Background & Aims: supracondylar humerus FRACTURE is one of the most common pediatric elbow FRACTUREs accounting for about 16% of the pediatric FRACTUREs. Loss of REDUCTION is one of the complications after CLOSED and percutaneous fixation. This research is aimed to investigate the factors involved in the loss of REDUCTION. Method: In this descriptive study, the children with supracondylar humerus FRACTUREs were examined. 175 children under the age of 10 with type 3 and 4 supracondylar humerus FRACTURE FRACTUREs who underwent CLOSED fixation and pinning were entered into the study. The studied factors were analyzed by a logistic regression method. Results: in this study 175 children under the age of 10 including 71 girls and 104 boys (59. 4%) with the average age of 5. 4± 2. 4 were investigated. In 153 cases, (87. 4%) the fixation was anatomical and stable during the follow-up; while 22 cases (12. 6%) had the loss of fixation. The most important anatomical disorder was internal rotation displacement in the medial distal part of FRACTURE in these 22 cases. Pinning technique and obesity were among the effective factors in the failure of the anatomical REDUCTION. In a way that obese children (above 85 percentile or IBM>25) and the lateral pinning location were divergent but they crossed in the FRACTURE site and were effective with odd ratios of 1. 3 (CI 95% 0. 8-2. 3) and 1. 8 (CI 95% 0. 9-2. 3), respectively. In 14 cases (63. 6%) the failure was due to the place of FRACTURE cross and in 8 cases (36. 6%) the complication occurred in the obese children. The FRACTURE type had no effect on the loss of REDUCTION as no difference was observed. Conclusions: Obesity and fixation technique are among the effective factors in the loss of REDUCTION in pediatric supracondylar humerus FRACTUREs. In obese children, cross-suitable fixation should be considered to prevent complications.

Background: Distal radius FRACTURE represent approximately one-sixth of all FRACTUREs treated in emergency departments. According to high incidence rate, different mechanisms of injury and new treatments for this FRACTURE, it is becoming one of the most challenging of all kinds of FRACTUREs.Objective: to compare treatment outcome of traditional cast immobilization versus modern percutaneous pinning procedure in patients with distal radius FRACTUREs.Methods: In this randomized clinical trial study, 198 patients with "displaced but stable distal radius FRACTURE without joint incongruity", were split into two groups and each group was treated by one of the following standard protocols: A- CLOSED REDUCTION+Long arm cast; B- CLOSED REDUCTION and Percutaneous pinning and Short arm cast. The patients were followed up after operation for three months from the point of view of: 1- satisfaction (based on Saito chart) 2-Loss of REDUCTION 3- Finger stiffness 4- Pin tract infection and 5-The mean of post operation follow up visits. For statistical analysis the Fisher's exact test and chi-square test were used by SPSS software16 Results: In group A, six cases of loss of REDUCTION were detected in the first week who were treated by re-REDUCTION and P.C pinning procedure; But no cases of loss of REDUCTION were diagnosed in group B. Satisfaction percentage for Excellent value was 81.8% in group A and 93.9% in group B (p=0.131). Finger stiffness incidence rate in group B was meaningfully lower than group A (p=0.039). Pin tract infection incidence rate was 15.1% in group B; all of them were treated by pin removal and oral antibiotic therapy. The mean of post operation visits was 4.4 in group B and 3.6 in group A out of five sessions (p<0.0001).Conclusion: It seems that CLOSED REDUCTION and P.C pinning is a safer and less complicated procedure, especially in decreasing finger stiffness in these FRACTUREs.

Introduction: Nasal bone FRACTURE is the most common facial FRACTURE and the third most common FRACTURE of the human skeleton. The diagnosis and proper treatment of the nasal bone FRACTURE are based on physician’s findings and skill. The way to manage the nasal bone FRACTURE ranges from CLOSED REDUCTION to open REDUCTION. Insufficient REDUCTION caused secondary deformity after the swelling subside, and lead to requests of other surgical procedures.  Objective: To evaluate satisfaction rate of patients and physician from outcome of CLOSED REDUCTION 1 month later nasal FRACTURE.Materials and Methods: The descriptive study reviewed patients with nasal FRACTURE and treated by CLOSED REDUCTION at Amir-al-momenin hospital (Rasht) in 2007-2008 years. According to physical examination and radiologic findings, nasal FRACTUREs were classified. Demographic data, time of injury, mechanisms and severity of FRACTURE were recorded on data sheet. Patients were followed up 1 month later of nasal FRACTURE and their satisfaction upon Likert scale was recorded. The physician described satisfaction as good, fair, poor. Results: In this study from 67 patients 76.1% were male and 23.9% were female. Mean age of patients was 30.17±13.45 years. The major cause of the nasal FRACTUREs was attributed to fighting (43.3%).  B-type, U-type and F-type FRACTUREs composed 70.1%, 25.4% and 4.5% respectively. 26.9% of patients had soft tissues damages and 3% had FRACTURE in other facial bone. 36 patients (53.7%) were satisfied, 17 patients (25.4%) were very satisfied and 14 patients (20.9%) were unsatisfied. None of them were very unsatisfied. Physician evaluated outcome as good, fair, and poor in 65.7% (44 cases), 23.9% (16 cases) and 10.4% (7 cases) respectively. Conclusion: Although, there isn’t statistically significant difference between different type of FRACTURE or presence of soft tissue damage and patients' satisfaction rate, there is statistically significant difference between them and physician's satisfaction rate (P=0.02 and P=0.049). The results showed that in cases with severe FRACTURE (F-type) and presence of soft tissue damage, CLOSED REDUCTION should be considered carefully as the choice of treatment.

