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Background: A coherent measurement approach for sagittal alignment of the distal femur after fracture reduction or distal femur osteotomies is not available. The present study aims to introduce a new method using Blumensaat's line and tangent lines to the femoral cortexes to determine the sagittal alignment of the distal femur. Methods: 113 patients who had true lateral knee radiographs were included. All of the radiographs were evaluated by one fellowship-trained knee surgeon and one radiologist using the PACS system. The Blumensaat's line was determined on the true lateral knee radiographs. Then, three long lines were drawn on the distal third of the femoral shaft. The first line is tangent to the anterior cortex of the femur, the second line is along with the anatomical axis of the femur, and the third line is tangent to the posterior cortex of the femur. The angles between Blumensaat's line and these lines were measured. Intraclass Correlation Coefficient (ICC) was used to measure the strength of inter-and intra-rater agreement. Results: The mean angle between the Blumensaat's line and the anatomical axis of the femur was 35.4 ± 3°. The mean angle between the Blumensaat's line and the line tangent to the anterior femoral cortex and the line tangent to the posterior femoral cortex were 34.5 ± 3° and 35.2 ± 3°, respectively. Excellent inter-and intra-rater reliabilities were observed between the measurements (ICC = 0.96 and ICC = 0.98, respectively). The angle between the Blumensaat's line and the line tangent to the posterior femoral cortex was significantly higher in participants aged < 38 years (p = 0.049). No other significant association was found between the angles and demographic characteristics of the patients. Conclusions: The expected mean angles between the Blumensaat's line and the distal femur were 34.3 to 35.4 degrees. This finding could be useful to determine the normal sagittal alignment of the distal femur. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Background: Anterior Cruciate Ligament (ACL) reconstruction is a common surgery in orthopedics. Strategies that could reduce the bleeding during the surgery could be helpful. Here, we aimed to assess the effects of tranexamic acid injection in ACL reconstruction on patient's functions. Methods: This is a clinical trial performed in 2019–2020 in XX on 61 patients with teared ACL who were candidates of surgical reconstruction. Patients were divided into two groups receiving 15 mg/kg of intravenous tranexamic acid and normal saline. Data regarding the following items were collected: amounts of drain discharge, the severity of the swelling, the pain severity in 1, 7 and 14 days after the surgeries and restrictions in joint range of motion (ROM) in 30 and 60 days after the surgeries. Results: We observed significantly lower swelling severities in patients who received tranexamic acid in different measuring times (P = 0.029). These cases also had significantly lower pain severity after 30 days post-operation (P = 0.041). We also observed that patients in the tranexamic acid group had significantly lower ROM restriction than controls (P < 0.001). The total knee scores were similar in both groups (P > 0.05). Conclusion: Administration of intravenous tranexamic acid significantly improved swelling, pain and lower ROM restriction in patients undergoing ACL reconstruction. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are common in elderly patients. The surgery is usually delayed due to underlying conditions, and pain control is crucial while the patient is cleared for surgery. In this randomized controlled trial (RCT) study, we hypothesized that the application of skin traction in patients with intertrochanteric fracture does not significantly change the Visual Analogue Score (VAS) of pain. Methods: This is a prospective, single institution, parallel randomized controlled trial. Two hundred and twenty-nine patients with isolated intertrochanteric fractures were enrolled in the study. Patients with neurologic issues, drug addiction, scars or swelling, or vascular issues at the site of skin traction application were excluded from the study. Patients were divided into two groups: group A included 97 patients, and group B included 95 patients. Skin traction was applied for group A, while only a soft pillow was put beneath the patients' knees in the other group. The VAS score was measured after the diagnosis, two hours before the operation, and 24 h after the surgery. The morphine dosage administered per day was documented for both groups. Results: After excluding patients with postoperative delirium, 154 patients (55 males and 99 females) with isolated intertrochanteric fractures (69 right-sided and 85 left-sided), and a mean age of 70 ± 10 remained in the study. There were no significant differences between the two groups regarding age, gender, and mean time from injury to admission (P >.05). The mean VAS score measures and morphine dosage administered per day were not significantly different between the two groups (P >.05). Both groups experienced significant pain relief 24 h postoperatively (P <.001). Conclusion: Pre-operative skin traction application affected neither the patients' VAS scores nor the mean morphine dosage per day in patients with isolated intertrochanteric fractures. Our data does not support the routine application of pre-operative skin traction in patients with intertrochanteric fractures. Trial registration: The project was registered in the Iranian Registry of Clinical Trials (registration reference: IRCT20180729040636N3, registration date: 01/07/2020). Level of evidence: 1. [ABSTRACT FROM AUTHOR]

