After head trauma, pelvic Fractures are the most common cause of death in patients with multiple trauma. The primary cause of death in patients with a pelvic Fracture is uncontrollable bleeding, and in cases of delayed intervention, hemorrhagic shock is the main cause of death. Bleeding from the external iliac artery following Pelvic Ring and Acetabulum Fractures is an uncommon injury and an orthopedic emergency. A 48-year-old man was referred to the hospital, diagnosed with an APC II Pelvic Ring, Acetabulum Fractures. The patient developed thrombosis in the external iliac artery 48 hours after admission with a lack of femoral pulse. CT angiography was performed for further assessment. Then, upon surgery, the anterior column of the Acetabulum on the left side with symphysis disruption, an open reduction, and internal fixation with a 3. 5 reconstruction plate via a modified Stoppa approach was used. Sacroiliac disruption on the right side was repaired by percutaneous sacroiliac screw fixation. In the same session, the vascular repair was conducted via interposition graft of PTFE. After the treatment interventions, the patient's general condition was satisfactory, and he was discharged without any particular complication. Due to the possibility of arterial injury in this type of trauma, appropriate treatment can be done at the right time by checking pulses. While artery injuries are rare, they could be life-threatening.

Asymmetrical traumatic bilateral hip dislocations are rare in comparison to unilateral dislocations. In the present case report, we presented a 20-year-old man suffering from the asymmetrical traumatic bilateral hip dislocation, anterior dislocation on the left side, and posterior dislocation associated with Acetabulum Fracture on the right side. Both dislocations were closely reduced in the operating room, and skeletal traction was applied to the right side due to the instability. A week later, the acetabular Fracture went through the open reduction and internal fixation via the posterior Kocher-Langen beck approach. The 4-year follow-up of the patient was favorable.

A few specimens collected from northeast of Iran were identified Helvella Acetabulum (L.) Quél. (Pezizales, Helvellaceae) (Dennis 1981): Fruit-bodies (apothecia) cup shape, 2–6 cm diam., inner or fertile surface pale brown, glabrous; lower surface yellow brown to brown, with pallid to cream-coloured ribs extending from the stipe base to the cup; margin incurved toward the center when young, irregular and torn in age. Stipe 2–5 cm high, 2–4 cm thick, whitish to pale creamy, deeply ribbed. Asci cylindrical, hyaline, 8-spored. Ascospores broad ellipsoid, hyaline, with an oil droplet, 15–18 × 10–13 µm (Fig.1).Materials examined: W Azarbaijan province, Naghade to Oshnavieh, on soil, 15.5.2010, Aghaalinejhad and Ozzar (IRAN 14727 F); W Azarbaijan province, Piranshahr to Jaldian, on soil, 20.5.2009, Asef (IRAN 14781 F); Kordestan province, Marivan, Negel, on soil, 5.5.2006, Asef (IRAN 14780 F); E Azarbaijan province, Arasbaran, Makidi, on soil, 8.6.2007, Asef (IRAN 14779 F).Cup shape fruit-bodies, ribs on surface of stipe and apothecium clearly distinguish H. Acetabulum. Two species, H. leucomelaena (Pers.) Nannf. andH. queletii Bres. also have veined stipe, but the ribs seldom extending to the cup. This fungus has previously been reported from forests of Golestan province (Arefipour et al.2004).

