A Method of Time Prediction in Epiphysiodesis for Limb Length Discrepancy Based On Multiplier.

Objectives: The most critical step in the calculation of final limb length discrepancy (LLD) is estimating the length of the short limb after skeletal maturity(Sm). Paley's multiplier method is a fast, convenient method for calculating Sm and LLD after skeletal maturity; nonetheless, the calculation of the process of Sm and LLD in acquired type cases is complex in contrast to congenital type in this method. Notwithstanding, the multiplier method uses a variable called "growth inhibition" for the calculation process in acquired type LLD; however, its mathematical proof has not been published yet. The present study aims to find out whether there is an alternative way to estimate the length of Sm and LLD in skeletal maturity without using growth inhibition (GI) and its complex calculation process in acquired type LLD. Methods: We used trigonometric equations to prove the GI concept and conducted proportionality analysis to calculate the length of short limbs and LLD in skeletal maturity without using GI. Results: Based on the results, the following proportionality can estimate the length of the short limb in skeletal maturity. (ΔLm/ΔL = ΔSm/ΔS). Conclusion: The GI concept can be proved trigonometrically; nonetheless, its numerical value is not necessary for estimating the length of the short limb in skeletal maturity. Instead, a simple proportionality analysis serves the purpose of calculation.

Screening for Femoral Head Osteonecrosis Following COVID-19: Is It Worth It?

Objectives: Based on WHO data, as of June 2022, there were 532.2 million confirmed COVID-19 cases globally. In the initial phase of the COVID -19 pandemic, patients experiencing critical illness marked by severe respiratory distress were commonly subjected to corticosteroid treatment. Regrettably, the administration of exogenous corticosteroids stands as the prevailing cause of ONFH. In the current narrative review, we aim to evaluate if active screening should be utilized to diagnose post-COVID-19 ONFH in its early stages. Methods: The databases for PubMed, CINAHL, and Science Direct were systematically queried in March 2022. The search terms were as follows: "COVID-19", "severe acute respiratory syndrome", "coronavirus", "systemic steroid", "corticosteroid", "femoral head osteonecrosis", "avascular necrosis", or "steroid therapy." The included studies for review were all required to be peer-reviewed studies in the English language with Reported complications linked to steroid therapy in COVID-19 patients or potential connections to the development of ONFH in individuals recovering from the novel coronavirus have been documented. Results: Systemic corticosteroids were frequently employed in managing critically ill COVID-19 patients. The CDC reports up to June 2022 showed more than 4.8 million COVID-19 hospitalizations in the US, with approximately over one million patients receiving steroids. In a study of ONFH after infection with COVID-19, all patients had bilateral involvement. The average duration from the initiation of corticosteroid treatment to the onset of symptoms was 132.8 days. Conclusion: In summary, a distinct correlation exists between the administration of steroids to individuals with COVID-19 and the subsequent risk of ONFH. Moreover, an elevated dosage and prolonged duration of steroid therapy in COVID-19 patients are associated with an increased likelihood of developing ONFH. Therefore, active screening for high-risk patients, that may have received systemic corticosteroid treatment during a COVID-19 illness, may be reasonable.

The Atypical Dopamine Transporter Inhibitor CE-158 Enhances Dopamine Neurotransmission in the Prefrontal Cortex of Male Rats: A Behavioral, Electrophysiological, and Microdialysis Study.

