A Comparison between Oblique and Vertical Incisions on the Hamstring Tendon Harvesting in Anterior Cruciate Ligament Reconstruction and Infrapatellar Branch Injury of the Saphenous Nerve.

Objective The present study aimed to compare the oblique and vertical incisions in hamstring tendon harvesting in anterior cruciate ligament (ACL) reconstruction and in infrapatellar branch injury of the saphenous nerve. Methods The present study was conducted at a tertiary referral center for 12 months. Patients with an indication of reconstruction of ACL tear were included in the study, who were then randomized into two groups (vertical [VG] and oblique [OG] groups). After excluding a few cases, 92 patients were eligible for further analysis (VG: n= 44; OG: n = 48). They were followed-up for 9 months after the surgery, and loss of sensation over the knee and over the proximal aspect of the operated leg was recorded. Results The mean lengths of the incisions were 27 mm and 38 mm for the OG and VG groups, respectively. The total rate of hypoesthesia was 40% (27 patients). A total of 12 (25%) and 25 patients (56.8%) on the OG and VG groups, respectively, reported hypoesthesia symptoms. The presence of hypoesthesia in patients in the VG group was two times higher than in the OG group. No statistical correlation was observed between the nerve injury and age, gender, education, and delay from injury to reconstruction. Conclusion Oblique incision, which showed lower risk of nerve damage, might be more recommended for graft harvesting. Patients who underwent reconstruction of the ACL in the OG group had a lower incidence of peri-incisional hypoesthesia when compared to those in the VG group.

Clinical effects of date palm (Phoenix dactylifera L.): A systematic review on clinical trials.

PURPOSE: The aim of present study was to review and categorize the clinical trials investigating the clinical effects of different botanical parts of dates compared with any controls. METHODS: All clinical trials (randomized, pilot, quasi-experimental, cross-over. and non-randomized clinical trials) evaluating the clinical effects of date palm from 2000 until August 2019 in English and Persian languages were included in this systematic review. The methodological quality of the included studies was evaluated according to the risk of bias assessment of Cochrane handbook of systematic reviews, and then reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. RESULTS: Twenty-six studies met the inclusion criteria. Studies were performed in 8 categories based on different botanical parts of date palm. These categories were obstetrics, gynecology, oncology, dermatology, hematology, gastroenterology, endocrinology, metabolism, and infertility. A total of 38 % of included studies were randomized controlled trials. Further, 80 % of the included studies had performance and detection bias. Finally, about 50 % of them had selection bias and about 20 % had attrition and reporting bias. CONCLUSION: The widespread consumption of date palm as medicinal and botanical plant suggests the importance of this plant in human healthcare. The clinical trials conducted so far have explained a number of clinical effects of date palm. However, there is not enough clinical evidence to support the clinical effects in other review articles and traditional medical systems, and further randomized controlled trials with robust designs and methods are required.

A Comparison between Oblique and Vertical Incisions on the Hamstring Tendon Harvesting in Anterior Cruciate Ligament Reconstruction and Infrapatellar Branch Injury of the Saphenous Nerve / Uma comparação entre incisões oblíquas e verticais na coleta do tendão dos isquiotibiais na reconstrução do LCA e na lesão do ramo infrapatelar do nervo safeno

