Morteza Gholipour

The ankle comprises two main ligamentous complexes: the medial and lateral complex. In cases of chronic ankle instability following a sprain involving both complexes, rotational ankle instability can develop. We introduce a 25‐year‐old male with rotational ankle instability who reported having 20 episodes of “giving away” over the 6 months following an ankle sprain. Due to persistent instability, the patient was deemed a candidate for surgical reconstruction. An Achilles tendon allograft was utilized to reconstruct four ligaments—two from the lateral complex (the anterior talofibular ligament [ATFL] and calcaneofibular ligament [CFL]) and two from the medial complex (the tibiocalcaneal ligament and anterior tibiotalar ligament, components of the deltoid ligament). At the final follow‐up, the patient’s American Orthopedic Foot and Ankle Society (AOFAS) score was 89, the pain level was rated at 2 on the visual analog scale (VAS), and there was no significant restriction in the range of motion. While arthroscopic repair is the preferred option, an open surgical approach was chosen to adequately address all the ligamentous injuries, as the patient had two complete ruptures in addition to two partial tears.

Patients with neurological conditions like cerebellar atrophy and ataxia face many challenges when recovering from fractures. This case report details the management and recovery of a 45‐year‐old woman with severe, pre‐existing cerebellar atrophy and ataxia who sustained a right femoral shaft fracture after a fall. Before her injury, her neurological impairment required her to use a walker to move around. She underwent open reduction and internal fixation (ORIF) and was given a 3‐month period during which she could not put weight on her leg. Her rehabilitation involved a team approach focused on specific goals, emphasizing early knee range‐of‐motion exercises. Given her dual diagnosis, the intensive program focused on various training components, including progressive resistance, coordination drills, and challenging balance exercises. These exercises have been shown to reduce ataxia symptoms and improve motor function significantly. The tailored intervention operated on the idea that the quality and difficulty of rehabilitation are key factors for positive outcomes in patients with degenerative cerebellar ataxias (DCAs). After 3 months, the fracture healed well, and the patient moved to full weight‐bearing, showing significant improvements in mobility and independence. This case highlights that a unified, specialized, and evidence‐based team approach can lead to successful functional recovery, even in complex neuro‐orthopedic situations. It aligns with modern rehabilitation methods that focus on enhancing the quality of life by reducing secondary impairments.

Pipkin Type IV fractures, which involve femoral head fractures combined with posterior acetabular wall and femoral neck injuries, present significant surgical challenges and are associated with high complication rates. This case report describes a 34‐year‐old male who sustained a Pipkin Type IV fracture, presenting with ipsilateral floating knee injury (Fraser Type I) and quadriceps tendon rupture following a motor vehicle collision. The treatment approach included a staged surgical protocol involving closed hip reduction, intramedullary nailing for femoral and tibial fractures, quadriceps tendon repair, and acetabular fixation. Despite experiencing substantial blood loss requiring transfusion, the patient achieved functional recovery, with a Harris Hip Score (HHS) of 85 and Lysholm knee score of 78 after 1 year of follow‐up. This case highlights the necessity of a systematic, multidisciplinary approach to managing polytrauma cases. Timely anatomical reduction, comprehensive bony and soft tissue repair, and individualized rehabilitation are essential for optimizing patient outcomes.

Introduction: Pilon fractures management is a challenge. Orthopedic surgeons should manage fracture and soft tissue injury simultaneously in optimum condition. This study evaluates the outcomes of the management of Pilon fracture in two different approaches. Materials and methods: 40 patients were included with Pilon fractures Between March 2016 and March 2018. Patients were divided into A and B groups. Group A was operated with the external fixator of the pilon and open reduction and internal fixation (ORIF) of distal fibular in the first stage, and medial plating of the pilon in the second stage. Group B was operated with posterior plating of the pilon and fibular by posterolateral approach at the first stage and medial distal tibia plating in the second stage. The AOFAS score, postoperative satisfaction questionnaire score (MODEMS) score, surgical wound complication, union rate, and operation time were evaluated in 12-month follow-up. Results: 40 Pilon fractures were evaluated finally. 28 were male and 12 were female. Average time for union was 200 ±10 days in group A, and 215±20 days in group B. The average operation duration in the first stage was 65±10 min in group A and 60± 15 min in group B. The MODEMS score at the end of the first stage in most patients of group A was somewhat dissatisfied(86%) and in group B was somewhat satisfied (84%). This score at the end of the 12-month follow-up in most patients of group A and group B was somewhat satisfied, 85% and 87% respectively. The mean AOFAS score in groups A and B were 87.5 and 89.4 respectively at the end of follow-up. There was no significant difference between the two groups in the union rate and time and duration of the operation. Patients in the posterior plating group were more satisfied during the first stage of surgery but in the long-term follow-up, there was no difference between the two groups. Conclusion: Most surgeons prefer the two-stage strategy and external fixator usage at the stage one to manage the soft tissue complications in the pilon fractures . Based on the result, Posterior plating may be a substitute for external fixation in the first stage of Pilon fractures management.