BACKGROUND: Dopamine plays a key role in several physiological functions such as motor control, learning and memory, and motivation and reward. The atypical dopamine transporter inhibitor S,S stereoisomer of 5-(((S)-((S)-(3-bromophenyl)(phenyl)methyl)sulfinyl)methyl)thiazole (CE-158) has been recently reported to promote behavioral flexibility and restore learning and memory in aged rats. METHODS: Adult male rats were i.p. administered for 1 or 10 days with CE-158 at the dose of 1 or 10 mg/kg and tested for extracellular dopamine in the medial prefrontal cortex by means of intracerebral microdialysis and single unit cell recording in the same brain area. Moreover, the effects of acute and chronic CE-158 on exploratory behavior, locomotor activity, prepulse inhibition, working memory, and behavioral flexibility were also investigated. RESULTS: CE-158 dose-dependently potentiated dopamine neurotransmission in the medial prefrontal cortex as assessed by intracerebral microdialysis. Moreover, repeated exposure to CE-158 at 1 mg/kg was sufficient to increase the number of active pyramidal neurons and their firing frequency in the same brain area. In addition, CE-158 at the dose of 10 mg/kg stimulates exploratory behavior to the same extent after acute or chronic treatment. Noteworthy, the chronic treatment at both doses did not induce any behavioral alterations suggestive of abuse potential (e.g., motor behavioral sensitization) or pro-psychotic-like effects such as disruption of sensorimotor gating or impairments in working memory and behavioral flexibility as measured by prepulse inhibition and Y maze. CONCLUSIONS: Altogether, these findings confirm CE-158 as a promising pro-cognitive agent and contribute to assessing its preclinical safety profile in a chronic administration regimen for further translational testing.

Does the postoperative quality of reduction, regardless of the surgical method used in treating a calcaneal fracture, influence patients' functional outcomes?

BACKGROUND: The extensile lateral approach (ELA) and sinus tarsi approach (STA) are commonly utilized for surgically treating calcaneal fractures. This study compared the outcomes of ELA and STA in the management of calcaneal fractures and assessed the influence of postoperative quality of reduction on functional and pain scores. METHODS: The study included 68 adults with Sanders type-II and type-III calcaneal fractures who underwent either ELA or STA surgery. Pre- and postoperative radiographs and computed tomography scans were analyzed, and functional and pain scores were evaluated using the Manchester Oxford Foot Questionnaire (MOXFQ), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and Visual Analogue Score (VAS) during follow-up visits. RESULTS: Out of the total patients, 50 underwent ELA surgery while 18 underwent STA surgery. The anatomic (excellent) reduction was achieved in 33 (48.5%) patients. There were no significant differences between the ELA and STA groups concerning functional scores, pain scores, the proportion of excellent reduction, and complications. Additionally, anatomic reduction, compared to near or non-anatomic (good, fair, or poor) reduction, demonstrated a decrease in MOXFQ (unstandardized ß coefficient: -13.83, 95% CI: -25.47 to -2.19, p = 0.021), an increase in AOFAS (unstandardized ß coefficient: 8.35, 95% CI: 0.31 to 16.38, p = 0.042), and a reduction in VAS pain (unstandardized ß coefficient: -0.89, 95% CI: -1.93 to -0.16, p = 0.095) scores. CONCLUSION: In conclusion, we found no significant differences regarding complications, excellent reduction, and functional scores between STA and ELA surgeries. Therefore, STA may be an effective alternative for the treatment of calcaneal fractures in Sanders type II and type III calcaneal fractures. Furthermore, the anatomic reduction of the posterior facet correlated with improved functional scores, emphasizing the importance of achieving it for restoring foot function regardless of surgery type or time between injury and surgery.

Job satisfaction, Career Burnout, and Work-Related Well-Being Prevalence among Orthopedic Surgeons: A Nationwide Study.

Background: Burnout is a well-known consequence of chronic stress. Orthopedic surgery is among the most desired specialty among Iranian medical students. The nature of the job, the income, and the ability to deal with stress can all be stressful factors for orthopedic surgeons. Nonetheless, little is known about how these medical doctors work and live in Iran. The present study aimed to assess job satisfaction, engagement, and burnout among Iranian orthopedists. Methods: A nationwide online survey was conducted in Iran. Job satisfaction, engagement, and burnout were evaluated using the job description index (JDI), Utrecht Work Engagement Scale, and Maslach Burnout Scale. They were also asked some additional questions related to career choice. Results: A total of 456 questionnaires (41% response rate) were retrieved. Overall, 56.8% of the participants experienced burnout. The burnout levels significantly differed based on age, years from graduation, working in public hospitals, operating more than 10 patients in a week, monthly income, having less than two children, and being single (P<0.05). They scored higher on work questions on the present job and jobs in general but lower scores on pay and opportunities for promotion. Conclusion: In a national study of orthopedic surgeons, their primary concern in JDI was "pay and promotion." Burnout was substantially associated with respondents' characteristics, such as younger age and having fewer children. This will lead to impaired performance, increased patient complaints, and the tendency to immigrate.

