Background: Distal femoral INTRA-ARTICULAR fractures (DFIAF) can be very challenging. Although، satisfactory outcomes have been reported، however، there are several complications interfering the patients after treatment. In current retrospective study، the outcomes of treating DFIAF with open reduction internal fixation (ORIF) using locking plates (LCP) were investigated. Material and Methods: There were 51 patients enrolled. In last visit، Lysholm score was completed for all of the patients. Pain intensity and satisfaction were measured using visual analogue scale (VAS). Degenerative changes were assessed on plain x-rays. Bilateral knee range of motion was measured and compared. The patients were followed for 17. 4± 7. 2 months. Results: Fractures were united in all of the patients. Degenerative changes were found in 15 patients (29. 4%). The pain intensity was 2. 7± 1. 3. Nineteen patients required to use analgesics (37. 2%). VAS for satisfaction averaged 7. 7± 1. 1. The Lysholm score averaged 81. 8± 8. 3. The range of knee motion was significantly limited inn operated side compared to the healthy one (116. 6± 12. 4 Vs 125. 3± 7. 3; p<0. 001). Conclusions: Treatment of DFIAF using ORIF can be associated with complete fracture healing. However، the incidence of degenerative changes and consequent complications such as pain and loss of ROM are considerably concerning.

Strength measurement of rock requires testing that must be carried out on test specimens with particular sizes in order to fulfill testing standards or suggested methods. Often, the coring process breaks up the weaker core pieces, and they are too small to be used in either index tests or conventional strength tests such as point load index (Is) and Brazilian tensile strength (BTS). One of the index tests to indirectly determine the rock strength is the BLOCK punch index (BPI) test, which requires flat disc specimens without special treatment. This study aimed to evaluate the applicability of the BPI test for predicting the uniaxial compressive strength (UCS), BTS and IS of the sandstones by empirical equations. Also, we have compared the performance of the BPI and IS for predicting the UCS and BTS. It was experimentally shown that BPI is a reliable method for predicting the UCS, BTS and Is of the sandstones under study. Moreover, the results indicate that BPI could be utilized with same importance as Is for predicting the UCS, while predicting the BTS by Is appears to be more reliable than BPI.

Introduction: Fractures of distal radius are common in adulthood and treatment of these fractures especially displaced intraarticulars is controversial. External fixation is one of treatments for these fractures. This study was designed to evaluate the results of distal radial intraarticular fractures treatment with external fixator (transfixation). Materials and Methods: This is a study with no control in which 26 patients (30 fractures) with distal radial fractures (universal type IV) where selected by convenience method. Closed reduction and external fixator application for 6 weeks was performed in all patients. Patients were followed for one year.Results: There were 26 patients (4 bilateral cases) including 24 males and 2 females. Their average age was 28±5 years. Average follow up time was 8 months (6 to 20 months). Clinical and radiographic union occurred in all patients. At the last follow up four patients had pain with vigorous activity (13%). Limitation of motion was severe in one patient (3%) and mild in two patients (6%). Average radial shortening was 4 millimeters and average volar tilt and unlar inclination were 5.4±6.6° and 12.5±4.5° respectively. Conclusion: Considering our clinical and radiological results it seems that external fixator is a good method for treatment of displaced intraarticular distal radial fractures.

Synovial Sarcoma (SS) is a rare and aggressive sarcoma that usually occurs around the knee joint; it rarely involves the hand. Joint involvement by SS is extremely rare. We report a case of wrist intraarticular SS presenting with chronic wrist pain. The patient underwent surgical excision alongside with local radiotherapy and chemotherapy. After 24 months of follow up, there was no recurrence or metastasis. Intraarticular SS should be in a differential diagnosis list of chronic wrist pain even though it is extremely rare.

