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Septic arthritis is a serious orthopedic surgery and delayed management causes irreparable damages. The knee is the most common site involved in septic arthritis. The purpose of this study was to determine mortality rate, adverse joint outcome and prognostic factors in adult patients diagnosed with septic arthritis of the knee who had undergone debridement surgery.

This retrospective cohort study was carried out using the medical records of all adult patients admitted to Sari Imam Khomeini Hospital and Sari BuAliSina Hospital between 2009 and 2019 who were treated with either arthrotomy or arthroscopic irrigation for acute septic arthritis of the knee. Patients with prosthetic joints were excluded. The rate of mortality was determined. Clinical findings, laboratory evidence, knee radiographs, and the Knee injury and Osteoarthritis Outcome Scores (KOOS) were compared through statistical analysis to identify possible prognostic factors.  Radiographic severity was classified based on the Kellgren-Lawrence grading.

We included 31 patients and there were 41.9% female patients (mean age= 51.1±20.56). The most common underlying diseases were hypertension (29%) and diabetes mellitus (25.8%). Staphylococcus aureus was identified in 16.1% of synovial fluid cultures. The mortality rate was 22.6%. Factors influencing mortality included older age (P=0.003), diabetes mellitus (P=0.031), fever (P=0.038), length of hospital stay (P=0.019), high C-reactive protein levels (P=0.002), low creatinine clearance (P=0.003), and type of pathogenic microorganisms (P=0.028). Age was the only factor significantly associated with higher radiographic severity (P=0.014).

Septic arthritis is an infectious orthopedic emergency that is associated with a high mortality rate even after joint surgery and debridement. Therefore, proper management and updating information about this disease and its treatment methods are necessary.

Osteoarthritis and osteoporosis are the most important causes of skeletal disorders and there are controversies over the relationship between these diseases and other factors. The aim of the present study was to investigate the relationship between osteoarthritis and osteoporosis and also the association between these two diseases and patients’ demographic and lifestyle characteristics.

This cross-sectional study was performed in patients attending Sari hospitals in the fourth quarter of 2019 selected via census sampling. Knee radiography was performed and the severity of osteoarthritis joint was determined based on Kellgren-Lawrence criterion. Bone mineral density (BMD) was also measured by DXA scan. Data was collected using demographic questionnaire and lifestyle dimensions. Data were analyzed in SPSS V18.

A total of 77 patients were studied. The mean age of patients was 57.3±10.3 years and the majority were females (n= 73, 94.8%). Severity of osteoarthritis was determined as mild in 28 (36.36%), moderate in 31 (40.26%), and severe in 18 (23.38%) patients. The mean BMD level was 0.76±0.06 g/cm2. There was a significant difference between the severity of osteoarthritis and BMD level (P=0.008). Significant differences were found between patients with osteoarthritis and osteoporosis in age, sex, weight, and some lifestyle indicators (P<0.05).

Osteoarthritis of the knee joint is associated with osteoporosis. But, demographic and lifestyle characteristics could have a major role in the incidence of these diseases.

Intertrocentric femoral fracture is the most common fracture and has the highest mortality rate after surgery. The main treatment for this type of fracture is surgery and the choice of appropriate surgical instrument plays a key role in reducing the incidence of complications. This study amed at comparing clinical outcomes between Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) in surgical treatment of unstable intertrochanteric fractures of the femur.

A cross-sectional study using causal-comparative design was conducted in all patients attending orthopedic clinic in Sari Imam Khomeini Hospital with intermittent femoral fractures who needed surgical treatment between 2012 and 2018. Thirty patients were randomly divided into two groups to be treated either by DHS or PFN implants. The two groups were compared for clinical results, including operation time and and anesthesia time, the need for blood transfusion during and after the surgery, cut out of the device, fracture fusion, and neck and emoral trunk angles. Data analysis was done in SPSS V21.