Role of Hip Arthroscopy in the Treatment of Avascular Necrosis of the Hip: A Systematic Review.

Background: Avascular necrosis (AVN) or osteonecrosis of the femoral head occurs as a result of a vascular supply disruption that could lead to hip osteoarthritis. Recently, several joint-preserving procedures have been suggested to improve the outcome of AVN, including hip arthroscopy. This systematic review aimed to investigate the role of hip arthroscopy to preserve hip joints suffering from AVN. Methods: This review was conducted to collect data on hip arthroscopy from the available literature for the management of AVN. The collected articles included those that were focused mainly on the management of AVN assisted by arthroscopy and published up to 2020 that were searched in four databases using such keywords as "Avascular Necrosis", "AVN", and "Osteonecrosis" in combination with "Hip Arthroscopy" or "Arthroscopic Hip Surgery". Results: In total, 13 articles met the eligibility criteria, and no severe complications were reported after arthroscopy in patients with AVN. Moreover, the Harris scores were higher than 79 after the operation. The majority of the assessments showed that the use of arthroscopy was effective in the diagnosis and treatment of patients with AVN, except for one study, which had been performed on patients with stage IV AVN. Conclusion: The findings supported the idea that hip arthroscopy is effective in the treatment of AVN. This approach is becoming more popular for the diagnosis and treatment of hip disorders.

The medial prefrontal cortex to the medial amygdala connections may affect the anxiety level in aged rats.

BACKGROUND: Aging changes brain function and behavior differently in male and female individuals. Changes in the medial prefrontal cortex (mPFC)-medial amygdala (MeA) connectivity affect anxiety-like behavior. OBJECTIVES: Therefore, this study aimed to investigate the effect of aging and sex on the mPFC-MeA connection and its association with the level of anxiety-like behavior. METHODS: We divided the Wistar rats into the male and female young rats (2-3-month-old) and male and female old rats (18-20 months old). First, the open field test (OFT) was performed, and then 80 nl of Fluoro-Gold (FG) was injected by stereotaxic surgery in the right or left MeA. After 10 days, the animals were perfused, their brain removed, coronal sections cut, and the number of FG-labeled cells in the right and left mPFC of each sample was estimated. RESULTS: Based on our results, old animals revealed less anxiety-like behavior than young ones, and young females were less anxious than young males, too. Interestingly, MeA of old male rats received more fibers from the bilateral mPFC than young ones. Also, this connection was stronger in the young females than young males. Altogether, the present study indicated that old individuals had less anxiety-like behavior and stronger mPFC-MeA connection, and young female rats were less anxious and had a stronger connection of mPFC-amygdala than males of the same age. CONCLUSION: Thus, it seems that there is a negative relationship between anxiety levels based on the rat's performance in the OFT apparatus and the mPFC-MeA connection.

Effect of dimethyl fumarate on the changes in the medial prefrontal cortex structure and behavior in the poly(I:C)-induced maternal immune activation model of schizophrenia in the male mice.

