mohammad hosein ebrahimzadeh

The external fixators (pins) have many applications in orthopedic surgeries in the field of trauma. The success of clinical applications of external fixators has decreased due to their infection after orthopedic surgery. Meanwhile, the loosening of the pin embedded in the bone occurs due to the presence of bacteria and the formation of biofilm on the pin, and this infection will progress to the joint surface of the bone and the pin. Among the different techniques to improve the bone-pin interface in external fixation, coating the pins with antibacterial materials proved to be the most effective. Accordingly, the present study has focused on synthesis by sol gel method, structural, and antibacterial evaluations of Ag-FHA structure. The FESEM images and Mapping analysis confirmed the nano-scale size and homogeneous dispersion of particles in the Ag-FHA structure, respectively. In addition, the FTIR results indicated the hydroxyapatite formation in obtained structure. The XRD analysis has shown that the conversion of the amorphous phase to the crystalline phase occurred in all structures at a temperature of about 300 to 350 ° C , and the formation of the HA phase is increased and completed at 600 ° C. The antibacterial study was done by minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) determination. The obtained results showed that the Ag 0.2-FHA could significantly inhibit the growth of Staphylococcus aureus and Escherichia coli.

Fixators are the basic equipment for fractures that are divided into two categories, internal and external. The success of clinical applications of external fixators has decreased due to their infection after orthopedic surgery. Meanwhile, the loosening of the pin embedded in the bone occurs due to the presence of bacteria and the formation of biofilm on the pin, and this infection will progress to the joint surface of the bone and the pin. Natural elements with antibacterial activity attract much attention as a coating on implants surface in orthopedics surgery. This article reviewed common elements with antibacterial activity that can be loaded into the HA structure as a coating for improving their clinical efficiency. Substitution ions such as copper, silver, magnesium, strontium, zinc, silicon, and fluoride in an appetite network can stimulate bone formation at the fracture site. In this article, common antibacterial ions in the form of loading -HA have been investigated as coating orthopedic fixators. good strength and antibacterial activity presented for silver, and corrosion resistance and high porosity are advantages of copper. Also, magnesium with favorable biocompatibility and biodegradability, zinc with high strength, and silicon and fluorine with high flexibility, favorable mechanical properties, and corrosion resistance are introduced. Among the mentioned elements, silver and fluoride, due to having more favorable antibacterial activity and excellent bone regeneration, can be more suitable candidates for loading in the HA structure with the application of the coating on the orthopedic surface.

To improve the education of orthopaedic residents and enhance patient care in the Iran's healthcare system, it is necessary to gather information about the current status of scientific, practical, and research-based education for residents.

The research project initially focused on examining the executive curriculum in 14 centers affiliated with 6 different medical universities. Subsequently, an investigation was conducted into human resources, infrastructure, operating room facilities, educational and research outcomes, as well as the regular implementation of practical examinations to evaluate the performance of residents during their residency years. All the aforementioned aspects were covered using a comprehensive questionnaire, which was distributed via the "Formafzar.com" website as a link to the heads of departments in these centers by the Iranian Orthopaedic Association. The relationship between facilities and equipment and passing the future specialized orthopaedic board examination was also evaluated.

Among the examined centers, only 20% adhered to the criteria of Iran educational curriculum in all aspects of human resources, education, and research.

a regular evaluation of teaching methods used by international centers and the national curriculum is necessary for orthopaedic training centers in Iran. Additionally, regulatory systems should monitor the training process of orthopaedic residents to standardize services, equipment, and educational programs in the country.

Ankle arthrodesis is one of the major surgeries for the treatment of advanced osteoarthritis of the ankle joint. There are various techniques available for ankle arthrodesis and each technique has unique advantages and disadvantages. The aim of the present study was to evaluate the results of ankle arthrodesis with two this different approaches.

The medical records of the patients who were admitted for ankle arthrodesis and treated by a single surgeon from January 2015 to January 2020 were reviewed. The patients were recalled for re-evaluation after a mean follow-up of 19 months. Functional outcomes were assessed using validated AOFAS Ankle-Hind foot score, Manchester-Oxford Foot Questionnaire (MOXFQ) and visual analog scale (VAS) score for pain. The collected data were recorded in a pre-designed checklist and then analyzed using SPSS software.