Scaffold creates a chance for bone growth and facilitates cell adhesion, growth and differentiation in orthopedic surgeries. Designing scaffold with adequate porous geometry and suitable compressive strength is debatable among biomaterial engineers and clinical orthopedic surgeons. Therefore, in this study we fabricate a novel porous hydroxyapatite-wollastonite reinforced with 0, 5, 10, and 15 wt% alumina nanoparticles (ALN: 40–80 nm) for bone substitute. In the current work, a porous cylindrical scaffold (6 mm × 10 mm) fabricated with space holder (SH) technique using sodium bicarbonate (NaHCO 3) as a porous agent. The porosity, compressive strength and the biological behavior of the porous samples were investigated using standard mechanical and biological testing. After making the specimen, scanning electron microscope (SEM) and X-ray diffraction (XRD) analysis were performed to verify the accuracy of the nanomaterial's properties. The mechanical and biological analysis (swelling & water absorption) showed that the sample with 10 wt% alumina nanoparticles (ALN) had both proper compression strength vs. porosity percentage and bioactivity response. The molecular modeling for predicting the elastic modulus of bio-nanocomposite were performed and the results were close to the experimental values. The obtained result, indicated that compressive strength increased from 2.8 to 3.5 MPa with 49% to 61% porosity value. The sample with 10 wt% ALN and wollastonite showed clinical applications of these composites as a bone-substitute. Unlabelled Image • A novel porous scaffold creates a chance for bone growth and facilitates cell adhesion. • A novel porous hydroxyapatite-wollastonite reinforced with alumina nanoparticles for orthopedic bone substitute. • The samples showed a compressive strength with 3.5 MPa and 61% porosity value. • The space holder technique was applied using NaHCO 3. • The micromechanical model was utilized to predict the effect of porosity on elastic modulus of the specimen. [ABSTRACT FROM AUTHOR]

Background: One of the most common fractures in the skeleton happens in the femur. One of the important reasons for this fracture is because it is the longest bone in the body and osteoporosis affect this part a lot. The geometric complexity and anisotropy properties of this bone have received a lot of attention in the orthopedic field. Methods: In this research, a femur designed using 3D printing machine using the middle part of the hip made of polylactic acid–hydroxyapatite (PLA–HA) nanocomposite containing 0, 5, 10, 15, and 25 wt% of ceramic nanoparticle. Three different types of loadings, including centralized loading, full-scale, and partially loaded, were applied to the designed femur bone. The finite element analysis was used to analyze biomechanical components. Results: The results of the analysis showed that it is possible to use the porous scaffold model for replacement in the femur having proper strength and mechanical stability. Stress–strain analysis on femoral implant with biometric HA and PLA after modeling was performed using the finite element method under static conditions in Abaqus software. Conclusion: Three scaffold structures, i.e., mono-, hybrid, and zonal structures, that can be fabricated using current bioprinting techniques are also discussed with respect to scaffold design. [ABSTRACT FROM AUTHOR]

Purpose: High-energy tibial fractures may cause compartment syndrome, which needs fasciotomy. However, in this procedure, close fractures become an open wound and choosing the best type of fixation for this situation has been a problem. We assumed early open reduction and internal fixation (ORIF) instead of late internal fixation or external fixation, or stage-based approach is a better method.Methods: We collected fifty-seven medical records from 2012 to 2017 stored in Alzahra and Kashani University Hospital databases. We selected important information of their medical files, called the submitted phone numbers, and asked them to come to our clinic and examined their leg for any malunion and/or movement restriction postoperatively. We asked about pain and paresthesia in their leg. Twelve cases were excluded.Results: Demographic variables were not significantly different between these two groups. Deep infection, malunion, decreased range of motion in both knee and ankle joints, pain and paresthesia mainly occurred in external fixation group, except malunion (p value = 0.032), other variables were not statistically significant between two groups. More surgeries were performed predominantly for external fixation group (p value < 0.001). External fixation stayed 4.7 days longer at hospital although it was not statistically significant (p value = 0.108).Conclusion: It is better to perform fasciotomy and ORIF simultaneously in one surgery to lower the number of surgeries, days of hospitalization, decrease the risk of deep infection, malunion and movement restriction although its postoperative outcomes were not considerably different from external fixation. We indicate that stage-based approach is accompanied by poor outcomes and lesser satisfaction. [ABSTRACT FROM AUTHOR]

