Percutaneous vertebroplasty is a promising therapeutic technique for pain control in patients with pathologic fractures of vertebral bodies. Percutaneous vertebroplasty is an appropriate treatment for vertebral pathologic fractures, which is resistant to other usual treatment. It is a useful and only choice in special cases, because of less tissue damage and there is no risk of open surgery and patient's embolization is rapid. Herein we described the first case of percutaneous vertebroplasty in Yazd shahid sadoughi teaching hospital, which was done in ordybehesht 1386 in a 72 years old male with pathologic fracture of 2 lumbar vertebrae. He was suffered from pain and disability and open surgery was not appropriate treatment for him.

Background: There are many methods for evaluating a traumatized metacarp. Objectives: This study sought to evaluate the accuracy of the metacarpal Compression test for the diagnosis of metacarpal fracture. Methods: All patients with metacarpal trauma were tested via placement of axial load (Compression) on the metacarpal; induction or exacerbation of pain on each metacarp was recorded upon applying axial pressure. Then, an X-Ray imaging system was used to identify and record the presence of fracture. All data were entered into a 2x2 table, and then negative predictive value (NPV), positive predictive value (PPV), sensitivity and specificity of the test were calculated. Results: After careful physical examination and application of the axial pressure on the metacarpal bone, 16(23. 68%) patients did not experience any pain during axial loading (none had fracture). According to the statistical analyses of the data, the proposed method had a 69% specificity, 100% sensitivity, 86% PPV and 100% NPV. Conclusion: Our findings showed that axial loading applied on the metacarpal bone, when it leads to pain, is a good marker for fracture. On the other hand, patients with negative test results had no fracture on radiography, which emphasized 100% NPV of the test.

The rock masses have naturally a large number of cracks and discontinuities which cause to be prone to damage under dynamic loading. The earthquake as a kind of dynamic loading may propagate the inherent cracks in rock masses and leads to failure of the rock structures such as mines, oil and gas wells, tunnels, dams, etc. Therefore, the fracture of rock masses due to cracks under earthquake should be considered by civil, mining and even mechanical engineers and researchers. fracture mechanics as a branch of mechanical engineering science has been frequently employed for investigating the fracture behaviour of cracked rock structures. According to the orientation of crack relative to applied load, the cracked parts may be subjected to pure or combined mode loading I, II and III. The underground rock masses are often subjected to a compressive loading due to the pressure of upper rock masses. In the first sight, the crack flanks under Compression are pressured together and the geometry discontinuity is vanished. However, the crack faces may be subjected to sliding loading and the vulnerability of cracked rock masses is still remained. Therefore, the fracture analysis of cracked rock masses under Compressionshear loading should be investigated. Similar to the mixed mode I/II loading, there are several studies in the literature investigated the fracture of cracked specimens under Compression-shear loading both experimentally (Al-Shayea, 2005) and theoretically (Li et al., 2009). From the theoretical viewpoint, the Compression is considered as a compressive stress in the stress field around the crack tip and then the fracture criteria based on new stress field is utilized for predicting the fracture resistance of cracked specimens. The aim of this paper is to present a new approach for predicting the fracture load of cracked rock samples under Compression-shear loading. The new approach is based on the maximum tangential stress (MTS) criterion which is one of the classical fracture criteria in fracture mechanics.

Physical examination is the most important procedure for examining traumatized patients and ruling out possible bone fractures. Edema, deformity, ecchymosis, tenderness on trauma location, and limited bone movement are among the signs of fracture. The diagnosis is documented by plain radiography. The number of false positive cases in this test increase in the presence of soft tissue injury along with bone damage. In this case, a great number of X-rays will be taken daily and many patients will be exposed to radiation, unnecessarily (1). The question to be fully answered is whether all cases of trauma and pain require radiographs or not? ...

