Background: The objective of this study was to determine whether the injection of botulinum toxin A (BTA) in the medial head of the gastrocnemius muscle could yield improvements in function and disability in patients with chronic plantar fasciitis with follow-up 12 months after treatment. Methods: Thirty-two patients with chronic plantar fasciitis were included in the study and randomly allocated to the BTA and placebo groups. The visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scores were used to evaluate pain levels pre- and postinjection as well as function of the foot, respectively. Patients were also asked to rate their treatment satisfaction 1 year after injection. The range of dorsiflexion was measured before and 12 months after the injection. Results: At the 12-month follow-up, the mean VAS decreased from 7.8 to 4 in the placebo group and from 8 to 0.33 in the BTA group. Furthermore, the mean AOFAS scores increased from 48.4 to 65.3 in the placebo group and from 45.5 to 90.6 in the BTA group. The postinjection scores in the BTA group were significantly higher than those in the placebo group ( P < .001). Patient satisfaction in the BTA group was higher than that in the placebo group at the 12-month follow-up. Conclusion: In patients with chronic plantar fasciitis, the use of BTA had a positive effect on improvement in pain and foot function 1 year after treatment. Level of Evidence: Level I, prospective randomized controlled trial.

Endoscopic retrieval of proximally migrated biliary plastic stents may be technically challenging and sometimes unsuccessful. Here we report the case of a 59-year-old woman with a migrated biliary stent in the right hepatic duct, which was diagnosed after the patient presented with cholangitis. The patient presented with constant abdominal pain in the right upper quadrant lasting for two days, along with nausea and bilious vomiting. The stent was retrieved by a polypectomy snare after failure of biliary basket and forceps. We performed a novel procedure for extraction of a migrated plastic stent, by using a polypectomy snare.

Background: During the outbreak of the novel coronavirus disease 2019 (COVID-19), Sina Hospital in Tehran, Iran, dedicated a majority of its facilities and workforce to fight this crisis. Meanwhile, our academic trauma center continued to admit emergency trauma patients. Case Report: In this case series, we tried to discuss five previously healthy trauma patients who underwent orthopedic surgery and were diagnosed with COVID-19 later. Also, we described our detailed protocol for the management of orthopedic patients during the pandemic. Conclusion: During COVID-19 time, we continued to provide our best service to the trauma patients while keeping our personnel as far as possible from direct contact with the patients until it was necessary.

No abstract

Background: Wound complications are major morbidities after orthopedic surgery, and thrombo-prophylactic drugs may increase the likelihood of such complications. In this regard, our study has evaluated the possible effects of rivaroxaban on wound complication issues following spinal canal stenosis surgery. Methods: This prospective cohort study was conducted on 40 patients suffering from spinal canal stenosis secondary to degenerative lumbar spine changes. The eligible patients included those patients receiving rivaroxaban to prevent thrombo-emboli post-operatively. The patients were followed up for three months and assessed for postoperative wound-related complications. Results: None of the patients suffered vascular and thromboembolic complications. Regarding wound complications, these events are mostly limited to the first week post-operatively, including wound dehiscence in 5.0%, serosanguineous discharge in 25.0%, erythema in 35.0%, superficial infection in 10.0%, requiring surgical debridement in 5.0%, cellulitis in 10.0%, and wound induration in 30.0%. Deep infection or hematoma was not reported in our patients. Erythema and wound induration remained 10.0% and 15.0% within the second week, respectively. The hypertrophic scar was a delayed complication that appeared in 15.0% of patients within 1 to 3 months post-operatively. Conclusion: The main risk profiles related to wound complications, especially infections, were a history of hypertension (HTN), uncontrolled diabetes mellitus (DM), and renal insufficiency. The use of rivaroxaban may be accompanied by temporary and minor wound complications and not with potentially debilitating morbidity in patients undergoing spinal canal stenosis surgery. Therefore, its prescription as a safe thrombo-prophylactic drug in patients undergoing spinal canal stenosis surgery is confidently recommended.

A Monteggia fracture is a proximal ulnar fracture with proximal radioulnar ligamentous instability. While there is no precise definition, Monteggia-equivalent fractures are generally considered Monteggia fractures accompanied by radial head fractures. These are rare. In this study, we report a rare variation of a Bado type IV Monteggia-equivalent lesion (fracture of proximal ulnar shaft, proximal radial shaft, and radial head) and its management.

The article's abstract is not available.  

The article's abstract is not available.