Abstract Objective The present study aimed to compare the oblique and vertical incisions in hamstring tendon harvesting in anterior cruciate ligament (ACL) reconstruction and in infrapatellar branch injury of the saphenous nerve. Methods The present study was conducted at a tertiary referral center for 12 months. Patients with an indication of reconstruction of ACL tear were included in the study, who were then randomized into two groups (vertical [VG] and oblique [OG] groups). After excluding a few cases, 92 patients were eligible for further analysis (VG: n= 44; OG: n = 48). They were followed-up for 9 months after the surgery, and loss of sensation over the knee and over the proximal aspect of the operated leg was recorded. Results The mean lengths of the incisions were 27 mm and 38 mm for the OG and VG groups, respectively. The total rate of hypoesthesia was 40% (27 patients). A total of 12 (25%) and 25 patients (56.8%) on the OG and VG groups, respectively, reported hypoesthesia symptoms. The presence of hypoesthesia in patients in the VG group was two times higher than in the OG group. No statistical correlation was observed between the nerve injury and age, gender, education, and delay from injury to reconstruction. Conclusion Oblique incision, which showed lower risk of nerve damage, might be more recommended for graft harvesting. Patients who underwent reconstruction of the ACL in the OG group had a lower incidence of peri-incisional hypoesthesia when compared to those in the VG group.

Resumo Objetivo O presente estudo teve como objetivo comparar as incisões oblíquas e verticais na coleta dos tendões dos isquiotibiais na reconstrução do ligamento cruzado anterior (LCA) e na lesão do ramo infrapatelar do nervo safeno. Métodos O presente estudo foi realizado em um centro de referência terciário por 12 meses. Pacientes com indicação de reconstrução de uma ruptura do LCA foram incluídos no estudo, os quais foram randomizados em dois grupos (vertical [GV] e oblíquo [GO]). Após a exclusão de alguns casos, 92 pacientes foram elegíveis para análise posterior (GV: n= 44; GO: n = 48). Eles foram acompanhados por 9 meses após a cirurgia, e a perda de sensibilidade sobre o joelho e sobre o aspecto proximal da perna operada foi registrado. Resultados Os comprimentos médios da incisão foram de 27 mm e 38 mm para os grupos GO e GV, respectivamente. A taxa total de hipoestesia foi de 40% (27 pacientes). Um total de 12 (25%) e de 25 pacientes (56,8%) dos grupos GO e GV, respectivamente, relataram sintomas de hipoestesia. A presença de hipoestesia em pacientes no grupo GV foi duas vezes maior do que no grupo GO. Não foi observada correlação estatística entre a lesão do nervo e idade, gênero, escolaridade e demora entre a lesão e a reconstrução. Conclusão A incisão oblíqua, que apresentou menor risco de lesão nervosa, pode ser mais recomendada para a coleta do enxerto. Pacientes submetidos à reconstrução do LCA no grupo GO tiveram menor incidência de hipoestesia peri-incisional quando comparados aos pacientes do grupo GV.

Effects of date fruit (Phoenix dactylifera L.) on labor and delivery outcomes: a systematic review and meta-analysis.

BACKGROUND: The rate of cesarean section is increasing in all over the world with different drafts in various countries. This growth increases unpleasant outcomes of delivery. Recent studies explained the benefits of date palm fruit on labor process improvement. Date fruit can be considered as a factor for increasing vaginal delivery and also reducing the frequency of caesarean section in order to prevent its great complications. This systematic review has been designed to review clinical studies that investigate the effects of date palm fruit on labor outcomes (duration of labor stages, bishop score, and frequency of cesarean section) compared with routine cares. METHODS: This study was performed in 2019. Required data has been collected from electronic databases and manual searches. All randomized clinical trials evaluating the effects of date palm fruit on labor and delivery that were published from January 2000 to August 2019 in English and Persian languages, were incorporated in this systematic review. The methodological quality of the included studies was evaluated according to the risk of bias assessment of Cochrane handbook of systematic reviews, and were then reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. RESULTS: Eight studies were included in the qualitative and quantitative synthesis. Meta-Analysis showed that date fruit consumption can significantly reduce active phase of labor (three trials with 380 participants; (MD = - 109.3, 95%CI (- 196.32, - 22.29; I2 = 89%), P = 0.01), and also it can significantly improve the bishop score (two trials with 320 participants; MD = 2.45, 95%CI (1.87, 3.04; I2 = 0%), P < 0.00001). Date fruit consumption had no effects on the duration of first, second, and third stages of labor, and the frequency of cesarean section. CONCLUSION: Date can reduce the duration of active phase and improve the bishop score; however, due to from the low to mediate quality of the studies; it seems that the other studies are needed to prove these results better than this.