Background: The risk of fractured vertebral increases in patients with rheumatoid arthritis as they are more likely to suffer from osteopenia, and osteoporosis. Objectives: This study aimed to investigating the rate and risk factors of vertebral fractures in patients with rheumatoid arthritis. Methods: We recruited 201 patients aged between 30 and 70 who attended the rheumatology department at Shahid Hemn Teaching Hospital in Sulaymaniyah, between January and September 2022. Medical records were reviewed for disease and treatment characteristics while also clinically evaluated by a rheumatologist. Spinal radiographs were assessed by two experienced radiologists blinded to patients’,clinical diagnosis and status. Compression fractures were classified by using the Genant semiquantitative method, and the type of fracture was classified as wedged fracture, biconcave fracture, or crushed fracture. Results: Of the 201 included participants, 151 were female, and 50 were male. The BMI of women was higher than men by nearly four points (P < 0. 001). Most women were also illiterate (68/151, 45. 0%) and unemployed (139/151, 92. 1%). Hypertension (28. 4%) and diabetes mellitus (14. 4%) were the most reported comorbidities. Women were more likely to have higher DAS28 scores while men had more vertebral fractures (P = 0. 003). The probability of fractures increased with age, male sex, and illiteracy compared to primary school, osteopenia, and osteoporosis through simple and multiple logistic regression models. Conclusion: With at least one fracture affects females and males at a rate of 27. 8% and 52. 0%, respectively. Also reported that age, male sex, illiteracy, osteopenia, and osteoporosis significantly increase the risk of fractures.

Background: In the patients with osteoporotic vertebral Compression fracture (OVCF) treated conservatively, significant progressionof the local kyphosis due to an impaired healing leads to reduction in the quality of life. Thus, it is of critical value to identifythe predictors of this major complication. Objectives: The current prospective cohort study aimed at evaluating the predictors of progression in the local kyphosis in a seriesof patients with acute OVCF undergoing conservative treatment. Methods: Eligible patients with OVCF were identified and local kyphosis progression was evaluated after four months of conservativetreatment. Demographic characteristics such as gender, age, and body mass index (BMI), as well as radiographic characteristicssuch as the location of fracture, bone mineral density (BMD), andserum25 (OH) vitaminDlevel were compared between the patientswith local kyphosis angle (LKA) progressed 30° (group A) and the patients with LKA remained < 30° (group B). Results: From a total of 60 patients with OVCF, LKA progressed  30° in 19 patients (31. 7%). The mean change of LKA was 16. 2°  7. 2° in group A and 1. 92°  2. 7° in group B (P < 0. 001). Higher age, lower BMI, and lower spinal BMD were significantly associatedwith LKA progression  30° (P = 0. 013, P < 0. 001, and P = 0. 037, respectively). The involvement of thoracolumbar junction (T11-L1)was more frequent in group A (P = 0. 049). Anterior cortical wall fracture was more frequent in group A as well (P = 0. 007). Afteradjustment of confounding factors, the association of LKA progression with the age, BMI, and the level of fractured vertebra stillremained significant. Conclusions: Significant progression of LKA following conservative treatment of OVCF is correlated with the level of fractured vertebra, BMI, and age of the patients. These factors could be used to select patients most benefit from conservative treatment.

Background: Comminuted distal metaphyseal fractures of tibia, often pose major treatment problems. Closed reduction, leads to high rate of malunion, while open reduction is associated with high risk of wound problems, joint stiffness, and nonunion. Biological fixation of these fractures by locking Compression plates (LCP) is another alternative for fixation of this difficult fracture.Methods: 22 patients with comminuted fracture of distal metaphysic, in a two-year period were treated with percutaneous application of LCP. The cases were evaluated clinically and rediographically with an average follow-up of 11 months. Results: Union was achieved in 19.2 (15-28) weeks in all cases. No skin breakdown and no malunion were observed. Full ankle motion was observed in all but 3 patients who had restricted dorsiflexion. One case of superficial wound infection was observed. Plate prominency was seen in 3 patients that caused skin irritation in one case. All swellings subsided and blisters healed within two weeks. Conclusions: With better preservation of blood-supply in biological application of LCP plates in distal tibial metaphyseal fractures, fast healing potential with fewer complications is to be expected.