Summary Background Open reduction and internal fixation have been described as the gold standard for the treatment of acetabular fractures, but the high complications of these surgeries have led surgeons to seek less invasive procedures. In recent years, minimally invasive treatment, such as fixation through the skin have been proposed. The aim was to assess acetabular fracture outcomes of combination of posterior approach (Kocher-Langenbeck [KL]) with anterior percutaneous screw fixation (APSF) with minimally invasive surgery (MIS). Methods Between February 2017 and July 2019, 155 patients with acetabular fractures underwent fixation with the KL + APSF approach. For 1 year functional outcomes, radiographic findings, and postoperative complications were evaluated. Results Of 155 patients with a mean age of 40.16 ± 10.32 years, 82 patients were male and 73 were female. The most common pattern of fracture was both columns (32.9%). The average blood loss was approximately 527 ml. The average operation time was 85 min. The mean length of surgical incision was 113.3 mm. Harris’ hip score was excellent in 75.5% of cases. The mean VAS score was approximately 4 and 91.6% of patients returned to pre-trauma activity. In 74.8% of cases, the reduction was anatomical. Complications after surgery were very insignificant and included the following: 2 patients had foot drop within 5 months both patients recovered, 2 patients had femoral nerve palsy and 3 cases of deep vein thrombosis and 1 case of pulmonary thromboembolism were treated. There were four patients with surgical site infections, all of whom recovered and two of the seven patients with osteoarthritis underwent total hip arthroplasty. Conclusion Combining posterior approach with minimally invasive anterior method in fixation and treatment of acetabular fractures is a safe and reliable method and showed significant functional results with minimal complications.

Background: To reduce the complications of orthopedic surgery, the desire for less invasive procedures, such as, knee arthroscopy to repair the anterior cruciate ligament, has increased. There are, currently, two common positions for limbs that are used during surgery depending on the surgeon's experience. Therefore, our aim was to investigate the effect of limb position on complications after anterior cruciate ligament reconstruction surgery.Materials and Methods: From April 2016 to July 2020 at our orthopedic-sports trauma center, 688 patients between the ages of 18 and 50 with anterior cruciate ligament rupture underwent reconstruction surgery with a hamstring graft. Patients were divided into two groups in terms of limb position at the time of surgery. For three months, patients were evaluated for surgical complications, basic demographic information, and information during surgery.Results: There was no statistically significant difference between the two groups in terms of demographic information, side of injury, preparation time, tourniquet time, operation time, and duration of hospitalization. At quarterly follow-up, there was no significant difference between the two groups in terms of postoperative complications (P= 0.976).Conclusions: There is no difference between compartment syndrome and deep vein thrombosis in different situations, therefore, the surgeon should operate in any position he is skilled in. Also, surgeons should always pay special attention to these complications and provide necessary training to patients in order to prevent them.

Background: Wrist function has a significant impact on quality of life, which is why restoring normal wrist movement after surgery is so important. Due to the COVID-19 pandemic, and the restrictions imposed on “face-to-face” visits, using smartphones has become more important in tracking patients. The main purpose of this study was to determine the accuracy of telemedicine in following up patients who had undergone distal radius fracture operation. Materials and Methods: From February to October 2020, 126 patients between 20 and 60 years old were randomly selected at our orthopedic trauma center. All patients were visited in person by an orthopedic surgeon in the morning (control group) and again all of them were visited online via smartphone in the evening by another orthopedic surgeon (case group). Both visits were done at regular intervals in the 2^nd, 6^th, and 12^th weeks after surgery. Patients were evaluated for extremity function outcomes and joint range of motion. Results: The two groups were similar in terms of mean Patient-Rated Wrist Evaluation score and Disabilities of the Arm, Shoulder, and Hand score and did not show a statistically significant difference (P < 0.05). There was no significant difference in wrist range of motion measurements between the two groups (in-person visits and smartphone visits) during the follow-ups (P > 0.05). Conclusion: Changes in wrist range of motion after surgery can be assessed with high accuracy using smartphone applications and this method can be considered as a proper alternative to frequent in-person visits to evaluate postsurgical wrist condition.

