined 6-12 weeks (mean of 9.3 weeks) in close and 12-16 weeks (mean of 13.25 weeks) in open reduction. Complications included non-:::::union::::: in open (one patient, 5%), infection in open (one patient, 5%), shortening in both (one patientin, 5%), limited range of movement in both (one patient, 5%) and malrotation in close (one patient, 5%) groups. Close reduction group showed higher rate of radiologic callus formation and earlier full weight bearing than open reduction group (P<0.005), but :::::union::::: rate was not significant. Conclusion: This study showed that there is no difference between final :::::union::::: rate of open and close reduction by interlocking intramedullary nailing in femoral shaft fractures.

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Background and Objective: Treatment of scaphoid fractures is studied extensively due to the specific anatomic shape and position, blood flow and its performance. In recent years, several treatment methods have been devised which are associated with various findings. This study was done to evaluate the short-term results of limited dorsal approach in treatment of scaphoid fracture. Materials and Methods: In this descriptive study, 14 male patients with scaphoid fracture were gone under limited dorsal approach in treatment of scaphoid fracture in 5th Azar teaching hospital in Gorgan, Iran. Patients were followed up for 12 weeks and the onset of infection, screw breakage and joint degenerative changes were evaluated. Results: 64% of scaphoid fractures were in waist of the bone. The mean time to :::::union::::: was 10.5 weeks. 64% of patients returned to work after 12 weeks. In none of the patients, infection, wound breakdown and joint destruction were seen. There were two-delayed :::::union::::: (> 12 weeks) and two screw head prominency in the scaphotrapezial joint but patients did not complain and their hand movements had no problem. During procedures, two guide pin failures occurred with no adverse effect in fixations. Complications were minor and wrist movements were nearly normal. Conclusion: Limited posterior approach in the treatment of scaphoid fractures is an easier, faster and better :::::union::::: rate. Despite the short duration of follow-up study, this method is recommended in the treatment of scaphoid fractures.

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Background and Objective: Four percent of fractures were happened in clavicle bone. This study was done to evaluate the outcomes of superior reconstruction plating method in middle third of clavicle fracture. Materials and Methods: This descriptive study was carried out on 31 patients with middle third of clavicle fracture in Tehran-Iran, during 2009-12. The patients were treated surgically with superior reconstruction plating method. The treatment outcomes were determined by regular follow up in constant shoulder score, duration of :::::union::::: and complications of surgery. Results: The mean value of constant shoulder score was 87.6 which are reduced by chronical age. Non :::::union::::: rate and infection occurred in 3.2% and 6.5% of subjects. Duration of :::::union::::: and pre-scapular pain is increased by chronical age. Conclusion: Superior reconstruction plating method is recommended for middle third of clavicle fractures due to low complication, high constant shoulder score and lower treatment cost.

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Background and Objective: Chronic osteomyelitis with huge bone defect is one of the most catastrophic problems in long bone fractures. This study was done to evaluate the distraction osteogenesis with AO tubular external fixator in chronic osteomyelitis with huge bone defect. Methods: In this descriptive study, 12 patients (11 males, 1 woman) with chronic osteomyelitis with huge bone defect underwent distraction osteogenesis with AO tubular external fixator in 5th Azar teaching hospital in Gorgan, Iran. Patients were followed up for 16 months and the onset of re-infection, bone graft, pin loosening, refracture and neurovascular injury were evaluated. Results: All of fractures were open, due to vehicle accident. The fractures include four legs, seven femurs and one tibial plateu fracture. Primary fixation was done with plate (5 cases), Intramedullary Nail (5 cases) and skeletal traction (2 cases). Mean time onset of fracture to treatment with AO tubular external fixator was 75.5 days. Mean sequestrum length was 8.8 cm which it was in femur 10.71 cm and in leg was 6 cm. Mean overall treatment was 16.08 months or 1.91 month/cm. Re-infection and neurovascular injury were not seen. Eight superficial infections treated with antibiotic and four cases of pin loosening were assembled with pin fixation. Seven cases required bone grafting. Premature consolidation in five cases and deviation of bone transport segment were found in four patients which treated with modification in external fixation. Conclusion: Distraction osteogenesis using AO tubular external fixator in chronic osteomyelitis with huge bone defect is suitable treatment method, saving the organ and prevents the amputation.

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Background and Objective: A high percentage of patients with multiple traumas sustained at least from an orthopedic problem. One of the high frequent lesions was femoral shaft fracture. The aim of this study was to determine the amount of bleeding and the need for blood transfusion in femoral shaft fractures and risk factors.

Methods: This descriptive, retrospective study was done on 84 patients with femoral shaft fractures whom were operated in Imam Khomeini Hospital in, Sari, in northern Iran during 2012-15. Age, sex, comorbidities, type of fracture, hospitalization period, pre and post-operative hemoglobin and blood unit's loss were recorded for each patient.

