BackgroundAs the total hip arthroplasty (THA) mainly aims to improve the quality of life of the patients, study of health-related quality of life (HRQoL) after THA has attracted much attention. Yet, the results considerably vary between studies. Here, we evaluate the HRQoL of the patient after THA, for the first time in the Iranian population.MethodsIn a case-control study, HRQoL was assessed in 217 patients after THA and compared with a matched reference population. The 36-item short-form health survey (SF-36) was used for the evaluation of HRQoL. A multiple linear regression model was used to investigate the influence of sociodemographic and clinical characteristics of the patients on the HRQOL.ResultsThe mean follow-up of the patients was 27 ± 18 months. The mean total SF-36 score was 41.4 ± 22.2 in the case and 67.3 ± 26.6 in the control group (p = 0.001). The mean physical component score, but not the mental component score, was significantly lower in the patient group (p = 0.001). Except for the vitality and emotional role, all other SF-36 subscales were significantly lower in the case group. Male sex (B = 4.52, p = 0.023), number of comorbidities (B = − 4.82, p = 0.011), body mass index (B = − 1.18, p = 0.044), number of post-operative complications (B = − 6.57, p = 0.001), and adherence to physiotherapy protocol (B = 2.09, p = 0.014) were associated with HRQoL after THA.ConclusionAlthough THA is considered as one of the most successful orthopedic practices, it is associated with remarkable reduced HRQoL in Iranian population when compared with the reference population. A variety of patients-associated factors influence the HRQoL after THA.Electronic supplementary materialThe online version of this article (10.1186/s12891-019-2428-0) contains supplementary material, which is available to authorized users.

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Background: Combined injuries of Mid-shaft clavicle fracture and Acromioclavicular (AC) joint dislocation are rare, and only a few cases have been reported. Several treatment options including surgical, conservative and hybrid approach have been described. Yet, there is no consensus regarding the optimal management approach for this injury. Objectives: Here we reported a case of Mid-shaft clavicle fracture with associated type IV AC joint dislocation in a 29-year-old male following a cycling accident. Methods: Both parts of the injury were fixed surgically. Meanwhile, the patient did not follow the postoperative protocol and started the heavy sports activities one month after the surgery. Results: The patient showed up 6weeks after the surgery with slightly uncorrected AC joint. However, he was satisfied with the results and accordingly no intervention was done for the correction of the AC joint. Conclusion: Our case reveals the importance of adherence to the postoperative protocol in this combined and challenging injury and we recommend surgical fixation for such injury.

Background: In the current diagnostic procedure, generally, both plain radiographs and 3D-CT scans are used for the diagnosis of acetabular fractures. There is no consensus regarding the value of a three-dimensional computerized tomographic (3D-CT) scan alone in the classification of acetabular fractures. In this study, we compared the accuracy of 3D-CT scan and plain radiography through the evaluation of their agreement with the intraoperative surgeon's classification. Method: In a retrospective study, patients who were referred to our center with an acetabular fracture and underwent surgical treatment were included. The classification of acetabular fractures was performed once using Judet view plain radiographs and once using a 3D-CT scan by the corresponding one Experienced musculoskeletal radiologist one independent trauma fellowship-trained orthopaedic who routinely treat acetabular fractures and based on Letournel and Judet classification (17 and 23 years of experience respectively). Cohen's kappa value was used for the assessment agreement between the two imaging modalities, as well as between the imaging modalities and intraoperative classification. Results: Medical files of 152 patients with acetabular fracture were retrospectively reviewed. A kappa value of 0.236 was obtained as the agreement level between radiographs and intraoperative findings (p < 0.001). A kappa value of 0.943 was obtained as the agreement level between 3D-CT and intraoperative classification (p < 0.001). An agreement level of 0.264 was found between the Judet radiographs and 3D-CT scans (p < 0.001). Conclusions: 3D-CT scans are reliable enough in the classification of acetabular fractures, and plain radiographs could be omitted to avoid radiation exposure as well as to reduce the cost for patients who sustain acetabular fractures.

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Background: There is no concrete information about many aspects of femoral fracture, including its best management. We hypothesized that reporting the outcomes of patients managed with the same therapeutic algorithm would help the selection of best management strategies.  Objectives: In this study, we report the outcomes and complications of femoral head fracture in patients treated according to our therapeutic algorithm. Methods: In a retrospective review of a prospectively collected orthopedic database, 41 patients with femoral head fractures were evaluated. Fractures were classified by the Pipkin classification system. The clinical outcome was assessed with the Harris Hip Score (HHS). In brief, our therapeutic algorithm included conservative treatment for the congruous joint of Pipkin type I and II, total hip arthroplasty for unfixable fractures of Pipkin type III, and IV, and fixation via three approaches otherwise (Smith-Peterson, Kocher, or surgical dislocation). Results: Of 41 cases, 34 cases (82.9%) had uncomplicated outcomes. The number of associated injuries was significantly more in patients with complicated outcomes (P=0.049). Avascular necrosis was the most common complication (n=5, 12.2%). Their Mean±SD HHS was 85.1±109. Accordingly, HHS scoring had poor, fair, good and excellent results in 4 (9.8%), 6 (14.6%), 13 (31.7%), and 17 (41.5%) patients, respectively. The mean HHS score was significantly lower in patients with complicated outcomes (P=0.007). The mean HHS score was not associated with types of fracture (P=0.071).   Conclusion: The outcome of femoral head treatment was good to excellent in the majority of patients. However, patients who underwent total hip arthroplasty or had associated injuries are at higher risk of an inferior outcome.