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Ankle fractures are among the most common types of fractures seen in the United States. Few studies have analyzed the use of a locking compression plate (LCP) hook plate in the fixation of malleolar fractures. The goal of this study was to analyze postoperative outcomes in malleolar fractures fixed with a 3.5-mm LCP hook plate. A cohort of 74 patients with ankle fractures treated operatively with hook plates between 2011 and 2021 by a single orthopedic surgeon was retrospectively reviewed. Time to union, duration of non–weight bearing, final range of motion, postoperative complications, demographics, and comorbidities were recorded. A total of 66 patients fulfilled our inclusion criteria. There were 5 isolated medial malleolar, 34 bimalleolar, and 27 trimalleolar fractures. There were 46 women and 20 men with a mean age of 60.9±18.9 years. Fourteen patients had diabetes, 27 had osteoporosis, and 4 were current or former tobacco users. All patients achieved union, with a mean time to union of 10.9±5.3 weeks. The mean time to weight bearing was 50.2±18.4 days. The mean length of follow-up was 8.1±5.6 months. At final follow-up, mean dorsiflexion was 9.9°±4.3° and mean plantarflexion was 14.1°±5.1°. Six patients experienced postoperative complications such as surgical site infections and posttraumatic osteoarthritis. This study demonstrates that the use of a 3.5-mm LCP hook plate in the operative fixation of malleolar fractures has a high rate of union while maintaining low rates of postoperative complications. [ Orthopedics . 202x;4x(x):xx–xx.]

Coronavirus disease 2019 (COVID-19) rapidly changed the landscape of health care, particularly in the New York City area. The elderly population is particularly vulnerable to both the novel coronavirus and the effects of a fracture. The goal of this study was to compare trends and outcomes of hip fracture patients during the pandemic. This was a retrospective chart review of hip fracture patients from a suburban academic hospital on Long Island, New York, who presented from March 1 to May 30, 2020. Patient COVID-19 status, demographics, and hospital outcome measures were recorded. Statistical analysis was performed using heteroscedastic t tests for quantitative variables and chi-square tests for qualitative variables. There were 82 patients in the 2020 cohort and 111 in the 2019 control group, representing a 29.9% decrease in cases. The 2020 cohort presented to the hospital an average of 2.77 days after injury compared with 1.15 days for the 2019 control group ( P =.0976). Patients in the 2020 cohort were more likely to be discharged home than to rehabilitation ( P P =.0809). There was no increase in 1-, 3-, or 6-month complications or mortality. During the pandemic, fewer patients were admitted with hip fractures, and the time from injury to presentation doubled. Patients were significantly less likely to be discharged to rehabilitation and more were discharged with oral anticoagulants. Overall, there was no increase in complications, and these data indicate that the authors were successfully able to provide high-quality care to hip fracture patients during the pandemic. [ Orthopedics . 2021;44(5):293–298.]

OBJECTIVE To evaluate whether the implementation of a geriatrics-focused orthopedic and hospitalist comanagement program can improve perioperative outcomes and decrease resource utilization. DESIGN A retrospective chart review study was conducted before and after the implementation of a geriatrics-focused orthopedic and hospitalist comanagement program, based on the American Geriatrics Society (AGS) AGS CoCare:Ortho®. SETTING A large urban, academic tertiary center, located in the greater New York metropolitan area. PARTICIPANTS Patients 65 years and older hospitalized for operative hip fracture. Those with pathologic or periprosthetic fractures, and chronic substance use were excluded. MAIN OUTCOME MEASUREMENTS Outcome measures included: time to operating room (TtOR), length of stay (LOS), daily and total morphine milligram equivalents (MME), use of preoperative transthoracic echocardiogram (TTE) and blood transfusions, perioperative complications (e.g., urinary tract infections), and six-month mortality. RESULTS Our study included 290 patients hospitalized with hip fracture, before (N=128) and after (N=162) implementation. When compared to the pre-implementation group, the post-implementation comanagement group had a lower TtOR (36.2 vs 30.0 hrs, p=0.026) and hospital LOS; decreased use of indwelling bladder catheters pre and postoperatively (68.0 vs 46.9%, p