Results: In 43 patients (51.19%) plate and in 41 patients (48.80%) intramedullary naling were used for treatment of fractures.13 (15.47%), 33 (39.28%) and 37(44.04%) of patients were received one, two and three blood units, respectively. There was no significant relationship between energy intensity and age. There was significant relationship between the intensity and the type of fracture (P<0.05). A significant correlation existed between blood unit transfusion with sex, fracture type, hemoglobin before surgery and fracture energy intensity (P<0.05).

Conclusion: Based on the results of this study, it is recommended for hip fracture at least 3 units of blood should be reserved.

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The proximal radioulnar joint plays an important role in elbow and forearm movements. Radial head fracture involves about 20% of the elbow fractures, which is most often accompanied by other damage to the soft or bone tissue. Isolated form is about 2% and bilateral form is rare. Most radial head fractures are the result of low energy and falling down with outstretched hands. Heavy sports injuries, high energy trauma and crashes cause a breakdown with displacement and the possibility of further complications.In this article we  reported a woman  nurse with 35 years old whom suffered pain and swelling of both elbows due to simple falling down with outstretched hands. In the clinical examination, there was a bilateral tenderness and swelling of the elbows. Movements were decreased in right side. There was no nerve defect. In the Xray radiography, bilateral radial head fractures, Mason-type 3 at right and type 1 at left elbow were observed. Right elbow treated by open reduction and internal fixation by mini plate and screws and left side treated by conservative method. The patient was discharged with indomethacin 25 mg 3 times a day for 6 weeks and bilateral long arm splint for 5 to 7 days, active movements were begun. Subsequently, the patient was not adviced for physiotherapy. Complete movements of elbow joints were obtained in right side and left side after 8 and 4 weeks due to teratment. Precise clinical examinations and correct radiographs are necessary to diagnose the bilateral radial head fractures. Early diagnosis and proper treatment and, if necessary, physiotherapy leads to proper improvement and acceptable movements and function.

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Pediatric femoral neck fracture is rare and account for less than 1% of all fractures in childhood. The proximal femur in children is extremely strong, and high-energy forces in 80-90%, following the axial force associated with hip rotation or direct blow are necessary to cause fracture. In this report, the method of femoral neck fracture fixation in eight-year-old girl after car accident is reported. During the operation, we noted a severe femoral neck fracture that was irreparable with the available tools (pin, screw, plate and DHS), which inevitably had to be used by Transosseous method with fiber wire #2, used in proximal humeral fracture fixation. Then, we obtained a fairly satisfactory result with a distal femoral pin inserting it into two-sided spica cast. Although, this kind of fracture is rare, but with a qualified clinical examination, early diagnosis, proper treatment, familiarity with surgical techniques and fixation reduces the complications and this method can be effective in obtaining the desired result.

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Osteoid osteoma is benign bone tumor, in which talus bone involvement is rare. This case was a 17 year old man with a right ankle pain and reduced range of motion since one year ago. Following clinical evaluation and radiological studies (X-ray, CT scan, and MRI), a bone tumor was detected in the talus with a possible diagnosis of Osteoid osteoma. The patient was operated with ankle anterior approach and the tumor was resected from the site. The patient was discharged after two days. The patient's pain was eliminated after surgery. Ankle movements are back after two months. Due to the rare nature of the disease and clinical diagnostic problems and its unusual radiographic manifestations, osteoid osteoma in chronic ankle pain in young patients, is included in the list of differential diagnosis.

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Background and Objective: Knee osteoarthritis is one of the most common causes of musculoskeletal disability. This study was performed to determine the effect of endurance training and glucosamine consumption on Insulin-Like Growth Factor 1 (IGF-1) and Insulin-Like Growth Factor Binding Protein 3 (IGFBP-3) gene expression in knee tissue of mice with osteoarthritis.
Methods: This experimental study was performed on 30 adult male Wistar rats. Induction of osteoarthritis of the knee was performed by surgery. The animals were randomly allocated into 5 groups and each group consisted of 6 mice. Groups include: Control, Saline, glucosamine, train and train-glucosamine. The training program for eight weeks, three sessions per week and included 29-25 minutes running on a treadmill at a speed of 15 m/ min for the first week, and each week one meter per minute was added to reach 22 m/min for the eighth week. All animals followed 12-hour fasting and 48 hours after the last session of the session, anesthetized with intraperitoneal injection of Ketamine and Xylosin. The expression of IGF-1 and IGFBP-3 of cartilage was measured by Real Time PCR.
Results: Expression of IGF-1 and IGFBP-3 increased to be 22% and 6% in control group compared to Saline group. Also, level of IGF-1 in exercise groups, glucosamine and exercise-glucosamine group was significantly increased compared to control group (P<0.05). The gene expression of IGFBP-3 in the exercise-glucosamine group was significantly increased compared to the control group (P<0.05).
Conclusion: Probably Chondrocytes secrete higher levels of IGF-1 during tissue damage that causes the structural synthesis of collagen 2 and proteoglycans and Finally, endurance training with consumption of glucose amine increases the expression of IGFBP-3 gene.