Meniscal root tears significantly impair knee biomechanics and can lead to early osteoarthritis if left untreated. This study aimed to systematically evaluate and compare the efficacy of different treatment techniques in patients with meniscal root tears. A comprehensive literature search was conducted using specific MeSH terms and related keywords. Data were extracted independently by two reviewers and analyzed using a random-effects model. Outcomes assessed included Lysholm score, International Knee Documentation Committee (IKDC) score, and medial meniscus extrusion (MME). Thirty-three studies were included. Both pull-out and all-inside repairs demonstrated significant improvements in functional outcomes. For Lysholm scores, pull-out repair showed a mean difference (MD) of 29.9 (95

Ramp lesions, tears involving the peripheral attachment of the posterior horn of the medial meniscus, significantly impact knee stability and function, particularly in association with anterior cruciate ligament injuries. However, evidence regarding optimal treatment strategies remains inconclusive. This systematic review and meta-analysis aimed to evaluate and compare the clinical efficacy of various treatment modalities for ramp lesions. A comprehensive systematic search was conducted across major electronic databases, including PubMed, Scopus, and Web of Science, up to June 2025. Studies were included based on predefined eligibility criteria. Data extraction was performed and meta-analytic synthesis was conducted using random-effects models. A total of 17 studies met inclusion criteria. The pooled mean difference demonstrated significant improvements in both IKDC (MD=28.5 points; 95% CI: 27.9-29.2) and Lysholm scores (MD=28.5 points; 95% CI: 27.9-29.2). Subgroup analyses revealed notable effectiveness for AIR compared to CM and PM, with statistically significant subgroup differences (p<0.05). The overall treatment success rate was 87% (95% CI: 83-92%). Across techniques, patient-reported outcomes improved markedly (IKDC fixed-effect pooled Mean Difference [MD] 28.8 points, 95% CI 28.2-29.4; random-effects overall effect significant; I²=98%). In anterior vs posterior all-inside subgroups, IKDC showed no robust between-approach difference on the random-effects test (χ²=0.51, p=.48), with a small fixed-effect difference (χ²=4.34, p=.04). Lysholm scores also improved substantially (fixed-effect pooled MD 28.0 points, 95% CI 27.3-28.7), and the between-approach difference was significant, favoring the posterior subgroup on the fixed-effect model. The pooled clinical success proportion was 90% without a significant difference between approaches (p=.10). The findings indicate that surgical interventions, particularly All-inside repair has effectively improved knee function and patient-reported outcomes following ramp lesions compared to conservative management and partial meniscectomy. However, no.

Radiocarpal dislocation (RCD) is a rare but severe injury, often resulting from high-energy trauma such as motor vehicle accidents and falls. This study aims to synthesize existing case reports and series to provide insights into the epidemiology, associated injuries, and management strategies for RCD. A systematic search of PubMed, Scopus, and Web of Science was conducted, including English-language case reports and series up to August 5, 2023. Data extraction followed PRISMA guidelines, with bias assessment using Joanna Briggs Institute criteria. Descriptive statistics and t tests were applied to analyze demographics, treatments, and outcomes. Among 343 articles, 57 met inclusion criteria, covering 303 patients. The mean age was 36.52 years, with males comprising 78.9

Aims:The significance of periosteal vessels in the healing of tibial shaft fractures is well-established. However, the gross anatomical patterns and differential distribution of these vessels on the medial versus lateral surface of the tibial shaft have not been thoroughly described. This study aimed to illustrate the comparative anatomy of periosteal circulation on the medial versus lateral surface of the tibial shaft, where tibial plates are commonly applied. Methods:Ten adult fresh cadavers underwent aortic injection with coloured silicone to investigate the vascular system of the lower limbs, including the tibial extraosseous circulation. Following material fixation, the medial and lateral tibial surfaces were dissected extraperiosteally from the knee to the ankle joint to visualize the gross anatomy of periosteal vessels running along the medial and lateral surfaces of the tibial shaft. Results:In all specimens, periosteal vessels on the lateral tibial consisted of six to eight main trunks in 17 out of 20 specimens. These vessels were evenly distributed, horizontally oriented, and exhibited variable side branching. Most of these vessels crossed the anterior tibial crest, terminating on the medial side. The extensor muscles on the lateral tibial surface made negligible contributions to the periosteal circulation. The medial tibial surface received its periosteal blood supply partly from the terminal branches of the traversing vessels from the lateral surface and partly from branches of the posterior tibial artery. These vessels were shorter, smaller, sparsely scattered, randomly distributed, and exhibited greater variability in number and size compared to their lateral counterparts. Conclusion:Periosteal circulation to the anterior two-thirds of the tibial shaft is mainly delivered through the lateral tibial surface. When periosteal circulation is a concern, lateral plating may be more disruptive compared to medial plating.