A total of 32 patients, 18 men and 14 women with a mean age of 46.7 years were included in the study. 67.6% had history of ankle fractures. Anterior approach was used in 24 patients, 75%, and the rest of the patients had surgery with lateral approach (25%). The most common instrument for arthrodesis was concomitant use of plate and screws in 18 patients (56%). Union occurred in 28 patients (87.5%) within 11.1 weeks after the surgery. The AOFAS score increased significantly and MOXFQ and VAS scores decreased significantly following the surgery (p<0.001 for each). Advanced age and intramedullary nail were related to prolonged time to union (p<0.05). Surgical approaches (either anterior or lateral) had no association with AOFAS, MOXFQ, and VAS scores. Non-union was seen in 4 patients (12.5%) and deep infection in 3 patients (9.3%) after ankle arthrodesis.

The study results showed that, this surgery could improve patients’ pain and function with relatively low post-operative complications.

 Pulley is a synovial tissue that attaches the flexor tendons to the dorsal portions of the fibro-osseous tunnel near the tendon attachment. Pulley type A with ring structure is one of the most important pulleys in fingers. Two-stage reconstruction by silicon is the common treatment in damaged tendon which has long recovery time and the tendency of the repaired tendon to adhere to the fibrous-bone tunnel around it. Accordingly, the one-stage reconstruction by synthetic pulley is a promising approach to resolve the mentioned problems.

 In the present research, the polyurethane (PU) nanofiber scaffolds have been designed for synthetic pulley applications, and their mechanical and structural properties have been evaluated.

 The structural properties of nanofiber scaffolds show similar properties to protein and polysaccharide fibers in the extracellular matrix (ECM). The Fourier transform infrared spectroscopy (FTIR) results confirmed the functional groups of PU without any unwanted reactions. The amount of stress (3.19 ± 0.54) and Young's modulus (1.20 ± 0.39) in PU nanofiber scaffolds show similar mechanical properties to natural pulley.

 The obtained results showed that the PU nanofibers scaffolds can be proposed as a suitable candidate for fabrication of synthetic pulley in flexor tendon injuries.

Occurrence of infection is one of the complications of orthopedic surgery, which has bad consequences for the patient and the health care system. Loosing of bone tissue occurs due to the formation of a biological layer on the implant fixator, and it leads to the breaking of the infected implant and subsequently to local inflammation and bone destruction. In this review article, the effect of hydroxyapatite-loaded with antibiotics, due to its effective biological activity and appropriate chemical structure in orthopedic treatments is investigated. Vancomycin, gentamicin and tobramabicin are common antibiotics in orthopedic surgeries. The use of these mentioned antibiotics by injection cannot effectively reduce or treat the infection on the surface of the implant. In this regard, the use of antibiotic coatings on the implant surface can be a more effective method in controlling infection after orthopedic surgeries. Studies show that the implants coated with hydroxyapatite-loaded with antibiotics are a suitable choice for useful applications such as reducing recovery time, reducing pain and simultaneous growth of new bone on the implant. Researchers showed that the antibacterial activity and clinical applications of implants coated with hydroxyapatite along with antibiotics are very effective in orthopedic surgeries. All the examined antibiotics showed favorable results in the treatment of infection, and Vancomycin, due to its longer release time and the lowest level of toxicity compared to other antibiotics, can be used as a medicine. With more successful clinical results, it can be used in hydroxyapatite loading in order to cover the orthopedic schanzes

Several devices have been described for fixation of displaced medial malleolar fractures. Fullythreaded cancellous screws engaging the bone may provide advantages compared to partially threaded screws.This study was designed to compare the clinical results of fully and partially threaded 4 millimeter cancellousscrews in fixation of medial malleolar fractures.