Findings showed no significant difference between DHS and PFN implantation in terms of fracture fusion (P= 0.234) and cut-out of the device after the surgery (P= 0.157). It was also found that DHS required less time for surgery and anesthesia (P= 0.012). Patients treated with DHS also required significantly less blood transfusion than those in PFN group (P= 0.02).  

In this study, treatment of unstable intertrochanteric fractures using DHS was found to be superior to PFN due to lower length of surgery and anesthesia, and lower need for blood transfusion.

Osteoporosis is a general skeletal disease characterized by decreased bone mass over the years, bone fractures, decreased bone strength, and consequently increased bone fragility and fracture susceptibility. There is paucity of information about the effect of calcitonin on osteoporosis in Iran. The current study aimed at investigating the relationship between serum calcitonin levels and osteoporosis in women aged 40-70 years old.

This cross-sectional study was carried out in women with osteoporosis (n=29) attending Sari Imam Khomeini Hospital who were selected by census sampling in 2019.  Written consent was obtained and the participants entered the study based on bone densitometry. They were divided into three groups of normal (n=8), osteopenic (n=10), and osteoprotic (n=11). Mean serum levels of calcium, phosphorus, and calcitonin were measured in all patients. Data analysis was conducted in SPSS V23.

The mean serum levels of calcium, phosphorus, and calcitonin were 0.43±1.58, 0.64±2.04, and 1.08±3.59, respectively indicating no significant relationship between their concentrations and osteoporosis (P> 0.05).  

The study showed no relationship between the three groups of patients in serum calcium and phosphorus levels, which means that the body maintains normal serum levels of these salts even with severe osteoporosis. Serum calcium and phosphorus tests can not be used to comment on bone density.

 Cerebral palsy Spastic Diplegia (CPSD) is the most common motor disability in childhood. It is a neurodevelopmental condition beginning early in life and continues throughout life. In addition to mobility problems, the environment can also affect the CPSD children’s social participation. This study aims to investigate the relationship of environmental factors with the social participation of children with CPSD.

This cross-sectional study was conducted on 116 parents of children with CPSD referred to the occupational therapy clinics in Tehran, Mazandaran, and Alborz provinces of Iran in 2018-2019. They were recruited using a convenience sampling method. Parents completed the European Child Environment Questionnaire (ECEQ) and the life habit questionnaire to assess their perception of the environmental factors and their children’s participation, respectively. The Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R) was initially used to classify the gross motor function (walking ability) of the children with cerebral palsy living in Europe (The SPARCLE project). We used it to estimate cognitive levels in children. The Pearson correlation coefficient and linear regression of SPSS version 22 were used to analyze the results.

 Based on the GMFCS-E&R classification, 23.3% of children were at level I, 27.6% at level II, 31.9% at level III, and 17.2% at level IV. Moreover, 89.7% of the children had an IQ>75, and 85.3% had no seizures. All domains and sub-domains of ECEQ had significantly correlated with social participation (P<0.01), where the physical environment had the highest correlation (r=-0.811, P<0.01). Based on the linear regression model, physical environment (β=-0.475, P<0.01) and attitudinal environment (β=-0.285, P<0.05) were the predictors of social participation (adjusted R2=0.71).

 Physical and attitudinal environments are predictors of social participation in children with CPSD. Environmental modifications and adaptations at home, community, school, and especially transportation system can increase the social participation of these children.

Car accidents are one of the most common causes of traumatic mental disorders. This study was done to evaluate the symptoms of post-traumatic stress disorder (PTSD) in patients with lumbar spinal dislocation fractures caused by road accidents.

This case-control study was performed on 100 patients with lumbar spine dislocation fractures due to road accidents. After the seventh day, they were admitted to the orthopedic and trauma wards of Imam Khomeini Hospital in Sari. It was done six months after hospitalization. Data collected from 100 non-injured individuals using the Marmar and Weiss Revised Event Impact Questionnaire (Impact of Event Scale - Revised: IES-R) were compared.

