Intramedullary screw fixation provides a less-invasive means of surgically managing metacarpal fractures. While there are advantages to using this technique compared to CRPP and ORIF, disadvantages of Intramedullary screw fixation include loss of reduction intraoperatively due to sagittal and coronal plane translation. The blocking screw technique has been previously described as a solution for this problem in Intramedullary fixation of long bone fractures. We describe the blocking screw technique as applied to aid Intramedullary screw fixation of metacarpals.

Background: Tibial diaphyseal fracture is the most common fracture of long bones. In Iran plating and undreamed tibial nailing (UTN) are the most commonly used methods and because of paucity of equipments such as c-arm and reaming sets, the reamed method is rarely used. This study compares these two methods.Methods: In a randomized clinical trial study including 100 patients (78 males, 22 females; mean age=24 years; range=16-50 years) undergoing UTN and plate-screw in the treatment of uncomminuted closed tibial shaft fractures (50 patients in each group) were compared regarding the union time and complications after a mean follow up of 16 months (12- 20 months).Results: the mean time to union was 16 weeks with UTN and 14.3 weeks with plate-screw fixation. There was 4 (8%) and 3 (6%) non unions after UTN and plating respectively. Plain radiographs in both groups showed angulation in 3 patients; all in distal third and in varus (6%). There was not any infection after UTN but one case of superficial and one case of deep infection were noticed after osteosynthesis with plate and screw (4%). Four patients after UTN and 4 patients after fixation with plate-screw required reoperation (8%).Conclusion: plate-screw osteosynthesis yielded satisfactory results in uncomminuted closed fractures of the tibial shaft comparable with UTN results.

Background: Clavicle is a common bone to fracture, and is most often treated with nonsurgical methods. Surgery may become indicated in occasional case of irreducible fracture with considerable displacement, open fracture, floating shoulder, and associated neurovascular injury, nonunion. There is still uncertainty about the best surgical method for this condition. In this study, we evaluated the results for intra-medullary screw fixation of clavicle fracture.Methods: In a prospective study between March 2005 and March 2007, 20 clavicular fracture (13 males, 7 females) with mean age of 32 years old (20-55), that had indication for surgery, were fixed with intra-medulary cannulated screw through a mini incision. We evaluated time to union, shoulder range of motion, side effects and patient satisfaction with a mean follow-up of 6 months (4-10 months).Results: The mean time to union was 10 weeks. The union was uncomplicated in 19 (95%) patients, while 1 case (5%), the bending of cannulated screw after a new trauma, required replacement by a thicker screw. There was no significant complication after surgery. All the patients were satisfied with the surgery.Conclusions: Cannulated screw is an effective fixation method for the claviclular fractures that are amenable to surgical treatment. Supplemental studies are necessary.

Objectives: Headless screw fixation used to treat metacarpal neck and metacarpal shaft fractures is gaining popularity. The aim of the study is to determine the proportion of the metacarpal head articular surface that is compromised during retrograde insertion of headless screws. Methods: Metacarpal screw fixation through a metacarpal head starting point was performed using fluoroscopic guidance on 14 metacarpals. Headless compression screws, with a tail diameter of 3. 6mm, were used. The specimens were subsequently skeletonized and digitized using a 3-dimensional surface scanner. The articular surface defects created by the screws were then determined using computer software. screw position in the dorsal aspect of the metacarpal head was expressed as a percentage of the total volar-to-dorsal distance. Results: The 14 metacarpals studied consisted of 2 index, 4 long, 4 ring and 4 small metacarpals, taken from 4 hands. The average total metacarpal head surface area was 284. 6 mm2 (range, 151. 0-462. 2 mm2),the average screw footprint in the metacarpal head was 13. 3 mm2 (range, 10. 3-17. 4 mm2), which compromised a mean of 5. 0% (3. 0-7. 8%) of the total cartilaginous metacarpal head surface area. In the sagittal plane, screw placement was found to lie in the dorsal 37. 4% of the metacarpal head (range, 20. 7-58. 6%). Conclusion: The proportion of the articular surface area injured with retrograde insertion of headless compression screws into the metacarpal head is 5. 0%. screw placement is generally in the dorsal 37% of the metacarpal head. Level of evidence: V

Background: There are various methods to correct leg length discrepancy (LLD), each with their own specific problems and complications. We would like to report the results of lengthening over an Intramedullary nail.Methods: In a prospective study, twelve patients who had LLD from previous femoral fractures underwent lengthening with Wagner external fixator over Intramedullary nail in a training hospital in Tehran-Iran. The Intramedullary nails were locked with screws after the projected length was achieved and external fixator was removed. The outcome of treatment and the complications were evaluated in a 2-year follow-up.Results: The average achieved lengthening was 4.2 cm (3-6 cm). Eight patients developed pin track infection, one case had osteomyelitis. All the cases united, with no malunion of fracture. The increased duration of external fixation remaining on the limb was closely related to the occurrence of pin track infection (r=.821, p=.001).Conclusion: Femoral lengthening over a nail decreases the duration of external fixator usage, improves patient's comfort and compliance and avoids axial deviation and fracture of regenerate bone.

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.

Background: Ankle syndesmosis injury is among the common ankle injuries. This injury results in a long-term inability to perform physical activities. Various surgical techniques have been experimented that each accompanies with limitations, advantages, and disadvantages, and controversial outcomes have been presented. In the current study, two techniques of tightrope and tricortial-screw fixation were compared. Methods: The current randomized clinical trial study was conducted on 30 patients with ankle syndesmosis injury in the Alzahra and Kashani hospitals, Isfahan, Iran, during the years 2014-17. The patients were randomly divided into two groups of tightrope and tricortical-screw treatments. The two groups were followed and compared considering the range of motion, American Orthopedic Foot and Ankle Society (AOFAS) score, required time for return to work, and need for reoperation within 6, 12, and 18 months. Findings: Patients of the two groups were not different regarding age, gender, and body mass index (BMI) (P > 0. 050); but the recovery time and need for reoperation were significantly less in tightrope group (P < 0. 001). According to AOFAS score, tightrope group was better considering pain, activity limitation, maximum walk, and walk surface (P < 0. 050); but they were not statistically different regarding plantar and dorsiflexion, gait, sagittal motion, hind foot motion, and function (P > 0. 050). Conclusion: Based on the findings of the current study, tightrope fixation technique was accompanied with better outcomes in comparison to tricortical-screw fixation in ankle syndesmosis injury.

Context: Flexible Intramedullary nails have been reported to provide a stable humeral fixation with satisfactory results in terms of union and complications. In this study, Kirschner wire (K‑ wire) was used to achieve a closed Intramedullary fixation of humeral shaft fractures. Subjects and Methods: This study included forty cases of the displaced diaphyseal fracture of the humerus based on inclusion and exclusion criteria. The study was done at Kasturba Hospital, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, between the periods January 2003 and November 2006. All the cases were operated after clinical evaluation. The final evaluation of the result was done by Qidwai’ s clinical and radiological criteria. Results: A total of forty cases were available for the study. K‑ wire of different sizes was used; the average duration of surgery was 45. 3 ± 7. 2 min. The average time taken for radiological union was 12. 1 ± 1. 9 weeks. The patients were analyzed by Qidwai’ s criteria and had excellent result in 30 (83. 3%) cases, good in 4 (11. 1%) cases, and poor in 2 (5. 6%) cases. Three patients were lost to follow‑ up, and one patient was died due to medical illness. Conclusion: Intramedullary K‑ wire fixation is a satisfactory, safe, simple, minimally invasive technique and cost‑ effective treatment for humeral shaft fractures. It gives elastic mobility and stability.