In a randomized clinical trial study 44 patients with displaced closed medial malleolar fractures wererandomly divided into two groups. Two fully threaded four millimeter cancellous screws were used for fracturestabilization (FT group) in the first group, while, the second group was operated by use of two partially threaded fourmillimeter cancellous screws (PT group). The clinical outcomes and complications were compared in two groups atone year follow up.

Nineteen patients in FT group and 21 in PT group were present at final follow up. Nonunion was notdeveloped in either group but two cases (9%) of delayed union occurred in PT group. The rate of postoperativeinfection and symptomatic hardware were not statistically different. Functional assessment using AOFAS, MOXFQand VAS scores showed no significant difference between the two groups.

Both fully and partially threaded 4 mm cancellous screws can be considered as acceptable devices forthe fixation of medial malleolar fractures with good and comparable clinical results.Level of evidence: I

To study the creep behavior for a series of biodegradable nanocomposites, which are used as implantable devices in the body such as bioscrews, is a crucial factor. In the current paper, we are investigating these biomaterials -short-time creep and creep recover manners- in several classic models.

The creep and creep recovery behaviors of nanocomposites composed of biodegradable polymer blends, poly (D/L) lactic acid (PDLLA) and polycaprolactone (PCL) reinforced with three different contents of 1, 3 and 6 percent weight percentage (Full name?)% bioactive glass nanoparticles (m-BGn) were modeled. Several theoretical models including Findley power law, Burgers and Weibull models were used to establish the relations between m-BGn dispersion and final creep and creep-recovery behaviors of nanocomposites.

The Findley power law model confirmed that the lowest ‘A’ and highest ‘n’ parameters ( A is the amplitude of the transient creep strain and n is the time exponent) belong to the sample with the highest young modulus and the nanocomposites compared to PDLLA/PCL  blends have the lower ‘A’ and higher ‘n’ which can be related to retardation effect of m-BGn on creep strains. Besides, the burgers model results illustrated that all viscoelastic and viscoplastic parameters for nanocomposites possess higher values than those of the neat PDLLA/PCL blend. It means that the addition of glass nanoparticles leads to decrease creep strain , increasing the Burgers model prediction values which have inverse trend with . Moreover, the weibull distribution model results acknowledge that the introduction of m-BGn into PDLLA/PCL polymeric blends cause decrease  in the viscoelastic strain recovery values. This is due to hindering effects of m-BGn on creep recovery behavior of nanocomposites.

The results obtained from modeling of creep-recovery manners of PDLLA/PCL blend and its nanocomposites approved that the bioactive glass reinforcement nanoparticles play  impeding role on creep and creep recovery behaviors..Level of evidence: I.

Foot function index (FFI) is a worthy subjective patient reported outcome measures (PROM) tool forevaluation of the outcomes of medical interventions on foot and ankle. This study was conducted to assess the validityof the Persian version of the foot function index (FFI). After translating the original FFI into Persian, back-translation was performed on the agreed Persian versionand the final version was established. A total of 113 Persian-speaking patients with foot and ankle problems wereenrolled in this study and were asked to fill in the FFI. The Cronbach’s alpha for subsections of FFI and MOXFQ was above 0.8 and 0.7, respectively, while it was0.95 and 0.93 for total FFI and MOXFQ, respectively. The ICC for all subsections of MOXFQ and FFI was above 0.7.The Pearson’s correlation coefficient for all subsections of FFI and MOXFQ was significant (P<0.01). The Persian version of FFI is valid and reproducible in Persian speaking population.Level of evidence: IV

the aim of this study is to evaluate the prevalence and effect of depression and anxiety on the shoulder range of motion, as well as the objective and subjective symptoms in patients suffering from frozen shoulder. Between 2013 and 2014, in a cross‑sectional study, we evaluated 120 patients with idiopathic frozen shoulder. We collected the demographic data for each patient and measured shoulder range of motion in four directions in both limbs. All patients flled out visual analog scale (VAS) for pain and the disabilities of the arm, shoulder, and hand (DASH) questionnaires. Both Hamilton anxiety and depression questionnaires were flled out for each patient. A total of 92 patients (77%) with idiopathic frozen shoulder showed symptoms of depression, while only 32 (27%) of them experienced anxiety. Thirty‑two patients (27%) showed symptoms of both depression and anxiety. Although elevation and abduction were not affected by depression, internal and external rotations were more restricted among patients who had symptoms of depression. DASH and VAS scores were higher in patients with symptoms of depression. In terms of anxiety, only VAS and DASH were different between two groups. In multivariable analysis, DASH score was correlated with severity of both anxiety and depression symptoms. While there is no defnitive relationship between symptoms of depression or anxiety and shoulder range of motion in patients suffering from frozen shoulder, patients who suffer from depression or anxiety experienced increased pain and limb disability.