There was no statistically significant relationship between PTSD and age, sex, marital status, education of the two groups. In all subscales related to the effect of the event, ie avoidance, disturbing thoughts, and over stimulation indices, the mean score of the participants in the case group was significantly higher than the mean scores of the individuals in the control group (P<0.05). The mean in case group was significantly higher than the mean in the control group (P<0.05).

The results of this study indicate the important role of road accidents in the formation of PTSD symptoms.

One of the most important complications of bone fractures is nonunion. This research aimed at comparing the effect of exchange nailing and plate augmentation on complications after surgery and the time to achieve desired outcomes.

This descriptive-analytical study was conducted in 12 femoral shaft nonunion cases treated operatively in 2011-2018 (eight patients were managed with plate augmentation and four patients were treated with exchange nailing). Demographic characteristics of the patients, type of fracture and type of surgery were recorded. A year after the surgery, anteroposterior and lateral view profiles were prepared from all patients and the extent of bone fusion was evaluated by orthopedic surgen.

Four patients (33.33%) underwent intraosseous nail replacement surgery and eight (66.67%) underwent plate augmentation surgery. Two patients (16.67%) developed infections and five (41.67%) had a short limb complication. The average limb shortness in these patients was 1.10±0.22 cm. The average duration of union after discharge was lower in patients with plate augmentation than those with replacement of the intramedullary nail.

In current study, faster uninon achieved, so, augmentation plating could be a good choice in patients with femoral shaft nonunion.

One of the factors affecting the prognosis of distal radius fracture is anatomical correction. Several studies conducted in connection with the reconstruction of anatomical and functional consequences, which have had conflicted results. This study has been designed and implemented aimed to investigate the relationship between radiological index (anatomical) after displaced distal radius fractures with function and clinical outcomes.

This is a retrospective cohort study to assess the association of radiological indices with clinical and functional outcomes of distal radius fractures. In this study, radiological indices, including the radius, volar tilt, tear drop angle, articular cavity depth and AP Distance were investigated. Pinch and grip strength were measured and Quick DASH questionnaire evaluated the performance.

Pain score significantly correlated with radial shortening (P=0,038), but it was not independent of treatment method. Patients’ satisfaction rate was significantly lower in patients with abnormal articular depth, independent of age and treatment method (P=0.004). Quick-DASH score significantly correlated with radial shortening and articular cavity depth, independent of treatment method and age (P=0.006). Percutaneous pinning associated significantly with less pain, less disability and more satisfaction (P<0.05).

Radial shortening, articular cavity depth had a correlation with the clinical and functional outcomes. While Some studies suggested radiological indices in the elderly is not necessarily have a correlation with functional outcomes, in this study correlation of radiologic indices with clinical and functional outcome was independent of age.

Research is one of the significant foundations of community development, which requires understanding the capabilities, weaknesses and strengths of programs. This study aimed at investigating the motivations and barri ers to research in clinical faculty members.

This descriptive-analytical study was conducted in clinical faculty members (surgeon and non-surgeon) in Mazandaran University of Medical Sciences using census sampling. Data were collected via Research Barriers Questionnaire (Sotodeh Asl et al.) and Research Motivation Scale (Salehi). Data analysis was done applying Mann-Whitney test and Kruskal-Wallis test.

One hundred thirty-nine individuals aged 40-50 years participated in this study and the participation rate was high (81%). The motivation for research activities was higher in females (59.92 ± 6.38) than males (57.24 ±5.47) (P< 0.05). Major obstacles to preparation and compiling a research project, in both surgeon and non-surgeon groups, were lack of clear research needs (3.68 ± 0.67) and priorities (3.11 ± 0.89) in the university. In project implementation, lack of appropriate space(3.50 ±1.04) was reported as the main problem by both groups. In administrative and management context, little attention to creativity (3.80 ± 0.86) and financial and budget problems (3.27 ± 1.21) were the main barriers according to both surgeon and non-surgeon faculty members, respectively (P> 0.05).

Despite sufficient motivation, organizational and individual barriers affect research activities. These obstacles could be removed by clarifying research priorities, creating a suitable physical space, and solving financial problems.

