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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: 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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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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Posterior shoulder fracture dislocation (PSFD) is a rare and challenging injury. Early diagnosis and treatment can prevent serious complications and disability, reducing the risk of avascular necrosis of the humeral head and joint destruction. Several treatment options have been proposed, depending on the patient’s age, duration of dislocation, humeral head bone defect, length of the metaphysis attached to the reverse Hill-Sachs, osteopenia and functional demand, and concomitant diseases. Open anatomic reduction and internal fixation is a suitable option, particularly in young and active individuals. Humeral joint replacement is recommended for non-fixable 3- or 4-part fractures, particularly in elderly individuals with low demand and osteoporosis. This article reports a case of closed, irreducible PSFD that was treated with open reduction and internal fixation using a plate and deltopectoral approach.

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Background and Objective: Adhesive capsulitis is one of the most common shoulder disorders, particularly in diabetic patients, and its treatment has been challenging. Adhesive capsulitis begins with a gradual increase in shoulder pain, spontaneous onset, and limitation of active and passive movements of the glenohumeral joint in all directions. In 90% of cases, it responds to conservative treatment; however, if there is no symptomatic improvement after 3-6 months of conservative treatment, surgical treatment, including arthroscopic or open capsular release, should be considered. The current study aimed to compare the efficacy of non-surgical and arthroscopic treatments on shoulder function and pain in diabetic patients with adhesive capsulitis.
Methods: This quasi-experimental study was conducted on 48 diabetic patients (16 males and 32 females; mean age: 53.56±15.93 years) with adhesive capsulitis referring to the orthopedics clinic of 5th Azar Educational and Therapeutic Center in Gorgan, Iran during 2021-2022. Initially, patients were placed under the supervision of shoulder fellowship for conservative treatment for 3 months, and patients without any clinical improvement and with resistant to conservative treatments after 6 months were included in the study. Patients were voluntarily decided to be assigned to one of two treatment groups: Non-surgical (conservative treatment) and arthroscopic surgical (arthroscopic shoulder release). The functional outcomes and limitations of shoulder movement of patients were compared based on the disabilities of the arm, shoulder, and hand (DASH) score in the pre-test and after 3 and 6 months of intervention. The data were presented using descriptive statistical indices. Then, the functional outcomes and limitations of shoulder movement were evaluated.
Results: The mean shoulder function score 3 and 6 months after the intervention was lower in the arthroscopic release surgery group (45.80±19.32 and 43.10±14.12) than in the conservative treatment group (67.89±17.46 and 72.10±15.16) (P<0.05). The mean and standard deviation of symptom scores, such as pain, burning, weakness, and stiffness of the shoulder, 3 and 6 months after the intervention were lower in the arthroscopic release surgery group (12.70±5.66 and 10.02±4.06) than in the conservative treatment group (19.83±8.17 and 21.14±9.37) (P<0.05).
Conclusion: The decreased shoulder function and symptom severity at 3 and 6 months after the intervention was more effective in the arthroscopic release surgery group than in the conservative treatment group.
 

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Background and Objective: Various surgical techniques, including Open Reduction and Internal Fixation (ORIF), Minimally Invasive Plate Osteosynthesis (MIPO), and External Fixation (EF), have been proposed for the tibial pilon fractures treatment. However, limited comparative data exist regarding the outcomes of these three methods. Despite advancements in surgical procedures, the outcomes have not consistently been excellent, and patients often experience numerous complications. This study aimed to evaluate the outcomes and complications of the tibial pilon fractures treatment in a six-month follow-up.
Methods: This descriptive-analytical prospective cohort study was conducted on 22 patients (18 men and 4 women; mean age=39.4±10.8 years) who presented with tibial pilon fractures at the Fifth Azar Educational-Therapeutic Center in Gorgan, Iran, from April 2020 to March 2022. All 22 eligible patients agreed to participate. Following the necessary treatment determined by the attending physician, patients were examined after six months, and their outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle score.
Results: The majority of fractures (54.5%) were of closed type. The surgical procedures performed included two-stage EF (40.9%), ORIF (31.8%), expert nailing (13.6%), and MIPO (13.6%), respectively. A total of 72.7% of patients experienced early or late postoperative complications. The most common postoperative complications were osteoarthritis and wound dehiscence, occurring at a rate of 18.2% each. The mean AOFAS score for patients was 82.3±11.2. AOFAS scores were classified as excellent in 4 patients (18.18%), good in 12 patients (54.55%), moderate in 4 patients (18.18%), and poor in 2 patients (9.09%). A statistically significant inverse correlation was observed between the mean surgical time and the AOFAS score (r=−0.661, P=0.001). Furthermore, a statistically significant direct correlation was found between the mean surgical time and the mean length of hospital stay (r=0.571, P=0.006). Surgical time for patients undergoing MIPO (68.3±7.6 minutes) was significantly shorter than that of the other three methods (P<0.05). For open fractures, the frequency of ORIF was significantly higher than that of other procedures (P<0.05). Osteoarthritis was observed as a treatment complication in both expert nailing and two-stage EF interventions. In contrast, non-union and wound dehiscence complications were exclusively observed following ORIF. Superficial infection and mal-union were only observed after two-stage EF, and all instances of deep infection occurred with MIPO.
Conclusion: Two-stage EF and ORIF were the most common surgical techniques employed for patients with tibial pilon fractures. Worse postoperative complications, including non-union and wound dehiscence, commonly occurred in ORIF procedures. However, there was no statistically significant difference in patient-reported outcomes based on the AOFAS self-report questionnaire among the various surgical techniques.