Tehran University Medical Journal

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Background: Tibial and femoral fractures, commonly seen in emergency departments, may be associated with various knee ligament injuries. The aim of this study was to determine the prevalence of such fracture-associated knee ligament problems, with especial attention to rapid diagnosis.
Methods: This study was carried out in patients with femoral or tibial fractures who were operated on in Imam Khomeini Medical Center from March 2003 to March 2005. All patients underwent surgical repair immediately after acute fracture, followed by a thorough knee examination. Patients with positive clinical findings were further evaluated using the stress view and arthroscopy.
Results: We enrolled 470 cases in this study, of which 266 were tibial and 204 were femoral fractures. There were 404 men and 67 women, with an average age of tibial fracture patients was 34.5 and 44.6 years for those with femoral fractures. Of all fractures, 66% were due to car accidents, 16% to industrial accidents and 8% due to falling. The overall prevalence of ligament injuries in tibial fractures was as follows: 6.58% ACL tearing, 2.5% PCL, 21.95% MCL and 14.63% LCL. The overall prevalence of ligament injuries in femoral fractures was as follows: 6% ACL tearing, 3% PCL, 14% MCL and 8% LCL.
Conclusion: The prevalence of ligament injuries of the knee was highest in distal femoral and tibial plateau fractures. It is prudent to perform a thorough knee examination once the fracture is stabilized in the operating room for the early detection of ligament injuries and prevention of further complications.

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Background: Pin loosening and infection in skeletal traction are important problems in orthopedic surgery and methods which are usually used to manage these problems, are costly and sometimes complicated. In this study, the efficacy of using cast support in infection and loosening of proximal tibial pin was investigated.

Methods: In a randomized clinical trial, 60 patients referring to Rasul-e- Akram hospital from 1383 to 1384, who needed to have proximal tibial pin for at least one month, were studied. All patients were treated with oral antibiotic until 24 hours after pin insertion. Depending on using cast support or not, they were randomly categorized into two groups (30, 30). The rate of pin loosening and infection between these two groups were compared.

Results: In the group without cast support infection rate was about %26.7 while this rate was %13.3 in the group with cast support, which means no significant difference (.33). In addition, although the rate of loosening in the group without cast support was more than the other group, it had no statistical meaning. (%20 compared with %10, p= 0.47)

Conclusions: Cast support doesn't affect the rate of pin loosening and pin site infection. However, considering correct technique for pin insertion including prevention of thermal injury and local hematoma is very important. Therefore, the use of cast support is an optional choice up to surgeons' preference.

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Background: Orthopedic trauma is a common type of injury in children and may cause deep and permanent psychological and physical damage both for the patient and the parents. This study aimed to analyze the epidemiology age, gender distribution and the mechanism of injury in patients presenting to a level I trauma center in urban population of Tehran. Methods: In this prospective descriptive study, the patients under 19 years old with orthopedic trauma who were hospitalized in Tehran Shafa University Hospital were entered. This hospital is the main orthopedic referral center in Iran. The patients were prospectively evaluated from April 2013 to March 2014. The data were collected and analyzed. Results: The study included 1081 patients under 19 years old. There was a male predominance (76.8% n= 830). The boys had a higher mean age 11.04±5.06 year, versus girls with mean age 8.67±4.63 year (P< 0.05). The peak age of boys was 18 and the girls had two peaks at three and nine. The fractures occurred in upper limb in 70.8% (n= 621) and 29.2% (n= 256) in lower limb of patients. There were 27 cases with joint dislocation, 5 cases with knee ligamentous injuries, 128 cases with soft tissue injuries and 44 cases with spine injuries. The most frequent mechanism in both gender were falls from standing position (48.5%). The most common fractures were foreman both bone fractures (n: 146 16.7%), elbow supracondylar fractures (n: 134, 15.3%) and distal radius fractures (n: 84, 9.6%). The most fractures occurred in summer (30.1%) and the least in winter (18.1%). Conclusion: Evaluation of epidemiologic factors can lead to the best prediction and treatment planning of trauma. Early recognition of injury, even minor, and expected care using specialized teams will help to improve outcomes for these patients. This study determines the most at risk children for trauma and fractures and may help the parents to prevent damage.