Association between vitamin D and anterior cruciate ligament injury (ACLI) in male athletes is poorly understood, and current data are not sufficient and consistent. The present study investigated the association between vitamin D and ACLI in some Iranian male athletes.

This cross-sectional study was carried out in 100 male athletes with knee pain attending Sari Imam Khomeini Hospital, Iran 2016. They were evaluated into two groups: male athletes with ACL injury (AI group; n=50) and without ACL injury (WAI group; n=50). ACL injury was verified according to physical examination and MRI findings. Data, including the age, serum 25 (OH) D concentrations, body mass index (BMI), and previous history of exercise were recorded and analyzed in SPSS V20.

The mean age of participants and their serum 25 (OH) D levels were 28±6 years and 25.07±1.02 ng/dl, respectively. There were no significant differences between the two groups in mean age, BMI, and previous history of exercise (P> 0.05). The mean serum 25 (OH) D levels were found to be significantly lower in AI group than those in WAI group (P< 0.001).

The current study showed that lower serum concentrations of 25 (OH) D are associated with the risk of ACLI in male athletes.

Vascular trauma is an emergency limb-threatening situation and the third leading cause of mortality and morbidity (amputation) all over the world which can lead to significant complications due to lack of correct diagnosis. The aim of this study is to evaluate the frequency of various orthopedic injuries in traumatic patients requiring vascular surgery interventions.

This study was a retrospective descriptive-analytic study. All the patients suffering from trauma that required vascular surgery intervention and were referred to Imam Khomeini Hospital in Sari during 2016-2017 were included in this study.

Of 43 patients, 90.70% were male and 9.30% were female. The mean age of patients was 36.37±11.27years. The most frequent mechanism of trauma was motor accidents. The most extremity involvement was in the left lower limb and in terms of vascular damage; the peritoneal arterial region (23.20%) was the most frequently involved area. For orthopedic damage, 86% of the patients had fracture and 14% had dislocation. Based on the fracture site, the most frequent fracture was tibiofibular distal (23%) followed by knee joint (14%). Among the cases of fracture, the most abnormal type was open fracture (74/40%) and the most abnormal type of dislocation was anterior dislocation (9/40%).

The most frequent cause of vascular trauma was accidents with vehicles, and the need for more precise compliance with traffic regulations to reduce injuries should be considered. Also, vascular damages were associated with higher orthopedic fractures, mostly in the lower extremities of the left and in the popliteal region. Early diagnosis, early restoration, patient transfer to appropriate center, and the appropriate medical and surgical treatment can greatly reduce morbidity and mortality rates.

Non-syndromic bilateral humeroradial synostosis is a very rare congenital anomalies of the upper limbs. This condition often occurs in conjunction with various syndromes and is associated with a positive family history. Herein, we report a 6 year old boy with non-syndromic bilateral humeroradial synostosis, without aplasia, hypoplasia or family history. Both elbows were constant at 90 degrees flexion and the patient was not able to perform supination and pronation. Internal rotation, external rotation, and abduction movements of shoulder were normal. Except bilateral humero radial synostosis, findings of physical examinations, lab tests, and imaging were normal. Parents rejected surgical treatment.

Non::union:: of bone fracture is a clinical and treatment challenge. Satisfactory repair of orthopedic fractures is of great importance and systemic treatment is used to achieve this goal. This study aimed to investigate the effect of Teriparatide (CinnoPar®) on non::union:: fractures. A quasi-experimental study was conducted in 17 patients with non::union:: bone fractures. Radiographic evaluation was performed before the intervention and non::union:: was confirmed by a radiologist. Then, all patients received Teriparatide for three months. Afterwards, a control x-ray image was taken to assess the outcome. Sixteen patients (mean age: 45.18±20.51) with non::union:: fracture were evaluated, including nine males and seven females. The mean time after the accident was 50 ±24.48 weeks. Femoral bone was the most reported impaired site (n=8). After treatment with Teriparatide (CinnoPar®) improvements were seen in 10 patients (P= 0.002).  Treatment with CinnoPar® was found to be effective to some extent. However, due to the small sample size in this study, the efficacy of CinnoPar® needs further assessments.