BACKGROUND: The link between maternal immune activation (MIA) and the risk of developing schizophrenia (SCZ) later in life has been of major focus in recent years. This link could be bridged by activated inflammatory pathways and excessive cytokine release resulting in adverse effects on behavior, histology, and cytoarchitecture. The down-regulatory effects of immunomodulatory agents on the activated glial cells and their therapeutic effects on schizophrenic patients are consistent with this hypothesis. OBJECTIVE: We investigated whether treatment with the anti-inflammatory drug dimethyl fumarate (DMF) could rescue impacts of prenatal exposure to polyinosinic:polycytidylic acid [poly (I:C)]. METHODS: Pregnant dams were administered poly(I:C) at gestational day 9.5. Offspring born from these mothers were treated with DMF for fourteen consecutive days from postnatal day 80 and were assessed behaviorally before and after treatment. The brains were then stained with Cresyl Violet or Golgi-Cox. In addition to the estimation of stereological parameters, cytoarchitectural changes were also evaluated in the medial prefrontal cortex. RESULTS: MIA caused some abnormalities in behavior, as well as changes in the number of neurons and non-neurons. These alterations were also extended to pyramidal layer III neurons with a significant decrease in dendritic complexity and spine density which DMF treatment could prevent these changes. Furthermore, DMF treatment was also effective against abnormal exploratory and depression-related behavior, but not the changes in the number of cells. CONCLUSION: These findings support the idea of using anti-inflammatory agents as adjunctive therapy in patients with SCZ.

Comparison of the Dynamic Hip Screw with the Dynamic Hip External Fixator for Intertrochanteric Fractures: Report of a Randomized Controlled Trial.

BACKGROUND: Pelvic fracture is one of the most common fractures in the elderly, especially in the intertrochanteric region. Therefore, in the present study, an external fixator was designed specifically for intertrochanteric fractures. The present study aimed to compare the operating time, amount of bleeding, and mortality rate between the patients who received either dynamic hip external fixators (DHEF) or dynamic hip screw (DHS). METHODS: In 2018, 46 patients with intertrochanteric fracture due to trauma and high anesthesia risk were included in the study and randomly assigned to two groups of control (n=24, patients treated with DHS) and intervention group (n=22, patients treated with the DHEF). Treatment was carried out using the DHEF which was newly designed and placed outside the patient's body under short and light anesthesia. After 3 and 12 months of follow-up, the two groups were compared for some variables, including mortality rate, pain intensity, Harris hip score (HHS), cut-off rate of the device, femoral neck angles before and after the operation, hemoglobin changes, hematocrit levels before and after the operation, the number of injected blood units, and the number of hospitalization days. RESULTS: Mortality rate was higher in open surgery with DHS. The assessment of variables in both intervention and control groups demonstrated that duration of operation (P<0.001), hospitalization length, time to union (P=0.001), pain intensity five days after the operation, as well as changes in Hb and HCT, were significantly higher in the control group than the intervention group. The mean HHS scores of 83.5±14.3 and 78.2±11.5 were gained for the DHEF and DHS groups, respectively (P=0.22). CONCLUSION: Considering the superior results of treatment with the external fixator in comparison with the DHS, such as lower mortality rate and fewer complications, a dynamic hip external fixator can be prescribed in patients with intertrochanteric fractures and high anesthesia risk.

Comparison of Partially Threaded and Fully Threaded 4mm Cancellous Screws in Fixation of Medial Malleolar Fractures.

BACKGROUND: Several devices have been described for fixation of displaced medial malleolar fractures. Fully threaded 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 cancellous screws in fixation of medial malleolar fractures. METHODS: In a randomized clinical trial study 44 patients with displaced closed medial malleolar fractures were randomly divided into two groups. Two fully threaded four millimeter cancellous screws were used for fracture stabilization (FT group) in the first group, while, the second group was operated by use of two partially threaded four millimeter cancellous screws (PT group). The clinical outcomes and complications were compared in two groups at one year follow up. RESULTS: Nineteen patients in FT group and 21 in PT group were present at final follow up. Nonunion was not developed in either group but two cases (9%) of delayed union occurred in PT group. The rate of postoperative infection and symptomatic hardware were not statistically different. Functional assessment using AOFAS, MOXFQ and VAS scores showed no significant difference between the two groups. CONCLUSION: Both fully and partially threaded 4 mm cancellous screws can be considered as acceptable devices for the fixation of medial malleolar fractures with good and comparable clinical results.