Hematoma Block Versus General Anesthesia in Distal Radius Fractures in Patients Over 60 Years in Trauma Emergency.

BACKGROUND: Distal radius fractures are among common fractures in the elderly. Regarding the age, background diseases, and possible risks, analgesia method is of great importance in this group. OBJECTIVES: The aim of this study was to compare two analgesia methods including hematoma block and general anesthesia in people over 60 years in the orthopedic emergency department. METHODS: 68 elderly patients referring to the emergency department of a medical teaching center were selected based on the inclusion criteria for a non-randomized clinical trial. The patients were placed in two groups of 34, which were matched for age and sex. Hematoma block was used as the analgesic method in one group and general anesthesia was used in the other group. These two groups were compared for pain intensity, analgesia duration, and anesthesia side effects. The SPSS software (Statistical Package for the Social Sciences, version 17.0, SPSS Inc., Chicago, Ill, USA) was used for data analysis. RESULTS: 68 elderly patients (mean age of 70.3 ± 6.6) with a dislocated distal radius fracture which required closed reduction were examined. The duration of manipulation and surgery and discharging time were significantly different between two groups and they were all lower in the hematoma blocked group. Pain intensity evaluation indicated a statistically significant difference during initial hours after fracture reduction and fixation so that pain intensity was less in elderly patients under hematoma block than patients who underwent general anesthesia in one and six hours after surgery. Need for narcotic was 35.2% in the general anesthesia group which also showed a significant between-group difference. CONCLUSIONS: Hematoma block analgesia used in distal radius fractures of the elderly is a very safe and effective method that seems preferable to general anesthesia in emergency departments.

Effects of preoperative non-steroidal anti-inflammatory drugs on pain mitigation and patients' shoulder performance following rotator cuff repair.

PURPOSE: Pain is one of the most important factors adversely affecting clinical outcomes of operated patients. The present study aims at evaluating effects of preoperative COX2 non-steroidal anti-inflammatory inhibitors on pain mitigation and performance of patients with shoulder rotator cuff tear. METHODS: This case-control study was conducted on 60 patients suffering from rotator cuff injury candidate for arthroscopic repair. The patients were classified in two parallel and matched groups. One group (case group) was treated using Celecoxib (200mg/12h) started 48 hours before surgery and continued for 10 days after operation. In the control group, the placebo was prescribed in the same way. Postoperative pain, side effects, sleep disturbance, and short-term outcomes were compared between two groups using DASH questionnaire. RESULTS: Postoperative pain in the Celecoxib group significantly decreased in comparison with the control one. The difference was statistically meaningful (P<0.001). Well motion ability was seen in 80% of patients of the Celecoxib group. It was 26.6% in the placebo group since pain inhibited them from exercising more motions. In this regard, there was a statistically meaningful difference between these two groups (P=0.02). Sleep disturbance was meaningfully at higher levels in the placebo group (P=0.001). Following up the patients for three months, it was made clear that performance of the Celecoxib group was better than that of the placebo one. CONCLUSION: COX2 inhibitors are well efficient in patients' pain management after arthroscopic rotator cuff repair surgery. It results in less life complications, less sleep disturbances, improvement of patients' short-term clinical outcome, and more quick recovery.

Comparison of outcome of femoral shaft fracture fixation with intramedullary nail in elderly patient and patients younger than 60 years old.

