Level I.

Background:Distal radius fractures are one of the the most common adult fractures encountered during the clinical practice of an orthopedic surgeon.12 Although several methods of treatment are suggested for these fractures, there are still controversies about the best treatment approach in the literature. Volar plating of distal radius fracture is a method of treatment which has become increasingly popular. One of the complications of this technique is flexor tendon rupture. The purpose of this study was to evaluate the protectiveness of complete repair of pronator quadratus muscle against flexor tendon rupture.Materials and Methods:From September 2010 to September 2012, a consecutive series of 157 patients who were younger than 60 years with unstable distal radius fractures were included in the study. A standard volar approach to the distal radius was carried out. The radial and distal ends of pronator quadratus muscle were meticulously elevated from the radius and after volar plate fixation of the fracture, pronator quadratus muscle was restored to its normal insertion. We achieved full coverage of the plate with this muscle and followed the patients postoperatively.Results:A total of 135 patients were studied. The mean age of patients was 34 ± 10 years (range 20-60 years). One 55-year-old diabetic female patient with flexor tendon rupture was identified. The flexor pollicis longus tendon had ruptured 16 months after surgery.Conclusions:Pronator quadratus repair should be done in distal radius fracture to protect flexor tendons.

Purpose This study aimed to assess the rate of iatrogenic mid-substance supericial medial collateral ligament (sMCL) tear due to the medial pie-crusting technique during varus deformity total knee arthroplasty and compare the knee society score (KSS), range of motion (ROM), and instability rate of the repaired group to the control group with intact sMCL. Methods For this retrospective series of prospectively collected data, the multiple needle puncturing technique was performed for 653 out of the 1768 knees during algorithmic medial soft-tissue release. Iatrogenic tear was observed in 35 knees (5%); hence, repair with running locking nonabsorbable braided suture was performed. Patients were visited and reviewed both clinically and radiographically at 6 weeks, 3 months, 6 months, 12 months, and annually thereafter. Chi-square, ANOVA, Mann-Whitney, independent and paired t test were used to analyze the variables. P value < 0.05 was considered statistically signiicant. Results 85% of the repaired sMCL had stable joints with a mean KSS of 88 ± 3 and a mean ROM of 103 ± 11 degrees (°). The other ive patients (15%) with mean KSS of 40 ± 8 and mean ROM of 81° ± 5° had an instability and needed to undergo a revision surgery. The control group had a mean KSS of 86 ± 15 and mean ROM of 107° ± 8°; however, 7 knees had an instability and needed a revision surgery. No signiicant diference was observed in terms of KSS (P = 0.86) and ROM (P = 0.64) between the control and repaired groups. ConclusionThe mid-substance sMCL tear is an important intraoperative complication of medial pie-crusting. Repairing this iatrogenic tear with nonabsorbable suture had satisfying clinical outcomes regarding the postoperative knee ROM and KSS in comparison to the control group. However, there is a chance of failure, which should be perceived by the surgeons. Level of evidence Therapeutic studies, investigating the results of treatment, Level III.

I.

No abstract

Background The safety of continuing Total Joint Arthroplasty (TJA), as an elective procedure, during the pandemic is controversial. The present study aimed to investigate the incidence of symptomatic COVID-19 and its related risk factors in unvaccinated patients after TJA within one month post-discharge in two large cities of our country. Methods The present prospective study included all the patients admitted to three hospitals, located in two high-populated cities of our country from April 1st, 2020, to April 1st, 2021, for elective TJA. Urgent TJA (traumatic fractures) were excluded. The primary outcome was symptomatic COVID-19 within one-month after discharge that was diagnosed using the SARS-CoV-2 RT-PCR test. Afterward, the incidence of the COVID-19 in the study population was compared with the general population to estimate the safety of elective TJA during the pandemic. Results From the 1007 patients undergoing TJA, 755 patients met the inclusion criteria. None of the patients was vaccinated against COVID-19. Among them, 18 patients (2.4%) developed symptomatic COVID-19 within one-month after discharge. In the same time interval, the incidence of COVID-19 was 2.2% in the general population of these two cities, which was similar to the incidence reported in the study population. Of the patients who were positive for COVID-19, four patients were hospitalized, and 3 of them were ICU-admitted; however, no mortality was reported. Conclusion The TJA will be a safe elective procedure for the patients during the pandemic if the preventive protocols are followed strictly.

Background:Implantation of joint prosthesis, either in the knee or in the hip, may cause some problems such as an infection, so that a timely treatment is essential. In this respect, discovering a marker detecting the incidence of an infection is one of the requirements of arthroplasty. The present study was conducted to determine variations of two markers in arthroplasty and infection incidence in Iranian patients.Materials and Methods:This prospective study was carried out in Isfahan’s educational treatment centers from 2009 to 2011 on patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgical operations. The erythrocyte sedimentation rate (ESR) was measured by Sed rate device (Lena) and C-reactive protein (CRP) by autoanalyzer device (Erba) with the unit of ng/dL. The patients underwent ESR and CRP tests the day before operation, the day of operation, and 1, 2, 5, and 15 days and 1, 3, 6, and 12 months after operation.Results:Mean ESR increased during the first 5 days then decreased gradually lasting for 3 months. After 1 year it increased to a level higher than before the operation. The variations in ESR values were 19.1 ± 12.9 before the operation and 21.14 ± 10.8 after 1 year with significant difference (P < 0.001). The level of CRP had an upward trend from the first day after operation and reached its maximum on the second day, then had a downward trend up to 1 month after the operation; however, it did not reach its preoperative level during 1 year.Conclusion:ESR and CRP and their variations can be suitable factors to detect probable infections in patients undergoing TKA and THA operations.

Background and Objectives. The null hypothesis of this study was that TA has no effect on postsurgical bleeding in patients undergoing TKA. Methods. This study was a double-blind randomized trial. In the first group (T) patients received 500 mg of intravenous Tranexamic acid (TA) twice (once preoperatively and once 3 hours postoperatively) and in the second group (P) they received slow infusion of normal saline as placebo. The primary outcome of the study was the level of Hb 48 hours after surgery. Results. Hb levels 48 hours after surgery as the primary outcome were 10.92 ± 0.97 and 10.23 ± 0.98 (g/dL) in groups T and P, respectively, and the difference was statistically significant (P = 0.001). Statistically significant differences were also observed in Hb levels 6 and 24 hours after surgery, the drain output 48 hours after surgery, and the number of units of packed cells transfused between study groups (P < 0.05). There was no significant difference in duration of hospitalization between the study groups (P = n.s.). Conclusions. The low dose perioperative intravenous TA significantly reduces blood loss, requirement for blood transfusion, and drain output in patients undergoing TKA. However, duration of hospitalization did not change significantly.