Aim/Introduction. This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU). Materials and Methods. In this prospective cohort study in a university hospital, all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with P value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression. Results. Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89-8.02). After analysis, previous history of DFU or amputation [OR = 9.65, 95% CI (2.13-43.78), P value = 0.003], insulin usage [OR = 5.78, 95% CI (2.37-14.07), P value < 0.01], gender [OR = 3.23, 95% CI (1.33-7.83), P value = 0.01], distal neuropathy [OR = 3.37, 95% CI (1.40-8.09), P value = 0.007], and foot deformity [OR = 3.02, 95% CI (1.10-8.29), P value = 0.032] had a statistically significant relationship with DFU incidence. Conclusion. Our data showed that the average annual DFU incidence is about 2.8%. Independent risk factors of DFU development were previous history of DFU or amputation, insulin consumption, gender, distal neuropathy, and foot deformity. These findings provide support for a multifactorial etiology for DFU.

Objective:Successful closure is a primary step of treatment in open fracture wounds. Delayed healing or complications can lead to increased treatment duration, costs and disability rates. The aim of this study was to compare Negative Pressure Wound Therapy (NPWT) and conventional wound dressings in patients with open fracture wounds.Methods:In a prospective randomized clinical trial study, 90 patients with open fractures that were referred for treatment were enrolled between February 2013 to March 2015. Patients were divided into two groups. Group I underwent NPWT and group II underwent conventional wound dressing. Then patients were followed up for one month. Within the one month, the number of dressing change varied based on the extent of the wound. Duration of wound healing, presence of infection and the number of hospitalization days in these patients were recorded and compared at the end of the study between the two groups. Questionnaires and check lists were used to collect data. Analysis was done with SPSS 20, paired sample T-test, and chi-square tests. P<0.05 was considered significant.Results:There was a significant difference between the rate of wound healing in the group one or NPWT group and group II (conventional wound dressings) P<0.05. There was no significant difference between two groups in incidence of infection (P=0.6).Conclusion:Using NPWT expedites the healing process of extremity wounds. It is more economical and can be considered as a substitute for the treatment of extremity wounds.

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Objective:This study compared functional outcomes and preoperative between cemented and uncemented bipolar hemiarthroplasty in patients older than 65 years with subcapital displaced femoral neck fracture.Methods:Fifty one patients with displaced femoral neck fracture were enrolled in this study. Twenty nine patients underwent uncemented bipolar hemiarthroplasty and 22 underwent cemented bipolar hemiarthroplasty. Physical examination and radiographs were performed at the first and sixth months after operation and results were recorded. The patients’ pain and function were measured with Visual analogue Scale and with Harris Hip Score (HHS), respectively and then compared with each other.Results:The mean duration of follow up was 18.9 and 19.5 months in the cemented and uncemented groups, respectively. All patients were followed up for at least 6 months. Mean operation and bleeding times were longer in the cemented group compared to the uncemented group (P>0.05). The mean pain score was significantly less in the cemented group compared to the uncemented group (P=0.001). Hip functional outcome based on HHS was more in the cemented group (P= 0.001). The intraoperative and postoperative complication rate was higher in the uncemented group (P<0.05).Conclusion:Although higher rates of intraoperative bleeding and surgery time were seen with cemented bipolar hemiarthroplasty in older patients with femoral neck fracture compared to uncemented bipolar hemiarthroplasty, cemented bipolar hemiarthroplasty can cause less complications and improve patients’ function in less time.

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Objective: Knee arthroscopy is a painful procedure which if untreated will cause intensive and prolonged pain that may prevent rehabilitation of patients. This study was designed to compare the analgesic effects of different opioids in the early post operative period in comparison to control group. Methodology: One hundred forty patients were prospectively assigned to four groups randomly. After arthroscopic menisectomy all patients received an intraarticular injection containing 9.5 ml bupivacaine 0.5% with 1:200000 epinephrine in a 10 ml syringe. The remainder of syringe was filled with one of the study solutions. Group I: 5mg methadone, group II: 5mg morphine, group III: 5 ml normal saline, group IV: 50 mg meperidine. At three stages in the ealy post operative period the need for analgesics was recorded. A statistical comparison was done afterwards. Results : In morphine group (group II), the analgesic usage in hospitalized and outpatients compared with other groups was significantly low(P<0.05). Conclusion: Morphine in comparison to meperidine or methadone is more beneficial in reducing pain or analgesic need when is added to bupivacain injection following arthroscopic menisectomy.

Background and Objective: Septic arthritis is a joint infection that causes metabolic and physiological disorders and if not diagnosed and treated on time can cause severe damage and disabilities. In this study, the effect of intravenous dexamethasone on septic arthritis, and the recovery process of the disease have been evaluated. Methods: In a non-randomized double blind clinical trial 60 patients assigned in two groups of 30 patients each were evaluated. After diagnosis of septic arthritis, group one received a dose of 0.15mg / kg / QD of dexamethasone and group two received the same amount of normal saline for four days. Then the patients were evaluated for treatment duration, inflammation and redness relief, joint movement and ESR and CRP levels. Results: After data collection they were compared with the X2 test, t-test, ANOVA and Mann-Whitney statistical test and were analyzed using SPSS18 software. Treatment duration was 3.27 ± 1.04 days, joint movement was 50.67 ± 9.7 degrees, inflammation and redness relief was seen after 4.1 ± 0.32 days, a decrease of 19.3 ± 2.89 in ESR levels were seen and reduction in CRP levels showed a statistically significant difference (P <0.05). Conclusion: In patients with septic arthritis in addition to routine antibiotic therapy, receiving intravenous dexamethasone can reduce the clinical symptoms of the disease symptoms and also accelerate recovery and return to daily activities.

Hydatid disease is caused by the tapeworm Echinococcus. Genus Echinococcus has different species including Echinococcus vogeli, Echinococcus granulosus and Echinococcus multilucularis. Echinococcus granulosus is the most common cause of hydatid disease in humans. This disease occurs either through direct ingestion of parasite eggs from contact with infected dogs or indirectly from the ingestion of contaminated water or food.Infestation of hydatid disease in humans most commonly occurs in the liver (55-70%), followed by the lungs (18-35%). Bone hydatidosis however is very rare (3%). We present herein a case of hydatid cyst of the fibula, which is an uncommon site for the occurrence of this disease.