Introduction & Objectives: Acetabular Fractures commonly occure in accident involving the weight bearing chain of the body. Our aim was to evaluate the surgical results of these Fractures. Material & Methods: All patients with actabulum Fracture requiring surgery in Sina hospital between 1378and 1381were included in this study. Patients with less than three months of follow up were excluded. Patients underwent a physical examination, a pelvic x-ray and if possible a bone scan in the final visit. Results: In all we studied 25 cases of which 23(92%) were male and 2(8%) were female. Patients had a mean age of 28.5 years (15-60 years) and with a mean follow up time of 13 months (3-36 months). The major cases of injury in our study was motorcycle-car accident which occurred in 18 cases (72%). The most common approach was kocher Langen Beck in which was used in 17 cases (%68). Other approaches such as Ilioinguinal approach and the combination of kocher Langen Beck Ilioinguinal was used in 3 cases (12%) and 5 cases (20%) respectively. Associated injuries were discovered in 19 cases (72%) which mainly consisted of injuries to the lower extremity. The most common type of Fracture were A (9 cases, 36%) and B, (7 cases, 28%). In 15 cases (60%) there were associated hip dislocations accompanied by Acetabulum Fractures. In the last visit, the Harris hip score was less than 70, 71-80, 81-90 and 91-100 in 12%,20%,24% and 44% of the cases we had avascular necrosis in 4 cases (16%), heterotypic ossification in 2 cases (8%) and hip arthritis in 3 cases (12%). We had good results regarding of motion, incongruity of articular surface and pain. There were 7 cases with nerve injury (28%), 5 of which were personal nerve injury and 2 were injuries to the lateral cutaneous nerve of the thigh. The two most common indications of surgery were displacement and joint incongruity (32.2%). Conclusions: Our results show that if surgical treatment of acetabular Fracture is carried out appropriately in cases where surgery indicated; good results will be achieved. Mianfull statistical differences were not achieved since the destribution of the variables were not normal yet we might be able to see a better result in young patients with simple Fractures whom undergo surgery soon after the injury. Relatively another problem in our study was the short duration of follow up; and the relative low rate of avascular necrosis and destructive joint disease might be due to that.

Background: Choosing the proper approach to surgical treatment of various types of acetabular Fractures can play an important role in minimizing adverse outcomes during and after surgery. In the present study, we described our experience on the outcome of Stoppa approach in anterior column acetabular Fractures. Methods: This was a retrospective analysis of 40 patients with acetabular anterior column Fractures that had undergone surgery with Stoppa approach. The study information, Harris Hip Score (HHS), and pre-and post-operative radiographic findings were collected by reviewing the hospital recorded files. Results: HHSs of 80 to 100 were achieved in 75. 0% of patients. Completed (anatomic reduction less than 2 mm) displacement reduction was found in 97. 5%. 2 mg/dl decreased serum level of hemoglobin (Hb) was found in 75. 0%, leading to blood transfusion in 60% of subjects. Regarding post-procedural complications, the common event was infection in 15. 0%, followed by degenerative joint disease (DJD) in 15. 0%. The post-operative complications were similar in men and women, but were significantly higher in patients older than 50 years than the younger patients. Conclusion: Stoppa approach is associated with high success rate and the occurrence of rare and tolerable major complications.

Background: acetabular Fracture is the result of high energy trauma which if treated properly, would cause little morbidity but improper treatment of this Fracture might cause severe morbidity due to degenerative change in hip joint. This study considers short-term follow of acetabular Fracture fixation in a 2-year period in a training hospital.Methods: out of 59 cases of acetabular Fracture (50 males and 9 females with mean age of 34±7.4 years), 36 patients who had undergone open reduction and internal fixation filled the functional outcome form of western Ontario mcmaster (WOMAC). The follow-up time was 10-24 months.Results: the most common mechanism of injury was motor-vehicle accident and the most common Fracture type was posterior wall Fracture. The most common associated injury was distal metaphyseal Fracture of radius and in the upper extremity ipsilateral posterior hip dislocation in the lower extremities. Sciatic nerve injury due to primary trauma was seen in 6 cases, peroneal nerve injury after surgery in 2 patients. Wound infection cases (19.4%) with no limitation in motion. Functional assessment was done in 6 and 10 months post op by WOMAC score. The maximum value was seen in posterior wall Fracture and the minimum value in T type, trans+PW and PW+PC Fractures.Conclusions: short-term WOMAC scores suggest good outcome in surgical treatment of acetabular Fractures. A long-term follow up and correlation with radiographic reduction results is recommended.