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 PRISMA guidelines, we conducted a comprehensive search of databases from 2000 to 2023. This search identified 15 relevant studies involving a total of 33 patients. 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.

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

Aims and Scope: Osteochondral lesions of the talus (OLT) are common injuries that occur following ankle sprains and fractures. Surgical management, either through open or arthroscopic technique, is required to eliminate the pain and restore the ankle’s function. This study aims to evaluate the prognostic significance of demographic variables and lesion’s characteristics. Method and Techniques: In this study, 40 ankle (40 patients), who underwent arthroscopic debridement and microfracture technique to treat osteochondral lesion of the talus, were evaluated retrospectively after two years. The functional outcome of the ankle joint was assessed by using foot – ankle disability score, (FADS), pain analysing scale score (PASS), American orthopaedic foot and ankle society (AOFAS) score, and Ogilvie-Harris scaling system. Then the association between patients’ age and gender, and the lesions’ characteristics, including size, grade, and location, were evaluated. Results: Outcome results varied according to the scoring system, but all patients achieved satisfied outcome and pain relieve. Younger patients with smaller lesions achieved a better clinical result. All measures including PASS, AOFAS, Ogilvie-Harris, FADS appeared to be significantly better in smaller lesions. (P-value <0.05) PASS and Ogilvie-Harris scales showed better results in younger patients. Ogilvie-Harris test result was notably superior in the lateral lesions. Conclusion: The patient’s age and size of the lesion are two prognostic factors of arthroscopic debridement and microfracture of OLTs. We believe arthroscopic management can be associated with a better outcome in lesions smaller than 1.5 cm in diameter and patients younger than 40-years-old. Level of Clinical Evidence: Level 2 – prognostic study

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.

Background: Depression and anxiety are the psychological problems that have intensified during Covid-19 and have affected the psychological well being of people. The purpose of this study was to systematically review the prevalence of anxiety and depression in Middle East countries.Methods: In this review, we searched for studies aiming to estimate the prevalence of depression and anxiety during the Covid-19 pandemic among the general population in databases including Scopus, PubMed, Web of Science, EMBASE, and Google Scholar from January 2020 to February 2021. We used the Comprehensive Meta-Analysis-2 software for data analyses and generated forest plots of the summary pooled prevalence.Results: In this systematic review, 55 articles with a total sample size of 28128 people were included. The pooled analysis of depression and anxiety amid the pandemic was estimated at 41% and 39%, respectively. Based on the study results, Iraq and Egypt had the highest prevalence rates of depression at 88% and 82%, respectively. Regarding anxiety, the highest and lowest prevalence rates were reported for Egypt with 91% and Qatar with 17%.Conclusion: To effectively provide mental health services for people, particularly the ones who are suspected of higher risk of depression and anxiety, it is necessary to identify individuals who are more likely to be suffered from psychological problems.

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.

Background: The sub-trochanteric (ST) fracture is relatively common. It does not have a single treatment but it can be repaired in a variety of ways. Objectives: The aim of this study was to compare the proximal femur locking compression plate (PFLCP) and intramedullary nailing in the treatment of ST fracture. Methods: This cross-sectional study was performed on 56 patients with ST fracture who referred to Firoozgar Hospital, Tehran, Iran, between January 2014 and December 2018. The patients were equally divided into two groups, PFLCP group and nailing group. The recovery and postoperative complications were evaluated by the Harris hip score (HHS). Results: Of the 56 eligible patients examined, 49 (87.5%) were male. The overall mean age was 42.7 ± 16.2 years. The status of the union was significantly better in the PFLCP group than in the nailing group (P = 0.038). The total mean HHS was 88.9 ± 14.1 with no significant difference between the two groups. The results of the logistic regression model showed that sex and age could significantly decrease the HHS. Thus, the HHS was influenced by female sex (OR = 0.851) and age of more than 60 (OR = 0.829). Conclusions: PFLCP provides an appropriate union, expedites the operation, and yields a very good HHS. Therefore, it can work even better than intramedullary nailing in some parameters, such as pain after the operation.

