Traumatic pelvic ring fracture during pregnancy: a systematic review.

Purpose: This systematic review aims to investigate the management and outcomes of pelvic ring fractures (PRFs) during pregnancy, emphasizing maternal and fetal mortality rates, mechanisms of injury, and treatment modalities. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive search of databases from 2000 to 2023, identifying 33 relevant studies. Data extraction included demographics, fracture types, treatment methods, and outcomes. Risk of bias was assessed using the JBI criteria. Results: Maternal mortality stood at 9.1%, with fetal mortality at 42.4%. Maternal factors impacting mortality included head trauma and hemodynamic instability. Fetal mortality correlated with mechanisms like motor vehicle accidents and maternal vital signs. Surgical and conservative treatments were applied, with a majority of pelvic surgeries performed before delivery. External fixators proved effective in fracture stabilization. Conclusion: Pelvic ring fractures during pregnancy present significant risks to maternal and fetal health. Early stabilization and vigilant monitoring of maternal vital signs are crucial. Vaginal bleeding/discharge serves as a critical fetal risk indicator. The choice between surgical and conservative treatment minimally influenced outcomes. Multidisciplinary collaboration and tailored interventions are essential in managing these complex cases.

Aspirin is as effective as low molecular weight heparins in preventing symptomatic venous thromboembolism following arthroscopic anterior cruciate ligament reconstruction.

OBJECTIVE: The optimal agent for thromboprophylaxis following arthroscopic anterior cruciate ligament reconstruction (ACLR) remains unclear, particularly in patients with a low baseline risk for venous thromboembolism (VTE). This retrospective cohort study aims to compare the effectiveness and safety of aspirin versus low molecular weight heparins (LMWHs) in this specific patient population. METHODS: We analyzed data from patients who underwent ACLR between March 2016 and March 2021, focusing on those with a low risk for VTE. High-risk individuals, identified by factors such as cardiac disease, pulmonary disease, diabetes mellitus, previous VTE, inflammatory bowel disease, active cancer, and a BMI > 40, were excluded (n = 33). Our approach included a thorough review of medical charts, surgical reports, and pre-operative assessments, complemented by telephone follow-up conducted over a 3-month period by a single investigator. We assessed the incidence of symptomatic VTE, including deep vein thrombosis and pulmonary thromboembolism, as the primary outcome. The secondary outcomes included to complications related to the surgery and thromboprophylaxis. Statistical analysis included descriptive statistics, univariate logistic regression models, and calculations of incidence rates. RESULT: In our study, 761 patients (761 knees) were included, with 458 (60.18%) receiving aspirin and 303 (39.82%) receiving LMWH. The two groups showed no significant differences in demographic factors except for age. The incidence of VTE was reported at 1.31% (10 individuals). Specifically, five patients in the aspirin group (1.09%) and five patients in the LMWH group (1.65%) developed a symptomatic VTE event (p = 0.53). Additionally, the two groups did not significantly differ in terms of other complications, such as hemarthrosis or surgical site infection (p > 0.05). Logistic regression analysis revealed no statistically significant difference in VTE risk between the two groups. CONCLUSION: This study, focusing on isolated ACLR in patients with a low baseline risk for venous thromboembolism, demonstrated that aspirin is equally effective as low molecular weight heparins for VTE prophylaxis following this surgery. LEVEL OF EVIDENCE: III.

Unusual presentation of talonavicular joint pigmented villonodular synovitis: a case report.

BACKGROUND: Pigmented villonodular synovitis is a rare yet locally invasive disorder impacting synovial tissues. This case report delineates the atypical manifestation of pigmented villonodular synovitis in the talonavicular joint, detailing its diagnostic complexity and successful management. CASE PRESENTATION: A 56-year-old Iranian patient with a 4-year history of chronic ankle pain, initially diagnosed with degenerative joint disease post-trauma based on imaging, underwent talonavicular fusion surgery. An unexpected pigmented villonodular synovitis mass was encountered during the procedure. Subsequent interventions encompassed tumor resection, talonavicular joint fusion, and allograft bone grafting. Despite the initial intervention, persistent pain and nonunion necessitated a secondary procedure, involving joint surface curettage and autograft bone grafting. At the 12-month follow-up, the patient remained pain-free without tumor recurrence. CONCLUSION: This case report highlights the significance of considering pigmented villonodular synovitis as a crucial differential diagnosis in chronic ankle pain, even when there is evidence of degenerative joint disease and a history of trauma. Magnetic resonance imaging serves a crucial role in accurate diagnosis. Treatment necessitates precise tumor removal, appropriate bone grafting techniques and secure fixation. LEVEL OF EVIDENCE: IV.

Mpox vaccination and treatment: a systematic review.

The Human monkeypox virus (mpox) belongs to the Poxviridae family, characterized by double-stranded DNA. A 2022 outbreak, notably prevalent among men who have sex with men, was confirmed by the World Health Organization. To understand shifting prevalence patterns and clinical manifestations, we conducted a systematic review of recent animal and human studies. We comprehensively searched PubMed, Scopus, Web of Science, Cochrane Library, and Clinicaltrials.gov, reviewing 69 relevant articles from 4,342 screened records. Our analysis highlights Modified Vaccinia Ankara - Bavarian Nordic (MVA-BN)'s potential, though efficacy concerns exist. Tecovirimat emerged as a prominent antiviral in the recent outbreak. However, limited evidence underscores the imperative for further clinical trials in understanding and managing monkeypox.

Congenital lumbosacral junction kyphosis in an adult patient: A case report.