Arthroscopic anatomic anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for an ACL tear and requires the use of fixed or adjustable-loop devices to fix a femoral-side graft. Although the adjustable mechanism is designed to provide one-way tensioning, there is a concern that the adjustable loop will loosen and lengthen during cyclic loads, creating graft laxity. The present paper is a retrospective study of patients who underwent ACLR with the fixation of a hamstring graft with an adjustable loop on the femoral side from November 2016 to October 2018. The knee’s functional outcome was evaluated using an International Knee Documentation Committee (IKDC) score, Lysholm score, Lachman test, and pivot shift test. The patients were assessed preoperatively and finally postoperatively after two years of surgery. Thirty-two patients were analyzed. Significant improvement was obtained in the final clinical outcome of the patients. Twenty-seven patients (84.4%) were Lachman negative, and twenty-eight patients (87.5%) were pivot shift test negative, the mean Lysholm score was 96.91, and the IKDC score was 91.47 (p < 0.001). There was no infection, graft failure, or flexion restriction. Arthroscopic ACLR with an adjustable-loop suspensory device is a successful fixation method for femoral-side graft fixation and offers a similar functional outcome as with fixed-loop devices.

Background/Purpose : Acne vulgaris is a very prevalent skin disorder and remains a main problem in practice. Recently, phototherapy with various light spectrums for acne has been used. There are some evidences that low-level laser therapy (LLLT) has beneficial effect in the treatment of acne lesions. In this study, two different wavelengths of LLLT (630 and 890 nm) were evaluated in treatment of acne vulgaris. Materials and Methods: This study was a single-blind randomized clinical trial. Patients with mild to moderate acne vulgaris and age above 18 years and included were treated with red LLLT (630 nm) and infrared LLLT (890 nm) on the right and left sides of the face respectively, twice in a week for 12 sessions, and clinically assessed at baseline and weeks 2, 4, 6, and 8. Results: Twenty-eight patients were participated in this study. Ten weeks after treatment acne lesion were significantly decreased in the side treated by 630 nm LLLT (27.7±12.7 to 6.3±1.9) (P0.05). Conclusion: Red wavelength is safe and effective to be used to treat acne vulgaris by LLLT compared to infrared wavelength.

Results: Out of 130 warts, 126 (97%) cases showed resolution after bleomycin injections. Ninety-five warts (73%) showed complete resolution and 31 (24%) cases showed incomplete resolution. The cure rate (80%) was better in warts with the size smaller than 20 mm in diameter in comparison with larger lesions (46%). After six months follow-up, 7 patients showed recurrence. Recurrence was seen more among those with greater number of warts. Conclusions: This form of treatment for resistant warts would be reliable, safe, and acceptable to the patients if it is performed under care and with proper dose and concentration.

