Background: The pelvic ring fractures (PRF) and acetabular fractures (AF) are among the major orthopedic injuries associated with high rates of morbidity and mortality. Open surgical stabilization is the standard treatment for the majority of these complications. Percutaneous minimally invasive surgical stabilization of the fractures has become an accepted treatment method for the past several years. This study investigated the outcomes of percutaneous Fixation of pelvic and acetabular fractures. Methods: Totally, 143 patients with PRF or AF of whom 95 cases were males underwent percutaneous Fixation between February 2015 and September 2016. All the operations were performed by a single surgeon in a supine position and under C-arm fluoroscopy visualization. The patients were followed up for one year. Results: All the fractures healed in all of the patients within the first postoperative three months. The patients could bear weight completely on both lower limbs. Out of 143 patients, 133 cases could get back to their preoperative work (93%). The mean amount of intraoperative blood loss was 29± 19 cc. Of the total patients, seven cases required oral analgesics because of moderate pain (4. 9%). The means of operation time and length of incision were 32± 8 min and 3. 2± 2. 4 cm, respectively. There was one screw back out and one deep infection. No neurovascular injury was reported in this study. Conclusion: Closed reduction and percutaneous minimally invasive screw Fixation for a pelvic ring or acetabular fractures is a useful surgical treatment option with low complication rates.

Acromioclavicular (AC) joint injuries are common and often seen in contact athletes, resulting from a fall on the shoulder tip with adducted arm. This joint is stabilized by both static and dynamic structures including the coracoclavicular (CC) ligament. Most reconstruction techniques focus on CC ligament augmentation as the primary stabilizer of the AC joint. The best surgical technique for some AC joint dislocations is still controversial. In this study, we explained a modification of the CC ligament reconstruction technique described by Wellmann. The method is based on minimally invasive CC ligament augmentation with a flip button/polydioxanone (PDS) repair, typically used for extracortical ACL graft Fixation. Patients commonly complain that heavy sutures under the skin in subcutaneous tissue irritate the skin and sometimes require reoperation for suture removal. We present an augmentation technique that resolves this issue by changing the suture knot location to the sub-clavicular position.

An obese 57-year-old woman with known hypertension and diabetes mellitus sustained multiple injuries during an accident, which caused anterior-posterior fracture-dislocation of the pelvic ring. Due to the drawbacks of conventional stabilizing methods for anterior-posterior fracture-dislocations of the hip in this setting, such as the inability to visualize anatomical landmarks fluoroscopically for the iliosacral screw technique and the compromised L5 pedicle preventing lumbopelvic Fixation, the patient underwent an innovative Hula Hoop technique described here. Using the Hula Hoop technique, a technique that has rarely been studied in humans, we avoided an invasive open procedure, decreased anesthesia time, reduced the size and number of incisions, and minim ized bleeding. After three months of routine physiotherapy and occupational therapy, the patient was able to walk with a walker and an ankle-foot orthosis. Level of evidence: V

Background: Central Venous Catheters (CVCs) are used not only as a tool to access to central venous system, but also for hemodynamic monitoring, parenteral nutrition, chemotherapy and hemodialysis. The use of CVCs is associated with some complications notably infections that are troublesome both to patient and physician. We conducted this study to examine catheter Fixation with skin fold technique and to evaluate risk of catheter infection in this method and compare it to conventional technique. Methods: This study is a controlled clinical trial (IRCT: IRCT2015081723229N1) and all cases are patients over 18 years, admitted to Hasheminejad Kidney Center from 2011 to 2012, who needed an internal jugular venous catheter for hemodialysis. Finally, two hundred and twenty two patients entered the study. We used chi square test and logistic regression for data analysis. P-value less than 0. 05 was considered significant. Results: In this study Mean± SD age of patients was 54. 50± 15. 71 years. Mean ± SD ages of patients in the case and control group were 54. 56± 16. 43 and 54. 42± 14. 84 years, respectively. The rate of catheter infection significantly decreased with skin fold technique: Five patients (3%) in case group and 13 patients (16%) in control group had infection (p=0. 002). Conclusion: The findings of this study demonstrated that catheter Fixation with skin fold could be an appropriate technique in comparison with current conventional method. However, further studies on other possible and unpredictable complications of this technique is required.

Background: Only 3% of all proximal tibial fractures result in an avulsion fracture of the tibial tuberosity. It is often seen in youngsters between the ages of 3 and 6 and is less frequent after puberty. Case Report: A 15-year-old boy was presented with severe left knee pain following a high jump. X-ray and computed tomography (CT) scan showed a tibial tuberosity fracture with joint surface involvement. The damaged part was fixed with a 4.5mm cannulated screw and washer, reinforced with 2 SwiveLock anchors. In the sixth week, full weight bearing and full range of motion (ROM) were obtained. Conclusion: The primary objective in managing tibial tubercle fractures is the restoration of both the extensor mechanism and the integrity of the joint surface in cases where they have been compromised.