K-wiresare generally used in orthopedic fracture surgery. Pinning with metal wires is a reasonable option for proximal humeral fractures treatment. One 91-year-old man received multiple K-wire fixation for left proximal humeral fractures. Later in postoperative follow-up at the outpatient department, he illustrated symptoms of tenderness, swelling, coin-sized bullae formation and ecchymosis over left axillary region.K-wire migration was noted, which lead to brachial artery injury with traumatic pseudoaneurysmformation. The patient underwent emergent surgery wherepreviously placed K-pins were removed and then received revascularization surgery afterward. Functional shoulder brace was adopted for his postoperative immobilization of left shoulder and fracture site bony :union: was noted an year later. He lead independent activity of daily life as previously before the accident.
Previous documents had reported potentially dramatic complications related to wires migration and most of them were intra-thoracic migration cases. We present the uncommon case of brachial artery injury with traumatic pseudoaneurysm. While it may not be as detrimental injury as intra-thoracic migration of K-pins, brachial artery penetration could lead to more undetected clinical symptoms and result in irreversible damage. Orthopedic surgeons should consider related risks when using K-wire fixation over proximal humerus,especially in cases of elder patients with possible lowcompliance to immobilization and low bone quality. Most important of all, doctors must alert patients about the importance of returning for follow-up evaluation postoperatively,and for the removal of K-wires.

Developmental dysplasia of the hip (DDH) includes a wide range of abnormalities of the hip that can emerge at any time including embryonic period, infancy, or childhood. The purpose of this study was to examine the clinical and radiographic outcomes of patients with DDH, treated with adductor tenotomy and closed reduction.

The study was retrospectively performed on 30 children (33 joints) with DDH,who were treated with adductor tenotomy, closed reduction and SpicaCast in Ahvaz Razi Hospital during 2015-2017. Inclusion criteria were patients diagnosed with DDH and below 2 years of age. Exclusion criteria were connective tissue diseases, secondary dislocation due to previous infection and acetabulum dysplasia in the context of specific syndrome. After the operation, the patients were evaluated for the severity of injuries associated with dislocation or subluxation of hip joint and hip joint congruity. Theradiographic results were studiedbased on Severin, Tonnis grading, McKay and acetabularindices.

The preoperative mean acetabular index of36.54 ± 3.27 degrees significantly dropped to postoperativeof 27.06 ± 2.15 degrees. According to McKay criteria, 90.9% of the patients had excellent and good therapeutic results after the surgery. According to Tonnis criteria, 93.9% of patients were in Class I and II after the surgery. Moreover, in radiographic evaluations,96.9% of the patients were in Class Ia and Ib  based on Severin criteria.In 1 patient (3.03%), osteonecrosis of the head was found, in 2 patients (6.06%), walking and lameness impaired walking, and in 3 patients (9.09%), sitting was reported. All patients were female in this study.

According to the clinical results and evaluations of this study, closed reduction along with adductor tenotomy can be used as an appropriate technique for the treatment of patients with DDH at an early age.

Osteoporosis is the most common metabolic bone disease. The aim of this study was to evaluate the effects of teriparatide on the incidence of fractures and bone density in postmenopausal women with osteoporosis. A clinical trial was performed in all postmenopausal women aged 45-75 years old with osteoporosis attending a teaching hospital affiliated to Mazandaran University of Medical Sciences, Sari, Iran. The participants were divided into control and experimental groups (30 patients per group). The experimental group received daily subcutaneous injection of teriparatide (CinnoPar® pen 250 mg, eight units) for six months. Patients in the control group received alendronate 70 mg weekly for six months. Fractures and densitometry were measured at baseline and after six months in both groups. Bone densitometry values in spine and femoral neck at baseline and after six months were significantly different between the experimental and control groups. Bone densitometry values increased dramatically in both groups. Alendronate significantly improved bone densitometry values of femoral neck after six months compared to baseline (p>0.002). Teriparatide significantly improved bone densitometry values of the spine after six months compared to the baseline (p>0.001), but did not have a significant effect on bone densitometry of femoral neck compared to baseline (p>0.085). Alendronate, calcium and vitamin D supplements are the first choices in treatment of osteoporosis in menopausal women. As the second-line treatment for osteoporosis, teriparatide could be used alone to relieve pain and improve bone density (especially in the spine) in postmenopausal women.