Background: how an Acetabulum breaks is dependent upon the amount and direction of impact and the limb position at the moment of trauma. Fractures of posterior acetabular lip are the most common variety. The lip results of such intra-articular Fractures have direct relation with accuracy of reduction. This is a report and analysis of a personal experience with posterior acetabular lip Fractures in a university set-up.Methods: thirty one consecutive patients (29 males, 2 females) with posterior acetabular Fracture underwent open reduction between 2000-2004, the mean age was 32 years (22-68). They were evaluated clinically and radiographically after an mean period of 22 months.Results: in the 31 patients, 8 cases had "marginal impaction", 7 cases had comminuted posterior lip Fractures, and 5 patients had free fragments inside the joint. Five femoral heads showed articular surface damage. The follow-up harris Hip scores were excellent in 9, good in 12, fair in 4 and poor in 3 patients. In those with single fragment posterior lip Fracture, one patient (14%) had fair or poor results, while about half of the patients with "marginal impaction" were either fair or poor. Two patients required hip replacement. Conclusions: posterior lip acetabular Fractures are notorious and getting complicated even with good open reduction. "marginal impaction" fragments is in particular, an important determinant of final results and requires special attention and exact anatomic reduction.

Background: Unstable pelvic Fractures are major orthopedic injuries with high rates of morbidity and mortality. Open surgical stabilization is the standard treatment for a great number of them. Percutaneous surgical fixation has become an accepted treatment method in last several years. We would like to report our experience with this relatively, newer technique in a small mixed group of unstable pelvic ring Fractures.Methods: This is a report of 16 cases (13 males, 3 females) with mean age of 31±8 years of pelvic and acetabular Fractures who received percutaneous iliosacral or iliopubic screw fixation, under C-arm imaging control, and had a 6 months period of clinical and radiographic follow-up.Results: All 16 cases had healed their Fractures at follow-up and had full weight-bearing status. 12 cases returned to their pre-Fracture activities. One screw break and one wound infection were the complications list. There was no neurological deficit, and average blood loss was 10 milliliters.Conclusion: Percutaneous iliosacral or iliopubic screw fixation for, respectively, posterior pelvic ring or anterior column acetabular injuries are useful surgical treatment options with low complication rates.

Statement of Problem: In a previous study it was reported that a durable resin-ceramic tensile bond could be obtained by an appropriate silane application without the need for HF acid etching the ceramic surface. Evaluation of the appropriate application of silane by other test methods seems to be necessary.Purpose: The purpose of this study was to compare the interfacial Fracture toughness of smooth and roughened ceramic surfaces bonded with a luting resin.Materials and Methods: Ceramic discs of 10 mm in diameter and 2 mm in thickness were prepared.Four different surface preparations (n=10) were carried out consisting of (1) ceramic surface polished to a 1µm finish, (2) gritblasted with 50µm alumina, (3) etched with 10% HF for 2 min, and (4) gritblasted and etched. The ceramic discs were then embedded in PMMA resin. For the adhesive area, the discs were masked with Teflon tapes. A circular hole with diameter of 3 mm and chevron-shaped with a 90° angle was punched into a piece of Teflon tape. The exposed ceramic surfaces were treated by an optimised silane treatment followed by an unfilled resin and then a luting resin cylinder of 4mm in diameter and 11 mm in length was built. Specimens were stored in two different storage conditions: (A): Distilled water at 37°C for 24 hours and (B): Distilled water at 37°C for 30 days. The interfacial Fracture toughness (GIC) was measured at a cross-head speed of 1 mm/min. The mode of failure was examined under a stereo-zoom microscope and Fracture surfaces were examined under Scanning Electron Microscope.Results: The mean interfacial Fracture toughness values were; Group A: 1) 317.1±114.8, 2) 304.5±109.2, 3) 364.5±169.8, and 4) 379.4±127.8 J/m2±SD. Group B: 1) 255.6±134.4, 2) 648.0±185.1, 3) 629.3±182.6 and 4) 639.9 ±489.0 J/m2±SD. One way Analysis of Variance showed that there was no statistically significant difference in the mean interfacial Fracture toughness for groups A1-A4 (P>0.05). However, the mean interfacial Fracture toughness for group B1 was significantly different from that for groups B2, B3 and B4 (P<0.05). Independent-ٍٍٍSamples T-Test results showed that there was a significant increase in the GIC mean value for groups B2 and B3 after 30 days water storage (P<0.05). The modes of failure were predominantly interfacial or cohesive within the resin.Conclusions: The Fracture toughness test method used in this study would be appropriate for analysis of the adhesive zone of resin-ceramic systems. From the results, it can be concluded that micro-mechanical retention by gritblasting the ceramic surfaces could be sufficient with no need for HF acid etching the ceramic surfaces when an appropriate silane application procedure is used.