Statement of Problem: In a previous study it was reported that a durable resin-ceramic tensile bond could be obtained by an appropriate silane application without the need for HF acid etching the ceramic surface. Evaluation of the appropriate application of silane by other test methods seems to be necessary.Purpose: The purpose of this study was to compare the interfacial fracture toughness of smooth and roughened ceramic surfaces bonded with a luting resin.Materials and Methods: Ceramic discs of 10 mm in diameter and 2 mm in thickness were prepared.Four different surface preparations (n=10) were carried out consisting of (1) ceramic surface polished to a 1µm finish, (2) gritblasted with 50µm alumina, (3) etched with 10% HF for 2 min, and (4) gritblasted and etched. The ceramic discs were then embedded in PMMA resin. For the adhesive area, the discs were masked with Teflon tapes. A circular hole with diameter of 3 mm and chevron-shaped with a 90° angle was punched into a piece of Teflon tape. The exposed ceramic surfaces were treated by an optimised silane treatment followed by an unfilled resin and then a luting resin cylinder of 4mm in diameter and 11 mm in length was built. Specimens were stored in two different storage conditions: (A): Distilled water at 37°C for 24 hours and (B): Distilled water at 37°C for 30 days. The interfacial fracture toughness (GIC) was measured at a cross-head speed of 1 mm/min. The mode of failure was examined under a stereo-zoom microscope and fracture surfaces were examined under Scanning Electron Microscope.Results: The mean interfacial fracture toughness values were; Group A: 1) 317.1±114.8, 2) 304.5±109.2, 3) 364.5±169.8, and 4) 379.4±127.8 J/m2±SD. Group B: 1) 255.6±134.4, 2) 648.0±185.1, 3) 629.3±182.6 and 4) 639.9 ±489.0 J/m2±SD. One way Analysis of Variance showed that there was no statistically significant difference in the mean interfacial fracture toughness for groups A1-A4 (P>0.05). However, the mean interfacial fracture toughness for group B1 was significantly different from that for groups B2, B3 and B4 (P<0.05). Independent-ٍٍٍSamples T-Test results showed that there was a significant increase in the GIC mean value for groups B2 and B3 after 30 days water storage (P<0.05). The modes of failure were predominantly interfacial or cohesive within the resin.Conclusions: The fracture toughness test method used in this study would be appropriate for analysis of the adhesive zone of resin-ceramic systems. From the results, it can be concluded that micro-mechanical retention by gritblasting the ceramic surfaces could be sufficient with no need for HF acid etching the ceramic surfaces when an appropriate silane application procedure is used.

Background: As a minimally invasive operation, kyphoplasty has become popular in the treatment of Osteoporotic Vertebral Compression fracture (OVCF). Objectives: This study aimed to evaluate how the timing of kyphoplasty affects the parameters of sagittal alignment in OVCF. Methods: In this prospective study, the patients with OVCF, who underwent kyphoplasty at our center, were recruited. Pre-and post-operative vertebral height, local and total kyphosis, coronal axis, sagittal vertebral axis, pelvic tilt, lumbar lordosis, sacral slope, and spino-cranial angle were evaluated and compared between acute OVCF (kyphoplasty performed within 1 month after injury) and chronic OVCF (kyphoplasty performed after 1 month from injury) patients. Results: Kyphoplasty was done for 18 acute and 28 chronic OVCF patients. All of the evaluated parameters, except spino-cranial angle, were significantly improved after the kyphoplasty. A significant difference was observed between the mean lumbar lordosis improvement of the two groups (P=0. 026). In particular, the Mean± SD lumbar lordosis improved 6. 1± 6. 6º in the acute patients and 0. 92± 7. 86º in the chronic group. No other significant difference was observed between the improvement of the spinopelvic parameters in the two groups. Conclusion: The timing of kyphoplasty impacts the improvement of spinopelvic parameters, as well as the reduction of pain and restoration of vertebral height.