The aim of this study was to compare the therapeutic effects of four methods of ultrasound (US) alone or in combination with low-level laser therapy (LLLT) (L/US), intra (InCI), and extra (ExCI) sheath US-guided corticosteroid injection in the treatment of long head of the biceps (LHB) tendonitis. In a randomized clinical trial, patients with LHB tendonitis were enrolled in four groups (US, L/US, InCI, and ExCI). Pain using visual analogue scale (VAS) and shoulder performance according to Constant-Murley score (CMS) were evaluated at five visits of before, one week, one month, three months, and one year after treatment. VAS and CMS scores were improved after treatment in all four groups and at all visits in comparison with before treatment. The VAS score in the one-week visit was lower in the InCI group than in all other groups, but it became similar to the score of the ExCI group after this visit and was significantly lower than the score of the US group one year after treatment. CMS was similar at all visits between InCI and ExCI. At one-week and one-month visits, significant differences were seen between the injection groups and the two other non-injection groups, but at the last visit, CMS of the InCI group was only significantly different from that of the US group. Although intrasheath corticosteroid injection under US guidance is an effective method for the treatment of LHB tendonitis, especially in the 1st week after treatment, extra sheath injection also has acceptable results. Using L/US as a less invasive treatment could be as effective as using corticosteroid injection in long-term.

Knee dislocations are uncommon (<0.5% of all dislocations); however, they may result in catastrophic outcomes secondary to their high-energy nature and neurovascular injuries. The objective of this study was to evaluate the clinical outcome of knee dislocation management. Subjects and A total of 20 consecutive adult patients with knee dislocation were enrolled in this cross-sectional study between 2011 and 2014. A single knee surgeon examined all the patients for knee instability for subjective evaluation of knee function using the Lysholm Knee Questionnaire, Knee Society Score (KSS), and Short Form-36 (SF-36). The average Lysholm Knee Scores and KSS were 68 (range: 18–100) and 65 (range: 15–97), respectively. All domains of SF-36 among the studied patients were lower than that of the normal population. We could not find any correlation between age, body mass index, and interval between initial trauma and operation with outcome variables (Lysholm Knee Score, KSS, and SF-36 Physical Component Score, and SF-36 Mental Component Score). The knee function after proper management of dislocation is reasonable, but prolonged course of management and multiple operations may decrease the patients' quality of life.

In surgical treatment of thoracolumbar burst fractures, most authors try to lower the number of vertebrae involved during the surgery.
The aim of this study was to evaluate the outcome of a medium-segment posterior spinal fixation in these patients.
Patients and We retrospectively reviewed 27 patients (18 male, 9 female) with mean age of 39.4 ± 15.0 years old in a before-and-after study. The mean follow-up period was 38.4 ± 15.6 months. We involved 2 intact above vertebrae and one intact below vertebra, inserting a pedicular screw at the fractured level and supplemented the construct with contralateral infralaminar hook. Clinical and radiologic characteristics were assessed with American spinal injury association (ASIA) scale, oswestry disability index (ODI), visual analogue scale (VAS), and plain radiography. Data analysis was carried out by SPSS version 11.5 software.
Mean post traumatic kyphosis was 15.7° ± 3.3° that was changed to - 8.5° ± 4.3° and ° ± 4.4° at immediate and last visit after surgery, respectively. Mean loss of correction (LOC) was 9.5° ± 1.9° (P In surgical treatment of thoracolumbar burst fractures, a medium-segment posterior spinal fixation, although cannot maintain the radiologic reduction of the fractured vertebrae efficiently, is not only associated with acceptable clinical outcome but also spare one lower intact lumbar segment and therefore recommended.