Rare lumbosacral junction kyphosis due to S1-S2 hemivertebra in a 40-year-old woman was managed surgically, improving neurological disturbances, and low back pain. Early intervention is vital for congenital anomalies.

Fixation method can affect posterior tibial slope in opening-wedge high tibial osteotomy: a retrospective study.

BACKGROUND: Posterior tibial slope (PTS) alterations following open-wedge high tibial osteotomy (OWHTO) can cause instability and excessive tibial translation in the sagittal plane. These changes can be influenced by the type of fixation. This study aims to compare PTS changes between patients undergoing OWHTO with Puddu plate or TomoFix plate fixation. METHODS: In this retrospective cohort study, we included 104 knees from 85 patients undergoing OWHTO, with a mean age of 41.98 ± 9.95 years; 51.8% of the participants were male. Seventy-two knees were fixed with Puddu plates, while 32 knees were fixed with TomoFix plates. PTS changes, demographic factors, Cincinnati Knee Rating Score (CKRS), Tegner-Lysholm score (TLS), length of stay (LOS), and complications were evaluated. PTS changes were measured preoperatively, immediately postoperatively, and at the 6-month follow-up. RESULTS: Demographic factors were similar between the Puddu plate and TomoFix groups. There were no significant differences in preoperative, postoperative, or follow-up PTS measurements between the two groups. PTS changes were not significant in the TomoFix group postoperatively or at follow-up. However, the Puddu plate group showed a significant increase in PTS both postoperatively (P = 0.027) and at follow-up (P = 0.014). CKRS, TLS, LOS, and complications did not significantly differ between the groups. CONCLUSION: While overall PTS changes did not significantly differ between the Puddu Plate and TomoFix Plate groups, analyzing changes within each group revealed distinct results. TomoFix fixation exhibited nonsignificant PTS changes, while Puddu plate fixation resulted in a significant increase in PTS after surgery and at the 6-month follow-up. Our findings suggest that the choice of fixation may influence PTS changes after OWHTO. LEVEL OF EVIDENCE: Level III.

Trans-Table Intraoperative Fluoroscopic Technique for Obtaining a True Lateral View of the Proximal Femur in the Lateral Decubitus Position.

The management of proximal femoral fractures, especially comminuted subtrochanteric ones, poses a surgical challenge. It is relatively easier to perform the open reduction of these fractures in the lateral position on a standard radiolucent table, but obtaining an accurate lateral view of the femoral head and neck remains difficult. This study presents a method that overcomes the limitations of fluoroscopy in the lateral decubitus position and improves the accuracy of obtaining a true lateral view. The technique involves positioning the patient in the lateral decubitus position with the unaffected hip flexed at a 45° angle. Additionally, the C-arm is tilted 30-35° cephalad, eliminating the need for position changes or leg manipulation. This method reduces the risk of losing reduction, particularly in cases involving obese patients or complex fractures. By simplifying proximal femur fixation in the lateral decubitus position, this technique can potentially improve patient outcomes.

External Fixator as a Viable Treatment Option for Combined Pelvic Ring and Sacrum Fracture in a Pregnant Patient: A Case Report.

We report a case of a 32-year-old pregnant woman who suffered a combined type pelvic fracture and medial malleolus fracture due to a car accident at 24 weeks and 2 days of gestation. She underwent external fixation of the pelvic ring and percutaneous screw fixation of the ankle fracture. She recovered well and delivered a healthy baby by cesarean section at 37 weeks and 1-day gestation. External fixation can be a definitive treatment option for some pelvic fractures with anterior instability in pregnant patients, as it reduces the risk of fetal harm.

Reliability and Validity of the Persian Version of the Body Image Disturbance Questionnaire-Scoliosis in Patients with Adolescent Idiopathic Scoliosis Who Did Not Have Surgical Indication.

Background: Adolescent Idiopathic Scoliosis (AIS) is the most common spinal deformity disorder associated with bad posture and reduced quality of life. The Body Image Disturbance Questionnaire-Scoliosis (BIDQ-S) is a self-report instrument that assesses the concerns of scoliotic patients. This study aimed to translate and evaluate the reproducibility and internal consistency of the BIDQ-S in the Persian-speaking population worldwide suffering from AIS. Methods: The BIDQ-S was translated into Persian by two native-speaking Iranian translators and back-translated into English by two native-English translators. The resulting back-translated English BIDQ-S was then sent to the authors of the English BIDQ-S questionnaire for validation. After translation, it was provided for 41 AIS patients from those who referred to the outpatient clinics of Shafa Yahyaian Hospital from January 2020 to January 2021. Patients were asked to complete the Persian BIDQ-S and Persian Scoliosis Research Society-22 (SRS-22) inventories. Internal consistency and reproducibility were assessed using Cronbach's alpha and interclass correlation coefficients (ICC), respectively. The validity of the questionnaire was evaluated by comparing the scores obtained on the Persian BIDQ-S (P-BIDQ-S) inventory with those obtained on the SRS-22 subscales. Results: The consistency and reliability of the P- BIDQ-S inventory were confirmed by Cronbach's alpha of 0.856 and interclass correlation coefficients of 0.882. The P-BIDQ-S scores directly correlated with the level of education of patients (r=0.21, P=0.041). The correlation coefficient between the P-BIDQ-S inventory and the SRS-22 questionnaire was -0.56 (P=0.001). A significant correlation was also observed between the P-BIDQ-S items and all of the SRS-22 subscales (P<0.05). Conclusion: The P-BIDQ-S inventory maintains adequate reliability, internal consistency, and reproducibility for the evaluation of Persian-speaking AIS patients.