Summary Background Intertrochanteric fractures are associated with high mortality and morbidity, so these patients should undergo fracture fixation surgery immediately. Despite surgery, the possibility of fracture fusion may not occur due to the association with various causes. Therefore, our aim is to investigate these factors (TNF‑a, IL‑1, Hb) and their effect on fracture union after fixation. Methods From 2018 to 2020, at our orthopedic trauma center, 163 patients older than 50 years with intertrochanteric fractures underwent DHS fixation surgery. Patients were divided into anemic and non-anemic groups in terms of preoperative hemoglobin level (standard hemoglobin 11 mg/dl). For 3 months, patients were assessed for union and failure fixation criteria, levels of proinflammation (TNF‑α, IL-1) and level of hemoglobin. Results The results show that out of 163 patients with fractures, at the time of initial admission, 74 patients had less than 11 hemoglobin g/dl. Patients with union fractures had higher hemoglobin levels than patients with non-union (11.71 ± 1.51 versus 11.24 ± 1.96), which was statistically significant between hemoglobin and union level (p = 0.030). At the end of the third visit (third month), 44 (59.5%) anemic patients received union completly, while among the patients with normal hemoglobin level, 32 (36%) received union bread, which was statistically significant (p = 0.003). There were no statistically significant differences between proinflammatory factors before surgery and 3 months after surgery (p > 0.05). Conclusion Due to the effect of anemia and proinflammatory factors in the process of healing fractures and bone formation and creating musculoskeletal balance, low hemoglobin level before surgery has a significant effect on fracture union and failure of fixation. So it is recommended to correct this anemia in these patients before surgery and during follow-up.

Background: Environmental factors play a key role in the occurrence of pediatric supracondylar humerus (SH) fracture which has been widely affected by the COVID-19 pandemic and the measures taken to curb its spread. In this study, we aim to investigate the ultimate impact coronavirus pandemic has had on SH fractures in children. Materials and Methods: This retrospective cohort study compares SH fractures which occurred during the pandemic with their prepandemic counterpart in a pediatric trauma public hospital. Patient's data, submitted from February to July 2020 and 2019, were collected and divided into two groups based on fractures’ time of occurrence, i.e., during or before the pandemic. Results: There was no significant difference in terms of gender, type of fracture, injury location, and time of admission during a day between the aforementioned groups. However, in the pandemic group, patients were transferred to the operating room significantly quicker (odds ratio; 2.13 vs. 0.607, P = 0.01) and the surgery duration was shorter (40.17 ± 12.28 min vs. 49.11 ± 15.48 min, P = 0.011). It was found that the location of injury (home, school, etc.) varied between the two groups (P = 0.01) and the proportion of domestic injuries during the pandemic grew significantly (53.6% vs. 19.8%). Conclusion: Although the incidence of pediatric SH fractures has decreased due to the closure of schools and sports clubs during the pandemic, domestic occurrence of the same fracture type has grown disproportionately. To prevent this trend, pediatric centers should educate parents on child safety measures and fracture risks during the lockdown.

Background: As the prevalence of the coronavirus increases, there is now more emphasis on reducing “face-to-face” patient visits. Therefore, the use of smartphones and their special medical applications can play an important role in following up patients. The aim of this study was to evaluate the use of smartphone in evaluating clinical outcomes and range of motion (ROM) of patients after anterior cruciate ligament reconstruction (ACLR). Materials and Methods: From January to December 2020, 112 patients between 20 and 50 years old were randomly selected at our orthopedic sports center. All patients were visited online through smartphone by a knee fellowship surgeon in the morning (case group) and again all of them were visited online through smartphone in the evening by another knee fellowship surgeon (control group). Both visits were done at regular intervals in the 2^nd, 6^th, and 12^th week after surgery. Patients were evaluated for function outcomes and joint ROM. Results: The two groups were similar in terms of mean International Knee Documentation Committee score, Lysholm knee score, and Tegner Knee Score and did not show statistically significant difference (P < 0.05) There was no significant difference in knee ROM measurements between the two groups (face-to-face visits and online through smartphone visits) during the follow-ups (P > 0.05). Conclusion: Smartphone apps are highly effective in assessing postoperative condition of knee ROM after ACLR, especially in the short time. However, this ability has been reduced in evaluating the long term. Hence, evaluation is still necessary through direct examination in the presence visit.