Similar to metallic implant, using the compact bio-nanocomposite can provide a suitable strength due to its high stiffness and providing sufficient adhesion between bone and orthopedic implant. Therefore, using zirconia-reinforced calcium phosphate composites with new generation of calcium silicate composites was considered in this study. Additionally, investigation of microstructure, apatite formation, and mechanical characteristic of synthetic compact bio-nanocomposite bones was performed. Desired biodegradation, optimal bioactivity, and dissolution of tricalcium phosphate (TCP) were controlled to optimize its mechanical properties. The purpose of this study was to prepare the nanostructured TCP-wollastonite-zirconia (TCP-WS-Zr) using the space holder (SH) technique. The X-ray diffraction technique (XRD) was used to confirm the existence of favorable phases in the composite's structure. Additionally, the effects of calcination temperature on the fuzzy composition, grain size, powder crystallinity, and final coatings were investigated. Furthermore, the Fourier-transform infrared spectroscopy (FTIR) was used for fundamental analysis of the resulting powder. In order to examine the shape and size of powder's particles, particle size analysis was performed. The morphology and microstructure of the sample's surface was studied by scanning electron microscopy (SEM), and to evaluate the dissolution rate, adaptive properties, and the comparison with the properties of single-phase TCP, the samples were immersed in physiological saline solution (0.9% sodium chloride) for 21 days. The results of in vivo evaluation illustrated an increase in the concentration of calcium ion release and proper osseointegration ratio, and the amount of calcium ion release in composite coatings was lower than that in TCP single phase. Nanostructured TCP-WS-Zr coatings reduced the duration of implant fixation next to the hardened tissue, and increased the bone regeneration due to its structure and dimensions of the nanometric phases of the forming phases. Finally, the animal evaluation shows that the novel bio-nanocomposite has increasing trend in healing of defected bone after 1 month. [ABSTRACT FROM AUTHOR]

Background: It is unclear what role COL1A1 polymorphisms play in anterior cruciate ligament (ACL) injury pathophysiology. The present study investigated the relationship between COL1A1-1997 guanine (G)/thymine (T) (rs1107946) polymorphism and ACL injury. Moreover, the possible effect of this polymorphism on the postoperative outcomes of ACL reconstruction surgery was evaluated. Methods: This prospective case–control study was performed on 200 young professional men with an ACL tear who underwent arthroscopic ACL reconstruction surgery. Moreover, 200 healthy athletes without a history of tendon or ligament injury who were matched with the case group were selected as the control group. DNA was extracted from the leukocytes of participants, and the desired allele was genotyped. Clinical outcomes were collected for the case group before and one year after surgery. Results: The genotype distribution was in accordance with the Hardy–Weinberg principle. In the ACL injury group, the G allele frequency was non-significantly higher than the healthy controls, with an odds ratio [95% CI] of 1.08 [0.79–1.47] (P = 64). We did not find a significant difference between the genotype of individuals—GG, GT, and TT—in the case and control groups (P > 0.05). Clinical outcomes of the ACL tear group were significantly improved in terms of preoperative values. However, none of them were significantly different between the three genotypes (GG, GT, and TT). Conclusion: According to the findings of the present investigation, single-nucleotide polymorphism (SNP) at COL1A1 rs1107946 (G/T) was not a predisposing genetic factor for ACL injury in a young professional male athlete population in the Middle East. Furthermore, patients' responses to treatment were not different between distinct genotypes. Level of evidence III. Highlights: Collagen gene variations seemed to have an association with anterior cruciate ligament (ACL) injury among professional athletes. This study shows no association of a type of COL1A1 polymorphism ACL injury in a young professional male athlete population. Different genotypes of COL1A1 have similar outcomes in ACL reconstruction surgery. [ABSTRACT FROM AUTHOR]