Introduction: After caesarean, mothers need to take care of their babies as soon as possible, and pain relief in them leads to more comfort and faster recovery and it reduces hospitalization time and complications such as pulmonary thromboembolism as well as treatment costs.Objective: Determining the effect of TAP BLOCK by injection of Bupivacaine 0.25% after caesarean section on post operative pain.Materials and Methods: This study was performed on seventy six women that underwent elective caesarean section. Then, the women were randomly divided into two groups. Six women were excluded from the study which was a double-blind clinical trial. In the case group: 20cc of Bupivacaine 0.25% was injected between transverse abdominal muscle fascia and internal oblique muscle fascia, and in control group the same amount of normal saline was used. Pain intensity was measured by VAS score at 2, 4, 6, 12, 24, 48 hours after surgery. In both groups, if the patient needed pain relief, diclofenac suppository was used and its dose was recorded. Some complications such as nausea, vomiting and dizziness were recorded too, data were analyzed by SPSS (21) software, P value less than 0.05 was considered statistically significant.Results: VAS score at 2, 4, 6 hours after surgery in case group was significantly lower than that in the control group. (P=0.0001, P=0.0001, P=0.039), respectively. The mean number of administered diclofenac in bupivacaine group was lower than that in placebo group (P=0.0001). The mean and standard deviation of pain free period in bupivacaine group was 13.77±2.41 and in placebo group was 5.94± 1.27. Survival rate of analgesia was 14.3% in bupivacaine group and 2.9% in placebo group. This difference was statistically significant (P= 0.001).Conclusion: Transverse abdominal plane BLOCK with Bupivacaine 0.25% can reduce post caesarean pain without any side effects, such as dizziness, nausea and vomiting, and any effect on the time of ambulation. It can also reduce use of analgesics.

Purpose: Together with the increase of orthodontic treatment needs the use of functional apparatus has been increased. Furthermore, different studies has been done on skeletal and dental changes after the use of these functional appliances, but few studies discussed soft tissue changes in the field. So, this study was carried out in order to evaluate soft tissue changes following the use of Twin BLOCK functional appliance.Methods & Materials: This study was quazi experimental done on 13 patients (7 girls and 6 boys) with 7 years and 7 months to 12 years and 6 months of age. All patients were Cl II Div.I malocclusion, Iranian, Muslim, resident of Tehran and with no previous orthodontic treatment and tooth extraction. The period of treatment with the apparatus varied between 7 to 17 months. The studied angular variables were nasolabial, nasofacial, facial convexity,H angle, mentocervical, nasomental and mentolabial. The liner variables were lower and upper lip to E line, upper and lower lip thickness, prominence and length, upper and lower face height. All variables were compared before and after the use of Twin BLOCK and recorded in a questionnaire and were analyzed by T - test. Results: The study showed that nasolabial, nasofacial, Lower lip to E line and Upper lip length decreased slightly with the use of apparatus, while facial convexity, H angle, upper lip prominence, upper lip thickness and upper lip to E line decreased significantly. As well as, mentocervical, upper lip thickness, lower lip prominence and soft tissue lower face height increased slightly and nasomental, mentolabial, soft tissue upper face height and lower lip length increased significantly.Conclusion: Following the treatment with Twin BLOCK, the lower face soft tissue moved anteriorly leading to decrease in profile convexity. The upper and lower face soft tissue height increases and their ratio improved. The upper and lower lip thickness reduced, but upper lip length did not change and lower lip length increased after the treatment. The space between upper and lower lip edge to E - line moved to a normal range and labiomental fold became wider.

Objectives: We aimed to assess the most effective route for Tranexamic acid (TXA) administration among Intraarticular (IA), Intravenous (IV), and combined IA/IV for Total Knee Arthroplasty (TKA) surgeries. Methods: A double-blinded clinical trial was run on 147 TKA candidates. Blood loss and hemoglobin (Hb) drop were evaluated using the Gross and Nadler formula in three matched case groups administered TXA during the TKA through IV, IA, or combined IA/IV route. Tourniquet was used on all operations for controlling intraoperative blood loss. No drainage catheter was used for the cases. Results: The combined group showed an average blood loss of 630±, 252 ml, which was significantly lower than that in the IV group (878±, 268 ml, P<0. 01) and the IA group (774±, 288 ml, P=0. 03). Furthermore, the mean Hb and hematocrit drop were significantly lower in the combined group, compared to the other two groups, 48 and 72 h postoperatively (P<0. 05). Conclusion: The combined IA/IV route had a 28% and 19% reduction of blood loss, compared to the IV or IA methods, respectively. Therefore, using TXA via the combined IA/IV route may be more effective for reducing perioperative blood loss following TKA surgery using a tourniquet without drain placement.