Introduction: Patellar dislocation is a relatively common injury. However, in rare circumstances along with dislocation of the patella, some types of fractures occur, making the treatment challenging and difficult.

Background: The sub-trochanteric (ST) fracture is relatively common and does not have a single treatment. It can be repaired in a variety of ways each of which has different complications as well as different treatment costs. Accordingly, the purpose of this research is comparing the side effects and cost effectiveness of proximal femur locking compression plate (PFLCP) with intramedullary nailing in the treatment of sub-trochanteric fractures Methods: This cross-sectional study was performed on 56 patients with ST fracture who were referred to Firoozgar hospital between January 2014 and December 2018. Two methods were used for treatment of fractures by physicians. The method of surgery for group A was the PFLCP while for group B it was the nailing. The postoperative complications and treatment costs were evaluated and recorded in a specific sheet for each patient. Results: In this study, of the 56 eligible patients examined, 49 (87.5%) of the participants were male. The mean age of the all patients was 42.7±16.2 years. The motion restriction in group A was significantly (P=0.041) milder than group B. So, the total cost of treatment in group A was significantly (P=0.045) lower than in group B. Also, the results of logistic regression model revealed that sex and age could significantly reduce the incidence of side effects with males [OR=0.851] and those younger than 30 years [OR=1.629] having fewer side effects. Conclusions: Use of a PFLCP first causes fewer side effects and less motion restriction after operation. The cost of treatment is lower and it is more cost-effective.

BACKGROUND:Bilateral rupture of the patellar tendon is a very rare injury, which takes place in relation to chronic systemic diseases. These injuries are known causes. Some of these causes are particular in patellar tendon rupture and another are in quadriceps tendon rupture.CASE PRESENTATION:70-year-old diabetic man with simultaneous bilateral patellar tendon disruption of proximal insertion without trauma, receiving long-term hemodialysis.CONCLUSIONS:In the present study, we report a case of patellar tendon rupture that has two differences with literature: first, renal failure is a known risk factor for quadriceps tendon rupture, and secondly, the prevalent age of patellar tendon rupture is less than 40 years. Clinical picture, diagnosis, pathogenesis and treatment are discussed. Finally, the literature is reviewed based on previous studies.

Background: Nosocomial infections due to high mortality and economic cost are one of the most important challenges that hospitals face with it. Reports show that hospital acquired pneumonia (HAP) is the second most common nosocomial infection in some countries such as the United States. Objectives: The aim was to study the frequency and resistance pattern of Acinetobacter baumannii isolates against imipenem. Methods: This cross-sectional study was conducted for 2 years on patients with nosocomial pneumonia caused by A. baumannii in 2 major university hospitals in Mashhad, Iran. After detection and identification, data regarding mortality, length of hospital stay, and treatment were collected. Furthermore, the pattern of antibiotic resistance was investigated in A. baumannii against imipenem. Results: In this study, among 700 patients with nosocomial pneumonia, 364 and 336 of those were male and female, respectively. All of these received imipenem. Of the total patients, 317 cases (45%) were resistant to imipenem. 84% of these patients were cured and the remaining 16% expired (P value = 0.001). A. baumannii resistance to the imipenem in both hospitals had an increasing rate. The resistance rate in the Ghaem hospital increased 96.6% at the end of the period compared to beginning of study (P value = 0.004). Also, a similar increase (94.7%) was observed in the Imam Reza hospital (P value = 0.003). Conclusions: According to our results, excessive use of imipenem has been caused by antibiotic resistance, for this, the appropriate selective choice of antibiotics should be considered. At first, other antibiotics such as new generations of cephalosporins should be chosen for empirical treatment of A. baumannii.