Rhenium-188 radiosynovectomy for chronic haemophilic synovitis: Evaluation of its safety and efficacy in haemophilic patients.

INTRODUCTION: Radiocolloids labelled with less costly and more accessible radionuclides such as rhenium-188 are of interest to developing countries compared with those labelled with rhenium-186 and yttrium-90. AIM: This study was aimed to evaluate the efficacy and safety of radiosynovectomy using rhenium-188 in patients with chronic haemophilic synovitis and recurrent hemarthrosis. METHODS: In this quasi-experimental prospective study, 20 haemophilic patients were evaluated at preinjection, and at 1, 3, 6 and 12 months after injection. Magnetic resonance imaging (MRI) was done to measure synovial thickness and to calculate Denver score. Joint radiographs were taken to measure the Pettersson score. The Gilbert questionnaire, Functional Independence Score in Hemophilia (FISH) and visual analogue scale (VAS) for pain were completed, and the number of bleeding episodes and factor consumption were recorded at each follow-up visit. RESULTS: The number of bleeding episodes, the amount of factor consumption per month, VAS pain scores and synovial thickness decreased significantly over time (P < .05). Gilbert and FISH scores showed significant improvement (P < .001). However, Pettersson score and Denver score showed no significant changes after injection. Minor complications including temporary pain and swelling occurred in 20% of patients, and no major complication was observed after rhenium-188 injection. CONCLUSION: Our results indicated high clinical impact, efficacy, safety and low invasion of rhenium-188 in radiosynovectomy of haemophilic patients. Considering the availability and relatively low cost of rhenium-188 in developing countries, this can be a good treatment option for haemophilic patients with recurrent hemarthrosis, particularly when the synovial hypertrophy is not massive yet.

Injury Patterns among Motorcyclist Trauma Patients: A Cross Sectional Study on 4200 Patients.

BACKGROUND: Motorcyclists are among the most vulnerable groups of road accident victims, who are prone to a growing mortality rate due to the constant rise in the number of accidents. This study was performed to investigate the injury patterns among motorcyclist trauma patients admitted to Kamyab Hospital, the largest trauma center affiliated with Mashhad Univercity of Medical Sciences, Mashhad, Iran, due to an accident. METHODS: This cross-sectional study was conducted on motorcyclists referred to our hospital due to accidents from August 23, 2014 to August 22, 2016 to receive treatment. After the accurate examination of the collected data and correction of the potential errors, they were subjected to analysis. The gathered data included the demographic variables, injury pattern, accident time, and accident type. Data analysis was performed in Stata Software, version 12. RESULTS: A total of 4,205 motorcycle accident cases were hospitalized (14% of all cases were hospitalized during the two-year study period). The mean age of the patients was 30 years, and 88% of them were male (a male to female ratio of 7.3). Car- and pedestrian-motorcycle collisions were the most common causes of injury that accounted for 68% and 22% of the cases, respectively. The head was the most commonly injured site of the body; in this regard, 59.7% of the admitted patients and 85.4% of total death cases had a head injury. In addition, 67% of the target population received trauma in more than two parts of their body. The elbow, arm, and hip were the least regions involved. CONCLUSION: Motorcycle accidents cause severe physical injuries to the patients' body. Head injury was the most common type of trauma, leading to a wide range of disabilities. Therefore, the use of crash helmets and avoidance of dangerous driving behaviors will remarkably decrease such trauma.

Bilateral Arm-Abduction Shoulder Radiography to Determine the Involvement of the Scapulothoracic Motion in Frozen Shoulder.

BACKGROUND: We hypothesize that there is no difference in the motion of the scapula with respect to the thoracic wall (scapulothoracic interface) between the affected versus non-affected shoulder on 0° and 90° standard arm abduction radiography. METHODS: We enrolled 30 patients with the diagnosis of unilateral frozen shoulder after ruling out of other pathologies. Bilateral standard shoulder radiography was done in two position of 0° and 90° of arm abduction. Non-affected side was used as a control group. RESULTS: The mean scapulothoracic angle of the affected side was significantly larger than the non-affected side in both 0° and 90°of abduction in spite that the scapulohumeral angles were comparable in 0°, indicating potential alteration in scapular positioning. CONCLUSION: Scapulothoracic motion and position can be affected in frozen shoulder along with other areas. All treatment modalities should be applied to this area as well if substantial difference was detected between the two sides.