BACKGROUND: Although intramedullary nailing (IMN) is an established and accepted operative treatment for femoral shaft fracture in patients younger than 60, there is a lack of data on the results of this treatment on those over 60. The purpose of this study was to determine if the outcome of IMN for femoral shaft fracture in elderly patients is also acceptable. Particular challenges in this group of patients included osteopenia and other associated multiple medical problems frequently observed. METHODS: The outcome of 84 patients who had IMN for femoral shaft fracture was reviewed and the results were compared between two groups of patients (younger than 60 and over 60 year old patients). Complications and mortality was analyzed for each group, and then compared between the two groups by testing the null hypothesis that the outcome of treatment in the two groups are similar (P>0.05). RESULTS: The mean duration of follow up was 57.3 months (range: 10-94 months). Incidence of malunion, nonunion, infection, DVT, and dependence on walker/crutch in the groups were similar and differences were not significant (P>0.05). However, incidence of mortality (P<0.05), knee pain, loss of motion, and dependence on cane were significantly higher in elderly patients (P<0.05). CONCLUSIONS: There is no significant difference between the outcomes of femoral shaft fracture treatment with IMN fixation in younger patients when compared with elderly patients. However, elderly patients with IMN have more symptoms when compared with younger patients.

Prevalence of malignant soft tissue tumors in extremities: an epidemiological study in syria.

BACKGROUND: Although the majority of soft tissue masses are benign, it is important to consider malignancy in differential diagnoses. Because most soft tissue sarcomas present as a painless mass, clinicians must watch for signs suggestive of malignancy, including large size, rapid growth, and site deep into the deep fascia. The purpose of this study was to determine the relative prevalence according to sex and age, site of tumor, skeletal distribution, and treatment (surgery, chemotherapy and radiotherapy) before and after surgery, and ascertain the relative frequency of these tumors in specific anatomic sites and age groups based on pathological studies. METHODS: A total of 308 patients, with a musculoskeletal tumor were evaluated retrospectively. All of the patients enrolled into this study were referred to the Beirouni Hospital of Damascus University with a proven diagnosis of malignant soft tissue tumors from the beginning of January 2008 until the end of 2010. The prevalence of the malignant soft tissue tumors in these patients was analyzed. For purposes of analysis, all lesions were placed in 1 of 9 categories: hand and wrist, forearm, humorous (arm), proximal limb girdle (axilla and shoulder), foot and ankle, thigh, hip and buttocks region, trunk, and other lesions. Age and sex also were recorded. RESULTS: MALIGNANT TUMORS CONSISTED OF SEVEN DIAGNOSTIC CATEGORIES: malignant fibrous histiocytoma (23%), liposarcoma (22%), rhabdomyosarcoma (9%), leiomyosarcoma (8%), malignant schwannoma (5%), dermatofibrosarcoma protuberans (5%), synovial sarcoma (10%), fibrosarcoma (13%), extraskeletal chondrosarcoma (1%), and extraskeletal Ewing sarcoma (4%). CONCLUSIONS: Despite the multitude of pathologic possibilities, most malignant soft-tissue tumors are classified into a small number of diagnoses. These may be further defined when the site of the lesion and the age of the patient are considered. Knowledge of tumor prevalence will assist radiologists in establishing a suitably ordered differential diagnosis when a soft-tissue tumor has a nonspecific radiologic appearance.

Treatment of neglected malunion of the distal radius: a cases series study.

BACKGROUND: Malunion is the most common complication following distal radius fractures. Aim of this study was to evaluate the results of distal radius corrective osteotomy and plate fixation by dorsal approach in the malunion. METHODS: In this retrospective study, 14 patients with neglected distal radius malunion from 2005 to 2011 were studied. All patients were treated with an opening wedge osteotomy with a dorsal plate and cancellous bone grafting. Radiological and clinical measurements were performed pre and postoperatively. All patients were followed at least for two years. RESULTS: Fourteen patients with a mean age of 42.5±10.2 years including 2 females (14.2%) and 12 males (85.8%) were studied. Radiological healing was achieved in all osteotomies at a mean of 11.5 (range: 11 to 14) weeks. There were significant differences between wrist function and radiological findings before and after treatment. Following the operation, all patients were relieved of pain. There were not any complications. CONCLUSION: Based on our findings, dorsal approach for osteotomy and plate insertion is an effective approach with good final results and no major complication for the treatment of distal radius malunion.