Background: Topical flocinolone acetonide and tacrolimus have been used to treat vitiligo for a long time, but there is not enough data available to conduct management decision for these patients. Tacrolimus and corticosteroid have been used for head and neck lesions successfully, and have been accepted as standard treatment. The present study is designed to compare the therapeutic effects of flocinolone acetonide and tacrolimus with each other and with the placebo in the treatment of vitiligo lesions of upper extremities. Methods: The current study was carried out on 28 patients of 16-53 years of age with 150 depigmented lesions of upper extremities. The lesions ranged from 3 to 6 cm. 50 lesions were treated with flocinolone acetonide in isopropyl alcohol (50 grams in 50 cc), 50 lesions with tacrolimus, and 50 control lesions with placebo. Patients were followed for 6 months and visited at 2, 4 and 6 months. Disease response was evaluated by approach of clinical criteria. We considered complete or partial repigmentation as the most important clinical criteria. No systemic treatment or phototherapy was used in this study. Moreover, patients were assessed for any possible drug side- effects. Standard photography was applied in order to follow any changes in lesions. The repigmentation achieved for each group and at each follow-up visit were analyzed and compared to the other groups. Findings: The response rate for the tacrolimus group was: 5 lesions showed complete response, 10 lesions showed partial repigmentation, 3 patches worsened, and 32 showed no alteration. In the flocinolone group 8 lesions had complete response, 24 lesions showed repigmentation, 3 lesions showed partial repigmentation, 3 lesions worsened, and 40 lesions showed no alteration. In the placebo group 1 lesion showed complete response, 3 showed partial response, 6 lesions worsened, and 40 showed no alteration. In our study the response rate of both flocinolone acetonide and tacrolimus groups showed a significant difference to the placebo group (P = 0.049 and P = 0.034, respectively), but no significant difference was observed between the two groups (P = 0.67). Conclusion: Topical flocinolone acetonide and tacrolimus showed no significant differences in the treatment of vitiligo Lesions; therefore, further studies are needed for treatment guidelines.

Background: The most common drug side effects are skin reactions. These reactions range from simple maculopapular eruptions to massive epidermal necrosis. There are still not enough data about drug eruptions in Iran, because minor side effects resolve spontaneously or are treated in outpatient settings. In this survey, we studied skin drug eruptions among patients admitted to dermatology departments of two hospital centers in Tehran. Methods: This was a descriptive study and included all cases who were admitted in Rassoul-e-Akram and Loghman-Hakim Hospitals for skin drug reactions between 2001 and 2009. We derived demographic data and other information from medical records. Findings: Our samples included 150 patients (90 females and 60 males). Frequency of different skin reactions was as follows: maculopapular eruptions 82 cases, Steven Johnson syndrome 31 cases, urticarial reactions 10 cases, toxic epidermal necrolysis reactions 5 cases, erythrodermal eruptions 8 cases, edematous eruptions 4 cases and multiform erythema 2 cases. The most common drugs that created reactions were (in order): phenytoin, carbamazepine, lamotrigine, penicillin, and co-trimoxazole. These five drugs were responsible for 50 percent of all cases. Most of the drugs were prescribed for urinary tract infections, convulsions, and diarrhea. Conclusion: Skin drug reactions in this study varied tremendously from the simplest types i.e., maculopapular eruptions, which is the most common form worldwide, to the most complex ones i.e., toxic epidermal necrolysis. According to our findings, maculopapular eruptions and Steven Johnson syndrome are the most common forms of skin drug reactions in hospitalized patients.

Background: Alopecia areata (AA) affects 0.1%-0.2% of the general population, and occurs in both males and females. Initial presentation occurs most commonly in the late teenage years, early childhood or young adulthood, but can happen in all ages. In the present study, we aimed to find an association between the onset of AA and preceding emotional stress. Methods: A total of 47 patients diagnosed with AA and 47 controls (healthy subjects matched on age and gender) were enrolled to the study at the dermatology clinic of Hazrat Rasoul Akram Hospital, Tehran, Iran. Participants were administered Paykel's questionnaire for recent life events, and the demographic data of all subjects was also collected simultaneously. Findings: The distribution of AA was as follows: 30 (63.8%) subjects in head, beard in 16 (34%) and body in 1 (2.1%) subject. The total score of recent life events (during the last 12 months) was not significantly different between the AA patients (6.9 ± 1.01) and the control subjects (7.12 ± 0.91) (P = 0.95). Conclusion: Our findings do not support the hypothesis that stressful life events are associated with the occurrence of AA.