Background and purpose: Missed detection of some major trauma in the context of multiple trauma remains a persistent problem in both clinical aspects and forensic medicine. This study aimed at investigating the prevalence of missed injuries in patients with major trauma. This prospective cross-sectional study was done in all multiple trauma patients (7-28 years of age) admitted to emergency, orthopedic, and surgical departments in Sari Imam Khomeini Hospital, 2016. Data was collected using a checklist to study the demographic information (age and gender), mechanism of injury, time of injury, the type of trauma, and treatment interventions. SPSS V19 was used for data analysis. The patients were 82% males. The frequency of missed injury was 5.8%, including clavicles, metacarpal, scaphoid, acetabulum, femoral neck, intertrochanteric, heels, Lisfranc, and ankle fractures, and hip dislocation. The results indicated a relationship between the frequency of missed injuries and older ages, more trauma, male patients, blunt trauma, and higher level of consciousness
(P= 0.034). Also, in 44.4% of the cases, identifying the damage led to changing the non-surgical treatment to surgical treatment. Tertiary surveys in multiple trauma patients could be of great benefit in identifying missed injuries and eventually cause better patient management.

Postoperative infection has been one of the most frequent problems in orthopedics. The aim of this study was investigating type and amount of prophylactic antibiotics used in the orthopedic cases administered in Shahid Beheshti Hospital in Babol, northern Iran. Reporting these results can be helpful for better planning for control and management programs of health and treatment.
This cross-sectional study was conducted on 450 traumatic and non-traumatic patients underwent elective orthopedic surgeries and received antibiotic prophylaxis during 2015-2016. The necessary data were collected from the patient's records using a predesigned checklist. This checklist consisted of demographic information, type and mechanism of trauma and information related to prophylaxis (name of antibiotic, dosage, administration method, time to start prophylaxis, administration intervals and overall prophylaxis duration).
Out of 450 patients, 300 (66.7%) were male and others were female. The mean age was 42.37±21.53. The most commonly used antibiotic was cefazolin (n=437, 97.3%) and gentamycin (n=276, 62%), and the lowest was amikacin (n=8, 1.8%). Mean duration of use was 4.92±1.8 days, ranging from 1 to 15 days.
The results showed that the use of prophylactic antibiotics is high and they should be administered with more precise control. The most commonly used antibiotic for prophylaxis was cefazolin and the least was amikacin.

Orthopedic trauma is a common injury in children and may cause deep and permanent psychological and physical damages for the patients and their families. Recognition of the incidence rate of these injuries can help design effective treatment plans. This study aimed to identify various dimensions of orthopedic trauma in children in Abu Ali Sina Hospital of Sari, Northern Iran. In this prospective descriptive study, patients under the age of 16 years with orthopedic injuries, hospitalized in Bu Ali Sina Hospital during 2015-2016 were entered into the research. Information related to the age, gender, and mechanism trauma was collected. Data analysis was performed in SPSS using Chi-square, as well as paired and one-sample t-tests. In total, 525 patients below the age of 16 years were assessed, (65.3%) with a mean age of 9.7±4.4 were male years and the rest were female (34.7%) with the mean age of 7.7±6.4 years. While most injuries in male subjects were in the age range of 14-16 years, for female participants two poaks in the age ranges of 2-4 and 14-16 years was seen. Moreover, 81.7% of the fractures were related to the upper limbs while 18.3% of the traumas were observed in the lower limbs. Furthermore, the most common location of incidents was home, and most frequent mechanism in both genders was falling (42.3%). In addition, the most common time of injuries was the fall season (44.6%). According to the results, most orthopedic trauma (56.7%) were observed in children and adolescents with normal body mass indexes, and only 8.29% of fracture cases were related to obese or overweight patients aged 2-16 years. Children are at risk of severe orthopedic trauma, which is due to lack of information, awareness, and education. Examining the safety of children and keeping them away from such injuries is essential and must be stadied in other large cities in other the developing countries.