Albumin and fibrinogen levels' relation with orthopedics traumatic patients' outcome after massive transfusion.

BACKGROUND: Severe bleeding is common during limb trauma. It can lead to hemorrhagic shock required to massive blood transfusion. Coagulopathy is the major complication of massive transfusion-induced increased mortality rate. Aim of this study was evaluation of fibrinogen and albumin levels association with orthopedics traumatic patients' outcome who received massive transfusion. METHODS: In a cross sectional study, 23 patients with severe limb injury admitted to orthopedic emergency department were studied. All the patients received massive transfusion, that is, >10 unit blood. Albumin and fibrinogen levels are measured at admission and 24 h later, and compared according to final outcome. RESULTS: Twenty-three traumatic patients with severe limb injuries were studied, out of which ten (43.2%) died and 13 (56.8%) were alive. There was significant difference between patients outcome in fibrinogen level after 24 h, but no difference was observed in albumin levels. Based on regression model, fibrinogen after 24 h had a significant role in determining the final outcome in traumatic patients who received massive transfusion (odds ratio 0.48, 95% confidence interval 0.15-0.92, P = 0.02). CONCLUSIONS: According to our results, fibrinogen level is the most important factor in determination of orthopedics traumatic patients when received massive transfusion. However, serum albumin does not play any role in patients' outcome.

Orthopedic injuries following the East azerbaijan earthquake.

BACKGROUND: Evaluating demographic characteristics, distribution and types of orthopedic injuries following major earthquakes may be helpful in future planning for disasters. OBJECTIVES: This study aimed to analyze data from trauma patients with extremity injury resulting from the earthquakes of East Azerbaijan, Iran. PATIENTS AND METHODS: Medical records of 686 patients admitted to Shohada hospital, Trauma Center of Tabriz University of Medical Sciences were reviewed. There were 200 patients with extremity injury assessed. Demographic characteristics and patterns of injuries in these patients were evaluated. RESULTS: In this study, there were 105 females (52.5%) and 95 males (47.5%), out of which, 6 (3%) patients with associated severe head injuries died. The most common sites of injury were lower extremities (81 patients, 41.5% of total victims) while 32 patients (16%) suffered from both upper and lower extremity injuries. Open Fractures were seen in lower extremities of 26 (13%) patients. Compartment syndrome was observed in 3 (1.5%) patients with lower limb fractures. Also, 42 (21%) patients living in Tabriz were injured while they were running away (falling down the stairs and jumping out of windows). CONCLUSIONS: Extremity injuries especially open fractures of lower limbs account for the majority of hospitalized victims. Compartment syndrome is one of the main problems that should be addressed. Our study demonstrates that people still need more education regarding earthquakes and the government should direct more attention to this issue.

Long-term follow-up results of delayed fixation of femoral neck fractures in adults.

BACKGROUND: Femoral neck fractures are urgent injuries that require precise reduction and stable fixation. In some cases, however, early treatment is not possible. OBJECTIVES: The present study aimed to evaluate long-term results of delayed fixation of femoral neck fractures using cannulated screws. PATIENTS AND METHODS: This retrospective descriptive-analytical study was conducted on 26 patients with femoral neck fractures. The patients were treated through a closed reduction and fixation method using cannulated screws. Patients were followed up for at least five years and the rate of complications was determined. RESULTS: In this study, 26 patients with mean age of 34.3 years were assessed. Average time interval from injury to surgery was 46.4 ± 12.2 hours; 18 patients (69%) were operated on with more than 36 hours of delay. Incidence of AVN and nonunion was reported in 10 (38.4%) and 3 (11.5%) patients, respectively. CONCLUSIONS: Time plays an important role in treatment results of femoral neck fractures. To treat the fractures, closed reduction and fixation using cannulated screws may still be the best option.