Frozen shoulder is resulting in limb disability and reduction of quality of life but the factors associated with patients’ disability and quality of life is not clear. To assess pain, disability, the quality of life and factors associated with them in patients suffering from frozen shoulder.
We enrolled 120 patients (37 men and 83 women) with phase-II idiopathic frozen shoulder in our cross-sectional study. Demographic data were collected and shoulder range of motion was measured in four different directions (elevation, abduction, external and internal rotation) in both upper limbs. Patients were asked to fill out Visual Analog Scale for pain (VAS) and, Short-Form Health Survey questionnaire (SF-36) as well as Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. We asked the patients to fill out the Hamilton anxiety and depression questionnaires.
The mean of VAS pain, DASH, PCS, and MCS scores were 69(18), 53(17), 35(8.0), and 42(10) respectively. All the domains of SF36 questionnaires where below the normal population except physical function. VAS pain score was correlated to Hamilton depression scores in both bivariate and mulivarilable analysis. DASH score were correlated to sex, age, ROM, and both Hamilton anxiety and depression scores; However, DASH score only impact with Hamilton anxiety and ROM independently. PCS is correlated to age and MCS to Hamilton depression.
Patient with frozen shoulder are more suffering from pain and disability secondary to psychiatric parameters such as depression and anxiety than demographic features or even restriction of range of motion.

Radial tunnel syndrome is a disease which we should consider it in elbow and forearm pains. It is diagnosed with lateral elbow and dorsal forearm pain may radiate to the wrist and dorsum of the fingers. The disease is more prevalent in women with the age of 30 to 50 years old. It occurs by intermittent compression on the radial nerve from the radial head to the inferior border of the supinator muscle, without obvious extensor muscle weakness. Compression could happen in five different sites but the arcade of Frose is the most common area that radial nerve is compressed. To diagnosis radial tunnel syndrome, clinical examination is more important than paraclinic tests such as electrodiagnsic test and imaging studies. The exact site of the pain which can more specified by rule of nine test and weakness of the third finger and wrist extension are valuable physical exams to diagnosis. MRI studies my show muscle edema or atrophy along the distribution of the posterior interosseous nerve. Although non-surgical treatments such as rest, NSAIDs, injections and physiotherapy do not believe to have permanent relief, but it is justify undergoing them before surgery. Surgery could diminish pain and symptoms in 67 to 93 percents of patients completely.

The prevalence of neglected developmental dysplasia of the hip (DDH) has been decreasing. Nowadays, the disease is rarely seen in walking age children. The purpose of this study is to assess the results of simultaneous osteotomy of femur and pelvic bones in such children. We performed a retrospective study on 30 children aged 3.8±0.9 (range: 1.5-7) years old, with DDH who underwent surgical operation in our hospital from August 2001 to September 2006. Tönnis and Severin grading systems were used to classify the radiographic status of the hip in pre- and postoperative era, respectively. Improvement in function and limp was also evaluated by the modified McKay’s classification. From the 30 cases, six patients excluded in the course of the study and among the remaining patients, 12 had bilateral involvement. The mean follow-up period was 7.6±0.8 (range: 5.1-11.3) years. During the last visit, radiographic status of the operated joints, according to Severin classification was as follows: Class I: 12 patients; Class II: 20 patients; Class III: 3 patients; Class IV: 1 patient; and Class VI: 1 patient. Although through the follow-up, two hips subluxated, necrosis happened in three and one joint was re-dislocated, simultaneous femoral and innominate osteotomy in the walking age children with DDH has relatively good clinical outcomes.

Fractures of the knee account for about 6% of all trauma admissions. While its management is mostly focused on fracture treatment, it is not the only factor that defines the final outcome.

This study aimed to study objective and subjective outcomes after proximal tibial versus distal femoral fractures in terms of knee instability and health-related quality of life.