congenital foot deformities are among the most common congenital abnormalities causing morbidities, disturbing the normal gait and affecting patients’ quality of life. The aim of our study was to find out the prevalence of such abnormalities in neonates born at a referral center in northern Iran. This study was a descriptive cross-sectional study on the neonates born in Imam Khomeini hospital of Sari in a two-year period. The variables considered in our study were gestational age at the time of delivery, medical conditions complicating the pregnancy including diabetes, chronic hypertension, obstetrical complications like olygohydramnios, polyhydramnios, and malpresentations, mothers' age, chronic diabetes, hypertension, mothers' addiction, sex and birth weight of the newborn, history of having a child with congenital limb anomaly and the type of delivery. Photography of newborns' feet was taken on first day of birth to be assessed by an orthopaedic surgeon. In addition, the babies were examined the day after birth by one of the two neonatologists and the suspicious cases were referred to the orthopedic surgeon. Statistical analysis was performed by SPSS software. From 2025 neonates studied, 210(10.4%) calcaneovalgus, 7 (0.3%) clubfoot, 156(7%) cases of ''PesVarus'', 22 cases of (1.1%) metatarsus adductus, and 1 case of polydactyl were recognized. Among all variables, only mothers' age and cigarette smoking during pregnancy had association with congenital foot abnormalities. The most prevalent congenital abnormalities in our study was Pes Calcaneovalgus and a positional mild ''Pes Varus''. The low rate of club foot, polydactyly and metatarsus adductus are notable,

Various studies have been conducted on the local and systemic effects of orthopedic hardware. This study aimed to evaluate the pathologic reactions to orthopedic hardware (nail and plate) in patients.
In this descriptive study, the pathologic reactions of 15 patients (12 males and 3 females) with a mean age of 37.41 years, who underwent orthopaedic hardware removal surgery in two Hospitals in Sari, Iran, were assessed through observation, laboratory tissue evaluation, and a questionnaire.
In this research, no allergic reaction was observed in the patients after the insertion of hardware. In this regard, 6.66% of patients reported infection after insertion of hardware, and there was one case of non::union::. Furthermore, no systematic complication was observed in any of the patients. The majority of patients had moderate tissue inflammation at the hardware site, and there was no evidence of malignancy in any of the pathology samples.
According to the results of the research, a moderate level of tissue inflammation might be observed at the site of orthopedic hardware placement.

A high percentage of patients with multiple traumas sustained at least from an orthopedic problem. One of the high frequent lesions was femoral shaft fracture. The aim of this study was to determine the amount of bleeding and the need for blood transfusion in femoral shaft fractures and risk factors.
This descriptive, retrospective study was done on 84 patients with femoral shaft fractures whom were operated in Imam Khomeini Hospital in, Sari, in northern Iran during 2012-15. Age, sex, comorbidities, type of fracture, hospitalization period, pre and post-operative hemoglobin and blood unit's loss were recorded for each patient.
In 43 patients (51.19%) plate and in 41 patients (48.80%) intramedullary naling were used for treatment of fractures.13 (15.47%), 33 (39.28%) and 37(44.04%) of patients were received one, two and three blood units, respectively. There was no significant relationship between energy intensity and age. There was significant relationship between the intensity and the type of fracture (P Based on the results of this study, it is recommended for hip fracture at least 3 units of blood should be reserved.