Prevalence of vitamin D deficiency and secondary hyperparathyroidism in nonunion of traumatic fractures.

Nonunion is common complication of fracture management. Various factors are involved in its occurring. Metabolic and endocrine factors are often overlooked. So that aim of study was to evaluate the level of vitamin D and PTH in patients with unexplained nonunion and fractures due to low energy trauma. In the case control study, 30 patients with tibial nonunion compared with 32 patients with normal bone healing. There were matched according to, surgical treatment, sex, age and body mass index. In order to measure the serum levels of laboratory parameters, vitamin D and parathyroid hormone, blood samples were taken and were sent to a reference laboratory. A high percentage of vitamin D deficiency was observed in tibial unexplained nonunion (60%) versus 30% in normal union. The level of vitamin D in patients with nonunion was significant difference compared with normal union (25.8±20.4 nmol/l versus 49.03±26.9 nmol/l, P=0.002). PTH measurement showed that was not meaningful statistical difference between two groups but prevalence of hyperparathyroidism in nonunion was higher than union (33% versus 9.3%). In other laboratory findings were not statistical difference. According to our results, vitamin D deficiency in unexplained tibial nonunion fractures are common. In areas with high prevalence of hypovitaminosis D, that could be one reason of unexplained nonunion.

Adolescence spinal epidural abscess with neurological symptoms: case report, a lesson to be re-learnt.

Epidural abscess of the spinal column is a rare condition that can be fatal if left untreated. It promptly progresses and can cause neurologic paralysis, urinary retention or cauda equina syndrome. Compromised immune system that occurs in patients with diabetes mellitus, AIDS, chronic renal failure, alcoholism, or cancer is a predisposing factor. It mostly occurs in adults. Here we would like to report a case of spontaneous pyogenic lumbar epidural abscess with neurological deficit diagnosed in a 15 year old boy. We treated this case successfully with surgical microscopic decompression and drainage.

Skeletal tuberculosis presenting as a small cystic lesion in the medial femoral condyle.

Skeletal tuberculosis is an unusual disease involving bone and joints and it may have different manifestations. This report introduces a 25-year-old woman suffering from chronic knee pain without any response to conservative treatments for one year. X-ray was normal but CT-scan and MRI indicated a small lesion in medial condyle of the femur. The patient underwent percutaneous CT-guided biopsy. Following an evaluation of the obtained sample, tuberculous osteomyelitis was detected. After resection of the femoral mass and starting anti TB medical treatment, symptoms dramatically eliminated.

Osteoid osteoma of a scapula: a case report in a 34 years old woman.

Osteoid osteoma is a benign bone tumor and accounts for 10% of benign tumors. Almost any bones can be involved but half of cases involving femur or tibia. Osteoid osteoma is a rare tumor of the scapula with only 18 reported cases in the literature. We presented a case of osteoid osteoma of the scapula in right shoulder in angle of coracoid and geloneid in a 34- year old woman. She had right radicular shoulder pain increased at night for 4 years. An important point about this case is that, patient was treated in long-term with miss diagnosis of cervicospinal discopathy. The key of diagnosis in this patient was paying attention to the nature of night increasing pain and performing bone scan. After the operative curettage of the tumor, the pain dramatically stopped and a few weeks of physical therapy led to full range of motion in her shoulder.

Using a vascularized bone graft from the distal metaphysis of radius in treating scaphoid nonunion: first report from a developing country.