This retrospective, cross-sectional, cohort study was carried out on 80 patients with either isolated proximal tibial (n = 42) or distal femoral (n = 38) fractures, who underwent open reduction and internal fixation. All the fractures were classified based on the Schatzker and AO classification for tibial plateau and distal femoral fractures, respectively. The patients were followed and examined by an orthopedic knee surgeon for clinical assessment of knee instability. In their last follow-up visit, these patients completed a Lysholm knee score and the short-form (SF) 36 health survey.

Among the 42 tibial plateau fractures, 25% were classified as Schatzker type 2. Of the 38 distal femoral fractures, we did not find any type B1 or B3 fractures. The overall prevalence of anterior and posterior instability was 42% and 20%, respectively. Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL) injuries were detected clinically in 50% and 28%, respectively. The incidence rates of ligament injuries in tibial plateau fractures were as follows: Anterior Collateral Ligament (ACL) 26%, Posterior Collateral Ligament (PCL) 7%, MCL 24%, and LCL 14%. Medial collateral ligament injury was the most common in the Schatzker type 2 (50% of the injuries). Distal femoral fractures were associated with ACL injury in 16%, PCL in 13%, MCL in 26% and LCL in 14%. However, final knee range of motion (ROM) and function (Lysholm score) were not associated with fracture location. No statistically significant difference was observed between the two groups, except for the valgus stress test at 30°knee flexion, which was more positive in tibial fractures. All eight domains of SF-36 score in the distal femoral and proximal tibial fractures were significantly different from the normal values; however, there were no statistically significant differences between femoral and tibial fracture scores.

Although ROM is acceptable in knee joint fractures, instability is common. However, it seems that knee function and quality of life are not associated with the location of the fracture

Providing care for patients with chronic disability affects caregivers’ social lives and relationships and can lead to poor health and lower quality of life.

In this study, our goal was to assess the quality of life in spouses of war veterans with bilateral lower limb amputations to find factors affecting caregivers’ quality of life.

In a cross-sectional study, spouses of 244 veterans with war-related bilateral lower limb amputations for at least one year were invited to participate in this study; 189 couples accepted to participate. Information about age, gender, education level, duration of time since amputation, duration of care provided by the spouses and SF-36 questionnaire for both veterans and their spouses were collected.

The average age of spouses was 47 years and duration of care provided by spouses was 25 years. We found lower scores for general health domains in amputees’ spouses compared to the general population. Factors correlated with both Physical Component Summary (PCS) and Mental Component Summary (MCS) included the duration of care, duration of marriage, spouses’ education level and the veterans’ PCS and MCS scores. Veterans’ age, spouses’ age and the number of children only correlated with PCS. Veterans’ education level only correlated with MCS. In multivariable analysis, only spouses’ education level correlated with MCS and the veterans’ PCS only correlated with that of spouses.

The quality of life of amputees and their spouses were closely correlated; therefore, any improvement in one is likely to improve the other. In addition, lower education level should be considered as a risk factor for poorer quality of life in amputees’ spouses.

Recently, investigations have indicated that caring of a chronically ill family member strongly influences the health status and the quality of life (QOL) of the caregiving family members.. The purpose of this study was to examine the relationship between health-related QOL of veterans with chronic spinal cord injury and their caregiving spouses..Patients and We designed a cross-sectional study including two groups; veterans with chronic spinal cord injury and their caregiving wives who were living in the city of Mashhad, Iran. The patients with spinal cord injury were veterans from the Iran-Iraq war (1980-1988). All the participants filled out the short form 36 (SF-36) health survey questionnaire. A Pearson correlation coefficient was calculated for the scales of the two groups.. The mean age and standard deviation of veterans and their spouses were 48.5 ± 5.9 and 44.8 ± 7.2, respectively and their number of children ranged between 0-6. Our data analysis showed that there was a significant difference between the two groups in some domains of the SF-36, including PF, MH, PCS, MCS, BP and GH (P < 0.05), but there was no significant difference in RP, VT, SF and RE between the two groups.. The results indicate that a decrease in health status level of veterans, physically and mentally, can affect the health-related QOL of their caregiving spouses..