Background: Previous studies have explored the outcomes of CLOSED REDUCTION and percutaneous pinning in managing dorsal FRACTURE-dislocations of the proximal interphalangeal (PIP) joint, although these studies were limited in scope.  Objectives: This study aims to report this technique’s clinical and radiographic outcomes in the treatment of PIP joint dorsal FRACTURE-dislocation. Methods: We conducted a retrospective review of twelve patients with unstable dorsal FRACTURE-dislocations of the PIP joint that underwent CLOSED REDUCTION and percutaneous pinning. Parameters, including range of motion (ROM), grip strength, pinch strength, and PIP joint pain assessed via a visual analog scale (VAS). The PIP joint function was evaluated using quick disabilities of the arm, shoulder, and hand (Quick-DASH) questionnaire. Results: At a mean follow-up of 18.6 months, the mean PIP ROM was 99±5.3 (range 90-110), representing 90.2% of the contralateral side (P=0.31). The mean flexion contracture and extension lag were 6.7±3.2º and 6.3±3.1º, respectively. Patients reported a mean VAS score of 3.3±1.5 and a mean quick disabilities of the arm, shoulder, and hand (Quick-DASH) score of 10.8±6.1 points. The mean pinch strength of the involved hand averaged 80.4% of the contralateral side (P=0.19), and the mean grip strength averaged 92.29% (P=0.28). All patients achieved union with radiographically concentric joints, and no subluxation or dislocation events occurred during follow-up. Although radiographic evidence of arthritic changes was observed in all patients, these changes were clinically asymptomatic.  Conclusion: CLOSED REDUCTION and percutaneous pinning offer a simple, accessible, and minimally invasive technique for managing PIP joint dorsal FRACTURE-dislocations. The observed clinical and radiographic outcomes demonstrate stability and concentricity of the joint, suggesting this technique as a valuable surgical option for such injuries.

Background & Aims: The zygomatic arch is the most prominent portion of the face and is commonly injured during facial trauma. It articulates with the frontal bone, temporal bone, maxilla, and sphenoid bone, and serves as the main bridge amongst these bones. Isolated arch FRACTUREs comprise 10% of all zygomatic FRACTUREs and 5% of all facial bone FRACTUREs. Treatment of zygomatic arch FRACTUREs varies from observation to open REDUCTION. The Gilles temporal approach is a commonly used surgical technique for the REDUCTION of zygomatic arch FRACTUREs. However, this surgical approach is associated with a facial scar in the hairline and risks of facial nerve palsy. In this research, we performed a new method using a fifty millimeter needle without surgery cut for replacement of broken zygomatic arch and evaluated the amount of pain, edema, maximum mouth opening, and ecchymosis before and after the surgery. Materials & Methods: CT scans were taken of all the patients with isolated zygomatic arch FRACTURE who were referred to Imam Reza Medical Center and department of maxillofacial surgery during 201920. The 50 mm needle was used for REDUCTION with the new method. Results: This study was performed on 7 patients with isolated FRACTUREs of zygomatic bone. The mean age of patients was 33. 85. 5. 87 years. Significant REDUCTION in pain was reported during 7 days after surgery, but the rate of edema (p = 0. 539) and the amount of mouth opening after surgery did not show a significant difference. Conclusion: In reviewing the above studies and comparing them with the present study, it was observed that in simple FRACTUREs, the surgical method of the present study was a very useful and uncomplicated method in patients. Despite open REDUCTION methods, these methods have a lower scar rate, the duration of surgery is reduced, and this can lead to faster recovery of the patient.

Spinal FRACTUREs are up to four times more common in patients with AS than the general population. FRACTUREs in this population have a high incidence of neurologic complications, with spinal cord injury at initial presentation. The vast majority of these injuries are 3-column injuries resulting in an unstable spine. The diagnosis unfortunately, can frequently be missed or delayed. The mortality rate ranges from 18 to 32% in various series

Background: The colles FRACTURE is always accompanied by a severe pain when the physician tries to reduce it. Hematom block is one of the regional aesthetic techniques that used to anesthetize the patient.especialy in the population with age related problem that accompanies with high risk anaesthesia. Materials and methods: 80 patients 45-65yr old with ASA physical status I or III requesting hematom block were randomized into two groups, with or without bicarbonate addition to lidocaine in CLOSED REDUCTION of colles FRACTURE, respectively. The patients were sedated with midazolam 0.15 mg/kg and fentanyl 1mic/kg for both groups. In B group and A group the patient were anesthetized by 9 ml lidocaine 2% and 1ml bicarbonate 7.5% and 9 ml lidocaine 2% and 1ml water solution respectively. After alternative injection and aspiration into the FRACTURE area, all samples were studied in terms of onset of anesthesia and its quantity of pain by visual analogue score (VAS) before, during and thirty minutes after REDUCTION. The data was gathered using a checklist and analyzed by SPSS software through descriptive statistics and Chi two paired T test & X2. Statistical significance required P < 0.05 (P <0.05).Results: The study showed that onset of analgesia in B group (H. block with bicarbonate) with (388.2±63.8sec) and in groups A (H. block without bicarbonate) with (469.2±32.2sec) respectively (p=0.0001).VAS in the starting time of injection in B group with (7.9±1.9) and in A group (7.5±0.93) respectively (p=.069). Also, VAS during manipulation in B group was (1.4±0.75) and in A group (1.8±0.83) respectively (p=0.029). Eventually, thirty minutes later VAS scores of (4±0.81) in B group and in A group (4.7±0.88) respectively (p=0.001).Conclusion: Bicarbonate addition to lidocaine as an additive agent has a great effect on acceleration of anesthesia with REDUCTION of post operative pain score. So hematoma-block with bicarbonate additive is recommended for this kind of FRACTURE.