Scaphoid fractures are common and prone to nonunion if left untreated. In this study, the outcome of using a vascularized bone graft was investigated in scaphoid nonunion. Twenty patients with scaphoid nonunion were recruited from Shohada Hospital. A reverse-flow vascularized bone graft was obtained from the distal metaphysis of radius and inserted into the gap of scaphoid fracture. Long and short thumb spica casts were used for 1.5 and 2 months thereafter, respectively. Union, motion, pain and the patients' satisfaction rate were documented. Twenty patients, 19 males and 1 female, with a mean age of 25.15 +/- 6.62 (range: 17-40) years were studied. The fractured were in the waist of the bone in 17 cases and in the proximal pole in 3 cases. Preoperative pain and pain plus compromised grip strength were reported in 11 and 9 patients, respectively. The rate of patients with pain decreased significantly after operation (100 to 25%; p < 0.001). Complications happened in 7 patients (35%) after operation including pin fracture (n = 2), change of occupation (n = 2), nonunion (n = 1), delayed union (n = 1) and irritation (n = 1). Union achieved after 10.71 +/- 1.62 (range: 8-14) weeks in average, post-operation. Mayo wrist score improved significantly at the endpoint. The range of motion of the wrist did not change significantly after operation. Eighty percent of the patients rated the satisfaction rate as good to excellent. This study is the first one from a developing country indicating that the technique of using a reverse-flow vascularized bone graft in treating scaphoid nonunion is considerably successful and safe.

Evaluation of molecular genetic variation associated with deep venous thrombosis in lower limb fractures in traumatic patients.

BACKGROUND: Genetic variation in multiple genes associated with hemostasis and thrombosis is well documented to impact the rates of future venous thromboembolism; in addition, trauma and orthopedic surgery in lower limb and immobilization are important factors in increasing the incidence of thrombosis. Gene mutation can be predisposing factor for thrombosis in traumatic patients under anti-coagulant agent prophylaxis. The aim of this study is to evaluate the different gene mutations in these patients. MATERIALS AND METHODS: In this cross-sectional descriptive study, the sample consisted of 53 patients with deep venous thrombosis (DVT) and 32 traumatic patients without thrombosis as the control group. Two groups matched together according to sex, age, weight, and medications. DNA analysis for mutation of multivariate of genes in thrombosis was studied. RESULTS: Regarding gene variations, there was statistically significant difference only in Prothrombin (Factor II, G20210A) between the patients with thrombosis and control group (P = 0.01). But, there was no difference between two groups considering other gene mutations. Mutation of Prothrombin gene (G20210A) was a predictive factor for thrombosis with odds ratio of 1.1 (CI 0.3-1.9). CONCLUSION: According to the outcomes resulted from this study, genetic mutation in Prothrombin (Factor II [G20210A]) is one of the most important genetic variations involved in traumatic patients with DVT despite prophylaxis. Genetic mutation in Prothrombin appears to be predisposing factor for thrombosis associated with trauma.

Comparison study of therapeutic results of closed tibial shaft fracture with intramedullary nails inserted with and without reaming.

Tibia fractures are the most common type of long bone fractures in US. This study aimed at comparing the therapeutic results of closed tibial shaft fracture with intramedullary nails inserted with and without reaming. In this randomized clinical trial study, 60 patients with a fracture of the tibia were examined. The patients were randomly divided into two groups. Thirty patients treated through inserting intramedullary nail with reaming technique (group A). The other 30 patients treated through inserting intramedullary nail without reaming technique (group B). After operation physical examination and control radiography were taken up to 6 month and results were compared. Sixty patients suffering from closed tibial diaphysis fractures were studied. Mean age of the group A and B were 40.24 +/- 12.32 and 38.42 +/- 14.28, respectively. Group A consisted of 24 (80%) males and 6 (20%) females while group B consisted of 24% females and 76% males. Considering fracture based on OTA criteria (p = 0.4) and severity of soft tissue damage based on Tscherne classification (p = 0.6), there was no statistically meaningful difference between groups A and B. The study demonstrated that degree of horizontal displacement, mean time of surgery, post-operation infection, organ shortness at the end of the follow-up period, organ deviation in patients of the group A was significantly more than that of the group B. Time required for callus formation (mean time of union), mean time of full weight bearing time and mean time of return to normal activities in group B was significantly more than that of the group A.