Validation of the Persian Version of the American Orthopedic Foot and Ankle Society Score (AOFAS) Questionnaire.

BACKGROUND: American Orthopedic Foot and Ankle Society Score (AOFAS) is a reliable and reproducible measurement tool which is commonly used for the assessment of foot and ankle conditions. In this study we aimed to translate and assess the psychometric properties of the Persian version of AOFAS questionnaire. METHODS: In this study, we enrolled 53 patients with ankle and hindfoot conditions. Our study was conducted according to five staged cross-cultural adaption steps including translation, synthesis, back translation, expert committee review, and pretesting. After that reliability of the subjective parts calculated by Cronbach's alpha and the intraclass correlation coefficient (ICC) and the reliability of the objective items estimated using Cohen's kappa test. Also, construct validity was assessed by testing the Persian AOFAS against the SF-36 questionnaire. RESULTS: Chronbach's alpha coefficient was 0.696, which was considered acceptable. Furthermore, the test-retest reliability measured by using the ICC for the subjective subscales was 0.853 (P<0.001). The reliability of testing the objective subscales was calculated by using Kappa, which indicated acceptable values. Pearson correlation coefficient between AOFAS and SF-36 was 0.415 (P=0.008). In addition, floor and ceiling effects were calculated 1.9% and 7.5% respectively. CONCLUSION: In our study, Persian translation of AOFAS demonstrated acceptable validity and reliability with no need to be culturally adapted.

Clinical Outcome of Anatomical Transportal Arthroscopic Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft.

BACKGROUND: Good clinical outcome and return to sport and daily functions after anatomical arthroscopic anterior cruciate ligament (ACL) reconstruction is goal standard in this surgery. but to date, there are different challenging issues between orthopedic surgeons regarding graft selection and surgical techniques. METHODS: We retrospectively reviewed the patients who underwent anatomical arthroscopic one bundle ACL reconstruction with quadruple hamstring tendon autograft from 2010 to 2016 in our orthopedic sport medicine center. Eighty-two eligible patients (82 knees) who had met our inclusion criteria were examined in terms of knee stability by clinical examinations and KT 2000 arthrometer and - also were evaluated regarding variables related to their health and knee status with a mean 48months follow-up. RESULTS: Seventy-seven patients (93.9%) were male and the other 5 cases (6.1%) were female. The mean age was 33 ± 8.06 years old at the time of surgery and mean BMI amount was 26.81 ± 3.72. 78 patients (95%) returned to pre-injury sport activity level after ACL reconstruction and two patients (2.4%) had re-rupture. 63 patients (76.8%) had negative anterior drawer and 67patients (81.8%) negative lachman tests respectively. 10 patients (13%) were found to have positive pivot shift tests which was correlated with pain and a less KOOS scores with a significant difference (P= 0.03). 72 patients (87%) had negative tests in active and 70 (85.4%) had less than 3 mm side to side difference in manual testing by KT2000. Final KOOS score was 70.87 ± 19.76. Mean Lysholm score was 90 ± 4.77. Mean International Knee Documentation Committee (IKDC) score of this study was 85 ± 14.11.Patients who had concomitant partial meniscectomy had significantly lower IKDC scores (P<0.01).Mean kujala score was 79 ± 3.07. CONCLUSION: The use of quadrupled hamstring tendon autograft besides the most important part of the treatment which is the surgical technique would yield to excellent results in ACL reconstruction both subjectively and objectively. In addition, patient selection and surgeon's experience should be considered in determining the treatment plan for the patients.Level of evidence: IV.