The Oxford Knee Score (OKS) is a short patient-reported outcome instrument that measures pain and physical activity related to knee osteoarthritis. The purpose of this study is to evaluate, construct validity and consistent reliability of the Persian version of the OKS. The case series consisted of 80 patients who were clinically diagnosed with having knee osteoarthritis. All patients were requested to fill-in the Persian OKS and Short-Form 36 Health Survey (SF-36). Correlation analysis between the Persian versions of these two instruments was then carried out. The scores of the Persian SF-36 were used to evaluate convergent and divergent validity of the 12-item Persian OKS. From a total of 80 patients, 63 were female (79%) and the remaining 17 were male (21%) with a mean age of 52.2 years. In the present study, high Cronbach’s alpha of 0.95 confirms excellent internal consistency of the Persian OKS scale similar to previous investigations. The results confirm that the Persian version of this instrument is valid and reliable, similar to its English index and its subsequent translations in different languages. The Persian OKS is a reliable instrument to evaluate knee function in patients with knee osteoarthritis and is a useful tool for outcome measurement in clinical research.

A seven year-old boy with several painless masses on the ribs and shoulder was referred to our hospital. The masses were so prominent that they prevented the child’s sleep. Since the patient had been ridiculed by his friends due to the rib prominences, he had refused to attend school. After clinical and radiological evaluations, the masses were diagnosed as hereditary multiple exostoses of the shoulder and ribs. He underwent surgery for cosmetic reasons resulting in the patient’s return to a normal life.

To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant,University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient. The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion. According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid-term outcomes.

Loss of motion is a well-known complication after elbow trauma and in severe cases, arthrolysis of elbow is the procedure of choice. The posterior approach might have some advantages especially in post-traumatic patients who have undergone the same surgical approach in the past.. The aim of this study was to evaluate the short-term outcomes of elbow arthrolysis through posterior approach. Moreover, we assessed the effect of operation on the patients’ quality of life.. Patients and During a retrospective-cohort study, the medical records of 14 patients (12 men, two women) whose range of movement had been limited post-traumatically and had undergone elbow arthrolysis with posterior approach were reviewed. Before intervention, the patients had a flexion less than 100 degrees or an extension lag of 30 degrees or more. For evaluation of the final outcomes, they were invited to participate in our study and the final range of motion, visual analogue score (VAS), disability of arm, shoulder and hand (DASH), Mayo elbow score (MES) and short form health survey (SF-36) scores were measured in the patients.. Mean age of the participants was 28.7 years. The interval from initial injury and arthrolysis was 16 months and the patients were followed for 14 months. The mean range of motion in patients before surgery was 35.8 degrees, which was increased to a mean of 108.9 after the surgery, indicating a 73.1 degrees improvement. The means of VAS, DASH, Mayo elbow and SF-36 scores in the patients were 1.6, 34, 68 and 43, respectively. A significant inverse correlation was found between the preoperative range of motion and final range of motion.. According to our results, elbow arthrolysis through posterior approach could be an effective technique with low complications. Since the final range of motion improved significantly, it might be a valuable method in promoting the patients’ quality of life..

We were curious about the degree of anxiety and depression and their effect on the quality of life of the caregivers of veterans with spinal cord injury (SCI). A convenience sample of 72 out of 120 caregiver spouses of veterans with spinal cord injury participated in our study. The Hospital Anxiety and Depression Scale (HADS) were considered as a measure of depression and anxiety. The World Health Organization Quality of Life BREF questionnaire (WHOQOL-BREF) was considered to evaluate the quality of life. To compare the caregivers, we enrolled 74 matched caregiver spouses of patients without spinal cord injury. The average age of the spouses was 44.7±6.5. The average time elapsed from the injury was 26.4±3.1 years. There was a significant difference in all domains of quality of life and depression between the caregivers and the control group, but there was not a significant difference in terms of anxiety. There was a negative correlation between depression and age, level of education and quality of life. Mental care support should be implemented for veterans and their spouses in addition to the provided facilities.