Background: Acne vulgaris is a chronic inflammatory disease of pilosebaceous follicles. It is one of the most important skin disorders during adolescence. Zinc is one of essential trace elements in the body that has major roles in maintaining health. The main objectives of this study were to measure zinc serum levels and assess its relationship with age, sex, and disease severity in patients with acne vulgaris. Methods: 100 consecutive patients with acne vulgaris referred to Hazrat-Rassoul-Akram hospital in 2010 were enrolled as a non-random sample. Fasting blood specimens were taken at 9 am and serum zinc level was measured by atomic absorption spectrophotometry method. Findings: Mean serum zinc level of acne patients in this study was 106.78 ± 22.2 µg/dl. Mean levels of serum zinc were significantly lower in women compared to men (104.54 ± 2.72 µg/dl and 115.19 ±1.71 µg/dl, respectively; P < 0.05). There was no significant correlation between serum zinc and acne history or severity. Conclusion: According to our findings, there is no link between serum zinc level and acne severity. Further evaluation of other contributing factors is suggested.

Hirsutism is a common clinical condition with different etiologies. Many of these patients have frank or subclinical abnormalities in the adrenal and ovarian steroidogenesis. The disease may be associated with other clinical signs of hyperandrogenism. The objective of this study was to investigate the clinical features of hirsutism and its etiologic factors in premenopausal Iranian women.In a cross-sectional study, 790 consecutive premenopausal women referred to the dermatology Clinics of Hazrat-e Rasool and Firoozgar University Hospitals and three private dermatology clinics during 2001 - 2003 with the clinical diagnosis of hirsutism were studied. All patients underwent detailed clinical assessment and transabdominal ultrasonography of the ovaries. Endocrinologic work-up was performed for 285 patients.Hirsutism was mild in 65%, moderate in 32.5%, and severe in 2.5% of the patients. Positive family history was found in 56.2%. Hormonal studies revealed some abnormalities in 35.2% of the patients. Coexisting medical conditions included acne in 70% of the patients, menstrual irregularity in 38.6%, androgenic alopecia in 21.3%, obesity in 6.5%, acanthosis nigricans in 4.9%, and diabetes in 0.6% of the patients. Etiology of hirsutism was identified as polycystic ovary syndrome (62.53%), idiopathic (35.19%), congenital adrenal hyperplasia (0.38%), prolactinoma (0.13%), and undetermined (1.77%). Polycystic ovary syndrome was diagnosed more frequently in women with menstrual irregularity than eumenorrheic patients (97.70% vs. 40.41%, P0.001).Hirsute patients frequently have either elevated androgen levels or clinical conditions associated with hyperandrogenemia. Eumenorrhea does not rule out endocrine abnormality and particularly polycystic ovary syndrome which is a common cause of hirsutism. We recommend performing endocrinologic work up, investigation of coexisting hyperandrogenic states, and evaluation of polycystic ovary syndrome in all patients with hirsutism.

A wide range of clinical manifestations may be seen in scabies, from classic pruritic papules and burrows to secondary features such as impetigo. Bullus lesions are a less frequent. Twenty cases of scabies presenting with bullae have been reported so far in the medical literature. Differentiating this subtype of scabies from the immunobullous disease bullus pemphigoid is a diagnostic challenge. A 42-year-old man was referred to our dermatology outpatient clinic with 3-month history of severe pruritus and tense blisters affecting mainly the lower trunk, arms and legs. An initial biopsy was suggestive for bullous pemphigoid. Close physical examination revealed small excoriated papules and a few burrows on borders of the hands and wrists. Skin scraping of the lesions on wrists was positive for Sarcoptes scabiei. Another biopsy specimen from a recent blister revealed subepidermal bullae with fibrin and inflammatory cells, particularly eosinophils. Direct immunofluorescence exam was negative. The patient was treated with lindane lotion followed by crotamiton cream with near complete resolution of the lesions. Scabies must be considered in patients presenting with recent onset of unexplained pruritic bullous lesions. Biopsy and immunofluorescence studies together with skin scrapings for Sarcoptes scabiei could help to differentiate these cases from bullous pemphigoid. Antiscabietic treatment results in resolution of bullous lesions in the affected patients.