Psychometric Properties of the Persian Version of the Simple Shoulder Test (SST) Questionnaire.

BACKGROUND: To validate the Persian version of the simple shoulder test in patients with shoulder joint problems. METHODS: Following Beaton`s guideline, translation and back translation was conducted. We reached to a consensus on the Persian version of SST. To test the face validity in a pilot study, the Persian SST was administered to 20 individuals with shoulder joint conditions. We enrolled 148 consecutive patients with shoulder problem to fill the Persian SST, shoulder specific measure including Oxford shoulder score (OSS) and two general measures including DASH and SF-36. To measure the test-retest reliability, 42 patients were randomly asked to fill the Persian-SST for the second time after one week. Cronbach's alpha coefficient was used to demonstrate internal consistency over the 12 items of Persian-SST. RESULTS: ICC for the total questionnaire was 0.61 showing good and acceptable test-retest reliability. ICC for individual items ranged from 0.32 to 0.79. The total Cronbach's alpha was 0.84 showing good internal consistency over the 12 items of the Persian-SST. Validity testing showed strong correlation between SST and OSS and DASH. The correlation with OSS was positive while with DASH scores was negative. The correlation was also good to strong with all physical and most mental subscales of the SF-36. Correlation coefficient was higher with DASH and OSS in compare to SF-36. CONCLUSION: Persian version of SST found to be valid and reliable instrument for shoulder joint pain and function assessment in Iranian population.

Factors Associated with Pain, Disability and Quality of Life in Patients Suffering from Frozen Shoulder.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Leech therapy in nearly total amputation of fingers without vascular repair: a case report.

INTRODUCTION: In the absence of microvascular replantation or in crash injury cases in which obtaining an acceptable function is not possible, amputation of the injured finger seems to be the best treatment modality. Some studies recommended leech therapy for this kind of injury after vascular repair to decrease venous congestion. CASE PRESENTATION: In this case report, the authors presented a case of leech therapy after near total amputation of the fingers. A 25-year-old patient was admitted following a sawing injury with crashed bundles of the third, fourth and fifth fingers. Microvascular surgery was not performed because of crush injury. DISCUSSION: After a simple repair and pin fixation, the patient was treated using leech therapy. The result was satisfactory. The third and fourth fingers were salvaged. It seems that in cases where a small part of the skin is still attached to the amputated part, even with complete crash of both bundles, leech therapy can help salvage the amputated fingers.

Clinical outcome of ream versus unream intramedullary nailing for femoral shaft fractures.

BACKGROUND: Stabilization of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults; however, to ream or not to ream is still being debated. OBJECTIVES: The primary objective of this study was to determine clinical results following unreamed versus ream intramedullary nailing of femoral fractures. PATIENTS AND METHODS: Between January 2008 and August 2009, 50 patients with femoral shaft fractures were treated with unreamed or reamed femoral nails in our clinic. From this prospective single centre study, 16 patients were excluded due to insufficient follow-up data. According to the AO classification, fractures in this study were either type A or B. Dynamic proximal locking was performed in all cases. The remaining 34 patients were divided into two groups of 17 with ream or unream nailing. During and after the operation, we evaluated some variables in whole series. RESULTS: After statistical analyzes, we found that there were no differences in radiologic union time (P = 1) or full weight bearing time (P = 0.73) between ream and unream nailing. Nail breakage or iatrogenic fractures during nail insertion did not occur and we did not have any fat emboli in both groups but one secondary loss of reduction occurred in the unream group. Superficial infection after the operation was seen in one case which was treated successfully with antibiotics. In the ream group surgical time was about thirty minutes longer and differences were significant (P = 0.000). Patients had to pay more for ream nailing but the difference was not significant. We found no statistical difference between union time with or without reaming; on the other hand, there was significant increased operation length, blood loss and systemic changes in BP or So2 in the ream group versus the unream group. CONCLUSIONS: We advocate that unream nailing in traumatic femoral shaft fractures is a simple, safe and effective procedure with significant advantages, especially in multitrauma patients.